Relaxation is Not the Goal

I often recommend mindfulness meditation to my anxiety patients. People often find this experience relaxing in the moment, and that’s lovely, but I swear to you, this is not the central aim. Here’s why I encourage practicing meditation:

1. It is a potent way to learn the skill of noticing thoughts without giving them excessive energy. We often give thoughts undue energy by clinging to ideas, feeding them, automatically buying into them, treating them like facts that need to be followed or forcefully pushing them away. People often intellectually get the idea that this is a habit worth dropping, but experiential learning is powerful. What if you learned to pause in the midst of thoughts?  What if you got comfortable noticing them as a curious observer? What if you had the chance to decide whether you’d feed them (hey, some thoughts are helpful) or whether instead you’ll just label them & let them float away on their own time? What if you allowed them to arrive like popcorn and then naturally run their course rather than trying to push them away with all your might? Meditation allows you to taste these ideas in a calm, planned setting, so you can ultimately apply them broadly in your day to day life.

2. Meditation is a practice of shifting attention. Not keeping your attention stuck on one single, solitary place. Our brains weren’t designed to do that. Even monks’ brains! Our attention will naturally drift. Can you notice when that happens and shift back to the breath, or to sound, or whatever your target is? Can you do that gently? With a soft tone, not a pushy or judgmental one? If not, fine! That’s why you’re practicing. Keep moving in that direction. Can you see how this attention shifting might be handy even when you’re not sitting on a pillow?

3. Meditation gives you the chance to practice deciding, on purpose, to attend to what is rather than your imagination. My folks who struggle with anxiety are in the habit of spending excessive time and attention imagining what their colleague is thinking about them, guessing what germs lurk about, running through creative or even plausible What-If scenarios. None of those, even the plausible ones, actually exist in that moment. But your breath does, always. There are times when actual reality is more worthy of the priority of your attention. Meditation allows you to learn how to shift there. It allows you to practice making this distinction and choosing, over and over, what is here now, in reality.

In my view, meditation need not be hippie, spiritual, or even relaxing. It’s a concrete method to retrain your brain to develop a different stance toward your thoughts and emotions. Need an app to help guide you? I really like Buddhify. It gives you a ton of options for brief (even 5 minute) meditations. My recommendation is that frequent meditations are more important than long ones.

Noticing Automatic Thoughts

Have you heard the term “automatic thought”? Its presence can be quiet but powerful. Sometimes people tell me “I have no thought at all! I’m just on the train and BAM! I’m flooded with nothing but fear. No thought. Just emotion. Unbearable emotion.”

Such a common experience.

Here’s the thing. Dig a little deeper. Slow it down. Check in with a curiosity. Often there is an automatic thought that either precipitates or follows the emotion in some chicken and egg sequence. You don’t need to figure out the order; they likely influence each other. For example…

“I’m trapped” [thought] —> anxiety [emotion]—> “I can’t bear to feel this way” [thought]—-> heightened anxiety [emotion]—> “This feeling will make me freak out, flail around, and people will think I’m crazy” [thought]  —> heightened anxiety [emotion]

Take a breath. You don’t need to make the anxiety go away. You really don’t. Take a breath to give yourself space to ask “What is the thought”? Identify the actual words. Write them down. Notice them. Shift your stance from being entirely enveloped by the whole experience to being an observer. Watching it. Noting thoughts that might be amplifying the intensity of the emotion. Or thought that keep the emotion company.

Even if you already know what the thought is, check in at the time it arises because it’s this shift in stance when you’re activated that begins to shift the system. You may decide to challenge the thought (“What’s the actual evidence that I physically flail when I feel intense anxiety?”) or you may decide just to notice the thought without giving it undue attention (“Oh, ya, I know this thought. I’ll let it pop up and run its course.”) or you may decide to play with the thought by embracing it and even taunting it (“Welcome back Oh Familiar Panic Thought… You Can’t Hurt Me….Bring It!!!”). Consider using a thought record…. there are lots of apps that let you do this on your phone. I like CBT Thought Record Diary by MoodTools (Android or iOS). Or visit this site to download old school but effective forms.

