Who Says I’m Wrong?

Cognitive-behavioral therapists typically present a list of “cognitive distortions” that describe the common errors we make at the level of our thoughts. (You are likely to find a list of those distortions in virtually every CBT workbook, and even in the Articles section of my website). However, there is another process of faulty reasoning that has to do with forming incorrect beliefs, and at this deeper level, our judgment can get even further off track. Why does the mind generate such causal mistakes, or fill in missing data with false information? The following list cites some credible sources that explain how and why we tend to produce (and even defend) a faulty belief system. Look closely to see if you can identify any famous persons mentioned here, and consider whether you too might share the same vulnerability to human error.

Authorship Confusion.

Daniel Wegner creates the phrase “authorship confusion” to describe how people mistakenly assume responsibility for causing an event, simply because the thought preceded the occurrence.1

‘As If’ and ‘What If’ Thoughts Lead to Believed-In Imaginings.

Theodore Sarbin offers the phrase “believed-in imaginings” to describe the storied constructions people use to verify the existence of improbable events. A strong level of commitment to one’s story leads to a sense of realistic perception, causing the believer to move from an “as if” perspective to a conviction of actual reality. The person considers something as if it were true, and pretty soon, it becomes true. When this happens, the belief and the phenomenon cannot easily be differentiated.2

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 include thinking that actions, gestures or mental operations such as counting can bring about a desired event or stave off something bad, or that there is a meaningful relationship between random occurrences.3 Numerous other authors agree that the mind makes certain mistakes by allowing individuals to connect unrelated events while giving them unique significance.4

Cognitive Fusion.

Steven C. Hayes explains that we believe our thoughts to be literally true when perhaps they are not. Most of us have a propensity to look “from” our thoughts instead of “at” our thoughts, since ideas arise convincingly inside our heads in the form of language. Additionally, certain notions are defended and maintained because they exist in networks – or “relational frames” – with other thoughts. In this way, ideas become entrenched and we become “fused” with our thinking. “I’m right and I can give you the reasons” is a strong indicator of cognitive fusion.5

Cognitive Motivation to Reduce Uncertainty.

Leonard Zusne and Warren Jones illustrate that, “A ‘why’ question requires a ‘because’ answer. If the information is not available, incorrect information will be used.”6 The authors describe that we all have a cognitive motivation to secure explanations, however faulty. Other researchers agree that when individuals are faced with conditions of incomplete knowledge, they are compelled to construct beliefs in order to fill the gap of ambiguity and the unknown. This cognitive motivation to remove uncertainty is so powerful that the mind will prefer to fill the gap with incorrect information rather than to maintain a condition of uncertainty.7

Congruence is Preferred Over Truth.

Zusne and Jones also describe how we want to believe something simply because it matches up with how we feel. Our conclusions are geared toward seeking an internal state of congruence and consistency, and in this way we can replace the disturbing psychological condition of uncertainty or imbalance.8

Difficulty Tolerating Uncertainty.

Jeffrey S. Victor explains why even disturbing beliefs receive credibility, writing, “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.”9 Donald Spence agrees that because people do not easily tolerate uncertainty, they create irrational accounts when plausible explanations are unavailable.10 In an attempt to make life meaningful and for it to make sense, people assemble beliefs from a number of sources in order to stitch together personal unknowns. Steven Jay Lynn, et. al. concur that for this reason, individuals are vulnerable to a condition of overconfidence that is susceptible to the mind’s many flaws and imperfections.11

Evolution Favors Anxious Genes.

Aaron T. Beck explains that “our tendency to exaggerate the importance of certain situations – believing them to be a matter of life and death – overmobilizes our apparatus for dealing with threats and thus overrides normal functioning. It has been said that ‘evolution favors anxious genes.’ 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. Thus, the cost of survival of the lineage may be a lifetime of discomfort.”12

Magical Thinking.

Numerous famous writers including Sigmund Freud, Margaret Mahler, and Ernest Becker have discussed magical thinking as a primitive defense that is often used to relieve certain anxieties tied to the existential pain of separation, self-esteem, limitation, longing, loss, chance, death, and uncertainty. Magical thinking is described as the belief that thoughts and reality are connected and that thinking can influence the actual world. This is a universal condition that begins in infancy and continues to a large extent throughout everyone’s lifetime. Omnipotence (the belief that we caused something by thinking about it) is one form of magical thinking. Superstitious thinking is also similar to magical thinking.13

Heather Stone explains that magical thinking often emerges as an attempt to bypass ambiguity and the necessary psychological work of authentic suffering and existential awareness.14 Other authors clarify that under such conditions of uncertainty, lack of information, or an inability to explain phenomena, magical thinking will predominate. Magical thinking especially emerges when elements of chance, accident, hope, fear, and danger are conspicuous.15 Other forms of suffering that provoke magical thinking are seen at such times when profound longings emerge that accompany a perceived lack of control.16 From a behavioral perspective, magical thinking exists largely to control the uncontrollable.17

Overvalued Ideation.

The International Obsessive-Compulsive Foundation describes this phenomenon as “when the person with OCD has great difficulty understanding that his/her worry is senseless.”18 Jonathan Grayson similarly says it is “the belief that the concerns underlying the symptoms are entirely realistic.”19 Steven Phillipson states that from this perspective, “the patient is not fully aware in a logical way that the threat is of an irrational nature. 20

Reinforcement.

