An Acceptance and Commitment Therapy Approach to New Year's Resolutions

by Annabelle Parr

As we enter another new year, many of us have set our 2017 resolutions. Maybe you make resolutions, maybe not, but either way this is generally a time of reflection. In what ways do we hope this year will be different from last? What are we hoping to change in our lives? What goals do we have going forward?

 The new year always seems to be a good time to think about making some changes because it gives us the chance to start fresh in some ways. But in other ways it is simply just another day. Nothing changed automatically on January first. What can change is our perspective, and it is our job to ensure that our actions follow. This is the tough part. Do you find yourself already struggling to maintain your resolution? Do you wonder why we have such a hard time keeping our resolutions for more than a few weeks? How do we make our resolutions stick?

The truth is, change is often slow. Occasionally we are able to make huge changes immediately, but more often than not change takes time. New year's resolutions often fail to take into account that it may actually take you all year to create the change you were hoping to see on January second. When we fail to recognize all the small steps on the road toward change, we set ourselves up for disappointment and failure. A new year's resolution sounds like an easy solution: set a major goal for the new year ahead. But our resolutions are empty unless they are backed by action, and creating a resolution doesn't necessarily help us to make an action plan.

Acceptance and Commitment Therapy (ACT) offers some ideas and tools that can be very helpful in guiding us along the process of change. Whether you come in to see a therapist for Acceptance and Commitment Therapy, or whether you apply the wisdom it can offer to your life on your own, this model can help us to keep our resolutions all year long.

ACT aims to increase psychological flexibility, which means that you are able to connect to the present moment consciously and choose to behave in a manner as consistent with your values as the situation allows. Part of the purpose behind ACT is to get in touch with your personal values (not those determined for you by society, family, friends, or any other external source), and then use these values to guide your actions and formulate specific goals. This is usually what we are aiming for with our new year's resolutions.

For example, if my resolution is that I want to eat healthier, a good place to start is to examine my values. Do I feel like I "should" eat healthier because I feel pressured by our health conscious culture or by my friends, family or partner? Or do I want to eat healthier because I value my physical health, deep in my heart? Or perhaps I value my role as a model to my children, and want to eat healthier for this reason. Once I determine my values and make sure that my resolution is driven by my own intrinsic motivation, then I can create a concrete plan of action to move forward.

The Choice Point Model, another helpful ACT tool, offers us a framework to use when we face a decision. A choice point is a moment in time where we can choose to act in a manner that is either consistent or inconsistent with our values. The Choice Point is about identifying the hundreds of moments in a day where we can be on autopilot and be driven by thoughts and feelings, or we can make a conscious, deliberate choice that is in the service of our values. When in this moment, we can use the acronym STOP:

S: Slow down. Take 3 mindful breaths.

T: Take notice. What are you thinking and feeling?

O: Open up. Make room for those thoughts and feelings instead of trying to avoid the discomfort.

P: Pursue values. Do what matters to you.

Sometimes, in a Choice Point, we will choose to avoid or procrastinate acting in a values consistent manner, and that is okay. Give yourself grace when this happens. But remember that though avoidance may provide relief for the moment, in the long run it will make us feel worse. So if we can STOP and choose to act in accordance with our values as frequently as possible, it will serve us.

As you approach this new year and begin thinking about your potential resolutions, remember that big change happens slowly, choice point by choice point. Remember to consider your values, and to STOP when you hit a choice point. If you feel you need some extra support along the road to change or healing...

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Anxiety in the Courtroom

Witness Preparation Services

by Annabelle Parr

Have you ever felt especially nervous before a big presentation? Do you find your heart racing and palms sweating when you have to speak in front of a large group of people? You’re not alone. On average, people rate their fear of public speaking higher than their fear of death. Potentially one of the highest pressure, highest stakes public speaking situations is on the witness stand in a courtroom or during a deposition. Even the most experienced witnesses can feel anxiety, which left unaddressed can hinder their testimony. Anxiety is the number one communication obstacle in legal proceedings (Pitera, 2013).

Source URL: http://www.utahcriminallaw.net/what-happens-if-a-witness-lies-in-court/

Witnesses typically have very specific fears related to testifying. Some common witness fears include, but are not limited to, a fear of letting people down, losing their job, making a mistake, looking incompetent, being embarrassed, judged or blamed, or having to reveal private, personal information. Witnesses also tend to take on more responsibility for the outcome of the case than is necessary or realistic (Pitera, 2013).

Though the source of a witness’s anxiety may be completely unrelated to their credibility or honesty, jurors tend to judge witnesses more on the basis of behavior than testimonial content (Afremow, 2011). Therefore, a testimony could be flawless and completely true, but if it is delivered poorly the concrete verbal content may not matter.

