Cognitive Distortions

Catastrophizing: You tell yourself that the very worst is happening or is going to happen.

Overestimating Probabilities/ Underestimating Coping Response: You overestimate difficulty or danger while underestimating your ability to cope with the situation.

All-or-Nothing (Black-and-White) Thinking: You view a situation in extremes rather than on a continuum.

Over-generalizing: You generalize from one situation to the next, believing that future experiences will be similar or identical to past experiences.

Self-Confirmatory Bias: You find “evidence” that helps you justify or maintain your belief system.

Emotional Reasoning: You think something must be true simply because it “feels” true.

Overvaluing Thoughts:  You ascribe credibility and meaning to senseless or random thoughts.

Overvaluing Sensations: You misinterpret bodily sensations as being exaggerated, life-threatening or dangerous.

Worrying as Superstitious Thinking: Continuing to worry helps you feel that you will not be caught off-guard. It also feels like constant worrying could ward off the dreaded situation.

Foreclosure: You focus on the possible ways that a situation might end, because it feels too hard to be in a state of uncertainty.

Mind Reading: You guess what others are thinking, and refrain from checking to see whether your impressions are correct.

Negative Review: You replay a performance, conversation or interaction after the moment has passed, focusing on your perceived shortcomings and wishing you had done something different.

Should Statements: You think in terms of how you, others, or the world “should” be. This type of thinking usually accompanies perfectionism and/or a rigid style of thinking.

Discounting the Positive:  You minimize or discount any positive feedback or perspective while maintaining a familiar, negative outlook.

Beck’s Negative Triad: You have a negative view of the self; negative view of the world; and negative view of the future.

Note to reader: This list is a compilation of some commonly used terms that have been originated, modified and/or re-stated by many cognitive-behavioral therapists. Dr. Stone therefore does not claim authorship to these terms.

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Finding the Compass in Compassion: A New Model of Caring for Others and Ourselves

When I first came to therapy as a client at the age of twenty-one, I worried at the end of my initial session that my suffering would burden my therapist in some way. “Isn’t it too much,” I asked, “to be constantly listening to the painful stories of others? How do you do it, hour after hour, day after day – doesn’t it wreck you? Isn’t it a burden? Are you sure you want me to continue?” My therapist closed her eyes for a moment, then opened them before deciding to speak. Her reply, which I have thought about many times over the years, was a revelation. “No,” she replied thoughtfully. “I don’t feel burdened. I feel . . . connected. I feel . . . moved.” This response was incredible to me, one I would not have considered. But I immediately grasped what she was saying, and believed her insight to be credible. From that point on, I knew that I was going to be okay, because she was going to be ok. After that pivotal moment, I knew we could both move forward, and that I could begin my work.

I share this true story with you with a specific purpose in mind: to give you the same glimpse, the same hope, the same pivotal moment, so that this can be your starting place as well. This internal shift – to be deeply moved by someone else’s pain – is the compass I would like to offer to you. Learning to become moved rather than overwhelmed can be the key to your emotional freedom, allowing you to be helpful and present without exhausting yourself in the process. This is the instrument you can use to assist you while you are in the process of assisting someone else.

The Circuit-Breaker.

I’ve had some unusual requests over the years, and this is one of them: some of my clients have specifically asked me to help them to care less – to not feel so much – because whatever they were experiencing was too painful. They were hoping that I could “dumb them down,” so to speak, in regards to their emotions. They were worried about someone, and it was wrecking them. Or, they weren’t feeling loved in their relationship, and wanted to diminish their longing. Whatever the circumstance, they were trying to suppress their feelings. Not only did they think this was an option – that it could actually be done – they thought I was somehow capable of helping them. They were hoping that I could find the circuit breaker to their emotions, and just switch it off.

You can only imagine my dismay. Isn’t the goal of therapy – or of life in general – to experience more instead of less? More integration, more awareness, more insight, more range of emotion, more balance, more fulfillment? I had to break it to them: “Even if I could help you to feel less, even if it were possible – which of course it is not – I wouldn’t do it. Because you can’t remove something that’s essential to you, something connected to your innermost self. Your feelings are precious, they’re authentic. They can’t, and shouldn’t, be killed. I’m sorry, but I can’t.” (This news never goes over very well).

Dr. Steven C. Hayes has proposed that in contrast to emotional avoidance, we should instead practice “experiential acceptance,” which would allow us to have a fuller range of authentic emotions.1 If you are one of those people who feel reluctant to having a broader range of feelings because it feels too overwhelming, you may want to read my other article, entitled, How to Practice Willingness. Suffice it to say, one of the main reasons we feel a barrage of negative emotions is because we refuse to feel them, and it’s the internal struggle to keep them at bay that keeps them so strong. I’ll say a little bit more about this later.

To be fair, I get it. The most characteristic thing about the heart may be very well be its expansive nature. And the fact that it aches. Caring about others comes certainly with a cost. It can leave us feeling depleted, disoriented, and overwhelmed – consumed by the problems of others. Ironically, certain acts of giving can even “backfire” to the point of producing unintended consequences or strained relationships. How did it happen that we had a certain intention in mind when we first started to be helpful, but suddenly ended up in a different spot? Surveying the fallout of depleted resources or strained relationships, we claim never to have foreseen the flaws in our well-meaning gestures. Believing our assistance was sure to be constructive, it can be difficult to comprehend just when or where “too much support” occurred, the “help” that inadvertently impeded the recipient’s success or independence in some way.

The Heart’s Trajectory.

Perhaps it is the amenable nature of kindness itself that has the ability to overextend us. Perhaps it is the enigmatic and existential condition of our hearts – that they are, by nature, boundary-less. Compassion can be limitless, and for better or for worse, the heart has the ability to spread out, seemingly forever. “Love knows no bounds,” as it were. The heart may not tell us when to stop and take inventory; it may not even notice when the recipient stopped benefitting, has given up motivation, or is using our good nature against us. The same may be true for guilt, a close relative of kindness, that offers no “sell by” date to indicate when our obligation has expired. It’s hard to know how far to extend ourselves.

But love as a “feeling” is far different than the “doing” aspect of love, and if we fail to notice this distinction, the “doing” part can hijack love’s unending flight. The slippery slope begins when we overestimate the powers of our giving, blurring the boundaries between caring and controlling. This “offense” may be quite forgivable, however, and it happens to the best of us – especially the kind-hearted.

In trying to keep pace with the heart’s trajectory, certain acts of generosity can go “above and beyond” until we find ourselves lost or over-extended. As we will discuss, there are numerous aspects of caring we will want to keep, since compassion has so many benefits, even to the giver. Although caring can indeed be risky business, I still believe we should remain open-hearted, allowing the heart to keep its expansive nature. But I would propose that instead of trying to turn it off, to limit something that can’t be diminished, we really just need to add something to the act of caring. That something is humility, the admission of being powerless. Because no matter what we tell ourselves, we really aren’t that influential over other people’s lives.

Blind Spots.

Unlike the heart, which may genuinely possess an infinite capacity for love, the mind has marked limitations, although it will never admit that it does. The mind possesses a built-in deficiency that it cannot see, where it overestimates its own capacity in a variety of ways. These are sometimes referred to in psychological literature as “blind spots.” One of these – the overconfidence effect – is a well-known bias that includes the subjective belief that one’s judgment is better than it actually is.2 If this appears as a quirky or harmless tendency, consider instead how overconfidence could lead to serious catastrophes – such as housing bubbles, stock market crashes, excessive litigation, and even war.

There are numerous times that we aren’t necessarily “right” when we think we are, and this may also apply to our conviction that we know what’s best for others. Admittedly, when a scenario is laid out in front of us, it’s easy to have an opinion about what the other “should” do. But we are spectators at best, and we should let this voice quiet down a bit.  Ask yourself whether you have correctly predicted everything in your own life, and if you can admit to being periodically surprised, why would you be so confident in your predictions about the lives of others?

Psychologists have also identified another blind spot which has to do with motivations, and this relative cluelessness about what drives us is another area of overconfidence. While we often assume we know ourselves well, the truth is that we can be deeply biased without even knowing that we are.3 To appreciate how we might be governed by hidden motivations, consider another question: What if our certainty in believing we know what’s best for others is really a protective “shield” – a defensive armor that prevents us from feeling too much discomfort or despair? We might be seeing something heartbreaking or chaotic, and it scares us. From here, we might suddenly be motivated to start advising or directing, aware only of our desire to be generous rather than our desire to feel less out-of-control.

“Preferred” emotional states, like feeling knowledgeable or superior, can push us toward the temptation to judge or to blame. This position might produce a sense of being momentarily powerful when we might otherwise feel overwhelmingly impotent. Likewise, feelings of “certainty” may temporarily remove our experience of disorientation, so it makes sense that we could be internally motivated to defend this style of thinking. In this way, our frantic attempts to create semblance in another person’s life may provide a sense of control when circumstances look exceedingly bleak or chaotic. As such, our drive to “fix” someone else’s pain can distract us from feeling desperate about their circumstances. “Helping” is a perfect camouflage for worry or despair, and for that reason, it can produce a blind spot. When this occurs, our rescuing can feel like a welcome distraction, and our assistance could possibly be more about saving ourselves rather than the other.

The Picket Line.