Famous behaviorists such as Ivan Pavlov, Edward Thorndike, and B.F. Skinner all produced well-known studies on superstitious behavior, demonstrating that when reinforcement and behavior are accidentally or intermittently paired, people learn that certain meaning exists, and that meaning has lasting power over them, even if it’s wrong.21

Susceptibility to Coincidence.

Stuart Vyse writes that our personal beliefs end up being formed by observing coincidences, and that this human sensitivity to coincidence is an “overlooked psychological truth and a monumental understatement.” 22 Raeann Dumont concurs, “Our personal belief system has been constructed by observing coincidences. . . . All of us, in every stage of life, have a limited reality.”23

Thought-Action Fusion.

Stanley Rachman describes “thought-action fusion” as a tendency to confuse thinking about an action with the action itself.24

Notes

1 Daniel M. Wegner and Thalia Wheatley, “Apparent Mental Causation: Sources of the Experience of Will,” American Psychologist 54, no. 7 (July 1999): 480-492.

2 Theodore R, Sarbin, “Believed-In Imaginings: A Narrative Approach,” in Believed-In Imaginings: The Narrative Construction of Reality, ed. Joseph de Rivera and Theodore R. Sarbin (Washington, D.C.: American Psychological Association, 1998), 19.

3 Jean Piaget, The Child’s Conception of the World (London: Routledge & Kegan Paul, 1929), 139-147.

4 Donald P. Spence, “The Mythic Properties of Popular Explanations,” in Believed-In Imaginings, 217-228; Jeffrey S. Victor, “Social Construction of Satanic Ritual Abuse and the Creation of False Memories,” in Believed-In Imaginings, 209; Leonard Zusne and Warren H. Jones, Anomalistic Psychology, A Study of Magical Thinking (Hillsdale: Lawrence Erlbaum Associates, 1989), 13 and 14.

5 Steven C. Hayes, Get Out of Your Mind and Into Your Life (Oakland: New Harbinger Publications, Inc., 2005), 57; “Real Tools for Real Change,” in Quick Tips for Therapists, www.newharbinger.com; Jason B Luoma, Steven C Hayes, “Cognitive Defusion,” in Empirically Supported Techniques of Cognitive Behavior Therapy: a Step by Step Guide for Clinicians, ed. W. T. O’Donohue, J.E. Fisher, and Steven C. Hayes (New York: Wiley, in press), 5.

6 Zusne and Jones, Anomalistic Psychology, 13, 14.

7 Piaget, The Essential Piaget, 146; Zusne and Jones, Anomalistic Psychology, 13 and 14; Steven Jay Lynn, et al., “Rendering the Implausible Plausible: Narrative Construction, Suggestion, and Memory,” in Believed-In Imaginings, 133.

8 Zusne and Jones, Anomalistic Psychology, 229-243.

9 Victor, “Creation of False Memories,” 209.

10 Spence, “The Mythic Properties of Popular Explanations,” 217-228.

11 Lynn, et al., “Rendering the Implausible Plausible,” 133.

12 Aaron T. Beck and Gary Emery, Anxiety Disorders and Phobias: A Cognitive Perspective (New York: Basic Books, 1985), 4.

13 Ernest Becker, The Denial of Death (New York: The Free Press, 1973), 155, 180 and 181; Mel. D. Faber, New Age Thinking, A Psychoanalytic Critique (Canada: University of Ottawa Press, 1996), 27; Robert W. Firestone, The Fantasy Bond (Los Angeles: The Glendon Association, 1985), 182 and 183; Sigmund Freud, An Autobiographical Study, in The Standard Edition of the Complete Psychological Works of Sigmund Freud, vol. 1, ed. and trans. James Strachey (London: Hogarth Press, 1959), 66; Giora Keinan, “Effects of Stress and Tolerance of Ambiguity on Magical Thinking,” Journal of Personality and Social Psychology 67, no. 1 (July 1994): 48-55; Margaret Mahler, et al., The Psychological Birth of the Human Infant (New York: Basic Books, 1975), 44; Jean Piaget, The Child’s Conception of the World, 139-147; Géza Róheim, Magic and Schizophrenia (New York: International Universities Press, 1955), 10, 11, 45 and 46; Stuart A. Vyse, Believing in Magic: The Psychology of Superstition (New York: Oxford University Press, 1977), 196-211; Zusne and Jones, Anomalistic Psychology, 13-32, 229-259.

14 Heather Stone, The Therapeutic Value of Magical Thinking: Exploring the Gap Between Longing and Fulfillment, Doctoral Dissertation (Petaluma: Meridian University, 2005), 8, 10, 13, 20, 21, 113, 142, 179-181, 192.

15 Vyse, Believing in Magic, 11.

16 Mahler, et al., The Psychological Birth, 44; D.W. Winnicott, “Transitional Objects and Transitional Phenomena: A Study of The First Not Me Possession,” The International Journal of Psycho-Analysis XXXIV (1953): 94; Jacqueline D. Wolley, “Thinking about Fantasy: Are Children Fundamentally Different Thinkers and Believers from Adults?” Child Development 68, no. 6 (December 1997): 998; Vyse, Believing in Magic, 11.

17 Vyse, Believing in Magic, 81.

18 International OCD Foundation, www.ocfoundation.org, Glossary of Terms.

19 Jonathan Grayson, Freedom from Obsessive-Compulsive Disorder: A Personalized Recovery Program for Living With Uncertainty (New York: The Berkeley Publishing Group, 2003), 236.

