Stress & Anxiety In The Tech Industry

Written by Lauren Helm, Ph.D.

"More than three-fourths who say stress interferes with their work say it carries over to their personal life..." - ADAA Workplace Stress & Anxiety Disorders Survey

Working in the tech industry can exceptionally rewarding and exciting, offering employees the opportunity to engage in challenging, creative, and meaningful projects, while also receiving great pay, benefits, and perks. The tech industry is known for valuing innovation, creative problem-solving, and the development of products that can have a huge impact on our daily living. Flexible work schedules, remote working options, and investment in employee professional development and self-care (free food and drinks, yoga, and meditation rooms!) are now the norm for many employees in the tech industry. The emphasis on taking care of employees’ needs has been a positive outcome that was driven in part to draw in talent, prevent turnover, and improve productivity. Despite the tech industry's emphasis on treating employees well, those that work in tech are not immune to other aspects of the tech world that create conditions ripe for high stress and anxiety. Although not true of every tech company, many tech industry employees face pressure to work long hours, be consistently productive, play multiple roles, and meet urgent or unpredictable deadlines. Unfortunately, anxiety and stress in tech is commonplace, but not often openly discussed. However, it is nearly impossible to ignore the impact of workplace stress because it bleeds into so many other important areas of our lives, affecting our energy, relationships, play, financial security, self-care. and sense of satisfaction or purpose in life.

Understanding Work Stress

What makes a job stressful? Generally, job stress is thought to be a result of an interaction between the employee and the working conditions. In other words, certain people will be more stressed by certain jobs. Sometimes our personality or coping style is not be a good fit for the demands of a particular type of job. Some people thrive in fast-paced settings, and others are worn down by them. When the job is not a good fit for someone, job stress is likely to occur.

Though unique employee characteristics often affect a person’s sense of stress in the workplace, for most people, feeling overtaxed, overworked, and minimally supported are universal recipes for increased job stress. Other sources of job stress may be certain workplace conditions that lead to stress, as identified by the CDC’s National Institute for Occupational Safety and Health (see NIOSH job stress article here), including the design of tasks (i.e. workload, breaks, length of workdays, tasks that don’t having meaning or provide a sense of control), management style (i.e. poor communication, not involving employees in decision-making), interpersonal relationships (i.e. lack of support from coworkers or supervisors, conflict with coworkers), work roles (i.e. unclear expectations or too many job responsibilities), career concerns (i.e. job insecurity, no room for growth), and environmental conditions (i.e. potentially dangerous working conditions, including crowding, noise, pollution, ergonomic problems). Universal psychological factors discussed in this APA blog that often lead to job stress include a sense of powerlessness and traumatic events that occur while on the job.

Stress in the Tech industry & Start-Up Culture

Those who work in the tech industry or in start-ups often face anxiety-provoking work environments on a daily basis, dealing with fast-paced and high-pressure environments that demand significant and sometimes unforgiving amounts of flexibility, creativity, and productivity. It can feel like life is being consumed by work, instead of being supported by it. Larger tech companies may leave employees feeling overworked and undervalued, like a "cog in a wheel," despite the significant time and effort they sacrifice in the service of the company. Start-ups may feel chaotic, unpredictable, and disorganized. Although employees may be expected to take on multiple roles, and projects require urgent attention, there may be poor guidance and communication, leaving employees frustrated and confused. Irregular sleep schedules and social isolation deplete needed inner resources for coping. All of these conditions are a recipe for chronic stress, anxiety, and depression, exacerbated by a culture of silence around mental health that deprives employees of much needed support and time for self-care.

Coping with a Stress at Work

Ultimately, stress both inside and outside of the workplace can have a significant impact on our ability to thrive. Selecting the most supportive work environment possible, and learning how to effectively manage stress, can potentially tremendously impact not only psychological and physical well-being, but work-performance and success as well. However, whether you work in tech or not, it is not always be possible to work at a job that is a good fit for your personality or needs. If you struggle with chronic stress or anxiety as a result, know that you don't have to suffer in silence or alone. Getting support is crucial: whether it be from friends, family, support groups, or a therapist you trust. Additionally, coping with the day to day stress as best you can with healthy strategies can help. Here are a few tips for coping with the often unavoidable work-related stress:

• Use a planner or calendar system to keep track of your schedule of activities: Although we often use multiple online, paper, or smartphone calendar systems, try to stick with just one (or two, if necessary) calendar or planner so that keeping track of your schedule doesn't become too complicated. For some, using a web-based calendar that can be easily updated and has automated to-do reminders integrated in is most effective, for others, using a paper-and-pencil weekly planner is more intuitive and intrinsically rewarding. Find a system that seems clear and easy to follow, and reference your planner regularly. This saves cognitive energy, because you don't have to hold everything you need to do in memory, and you can free up your attention to what needs to be attended to in the moment. Track work-related obligations and make sure to block off time in your schedule after work for valued-activities, self-care, friends/family, exercise, healthy eating, relaxation, and fun!

• Try to avoid over-scheduling your work day (if possible) and home life: Regular use of time-management skills is often essential for maintaining healthy work/life balance when you work at a high-pressure workplace. If you have the ability to go home during a set time, do your best to follow that consistently. Depending on your unique situation, it may be helpful to avoid long hours in the workplace at the expense of other important aspects of your life, such as your physical health, relationships with friends or family, or time spent on hobbies or passions. Ask yourself: Am I working to live, or living to work? Can work be a part of my life, not all my life?

• Try to create a separation between your work day and personal life in whatever way is feasible. The line between work and home life does not need to be rigid. Although healthy boundaries that separate work and home life can be difficult to create with the quickly changing landscape of the tech industry, they may prevent you from carrying the stress of work home, and give you the opportunity to experience restoration by focusing on rest, relaxation, and play.

• Allow yourself time to decompress and unwind after work: If you live with other people, it might be helpful to take 15-30 minutes to yourself to rebalance after a hectic workday before interacting so that you can prevent spill-over stress (so often we get into arguments because we are worn thin from a bad day at work). Try to let your loved ones know in advance that you taking this time is nothing personal, this is just a needed self-care routine and that allows you to be more refreshed and connected afterwards. Practice activities that help you release the tension of work as much as possible, whether it is a hot bath, a walk of silence in nature, listening to music, engaging in aerobic exercise, riding your bike, meditating, or journaling about your day.