When the unconscious veil of overconfidence disintegrates, it can be a bit of a shock. Shifting abruptly from over-involvement to sheer resentment, it’s tempting to detach in an exasperated gesture of “I’m done!” This is the visceral equivalent a “no more” gesture, of throwing up our hands and taking a step backwards as we put up an emotional wall. Interestingly, it isn’t until burnout starts to appear that we even begin to assess the landscape – searching for our compass, retracing our footsteps, and taking inventory. But as clear and decisive as this voice first announces itself, “I’m done!” often comes a little bit late. Despair and exhaustion have already culminated as a protest, signaling some sort of wear and tear. Like erecting a sign on a picket line, our objection indicates that something went wrong, that there was a breakdown of sorts, that we can no longer function on previous terms.

Unfortunately, many of our intuitive responses end up becoming self-defeating. Psychological research shows that when we try to numb our feelings or block something from awareness, we create a “rebound effect” where intrusive thoughts and images attack with a vengeance.4 The surge of worry that ensues, the decrease of positive emotions we didn’t intend to lose, and the loss of our connection with others – all these things come at a dear price while bringing us no closer to equilibrium. Trying not to care, it seems, isn’t feasible. “Suppressed caring” – if that’s what we’re trying to do – will inevitably break through and show up in some other form of wear and tear.5

The Bandits of Burnout.

“Compassion fatigue” is a known hazard to helping professionals, but any generous person can feel it every bit as much.  While this particular brand of burnout can feel depleting and exhausting, it would be a mistake to assume that it resulted from caring too much. On the contrary, compassion fatigue is caused by certain identifiable culprits that behave a little bit like gypsies. They are the “bandits of burnout,” drifters who seize our good nature and cause us to lose our compass. Easily unnoticed, they have a unique and disarming way of seamlessly creeping up on us. In order to catch them in the act, we need to notice these bandits before they take over, and if we pay close attention, we can begin to recognize them by the way they make us feel. We will know we have been emotionally hijacked when we:

  • Believe that we ultimately know what is best for another person.
  • Become too invested or attached to specific outcomes for the person we are concerned about.
  • Feel indispensable; attached to an identity that is heroic or “right.”
  • Feel resentment towards the person we were trying to help.
  • Feel dismayed that our efforts ultimately did not give us a sense of self-worth.
  • Feel hurt that our efforts did not produce any gratitude.
  • Feel frustrated or disappointed that our efforts did not produce significant changes.
  • Feel disoriented about unexpected outcomes.

So, what do we do once we recognize these culprits? We can learn more about what makes us particularly susceptible, and slow down before we get lost in our giving. We can develop the insight that this was never a matter of caring “too much.” Because the truth is, burnout sneaks up on us when we stop focusing on ourselves. If our desire is to help the other person re-engage with their own life, we must also work on re-engaging with our own. And it doesn’t need to happen in a radical, “I’m done!” gesture. Defending against worry or concern may seem like the right reaction, but ask yourself honestly: can you really decide to feel less – of anything – especially when considering your tremendous heart? I would argue that the answer is no, and I have something quite different in mind.

The Paradoxical Role of Compassion.

While ‘suppressed caring’ can cause a host of undesirable consequences, increased caring can allow a broader range of emotions that includes more richness, more ease, more space to breathe. It’s a feeling of being more connected to the self and the other – of feeling awake, flexible, and free. It feels like truth and presence and complexity. I recommend it.

If you need a more down-to-earth, practical reason for caring more, you should know that compassion and self-compassion contain enormous payoffs. Most notably, they generate what are called “protective factors” – things that actually enhance our wellbeing. Yes, compassion can provoke painful empathy, but it also has the ability to produce tremendous benefits, both physical and emotional.6 In one study, warm, gentle and soft vocalizations were scientifically shown to reduce cortisol (a chemical released during stress), and release oxytocin (a beneficial chemical).7 Oxytocin – the chemical that is released in moments of love and caring – reduces pain, blood pressure, and even anxiety.8

Thinking more kindly towards ourselves when we are worried about others would do wonders in a difficult situation, and speaking in gentle tones out loud or even inside our own heads might possibly be more beneficial than any concrete advice or negative judgment we would be tempted to convey. Forgiving others’ imperfections as well as our own is another aspect of caring more, and this is a more understanding position that acknowledges our common humanity.9   This would require a softer outlook, where we would refrain from harsh outward criticisms and self-recriminations. This qualitative shift would allow us to treat ourselves with more patience and kindness, and to accept our own limits.

The Paradoxical Role of Powerlessness.

Here is both good news and bad news: The bad news is that we never really had much control over others. And the good news is that we still don’t. Think about what this could mean to you, that you have limited power, and that you are not ultimately responsible for circling around another person’s life, holding their entire world together with duct tape.

Admitting powerlessness over others is neither apathy nor indifference. Rather, it is about respect. This acknowledgment is a key to emotional freedom; it provides more freedom and ease, a more comfortable space between the giver and the person we are trying to help. As my therapist so willingly shared, the experience of feeling moved by another’s relationship to their suffering can be uplifting, energizing, and inspiring. We find that through powerlessness we feel less of a struggle, less need to control suffering. We are less susceptible to the bandits of burnout.

There is a Buddhist saying: “Pain is inevitable, suffering is optional.” This means that without our interference or our rejection, pain will arise and dissolve on its own. (Yes, even other people’s pain). But suffering, on the other hand, is what happens when we struggle, when we try to fix or “improve” things, and here we may be talking about getting too involved in managing other people’s lives.

Many people who have been lost in the process of giving will have a huge reaction to the notion of powerlessness, mainly because they have begun to over-emphasize their role in influencing someone’s life. And perhaps this sneaky suspicion of powerlessness has presented itself before, and not in a pleasing way. To be sure, we can become so painfully worried that doing for others seems essential. But as with many profound axioms, there is a paradoxical element here: Admitting we are powerless can be very empowering. And the same is true on the other side of this paradox: believing we are powerful may blind us to our relative powerlessness.

It is difficult, and yet essential, that we come to terms with the fact that we really aren’t so powerful. As a therapist, I have to humble myself on a regular basis, realizing even though my clients are giving me express permission to help them, I do not have much – if any – control over their circumstances. For my clients’ sake and for mine, I need to not inflate my sense of importance, not to overstate my influence. Admitting our powerlessness over others is a humbling and ongoing practice that puts us back into reality. It asks us to take inventory, to remain aware of our personal limits. And luckily, it happens alongside caring, so our hearts can remain open. Admitting our powerlessness is different than the harsh stance of “I’m done.” It’s a gesture of respect that acknowledges the boundary between self and other. It makes us reasonable and humble; it helps us let go.

In the literature of Co-Dependents Anonymous, Step One reads: “We admitted we were powerless over others – that our lives had become unmanageable.”10 This step can be a revelatory goldmine when applied to our tendencies toward “helping.” If you have ever talked to an addict who is very sincere about their recovery, you will quite often hear them say, “I’m doing great, but I’m back to working on Step One.” As a therapist and recovering co-dependent, I can completely understand why someone would say that. Because Step One is, in my opinion, the most important step.

Compassion and powerlessness are two essential and complementary instruments of the compass. When used together, they keep us balanced and steady so we don’t topple over the landscape of other people’s lives. These stabilizing practices can help us to avoid succumbing to enabling behaviors, falling through the cracks of burnout, or overstepping our bounds.

Creative Hopelessness.

Now that the word “powerlessness,” may not trigger the same jolt, perhaps you won’t be so easily disheartened by the term “hopelessness.” In many ways, this is similar to the notion of “hitting bottom,” as the phrase is often used in 12-step recovery. Dr. Steven C. Hayes discusses the value of admitting how our repeated attempts to control outcomes can ultimately be defeating.11 Advising, directing, or rescuing others are short term strategies that may eventually fail. Approaches we are tempted to repeat in an effort to make things “better” can produce a feeling of change, but this can be a seduction more than anything else. Time and time again we exert our most valiant efforts, only to discover than nothing much has improved. Instead, by admitting our own limitations, new and creative solutions can emerge, often for ourselves and for the other person.

This is when “hopelessness” becomes a beautiful word, not something demoralizing. The openness, the feeling of surrender, the experience of hitting bottom – all occur when real change begins to happen. Interestingly, we have arrived at another paradox: by giving up, things suddenly begin to look hopeful again.

A similar concept, “radical acceptance,”12 is offered by Dr. Marsha Linehan, who recommends the simultaneous practice of both acceptance and change. We can thus radically accept the reality of our loved one’s circumstances while being proactive with our own self-care. Likewise, we can radically accept our powerlessness while increasing our compassion, exercising our ability to comfort without “fixing.” To be sure, powerlessness, creative hopelessness, and radical acceptance should not be confused with apathy or complacency. They are part of the delicate equation for creating balance so that we can care more without depleting ourselves. They are the more intricate inner-workings of the compass.

Circumstances Don’t Define Us. Or Them.

Too often we overstate our confidence in changing another person’s situation, ignoring the fact that they have free will and are on a very personal journey that may be only meaningful to them. When we become hyper-focused on the details of someone’s life rather than its potential for meaning and discovery, we might be thinking too literally, too superficially. We may simply be seeing the broken mechanisms of the compass rather than the beauty of its design, or the direction it might still be pointing.

But our concrete thinking is a limited perspective. We are not expected, nor are we entitled, to know what is ultimately best for another human being. Suspending our judgment and embracing a sense of not knowing, we can begin to appreciate the significance of another’s suffering – that it has courage, poetry and meaning – and is part of a significant and greater story that is largely mysterious. It is a story whose meaning may only be revealed later, and only to them.

