Addressing the why behind anxiety & OCD

In a recent podcast, I was asked about why: why people have certain obsessions and compulsions, why do some people have anxiety/ocd and others don’t... I hope to expand and further explain my thoughts about this because it’s super important for both sufferers and their supports. Everyone wants to know why. Here are my thoughts responding to the why’s:

Why do some people have anxiety and OCD and others not?

Many people do not really understand the experiences of people living with anxiety disorders and OCD. Anxiety is not just like anger, sadness or another kind of emotional state. Anxiety is excessive worry. Anxiety is a person’s brain mistaking the idea of danger with actual live danger. Anxiety is physical sensations in the body. Anxiety is doubt. Anxiety is uncomfortable. Anxiety is biological. Anxiety is a normal adaptive feature of all humans. It becomes maladaptive, or a presenting issue in therapy, when it’s getting in the way of: fun and functioning. Anxiety Disorders and OCD are believed to be in both camps of inherited and/or acquired, meaning it can be either/both genetics and life circumstances.

Compelling research of the brain scans of people with OCD show that their brains are literally firing off danger signals more often and rapidly than others (Simon et al. 2014). Anxious brains also have the unfortunately ability to be “over-active” in the area of the brain that processes errors…say like perceiving threats, which is why it’s so hard to just stop being anxious, or slow down when it comes to performing compulsions (Norman et al. 2019).

In my opinion, no one is immune to anxiety and anxiety is not all bad. Sometimes, it’s appropriately felt…and nothing really to do about it except wait it out! It’s when people fear anxiety or become intolerant of feeling it, that it leads to trouble. Regular old anxiety looks like waiting to hear results of a test or job interview, or driving somewhere unfamiliar for the first time, or having to talk in front of a group of unfamiliar people or when something is happening that you don’t really like. There’s nothing wrong with feeling anxious. For many, it gets compounded with self-criticism and makes it stick around way longer. Regular old anxiety can also swing into the obsessional side of things when the feared consequence is more far fetched, and the same worry keeps showing up. Anxiety is bound to show up more often when people are: drinking more alcohol/caffeine, getting bad sleep and encountering stressful situations.

Why certain obsessions/compulsions over others?

People don’t flick a light switch for no reason. For the sufferer who is asking themselves, why this particular idea, theme or topic? Know that your brain is trying to protect you from harm by, ironically, thinking of the scariest sh*t that would bother you. If the stuff you’re thinking about bothers you, it’s a sign that you don’t agree with it (ego-dystonic). There’s no thought or feeling in the world that would make you unlovable or unworthy of getting help. Anxiety & OCD latches on to people’s values. And there’s not a special reason why you were chosen to worry about a particular topic or anything you could have done differently in life to prevent it. I’m sorry you’re suffering and there is hope for recovery. Find your way to an OCD support group or specialist (see below for some websites).

In ERP: Within the ERP model, unwanted thoughts, feelings, images, sensations, and urges are thought to be random…but also related to a person’s value system. So maybe someone is flicking a light switch because they really care about keeping their family safe and this action makes it feel like that’s more possible. Or maybe it just feels right to do that action and there would be a lot of distress if prevented from doing it.

A good ERP therapist is going to help identify what the “core fear” is that drives a person’s worries (check out Yadin’s Underlying Core Fear and Greenberg’s writings on this).

In ICBT: Within the Inference Based CBT model, the why is really at the center of treatment through examining the story that surrounds a person’s doubt. To me, this is the first therapy that really is asking why someone believes their doubt to be true…and most people have a lot of logic and reasoning as to why! Some of the ingredients include: facts, rules, hearsay, personal experiences and it’s possible. So if someone is, for example, flicking a light switch, I might ask them about what they are hoping to prevent happening and what might happen if they don’t do that action. This helps me get toward the doubt itself. If the doubt was “my house might burn down from faulty wiring” and the story was “Well house fires happen (facts), People should turn off their lights before leaving (rules), I read a news article about how an entire apartment building burned down because someone didn’t unplug their straightener (hearsay), One time I flicked the switch and heard an electrical noise (personal experiences) and it’s possible my house could have an electrical problem and burn down (possible)”. With this super juicy story, it’s no wonder the doubt feels so real and potent. In treatment, sufferers learn to identify their own “inferential confusion” about their reasoning process and restore self-trust. So people with Anxiety & OCD likely have stories that fuel their doubt, but it’s really about their self-concept that creates distrust in themselves and attracts a certain kind of story. It’s a very interesting therapy and I highly recommend people learn about it!

To sufferers:

Don’t forget to ask WHY it’s worth it to work on this as a guiding force to managing symptoms: your values and goals in life.

Instead of questioning yourself and second guessing…ask yourself why it’s important to continue working on this? What’s at risk if you don’t? If you could put worry aside, what would you be doing?

To supports:

You don’t have to agree with someone’s anxiety in order to support them. While someone’s anxious thoughts or compulsions might seem ridiculous to others, it’s really not funny. We want to laugh with someone, not at someone, right? I love using humor in life and therapy, but that requires some planning and collaboration to be consensual. For example, when I named my generalized anxiety Veronica…it allowed me to laugh at myself. When I share Veronica with people in my life, they get to be in on it with me. Externalizing anxiety & OCD is a cognitive strategy called Cognitive De-fusion. It essentially allows us to get distance from the thoughts we’re having in order to choose what we do about the thoughts. From a distanced space, people can decide how to act or not act in response. There are some wonderful strategies in Acceptance & Commitment Therapy that help change the person’s relationship to their own thoughts.

If you are reading this and have a loved one in your life with untreated Anxiety & OCD, here are some ways that would be best to support them while seeing their compulsions:

-Maybe ask them at a later time, “Hey, I’d like to ask how best I can support you when I do notice you doing compulsions. Is it better for you to acknowledge it or leave you be?”

-Ask and encourage them to get support from and OCD specialist

-Tell them you CARE about how they are doing and are concerned

-Read and learn more about it

-Get support yourself: empathy is not an endless source for most people!

Hope this helps and if you need more support look at ADAA, IOCDF and ICBT.Online for therapists near you who specialize in anxiety and related disorders.

Best,

Sarah

Anxiety and Self-trust

I recently wrote a blog article for Anxiety & Depression Association of America’s OCD sig that touched upon the concept of self-trust as a major obstacle of folks living with anxiety and OCD. I hope to expand upon that idea more in this post, along with sharing some of the various frameworks for evidence-based treatment out there for sufferers.

In general, most people come to therapy because they have lost their ability to trust…whether it’s trusting their own decision making or themselves. No one is immune to anxiety. It’s something everyone will experience at some point. For those lucky to not feel it on a daily basis, it might be the feeling you get before a job interview or waiting to hear important news. Anxiety isn’t all bad and can be a reasonable experience in specific contexts.

Everyone also has intrusive thoughts at times: unwanted, weird, wacky, gross, disturbing, violent, sexually curious, etc. The difference between someone with anxiety & OCD and people without: is that most people can acknowledge the thought and move on pretty quickly…and not question their identity or self-concept as a result. People with anxiety and OCD will continue to assess and appraise their thoughts or react strongly in response to the thoughts.

