Feeling Lost in Anxious Thoughts & How to Find Your Way Again

Written by Lauren Helm, Ph.D.

We’ve all felt anxiety at some point in our lives (likely many times over, in fact), though perhaps it manifested in different ways. You may have noticed the rapid increase of your heart rate, faster, constricted breaths, the growing tension in your shoulders and neck, cold or clammy hands, or unease in the pit of your stomach. The experience of anxiety is unpleasant, to say the least, and as it builds, it certainly has a way of getting our attention.

Anxiety Has a Purpose

Why do we experience the uncomfortable sensations of anxiety? From an evolutionary perspective, fear and anxiety (two related but slightly different emotions) have a function: they keep us alive. More specifically, fear and anxiety are emotions that occur in response to a perceived threat. When we believe that something may harm us or is dangerous, we feel these emotions and they motivate us to protect ourselves from the danger, typically either by avoiding or escaping the threat.

Without fear or anxiety, we may not react to truly dangerous situations in an adaptive way, and thus not survive as a species. Imagine walking along and crossing paths with a Grizzly Bear. It certainly would not be helpful to feel no fear, and to feel like running up and hugging it! Our emotions give us invaluable information about the environment and about what actions we should take to protect our survival, based on how we feel.

Cognitive Errors

As incredible as our brains are, they also are prone to errors. We are not always able to accurately assess the true amount of danger (or safety) that may be present in our surroundings. Sometimes this means that we may miss a true threat that was present and suffer the consequences. However, in our modern day society, more often than not we experience the opposite – we overestimate the true amount of threat and thereby experience excessive anxiety as a result.

The problem with excessive anxiety is that it can negatively impact the quality of our lives in multiple ways. Prolonged, pervasive anxiety has an impact on our physical well-being, in addition to our psychological well-being. Chronic stress and anxiety can lead to a deterioration of optimal physical functioning, preventing your immune system, digestive system, and heart from performing the best that they can. Chronic anxiety may also interfere with your ability to sleep, eat, and generally function as you’d like to in life.

Depending on the context, anxiety may be an adaptive or problematic force in our lives.  In excess, the symptoms of anxiety can be overwhelming and interfere with our quality of lives, and thus it is often a worthwhile use of our time to become well-versed in the “language” of anxiety. Namely, how does it appear, and why? Once I understand anxiety, what can I do about it?

There are many different theories about what causes problematic anxiety, but this blog will focus on how anxiety may be developed and maintained by certain unhelpful thinking patterns. Cognitive distortions, or inaccurate thinking patterns, typically feed anxious feelings. They also may lead to avoidant behaviors, which perpetuate anxious thoughts and feelings. When the cycle of anxious thoughts, feelings, and behaviors occurs outside of our awareness, we can be left feeling baffled and as if our lives have begun to spiral out of our control. 

Perceived Threat

From an evolutionary perspective, it can be considered advantageous to be very sensitive to possible threat. In other words, our primal ancestors were more likely to survive if they very quickly and accurately responded to potentially dangerous situations. However, in modern day, an over-active threat-detection system can become burdensome. A low threshold for perceiving threat (i.e. situations very easily feel threatening) and an attentional bias to threat (i.e. focusing and narrowing your attention on potential dangers that surround you) can be a constant source of anxiety. Our threat-detection threshold and anxiety-proneness may be partly genetic, but it also is likely a result of having a previous experience that was stressful, anxiety-provoking, or traumatic. Our brains generally keenly remember frightening experiences so that we will readily detect the warning signs in the future and be better able to avoid encountering a similar potentially dangerous situation again. It makes sense that our brains are designed to work this way, but it also means that we have to cope with the surge of anxiety that comes from many "false alarms."

Catastrophic Thinking

Another thinking pattern that feeds anxiety is called catastrophic thinking. Catastrophic thinking occurs when our mind jumps to imagining worst-case scenarios when we are uncertain about an outcome. For example, our mind may imagine that our loved one has been involved in a car accident because they still haven’t returned home 30 minutes after they said that they would. Catastrophic thoughts may also be hidden from our conscious awareness, but still cause us to feel anxious and on edge. Catastrophic thoughts are often triggered by uncertainty and the unknown, and are attempts at anticipating and (ideally) preventing or avoiding very painful, negative imagined outcomes. 