I have heard it said that in one’s final moments, when looking back over the totality of one’s life, people who are dying tend to focus not so much on the significant events that transpired, but more on their responses to those events. Apparently, it is not the literal happenings that matter as much as the ways in which we reacted. The highs, the lows – the accidental circumstances that include both good fortune and bad – these do not carry as much weight as our responses do. Circumstances are not just imposed on us, they summon us, asking that we reveal or reinvent ourselves. They do not define us, nor the person we are trying to help.

Choosing Reality.

After listening to others’ stories over many, many years, I can tell you that Reality usually has something different in store than what we think “should” happen. I’m also both sorry and pleased to tell you that not one of us is a true contender against Reality itself. If we can’t completely rule over our own lives, how on earth do we think we can influence somebody else’s?

I saw a saying once: “Everything will be ok in the end. If it’s not ok, then it’s not the end.” So, before you say you know how some outcome will be, or how it will be if someone doesn’t approach things in the way you would have them do, consider that Reality often produces something better, something more personal, something that’s tailored to the unique story of a person’s life.

Take a look at your own life, and consider the most astounding things that have ever happened, both good and bad. They were always things that were previously unknown to you. Music is a great metaphor for this, because while you are the authority on your musical taste, you are also not literally the person that composed your music collection. If you’re so clear about your preferences, then what prevented you from writing all the songs in your music library? Not even your own imagination could have designed your favorite song, your happiest moment, your soulmate, or your greatest lesson.

If you are tempted to believe you know how another person’s future should unfold, take a moment to consider that you could not have predicted the details of your own life in their entirety. And if you are tempted to think you know what’s best for another human being, consider again the limitations of your own sense of control and your imagination. The meaning of another person’s life is something that may be knowable and reachable only to them. And it will be far different and more meaningful than anything you can possibly imagine.

 

Extras: Further Suggestions for Balancing Compassion with Powerlessness

If I’m Not “Helping,” What Should I be Doing Instead?

Breathe. Do less. Offer a walk, a hug, a movie, a dessert, or cup of tea. Offer your warmth, your company, but don’t give any advice. Here are some healthy practices you might try in the alternative:

  • Cultivate equanimity. When caught by excessive attachment, untangle yourself by considering, “My loved one has free will, and their life has meaning that may only be knowable to them. It is their choice how they move through their pain or suffering.” This may sound like indifference, but it isn’t – it is respectful of the other person’s journey and is a key to emotional freedom.
  • Try “lovingkindness” mantras, such as: “May I be safe. May I be happy. May I live with ease.” And then, “May my loved one be safe. May they be happy. May they live with ease.” Compassion means simply wishing well for the intended recipient. It needn’t be gushy, over-the-top, or complicated. As you reflect on their circumstances, try to generate some sincere well wishes. Keep it simple, and let it go.
  • Listen to free self-compassion meditations, such as on Kristen Neff’s website at self-compassion.org.
  • Practice “Step One” (admitting powerlessness over others). Or explore the idea of “radical acceptance,” embracing the other’s journey as really their own. If you are interested in the mindfulness and acceptance-based practices, work with “creative hopelessness,” where you take an honest look at the control strategies you may use around trying to “fix” others. Write them all down, and review whether or not they actually worked. Notice all your “shoulds” – both for others and for you. Let go of your control, your agenda, your need to be right, and the temptation to think about what’s best for the other person.
  • Practice mindfulness, acceptance and willingness. Stay in the present moment, feel more of your feelings, and don’t try to suppress a thought. But at the same time, remember the overconfidence effect, and beware of your blind spots. Stay a little guarded when it comes to your mind, since our thoughts cannot always be trusted. Attachment to outcomes, worrying about the person’s future, and judging their experiences or behaviors as good or bad – are a few common pitfalls of the “mind” that are also connected to burnout.
  • Embrace your humanity. Practice forgiveness toward yourself, for your limitations and your imperfections. It is enough for you to show up with your authentic presence; it’s ok not to have all the answers or the resources. It’s also ok to slow down. Refrain from harsh criticism and negative self-judgment. Above all, treat yourself with patience and kindness.
  • Dare to care more. Explore your own healthy balance between compassion and letting go. Find a sense of awe and reverence for your loved one’s story, however painful or triumphant. Appreciate it, but don’t own it. Care more and control less, for your own wellbeing and the wellbeing of your loved one.

Notes

  1. Walser, Robyn D., Westrub, Darrah. (2007). Acceptance and Commitment Therapy for the Treatment of Post-Traumatic Stress Disorder and Trauma-Related Problems, a Practitioner’s Guide to Using Mindfulness & Acceptance Strategies. Oakland: New Harbinger Publications, Inc., 200-201, 223-224.
  2. Moore, Don A., Healy, Paul J. (2008). “The trouble with overconfidence.” Psychological Review. 115(2):502-517; Hoffrage, Ulrich. (2012). “Overconfidence.” In Pohl, Rüdiger. Cognitive Illusions: a Handbook on Fallacies and Biases in Thinking, Judgement and Memory. New York: Psychological Press, 351-4; Kahneman, Daniel. (2011). “Don’t Blink! The Hazards of Confidence.” New York Times; Plous, Scott. (1993). The Psychology of Judgment and Decision Making. USA: McGraw-Hill, Inc.
  3. Pronin, Emily, Lin Daniel Y., Ross, Lee. (2002). “The bias blind spot: perceptions of bias in self versus others.” Personality and Social Psychology Bulletin, 28(3): 369-381; Pronin, Emily. (2008). “How we see ourselves and how we see others.” 320(5880): 1177-1180.
  4. Wegner, Daniel M., Schneider, David J., Carter, Samuel R., & White, Teri L. (1987). “Paradoxical effects of thought suppression.” Journal of Personality and Social Psychology 53 (1): 5-13.
  5. Gross, James J., Levenson, Robert W. (1997). “Hiding feelings: The acute effects of inhibiting negative and positive emotion.” Journal of Abnormal Psychology 62 (4): 565-85; Cioffi, Delia, Holloway, James. (1993). “Delayed costs of suppressed pain.” Journal of Personality and Social Psychology 64 (2): 274-82; Feldner, Matthew T., Zvolensky, Michael J., Eifert, Georg H., & Spira, Adam P. (2003). “Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge.” Behaviour Research and Therapy, 41(4): 403-411.
  6. Neff, Kristen. (2011). Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind. New York: HarperCollins Books, 47.
  7. Seltzer, Leslie J., Ziegler, Toni E., & Pollak, Seth D. (2010). “Social vocalizations can release oxytocin in humans.” Proceedings of the Royal Society B: Biological Sciences, DOI: 10.1098/rspb.
  8. Lee, Heon-Jin, Macbeth, Abbe H., Pagani, Jerome, & Young, W. Scott. (2009). “Oxytocin: the great facilitator of life.” Progress in Neurobiology 88 (2): 127-151.
  9. Brown, Brené. (2012). Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent and Lead. New York: Gotham Books, 128, 133; Brown, Brené. (2010). The Gifts of Imperfection: Let Go of Who You Think You Should Be and Embrace Who You Are. Center City: Hazelden.
  10. Co-Dependents Anonymous, coda.org/pdfs/Fellowship_Service_Manual.pdf.
  11. Hayes, Steven C., Strosahl, Kirk D. (eds.). (2004). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer Science and Business Media, Inc., 36, 47, 65, 70, 85-87, 99-100.
  12. Hayes, Steven C., Follette, Victoria M., & Linehan, Marsha M. (eds.). (2004). Mindfulness and

Acceptance: Expanding the Cognitive-Behavioral Tradition. New York: The Guilford Press, 30, 38, 62.

 

©2017 Heather Stone, Ph.D.

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Coping With Ambiguity (And the Trouble with Affirmations)

I don’t believe in affirmations, but I do believe in coping statements. Affirmations are a form of magical thinking, a fervent wish that Reality be somehow different than what it is. Affirmations are used for the purpose of cancelling out “negativity,” a practice that seeks to banish anything undesirable from appearing in the mind or in real life. However, psychological research shows that thought suppression will create a rebound effect, allowing disturbing thoughts and images to intrude with a vengeance. The result is to feel deflated and demoralized as the negative thoughts take over and spiral out of control. Worse, when we start to believe that our thoughts create reality, we may become even more discouraged or afraid. As Pema Chödrön states, “Affirmations are like screaming you’re okay to overcome this whisper that you’re not.”

Coping statements, on the other hand, especially the ones offered in this handout, are intended to help you use less control. They do not oppose Reality; rather, they help you to embrace it. Paradoxically, giving up control can help you feel more in control. The following are the kinds of statements people say to themselves when they have overcome anxiety disorders, so beginning to talk to yourself this way will help you to feel stronger – authentically stronger. After a while, your inner voice will sound more powerful than your anxious thoughts, and your symptoms will subside more easily. Coping statements are qualitatively different than affirmations, because they emphasize resilience, not perfection.

Practice Willingness for short increments of time, by saying:

“I’m willing to be anxious,”
“I’m willing to be uncomfortable.”
“I’m willing to accept Reality, on its terms.” “I’m willing to acknowledge that this difficult thing is happening.”

Set a timer, and just try to be willing for 30 seconds, 3 minutes, or whatever. We should be 100% willing, but we can’t do it all of the time. Practice willingness in short, manageable bursts. Imagine turning a willingness dial all the way up to 100%.