Thoughts often happen so fast that people may not realize the story they are constructing about the future, or themselves, which may be leading to further sensations in the body and rumination (obsessing) about the feared outcome. These thoughts (including feelings, images, sensations and urges) might be impacting a person’s ability to trust their own senses, intention, desire, feelings and memory…but it’s really a lack of trust in who they think of themselves to be (self-concept). If I trust that I’m a responsible human who is competent and resilient…I’m not going to fear accidentally leaving my stove on and killing my neighbors. In the Inference-Based CBT approach, this is essential to unraveling doubt and restoring confidence.

When people have anxiety they are doubting something. This is different than uncertainty. Uncertainty is information not yet known (Kamal & Burke, 2011). As Kate Goldhouse puts it: “We don’t know if the sun is going to come up tomorrow, but we have no reason presently to doubt that it will”. Not knowing information is something certainly can cause someone to feel anxious, but it will quickly resolve once the information is known. This is different than doubt. Doubting is a mistrust of information, fear (O’Connor & Aardema, 2011). Doubt leads to more doubt and is not easily resolved, even with information.

Here’s some ways that anxiety with doubt can sound:

Did I say or do the wrong thing? They could be offended or upset with me.

I don’t know what’s going to happen and don’t want to deal with anything stressful.

It’s possible the worst thing could happen.

If I am attracted to someone else, that would be like being unfaithful to my loving partner.

It just doesn’t feel right.

Something is going to go wrong, I just know it.

How can I be sure about ______ (insert super bothersome idea)?

I could be more at risk for getting sick.

In Inference-Based CBT, obsessional doubts are understood to have a story behind them and the way a person is applying their OCD logic/reasoning is confused, causing them to turn away from reality and their true self. People with inferential confusion (possibility>probability) are neglecting here-and-now information (observation, existing knowledge, inner sense, common sense) in favor of the doubt story. When you receive or neglect information in favor of the scary potential…you are in obsessional territory. There’s so much hope in this approach to anxiety & OCD treatment!

In ERP, a core fear is the idea that all a person’s worries can be synthesized into a concept that they are trying to avoid or prevent: avoiding emotion, being alone, being bad, death/dieing, ruining or suffering. Greenberg (building upon Yadin’s UFO concept) posits avoiding emotion as one of the core fears that drives a person’s symptoms. The core fear would not be present if a person trusted themselves: back to self-doubt.

In Greenberg’s Rumination-focused ERP, he suggests un-learning the belief that thinking about the problem will lead to any kind of solution…leaving the only solution to be giving up trying to solve it! Rumination is a choice, not something happening to you, which positions you in a place of power to fight back against symptoms. The first step is being able to identify when you are obsessing, unlearn any limiting beliefs about the helpfulness of thinking about it further, and then: stop, just plain stop. Go live your life. If you weren’t worrying, what you be doing? Go do that.

Learning about anxiety, OCD and the treatment options is really important for the advocacy and representation of sufferers. Hope this helps and please do continue to learn more!

Best,

Sarah

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

Coloring Books in Therapy

A few years back the field of art therapy was getting some mainstream attention because of how coloring books were being marketed to consumers. The way it was and still is (see here) being marketed is problematic. This type of product and its marketing created a wave of ethical and philosophical responses from the mental health community, especially art therapists (see some good reads about it: here, here, here and here). As someone who identifies as an art therapist, I used to find it offensive when people would acknowledge my field (art therapy) by referencing coloring books. As if the whole history of art therapy, the variety of applications, the years I spent studying in my specific art therapy graduate program could be summed up in a leisure activity.

This marketing and subsequent attention on art therapy as a product like coloring books also probably touched a nerve because the field of expressive therapies is often looked down upon in scientific communities and lacks longitudinal and empirical studies to be called “evidence based practice”. (Side note about this: as a result of the absence of scientific studies of art therapy outcomes/efficacies, insurance companies are often no longer covering this kind of treatment, so many intensive treatment programs are reducing or eliminating art therapy offerings to patients. More on that another time!)

Fast forward years later, I feel differently about the use of coloring books in therapy. As you can see in my website shop, I’m actually spending time designing and selling coloring book pages for people (therapists, providers and clients) to use as part of Exposure & Response Prevention treatment for OCD. Below are some thoughts about what’s problematic, what’s helpful to know, and how coloring books could be used ethically within and outside of therapeutic settings.

First, let’s be clear about two things: calling yourself an ‘art therapist’ and practicing ‘art therapy’. To call yourself an ART THERAPIST requires specific education requirements, there is a licensing process for this credential (which is lengthy, expensive and deserves much respect), there is an Association for this field, and clear ethical principles followed. To use ART THERAPY as a mental health provider simply implies using art as a therapeutic tool or intervention (similar to any other framework or therapy intervention: ACT, CBT, DBT, EFT, etc.). This means any therapist interested in using art with clients can say they are doing “art therapy”. Art isn’t owned by anyone and it’s OK for creative people to use art in session without being an art therapist, but therapists should be as thoughtful about this as they would be with any other intervention. To me, what’s special about being an art therapist is the ability to think more creatively about therapy applications, the deep insight into materials/use, awareness of what may be evoked through media, and the knowledge on how to intentionally facilitate the use art for therapeutic gain.

What’s Problematic About Calling Coloring Books “Art Therapy”:

It is not accurate or ethical to generalize or label a whole therapeutic field based on a single art-making practice, especially if that practice does not require a therapist presence. Without a therapist presence, it is not ‘therapy’ and could do harm to imply it is.

What happens if someone is using a coloring book titled “Art Therapy” and while using the product they have a traumatic memory resurface or become dysregulated using the coloring material? This could harm someone, to be unsupported in that moment. A coloring book does not replace a therapist.

If someone is easily dysregulated and using a difficult to control medium, this would likely add to their distress. An art therapist would know this information. Art therapists are often artists themselves and are aware of what materials could be used as agents of grounding. There is often much more occurring in therapy than people realize. There’s movement, frustration tolerance, building mastery, and much more happening that an art therapist is skilled in tracking, observing and supporting.

What’s Helpful About Coloring Books Being Used In Therapy Or For Therapeutic Use:

In the first few therapy sessions, the therapist and client co-create a therapy plan, which consists of a goal for therapy and objectives on how to meet that goal. There could be ethical use of coloring books to meet client objectives and goals, but this requires therapeutic intention and facilitation.

Many art therapists have had the experience of clients being nervous to engage with art because of being inexperienced or not skilled naturally. Some art therapists view art therapy as process based, where the product is less important than what is occurring during the making or through the making. Some art therapists view the product as just as important and will support the making with a desired outcome in mind.

Coloring books can be an accessible way to enter into art making with little room for self-criticism. While painting on a canvas is intimidating, picking up a colored pencil to fill in a shape feels more gentle. While making art about your life challenges may seem really abstract and fear-inducing, filling a page with color is not so abstract. Coloring books in session could be used as a supplementary tool to keeping clients emotionally present during difficult moments in session.