20 Steven Phillipson, “God Forbid,” www.ocdonline.com.

21 Edward L. Thorndike, A History of Psychology in Autobiography 3, ed. Carl Murchison (Worcester, MA: Clark University, 1936), 263-270; Ivan P. Pavlov, Conditioned Reflexes: An Investigation of the Physiological Activity of the Cerebral Cortex, trans. G.V. Anrep (Oxford, England: Dover Publications, 1960), 291; Pavlov, “Lecture I,” in Shipley Thorne, ed. Classics in Psychology (New York: Philosophical Library, 1961), 789; Burrhus Frederic Skinner, “‘Superstition’ in the Pigeon,” Journal of Experimental Psychology 38 (1948): 168-172.

22 Vyse, Believing in Magic, 60.

23 Raeann Dumont, The Sky is Falling (New York: W.W. Norton & Company, 1996), 43.

24 Stanley Rachman, “Obsessions, Responsibility, and Guilt,” Behaviour Research and Therapy 31, no. 2 (February 1993): 149-54; Rachman, “A Cognitive Theory of Obsessions,” Behaviour Research and Therapy 35, no. 9 (September 1997): 793-802.



Posted in Articles | Comments Off on Who Says I’m Wrong?

Treating Panic Disorder

TREATING PANIC DISORDER:  A COUNTER-INTUITIVE APPROACH.

If you suffer from “anxiety sensitivity,” you may be interpreting certain arousal states in your body to be threatening when in fact they are not. This has to do with a common cognitive distortion of giving too much importance and negative value to one’s fleeting or transient internal experiences. I call this “overvaluing sensations.”

People with anxiety sensitivity sometimes develop Panic Disorder, which may be described as a “fear of fear.” It is the presence of recurrent, unexpected panic attacks followed by at least one month of persistent concern over having another panic attack. A panic attack is a discrete period (20-30 minutes, maximum) in which there is a sudden onset of intense apprehension, fearfulness, or terror, often associated with feelings of impending doom. During these attacks, the following symptoms may be present: shortness of breath, heart palpitations, chest pain or pressure, choking or smothering sensations, feelings of unreality, or fear of dying, going crazy or losing control. In other words, an alarm is going off but it is really a false alarm, because the body is fine.

Sometimes the brain “misfires” and produces erroneous messages, and sometimes the body does the same kind of thing – it produces symptoms of panic (heightened physiological arousal) out of the blue. How terrible it is for a person who is already so sensitive to have this level of arousal! And it isn’t felt as “good news” to hear that there’s nothing “wrong,” because this level of suffering is really extreme.

As would be expected, people with Panic Disorder eventually tend to regard even “small” internal experiences, including the shifts that occur inside the body, with far too much significance. Feeling light-headed, or having your heart rate speed up, happens to all people pretty regularly, but to a person with anxiety sensitivity, these things are felt to be dangerous. “Overvaluing sensations” takes place when you feel a shift occurring inside your body and you go, “Oh my God! What was that!!?” That thought creates even more arousal, and it is the thought that triggers the panic. Efforts to control it won’t make it go away, and in fact, becoming “hyper-vigilant” (scanning your body for danger signs) will probably make you more likely to authenticate those sensations and set off another panic attack. Note: I always encourage people to get a full physical examination if there are any medical questions or concerns. However, once all medical causes of symptoms have been ruled out, it is time to take a different approach.

I recommend doing these two things simultaneously: give yourself a lot of sympathy and compassion for the fact that you are suffering, because your suffering is very real. But at the same time, acknowledge that your interpretations of your suffering may be distorted, and have a healthy skepticism of the catastrophic messages your mind is offering.

It Feels Real, So it Must be Real.”

Here is a really important question that I want you to consider: Why is it that people who have panic attacks almost always think that they are dying, going crazy, or losing control? The answer is because the mind is set up to seek congruence – in other words, it is not satisfied unless everything feels like it matches up. Unfortunately, however, the explanations that the mind produces are often a) wrong and b) devastating to think about.

Disturbing events beg for credibility, so the mind starts offering assumptions to “help” make sense out ambiguous situations. Because we think that the interpretation should fit the circumstance, and because the circumstance is pretty extreme (e.g., chest pains, racing heart, or sweating), we think we ought to have a really extreme explanation to go along with it. The important message I’m suggesting here is that the mind would actually prefer to give you the really bad news that you are dying rather give you the unclear message: “I haven’t got a clue. It’s just a feeling, nothing more, nothing less. Just move on with no really good explanation, other than something just misfired, or that you’re probably having a panic attack.” And that is precisely what you should be saying, because that is the real explanation. I like this quote from Jeffrey S. Victor:, “A mistaken explanation for emotional pain can be preferable for a confused person to the ambiguity of uncertainty.” This is huge. Please think about this, because it will help you give less credibility to the false messages your mind is offering when you are beginning to panic.

I have often noticed that normal experiences like excitement, or anything that creates an increased state of arousal, can feel threatening to people with anxiety sensitivity. Ask yourself whether you might sometimes be confusing things like anger, anticipation or excitement with anxiety. These heightened emotions can get misinterpreted as anxiety as soon as we put a negative label (judgment) on them, but if you think in terms of “arousal,” you will eventually come to realize that it’s really just neutral (neither good nor bad). I recommend re-labeling many of your heightened internal states as arousal whenever possible, because this interpretation does not carry such an emotional “charge.”

Control is Not the Answer. (Do the Opposite).