Move towards Ambiguity, by saying: “I’ll never know for sure.”

“Maybe it will happen, maybe it won’t.”
“I can’t predict the future.”
“Anything is possible.”
“I guess I’ll find out.”
“I guess I’ll just wait and see.”
“Things can be better or worse than I’m imagining.”
“I’ll cope with things as they happen.”

Stay with the Now, by saying:

“Back to Now.” (And tune in to your senses and your present activity). “Right now, in this moment, I’m ok.”
(You probably are. The worst we can feel is “extremely uncomfortable”).
“Right now, in this moment, I have relatively enough information.”
(If you’re craving more certainty, the present moment has more of it than any other time you might be able to imagine).

Move towards Acceptance, by saying:

“The nature of Reality is uncertain and unpredictable, and will remain this way whether I accept it or not.”
“I could choose resistance, but I usually lose that battle.”
“Acceptance is paradoxical: it empowers me, makes me more flexible, and brings me
closer to Reality.”
“When I try to struggle against Reality, I suffer.”
“Wishing for things to be different can be a trap. It can feel like an internal manipulation with my thoughts – a perpetual dissatisfaction.”

Give up Control in order to get your life back, by saying:

“Less struggle equals less anxiety.”
“I hate being blindsided. But if I have to trade letting go of worry for the possibility of being surprised – I’ll do it.”
“I’m willing to be caught off guard in order to have more experiences and feel alive.”
“Worrying doesn’t keep me safe. Bad things happen whether I worry or not.”
“It’s good that I can’t control everything. I couldn’t have created or predicted some of
the best moments, or people in my life.”
“Every good thing that ever happened to me came from the Unknown.”

Change your stance from Fear to Awe, by saying:

“I can have reverence and awe instead of just fear.”
“I am moved by the plight of humanity. I know there is also bravery, compassion,
kindness and grace – which also show up in the face of adversity.”
“I don’t know the end of the story. Things are sometimes unknowable, and yet, can
contain beauty and meaning that isn’t revealed right away.”

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What Are My Coping Skills?

BE PRACTICAL
Do you have directions? Contact numbers? A plan or goal? Money? The right clothes? Phone charged? Snacks/water? Enough time to get some place? And, do you need to be overthinking things (what can you reasonably let go of)?

REACH OUT
Know who supports you and let them in – tell others what you are going through.
Foster rapport; reach out to strangers if necessary; connect with helpful others.

COMMUNICATE
Ask nicely. Experts will help you more if you say, “Would you be willing to . . .” I’m wondering if you could educate me about this . . . “ “I’d be so grateful if . . . “ “This isn’t my area of expertise – what is your recommendation?”

PRACTICE SELF CARE
Breathe! Sleep, hydrate, and be well-nourished.

PRACTICE SELF-COMPASSION
“Channel” a wise, compassionate adult, and comfort your anxious self.
Be soothing, calming and understanding towards yourself.
Be forgiving to yourself or others.

BE DIRECT
Articulate needs / use direct rather than indirect communication.
Advocate for yourself / ask for help.
Utilize resources.

PRACTICE IMPULSE CONTROL
Act less impulsively – try not to hurt others or yourself.
Think before acting, such as your tone of voice or the words you are saying.
Don’t agree right away. Say, “Let me think about it – I’ll get back to you.”
Don’t overshare with the wrong people.
Slow down; take a break.
Don’t trade short-term relief for long-term negative consequences (e.g., escape/avoidance).
Don’t try to cope with drugs or alcohol.

BE FLEXIBLE
See alternate perspectives; practice empathy by putting yourself in others’ shoes.
Consider options and be flexible; go with a different plan if necessary.

BE PREPARED
Put in hard work: study, prepare, and don’t procrastinate.
Find the right experts and once you trust them, really follow their recommendations.

BE “GOOD ENOUGH”
Notice avoidance, procrastination and perfectionism, and don’t let them sabotage you. Just move forward and be “good enough.”
(Perfectionism makes it hard to approach things, while being good enough paradoxically helps you to do your best).

ADJUST YOUR THINKING
Only let your mind focus on something tangible or concrete – like making reservations, writing a to-do list, budgeting money, or researching something you need an answer to.

LABEL THE THOUGHT/ COME BACK TO THE PRESENT
Intangible thoughts, like worry, won’t help you, so don’t let them take you for a ride.
Practice being an Observer:
Say, “Worry, there is worry.” Or, “That’s a ‘what if’ thought.”
Bring your attention back to what you are doing, or redirect to another activity.
Tune in to your senses in that moment (sights, sounds, smells, etc).
Say, “Back to now.”

TRUST YOURSELF
Remember that you only show up in the Now, not in some imagined future scenario.
In the present moment, the moment you will always be in, you will have access to information that makes it more possible to respond.
For these two reasons – that 1) You will be there; and 2) you have all the information you need – you can trust yourself.

STAY HOPEFUL
Don’t wait for confidence to come before taking risks.
Fake it till to you make it.
Or, fake it till you become it.
Other: ________________

© Heather Stone, Ph.D. 2016

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Write a Letter to Your Suffering Self

Clients tell me that they have absolutely no idea how to have self-compassion, and while they easily demonstrate compassion for others, they just don’t know how to be compassionate with themselves. First, let me take some of the pressure off of you by suggesting that you don’t have to be over-the-top, out of character, or even “gushy” when you treat yourself compassionately. Rather, try to acknowledge your suffering with some sincere appreciation or sympathy. Simply wish for your own wellbeing. And most importantly, do not ever judge yourself as bad, stupid, or weak.

As an exercise in self-compassion, I suggest that you try to mentally divide yourself into two different parts. Imagine, if you will, that you are two separate selves, one that is wise and compassionate, and the other that is deeply suffering. Because many people are invested in avoiding or rejecting their anxious selves, just noticing this part can sometimes feel uncomfortable. What helps is to envision looking at your Suffering Self as if it were seated in an empty chair, right in front of you.

Who, exactly, is this Suffering Self? This is the part that is hurt and scared, the part that is hoping for reassurance and assistance. It is the part of you that’s “younger.” When humans suffer – when we are sick, injured, or anxious – we tend to regress in the sense that we actually feel smaller. In those moments, it can feel like our regular adult self just completely disappeared, putting this younger side in charge of any given situation. But if you think about it, the younger part is the least equipped to deal with something difficult, because when we’re younger, we don’t have skills, confidence, or experience. We shouldn’t expect this injured or frightened self to take charge or to do battle for us. And yet, we continually do so, often pushing this self to the front lines, so to speak.

Even if you have had little exposure to some caring, competent adults, you can still picture how such persons would behave. Capable adults can be soothing and calming. They are also better at seeing alternate perspectives, acting less impulsively, articulating their needs, utilizing resources, considering options, and most importantly, making direct requests.

What helps is to envision looking with compassion and curiosity at your own Suffering Self, as if it were seated in front of you. Try to consider, how does this image look to you, at this moment? What is its age? What can you say about its posture, countenance, or mood? What might this Suffering Self be thinking? What does it want? Amazingly, you might begin to describe this vulnerable part in much detail. Try to consider whether there is hope or hopelessness, what type of assistance, protection or company it needs, and from whom.

After learning more about your Suffering Self, begin writing your letter, as best you can. Take whatever time is needed to make it as personal and meaningful as possible. In terms of content, here are a few guidelines:

The majority of the letter is simply about offering validation. This is because when we are suffering, we don’t want so much to be talked out of our pain, and we don’t always need to be given advice. Rather, we want to know that our suffering was real, that it mattered, and that we feel understood. So, write as if you can convey this type of sympathy and understanding. These are some general phrases that could be used:

Dear Suffering Self,

I understand that when you are in this difficult place, you feel __________.
When things are this hard, you want to ___________.
You start to think that ______________, and wonder whether _______________.
You can’t help wishing that __________________.
____________ is a thought that often comes into your mind.
If you could long for anything it would be that you could have __________, __________, _________.
If somebody could just care enough to notice, they would see _______________.
______________ is what you need the most, but you have sometimes wondered whether it would ever come.
Having ____________ would make all the difference in the world.

The last part is to provide a comforting presence while refraining from giving instructions or advice. Such statements might be,

Suffering Self, you are so right to feel this way! This makes perfect sense to me. Of course you would feel exactly as you do. You have been in this place for such a long time, and I realize how hard this has been for you. I can see that you are in so much pain.

I am here with you; you don’t have to feel alone.
I see your goodness and your value.
You may have been overlooked or misunderstood in the past, but you are not anymore.
I trust you, and want to earn your trust as well.
I see the truth and the situation you are in, exactly as you do.
I know I have fallen short sometimes, but now I want to be here, I want to do my best.
I will stay with you so that you can feel reassured.
I care deeply about your feelings and your struggle.
Everything about you and what you are feeling matters to me.
If I could protect you, if I could stand by your side – even in certain moments of your past – I would do so unhesitatingly.
I am by your side and will take care of you. You are not alone.
I hope you can feel my presence. I’m here for you.”

The importance of this letter has many aspects to it, but the most relevant piece is that it will create a reminder or bridge for you to find your inner strength during difficult times. Put this letter somewhere where you will find it, and if you’re ever in a scared, hopeless or desperate state of mind, just take this letter out and read it. And try to believe it. After all, it came from the wisest, most compassionate part of you.

©2016 Heather Stone, Ph.D.