• Make sure to take your workday breaks. For some, it can be tempting to skip or shorten lunch or other work breaks to make sure you finish that important project on time. However, try to prioritize breaks just as you would any other work requirement. Your mental health and well-being is critical for sustained effort and attention. Try to use your breaks to do non-work related activities - think of it as "you" time. Use the time to hang out with coworkers, to exercise your body, or to practice stress-management activities outlined below. If your job offers you self-care based-perks, make sure to take advantage of them to help you to refresh and restore.

• Use stress-management & relaxation techniques throughout your day. During every opportunity that you can (e.g. allowed work breaks), practice relaxation and stress-management techniques to care for your body and mind. Exercise is a stress-management activity that can help discharge the physiological buildup of energy from anxiety or frustration, or energize and activate your mind during mental slumps or brain fog. Take the opportunity to walk (outside, if possible) during a break. Practice slow, diaphragmatic breathing at about 6 breaths per minute (5 second inhale, 5 second exhale) for 5 minutes to create physiological balance. Do gentle stretching after sedentary periods. Use a mindfulness app to help guide you through a 5-mintue meditation break. Use a creative outlet using a doodle book. Pay attention to whatever nourishes and restores you.

• Remember that you can't be perfect, and that's okay. True perfection isn't possible. A fear of failure often underlies the drive for perfection, but "failure" is often a necessary ingredient for learning and growth within multiple contexts of our lives, including our jobs. Try to remember that everyone you work with, including your boss or CEO, is imperfect, even if they do not show it. On a practical level, If you find that your job description and what you are actually doing in the workplace consistently don't match up, it might be worthwhile consult with someone about whether to talk about this with your employer to clarify expectations and brainstorm ways of addressing the discrepancy, so that both your and the organization's needs are better met.

• Speak up about the importance of mental health: Mental health stigma is a powerful oppressive force, often leading us to hide our emotional pain, and feel isolated and alone in our suffering. The reality is, approximately 1 in 5 individuals experiences mental illness within a given year. Anxiety and depression are much more common than most people think. Cultural myths that anxiety or depression are signs of "weakness" can be especially prevalent in certain industries. Stigma perpetuates shame and fear of judgment, creating a cycle of silence and suffering that prevents many from seeking needed support. Avoid shaming others who appear struggling. Invite open, accepting dialogue, recognizing that we are all human, and we all struggle.

• Get support.

  • Open Sourcing Mental Illness (OSMI) is a non-profit devoted to spreading mental health awareness, education, and resources within the tech industry.

  • Check out Startups Anonymous, a forum devoted to providing anonymous and positive feedback for those struggling in the tech industry.

  • Prompt is an initiative started by members of the tech industry to start more conversation about mental health in tech.

  • You might search for online or in-person support groups near you.

  • Receive support by opening up with trusted family members or friends.

  • Consider scheduling an appointment with a therapist or counselor to receive additional support, especially if anxiety or depression starts to pervade your life.

  • Talkspace is a subscription-based app to talk to therapists and counselors via text and video chat.

Know that you are not alone, and there is help available.

Follow Rise Psychology on Facebook or Twitter (@risepsychology). 

References

Sauter, S., Murphy, L., Colligan, M., Swanson, N., Hurrell, J., Scharf, F., Sinclair, R., Grubb, P., Goldenhar, L., Alterman, T., Johnston, J., Hamilton, A., Tisdale, J. (1999) Stress...at work. Retrieved from http://www.cdc.gov/niosh/docs/99-101/

Miller, L. & Smith, A. Stress in the workplace. Retrieved from http://www.apa.org/helpcenter/workplace-stress.aspx

Weiss, S. & Molitor, N. Mind/body health: Job stress. Retrieved from http://www.apa.org/helpcenter/job-stress.aspx

Exposure Therapy: Find Freedom From Fear & Anxiety

Written by Lauren Helm, Ph.D. 

“Face your fears.” The wisdom of this adage is built into exposure therapy, an intervention that has been extensively researched and shown to be very effective in treating various anxiety disorders. What is exposure therapy? This blog will break down why exposure therapy is used for anxiety, and how it works:

Why Exposure Therapy is Used for Anxiety

Anxiety disorders are characterized by anxiety that has taken on a life of its own, interfering with a person’s relationships, work, and quality of life.  Although fear and anxiety are normal emotional responses to threat (these emotions motivate us to avoid potentially harmful situations), anxiety disorders are characterized by pervasive and functionally-impairing levels of anxiety. It is proposed by behavioral psychologists that anxiety disorders develop as a result of classical, operant, and vicarious conditioning, important psychological concepts from learning theory that inform and guide exposure therapy.

Classical conditioning (Pavlovian conditioning) refers to associative learning. A conditioned response usually occurs after repeated pairing of a conditioned stimulus (usually a neutral stimulus) with an unconditioned stimulus. If an aversive stimulus (e.g. a loud, startling noise) that leads to an unconditioned response (e.g. a startle response) is repeatedly paired with a neutral stimulus (e.g. a fuzzy teddy bear), the two stimuli become linked, and the neutral, conditioned stimulus (e.g. the fuzzy teddy bear) will now evoke a similar response (e.g. a startle response, now considered a conditioned response) to the aversive stimulus. Classical conditioning is thought to play a role in the development of chronic, problematic anxiety. For example, let's imagine that a person becomes unpredictably violently ill and experiences serious, uncontrollable vomiting (i.e. the unconditioned stimulus) while he is shopping in a grocery store. He feels very anxious and on edge (i.e. the unconditioned response) as a result of the unexpected and severe nature of the illness. For some reason, he becomes ill on a few separate trips to various grocery stores, just by coincidence, and begins experiencing severe anxiety (i.e. the conditioned response) associated with even thinking about going into a grocery store (i.e. the conditioned stimulus). He stops going to grocery stores because of the severe anxiety and fear of experiencing another illness episode (even though grocery stores are not the direct cause of either becoming sick or the original anxious response) and his ability to take care of his needs is compromised. 