Typical anxious behaviors that jurors tend to interpret as signs of unreliability include non-verbal cues such as poor eye contact, fidgeting, appearing tense, and inconsistency of demeanor or tone (Afremow, 2011). Helping witnesses to become conscious of these subtle reactions as well as the sources of their anxiety before testifying can help them to manage the visible cues thus increasing their perceived credibility.

Meeting with a licensed psychologist who specializes in anxiety management is a great way to help prepare witnesses and allow them to address their anxiety before taking the stand. Using cutting edge, evidence-based, cognitive-behavioral techniques, the therapist can help witnesses modify their anxiety, bringing it into an optimal range for peak performance.

Source URL: http://www.everydayhealth.com/smoking-cessation/living/coping-with-the-urge-behaviorally-and-mentally.aspx

Therapeutic techniques that can help prepare witnesses include:

• cognitive reappraisal, which involves changing catastrophic cognitions that fuel anxiety and lead to poor performance
• grounding, mindfulness, and relaxation
• reduction of safety seeking, avoidance, or anxiety driven behaviors such as lack of eye contact, speaking too softly, fidgeting, talking too much or too little, or looking to the attorney for reassurance
• video-taped feedback, which can help reduce anxiety by showing the witness that they don’t look as anxious as they feel, as well as helping them to notice and address visible safety behaviors

A therapeutic setting offers a safe space to practice testifying and receive non-judgmental, constructive feedback and tools that the witness can apply in court and during depositions. If you or your client are preparing to stand as a witness, know that feeling anxiety is normal, but that it doesn’t have to determine the tone of the testimony.

CSAM IS HERE TO HELP

If you or someone you know might benefit from witness preparation services for anxiety or stress, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Afremow, J. (2011). Witness this: Behavioral science in the courtroom. Psychology Today. Retrieved from https://www.psychologytoday.com/blog/trust-the-talent/201110/witness

Pitera, M. J. (2013). Witness tip: Anxiety is the #1 barrier affecting communication. Litigation Insights. Retrieved from http://www.litigationinsights.com/witness-preparation-2/witness-tip-anxiety-is-the-1-barrier-affecting-communication/

More than Butterflies: Overcoming Social Anxiety

a guest blog post by Barbara Markway

The Signs, Symptoms, and Learning How to Cope

Most of us can relate to feeling anxious before a big speech, a job interview, or a first date. But for some, the experience is much more than butterflies in the stomach.

If you worry a great deal about what others think of you, you have social anxiety. You might be uncomfortable returning items to a store or ordering pizza over the phone. You might avoid social gatherings. You may have few or no close friends. Perhaps you’ve turned down job promotions because you feared needing to make presentations. Maybe you even use alcohol or drugs to feel more comfortable in social situations.

When social anxiety ramps up to this point – where you’re living your life based on fear – it’s morphed into what’s termed social anxiety disorder.

According to the Anxiety and Depression Association of America, social anxiety disorder is characterized by an extreme fear of judgment and scrutiny in social and performance situations. It’s a serious, real, and treatable disorder. According to the ADAA, about 15 million American adults struggle with social anxiety disorder, making it one of the most common psychiatric disorders, second only to depression.

Signs and Symptoms

The symptoms of social anxiety disorder fall into three categories: mental, physical, and behavioral. People with social anxiety are plagued by negative thoughts and beliefs about themselves. With the fear of possible rejection or disapproval being foremost in their minds, they scan their surroundings for any signs that confirm their negative expectations.

Physical symptoms most commonly include blushing, sweating, and shaking. Full-blown panic attacks, in which a rush of physical sensations bombards them all at once, are not uncommon.

Finally, people with social anxiety may go to great lengths to avoid the situations they fear.

Do you have a problem?

Because we all have some degree of social anxiety, how do you know whether you have a problem? Start with these questions:

Do you feel extremely uncomfortable in social situations?

Do you consistently avoid social situations?

Are you self-conscious and believe everyone is watching you?

Do you constantly worry about what you do and say?

Do you worry a great deal about doing something embarrassing?

Do you worry for weeks before the dreaded situation?

Do you critically analyze your own performance after the situation?

The more of these questions you answer “yes” to, the more likely it is you have social anxiety disorder.

Positive Thinking Versus Realistic Thinking

When feeling anxious, you’re likely to give yourself a pep talk and say things like, “Don’t worry. It’s no big deal.” Similarly, other people may tell you to “think positive.” Although well meaning, this advice is not particularly useful. What’s needed is not positive thinking but realistic thinking.