Everything about treating anxiety disorders tends to be “counter-intuitive.” It always feels like the opposite of what the person has already tried to do (e.g., avoid, escape, distraction, or control). First and foremost, stop struggling. Probably the best thing for you to do would be to move your body, since it’s already geared up to be in a “fight-or-flight” mode. Go outside and go for a brisk walk. Often people will tell me they tried to deal with a panic by suppressing anxious thoughts, or by lying down. When I ask if that worked, people usually say “no.”

I always know when someone is recovering from Panic Disorder when they say, “I had a panic attack last week, but it wasn’t that bad, it didn’t last that long, and it didn’t really scare me. And then I just went about my day.” Another client really impressed me when I noticed that she stopped insisting that her experiences play out in any particular way. While she used to say, “I can’t do ____________, I might have a panic attack,” she began to say, “I guess I’ll just have to wait and see.” And she actually smiled.

Remember, that a person is only diagnosed with Panic Disorder when they are afraid of having another panic attack. In other words, a person could have one panic attack in their lifetime, and maybe it even happened ten years ago, but if they are living their life in fear of having another one, they qualify for the diagnosis of Panic Disorder. Conversely, when a person has frequent panic attacks but is not afraid of them, they do not have the disorder. With that in mind, recovery is all about the willingness to be uncomfortable. People with anxiety often ask the question, “What is the worst thing that could happen?” But they rarely answer it in this way: “I will be really, really uncomfortable. (But I would be ok).”

One of the things that breaks my heart about people suffering from Panic Disorder is that they are afraid to do the very things that would make them feel better. Since the body has been determined to be their “danger zone,” even getting the person to breathe correctly is an area of resistance. Sadly, the same is true for exercise, which would do wonders for their panic as well as their health, and likewise they might also benefit from taking prescription medication.

Resistance to Medications.

The issue of taking prescription medications comes up often with people suffering from Panic Disorder. Most of these clients tell me that, “I can’t tolerate medication – I’m too sensitive.” Ironically, the same person may feel fine about drinking alcohol to deal with their anxiety, or taking “as needed” anxiolytics that may be actually more “harmful” (e.g., habit-forming). Similarly, many people suffering from panic are much happier taking over-the-counter medications and/or “supplements” that they can “prescribe” for themselves. While there are certainly a few people who generally cannot tolerate certain prescription medications, I have two psychological explanations for this type of treatment-resistance.

One possible explanation for medication refusal is that the psychotropic medications commonly prescribed for Panic Disorder (the “newer” anti-depressants or “SSRI’s”) have the less alluring, unglamorous distinction of having to be taken regularly on a daily basis. And this, believe it or not, is considered by some anxious people to be inherently less attractive. Some anxious people have a tendency to want to control everything about their bodies, including what, where, and when they want to take something. Thus, being medication-compliant, doing something on a regular schedule, and taking “orders” from their doctor – would all be considered completely out of the question!

Another likely reason why people with Panic Disorder often resist taking the appropriate medication has to do with the earlier problem of overvaluing sensations. While it is often the case that many people who begin taking an SSRI feel some temporary or mild side effect(s) before experiencing any therapeutic benefit, anxious people refuse to experience this possibility. Even though this is usually explained to patients at the time the prescription is given, these patients will say they can’t “tolerate” the side effect – and bail out too soon. I am often disheartened when I see that the person was probably one or two weeks away from feeling better, but they discontinued the medication due to their fear. While another person might regard the side effects as transitory and/or pretty tolerable, the person with anxiety sensitivity will go, “Oh my God! I felt something weird” – and abruptly discontinue their medication.

Another phenomenon that I see happening all too frequently has to do with the person’s insistence that the drug caused them to become “more anxious” and actually increased their symptoms. While I believe this to be probably true, I often attribute this exacerbation of symptoms to the person’s “hypervigilance” after taking the medication. They begin to have anticipatory anxiety about what the drug might do to them, and as explained before, it is their expectation of danger (the thoughts, not the medication) that likely triggered the panic. But don’t forget that often SSRI’s do cause an increase in anxiety early on.

You Can’t “Refuse” to Feel.

My experience of working with clients suffering from anxiety sensitivity is that they pretty much refuse to ever feel uncomfortable, which is really a mistake. Most of us would never go to the doctor and say, “I refuse to have another headache.” We just don’t make those kinds of ultimatums. The doctor might say, “I can give you some medicine so you can get rid of the headaches sooner, and maybe have them less often,” and the patient would be generally satisfied. But as I suggested before, people with anxiety disorders can sometimes be a little controlling. (I say this to you very gently). This controlling approach doesn’t work, because “what we resist persists.” In a way, it is like telling your body what it should be doing, but your body has its own autonomy and the ability to undermine your control. It does not ask your permission in order to function.

Taking a Counter-Intuitive Approach (Willingness).

What is required, then, is to become more flexible. Allow the sensations to just move through you. Be willing to be with whatever is happening. Learn to make friends with your body, and stop bossing it around, because you will lose. If you allow your body to have its fluctuations, it will be nicer to you. Don’t fight it. Acknowledge that your attitude towards your internal responses is extreme, and just try to “float” with the experience. Watch your thoughts and your physical sensations come and go, and stop struggling with your experiences. Learn to say, “It’s just a thought.” Or, “It’s just a feeling.” Practice feeling neutral, and become an observer, not a director, of your own internal states.

You live in a world of mystery and uncertainty, and this includes your body as well. Remember that everything I am suggesting is counter-intuitive.