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How to Practice Willingness

Many psychological approaches based in Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy and other mindfulness-based therapies propose willingness as an effective technique for coping with a variety of symptoms. I agree that this paradoxical approach is the best way to address our suffering, and you may too, once you realize that resistance has never really provided the relief you were hoping for.

Before we continue, I want to emphasize that the strategies I am proposing should only be used in regards to inescapable suffering – anything that you feel subjectively, such as a feeling, thought, or physical sensation. We are not talking about a situation you might be in, like being abused by a boss or a romantic partner. This approach is not intended to be a tool for remaining in unhealthy situations, since there are truly dysfunctional environments we sometimes need to remove ourselves from. What we’re talking about here is the relationship you have to your migraine, nausea, tinnitus, depression, or panic – anything that arrived unannounced and that you experience internally.

Intuitive = No / Counter-Intuitive = Yes

Despite how frequently we resort to distraction, avoidance, and escape as our usual “go-to” responses, these intuitive strategies most certainly fail when it comes to reducing our suffering. Even though we are able to see this at times, we still end up utilizing these self-defeating strategies. After the symptom has passed, it’s easy to have insight about how futile these attempts were, since we can clearly see what did or didn’t help. But when we are deeply struggling – when we are at our lowest ebb – we tend to forget what to do. Thus our insight waxes and wanes: at best, it is intermittent; at worst, it goes straight out the window.

Even when we begin to remember that we can’t escape our pain, it can still be very hard to practice willingness as an alternative to resistance. As it turns out, willingness is not especially hard to sell as an idea, but it is very difficult to sell as a practice. And it gets even harder when I encourage my clients to go further and actually want their symptoms, which is something I often suggest that they do. You may be feeling horrified after reading the last sentence, and believe me, I get it. Everything about this approach feels wrong. But so are our intuitive strategies, and since these don’t work very well, it might be time to try something new.

FAQ

Before we go on, let me first respond to some frequently asked questions, such as “What about self-care?” and “Shouldn’t I fight an illness or search for a cure?” Yes, of course, but here is something you need to consider. If the mind is working on something tangible, like scheduling a doctor’s appointment or researching treatment, that’s absolutely fine, because you are engaged in a task that’s measurable – you’re doing something concrete. But if your mind is refusing to feel something in the present moment that actually exists, resistance isn’t going to work, and that’s when such control strategies fail. If your mind is working on an escape route such as, “How long am I going to feel this way?” and “How can I make this pain go away?” – it isn’t doing anything productive, and it isn’t the best use of your mind. Rather than trying to escape the inescapable, see if you can just show up for the present moment you are in, and if that moment happens to include some discomfort, try moving towards your pain rather than pushing it away. Don’t worry; there’s more to this process, and I’ll help you learn how to do this.

Feel the “No!”

It’s easiest to begin by first noticing the resistance or implied “refusal” you have in response to your distress. This is a perspective of, “This can’t be happening. . . This is unacceptable. . . I can’t let this go on.” And yet, deep down, we know we ultimately lose those types of ultimatums with our bodies or our minds, since most often our symptoms just steamroll right over us.

Rather than engage in this losing battle, see if you can begin to appreciate how the refusal goes hand in hand with continued suffering. Vow to hold onto this insight, understanding that it is your sense of refusal which actually sets up you to fail, because “what we resist persists.” Once you feel more aligned with this awareness, locate the feeling inside your body that feels like a protest. Feel the “NO!” response, and see if you can soften the rigid stance you are taking. Then, draw in your next breath, taking the position of being “all in” or “fine; here goes . . . . “

It’s Not Forever

You may be glad to know this isn’t something that you need to do all day long. Practicing willingness can and should be done in small bursts – whatever you feel you can manage. If it feels too daunting, set the timer. You even can start with just thirty seconds, but I think for it to work effectively you should do it for at least five to twenty minutes. You also need to practice in a quiet space with no interruptions, because it’s too hard to achieve the right results when there are other distractions that are competing for your attention. Because of your symptoms and everything else you are dealing with, you need to put yourself in a quiet space in order to focus.

Admitting the Truth

Once you are in a place where you cannot be interrupted, begin by just admitting that the discomfort is there. You don’t have to like it, and you don’t have to agree with it, but see if you can simply admit the truth, that the experience is present. Ok so far? From there, move closer and closer toward it. And once you get really close to it, try going even farther than you intended. As with any skill or technique, the best way to nail it is to “over-shoot.” You actually have to go beyond the admission, go beyond the acceptance, and move straight into willingness. And then go past it.

“Oh, my God!” you might intuitively groan. “What is beyond willingness?” What is beyond willingness . . . is . . . (bear with me) . . . . wanting the symptom. It is actually going after the feeling, seeking it out, wanting it, and then . . . wanting more. I know it sounds hard, but I promise, what you’ve been doing has been harder.

The Problem of Resisting

Let’s talk more about resisting, and why it tends to increase our suffering. Resisting is sort of an attempt to flee, but if you think about it, it’s impossible to flee from an internal experience. The “fight-or-flight” response that’s built into our hardwiring was designed to protect us from danger, but it only applies to danger that is external. This survival mechanism was only supposed to help us run from an avalanche or flinch from a snake. It was never meant to help us avoid something subjective—something that’s inside the skin.

When we practice resistance as a coping strategy, we are trying to flee, at least mentally, and when we attempt this, all we are aware of is the pain. Feeling “trapped” is a common experience that goes with symptoms like anxiety or pain, but this notion only exists because “fleeing” is somehow considered to be an option. But how can it be? We’re residing inside of ourselves, and there is no place to go. Likewise, avoiding or fleeing from a triggering situation isn’t a viable strategy either, because Reality doesn’t like to replace what already exists with our own preferred circumstances.

But willingness gets along with Reality, because willingness agrees with what already exists. This gives us more energy, because agreeing takes a lot less work. While resistance produces the unintended consequence of increasing our discomfort by imploring us to struggle, wanting our suffering makes it less so. The reason? It’s because wanting something provides the awareness that we are separate.

To Relate is to Separate

Let me provide a little bit more explanation. When suffering predominates, the “Observer” part – the part that usually helps us to feel more distance – doesn’t like what it sees, and tries to vacate the scene. But without such presence, the suffering takes center stage. The result is to feel “fused” with the suffering, unable to achieve any distance. When we “refuse to feel,” there is no longer a sense of truly relating to our suffering – only a sense of hiding or turning away. In the end, “refusing” leads us straight into jeopardy – causing us, paradoxically, to be “re-fused” with our pain. And if it’s distance we want, it can only happen where there is a dynamic – a dynamic of relatedness. The most powerful tool you have when it comes to easing your suffering is to discover the real “You” that has the ability to notice things, and to want what’s real.

As you regard your discomfort from a curious place, you will begin to notice that You and the symptom are in relationship to each other. Moving towards it, even wanting your suffering, establishes a relationship dynamic that didn’t exist before, and therein lies your freedom. Suddenly you will discover that You and the experience are not the same. This safe presence can also give you something reassuring to focus on. One of the nicest things about practicing willingness is that it helps you find a great comfort in your ability to feel your own presence.

 “You” Are Not Your Symptom

In the beginning, don’t be surprised if you feel your own presence to be very small. Up until now, you may have only experienced the temptation to disappear, and the attention on your suffering has made it the most important thing. But even if you can sense only 1% Observer and 99% discomfort, this is a significant foundation that you can build upon. The good news is that you have already proved that the discomfort does not consume all of you – you just noticed that it isn’t 100%. Better still, paying more attention to the Observer will help it to become larger, and pretty soon your suffering will feel smaller by comparison.

Contrary to what you might think, showing up willingly in the presence of pain or discomfort can be a deeply moving experience, especially if you have never fully witnessed the truth about your own bravery. Knowing yourself in this new context affords you another gift as well. You will begin to see the best, most sincere part of you, the part that is willing to attend to something difficult – the part that can show up in a genuine, heartfelt way. This can change your internal experience. You might not learn anything new about how difficult your symptom is, but you will learn something about your own character and your courage that you never saw before. Aside from the eventual reduction in your symptoms, this is a very connected feeling that will affect your self-worth and the quality of your life.

Moving Forward, Inch by Inch

You are already getting a glimpse of why this might be a good idea, so let’s approach willingness together in a more structured way. From a compassionate standpoint, start inching your way forward. Take time with each step, and consider each one deeply:

  • Find the refusal
  • Soften the “No!”
  • Admit that the feeling is here
  • Agree that the feeling is here
  • Agree with the feeling
  • Want the feeling
  • Want more of the feeling

Discover all the nuances as you progress through this exercise, and notice how we’re not taking any action here. You’re still here, and the experience is still here. Nothing has really changed . . . or has it? Notice whether this exercise made you feel worse, better, or the same. If you’re still feeling bad, you might be evaluating too soon. Ask yourself sincerely: Did you try to use this exercise as a control strategy to make the discomfort go away? Because if you did, it wouldn’t work.

Take a big breath right now. The only way it’s going to work is if you go into willingness for its own sake, pure and simple. Change your objective. The purpose is not to reject the feeling, but to explore willingness in an open-minded, completely genuine way. Once your intention has changed and you are completely satisfied with your integrity, go through the steps again, this time making willingness your only goal. You can evaluate your suffering perhaps later on today, as a footnote. But don’t hold it so fiercely in front of you at this point.