Two types of unrealistic thinking contribute to social anxiety. First of all, you may overestimate how likely it is that something bad will occur. Second, you may exaggerate how bad it would be if the feared thing actually did happen.

Let’s look at an example in which Jennifer is worried about an upcoming business lunch she will be attending. She may have anxious thoughts running through her head such as: What if I don’t have anything in common with the other people there? What if there are awkward silences?

What could be a calming, realistic way for Jennifer to think about the lunch? Jennifer realizes that she may or may not have much in common with the other people there, but she at least does “OK” at these meetings. Even if she does not have much to offer, she can always ask people questions about themselves to show an interest in them. And even if there are some awkward silences, it’s not the end of the world. She can focus on trying to be helpful to the other attendees, to meet their needs. That’s what they are likely to remember.

What can you do?

But what if you feel out of control physically – rapid heartbeat, trembling and clammy hands, perhaps even some dizziness? These sensations can be so unnerving.

When you are anxious, you tend to breathe in a shallow and rapid manner. This can cause you to feel dizzy and short of breath. With practice, though, you can change this.

While sitting or lying down, place one hand on your chest and one on your belly. Take a deep breath and try to have your belly move more than your chest. Feel your belly rise as your lungs fill with air. Once you are able to do this, you have succeeded with the first step in learning belly breathing. Next practice breathing in slowly to a count of four and exhaling slowly to a count of four. Practice breathing with this steady rhythm, in and out. Notice how you feel more relaxed. Practice this several times a day for a few minutes at a time.

Belly breathing allows your body to calm down. With practice, belly breathing will help you be more relaxed, and no one will even know you are doing it.

When things make you anxious, you may find may find yourself developing a pattern of avoidance. For example, if you hate having to stand in front of a group to do any kind of presentation, you may not take a job that required this. Avoidance may temporarily help you feel better, but you never learn how to overcome the fear.

Most people find that gradually confronting their fears, one small step at a time, is what helps the most. For example, John hated any type of public speaking. When his therapist asked what first step he might be able to take, even though it still made him anxious, he thought he could ask one question in a meeting at work. There was a specific question he had regarding a new project a team was working on, and he planned what he would ask.

He was quite nervous ahead of time and practiced his belly breathing. He also used realistic thinking by reminding himself that he had a legitimate question and that others in the meeting likely would focus on the answer to the question rather than on him. He felt considerable relief when he was able to follow through. Over time, he gradually became more open to talking in front of the group.

Even if you do everything suggested here, you may still struggle. Sometimes it seems that the more we “fight” our anxiety, the more it fights back. Keep in mind though, you are not a “failure” if you feel anxious – you are human.

What You Don’t Know About Therapy

by Annabelle Parr

Admitting that you need help is one of the bravest things a person can do. Whether it’s asking for help from a friend or family member, or calling a therapist to make an appointment, reaching out for support takes great strength and courage.

Source URL: http://anythingbrilliant.com/home/daring-greatly-why-vulnerability-is-your-greatest-strength/

Deciding to seek therapy can feel especially daunting. While our friends and families know us, a therapist is a stranger at first. For some people, perhaps this is a comforting thought, as it may feel easier to talk to a stranger than a loved one.

But for others, especially those who struggle with vulnerability, the idea of talking to anyone, let alone someone new, might feel out of the question. You might wonder how you can trust someone you just met, and whose life you know almost nothing about? How can you be sure that they aren’t judging you? Are they really as compassionate as they claim?

Given that there is a fair amount of conversation surrounding therapy today, most of us know that therapists are kind, compassionate, empathetic, non-judgmental, impartial observers who are there to help us move through difficult situations and emotions. But what is often left out of the conversation is why therapists are that way.

Of course they have been educated and trained in their field. But what people don’t talk about very often, at least outside of the world of therapy/psychology, is that therapists tend to choose their career path because something in their life led them there. A person typically does not choose to become a therapist because their life was perfect or because they had everything all figured out.

Source URL: http://www.happystreet.london/blog-1/

Often, they have encountered their own set of struggles that led them to this field. They likely know how powerful therapy and psychoeducation can be from some sort of personal experience.

So when they say that they aren’t judging you, when they meet you with deep rooted understanding, it is because on some level they truly do understand. Though their story will not be the same as yours, they too have a story. They know what it is to struggle and they also know what it is to heal.

As their client, you will not hold their story. You may get little snippets of it every once in a while, when they decide that sharing a piece of their story may help you with yours, but for the most part, you will not know what their pain or struggle was. Nor should you. That is part of what makes therapy so helpful (and unusual). But even if you do not know what it is, remember that your therapist also has a story. With this knowledge in mind, it might be a little bit easier and less scary to let them earn your trust and to let them in on your story.

