Mindfulness & Meditation for Anxiety

When I suggest mindfulness or meditation, I often hear from folks: “My mind wanders too much, it’s not relaxing.” Or “It was great, I focused on my breath the whole time, my mind went blank.”

Feeling relaxed and super focused sounds very pleasant. It also isn’t going to happen every time. And I’m glad for that! Because there’s a larger aim, a more important one, at least for my purposes in helping people who struggle with anxiety. Let’s come back to that.

For now, after reading this paragraph, take a moment to close or lower your eyes and pay attention to your breath. Don’t try to change it, just notice it. Pay attention to the air entering the nostrils, or what it feels like in the back of your throat or filling up your belly. Notice the pace, and the pause between the inhale and the exhale. Just be curious about the physical details. Go ahead and try that for a couple minutes.

Did the mind wander? Yes? OK! That’s what it’s  there for, to generate thought. It’s really OK.

Now try again, and each time the mind wanders, just notice that, say to yourself “wandering” and gently, softly, quietly return your attention to your breath. It will wander again. If it wanders 100 times, shift 100 times. This moment of awareness followed by gentle shifting is the skill I’m most interested in. If you cultivate that, under less challenging conditions like sitting at your dining room table or on the meditation pillow, you will have a skill that is awfully handy when your mind does its thing off the meditating pillow. Because it will.

Cultivating mindfulness, especially for people who struggle with anxiety, is helpful, in part, because when the mind launches into a frenzy of catastrophic thinking or worry or intrusive thought, it can be useful to gently pause in awareness, with a compassionate “ah, there’s that thought” followed by a soft return to the present. A gentle shift.  Maybe to your breath, or maybe the sounds, or your kid right in front of you, or the task you’re trying to complete. The present. And meditation gives you practice with that gentle shifting.

Headspace is a good app for guided meditations. Another I like is Insight Timer, because I prefer non guided, just the breath. Whichever you choose, give it a shot this week, even just 10 minutes a day, and see what you notice.

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Minor Social Errors Happen All the Time

People who struggle with social anxiety often spend their energy trying not to make social mistakes.

For all of us, though, minor social errors happen all the time and major social errors are rare. Folks with social anxiety disorder often ignore that distinction and merge the two in their minds. They think errors ought to be avoided, period.

This causes trouble in so many ways. Here’s a sample:

  1. Vigilance for errors is distracting. Attention is a limited resource, so being on the lookout for errors prevents you from engaging fully in the interaction.
  2. Because errors happen all the time, you will spot an error. That will then narrow your focus more (doh!), increase your anxiety (doh!), unnecessarily diminish your confidence in your social capabilities (doh!), and will take you further from actual engagement in that interaction (shoot!).
  3. All that hyperfocus on and perceived importance of errors means you’ll remember the errors as the salient features of that interaction. That mistakenly builds your case for yourself as socially incompetent, which feeds into this cycle where you excessively fear making mistakes.
  4. If you fear making errors, which are inevitable, you’ll be more likely to avoid. And avoidance, though natural, is the enemy. It feeds anxiety, and takes you out of living a rich life.  

Do not waste your time trying hard to not make any social errors. Embrace them, feel the momentary cringe, and keep moving.

What are examples of minor social errors? My 8 year old daughter and I played the game of tracking them one afternoon. Here’s the honest to goodness list of what happened over 2 hours during our walk to and dinner with friends at a local restaurant:

  1. I waved to a stranger in a car, thinking the driver was my friend. She was not.
  2. I said hello to the waiter as we entered. He walked right by because presumably he didn’t hear my hello.
  3. While waiting, I responded to someone’s question chatting behind me, thinking she was talking to us. She wasn’t.
  4. They were talking loudly compared to others there.
  5. My friend accidentally let a curse word slip out in front of the kids.
  6. She then forgot someone’s name who was in the restaurant… who she had dated.
  7. Someone introduced himself to me despite having met me before.
  8. My friend’s daughter farted.

I challenge you to practice acceptance of social errors in your own life. If you’re up for it, play the game for part of a day… every time you notice an error, smile a bit. Change your attitude toward making errors so you don’t waste energy later trying desperately to avoid them. They make you human. 

 

Thoughts on Thoughts and Popcorn

Let’s talkPopcorn about two distinct types of troubling thoughts.

Some thoughts just pop into the mind. I call them popcorn. Bam! Suddenly an idea arrives and it’s vivid. “Ugh, that was so foolish!” or “That gross thing might have touched my hand!” or “What if they fire me?”  That type of thought can feel unpleasant, I know. And it happens to all of us. It’s not in our control. In fact, efforts to control this tend to backfire. Daniel Wegner did all kinds of fun research demonstrating the more you try to control thoughts (about white bears, in his original example), the more they rebound or come back with a vengeance.  

But then there’s what happens after that quick, popping thought, when we unadvisedly flesh out that initial thought, and turn it into a story we actively create. We’re adding more details, playing it out, giving it more attention. For example, following the initial “That was foolish!”, we might add “She probably noticed how anxious I was…did she look at me kind of sideways? Ugh, yes, she thinks I’m awkward. I am awkward! She won’t want to be around me anymore, why would she? I’m so incompetent, this always happens, people think I’m lame, and can’t hold a normal conversation … why aren’t I normal?…” and so on and so on… 

Tune in to see if you can spot the difference in your own experience. Pop versus fleshing it out.