Operant conditioning is also thought to play a role in the development and maintenance of anxiety disorders. Operant conditioning is a behavioral principle that refers to the learning that occurs because we experience either "reinforcement" or "punishment" as a consequence of something that we did or didn't do. This is learning that occurs as a result of the consequences of our actions. Reinforcement refers to anything that feels rewarding to us, and brings us pleasure or relief. Punishment refers to anything that is aversive or painful - something we do not want to experience. The man in our example above who became very ill found substantial relief (i.e. reinforcement) from avoiding going into grocery stores, which reinforced his use of avoidance behavior, and made him more likely to do avoid grocery stores in the future. When we avoid or escape something that makes us feel afraid, we feel relief, and simultaneously may make the conclusion that because we found relief, we must have escaped true danger. In sum, fear and anxiety are reinforced and strengthened as a result of the short-term relief that avoidance behaviors provide. An avoidance behavior is anything we do (or do not do) to avoid or escape something that causes (or "triggers") anxiety. However, avoidance of anxiety can lead to an escalating cycle of anxiety and avoidance. The next time we encounter the feared stimulus (i.e. the thing that triggered our anxiety, whether it be a person, place, thing, thought, memory, emotion, or physical sensation) in the future, the more likely we are to experience a more heightened fearful or anxious response (because we believe it to be truly dangerous), and to have stronger urges to avoid or escape.

Vicarious conditioning is social or observational learning - meaning that we learn by watching the consequences of others' behavior as they interact with the world. A young child may learn that the world is a dangerous, scary place by watching her mother look frequently frightened and anxious, commenting that she must always be on guard because otherwise she will get hurt. Perhaps a fear of dogs is developed by watching a friend get seriously injured from being bitten by a dog. We learn about the dangers of the world by observing others go through something frightening, and how they react, even if we have not directly experienced the same thing ourselves.

What It Is & How It Works

In exposure therapy, a therapist collaborates with her client to generate a list of relevant anxiety-provoking experiences (that are not actually dangerous) intended to elicit the very fear that the person has been avoiding. Exposures are developed based on the types of situations and emotional experiences that are avoided and cause problems in an individual's life. Although this may seem counter-intuitive, it is an extremely effective behavioral approach that helps individuals free themselves from the problematic cycle of anxiety and avoidance. Essentially, the reinforcement of avoidance is “blocked” during exposure therapy, and the client completing exposures begins learning how to face his or her fears without avoidance. In doing so, habituation occurs, which is like desensitization. When someone is exposed to something fear-provoking (that does not lead to a negative outcome) over enough time, the fear-provoking situation begins to lose potency. So long as the situation the client is exposed to is not truly dangerous, anxiety and fear will naturally drop off. With repeated exposures, the level of anxiety that is triggered becomes less intense and long-lasting. When avoidance is prevented during exposure therapy, the fear/anxiety response is no longer reinforced and strengthened. This leads the fear response to extinguish, fading away as time passes. New learned associations often occur after the feared-outcome does not occur, and the belief that the anxiety-causing situation was dangerous becomes less powerful and salient (e.g. "I guess I am safe and okay after all!"). 

Most people have trepidation about starting exposure therapy. It is understandably very uncomfortable, at least in the short-term. However, the long-term benefits can far outweigh the discomfort that may occur along with exposure therapy. Usually, it turns out that we hold beliefs about emotions (especially the emotions of fear and anxiety) that interfere with our willingness to effectively face our fears.

Common myths about emotion typically include beliefs that:

• Fear or anxiety will continue to escalate (without a ceiling effect or peak) indefinitely until the person gets away from whatever is causing them anxiety
• Fear or anxiety will become so intense that it will cause physical harm or death
• Fear or anxiety will become so intense that it will cause psychological damage, insanity, a loss of control, etc.

These beliefs often reflect a fear of emotions stemming from a commonly-held belief that emotions are dangerous. In and of themselves, emotions are not dangerous – they are physiological sensations (along with thought & urges). The sensations are designed to motivate us to act. The feelings that come along with emotions may be experienced as overwhelming (especially when we don’t understand them or it feels as though they can do us harm), but they will not hurt you (and it is not physically possible for them to intensify beyond a certain point). Frequently, exposure therapy results in the added benefit of being able to tolerate and accept intense emotions, and the learned experience that it is safe to fully feel your emotions. It’s what you do with your emotions that count – how we ACT can have a beneficial or detrimental effect on our lives and well-being. Therapists help you to learn how to effectively respond to your emotions, so that they don’t restrict your way of life.

A therapist who is well-trained in exposure therapy principles and will explain in more detail why it is not the case that intense, acute emotional experiences cause harm. In fact, one of the principles of exposure therapy is to ensure that individuals are absolutely not caused harm – otherwise that would defeat the point! Exposure therapy is all about learning that despite the anxiety, there is no danger, but rather, safety. Once this is sufficiently experientially learned and processed (not just known intellectually), dramatic change begins to occur.

Don’t worry – your therapist will collaborate with you to figure out the best pace of treatment. Depending on your needs, you may opt to participate in flooding (which essentially means that you face some of your most intense fears right away), or the more commonly used approach, gradual exposure (you work your way up an exposure hierarchy, starting with mild-moderate fears). Both approaches have been found to be equally effective, but differ in the length of time that they may take to complete, and in the likelihood of premature drop-out. Remember, exposure requires repeated practice facing your fears until a re-learning occurs. Sticking with exposure therapy until anxiety has naturally begun to dissipate (or tolerance of anxiety has increased) is essential for success.

It isn't easy by any means. But for many, completing exposure therapy can be deeply worthwhile. Finding out that you can successfully face your fears helps you to learn on an experiential level that you are *safe,* even if fear or anxiety show up. It may also help you connect with the tremendous strength and resilience that you have within you to help you move through challenge - inner resources that are invaluable for rebuilding a fundamental sense of trust in our ability to navigate what life brings us.

Are you interested in using exposure therapy to tackle your fears? If you'd like to speak with Dr. Lauren Helm, a licensed clinical psychologist at Rise Psychology trained in exposure therapy, please click here. 

Follow Rise Psychology on Facebook or Twitter (@risepsychology). 