Thoughts are just thoughts, and learning to change your relation to them can have a significant impact. But you first have to train yourself to notice them. Give it a shot.

Showing Care to Someone with Cancer

I often write about managing anxiety. This is a little different. People often don’t know what to do when someone they care about gets diagnosed with a terminal illness. They get paralyzed with fear. This post, written by a man with stage 4 cancer, beautifully describes some ideas to consider. There’s a lot of wisdom in his experience and advice.

Drinking: What to do

Many people use alcohol to regulate anxiety, or any emotion really….boredom, stress, anger, sadness. Sometimes it “works” in the short run: it loosens you up to talk to people at a party; it gives temporary relief from ruminating about the problems at work; it lets you forget for a few minutes that you’re unhappy.



But sometimes it gets out of hand, leading to fights with loved ones, physical problems, disruptions at work. AA is the most famous approach to addressing this problem, and, based on Hollywood movies, you might think it’s the only way. Although AA certainly works for some, there are other strategies that have evidence to back up their efficacy. These include harm reduction and moderation management. Abstinence is not the only way. AA is not the only way.


The tools in these other approaches include specific cognitive and behavioral strategies that can help: detailed tracking (with an app like DrinkControl or coins you move from one pocket to another), identifying cues and triggers, planned alternatives in bars (water between drinks, putting the drink down between sips, etc etc), building and maintaining motivation, surfing urges, identifying and managing interfering thoughts… so many more tools. This is an area that thankfully has been researched quite a bit. There is help out there.  

Want some group help with this? Smart Recovery is one option if you want to meet with others also working to cut down.

Or check out these helpful books, including ways to assess whether non-abstinence approaches make sense for your individual case:

Feel unsure? It’s so very normal to experience ambivalence. Start where you are. Maybe just track this week. Or write down the pros and cons of reducing your drinking. Or read this to consider some ideas. You don’t have to solve it all today. Just take a step.  

Radical Acceptance


Pain differs from suffering. We all endure pain. Of course we don’t like it…it genuinely hurts! What often exacerbates pain, though, is the fight against it.  For example “I shouldn’t feel this way!” or “There’s something wrong with me for being anxious” or “Why am I like this?!” or the physical bracing oneself against the feelings. All of this contributes to suffering. It’s uncomfortable enough to contend with pain, now you have to contend with BOTH pain AND suffering!

Radical acceptance is an alternative response to pain. It’s intentionally acknowledging what is, rather than using that energy and attention to wish for what is not. Fighting agony doesn’t make it go away; it makes it worse. So try acceptance as a first step. Acceptance is not condoning a thing, or pretending you like it. It’s simply acknowledging what is. So instead of “I shouldn’t be anxious!” try on “This is anxiety. This is fast heart beat. This is fear in my body. This is adrenaline.” Simple, non objective awareness of what is, in that moment. Reality. Pause there. See if that changes the experience for you at all. Even just a smidge.

This often gives people a little space to move forward differently. With a different, more effective stance. To gently shift attention to something worth their attention (hey, there’s a tree there, or my breath, or my kids). To approach something daring even though anxiety might come along too. To make all sorts of intentional choices that aren’t getting lost in the paralysis that often results from judgment and suffering.  Try it.

Social Anxiety, Some Tips

Social anxiety is so very common, and natural. People are social animals, and so if you get nervous, it may just mean that connecting with others matters to you. When you reach out, it feels risky. We’re hard wired to feel anxiety when we confront risk. So part of your task, if you’re wanting to do something different here, is to accept social anxiety as OK. Don’t let it change your behavior, don’t let it stop you from diving in to social situations.  Let it be background noise.

Here’s another tip. Notice where you put the priority of your attention.

Folks who struggle a lot with social anxiety often shift their attention during interpersonal interactions from the social task to the self. Self-focused attention includes focus on arousal, sensations, perceived appearance, emotion (e.g., “Do I feel anxious?”), private self  (e.g., “How am I doing?”), public self (e.g., “How do others see me?”). There are other options. Attention on the task is attention towards the behavior that’s required for the specific situation, e.g., the words being spoken. Attention on the environment is focus on the aspects of the environment not necessary for the task, e.g., the curtains in a effort to distract.