I’m Still Resisting ~ It’s Hard to Change

We recently learned how just doing this practice for the sole purpose of reducing your symptoms will eventually backfire, so it will become necessary to find deeper incentives for agreeing to have this experience. In order for you to want your suffering – really want it – you are going to need to find a higher purpose, or it might be too difficult to approach. This is going to be a very personal thing, and you must answer to yourself, from a heartfelt place, why on earth this would be a good idea. This is hard to do, so you will need to dig deep. If you have difficulty coming up with your own higher justifications, you may borrow from some of these below:

Why Do I Want to Feel This? (Finding Incentives Through Your Values)

  1. If you value self-improvement and personal growth, you might appreciate that: Moving towards my pain gives me practice to be with uncomfortable experiences. There will be many times in life where I need to demonstrate strength and flexibility in the face of adversity. This is an opportunity to develop myself. It’s like working a muscle, or training for something difficult, the inner equivalent of weight training or running a marathon.”
  1. If you value self-care and a holistic path to wellness, you may similarly appreciate that: Experiencing the pain helps me to not dissociate or use resistance, which can produce an unnecessary layer of suffering or discomfort. This is a natural, organic and straightforward way to ease my suffering.”
  1. If you value scientific thinking and the process of evidence-based discovery, consider that: Feeling all of my suffering gives me the chance to truly test my beliefs, such as the prediction that moving towards my symptom will only cause it to cascade out of control. Exposing this as a myth would be worth taking the risk. It’s a relief to have direct experience and a way to navigate through this. In this way, I can prove what works and what doesn’t.”
  1. If you value balance and having energy for other areas of your life, consider that: Agreeing with my suffering helps me to let go of the struggle, which was taking too much energy, removing me from what’s important in my life, and leaving me depleted and exhausted.”
  1. If you value the grace and serendipity that can emerge from random moments, this perspective can feel meaningful: Becoming intimate with my suffering tells me I am likely to learn something new that I may never have known otherwise. Because agreeing with my discomfort is so unfamiliar and difficult, everything that follows is sure to be a new understanding. Because this is a rare occurrence, it can be considered to be a gift. I’m not sure what the gift is yet, but I’m open to receiving it.”
  1. If you value being in the Now and practicing Mindfulness, this may feel important: Meeting my suffering forces me to be in the present moment. There is still a “connected” feeling about being in the Now, even if the Now is difficult.”
  1. If you value having a wider range of feelings and a fuller range of experience, this perspective affords that opportunity: Feeling more of the discomfort helps me to feel more expansive, rather than feeling trapped and limited inside my pain. I’m tired of making ultimatums with my symptoms that I eventually lose, of shrinking and hiding from discomfort. It hurts a whole lot, but when I agree to feel more, I notice more space inside of me, more room to breathe. It’s easier now to live inside my own skin.”
  1. If you value Truth, this higher justification may have unique significance: If I fully admit that I am in pain, I am closer to truth. Because I value truth, this experience feels meaningful. To me, there is no such thing as desirable or undesirable truth. Truth is always sublime.”
  1. If you value being closer to Reality, this perspective may also be inherently meaningful: Admitting the presence of my suffering helps me to come closer to what’s real, to meet Reality on its terms. When I insist that Reality conform to my wishes, it never happens, and I frequently get discouraged. Avoidance, distraction or escape are just “control tactics” – indirect and ineffectual means of trying to change my internal experience. I have better insight about this now. The willingness to be with what’s real is a privilege that feels simple, moving and meaningful. I choose Reality.”
  1. If you value developing self-worth and self-discovery, this incentive may feel important: To see this kind of bravery as I practice willingness, I have a window into my true nature, my character, my triumphant spirit. Moving closer to my suffering allows me to see who or what I am when I truly show up with presence.”
  1. If you care deeply about others, this higher justification may have importance: “Moving toward my suffering allows me to know more directly what others are experiencing. Finding the courage to face my suffering may allow me be of service to others, and to have more compassion.”

A personal note to my reader: Thank you for reaching for something so difficult. What more could a therapist ask for? Your willingness made me respect the hell out of you. I am deeply impressed by your bravery. You are so much more than your suffering. Be well.

2016 Heather Stone, Ph.D.

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Cognitive Defusion and Mindfulness Exercises

Cognitive defusion is the technique of becoming untangled from our thoughts. While cognitive fusion is the process of believing that our thoughts are literally “true,” cognitive defusion is the ability to regard thoughts simply as thoughts. The result of defusion is usually a decrease in the thought’s power over us as we loosen our attachment to the thought. The thought would not be something you had to believe or disbelieve, but would be only something you would notice. The goal of practicing defusion is to become a little bit more flexible around the thought, and to have a little more distance from it.

Defusion exercises work well when we have:
Depressing thoughts;
Thoughts about low self-worth;
Ruminative thoughts (mentally replaying something that happened in the past); or
Worry thoughts (imagining something scary happening in the future).

  1. Thank the mind” for the thought, but don’t resist the thought or try to suppress it. Don’t struggle with it, interpret it, elaborate on it, or try to process it. The thought is seductive – it will appear that if you just think about it a little longer, you’ll have some clarity and then be able to let it go, but that rarely happens. Trust me.

  2. Redirect your focus to some meaningful activity. Physically move into a different room, listen to music, go for a walk, read a book, etc. Redirecting your focus isn’t the same as “thought suppression” (which never works). Instead, becoming absorbed in something new is a form of mindfulness where you are paying attention to something real in the present moment, and in a non-judgmental way.

  3. Become an Observer by saying, “I’m having the thought that ______,” and finish saying the thought that you were just having. Or, “I’m having the feeling that ________.” Becoming a witness of your thoughts creates some distance between you and your mind.

  4. Just name things: Say, “worry, there is worry.” Or, “that’s catastrophizing,” etc. (if you are familiar with the names of cognitive distortions). Don’t put an evaluative label on the thought as being good or bad. The reason for this is that we will always try to use escape or avoidance if we think something is “bad,” but this strategy doesn’t work when it comes to our internal experiences. All we can do is notice our experiences until they lose their power.

  5. Notice when you are judging. Instead of perceiving a thought or feeling as “good or bad,” use more descriptive words, like, “helpful or unhelpful,” “adaptive or maladaptive,” “encouraging or discouraging.” Get more specific. Try to see your private experiences just as they are, as information (perhaps even misinformation) – but don’t judge them as having positive or negative qualities (for the reason explained above).

  6. Come back to the present by saying, “Back to now,” or “It’s not happening right now.” The truth is, past and future imaginings really aren’t happening right now! Don’t think of this strategy as simply trying to make yourself feel better. Think of it as being actually true. Then, redirect your focus to the present moment.

Cognitive Defusion for OCD Thoughts.

If you have scary, intrusive thoughts, and they tend to recur with a predictable “theme,” you may be experiencing obsessive thoughts. Research has shown that we intuitively try to help ourselves by suppressing the thought, which requires switching to different thoughts in order to cancel it out.

However, this strategy backfires and creates a “rebound effect,” making the intrusive thought even more persistent. To avoid this rebound effect, eventually settle on just one of these techniques, and use it each and every time your obsessive thought occurs:

  1. Come up with a “replacement” image – something arbitrary and neutral, like a red Volkswagen, a pink balloon, whatever – and always replace your thought with that same image each time the thought occurs. Don’t switch around to different images, make the image always the same.

  2. Visualize the thought appearing in your inbox on the computer. Notice the subject line, read the message once, but don’t delete it – just let it hang out in your inbox as a “read” message. Here you are deliberately agreeing not to suppress the thought. Don’t even think about replying to it. See if you can tolerate it just sitting there. Make a decision not to delete it.

  3. See the thought appearing as a new message on your cell phone. Picture listening to the message once but not deleting it, allowing it to remain forever in your imaginary voicemail. Accept the discomfort around it. Just say, “Yep, it’s still there.” Don’t check it and make a decision to not delete it.

  4. Picture your thought, feeling or image as an unwelcome guest, something you would rather turn away if it actually appeared at your door. Open the door and let it in. Let it be unpleasant, noisy, or scary. Imagine “making room” or “creating space” for it by letting it sit next to you or take up space in the room. It sounds hard but it’s an effective strategy. Pretty soon it will stop trying to get your attention.

  5. Imagine you have a “willingness dial,” where you allow yourself to be 100% willing to be with the thought or image. Turn the imaginary dial up all the way to 100 while you also turn your “resistance dial” close to zero. Say, “I want this feeling.” Or, “I want this thought.” You can also say, “Bring it on,” or “I’m willing to be uncomfortable.” I believe that this technique works better than all the others, because it goes after the anxiety and turns it on its head.

Remember the saying, “What we resist persists.” Do the opposite of what your intuition wants you to do.

Mindfulness

Mindfulness is a separate practice you will do on purpose, with or without symptoms or triggers, to train your mind and body to become more balanced and peaceful. It’s good if you set aside quiet time to do this every day, but some people work on being mindful throughout many of their waking moments (for example, tuning into your senses while you are bathing, doing dishes, stroking your pet, taking a walk, putting gas in your car, or cooking a meal).

Mindfulness encourages you to have ongoing, non-judgmental awareness with internal and environmental events as they occur on a moment-by-moment basis. Remember that the present is moving, so you will try to stay present with each new moment as it emerges. Think of it like exercise: you aren’t expected to do it continuously, but you can make an effort to do it intentionally at various designated times. There are different mindfulness practices, but the one that will translate best into your everyday life is the ability to become an Observer and just make contact with each experience as it shows up, noticing things in a neutral, compassionate, or curious way.