I often use coloring book pages as a form of alternate rebellion (DBT skill) and as a behavioral activation for depressed clients (CBT). Coloring books can be a coping skill, too. There is some wonderful evidence (also see: here and here) that coloring can be a mindfulness practice and tool for building emotion regulation skills.

As a therapist who specializes now in anxiety and OCD, I am finding that coloring books can be an effective tool within exposure work. ERP is a form of CBT used to treat GAD, OCD and Specific Phobias. In this treatment there are 3 kinds of exposures (imaginal, in-vivo and interoceptive) and clients work with a skilled clinician to co-create a hierarchy of fear-inducing activities meant to increase the person’s tolerance of distress, while reducing compulsions (response prevention). Coloring books with specific content can be used as a form of imaginal exposure for someone to interact with content that provokes some mild anxiety with the intention of habituation. Many people come to ERP really fearful of having to do stuff outside their comfort zone and have very little distress tolerance. The way I’m designing coloring book pages for folks living with and treating OCD are about leaning into fears, tolerating uncertainty and interacting with imagery with the intention of increasing tolerance. For someone with Harm OCD, seeing an actual knife in front of them may be too intense, but seeing a drawing of one might be tolerable. A therapist using coloring book pages in the treatment of GAD, OCD and Specific Phobias could be an accessible way for someone to start treatment. (If interested in this therapy please do: check out the International OCD Foundation page for more information on effective therapies and use their directory to find therapists in your area!)

In my perspective, what makes coloring books a legitimate form of art-based therapy depends on: therapy goals and objectives, intention of use and facilitation. While coloring books do not accurately represent the entire field of art therapy, I do think there is much value in coloring books used in therapy or with therapeutic intention.

The Way Things Are Going (Part 3): All Children Deserve Respect

All children deserve respect.

When respect is not provided, it is abusive.

Children are considered one of the most vulnerable populations in the world. Children have to be reliant on systems to regulate their basic human rights. Meaning, when a parent or caregiver is not able to provide basic human rights for a child, that the child is reliant on systems to notice and intervene (school, providers, department of human services, mandated reporters, etc). Children are generally not aware that their basic human rights are not being met.

It is no longer enough to provide the physical requirements of raising a human. Emotionally maturity is needed. Giving a place to sleep, food to eat, clothes to wear is not adequate parenting. Children need parents who are able to apologize, who actively cope with their own emotions, and model conflict resolution healthily on a regular basis.

Often adult caregivers feel they do not have to give a child an explanation, choice, praise, or use respectful language because of their own experiences growing up. To this adult caregiver, I ask you to explore your feelings and beliefs about how you grew up, the relationship with your parents now, the experience of being parented as a child, and the impact of your childhood has had on you as an adult. Are your childhood experiences ones you want to recreate? Are things as they are now, working for you, your family, and your child?

Perhaps you are the rare adult who had a pleasant experience in childhood and are now having challenges with raising your child. Or perhaps you are parenting another child already and are having challenges in parenting one. In this case, know that every child is different. Sometimes, caregivers have to learn specific parenting skills to match a particular child. It is not your fault (or theirs) and there are things you can do about it.

Respecting a child requires an abundance of patience, approaching issues with curiosity instead of judgment, supporting a child’s curiosity or confusion, accepting and assisting in self-discovery of boundaries by observing discomfort, offering opportunities for empowerment through choice, protecting the child from your own emotions, letting natural consequences play out, modeling appropriate boundaries, and listening rather than“fixing”.

When children feel listened to and understood, they learn their emotions are "normal" and in turn are able to validate their own experiences in the world. Growing up in a validating environment creates an adult who is more skilled at self-regulating emotions. A child can be shown respect by the caregiver through an energy of lightness in the caregiver, awareness of affect, body language, choice, humor, modeling emotional regulation skills, tone, and use of language.

The result of not learning to self-regulate emotions 

in childhood and adolescence is the formation

of an adult who is emotionally reactive (or distant),

has difficulty in relationships, 

feels disconnected toward themself,

and practices unhealthy coping skills to survive. 

If you are the caregiver reading this thinking, "That's me!" know you are not alone, and that individual therapy will be beneficial. At the very least, engage in self-care practices, move your body, read up on emotion regulation skills, and foster your own support system. It is not your fault and you have the power to do something to help yourself grow and your family thrive. You will be better able to be the caregiver you want to be, and that your family deserves if you, yourself, are regulated.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

Is individualism getting in the way of group therapy?

Pausing the caregiving series, The Way Things Are Going, this week to share some thoughts about the way things are going in my therapy world.

In my private practice, I’ve been working on some long held goals of mine. One of which is to facilitate more group therapy and community-based offerings. Partly as a way to live my values about equity and accessibility of therapy, but also as a path that offers so much joy and healing. An obstacle I didn’t expect to find, is a general reluctance in people to attend. Over the years, I have had many clients share with me feelings of loneliness, disconnection from others, difficulty creating and sustaining friendships, isolation, relational cutoffs, and lack of community around diagnosis or life experiences. My idealistic self thought to problem solve: let me create and offer groups! I have some group therapy offerings right now that have been wonderful, but really challenging to get more folks attending and attending consistently. No doubt that is typical growing pains of creating something new. However, it has lead to me wonder why people are seemingly less interested, especially when there is such a clear need for relational healing? Is individual therapy strengthening individualism? Is group therapy less appealing because the voice of the “expert” is not just the therapist? I’ve been reflecting on this a lot and feel it worthy of exploring in this post. Hope it inspires change and more willingness when considering joining group therapy!

“There is no human deed or thought that lies fully outside the experience of other people”

(Irvin Yalom, The Theory and Practice of Group Psychotherapy).

When you hear the words “Group Therapy” and what comes to mind? Most people associate group therapy with: Alcoholic Anonymous, movie scenes where very sad looking people are sitting in crappy chairs speaking very heavy things, or a hospital setting where the group members are obviously not well and kind of unrelatable? Please know—these depictions are not 100% accurate and don’t represent all of what group therapy can be.

Group psychotherapy began in 1905 with Joseph Hersey Pratt supporting patients in a hospital setting. It has a long history from supporting veterans returning to civilian life to patients whose lives were spent inside hospitals to cultural movements. Irvin Yalom, an author I love, has developed the leading text about group psychotherapy dynamics and writes so beautifully both about the role of therapist and the relational component within groups. There are different types of group therapy (arts based, psychoeducational, skills development, support groups, cognitive behavioral, interpersonal, etc.) and different styles of running a group. The way that I have learned, participated and facilitated groups is collaborative, power-sharing, and has rituals (beginning, middle, end). Group therapy has risks: it can be unpredictable, isn’t 100% confidential, has potential to harm through the way it’s run and other participants. Group therapy can be vulnerable, provoking and deeply moving.

Individualism is the idea that we are all unique and need to be autonomous to achieve realization. Americans are highly individualistic. It’s kind of the American dream: that we all have the power to achieve what we want. We’ve been taught about our rights and freedom and ability to speak/choose from early ages. In individual therapy, you get specialized care to tailor to your needs and goals. More people seem to be interested in therapy and generally more aware of mental health than ever. While individual therapy is efficient (only takes you 50-60 minutes per week or every other week) and gives you the ability to say you’re putting in the work on yourself. Is it really effective? Especially if the issues are relationally, interpersonally driven? You need others to heal and to correct your perception of self/other.