That first type of thought, the popcorn thought, is harmless and unavoidable. Learn to notice it. Label it. Accept it for what it is “Oh, Popcorn. Hello.”

And then practice spotting the “fleshing it out” thoughts. When you catch this happening, gently label that urge, smile a little because practice is awesome, and then attend to something that matters. Like your breath. Seriously, it keeps you alive. Or the person in front of you. Focus the priority of your attention outward. Not in your head. Choose to disengage from fleshing out thoughts that are not helpful and instead choose to engage your attention in the real world.

Happy practicing.

 

 

How to Pick a Therapist

If you struggle with obsessive compulsive or anxiety disorders, finding the right provider is not an easy task. There are hordes of clinicians. How do you choose?

Here are a few questions that may help narrow the field.

What proportion of the patients they treat struggle with your particular problem (e.g., OCD, panic disorder)? In directories, we’re asked to indicate our specialties by checking boxes from a giant list. Many folks check almost all options, so it’s not necessarily indicative of a genuine specialty. Dig deeper, respectfully.

Do they systematically track progress? Do they collect feedback about the therapy process? How? If you love reading peer-reviewed research, Lambert and his colleagues have conducted quality studies that have demonstrated tracking improves therapy outcomes and reduces likelihood of deterioration.

How often do they assign homework? You spend 167 hours a week outside of your therapist’s office. These hours count.There’s a strong evidence base that the amount of homework or practice exercises patients engage in predicts improvement. Is this a usual part of the clinician’s toolbox?

After you discuss the problems you want to work on, ask what specific treatments they tend to use in treating those problems. If you have OCD or an anxiety disorder, you want to hear the word “exposure”–there’s just too much evidence on its effectiveness to ignore.  

Although I consider all this information useful and reasonable, here’s a caveat. I don’t recommend firing all these questions at potential therapists when you first chat on the phone. Instead consider naturally working them into a conversation or two.

And obviously, you want to feel comfortable talking to them. Treatment can be challenging, so feeling comfortable with the person guiding and supporting you is an important component. Not sufficient, but necessary. Not surprisingly, the literature supports that alliance is a significant predictor of outcome, so find someone you can trust.   

 

Your Imagination

Imagination is a lovely thing.

It’s one of the things that makes humans powerful. Think of our ancestors. “Oh, I notice that rock is round… I wondeeeerrrr…” That’s how that story went and eventually there were wheels!

Almost everything that exists outside of the natural world started out in someone’s imagination. So, hey, imagination is great, and it can lead to useful things.

But something else stems from imagination, and it’s not so useful. Worry. “What if this awful thing happens??!?!!” or “I won’t be able to handle it if he breaks up with me” or “What if my kid turns out to be an unkind person?” Worry is future oriented, negative repetitive thinking, or anxious apprehension.

Of course everyone gets these thoughts.

If you feel plagued by worry, and find a lot of your attention is placed on negative ideas of the future, here are a couple things to try.

Start noticing it for what it is: imagination. Label it. When worry thoughts pop up, actually say to yourself, “oh, there’s imagination.” Take that step back, gently, away from the content. To call it what it is, imagining, just imagining. And then shift your attention, deliberately, to reality. To something physical and present, like the details of your breath, or the sights of what is right in front of you. To ground you in the present, in what is real. Need help? Try this 5 minute exercise to practice mindfully attending to sight. The point is to practice not pushing away or feeding worry thoughts, those fragments of imagination. Just gently shift the priority of your focus.

OR

Worry postponing. Pick a time, a 10 minute stretch in which your sole task will be to put all your effort into worrying. Nothing but worrying. Stay focused. Really do it. If worry thoughts arise outside that time, remind yourself that you have a dedicated time for that, and that you will come back to it then. This way your mind does not get constantly hijacked when you’d rather be putting your attention toward things that help you move toward your goals and values.

Step 1: Go chase meaning [even if anxiety tags along]

“Chasing meaning is better for your health than trying to avoid discomfort.”

-Kelly McGonigal, Ph.D.

Many people who struggle with anxiety work desperately hard to reduce the stress and anxiety in their lives. Most patients tell me at Session 1 that they want to get rid of anxiety, that that’s their goal. I get that. Anxiety doesn’t feel good.

And many have narrowed their lives in order to escape that feeling. They’ve stopped working, or taking their kids out to the city, or dating, or talking to new people, or taking adventurous trips.

They think “Once I feel less anxious, I’ll do those things again.”

Here’s the thing. Don’t do that. No matter how intense that anxiety is.

I know this is not easy to do. I do. The reality is this: it’s worth it to dive into a rich life, full of experiences that you value, that give you meaning, whether or not anxiety also happens to be there.

Let it be there, if it insists. And turns out anxiety tends to get less intense when you truly turn your attention to the parts of your life you value. But either way, don’t let it guide the life you build.