References

Bandura, A. (1985). Model of causality in social learning theory. In Cognition and psychotherapy (pp. 81-99). Springer US.

Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20(2), 261-282.

Barlow, D. H., Rapee, R. M., & Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23(4), 551-570.

Feeny, N. C., Hembree, E. A., & Zoellner, L. A. (2004). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10(1), 85-90.

Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. Oxford University Press.

Hofmann, S. G. (2008). Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical psychology review, 28(2), 199-210.

Blog reposted from Center for Stress & Anxiety Management blog: http://www.anxietytherapysandiego.com/blog/2015/2/21/swy4tbpb4algabok9hnlhw46us518b

Obsessions & Compulsions Can Consume Your Life

OCD can cause tremendous suffering and emotional pain, and consume your time, energy, and vitality.

Written by Lauren Helm, Ph.D.

OCD Awareness week is October 8th – 14th, an international effort started by the International OCD Foundation (IOCD) to spread awareness about Obsessive-Compulsive Disorder (OCD), which is estimated to affect 1 in 100 adults in the U.S. It is characterized by obsessions and/or compulsions that cause significant distress or impairment, or last more than 1 hour per day, on average. For each individual, OCD can look somewhat different, but the obsessions and compulsions that characterize OCD share certain features that we can learn to recognize with educated awareness. If you or someone you know has been diagnosed with OCD, you are probably aware of the tremendous suffering the disorder can cause. However, there are often many obstacles to getting diagnosed and treated. Not knowing the possible signs of OCD or that there are effective forms of treatment can block many from getting the treatment they need. This blog is intended to spread the word about some of the ways that OCD can manifest, and some of the ways that you or a loved one may seek help.

Getting to Know Obsessions

Do you struggle with thoughts or images that you found disturbing or unwanted, that repeatedly invade your mind, leaving you exhausted, worn thin and on edge from the endless battle they invite? Perhaps these thoughts are so opposite to who you see yourself to be, they make you shudder, and cringe at the fact that they crossed your mind…and yet they will not leave you alone, returning again and again, no matter how much time you spend monitoring your thoughts, no matter how hard you try to push them away when they appear, and how much energy you expend at attempts to ban them from your awareness.

You might feel confused or disgusted when you find yourself imagining doing something uncharacteristically sexual or violent, and terrified by the fear that you will act on the impulse. You might be unable to overcome the fear that you will accidentally cause someone harm or death, such as causing an accident while driving or dropping a sleeping infant. You might be tortured by terrible, frightening or disgusting images that violate your mind, the immoral or blasphemous images “tainting” who you are. Thoughts of contamination or of becoming ill might plague your mind, making your body and the environment feel constantly unsafe and in need of cleansing.

These examples of obsessions are not all inclusive, but are examples of common types of obsessions that those with OCD may experience. Obsessions are intrusive, unwanted thoughts, images, impulses and doubts that cause substantial distress and suffering, such as intense anxiety, shame, guilt or disgust. Although obsessions manifest somewhat differently for each individual, the common themes that underlie unwanted thoughts, images or impulses can be thought of as violations of the integrity of the body, mind, spirit, or sense of self/identity. Obsessions may be thoughts about contamination or illness, causing violence or harm to others, violating others, losing control, imperfection, engaging in religious blasphemy or moral violations, or unwanted sexual thoughts. The person suffering from obsessions does not actually act on these thoughts, but is often tortured by the fear of doing so and of what these thoughts mean about their character. Some people with OCD are preoccupied with “doing the right thing,” avoiding harm, or maintaining “purity” of the body (and/or mind or spirit), and the content of obsessions often feel particularly incongruent with who they are, adding to the spiral of confusion and distress, and fueling the motivation to heavily guard against these thoughts. To find relief, many individuals begin engaging in compulsions. A vicious cycle is created - the more that threatening, unwanted thoughts are pushed away, the more they return with ferocity and power.

Getting to Know Compulsions

Do you feel an uncontrollable urge to arrange things until they feel “just right,” becoming upset or agitated if you are prevented from doing so? Or perhaps the need to wash your hands again and again to eradicate a sense of contamination, experiencing a sense of urgency and need to get rid of the feeling of being “dirty” as thoroughly and quickly as possible?  Do you have a hard time leaving the house without repeatedly checking that the door has been locked more than once or twice, even driving back home long distances because of lingering doubt? Do you find yourself compelled to count to a certain number, or in multiples, to get your mind to finally let go of an obsession, or to feel safe again? Do you feel you have to eat the food on your plate in a certain order or specific rotation of your plate else you won't eat because of anxiety? Are you always asking others for reassurance to make things feel “right again,” to the point that both you and others are feeling burnt out from the constant need for reassurance? Do you compulsively mentally rehash events again and again, in a sort of mental loop without reprieve, looking for a way to prevent a feared outcome?

To contend with the power of obsessive thoughts, images or impulses, those with OCD may engage in compulsions, which are mental or physical behaviors that are intended to neutralize or reduce distress caused by obsessions, as well as the perceived likelihood of acting on obsessive thoughts/impulses. Compulsions can be thought of as a coping strategy, a way of getting relief from the overwhelming nature of obsessions. The short-term emotional relief that comes after engaging in compulsions is thought to reinforce continued obsessions and compulsions in the long-term. Compulsions themselves can be distressing, extremely time-consuming, and difficult to resist, leading those who suffer from OCD to feel at the mercy of their obsessions and compulsions.

The Cost of OCD

Both obsessions and compulsions can eat into individual’s lives, taking up more than 1 hour per day (sometimes occupying most or all of a person’s waking hours in severe cases). Not only do obsessions and compulsions cause emotional distress, they also can interfere with a person’s ability to function socially, within the workplace, or academically. Family members or loved ones are also often affected, as it can be hard to watch their loved one with OCD suffer, and to not know how to help. Sometimes, others in the person with OCD’s life can unknowingly reinforce obsessive-compulsive behaviors when trying to help.