“Do not mistake the appearance of efficiency for true effectiveness.”

(Yalom, The Theory and Practice of Group Psychotherapy).

Maybe it’s not individualism preventing folks from being willing to try group therapy. Maybe it’s more about keeping up appearances: by privately seeing your therapist weekly instead of vulnerably being in community with others, your life can generally stay the same. Maybe this is called fear or shame. In the book The Theory and Practice of Group Psychotherapy, Yalom writes, “People need people—for initial and continued survival, for socialization, for the pursuit of satisfaction. No one- not the dying, not the outcast, not the mighty—transcends the need for human contact.” In the self-compassion world, common humanity is the idea that through shared experiences of pain (all hardships = pain) we can feel less alone in the world (therefore psychologically safe). We need a safe place to heal within relational contexts. This is what group therapy provides. The people in your life may not be able to provide you with unconditional love, are skilled enough to validate you without judgement, or support you the way you need. This is what group therapy provides. Individual therapy can sometimes feel like much accountability, a direct spotlight on you and all your growing edges. Group therapy provides insight into other people’s lives and struggles (common humanity). It can sometimes be easier to learn about oneself when information is applied to others. This is why so much personal growth happens in learning environments. Group therapy allows the participants to hold each other accountable, too but with agreements to keep the group safe. Individual therapy can also be pricey, groups are generally more affordable. There’s many benefits to group that could reduce fear and shame is people could be brave enough to try it.

I’ll share a mistake I made in facilitating a group once. This group had two participants and two therapists facilitating. We had met three times and the roster was just continuing to be low. I thought maybe it’s not helpful to have such a small group and maybe it’s not efficient for me and this other therapist. Without much thought, I pitched the idea of closing group by the fifth or sixth meeting. The two participants were both very vocal about how upsetting this would be, how much they look forward to this group and didn’t understand why would it need to end. I felt embarrassed and humbled. Of course, we could continue. Of course, they were benefitting. How could I have assumed they weren’t gaining something from having this time, space, support and new friendships? Here I am, reinforcing beliefs about efficiency and forgetting my own intentions for initiating this offering. It was a great lesson for me: there is therapeutic value in being with other and a support can be felt with even one other.

I’ll continue saying more about The Way Things Are Going (Part 3) next week! Hope reading about group therapy and individualism might inspire you to say, “I’ll try it!” if/when considering attending group therapy.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

The Way Things Are Going (Part 2): WE WERE ALL ONCE A CHILD

Being a caregiver is arguably the most important and impactful job on Earth. To be a caregiver means to unconditionally provide for the needs of another. Caregivers are literally shaping the future of humanity. This act of love and labor is twenty four hours a day over a lifetime. It is also difficult, emotional, painful, time-consuming, triggering, and unpaid. Imagine that both of these depictions of caregiving are true. Practicing self-compassion for the role of caregiving is so essential.

Some ways self-compassion might sound:

“I’ve given so much and received so much.”

“I trust that I’ll continue to grow in this life and with this family.”

“It’s okay that I get it wrong sometimes. The times I get it right feel good, too.”

Kristin Neff has a specific mindfulness practice just for caregivers here and here.

Becoming a caregiver often allows people to revisit their own experiences of being a child, both good and bad. Intergenerational trauma describes the process of how an individual's or families' experience of trauma can transcend time, impacting future generations (biologically and emotionally) and relationships. Attachment theory suggests that early relationships with caregiver(s) teach a child about what is safe and unsafe about the world. This learning impacts future relationships and the ability to self-regulate emotions. Both of these frameworks and theories are important to be aware of when being in the role of caregiver and human. It is likely that you have experienced life events that have fundamentally changed you, for better or worse.

Sometimes caregivers are unaware of their own wounds, until they are in the role of caregiver and experience this role fully. One of the most beautiful parts about being a caregiver is the ability to heal yourself through being the type of caregiver you, yourself needed as a child. Please know it is never too late to heal. It is never too late to ask for help, seek support, start therapy, learn new skills or create change. 

Becoming the type of caregiver you needed in your own childhood, while fulfilling to you, does not mean that this is the type of caregiver your child needs you to be. This can be a painful realization when not aligned. To become the caregiver your child needs is the most caring act a caregiver can aim to do and requires the ability to be flexible to change and growth.

All humans sometimes feel the need to be in control, or rather have the perception of control. Children and caregivers sometimes struggle between a child’s need to feel in control and an adult balancing all that adults carry. When a child feels a need to be in control, know that this is OK and not wrong, especially when considering how much of a child’s life is really outside of their own control. A child who seeks control needs to be shown appropriate and healthy ways to have control. A child who seeks control may be doing this due to family roles, development, life transitions, mental health, and trauma. It's important to consider the function of their behavior and that behavior is a way of getting their needs met. What are they achieving (or not achieving) from their actions? How could the child get what they need in a more appropriate or healthy way? 

It is expected to see connections 

with your child’s emotions and behaviors, 

and your own.

Reframing a description of a child from one that is stubborn to one that is trying to get needs met is a more accurate and positive way of considering a child's behaviors and intention. It is not helpful to label a child as crazy, disrespectful, entitled, lazy, mean, manipulative, ungrateful, etc. If this need to label is coming up for you as a caregiver, try to explore the trigger (cause of stress) and judgment (what the trigger event personally meant to you and how it was received by you), as this may help uncover ways of thinking for you to work on in order to heal your own wounds. 

Cognitive distortions, or thinking errors, describe ways of thinking about yourself, others, and the world, which are generally oriented in the negative and may be inaccurate or unhelpful. Distortions are known for impacting a person’s physiological responses to stressors and overall emotional wellness. In my experience, most people can identify at least a few distortions in themselves, and people have cognitive distortions for a reason. The wounds you carry as a human and caregiver are also wounds other people carry. Being a human and caregiver with wounds to heal, means that there are likely moments when your wounds impact your ability to parent effectively and can sometimes lead to (re)-producing harmful experiences for a child. Acknowledging your own part in the relationship is crucial to making intergenerational change in your family. Prioritizing your own healing is the best thing you can do for your child.

A child's intention is to get their needs met,

 however they can. 

Their intention is most likely not 

to make your life harder or hurt you. 

It is the caregiver’s job 

to teach and help the child arrive 

at the many healthy ways to get their needs met 

and to re-shape maladaptive behaviors.

If you take away negative assumptions (about yourself or about your child) and remember the mindset of a child, you may begin to feel less triggered. It is unfair to position the child to the expectations of an adult's cognitive abilities. The brain of a child is still developing and every interaction is an opportunity for learning. Assume positive, assume with lightness.

Call for Reflection & Call to Action

Try to recall and remember what it is like to be a child. You already have this innate wisdom within you. You were a child once yourself. You may recall what it was like to feel powerless or to feel parented.

How can you act with this “I was once a child, too" mindset?

How can you give (act) yourself more compassion for your growing edges (parts that you are still working on)?