Some people need help with this. This is work I find meaningful, so contact me if you want my help.

In the meantime, check out one of my favorite TED talks here

.  Kelly McGonigal speaks about stress and offers sound advice on what to do with it.

Freedom from OCD: A book recommendation

51cU-0dEhuL._SX331_BO1,204,203,200_There are a lot of self help books out there. The market is saturated, and the quality varies tremendously. If you struggle with OCD, there are some good options, but here is my favorite: Freedom from Obsessive-Compulsive Disorder by Jonathon Grayson, Ph.D.

Here’s why:

The book focuses heavily on living with uncertainty. This focus is unique and accurately captures a core problem that folks with OCD (and many others!) struggle with. The author offers both a clear rationale for why accepting uncertainty is required for recovery, and concrete strategies for how to do that.

It is very clear that the author is a clinician who actually sees lots and lots of patients with OCD. I’ve met with hundreds of people with OCD, and as I read these books I think about how they would react to what is written. As I read this, I hear the author doing the same. He’s anticipating their “ya, but…”s, their head nods, their sometimes idiosyncratic fears, and the VERY WIDE RANGE of symptoms they struggle with. Some OCD books stick to the basic checkers and washers, and yet in real clinical work, we see a tremendous variability in content of obsessions and compulsions, though the process is often the same. It’s clear he really gets the OCD experience.

This book is filled with strategies that have been tested with solid scientific methods, and that tend to work for most people with this disorder. It’s meaty, dense, packed with information and strategies for getting better. And these strategies are grounded in research, in evidence. This is important. If you are struggling with OCD, go with the approach that has the best shot at helping.
If you struggle with OCD, check out this book. I bet it will resonate. If you need more help facing your OCD fears, I’d also be happy to talk with you.

The Duck

There’s a duck on my table.

It’s art that belongs to the woman who owns the office suite. It’s playful, and even a little silly… I like it. It reminds me of thoughts, and the idea that we ought not to take them so seriously. They’re just thoughts afterall. Sometimes they’re helpful, sometimes they’re not. So hold them lightly. People who struggle with anxiety or OCD often look at the world through their thoughts. That can be trouble.

Psychologists have a term called “cognitive defusion,” strategies that provide more distance from thoughts, less attachment, less “fusion.” For example, someone with social anxiety might think after meeting someone new “She thinks I’m boring. I’m so boring!” If you are fused with those thoughts, you might then spend the next several minutes ruminating about your perceived social incompetence and how you’ll always be alone, etc. The mind can be very active when it weaves a story!

Let’s rewind and play that out differently. If you’re practicing cognitive defusion, try on a different approach. When the thought “she thinks I’m boring” pops up in your head, notice it as a thought. You don’t need to make it go away, and you don’t need to feed it either. Take a second to say to yourself “I notice that I’m having the thought that… she thinks I’m boring.” Say it again and really take it in.

Practice now. Say “She thinks I’m boring.” And then say “I notice that I’m having the thought that she thinks I’m boring.”  Pay attention to the difference.

This is one of many tools to start to develop a different relationship with your thoughts, so they have less impact on the life you want to lead. If you want more help with this, a great book is Russ Harris’s Happiness Trap. I’m also happy to talk with you about treatment. I specialize in therapy for anxiety and OCD. You should know, though, that if you come to my office, you might notice a duck on my table.   

 

We Learn By Watching Ourselves

If you struggle with anxiety or panic, avoidance is your enemy.

If you’re afraid, it’s the most natural thing in the world to choose to get away from that scary thing as fast as you can. We’re built for that. It’s understandable. And when people talk about fight or flight, know that flight is usually the favorite. If a saber toothed tiger is coming your way, fighting is not a grand idea if fleeing is an option. So avoidance is natural, it makes sense. Unfortunately, it also feeds false alarm systems that keep you stuck in the anxiety and panic loop. Let me share two reasons.

  1. We all respond to rewards. Whether you’re a pigeon learning to play ping pong with food pellets (seriously), a child learning to stay in bed with a sticker chart, or a complicated adult struggling with how to respond to fear, the principle is the same: Reinforcement strengthens behavior. Rewards work. Each time you avoid, you manage to reduce that anxiety just a bit. It works, right? For a little while anyway. So you’ve just rewarded yourself with some relief, with the absence of anxiety. The bad news is that this reinforcement just made it more likely you’ll avoid again next time you have the opportunity. This is trouble for lots of reasons, including…
  2. People learn by watching themselves. If we see ourselves avoid the highway, restaurants, talking to that attractive person, stepping on certain parts of the ground, being far from home…. we reason “there MUST be some threat for me to be acting this way.” This isn’t always in our awareness, but avoidance convinces us even more that the thing we’re avoiding ought to be avoided. In the long run, it makes it scarier.  It increases the perception of threat. That’s not helpful.

 

In almost every treatment plan I create with patients struggling with anxiety, avoidance is one of the most primary targets. It isn’t easy, but many of my patients find it’s not as hard as they feared (imagination can be intense!). If you’re reading this and it resonates, think of one small way to act the opposite when you have the urge to avoid. Pick one thing. Pick something manageable, but challenging. Go!