Treatment for OCD  

The good news is, there are effective psychological and pharmacological treatments for OCD. Research strongly supports use of cognitive behavioral treatment (CBT) with Exposure and Response Prevention (ExRP or ERP) for helping those with OCD get relief -- a therapist who uses ERP will help someone with OCD to confront and respond differently to obsessions and the distress obsessions cause, and to avoid compulsions and other behavioral patterns that reinforce or maintain OCD. Additionally, SSRI medications have been found to reduce symptoms in OCD (you can ask your medical doctor or psychiatrist for more information about medication treatment options for OCD).

Building Awareness

As mentioned above, OCD Awareness week is happening soon, and the IOCDF has events that will occur throughout the week in various cities. IOCDF's website has information about about events happening near you, as well as informational resources and tools. A very informative list of common obsessions and compulsions can be found on the IOCDF website here. IOCDF also has a search tool for finding therapists in your area that work with OCD. The American Association for Anxiety and Depression (ADAA) also has free educational resources and links for support groups, apps, and a therapist search tool.

Finding Help

If you are concerned about possible signs of OCD in yourself of someone you care about, please know that there is hope! You are not alone, and there are many resources available for support.

Although it can be very helpful to learn about signs of OCD, and tempting to self-diagnose, please remember that a diagnosis of OCD can only be made by a qualified and credentialed mental or medical health professional. If you do not already have a treatment provider who treats OCD, the first step is to find a qualified mental health professional (preferably someone who specializes in OCD). You can ask your family doctor or primary care doctor for referrals. A medical doctor (MD) can also discuss medication treatment options with you - it may be helpful to work with a psychiatrist who specializes in working with OCD if possible. 

In order to find a psychotherapist who can perform CBT and ERP, you may search online therapy directories that focus on OCD and anxiety, such as online directories offered by ADAA or IOCDF, or your local state psychological association. It can be helpful to know what to look for in a potential therapist, because not all therapists use the type of treatment modality that is recommended as first-line of treatment (exposure and response prevention). This article by the IOCDF provides tips for what to look for during your search for a therapist, and what you might ask a potential therapist. Finding a treatment provider that you trust can help you stick it out even during the really challenging up's and down's that will inevitably be a part of your recovery process.

In addition to seeking therapy and/or medication treatment, you may look into local support groups for OCD as well. OCD Seattle, a local organization, has information about support groups in the Seattle area.

If you'd like to speak with Dr. Lauren Helm, a licensed clinical psychologist at Rise Psychology, for help with OCD, anxiety, or related issues, please click here. Dr. Lauren Helm is trained in using CBT and exposure therapy to treat OCD.

Follow Rise Psychology on Facebook or Twitter (@risepsychology). 

References

Clark, David A.; & Radomsky, Adam S. (2014). Introduction: A global perspective on unwanted intrusive thoughts. Journal of Obsessive-Compulsive and Related Disorders. Available online 18 February 2014. DOI: 10.1016/j.jocrd.2014.02.001 http://www.sciencedirect.com/science/article/pii/S2211364914000128 ↩

Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., & Simpson, H. B. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American journal of psychiatry, 164(7), 1.

Resources:

https://adaa.org/understanding-anxiety/obsessive-compulsive-disorder-ocd

https://adaa.org/screening-obsessive-compulsive-disorder-ocd

Helpful Ways of Approaching Expectations within Relationships

Written by Lauren Helm, Ph.D.

Throughout the course of our lives we develop many expectations about how we think our relationships should look and how others should treat us. Many of these expectations about relationships are so embedded in our way of thinking that they are hidden from our view and fall outside of conscious awareness, and yet these sometimes invisible (and not so invisible) expectations powerfully influence how we interact with and respond to one another. Unchecked expectations can run rampant, especially within the context of relationships, and run the risk of breeding resentment – not only in ourselves, but in our friends, family, and partner as well. But why is this? Isn’t it a healthy or “good” thing to hold high expectations of ourselves or others? To have high standards?

What Are Expectations?

To determine whether expectations are helpful or unhelpful, it’s often useful to start by clarifying what we mean when we use the word “expectation.” What is an expectation, really? The Oxford Dictionary defines expectation as “a strong belief that something will happen or be the case in the future.” In other words, an expectation is an assumption that a certain event will occur: That A will lead to B (or put simply, A --> B). This is similar to a prediction, which is a calculation that a certain event is likely to occur in the future, based on facts or evidence. However, an expectation is different from a prediction in that it becomes conflated with assumption, which is “a thing that is accepted as true or as certain to happen, without proof.” In the context of relationships, expectations are often unquestioned assumptions that someone ought to say or do something, rather than the informed prediction that they may. Expectations feel more like “rules,” rather than likelihoods. When rules are broken (A does NOT lead to B), a very different kind of reaction is evoked in us than when a simple likelihood does not pan out.

What Purpose Do Expectations Serve?

The meaning of expectation becomes much more complex when we consider the range possible functions that expectations may serve in our lives. We commonly experience an expectation not only as a belief or assumption that something should happen, but also as an attachment to (or corresponding emotional desire for) this particular outcome as well. We want it to happen, and are emotionally invested in it. Attachment to a particular outcome creates a negative emotional charge if we perceive that we didn’t get the outcome we are attached to.

Although attachment to outcome leads to painful emotional consequences if our expectations go unfulfilled, I would like to suggest that expectations or attachments are not universally harmful or “bad.” I believe there is nothing inherently bad or good about having “a strong belief that something will happen or be the case in the future,” or having desire for a particular outcome. In my view, having expectations and attachment absolutely makes sense, especially when we consider what roles they serve from an evolutionary perspective.  

Expecting that something will happen in the future is an essential survival tool that humans possess, which stems from our cognitive ability to think and plan ahead. Future-oriented thinking and planning has aided us in rapidly advancing and evolving as a species for many reasons, but especially because it allows us to predict and avoid harmful or depriving situations. Attachment to certain outcomes creates the emotional drive and motivation to avoid harm and to pursue pleasure and safety. We often use expectations to help us determine whether aspects of our lives (such as our relationships, career, living situation, or environment, etc.) “measure up,” and if not, our attachment to a different outcome may help motivate us to create change.