The most useful place to gently shift your attention to is the task itself. Here’s why self focused attention is so problematic. First, attention is a limited resource. Second, we all assume what we see in our minds is reality (oops), and therefore exactly what others see. So you are not only diverting attention away from the place that would serve you, but you are bringing it to a place that can exacerbate your perception of your poor performance. In your mind, you look foolish or boring, so you assume that’s what others see too. Or you notice physiological sensations and therefore assume that’s the main focus of what others see too.   Trouble. Shift to the task. Gently.


Practice now. Play with different scenarios… give a mini speech –it’s OK that you’re by yourself—and play it 3 different ways: attention on self (How do I appear??), then attention on environment (curtains!), then attention on task. What effects do you notice?


Karaoke & Excitement

If anxiety holds you back from doing something, watch this video for one idea on how to effectively frame those sensations.  Then come back.

I love the specific suggestion to think of it as excitement– the physical experience really is the same, and the label is legitimate. In addition, the underlying message here is that you need not get rid of (or even decrease!!) those sensations. Once you get in the habit of not making this goal so very central, anxiety genuinely grows quieter. And experiences get more comfortable. But, in the meantime, who needs calm when you’ve got excitement!!

I also like this strategy as an attention diffuser. Yes, there is anxiety. And your default is a laser focus on that and that alone. But remind yourself there is also excitement.  There is also karaoke. There is also adventure. There is also friends. There is also  …..etc. There are many aspects to attend to. Broaden your attention because that laser focus on anxiety misleads you into thinking that is all that experience has to offer.

Happy singing.

A Tool for Anxiety: Train Your Interpretation

If you hear a loud noise in the middle of the night, a vase crashing, what do you think happened? Do you think burglar? Or cat? One interpretation leads to one emotion (fear) while the other makes another (irritation, or relief if you started with “burglar”) more likely.

Many situations in life are ambiguous, and your interpretations or appraisals impact the feelings that arise.

Many studies have demonstrated that people who struggle with anxiety have a cognitive bias or a tendency to interpret events negatively. That not only effects feelings, but often  behavior too. Imagine seeing someone at a party and she looks away. If you interpret that moment as “She thinks I’m boring and doesn’t want to talk” you may walk away and miss the opportunity to make a connection. If, on the other hand, you consider “She might be shy” or “She hasn’t spotted me yet” you might feel more neutral and be more likely to move toward her to initiate a conversation.

There are many ways to work with these pesky thoughts that arise. One is through Cognitive Bias Modification programs. One I highly recommend comes out of the University of Virginia’s Psychology Program. They’re testing a new version that is informed by the 10 years of research that’s gone into this approach so far.

Check it out here.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
Some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,

still treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
Meet them at the door laughing,
and invite them in.

Be grateful for whoever comes
because each has been sent
as a guide from beyond.


I tend not to quote poetry. But this one resonates.

Many of us spend a lot of energy trying to force uncomfortable thoughts and feelings out. What would happen if you treated each one as a guest? Even anxiety? What if, rather than trying desperately to push it out, lock the door, make it go away immediately, you instead noticed its presence, said hello, and allowed it just to visit for a moment. What would happen if you let go of the struggle?

Guests come and go.

For some, this is an outrageous idea. Anxiety is painful. Why invite it in??? One reason is that anxiety and other uncomfortable thoughts and feelings are inevitable. They’re showing up whether you like it or not, whether they were invited or not. Another reason is that pushing away often amplifies distress. So now you have to contend with both the initial discomfort as well as the tension and suffering inherent in resisting something that would likely float in and out, if left alone.

How to get more skilled at disengaging from this struggle? Cognitive defusion exercises help. For example, next time you notice an uncomfortable thought or feeling, pause and say “Welcome.” Seriously. Imagine yourself handing that thought or feeling a cocktail or a cup of tea. It’s a guest.

You can also practice building that capacity with daily meditation, even very brief ones. This site offers many free guided meditations worth a listen.