Set aside time for mindfulness, and just watch each thought, physical sensation, or feeling as it comes into and out of awareness. Lower your expectations: it’s probably not going to feel glamorous, euphoric, totally quiet, or even like an “Aha!” experience. But it will feel better to simply have more distance from your thoughts. Just practice noticing your thought instead of analyzing it, getting lost in it, or pushing it away. If you do this over time, the thought will just come in and out of consciousness – it will just move on. But the mind is sneaky and will eventually take over again, so as soon as you notice you are suddenly lost in a thought, thank yourself for noticing this and come back to the Observer position. Simply start over again and don’t be discouraged. Remember, this is why they call it a “practice.” If you get lost a hundred times, just come back a hundred times.

If this seems too unstructured or vague, you might enjoy using some of these techniques to help you feel that you are “doing” something with your thoughts. By using visualization, you can gently interact with your thought, thereby giving your practice a little more structure. Although I’m giving you some different visualizations to choose from, settle on just one of these for the duration of your meditation session.

Mindfulness Exercises:

  • Imagine each thought appear as a drop that emerges and then disappears into a calm lake. Wait for the next thought to appear, and then watch it drop and disappear in the same way. Just notice.
  • Picture yourself sitting above a stream, place your thought on a lily pad, and watch it float gently by. When the next thought appears, do the same thing until it flows away from you and out of sight.
  • Imagine spray-painting your thought on the side of a car, and watching the car drive down the street until it disappears. When the next thought appears, do it again.
  • Imagine yourself driving a car and seeing your thoughts appear above you on billboards. Each time a thought appears on a billboard, imagine driving under or past it, leaving it far behind.
  • Imagine sitting in a field watching your thoughts float away on clouds. See this happening each time a thought appears until it eventually drifts away.
  • Imagine seeing your thought written in the sand before a wave washes over it and smooths it away. When the next thought appears, watch how it is erased in the same way.
  • Make up your own mindfulness exercise! But don’t switch around during an exercise – just keep to the one you choose for that day and keep practicing until you feel some distance from your thoughts.
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Missing Pedophile OCD: Don’t Let This Happen to You

Don’t let what happen to me? Did I read this right? Now that my title has grabbed your attention, I hope you will allow me to explain: By “you” I am referring to you, the therapist; by “this” I am referring to a potential misdiagnosis; and by “Pedophile OCD” I am referring to a form of Obsessive-Compulsive Disorder that is one of the worst types there is. With POCD, the person is worried that they might be a pedophile. But they aren’t.

This is perhaps your potential new client – someone who was finally brave enough to make it through your door and share their most unspeakable fear – that they might be a sexual predator of children. In actuality, this is a harmless human being who was beseeched by a “what if” thought that entered their mind at the most inopportune moment. Perhaps they heard the word “pedophile” in the news or watched an evil predator on TV. They might have had a random image of a child flash through their mind right when they were in the middle of making love. Or, at another ill-timed moment, they saw a photo of a child next to someone’s bed, or heard the voice of a child playing outside – right at the moment of orgasm.

In that split second, these paired associations partnered together “Pavlovian style” and did a hostile takeover on somebody’s brain. And now that person fears they are somebody evil. From that day forward, “What if I’m a pedophile?” is a thought that never stops running through their mind. Combining the scariest form of “Harm OCD” with the worst of “Sexual Orientation OCD,” POCD is a shameful, isolating experience. As they come to you for help, you are likely to ask your own set of questions: “Is this about sexual attraction? Is it Pedophilic Disorder? Is the client a danger to others?”

These are questions that previous therapists also had. Many of them took the clients’ words prima facie, leaving them feeling more worried and shameful. According to my clients, psychodynamic therapy came at great financial cost and over many long years, but exploratory work did nothing to ease their pain. Aversion therapy encouraged techniques like snapping their wrists or making themselves sick, an ineffective and demoralizing process. Old school CBT therapists, not current with the research on “thought suppression,” unsuccessfully recommended “thought-stopping.” Psychoanalytically trained therapists urged them to talk about repressed sexual urges, creating an inference of plausibility. Trauma-based therapists conveyed the possibility of a past molestation, an event that never occurred. Some therapists produced needless fear by mentioning that this might be “reportable.” Specialists in paraphilic (sexual) disorders often took the lead, leaving clients feeling even more deviant and defective than before.

“Well,” you might be thinking, “what if this OCD specialist is also looking through her narrow lens, and overlooked the fact that this really is a pedophile?” To answer this very valid question, Pedophilic Disorder can and should be ruled out, and if there is no desire to view child pornography, that is a very strong clue. There is also almost always some history of OCD in the person’s past, even if it used to be counting or checking, and often there is a family member who also suffers from OCD. But the real litmus test is how the client feels about their intrusive thoughts. If they’re breaking down in your office, and saying their thoughts are disturbing, it’s ego-dystonic. It’s their worst nightmare, not someone else’s.

None of us ever wants to confuse a diagnosis or offer the wrong treatment, but missing this diagnosis, when it applies, has the potential to forever desecrate a client’s life. This is a diagnosis we have to try never to get wrong. Imagine, for a moment, just how many other lives would be impacted if someone with POCD (or their therapist) never knew just what it was. These are clients who make false confessions, or isolate themselves for the purpose of “protecting” children. Imagine . . .

  • A woman ends a relationship with her dearest friend who opens a daycare center.
  • A nurturing mother no longer touches her baby.
  • A wedding is called off after the couple decides to share all of their innermost thoughts.
  • A gifted fifth grade teacher abruptly ends his career.
  • A loving husband and would-be father reneges on his promise to start a family.

In my article, Searching for Bad News: The Circuitous Path of Obsessive Thinking, I describe how people with obsessive types of OCD use a form of internal hypervigilance; checking their minds to see if certain thoughts have gone away, checking their body to see if they feel aroused when thinking about a child, or checking their character to see if they feel like a bad person inside. None of that is possible, by the way. As we learned from Daniel Wegner’s “White Bears” experiment, we have to conjure up a thought in order to reject it, and once that happens things get sticky from there. Clients who focus on their genitals don’t truly get an answer about whether they feel anything. Many males report feeling a vague uneasiness in their groin area, and because they feel “something,” they worry it is evidence of sexual arousal. Checking their character involves trying on different scenarios to investigate what their reactions “might” be, but in this dissociated game of speculation, they can’t really be sure. (Was that a surge of repulsion or excitement? It’s hard to tell).

Whether they feel something or they feel nothing, checking rituals become self-reinforcing. Behavioral compulsions, if there are any, might include checking the news to see if they were identified as a criminal, or checking children’s faces to see if they look frightened or uneasy in their presence. But children may wince or turn away for a variety of reasons, including the discomfort of being stared at. Sadly, POCD clients are likely to dismiss such reasonable explanations, making up their own “evidence” to vilify themselves.

When clients ask the question, “What if I’m a pedophile?” I tell them they’re not asking the right question. The question they should be asking is, “Do I have OCD?” Rather than researching the characteristics of predators on-line and running a side-by-side comparison (an ill-advised “checking” compulsion), we look at the diagnostic criteria of OCD.

If the first goal of therapy is psychoeducation, another important aim is to convey the futility of checking. When I hear clients insist on “knowing” who or what they are, I do various experiential exercises to demonstrate that “some things are impossible to check.” These clients are not just pondering, “What if I’m a child molester?” they are really wondering, “What if I’m a child molester and I don’t know about it?”

This subtle distinction is actually a blatant diagnostic clue. It might be real even though I don’t know about it” is a nothingness, a void, an empty space that cannot be examined because nothing is there. Even though it is an amorphous idea that cannot be explored, OCD clients are determined to unravel this type of paradox. To them, a lack of verification seems like a guilty “yes” when it is really a sincere “no.” Different images, different thoughts, different situations, different states of arousal – all need to be investigated and exhausted until the “there is nothing” answer remains. As one client explained, “You want to be 100% certain that something isn’t true. So you search really, really hard to make certain. But in the process, you get so attached to the idea that you start to believe it.”

Exposure-based treatment in CBT isn’t about watching child pornography or encouraging inappropriate interactions with children. Rather, the work is to achieve habituation. Clients may be encouraged to write or say triggering words, look at their niece or nephew’s picture, listen to children’s voices, or show up at events where children are present. Moving up the “hierarchical scale,” we work with an imaginal exposure that the client writes, records, and listens to in their own voice. The script contains their worst scenario: being accused and convicted of child molestation, devastating their loved ones who ultimately disown them, losing their sense of who they once were, and watching their lives come crashing down. Having no more threats left in its arsenal, OCD relents. Treatment is surprisingly quick (weeks to months), and, when introduced in the right way, remarkably effective.

So, now that you recognize this disorder:

  • A friendship endures through a lifetime of seminal moments.
  • A child sleeps in her mother’s arms.
  • A couple’s wedding vows express wholehearted trust.
  • A teacher touches the lives of two generations of children.
  • A husband strokes his pregnant wife’s belly.

All because you didn’t miss Pedophile OCD.

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Treating Insomnia with Cognitive-Behavioral Therapy and Relaxation Techniques

Insomnia and other chronic sleep disorders affect more than 40 million people in this country, and studies have shown that anxiety and stress play a significant part in this problematic condition. Quality of life, general health, and performance at work or other areas of life are frequently impacted, and the effects of chronic sleep deprivation can be debilitating. Newer research indicates that there is a vicious cycle between anxiety and insomnia – while anxiety can certainly interfere with sleep, sleep deprivation can also lead to an anxiety disorder.