In a sense, expectations become a form of judgment – an evaluative process informed by whether what we thought what “ought” to happen did. Much of the time, what we want or need influences what we believe should happen, especially within relationships. In this way, expectations are emotionally-driven beliefs about what we think needs to happen so that we can create lives that are happy, fulfilled, and keep us safe. From this perspective, it makes sense that when expectations go unmet, our minds automatically interpret this negatively and experience varying forms of intense emotional reactions that motivate us to correct the situation and move us back into a safe place, conducive for survival. Thus, in and of itself, expectation is not a “bad” thing, and can actually be helpful.

Indeed, expectations within relationships are commonplace and may be essential for creating healthy, safe, and supportive partnerships. Fitzpatrick and Sollie (1999) found that when participants in their study felt that their current relationship was close to what they would consider to be an ideal relationship, they reported greater levels relationship satisfaction, investment, and commitment to their partners. Our expectations often can reveal what we value and want to create within our relationships, and we tend to feel more satisfied when these expectations are met.

The Consequences of Unmet Expectations

That said, we can also get trapped in a vicious cycle when we do not have the awareness or tools we need for adaptively responding to unmet expectations. In a somewhat darkly revealing manner, the Oxford Dictionary illustrates how the word “expectation” may be used in a sentence, by providing the following example: “Reality has not lived up to expectations.” Not surprisingly, in defining expectation, we readily turn our minds to the painful experience of unmet expectations. Nearly all of us have felt the heavy drop of disappointment, and the sting of hurt, frustration, shame, or even rage that may come when reality sharply does not live up to our expectations (especially when it is a loved one has not lived up to our expectations and done what they “should”). Emotional wounding can be created from profoundly painful unmet expectations within relationships, particularly when unmet expectations leave us feeling intruded upon, neglected, betrayed, or abandoned.  Researchers have found that when expectations about connection, passion, and destiny go unmet, the satisfaction and commitment within relationships is undermined (Vannier & O’Sullivan, 2017). Sometimes, unmet expectations can be seen as a sign that we are not matched well with a partner. However, oftentimes, due to our social conditioning about romantic relationships, relationship expectations can be unrealistic or overly romantic in ways that make them almost impossible for a partner to meet, creating discontent and dissatisfaction. How many of us have expected that if our partner really loved us, they should be able to read our mind? Or that if we are in a “good” relationship, there should be very little to no conflict? Or that that for my partner to be my soulmate, my partner should enjoy the same activities I do, preferring to do them in the same way I do, and wanting to do them at the same time that I want? That my partner should know what I need, without my telling them? That the dishes should have been done already? And so on.

The problem with expectations in relationships is not that we have desires, needs, or boundaries (which are absolutely necessary for healthy relationship functioning), but rather, the problem is the emotional aftermath and suffering that happens when expectations go unseen, unquestioned, and are repeatedly unmet. Our minds almost always interpret and assign additional meaning to why unmet expectations occur, which compounds the emotional distress from feeling let down. Here are a few general examples of the possible emotional consequences of unmet expectations:

(1) Unmet expectations can lead me to feel as though the world is disorderly, chaotic, and/or does not make sense (because A did not lead to B, when I thought it had to). I may be left feeling confused or paralyzed because my expectations were logical rules that ordered chaos, and provided a sense of predictability that has now been stripped away.

(2) Unmet expectations can feel as though an unquestionable “rule” has been broken, leaving me with self-righteous anger or moral outrage in response to this perceived injustice, which may feel like a personal offense. Alternatively, I may question or mistrust others’ ability or willingness to “follow the rules.”

(3) Unmet expectations can feel as though I have been deprived of a critical resource because the thing I wanted and expected to happen did not (my desire or need has been blocked from me).

In response to the pain caused by these interpretations, our minds (often subconsciously) then try to determine how to address the source of unmet expectations. However, the process by which our minds try to “solve” the problem of unmet expectations is often by generating judgment-laden causal inferences about “why A is not leading to B,” which can then lead to a worsening spiral of painful emotions.

For example, if my partner has not met my expectation on a repeated basis and I am feeling emotionally distraught as a result, my mind is likely going to try to figure out why this is to try and fix it. Usually, when strong emotions are involved in the reasoning process, our minds tend to quickly jump to broad-sweeping conclusions and spend less time objectively evaluating the facts. Perhaps my partner and I really do see things differently, and hold different expectations. Usually, I am not likely to see this as acceptable – instead, I will perceive it as a threat and a problem. My mind will go into evaluative-mode and try to figure out why and what it must mean that they are not meeting my expectations. If you follow the trail of the mind’s automatic flow of thoughts you might find something like this… Why did they do this? Do they not care? Is there something wrong with how they see the world? Is there something wrong with who they are? Is there something wrong with me for expecting this? Do I expect too much? Is there something wrong with who I am? Within the context of close personal relationships, often a conclusion is made that about our partner’s or our own character. They (or I) must have done this because there is something wrong with them. There must be something flawed or bad about them (or me).

In sum, my mind has now concluded that the problem is that my partner is “bad” or “wrong” because I did not get what I expected. I essentially blame them for the frustration, disappointment, or sadness that comes from having my expectations unmet. Then, the “solution” is often to “fix or get rid of the problem (my partner).” Ouch! This line of thinking is strewn with judgments and will clearly color your experience of your relationship, and it is a recipe for resentment and/or shame (and more). If I try to “fix” my partner and this does not work, resentment builds, more judgments occur, and I am likely to emotional distance myself from them. Ultimately, we tend to experience more pain and disconnection as a result of this cycle. Even if my partner concedes and shifts his/her behavior to meet my expectations, there is a sense of obligation and duty – almost as though they are not doing this of their own free will. In turn, trust may be undermined and resentment, once again, can build.

This kind of responding to unmet expectations is very common, especially when expectations are gripped tightly and without question. Without our conscious awareness of their presence or power, expectations have the potential to drive our relationships with ourselves or others into the ground.  Excessive and unchecked expectations have to potential to be detrimental to healthy relationships with the self or other.

How Can We Better Respond to Expectations?

Often, we haven’t taken a step back enough to see that there are alternatives to automatically evaluating our relationships based on our unique set of expectations. The only alternative we may be aware of is to “lower our expectations,” which is really not too appealing if it leads us to “settle.”  Should we not want to strive for more? Should we not expect to be treated with more respect? More love?  