  • Learn to control things a little bit less, and you will be more in control.
  • Allow yourself to have symptoms, and they will be more likely to leave you alone.
  • Stop clinging to explanations, and things will start to make sense.
  • Practice detachment, and the world, your body, and your mind will feel more welcoming.
  • Acknowledge that there is a certain knowledge or truth that exists within uncertainty.
  • Notice, with compassionate awareness, the lack of fit between your desires and the real experiences you end up with, and you will begin to live more comfortably inside your own skin.
Posted in Articles | Tagged , , , , , , , , , , , , | Comments Off on Treating Panic Disorder

Suggestions for Supporting the Anxious Person

Dear Supportive Person,

The following are some suggestions that may benefit both you and the anxious person during difficult times.

Check in with your own feelings first, and notice your own responses as you begin to compose and comfort yourself. You will be very helpful just by modeling composure, compassion, and neutrality as you address the anxious person. The client is learning to address his/her symptoms as an objective observer, and it would be helpful if you adopt this attitude of neutrality as well. Speak in a loving but matter-of-fact manner. Let the anxious person look to the self for comfort, and walk their own path.

Briefly share your warmth and sincere concern, but do not be led by the momentum of the person’s anxieties. Resist the urge to rescue or offer excessive reassurances. This often unwittingly reinforces the client’s helplessness, anxieties, or dependence. Instead, try practicing some of these questions or approaches.

=========================================

I can see that you feel scared and overwhelmed. How can you reassure yourself right now?

Remember to practice controlled breathing: it really works.

I can see that you’re very anxious about this, but I believe that you have the ability to cope with this situation.

Let’s review your list of cognitive distortions together. Which ones might you be doing?

What are some healthier or more positive ways of looking at this situation?

What does the wise part of you say about this? I have seen a strong and insightful part of you that that gets you through these difficult times. If you were helping a friend through this, what advice might you offer?

You may want to redirect your thoughts right now. Try going for a walk, journaling, listening to music, etc. (whatever makes you feel good). It’s time to take a break from your thoughts right now.

Posted in Articles | Tagged , , , , , , , , | Comments Off on Suggestions for Supporting the Anxious Person

Look — You Are Not Your Mind

“You are not your mind,” I tell my clients. “You aren’t.”

This statement is usually followed by a mixed look of skepticism and pity: “She’s a psychologist, and she doesn’t understand that everybody is their minds! She seems misinformed. Everybody knows that our minds are who we are.” I secretly love this look, because while people think I’m nuts for making this statement, I’m really, really sure about this.

So I continue: “The mind causes painful, unnecessary, and meaningless suffering. The mind is very tricky and should be regarded with a good deal of healthy suspicion. It often takes us off our path. Ok, if it’s working on a concrete problem – planning, organizing, learning – that’s fine. But mostly it isn’t doing that – it’s trying to control our internal experiences, which it cannot do. Much of the time it gives us false messages. It creates distortions, makes us nervous wrecks, and takes us out of the present moment. It shouldn’t always be trusted.”

Here comes the next look: a little more interested, though struggling to be patient. So I keep going: “I think we all secretly hate being slaves to our minds. The mind is sometimes like a bully that taunts us or drags us around like a ragdoll.” Suddenly, a look of recognition emerges, because many people are all too familiar with the feeling of being enslaved by their minds.

I then see the wheels turning as their minds start thinking: “Maybe I can ditch this thing, the mind. Maybe I can beat it into submission so it will finally leave me alone for good. Is there a way to do that? How can I make it stop? How can I make it totally quiet all of the time? How can I think myself out of it when I want to? How can I put myself in the desired state I want to be in? How can I control the thought? How can I suppress the thought?” And so on.

Here comes my look – and it’s a look of compassion, because I have to explain that really, you can’t out-think the mind. I answer, “If you use control, you’re using the mind to battle with the mind. What will happen is that you end up feeling like you are caught in a great big net. You’ll struggle and you’ll fight, and then you’ll lose. You can’t out-think your mind, because it’s still the mind.”

I then see a look of disappointment, and maybe even despair. But this look can be encouraging, because it is often an indication that there might be a willingness to try something new. I then explain, “It doesn’t work the way you think. You don’t get to have any control over the mind. The mind keeps producing stuff, like a running commentary. There is going to be constant noise. But there is a better way to approach the mind, even though I’m reluctant to say that this is the way to ‘control’ it. Here’s what I’m recommending:

“Become really, really good at watching your mind. The part that’s looking is You. Feel yourself looking. That’s the only way to get a break from your mind. In that moment, you will know that you are not your mind, because, quite frankly, something else is looking. The You that is not your mind is the part that is observing. Rather than being yanked around by your thoughts, you will begin feel more space. Notice that there is a gap in there, a small distance between You and your thoughts. You will soon be grateful for this.”

I have to add here that the meditation gurus sometimes don’t say enough about attitude. Attitude is key. So I would like to emphasize, “In order to do this well, you need to cultivate a certain approach to observing. You only have a few options, but you can choose which one to be in: You can be curious, skeptical (but not rejecting), attentive, watchful, discerning (but not judgmental), incredibly interested, engaged, willing, neutral, detached, or compassionate. But not much else. No labels of good or bad. No judging. No analyzing. No evaluating. No ranking, rating, or making things better or worse. If you’re not quite sure what gear to be in, shift into neutral. Just observe.”