There’s a few more parts to this series that I look forward to sharing. The Way Things Are Going series is intended to be both empowering and thought provoking for caregivers. At times, moving through this blog series may feel heavy. I’m hoping for caregivers to examine their part in the caregiving relationship, in order to make positive changes in the family and to provide themselves with healing knowledge. I hope this blog helps you say something compassionate when reflecting on your journey.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

The Way Things Are Going: The Healing Caregiver (part 1)

The Way Things Are Going comprise a series of writings I’ve been working on for a while. It originally grew out of personal reflections and journaling from my therapy work with children, adolescents, and families. Over the years, I have worked as a mental health therapist in a variety of settings, and before that: a nanny, a yoga instructor, an administrator and artist. Through navigating the different levels of mental health systems and working with so many different people, I developed a clear vision of the reciprocal ways in which environments impact a child and family—as well as the ways a child and their family deeply effect each other. (For marriage and family therapists, I guess this is a systems perspective.) I’m seeing connections, patterns, and generational themes emerge across peoples and places. Many families I have worked with share similar issues, concerns, dynamics, experiences and frustrations, yet often are feeling alone and at a loss about how to parent. This is why I’m so passionate about supporting the parent/caregiver(s). Sometimes, the best way for me to help a child is through making changes at the caregiver level. 

I have intentionally chosen to use the word caregiver (and will continue in future posts), rather than parent, because I want to acknowledge the complexity of the role of parent and the various ways in which adults have caring relationships with children. It is possible, and very common, for any adult who has a child in their life to heal their own inner child both through their role as a caregiver and the relationship with the child. I hope to support caregivers in feeling understood, while also compassionately challenging them to break unhelpful patterns and heal. 

While it’s inevitable that often the role of being caregiver is healing, I think it’s often at a disservice to the child. Being the parent you needed as a child, does not mean that is the type of parent your child needs you to be now. All children require the adult(s) to become the caregiver(s) they need. Children often express their needs with little/no awareness or words to say what exactly that might be. It’s difficult. It’s triggering. It’s not work you have to do alone, even if you’re doing much of the labor of caregiving alone. Having your own support system, therapist, group will only help you be a more patient and emotionally available person for your family.

A simplified understanding of being a caregiver describes the ongoing discovery of identifying the child’s needs and adjusting to provide them the care they deserve (even if it’s not the care you received yourself in life). It is ideal for the caregivers reading this to make connections between their own histories and the family they are creating. For many caregivers, it can be easier to say a child “has issues” than to admit “I am having issues parenting” a child. For many caregivers, it can be easier to say “my child suffers” instead of “I’m suffering” or “I suffered as a child”. It should be understood that the experiences of being parented impact how care is provided to others and extends to all relationships (including the relationship with oneself).

Reflection Questions:

• How did you learn to be a parent/caregiver?

• How are things going in your home? With the relationships in your life?

• When was the last time you spent time thinking about what would make you feel joy or peace?

• Imagine a future where the challenges that exist now are happening less often and you are able to cope better with the challenges that arise. How will you know what “better” has arrived? What will be different? Be willing to identify specifics in behaviors or dynamics, dive deeper than feelings-based results, and be cautious of seeking happiness as a destination. 

The way things are going may include the past, the present, the things that are working well in your home, the good times, the in-between times, surviving the day to day, the times that are a real struggle, and the things that absolutely need to change. Making change happen and deviating from the path you are on currently is not an easy task. It’s important to cultivate motivation by considering what is at stake if change does not occur. Is your happiness at risk if things stay as they are? Is your bong with your child (or partner) at risk? Remember, the alternative to change is that things will continue as they are now and the feelings about the way things are going are likely to continue growing. Maybe it’s okay for things to continue as they are now, maybe it’s not. Your feelings and reflections while digesting this post is a snapshot of how are thing are going at this moment in time. Write it down, save it for review at a later time.

Practicing self-compassion for where you are at in this very moment can include:

• mindfully noticing what you feel by labeling emotions and sensations in the body

• acknowledging the community humanity that there are likely other caregivers who feel what you feel

• creating a message of self-kindness or encouragement to yourself.

The content I’ll be sharing more about in future posts within this series is intended to be both empowering and thought provoking for caregivers. At times, moving through this blog series may feel heavy. I’m hoping for caregivers to examine their part in the caregiving relationship, in order to make positive changes in the family and to provide themselves with healing knowledge. I hope this blog helps you say something compassionate when reflecting on your journey.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

OCD is not an adjective

This week, I’m saying more about OCD and being an OCD therapist.

Somehow mental health diagnoses make it into mainstream culture in ways that are minimizing and further stigmatizing. I remember back maybe 5+ years ago it was “this weather is bipolar” or jokes about suicidal ideation “if that happens, I’ll die”. In the past couple years there’s been more and more OCD versions of this “I’m so OCD” or “Arent’t we all a bit OCD?” 

The way OCD is used casually in our culture really does not represent OCD or capture the experience of living with OCD. Generally: if you enjoy it—-it’s not OCD. The stereotype of someone arranging the bookshelf just so, or washing their hands repeatedly are not the most common experiences of OCD, at least in my experience working with people. OCD is made of two parts: obsessions and compulsions. You can read much more about it here. One of the main therapies and most effective therapies (with medication management) is Exposure and Response Prevention (ERP). It’s also made up of two parts: exposure & response prevention. It is a very different therapy and one I’m super passionate about.

In my experience working with people living with OCD, the stereotypical examples of what OCD is, is not what most people experience. Here’s a snapshot: Imagine doing something you know is irrational, but feeling like you have to in order to avoid really scary things from happening. Imagine not being able to move on with your day or blink because you’re replaying everything you did that day (or years ago) to make sure you didn’t harm someone. Imagine washing your clothes every time a negative thought occurred. Imagine feeling responsible for the thoughts your brain comes up with. These are the sorts of beliefs OCD convinces people of. It’s not a personality trait, it’s not cute or funny, and it’s not an aesthetic decorating choice. People who experience OCD would be the first to tell you they wouldn’t wish it on anyone. 

OCD is not an adjective. I love that this phrase is becoming a sort of movement calling attention to the way mainstream culture misuses then invalidates people’s real life mental health experiences. It feels like we’re all living in a time where more people are aware of mental health issues than ever, while simultaneously there’s a common narrative that each generation is getting more “soft”. By calling attention to problematic happenings in our collective culture, perhaps like pointing out misuse of mental health terms in common vernacular, we can take shed light on something important and take personal responsibility.

A few challenges to being an ERP therapist are: supporting people gain confidence in the ability to face fears (ERP is hard work), building insight, getting distance from thoughts (cognitive defusion),  encouraging self-advocacy, learning/practicing to do nothing in the presence of anxiety, and teaching people’s support systems how to strengthen the work their person is doing in therapy.