Anxiety and stress are often the principal causes of insomnia, due to the secretion and elevated levels of stress hormones. Cortisol and its precursor, adrenocorticotropic hormone (ACTH), are the typical culprits involved in sleep disturbance. While increases in cortisol can be adaptive in helping the individual to deal with short-term stress, the oversecretion of cortisol that accompanies chronic stress will keep the individual from achieving a restful sleep. What does all of this mean? It means that managing your stress levels during the day will help you to sleep much better at night.

The Anxiety Disorders Association of America (ADAA) along with numerous reputable organizations list cognitive-behavioral therapy as a first line of treatment for people with insomnia. What’s more, this treatment is safe and effective. Unlike hypnotics, benzodiazepines, and other sleep medications, cognitive-behavioral therapy is completely natural and helps you overcome the underlying causes of insomnia. By addressing the thoughts and behaviors that can interfere with sleep and by helping you to develop better sleep habits, the benefits of CBT can be long lasting – and there are no side effects. To find a CBT therapist in your area, you can go to the Anxiety Disorders Association of America (ADAA) website, and use their provider locator feature. www.adaa.org

Helpful Tips.

1) Get some cardio exercise daily, and really wear yourself out (in a good way). Refrain from exercising 2-3 hours before bed. Don’t drink alcohol or eat sugar at night, because your blood sugar will spike and then drop during the night and wake you up. If you have to indulge, try to eat some protein at night to keep your blood sugar from dropping too much. Don’t drink too much liquid in the evening to avoid using the bathroom. Turn everything off, especially electronic screens and LED lights – they can interfere with melatonin levels and circadian rhythms.

2) Practice “sleep hygiene.” Only use your bed for sleeping, sex or relaxation so that your mind knows what your bed is for and doesn’t make any negative associations with going to bed. If you are lying in bed unable to sleep, get out of bed and don’t go back until you reclaim your bed for relaxation only. Don’t study in bed. Keep waking hours the same even if you’re tired, so that your sleep cycle doesn’t get off-track.

3) Keep a pad of paper next to your bed. If you have a particular worry, or if something simply pops into your head that you don’t want to forget, write it down before you go tosleep. Include the time tomorrow that you intend to either succumb to the worry or takecare of something concrete. While suppressing a thought never works (trying to silence your thoughts can backfire and make them even stronger), delaying a thought until later actually does work. Worrying on purpose during the day for a discrete period of time can also be an effective strategy, sometimes creating the paradoxical effect of making it difficult to worry. To clarify, planning to worry at a brief, designated time is totally different than “worrying all the time,” or letting your worry sneak up on you! But, you must actually make good on your promise, and attend to the worry or the task the very next day at the time you “promised” to do it.

4) Get yourself medically checked out for sleep apnea or other breathing obstructions. You might be waking yourself up to breathe, so it’s worth ruling this out, just to make sure. Don’t sleep on your back in case your own snoring wakes you up. If your partner is the one who snores, elicit their help in treating their snoring issue or sleeping arrangements.

5) This one’s important: be willing to be awake or asleep. If you refuse to be awake, you will be! Never give yourself imperatives or ultimatums – we always lose those types of power struggles with ourselves. With that said, it is okay to self-soothe, practice healthy behaviors, learn some new tools, comfort yourself, and improve your parasympathetic nervous system – but try to approach these things in a gentle, more flexible way.

6) Relaxation techniques are especially important in lowering stress levels throughout the day and improving your sleep at night.

First, slow and deep, diaphragmatic breathing (breathing through your nose, making your stomach, versus your chest, rise and fall), will produce a state of physical well being that tells your mind it is ok to relax.

Second, mindfulness can be practiced at any time, and any place, by simply directing your non-judgmental awareness to whatever is happening in the present moment. Or, you can become intently absorbed in following (or counting) your breath. Mindfulness meditation practices improve the relaxation response (parasympathetic nervous system) that lowers stress hormones and results in less reactivity to stress and pain. The best part is that the benefits carry over to your waking life, allowing you to witness your mind from a distance rather than becoming tangled up in your own thoughts.

Because the ADAA specifically lists meditation and music as two important relaxation techniques for reducing anxiety and stress, I have created some beautiful, relaxation music especially for you! I have also provided a very restful and calming spoken word“relaxation recording” that you can listen to at any time for relaxation and/or sleep. These free gifts can be downloaded and played at your convenience from my website in the section entitled, “Relaxation Room.” I recommend listening to music at night with the proper headphones on, so purchase headphones such as these that will feel as comfortable and smooth as your own pillow: www.sleepphones.com

Sleep well,

Heather Stone, Ph.D.

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OCD Distortions (And Who Says They’re Wrong)

Authorship Confusion.
Daniel M. Wegner uses the phrase “authorship confusion” to describe how people mistakenly assume responsibility for causing an event, simply because the thought preceded the occurrence.

Believed-In Imaginings.
Theodore Sarbin offers the phrase “believed-in imaginings” to suggest that people affirm the existence of improbable things. A hypothetical perspective, such as a “what if” thought, morphs into an “it is” thought – creating the feeling that an imagined scenario actually exists. The person considers something as if it were true, and pretty soon it appears to be true. When this happens, the belief and the phenomenon cannot easily be differentiated.

Causal Mistakes and Reasoning Errors.
Jean Piaget states that from a very young age, people develop mistaken beliefs about causal relationships between the mind and the physical world. Examples might include certain rituals such as counting, checking or repeating – compulsions that are intended to bring about something good or prevent something bad. The mind errs by taking unrelated events and connecting them, creating the feeling that there is a meaningful relationship between the two. Suddenly, meaningless things take on unique significance.

Cognitive Fusion.
Steven C. Hayes explains that we believe our thoughts to be literally true when perhaps they are not, and this happens because ideas arise convincingly inside our heads in the form of language. In this way, thoughts become convincing and we become “fused” with our thinking. The assertion, “I’m right and I can give you the reasons” is a strong indicator of cognitive fusion. Matthew McKay and Patrick Fanning agree: “There is no one so sure as someone totally deluded.”

Cognitive Motivation to Reduce Uncertainty.
Leonard Zusne and Warren Jones describe that we all have a cognitive motivation to secure explanations, however faulty. This drive to remove uncertainty is so powerful that the mind will prefer to fill the gap with incorrect information (even with catastrophic explanations) rather than tolerating the unknown. Jeffrey S. Victor explains that even disturbing beliefs receive credibility: “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.”

Congruence is Preferred Over Truth.
Zusne and Jones also describe how people want to believe something simply because it matches up with how they feel. Illness, fatigue, chronic pain, menapause, and PMS are good examples of this, where events or interactions become exaggerated or misinterpreted. The best example of this is a panic attack, where people explain the “spike” in their nervous system as evidence that they are dying, going crazy, or losing control. However, just because the thought feels congruent with our physical or emotional state, it doesn’t make it true.

Magical Thinking.
Sigmund Freud, Margaret Mahler, and Ernest Becker have discussed magical thinking as a “primitive” (early) defense mechanism that was originally designed to protect us from feeling helpless. Magical thinking is a universal condition that continues throughout everyone’s lifetime, often emerging in the face of “existential anxieties” surrounding separation, death or uncertainty. But in other moments where we feel a loss of control (like when chance, hope, luck, fear, or danger are present), magical thinking will show up as well. Magical thinking is the belief that thoughts and reality are connected and that thinking can influence the actual world. Omnipotence (the belief that we caused something by thinking about it) is one form of magical thinking, and so are superstitions. In fact, most of the distortions in this handout are, to some extent, a form of magical thinking. From a behavioral perspective, magical thinking exists largely to control the uncontrollable.

Negativity Bias.
Human beings have evolved to become very anxious, but this trait helped our ancestors more than it helps us. Aaron T. Beck explains that in earlier times when our physical survival was at stake, we could not afford to miss any danger signals. “It is better to have ‘false positives’ (false alarms) than ‘false negatives’ (which miss the danger) in an ambiguous situation. One false negative – and you are eliminated from the gene pool.” This is why it is said that “evolution favors anxious genes”: Our hypervigilant ancestors passed their genes on to us, and now we suffer from “negativity bias” – a propensity to focus on negative events or even perceived threats to the exclusion of neutral or positive things.

Overvalued Ideation.
This phrase means that the person “importantizes” or “overvalues” certain ideas, making random, fleeting thoughts more meaningful or threatening than they actually are. For example, having a disease or illness can seem plausible simply because it was on tv, mentioned in a conversation, or encountered in some other innocuous context. The International Obsessive-Compulsive Foundation describes this phenomenon as “when the person with OCD has great difficulty understanding that his/her worry is senseless.” Jonathan Grayson similarly says it is “the belief that the concerns underlying the symptoms are entirely realistic.”

Thought-Action Fusion.
Stanley Rachman describes a tendency to confuse thinking about an action with the action itself. For example, we all have senseless, random thoughts, such as, “What if I just drove into oncoming traffic right now?” or “What if I stood up and shouted an obscenity in the middle of church?” As often seen with OCD, these transient thoughts make some people concerned that they might actually do those things. However, actions require execution and volition; thinking the thought isn’t the same as actually doing it.

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