So if you are struggling and you choose to call a therapist for help, keep in mind that they already know how brave you are.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

Let’s Talk About Anxiety

by Annabelle Parr

Anxiety is a hot topic these days. It’s all over the news, and apparently it is on the rise. In the age of information and technology, we are constantly bombarded with doom and gloom news alerts, including reminders that on top of everything else, we are plagued with increasing anxiety. Eventually, these reminders can get exhausting and may even contribute to the anxiety that is apparently so prevalent in the first place.

Image source: https://www.theodysseyonline.com/poems-read-anxiety

Of course, there are benefits to all this conversation around anxiety: we have a better understanding of what anxiety is and as a result we may be able to understand and empathize with those who are struggling better. But it’s important to be careful that we don’t pathologize all anxiety, and that we don’t lose sight of the strength that exists in those who truly do have anxiety disorders.

Anxiety: Natural Response to Stress or Disorder?

The way we talk about anxiety today, it is easy to believe that all anxiety is inherently bad and forget that it’s our natural response to threat or danger. We actually need anxiety to survive; it prepares our body to respond appropriately in the face of danger. However, our physiological experience of anxiety developed back when the regular dangers humans faced included running from large, sharp toothed predators. So when we are experiencing the fight-or-flight response before a big exam or presentation, it may not feel particularly adaptive. But despite the discomfort that comes with anxiety, it is natural when it is experienced as the result of a particular situation or problem, when it is proportional to the stressor, and when it only lasts until the situation is resolved (ULifeline, 2016). Anxiety, though often painful, is an important and adaptive part of the human experience.

Image source: aconsciouslifenow.com

Though originally an adaptive response, anxiety does have the potential to be harmful when it manifests as “constant, chronic and unsubstantiated worry that causes significant distress, disturbs your social life and interferes with classes and work” (Active Minds, 2016). In other words, anxiety is no longer helpful when it begins to appear when there is no actual threat present. When a person experiences anxiety but has no threat to respond to, what happens? They begin avoiding situations that are actually safe. Their mind and body are telling them that safe situations are threatening, which can have a debilitating effect. When anxiety becomes disordered, it arises unexpectedly, is overwhelming, and, rather than catalyzing adaptive behavior in the face of a threat, often fosters avoidance of everyday situations (Here to Help, 2016).

Image source: http://www.huffingtonpost.com/2015/05/18/anxiety-photos-katie-crawford_n_7292548.html

So what is the takeaway? Anxiety is uncomfortable, but it helps us respond to threat, uncertainty, trouble, or feelings of unpreparedness (Active Minds, 2016). Anxiety becomes a problem (and possibly a disorder) when it comes seemingly out of nowhere and in the absence of a stressor proportional to the response, and it interferes with functioning in some way.

Recognizing Strengths as well as Struggles

There is no denying that feeling anxious is not pleasant. It can range from uncomfortable to unbearable. For those with anxiety disorders, anxiety is unpleasant on a whole new level; it can be completely overwhelming and paralyzing. It is hard to describe how out of control one can feel in the middle of a panic attack, or how draining it is to go through the day (week, month, or year) flooded with anxiety.

But in the midst of this struggle, it’s important to remember that anxiety doesn’t own you. It may be a part of you, and it may influence your life in various and profound ways. But anxiety does not determine who you are. A diagnosis does not define you. You are not a disorder. You are not weak, powerless, or alone.

Image source: http://quotesgram.com/from-brene-brown-quotes/

Acknowledging the pain anxiety can bring is so important, but it can also be helpful to recognize that struggling with anxiety may also foster certain strengths. According to Dr. Tracy Foose (2013), trait anxiety is associated with being “highly conscientious, honest, detail oriented, performance driven, socially responsible, [and] self-controlled.” Furthermore, learning to cope with anxiety can push us towards an increased self-awareness and knowledge of ourselves. Because it is so uncomfortable, it can motivate us to grow and change parts of ourselves or our lives that may not be serving us. And once we learn that we can move through the discomfort of anxiety, we often feel stronger and more confident in ourselves knowing that we have the fortitude to move through something so profoundly difficult (Sutherland, 2011).