In training to learn ERP, there’s instruction on how therapists can identify and respond to the validity of someone’s anxiety. Essentially, that someone can be experiencing anxiety for invalid reasons (imagined, hypothetical, irrational, illogical, etc.) and the therapist should be careful to validate the difficulty of experiencing symptoms, not the reason for having fears itself. This is because ERP therapists do not want to reinforce the fear cycle that people with severe anxiety and OCD get stuck in, which often drives compulsions. To not validate OC-thinking, therapists are challenged to demonstrate an understanding of a clients experience without strengthens OCD and anxiety.

This was super hard for me, personally. Coming to this particular niche as someone with a trauma focus and a lot of art therapy experience I had thought the main role of any therapist would be listening/validating. I questioned how it’s possible to be a warm therapist and not validate someone’s feelings? Today, I know so much more and understand how to balance being warm, caring, supportive and strong in the presence of strong OCD symptoms. It’s actually helped me think through and be more specific about how I validate all people.

One phenomenon I have noticed with people who have been in therapy for a while, especially those with trauma histories and those who have ERP experience, is some difficulty trusting one’s judgment and feelings. OCD by nature causes people to second-guess feelings and even the symptoms. OCD is called the doubt disorder. Therapies like ERP and ACT can encourage anxiety sufferers to lean into fears despite feelings, to not engage in safety-seeking behaviors, and to learn to take thoughts/feelings more lightly (rather than literal truth). Sometimes, self-doubt or being mistrustful of feelings comes as a result of successful therapy. It’s what being self-reflective requires, but it’s not black and white. In trauma, people often feel disconnected from themselves or reality (depersonalization/derealization) because the brain is protecting itself from actual danger. In OCD, people’s brains are misfiring often confusing hypothetical or imagined danger from actual danger. People with OCD can be known to also question whether their obsession or intrusive thought occurred or if symptoms they are experiencing are even real. Finding a therapist who really understands OCD, has ERP training and experience are important criteria to consider. I recommend looking for folks through the IOCDF website.

A nuance to consider is that people with trauma histories may have severe anxiety for valid reasons, even if the danger is imagined or irrational. While anxiety symptoms, like hyper-vigilance, may have helped a person possibly survive the trauma in the past, it may no longer be necessary to continue doing (post-trauma), but the brain has not learned another way. Through ERP and cognitive restructuring, new learning occurs and so much healing can happen. I believe in the power of ERP and hope to expand on it’s use with sensitivity.

In general, for folks who’ve done ERP or are in the maintenance phase of OCD management, I find that learning to practice self-compassion consistently is beneficial for recovery. Kimberly Quinlan has a wonderful workbook and Kristin Neff has a lot of free content out there. I’m sure I’ll write more on this in the future too: practicing self-compassion can feel like an exposure. Here’s a couple self-compassion with OCD examples using the 3 tenets (Neff & Germer):

Mindfulness:

OCD is really giving me a hard time today.

I’m noticing a thought about ___.

Common Humanity:

I know other people out there share my same OCD theme. Others with OCD struggle with this compulsion, just like me.

Self-Kindness:

I’ll do my best to keep trying to resist/delay compulsions and not to disqualify myself from care or love if I have a rough day.

My thoughts and obsessions don’t represent me.

I’m worthy of love and care no matter what I think about.

While OCD is not an adjective itself, calling OCD complicated is one adjective I’d bet many would agree on. I hope this post helps you say OCD is not an adjective the next time you hear it used like one! Looking forward to saying more next time, about parenting.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

ANXIETY, BOUNDARIES & SELF-ABANDONMENT

I’m writing to say more about the gray areas of anxiety, boundaries, and emotional wounds.

It’s taken me two weeks to write this post because I got stuck navigating the direction to take this topic. I started off with the question: “Is it anxiety or is it personal boundaries?”. In my draft last, I found myself wanting to infuse OCD and ERP treatment into the topic of anxiety and personal boundaries. I want to acknowledge that this entry would be a different post with OCD in mind. To say this topic is nuanced might be an understatement. The area that I’ve landed on for now, is the intersection of anxiety, boundaries, and emotional processing. I may expand on this topic in future writings, since it’s now clear to me how much more time this heading deserves. Thanks in advance for you patience with me as a new writer and your support in reading!

Note: The cultural perspective I am writing from is Westernized, US American Woman (white bodied, cis). I acknowledge my privilege and know my perspective isn’t going to be relatable to everyone. In this writing, I use the phrase “our culture” to reference the shared culture of living in the U.S. during this time in history and the societal/systemic impacts. That being said, please know I try my best to be sensitive, humble, and a lifelong learner.

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

—

Maybe it was the 2016 election, maybe it was the visibility of civil unrest, maybe it was the pandemic, maybe it’s ongoing global crises…but many people have felt an increase in anxiety and relationship issues in the past several years. Generally, it seems like more than ever there’s a self-awareness about mental health issues in our culture. I’m glad for the awareness and insight growing among people in this country. Yet, I feel that there is a tendency to label, or diagnose, problems as an ending point, rather than a beginning. Labels are an invitation to learn more and to invest time in uncovering reasons for its existence, which requires a personal responsibility to making inner/outer changes. Whether anxiety is biological, environmental, socially or situationally created it’s yours to understand and manage. This is hard to accept. This is painful to accept. It requires labor from the sufferer.

Anxiety itself may actually be a symptom of something else: a lack of social skills, attachment wounds, boundary violations (or a lack of boundaries altogether), co-dependency, communication issues, emotional neglect, fused thinking, harmful or highly conflictual relationships, issues with self-worth, lack of coping skills, limiting self-beliefs, low frustration or distress tolerance, self-abandonment, and thinking errors. Emotional and relational issues might be a cycle in which anxiety, fear, and self-criticism are abundant. To me, what’s exciting about considering the issues listed above as the potential drivers of anxiety is all the advocacy, choice, and personal empowerment that exists there: so much potential for healing.

It may seem a bit like a chicken-egg scenario and in some ways, that’s a fair description. So how do we make sense of this?

Here’s my way of scaffolding this big topic:

• Experiences of anxiety symptoms

• Reframing the presence of anxiety

• Exploring & identifying emotional drivers

• Full body listening

• Needs and boundaries

• Self-beliefs

• Self-compassion

• Practice authentic self-expression for well-being

A place to start self-discovering and unpacking anxiety roots might be to first think of some real life examples of when anxiety was strong in you. When does anxiety visit you? What was a situation you were not looking forward to? Identify some specific contexts, body language, communications, dynamics, environments, events, factors, interactions, peoples, and situations in which anxiety is abundant for you. What do you notice? There may be important information to reflect on.

A self-compassion technique called “full body listening” encourages information gathering (and later attending to) on sensations in the body during emotional moments. This self-compassion technique is from Kristin Neff and Christopher Germer who wrote the Mindful Self-Compassion Workbook. The idea being the body can be a guide for understanding and processing difficult emotions.

One way to “listen with the body”:

When you think of ____ (insert a specific difficult person in your life, dinner invite, receiving a lengthy text message, or other anxiety-inducing component), what do you notice happening within your body? Is it heavy? Is it hot/cold? Is there a lump in your throat? Is it feeling like a rock in your stomach? What would that part of your body that’s calling out with anxiety say?

Sometimes the body knows something isn’t okay, before the mind catches up. It’s hard to discern worry from wisdom.