Now I start to see the most genuine look, and it’s the look I was hoping for. “I want you to look at your mind sincerely, without an agenda. Just look at what is happening in the present moment. Be with what you see. And know that your thoughts can be accurate, they can be distorted, and they can be everything in-between. But all the while, know that You are here, and You are real.

Feeling Your Authentic Presence:

  • I would like to make introductions at this point, to help you make contact with the real You, the You that is not your mind.
  • Repeat your name silently, inside your head. Imagine filling up the room with your whole presence, as if you are entitled to take up the entire space you are in.
  • Know that you have a past, but you are not your past. You have a body, but you are not your body. You have symptoms, but you are not your symptoms. You have thoughts, but you are not your thoughts. You have a mind, but you are not your mind.
  • You are the presence that interacts with the world as it rushes towards you from the other direction.
  • You are the inner adult that was in the child when you were younger; and as a generous exchange, you are also the child who resides within your adult. Both parts are You – constant, ever-present, and aware.
  • Find yourself in the present moment. You are the one that has been moving through time, traveling inside the time capsule of your life, looking out from behind your face and perceiving, watching, noticing, and choosing. You were in the Now when you got here. And then you moved along with time. It was Now. And Now. And Now. And here You are, in the Now again. You are traveling in the Now. Now is fluid; it moves. And you’re moving with it, in every moment.
  • You are the one that feels moved in special moments. You are there when you find yourself absorbed in the middle of a project you are connected to. When things “call to you.” Or when things “speak to you.” You are present when you are touched, inspired, or drawn to things like music, art, food, nature, surroundings, or certain people. (And when you are bored, when you have adopted someone else’s truth, when you are trying to control, or when you are cut off from your body or your feelings, you will not recognize yourself).
  • You are the one who plays. If you need me to say more about this, you’re not playing!

Observe your reaction to all of this. (This is a good look.)

What Does All This Have to Do With Anxiety?

The mind causes suffering by doing two things: 1) it takes us into the future or the past, and 2) it judges things (even our own internal states), as being either good or bad. In contrast, by noticing instead of judging, and by staying present in the moment, you will be less anxious. Let go of your obsession with the future. Anxiety lives in the future, but You exist in the Now. Come back to the present moment, again and again. From this place, you can let go of the mind’s superstitious worry. When I say that we shouldn’t always trust the mind, it’s because the mind is giving you an illusion of false protection. The mind is tricking you into believing that worry will ward off the dreaded event. But the dreaded event doesn’t exist in the Now, and probably not even in the future. And worrying never protected anybody. Face it – nothing that we are anxious about ever ends up happening just as we imagined it. Yes, bad things happen, but not in the same way that we think they will. “So,” you ask, “what if something bad were to happen right now? Or sometime soon? Or later down the road? What then?”

You Will Be There:

“You will be there, to help yourself at every given moment. You are here Now, and You will be there, when the moment occurs – if it ever does. This is the most reassuring news you can imagine. You are the constant awareness that knows what to do. You are moving through time. You will have all the new information in that moment, to help you decide how to respond. The future may be unknown, but the constant is always You. You can be trusted.” And here I add: “I trust You. If there was an emergency right now, with the two of us in the room, I will trust the two of us to know just how to respond. Am I right to trust you?” And I always hear, “Yes, I can be trusted.”

This is a beautiful look. It’s soft, serious, and quiet. It’s much lighter, and very relieved. A few minutes ago, you felt scared and insecure, and yet I am saying to you here that You are the person I trust the most. Why am I trusting you? Because You are here, in this moment, and you recognize Yourself. That makes You very trustworthy.

So, please, just have a look. Just observe. Just look.

Posted in Articles | Tagged , , | Comments Off on Look — You Are Not Your Mind

Cognitive Restructuring

This process is recommended to help you restructure your thoughts and gain some healthy perspectives when you are feeling anxious. It is best to do this in the moment when you first notice any symptoms, but you can also use this practice after the situation has already passed.

  1. What triggered me?
  2. How did I respond?
    What did I feel?
    What did I do?
  3. What was the automatic thought?
    What did you say to yourself? The automatic thought can be the “caption” that describes your experience. For example, if you were looking at a cartoon of yourself, what would be written in the “bubble” over your head?
  4. What was the cognitive distortion that was connected to the thought? (See List Below)
  5. What was the underlying belief?
    This is the automatic thought taken to the next level or even to the extreme. See if you can exaggerate or expound on the automatic thought. Bring it to a general, overarching conclusion about the way life is for you.
  6. Compassion.
    Pause. Take a moment to give compassion to the part of you that has been suffering as a result of this belief. If you have trouble with this, think about how you would feel if you were gently addressing a small child who was hurt, someone you love, or your best friend. Then turn that kindness towards yourself.
  7. How can I dispute the belief?
    Think about the wise part of you. This is the objective, reasoning, insightful part that can offer some arguments against the negative belief. From this perspective, ask yourself:
    Is this really true?
    What are some other explanations?
    Are there other interpretations that are as true or truer?
    How might another person look at this?
    What are some healthier or more positive ways of looking at this situation?

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.
  • Intensified Focusing:
  • Overvaluing Thoughts: You ascribe credibility and meaning to senseless or random thoughts. (This often goes with Obsessive-Compulsive Disorder.)
  • Overvaluing Sensations: You misinterpret bodily sensations as being exaggerated, life threatening or dangerous. (This often goes with Panic Disorder.)
  • 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. (This often goes with Generalized Anxiety Disorder.)
  • Foreclosure: You focus on the possible ways that a situation might end, because it feels too hard to be in a state of uncertainty. (This often goes with Generalized Anxiety Disorder.)
  • Mind Reading: You guess what others are thinking, and refrain from checking to see whether your impressions are correct. (This is often goes with Social Anxiety Disorder.)
  • 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. (This often goes with Obsessive-Compulsive Disorder, or anger.)
  • Beck’s Negative Triad: You have a negative view of the self; negative view of the world; and negative view of the future. (This often goes with depression.)