Finally, if you do feel like anxiety is controlling your life, you don’t have to stay stuck in this space. Not only can anxiety teach you to embrace vulnerability and reach out for support from loved ones, but therapy offers very effective treatment. Cognitive Behavioral Therapy and Acceptance and Commitment Therapy can teach valuable coping skills, and can help to change your relationship to anxiety. Nothing will ever take anxiety away completely, but we wouldn’t want that because without anxiety, we wouldn’t survive. But therapy can help us learn that even in the worst throws of anxiety, we will survive, and even thrive.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

References:

Active Minds. (2016). NSOD: Difference between normal anxiety and an anxiety disorder.  Retrieved from: http://www.activeminds.org/component/content/article/512-nsod-difference-between-normal-anxiety-and-an-anxiety-disorder

Foose, T. (2013, Feb. 19). Positive traits seen in anxiety disorders. SF Gate. Retrieved from: http://www.sfgate.com/health/article/Positive-traits-seen-in-anxiety-disorders-4291474.php

Here to Help. (2016). What’s the difference between anxiety and an anxiety disorder?  Retrieved from: http://www.heretohelp.bc.ca/ask-us/whats-the-difference-between-anxiety-and-an-anxiety-disorder

Sutherland, M. (2011). The Benefits of Anxiety. Retrieved from: https://willowtreecounselling.ca/articles/the-benefits-of-anxiety/

ULifeline. (2016). Anxiety vs. anxiety disorders. Retrieved from: http://www.ulifeline.org/articles/439-anxiety-vs-anxiety-disorders

DEALING WITH BACK-TO-SCHOOL ANXIETY IN YOUNG CHILDREN

a guest blog post originally posted on SitterCity.com

As parents prepare their children for the school year to begin, it’s easy to get swept up in all the details: Are the school medical forms filled out? What’s left on the school supplies list? Have you found an after-school sitter yet?

Ticking off all the items on your family’s back-to-school checklist is important, but it’s equally important to pay attention to your child’s behavior during the weeks leading up to school. Anxiety about advancing to a new grade or starting a new school is normal; after all, people of all ages need time to adjust to a new situation. Here are a few ways you can turn those back-to-school jitters into excitement.

(Please note: If you suspect that something more than garden-variety jitters is going on, call your pediatrician who can refer you to a child psychologist for a consultation.)

Get some sleep.

A well-rested kid is a happy kid. While it’s fun to stay up late and sleep in during the summer, it’s important to get bedtime on track at least a week before school starts. Kids can feel grouchy, upset or fearful when they’re sleep deprived. Start practicing normal school day wakeups a week or two in advance so they get used to their new schedule.

Attend the open house. 

Schools often host an open house a couple weeks before classes begin. Be sure to clear your schedule for it — it’s an invaluable chance for your child to meet their new teacher and start feeling comfortable with them, as well as a chance to check out their new classroom.

Plan play dates. 

If you’re new to a school, open houses are also a chance for kids to mingle with their new classmates a little with the safety of you still being around, so they’re not making as many introductions on the first day of school. As you chat with the other parents, see if any of them are open to the idea of a play date, even if it’s just meeting up informally at the playground so your kids can continue to get to know each other.

Do a practice run. 

If your child is starting at a new school, take the time to do a dry run of the morning commute. On one of the mornings they’re waking up early, be sure to get them dressed and out the door on time, too. Practice walking or driving to school — whatever your normal commute will entail. If your child is taking a bus to school for the first time, drive along the bus’s route and answer any questions they might have about what school buses are like.

Eat at a cafeteria. 

Is this the first time your child will be eating a hot lunch at school? Go to a cafeteria-style restaurant to help them practice holding a tray, waiting in line, selecting from multiple options and sitting at a bench-style table. Even if you’re planning to pack a bag lunch, it’s doesn’t hurt to get your child used to a cafeteria-like environment.

Visit the library.

It’s time to do a little back-to-school reading! There are plenty of great children’s stories that address back-to-school anxiety. A few worth checking out are First Day Jitters by Julie Dannenberg; The Night Before Kindergarten and The Night Before First Grade, both by Natasha Wing; The Kissing Hand, by Audrey Penn; and Miss Bindergarten Gets Ready for Kindergarten, by Joseph Slate. Talk to your librarian to see if they have any other recommendations as well.

Take care of the details.

Pay attention to little things that will help make the first week of school smooth sailing. Have them pick out some new clothes and a new backpack for the first few days of school so there are no morning wardrobe meltdowns. If they’re bringing their lunch, plan out a few of their favorite meals ahead of time. Create a morning “launch pad” for backpacks and coats. These may seem like little things, but they can add up to a lot of stress for a child, and they’re easy to prepare for in advance.

Listen to them.

Keep those lines of communication open! Ask you’re child if they’re excited for school, what subject they’re looking forward to most and what friends they’re excited to see. If they’re experiencing social anxiety this is a good time to start talking it out and reassuring them. Being understanding and supportive is the most important thing you can do to ensure your little one has a great back-to-school experience.