In the context of this post, the body experiencing anxiety can be an indicator of a need and/or boundary. (This isn’t always true of body sensations and working with your therapist on this is a good idea.) Everyone has needs and boundaries. Where the body shows discomfort or resistance in stressful conditions can be a place to start. Although all humans have needs and boundaries, whether they are known or expressed is another thing. Remember, boundaries are not just for other people to follow, they are for you to follow, too. If you’re unclear what yours are, know that it’s OK and that it’s important for your well-being to further explore. This is the value of therapy and this is what a good therapist can support. It’s hard emotional labor and labor you don’t have to do alone.

A hypothesis I have is that anxiety can be created as a result of not being true to yourself (i.e. self-abandonment). If you are not expressing yourself, you may be more likely to feel anxiety. I’ll add a few words onto that last sentence, so it becomes even more enlightening: If you are not expressing yourself to the people you care about and who care about you, you may be more likely to feel anxiety around them.

If you give more than you are comfortable giving in relationships, this can cause anxiety and this is you violating your own boundaries (self-abandonment). Self-abandonment sounds like what it is: abandoning the self. It happens when a person seeks psychological safety by putting themselves second in a way that is actually harmful. This can be related to maladaptive coping and trauma surviving, too. Maybe this is where chicken and egg meet.

Sometimes in our culture, people receive the message that having needs is bad—selfish, a burden to others, unrealistic, “too much,” etc. People can internalize this messaging and in turn, create painful and limiting self-beliefs. It makes being aware of needs difficult. It makes identifying them, creating/enforcing boundaries and communicating effectively really difficult. Statements like, “I don’t want to hurt people’s feelings,” “I don’t want to bother them,” or “Saying how I truly feel would be rude” are indicating some areas to work on.

The choice of making someone else potentially uncomfortable/unhappy or tolerating a lot of anxiety yourself, is really a question about self-abandonment.

It may come as a surprise just how much depth there is to anxiety and the importance of authentic self-expression to well-being. The inner turmoil (anxiety) that gets stirred up when a boundary violation happens is an opportunity to make personal changes. Boundary violations can be experienced as someone harming (emotionally or physically) you (intentionally or not), someone doing or saying something you’ve expressed not wanting, and sometimes even being triggered unexpectedly. It’s possible to violate your own boundaries as well. When you violate your own boundaries by putting the feelings of others ahead of your own (in a way that causes you pain), you are self-abandoning.

Some examples of painful self-beliefs that can allow for boundary violations and self-abandonment are:

• “The feelings of others matter more than my own.”

• “My needs go unmet, so why bother trying to share what they are with others.”

• “I’ve been hurt so much by other people, it’s best not to let them see/hear the real me.”

• “If I’m truly myself, I could be rejected and the pain would be too much to bear.”

• “If I don’t give everything I have to friendships/relationships (even though I don’t get much from them back), I’ll end up alone.”

• “I’d rather suffer through this then deal with another person’s anger/emotions.”

A therapist once asked me, “Do you know—your feelings matter the most?” The implication was that my feelings should matter to me the most and behaviors can support that. It was a powerful moment.

While our culture may condition people to think centering ourselves as our priority is selfish and narcissistic, it’s not true. It might be very harmful to not center ourselves in our lives. The trick here is not to expect others to center us. While it’s important to be thoughtful and compassionate towards others, we cannot do this at the expense of ourselves. When the brain receives distress signals, even emotional and anxious ones, it causes physiological responses. This is why chronic stress is so damaging to people’s health. All of us have a responsibility, to ourselves, to cope with (regulate) feelings as they come up.

If reading this brought anything up for you emotionally, that would be expected and OK! It might be a signal to seek therapy and/or do more inner work independently. Here’s a couple recommended meditations that encourage self-compassion.

Anxiety therapy can encourage people to lean into discomfort—to tolerate anxiety is to manage anxiety. Leaning in is not always a healing path when anxiety is coming up due to emotional wounds. When you begin to center your own feelings and needs as a priority, there will be chances for vulnerable acts of authentic self-expression to take place. I hope this post helps you say something different in the presence of anxiety and to take opportunities to be your true self.

-Sarah

What If It All Work Out: Anxiety & Common Humanity

This week, I’m saying more on anxiety, “what if-” thoughts, and accessing compassion through common humanity.

Anxiety can be about both past and future. Something happened in the past that you didn’t like and have difficulty accepting, so you think about it additionally and worry about it (more to say about this in future posts). Anxiety can also be future oriented focusing on hypothetical happenings and possible outcomes of life events experiences. Some of the most common forms of anxiety are felt though body sensations and “What if-” thoughts.

Anxiety can appear as doubt, excessive worry, digestive issues, feeling keyed-up or on-edge, irritability, muscle tension, restlessness, uneasiness, rumination, stress, and more. Body sensations would include somatic experiences of anxiety such as cold/hot, heaviness, pain, sweating, tightness, tingling, etc. Experiencing anxiety is one of the most common experiences across identities. No one is immune to worry! It’s human nature to experience anxiety.

The brain associates survival with the ability to predict danger, so naturally the brain looks for areas to worry about to feel more safe. The irony is not lost. Why doesn’t the brain consider all the times in life when you’ve already coped with difficulty? Or that time when things did go unplanned and ended up somehow being okay? Some brains worry more than others and for a variety of reasons such as biology, environment, genetics, trauma history, etc. These factors can be the difference between just a worry and an anxiety disorder. Thoughts that start with “What if-” and end in a negative or undesired outcome are typical of anxiety. For some people, anxiety starts with physical discomfort or unease. Sensations and thoughts can make the brain believe it’s in danger, which is why anxiety feels so scary, even when it’s about hypothetical situations. Humans are hard-wired to desire certainty and predictability to feel safe in the world. But this doesn’t mean every worry thought or “what if-” is worth our time or is reason enough to take action.

Some people experience more anxiety than others and not all anxiety is bad. Anxiety can motivate us to make moves and attend to necessary things in life. When it becomes a problem is different for everyone, but generally if it’s getting in the way of achieving goals, bodily consequences, is out of balance to other emotions, is affecting others, or sleep. Biology, environment, and trauma experiences can be factors in the existence and persistence of anxiety. From a trauma informed perspective, it’s important to consider a person’s lived experiences and self-beliefs as sometimes a reason why anxiety persists, even when there is no present danger. If big T or little t’s have been a consistent part of a person’s life, hyper-vigilance may have at one point been needed to survive. Anxiety experts suggest that by reacting to anxiety as if it is real danger, we inadvertently are reinforcing the brain to be reactive which strengthens anxiety.