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, except: “foreclosure.”

Posted in Articles | Tagged , , , , , , | Comments Off on Cognitive Restructuring

Anxiety and Co-Dependency

A Sign of Co-Dependence: Compulsive Giving.

Anxious people tend to be co-dependent, often possessing a great capacity for empathy, a strong sense of responsibility, and a longing to channel their acute sensitivity. Due to their sense of compassion, they often have poor boundaries and become easily overwhelmed. Many anxious people find themselves lost in others’ emotional pain, or consumed by the energies of the people around them. Because they are responsible and conscientious, anxious people can also become easily exhausted, or find themselves giving “too much.”

The following reflections are some thoughts I have had over the years regarding the fine line between love and co-dependence. These thoughts developed from my own awareness that good intentions and deeds can go awry, that good people can do damage with their giving, and that there is this vague, diffuse line between generosity and pathology.

Compulsive Giving: What Need Does it Serve?

First, looking at this from an addiction model, I realized that giving can be compulsive, automatic, and not very conscious. (This is quite different than authentic giving, which feels more like a choice that comes from the heart). The compulsive type of giving is like a reflex – a knee-jerk response that happens without awareness of the other’s needs, or our own motivation. And it often serves to avoid uncomfortable feelings.

As with any type of addiction, the compulsive behavior exists to satisfy a need, or to try to produce a certain feeling. I’ve heard some people say that when they give compulsively, they hope to become indispensable and that they will have a guaranty that the other person will never leave them. Some people feel that over-giving serves to conceal their deeply hidden flaws or inadequacies (which are not as repulsive as they believe them to be). Giving can therefore be like a smoke screen, keeping the person from being potentially revealed, hiding all of their poetic flaws and human qualities. Giving can also make people feel worthy, needed, powerful, desirable, loveable, dominant, more in control – the list could go on.

Ask yourself what the feeling is, that you are trying to achieve. The most important thing to know here is that the need is not bad or wrong, it just is. Actually, we have to love that part, and we shouldn’t try to ignore it, deny it, or kill it! It’s very precious! But we shouldn’t manipulate to get it. Perhaps there is a part of us that thinks we can’t get the feeling, or satisfy the need, just by being ourselves. Maybe we think we are weak or stupid to even have the need in the first place. So, we think we have to control and contort ourselves (and the other) in order to have the feeling/need satisfied. Since the whole thing is really awkward and unattractive, we begin working behind the scenes, so to speak. 2

So we “use” giving (yes, like a substance), to manipulate in order to get our needs met. And, like a drug, it ultimately stops working while beginning to create problems of its own. The feeling we get is either fleeting or it doesn’t occur at all. When that happens, we feel frustration and rage, usually toward the other person. We say to ourselves and to the recipient: “I did everything right! In fact, I went far and above what I really wanted to do. It was too much, it even exhausted me. And I didn’t get _______ in return.” Exactly. What was the “_____”? The “_____” is the need, the thing that the other person wasn’t responsible for giving you. They didn’t sign up for this!

Separating Love from Co-dependence

The following is an easy technique that will help you determine whether you are acting compulsively. Use your body as a barometer. (That’s what therapists do when we work with clients – we notice what we are feeling when we are in the room with someone. It gives us important information about the person we are with, signals shifts that are occurring, and tells us how to next proceed.)

The body will certainly tell you the difference between generosity and pathology – it’s guaranteed. I don’t know what your body would do, but for me, if I’m manipulating, and giving more than I should be giving, my heart rate increases; everything speeds up; things seem to be rushing past me; the room is spinning; I don’t have time to process my feelings; I hate how I feel in that particular moment; I feel a sense of urgency; and I respond to this by moving faster and pushing past all of these uncomfortable sensations. I ignore them. I commit. I say yes. Nothing matches up. It’s like Elvis Costello’s lyrics in Accidents Will Happen: “Your mouth is made up, but your mind is undone!”

When things speed up, we know we are really in trouble. People in sales know this – that is why they talk really fast. They throw so much information at you so that you don’t have any time to consider and reflect. If you did, you wouldn’t buy their product. Speeding up is a great way for people to manipulate, or be manipulated. When things are happening too fast, next thing you know, you’re buying something (or buying into something) that your wise self knew was the wrong thing for you.

Remember that there is a continuum. You can catch yourself along the way. Even though it feels like we change from normal generosity to over-the-top co-dependency in just a few seconds, we don’t. It generally doesn’t happen like that. There are numerous definitive points along the way where, if we pay attention, we might realize we are going into the danger zone. Maybe you felt good about doing the first three things for someone, but then the fourth one was going to keep you up too late, make you miss an appointment, or prevent you from eating a meal. Or maybe you suddenly became aware that the person was taking advantage of your generosity, but you wanted to deny it. Or maybe the other person was emotionally pulling away from you, and you had to speed everything up in order to dazzle them, and ignore your own feelings of rejection. 3

Authentic Giving

On the other hand, you know in your body what authentic giving feels like. When I feel good about giving, there is spaciousness in my chest; I feel lots of room; time actually expands; I feel a flood of joy; I am delighted in the act of giving itself; and I do not feel the least bit pressured or drained. And, I expect nothing back from that person – that they should remember it, return it, enjoy it, or, most importantly – give me back the “feeling.”