I’d like to suggest that the problem is not that we have expectations (or even that we have “too many” expectations), but that when expectations are gripped tightly and without mindful awareness, they can stoke the fire of blame, self-judgment, and suffering. Here are a few suggestions for how you might respond to you and your partner’s expectations a little differently:

I. Expect that you (and your partner) will have expectations:

• Accept that expectations will be there whether you want them to be there or not. Expectations are largely ingrained in how we think for multiple reasons (e.g. they are connected to our brain’s strongly developed evaluative and planning abilities; they may be influenced by or even born from social and cultural conditioning, family norms, past personal experiences, etc.). That said, you can practice strengthening your conscious awareness of your expectations. Take note of what they are, how they show up, and how you respond so that you have a greater ability to intentionally choose how to deal with them.

• Remember, expectations are not inherently bad or good. Sometimes they can be helpful in informing our decision-making, especially when we step back to look at the whole picture and objectively identify as many contributing factors as we can. Sometimes they can be unhelpful, and create disempowerment or inaction.

• Try to come up with a plan for tolerating and coping with the disappointment and emotional pain that comes from unmet expectations. Use regular self-care and self-compassion when you experience a let-down. For severe disappointment or emotionally traumatic experiences, consider enlisting the assistance of a therapist to help you understand, cope with, and emotionally heal from what happened.

II. Try to separate out expectation (e.g., “This thing will and must happen”) from preference (e.g. “I like and want this/I do not like or want this.”):

• Make a written list of your wants vs. nonnegotiable needs (within relationship, the workplace, home life, etc.).  Then write down a separate list of your expectations for each important domain in your life, and compare this to your list of wants. Get clear about what your wants/needs versus expectations are. If you expect certain behaviors within a relationship, be as clear and concrete as you can about what these expectations are so that you can openly share these with your partner and determine what you both agree to. Vannier and O’Sullivan (2017) also suggest identifying any expectations that might be overly idealistic, unrealistic, and overly romantic, as these tend to undermine relationship health.

• Take ownership of what you want and responsibility for how you will respond to your wants being satisfied or not.

  • For example, you may try reminding yourself, “I want this. My want is valid. My want does not have to happen, but if what I want does not happen, I will step back to more fully understand it, and make an informed decision about what to do or not do about it.” Try to give yourself time to sort out what might be helpful for allowing your desire to be met, and avoid jumping to conclusions. The key is to practice engaging a conscious, intentional decision-making process, rather than reflexive or reactive one.

• When communicating what you want within relationship, sometimes it is helpful to share what you want as an invitation, rather than as a demand. If what you want is connected to a core value, openly share about why this is important to you, without expecting your partner to share your exact same views. Invite curiosity, discussion, and learning more about one another. Invitation is less likely to be experienced as a heavy, restricting obligation by your partner, and creates the opportunity for them to meet your desires more whole-heartedly, and from a place of freedom of choice. Engage in a dialogue about what you both want to create together, how you want to define the relationship, what kind of boundaries or limits you both agree to, how you both would like to be treated. Arriving at agreements about what you’d like in your relationship often creates a different outcome than when either partner silently holds expectations and becomes resentful when they are not fulfilled. Remember that agreements are not necessarily fixed in stone, and may shift and evolve with time as both of you grow in who you are as individuals. Try to regularly stay in dialogue and communication about what you both want so that your relationship agreements can be updated as needed.

• As hard as it is to not get what you want, try to practice acceptance of the fact that regardless of how hard you try, sometimes you will get what we want, and sometimes you won't. Sometimes others will not meet your expectations, and you will not meet theirs. This is a normal part of life. You are not in complete control of outcomes. Leave some room for some desires not being fully met. Try to also be open to these desires being met in other ways then you thought they would. Stretch yourself to be flexible while staying true to your values.

• Sometimes our attitude influences whether we are likely to experience our desires as being fulfilled. When we are flexible, open to experience, and grateful for what comes our way, there is much more space for satisfaction and fulfillment. Try to avoid excessively fixating on what you think is "wrong” as this can shut you down emotionally and cause bitterness and discontent.

• Keep in mind that many times nonnegotiable needs are related to survival (i.e. needs related safety, security, critical resources, etc.). Try to identify an action plan in advance that you will use if a nonnegotiable need is not met (have a plan for staying safe, etc.) and access professional help if needed.

III. When reality had not lived up to expectations try to remember there are many possible explanations for what happened.

• When A does not lead to B, remember that A may also lead to C, D, etc. There are often many possible explanations for what happened, just as there are many possible ways that we can respond in different situations. Moreover, there are usually multiple ways of responding to the same situation. Most of the time, A does not only lead to B. Reminding yourself of this often and coming up with alternative explanations for why A may lead to B can help build cognitive flexibility, a skill that helps us become more psychologically resilient in the face of challenge.

• Check your expectations - where did these expectations come from? Is it possible that they are unrealistic? If you were expected to meet the expectations you hold others to, could you meet them?

• If you tend to experience unmet expectations as rules that have been “broken," try to remember that much of the time, others have a very different set of expectations or “rules” that may be equally valid as your own. Just because your partner’s behavior might be different than your own, does not automatically make your partner wrong (or right). We are all free to see the world through our own lens, and to be true to who we are (that doesn’t always mean our lens will in harmony with our partner's, of course, but is helpful to remind ourselves to steer away from excessively trying to control or change our partner). Within your relationship, check in with yourself about where it might to helpful to loosen your grip if you tend to fall into the enforcer of rules. Alternatively, if you tend to feel overburdened or suffocated by the weight of your partner’s expectations, be honest with yourself so that you can then be open with your partner about what needs to change. In either case, try and come together collaboratively to see how the two of you can better approach your relationship expectations, since neither party's expectations are necessarily "right" or "wrong," - just different. If a relationship agreement has been broken, try to compassionately address the broken agreement together, and understand why it happened and what to do about it to repair the rupture (e.g. to decide whether the agreement needs to be adjusted, or you or your partner’s behavior needs to be adjusted). Try to focus on the underlying purpose of strengthening the health of your relationship, rather than punishing one another for “breaking the rules.”