The practice of self-compassion is correlated with a reduction in symptoms like anxiety, rumination, and depression (Warren et al., 2016). One of the three tenets of self-compassion that Kristin Neff and Christian Germer identified is common humanity. Common humanity is the understanding that pain is universal and acknowledging this can be regulating (make us feel safe again). Pain is the root of hard experiences and difficult emotions: anxiety is pain, deep empathy is pain, grief is pain, stress is pain, unmet expectations is pain, “What If-” thoughts are pain, etc. We can learn to be more compassionate to ourselves and others through acknowledging shared experiences. This isn’t to say pain experiences should be compared or universalized, as this would neglect the very real pain certain communities face more than others. While everyone’s experience of pain is unique and not comparable, the experience of having pain is shared. The brain associates safety with a sense of belonging. When we can acknowledge that others share in our pain, we tend to feel less threatened by the pain. The common humanity of anxiety excites me as a therapist, but also as a person also living with generalized anxiety. The things you tend to worry about are most likely worries shared by others, too. This is why OCD has several identified themes and why core fears often boil down to similar points (I’ll blog more on this in the future, too).

How can you determine whether worry is worth your time or deserves action? Why might anxiety be showing up? When do you know when to respond to and when to sit with it? It depends! In general, ask yourself if the topic or urge to take action is rooted in fear or values. For many people, anxiety shows up around the things we value, but is driven from fear of experiencing something unexpected or an outcome that is less than ideal.

There are many ways to manage and cope with anxiety. There’s not one way that works best for everyone and I encourage people to be open when practicing new ways of thinking and being to find what works for you. Personally, I’ve gained so much from self-compassion work and have seen first hand in my practice how powerful this can be for others. Self-compassion has been shown to increase therapy efficacies across modalities (Wetterneck et al., 2013).

Next time anxiety or “what if-” thoughts show up, try one of the practices below. There’s a selection of ideas here that I often use myself to cope and that I bring into my therapy practice:

• Accepting the uncertainty that comes with life. Accepting does not mean liking it.

• Allowing thoughts to be there and for time to pass. This can be the hardest and most important skill with with anxiety and OCD management!

• Checking in on vulnerability factors. Marsha Linehan’s DBT skills offer the idea that there are a variety of factors that contribute to us being more vulnerable to intense emotions. Checking in on things like new or ongoing conflict in relationships, body needs, food, physical pain, sleep, stress, etc. This might help explain why anxiety is more intense at certain times.

• Externalizing worry thoughts through a character or object. I chose “Veronica” for my anxiety. Here’s how I use it: “Oh, Veronica is showing up today! Thanks Veronica, appreciate the doom-and-gloom vibes!” By distancing my core self from my thoughts I’m able to take things more lightly. There are lots of other examples of applying this method in the Acceptance and Commitment Therapy world.

• Labeling: Identifying worry thoughts and worry sensations as exactly that!

• Mindfulness: Focus on what is actually happening in the present moment, rather than all the future possibilities.

• Reframe: Consider other alternatives to the What-if including some neutral or even positives. Like “What if nothing goes wrong at all?” or “What if something amazing happens?” or “What if something doesn’t go exactly like I planned, but it’s actually okay.”

• Self-compassion with common humanity: Think of others who might have experienced this situation as well. You are not alone here. Saying a message to yourself about this experience being one that is shared, rather than one that only you are coping with. What might you say if someone you care about was experiencing this same thing? Direct this toward yourself. Can you validate that your anxiety feelings are difficult? This is different than validating anxiety itself.

Hope this read helps you possibly understand yourself and others more. Above all, I hope this post helps you say something different in the presence of anxiety and “What-if” thoughts. Thanks for reading!

-Sarah

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.

Say With Sarah: Not just another therapy blog

RE: About Me

I am an artist, therapist, dog parent (with some lacking boundaries) + human who deeply cares about people and mental health!

Hi there!

I decided to re-work my initial post “What If …it all works out?” to explain a little why I’m here, what I have to say, and how I intend to post writings.

SAY WITH SARAH is the name of my business. Almost a full year ago, I transitioned from group practice into private practice. When I was thinking about a business name, I asked friends and colleagues to help me create something with meaning that I could use in more than my counseling practice. I hoped to metaphorically, and literally, say something important with it. So here I am, composing, and re-composing, a blog post for the first time during a time when there’s an abundance of mental health providers doing the same. There are already many therapist social media profiles and blogs that exist. I also believe in the unique quality that every person has to offer the world through being themselves. There’s a reason why therapist fit is one of the leading factors of therapy efficacy. The writings here will offer information on a few specific topics, personal therapy reflections, literature reviews, and the only thing that sets me apart from others: my perspective.

The majority of therapists find a niche area in the mental health field that they are most passionate or skilled at working with and name it as their speciality. Most providers also come to this field for a reason: they, themselves have experienced conflict, hardship, loss, mental health issues, trauma, etc. and/or have people in their lives impacted by mental health issues. Therapists, in general, are taught not to disclose much about themselves to clients. There are some interesting reasons behind disclosure beliefs, which I may blog about in future posts, and yet, people need to know enough to assess a good therapy fit of their therapist. We’re also living in a time where people are really benefiting from connecting to therapists online in nontraditional ways. Through blogging about the topics I care most about, I hope that my fellow peers, prospective clients, and people interested in mental health will learn something new, think deeper about their experiences or the experiences of others, and grow more compassionate. By interacting with my blog, I hope people can learn to say something, too.

The topics I’m most passionate about in my practice include:

• Anxiety: Anxiety is one the most common experiences and creates so much pain. I have lived with GAD for a long time and understand from a personal place the nuances of anxiety. I really love empowering kids, adolescents, adults, and families on how to manage the worries as they come up in life.
  
  

• OCD (OC-Spectrum): Anxiety and OCD are interrelated. I learned deeply about OCD for the first time through my therapy mentor and through working at Rogers Behavioral Health. This was the first time in my therapy career where I felt so intrigued and excited to learn. Relating to anxiety helped me understand the obsessive-compulsive cycle. Since then, I’ve dived into the OCD world and truly enjoy helping people get back time, freedom, and joy. What excites me about OCD is how obscure yet predictable it works, that there is a clear path on how to navigate it, and the role of the therapist is much more active.
  
  

• Parenting: Parenting is such a big topic and such an important one. We are all parented and have special knowledge of what it’s like to be a child. Parent coaching, parent training, family therapy are all areas that I care about deeply. I’ve worked with children for a long time: from being a kids yoga teacher and nanny pre-therapy life, an art therapist for children on the Autism Spectrum, and mental health counselor for children and families in crisis in community based settings. There is a lot of beautiful change that can happen at the parent level and sometimes the best way to help a child/family is by supporting the caregivers.
  
  

• Trauma: It’s an honor and privilege to be a trauma therapist. There are big T and little t experiences, both are valid and worthy of spending time processing and healing. Being trauma-informed means a therapist has specialized training and knowledge about how to interact and support folks who have lived through trauma. Supporting and helping people and their families recover and thrive after trauma is both rewarding and heavy.
  
  

The areas that I specialize in are also topics that co-occur in the lives of people. Across the board what I notice the most in therapy is the ability to be super compassionate towards others and a real absence when applied to the self. I look forward to diving more into these areas in the future and offering my say.

Thanks for reading!

-Sarah

*Disclaimer: My posts here are not intended to be a replacement for individual psychotherapy; the content is my opinion based on my life experiences and education; and, the content is not going to be ‘a one-size fits all’ model. If you are suffering, please reach out to your supports, seek out a therapist of your own, and contact crisis lines like 988 if needed.