So, the key is to start noticing the subtleties as they happen, using your body as a reference point. If things start moving too fast for you (internally), just concentrate on consciously slowing yourself down, remember to breathe, begin to comfort yourself, start paying attention, and wait – until you can feel yourself emerge again.

As an alternative to compulsive giving, ask directly for what you want, or ask the other what they really want. This is a brave thing to do. It risks revealing the self, but it is really, really worth it. This is the sign of authentic giving.

©2010 Heather Stone, Ph.D.

Posted in Articles | Tagged , , , , | Comments Off on Anxiety and Co-Dependency

Anxiety and the Sensitive Person

The Sensitive Person’s Level of Suffering and Need to Present Well

Individuals suffering from anxiety are often highly sensitive people whose acute awareness has become an affliction rather than a gift. In an effort to mask their psychological pain, anxious individuals often present extremely well — composed, attractive, competent, intelligent, or articulate.

Traits of perfectionism and attention to detail likely add to a generally favorable impression, and these same refined qualities may actually contribute to the individual’s legitimate degree of competence or significant achievement in life. While this presentation may reflect a high level of functioning in the external world, it also belies a demoralizing picture of a tortured internal reality.

Characteristically, anxious people also experience a sense of poignant transparency, a feeling that their anxieties might become visible and provoke the negative scrutiny of others. This contributes to a pervasive concern that others might unmask a vulnerable and imperfect self that is fraught with inadequacies assumed to be of exaggerated proportions. Moreover, their high level of insight that anxious symptoms are excessive or unreasonable creates a significant degree of shame and a strong motivation to keep anxieties undiscoverable to others. In this way, anxious people learn to present as unoffensive, competent, and above reproach in an attempt to avoid humiliation or rejection.

Not only are they uncomfortable in their own skin, anxious individuals are acutely aware of all the ways in which there is an imperfect fit between themselves and their immediate world. The specifics of their discrepant experiences are unique to each individual, and it is the therapist’s task to understand just how they are so. The following list comprises some of the inherent disparities between the anxious person’s inner and outer worlds.

The Assets and Liabilities of the Anxious Person

Gifts/Assets: Acute sensitivity.
Afflictions/ Liabilities: These individuals must adapt to an extraverted society that doesn’t always value this trait.

Gifts/Assets: Alert and discerning.
Afflictions/ Liabilities: To manage over-stimulation, anxious people insulate themselves from stressful situations, creating a worsened condition of increased sensitivity and decreased habituation to stress.

Gifts/Assets: Rich interior; reflective and contemplative.
Afflictions/ Liabilities: Often overwhelmed; criticized for thinking too much; lonely.

Gifts/Assets: Intelligent
Afflictions/ Liabilities: complicated “wiring.” High maintenance, like an expensive car. Become sick or exhausted.

Gifts/Assets: Empathic and compassionate.
Afflictions/ Liabilities: Poor boundaries; lack of assertiveness.

Gifts/Assets: Responsible and conscientious.
Afflictions/ Liabilities: Easily exploited by others, particularly bosses.

Gifts/Assets: Accuracy
Afflictions/ Liabilities: able to detect errors;

Gifts/Assets: Good at cognitive techniques such as identifying automatic thoughts.
Afflictions/ Liabilities: Hyper-vigilance; perfectionism; and rejection-sensitivity. Difficulty controlling levels of arousal. These may negatively affect performance levels.

Gifts/Assets: High level of functioning.
Afflictions/ Liabilities: Relaxation, recreation, and self-care receive low priority.

My Message to the Sensitive Person:

My message to you is that you can live and even thrive in a world that doesn’t quite match who you are and how you feel inside. Even if you cannot feel them around you, trust that there are other like-minded people such as yourself who are similar to you in nature and are as sensitive and deep as you are.
Regarding your feelings of transparency: No one can see into you unless you want them to.

While you may be able to intuit the feeling states of others, most people do not possess this ability. Even if it were true that others could sense your feelings or discomfort, it doesn’t mean they really know who you are. A good measure of determining whether someone truly knows you is whether they feel compassion, respect, or love for you. If you don’t get this feeling from others, then perhaps they don’t really know you.

Regarding your perfectionism: I have some bad news and some good news. The bad news is that you don’t have very much control. And the good news is that you don’t have very much control. In other words, you are off the hook in terms of trying to control everything and make it all come out ok. I encourage you to grieve over the fact that nothing can be done perfectly, and that you are not perfect. Grieving feels uncomfortable too, but it feels better than anxiety. Your need to be perfect is not helping to reduce your anxiety, it is actually increasing it. Learn to be ok with the feeling of being “good enough,” and practice doing things that are just “good enough.” Each one of us is a work in progress, and we are all beautifully, poetically flawed.

Last, celebrate your sensitivity, as it is a gift. Remember that as a result of your sensitivity, you make a great friend, a deep thinker, an original person, and someone with substance. I invite you to experience, with all your sensitivity, the natural expressions of humanness and imperfections that come with authentically relating to life. Your unique presence changes the world. I’m glad that you are here.

Sincerely,
Heather Stone, Ph.D.

Posted in Articles | Tagged , , , | Comments Off on Anxiety and the Sensitive Person