Learning by Doing

Hopefully some of these suggestions about how to shift your responding to expectations will help your relationship grow in awareness, depth, and resiliency. In general, bringing to light your beliefs about relationships gives you the chance to take a step back and non-judgmentally look at them from a different angle, so that you can be better equipped and able to respond with conscious intent, instead of reactivity. But be gentle with yourself and your partner -- these are challenging suggestions to put into place, and some may fit, where others may not be relevant or useful.  Remember that so many of our ways of approaching the world and relationships are deeply ingrained and are take significant time, effort, and lots of learning through trial and error. Practice patience with yourself, and try to use relationship challenges as an opportunity to re-commit to using the strategies that help you to build a healthier relationship with your expectations, yourself, and your partner.

If you find yourself excessively mired by expectation or having difficulty shifting how your approach to expectation within relationships, it may be helpful to practice these skills in a warm, supportive environment, where you can get feedback and guidance from a trusted therapist.

References

Fitzpatrick, J., & Sollie, D. L. (1999). Unrealistic gendered and relationship-specific beliefs: Contributions to investments and commitment in dating relationships. Journal of Social and  Personal Relationships, 16, 852–867. doi:10.1177/0265407599166010

Vannier, S. A., & O’Sullivan, L. F. (2017). Great expectations: Examining unmet romantic expectations and dating relationship outcomes using an investment model framework. Journal of Social and Personal Relationships, Advanced online publication.  

What To Do With Those "Bad" Emotions We All Feel

Written by Lauren Helm, Ph.D.; reposted from www.anxietytherapysandiego.com/blog

 

What To Do With Those "Bad" Emotions We All Feel

First, we can stop calling them bad! Emotions, in and of themselves, are not bad or good: they just are. They are often feared, however, and in our society, so called “negative” emotions in particular are judged, shamed, or hidden. What recent research has been finding is that it is not the emotions that cause the most suffering or difficulty leading our lives, its how we respond to our emotions that is key.

Emotions can be thought of as cognitive and physiological changes that urge us to behave in a particular way. They occur (or are “triggered”) in response to the situation that we are in – or, in other words, what we perceive is happening in our environment. The physiological changes that happen in our bodies (the “feelings” that accompany our emotions, like butterflies or a lump in our throat), and thoughts (i.e. how we interpret something, like, “This is scary” or “How sad”) usually motivate us to take a certain action. The emotion of fear, for example, may lead to physiological changes such as a racing heart, rapid breathing, a racing mind, along with thoughts that “I am in danger, I better get out of here,” and the strong urge to avoid or escape the situation.

The Benefits of "Positive" and "Negative" Emotions

Theorists posit that emotions guide us through life, and are designed to help us to survive. “Negative” emotions (such as fear, anxiety, sadness, stress, guilt, etc.) urge us to act in a self-protective way in the face of various potentially threatening situations. These emotions are broadly categorized as those that lead to an “avoidance” response. “Positive” emotions (such as joy, happiness, love, pleasure, etc.) generally are linked with safety and guide us to seek out more of whatever it was that elicited the pleasant emotion, thus typically leading to an “approach” response. Though our emotions are designed to guide us in directions that keep us safe and satisfied, this is not always the case. Oftentimes, instead of supporting us in leading the lives that we want to live, our emotions can seem to work against us, taking destructive control of our lives.

Emotion Regulation (aka How We manage our emotions)

How we relate to our emotions, and what we do with them is ultimately what may have the largest impact on our emotional health and the quality of our lives. Poor emotion regulation (the way that we regulate or how we respond to our emotions) is now thought to be a key determinant in the development and maintenance of multiple psychological and emotional disorders, such as anxiety and depression.

Emotion dysregulation is the relative absence of adaptive emotion regulation strategies. Specifically, Mennin and his colleagues (2007) define emotion dysregulation as:

(1) Heightened intensity and increased frequency of unpleasant emotions as triggered by internal and/or external cues

(2) Poor understanding of emotions

(3) Negative reactivity to one’s emotional state, and

(4) Reflexive and maladaptive behavioral reactions

What does this mean? Emotion dysregulation is when:  (1) we are easily and strongly emotionally-triggered,  (2) we have difficulty knowing what are emotions are and why we have them,  (3) we fear or judge having these emotions as “bad,” and (4) we react to our emotions automatically in rigid, unhelpful ways that often make the situation worse.

In other words, emotion dysregulation often leads to a spiral of distress, and in the long-run, makes negative emotions more intense and long-lasting.

Research is finding that emotion dysregulation perpetuated by certain problematic strategies that we use to manage our emotions. Typically, our automatic avoidant responding to distressing emotions and thoughts leads to short-term relief, but greater emotion dysregulation in the long-term. When we try to control or avoid painful or scary thoughts and emotions when there is not the threat of true danger, we are using emotion regulation strategies that may not work in our favor after all (see Hayes et al., 1996). Many studies have found that attempts to suppress thoughts or emotions actually increase their intensity and frequency (see review by Wenzlaff & Wegner, 2000). Trying to force yourself to stop feeling “bad” in order to feel better is unlikely to be helpful.

In contrast, in is much more likely to be helpful if you engage in adaptive emotion regulation, which, as conceptualized by Gratz and Roemer (2004), is characterized by:

(1) An awareness of and understanding of emotions

(2) Acceptance of emotions

(3) The ability to engage in goal-directed behavior and refrain from impulsive behavior when experiencing negative emotions

(4) Access to emotion regulation strategies perceived as effective

Thus, adaptive emotion regulation is the ability to (1) be able to notice, label, and understand your emotions, (2) acknowledge and accept, instead of resist, the emotions that are present for you, and (3 & 4) flexibly engage in actions that are called for and most effective depending on the needs of the situation, even while you are experiencing emotional upset.

What you can do

Emotion regulation is not about controlling or reducing your emotions, as much as it is about developing a flexible, accepting, and balanced approach to your emotions. This is no easy task, and takes a great deal of practice. Therapy, mindfulness, and/or self-compassion practice may help you to develop healthy emotion regulation skills. It may be worth investigating whether you would like to enhance your own emotion regulation abilities, as the ability to truly be with our emotions, as opposed to being controlled by them, can make all the difference in our lives.

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References

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of consulting and clinical psychology, 64(6), 1152.

Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284-302.