Probability Overestimation

Furthermore, probability overestimation occurs  along with catastrophic thinking – this is when we overestimate how likely it is that the “worst-case scenario” has or will occur. When we are feeling anxious, we often feel very certain that the worst-case scenario will occur even though realistically-speaking, the chances are much lower (or are little to none) that what we fear will actually happen. This feeling of certainty that the negative outcome will occur motivates us to take action to prevent it from happening ("it's better safe than sorry!"). Unfortunately, we may anxiously expend significant energy and time trying to prevent something that is not actually like to happen at all, without finding substantial or long-lasting relief. 

Worry

Worry and catastrophic thinking go hand-in-hand. When we worry, we dwell on the many possible negative “what if” scenarios, and use extensive cognitive energy to plan for or prevent these potential future threats from occurring. In moderation, planning for future threats can be helpful, but when it begins to take excessive time and energy (which is quite exhausting), it becomes maladaptive and interferes with your ability to function optimally. More often than not, the cost of worrying exceeds the benefits (it may become a waste of energy) and actually feeds the anxiety that it is intending to placate. Because worrying tends to happen in the form of verbal or analytical thinking and planning, it is thought that worrying can act as a form of cognitive avoidance that prevents full processing of emotions associated with catastrophic thoughts. Excessive worrying that is difficult to control can cause us to be constantly on-guard and on-edge, leading to muscle tension, concentration & sleep difficulties, and trouble relaxing. Worrying can also be self-reinforcing - if we believe that we thwarted a negative outcome because we worried (a coping strategy, of sorts), we will most likely engage in worrying again in the future. Unfortunately, worrying rarely pays off in the way we intend for it to.

These are just a few ways that our patterns of thinking can create and maintain anxiety, leaving us feeling trapped in our minds. Now we will explore strategies intended to help individuals suffering from anxiety develop more adaptive ways of responding to anxious thoughts, so that they can get unstuck. We will explore two evidence-based treatments provide strategies for managing unhelpful, unproductive thinking patterns.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) identifies how certain types of thoughts or ways of thinking in response to perceived threats actually create more difficulty for us, and potentially lead to anxiety, stress, low mood, and other problems. Simply put, situations do not cause negative emotions; our perceptions of them do.  

Some of the unhelpful or inaccurate patterns of thinking (cognitive distortions) related to anxiety include catastrophic thinking, probability overestimation (overestimating the likelihood of a negative outcome), worry, filtering out the positive and only seeing the negative, jumping to conclusions, mind reading (thinking you know another person’s intent for acting in a certain way, when this may not be true), personalizing, and black and white thinking. CBT therapists help individuals to alleviate the consuming nature of anxiety by using various strategies to address these cognitive distortions.

The various approaches that are used in CBT to deal with these types of “inaccurate” thinking patterns have historically served a common purpose: correct and change the “thinking errors” that create anxiety. Over time, CBT has evolved and has placed more emphasis on helping people to generate more flexible, adaptive thoughts and responses to their thoughts. Instead of merely trying to replace one problematic thought with a more helpful one, CBT can help an individual to generate more balanced and healthy thoughts, and more easily identify and non-reactively respond to problematic, anxiety-provoking thoughts.

In other words, if you notice that you are thinking in inaccurate ways, it is likely best to recognize that it may not be helpful to act on this inaccurate thought, and better to generate a new, alternative way of thinking about the situation that helps you to successfully reach your goals. Instead of trying “not to think” a thought (suppressing or shut out a problematic thought), modern versions of CBT emphasize helping you create more thoughts that are based on a more balanced review of available information, and are informed by your goals in a particular situation. Cognitive rigidity, or getting stuck in one narrow way of thinking, is usually what contributes to us further being consumed by anxious thinking and behaving. Thus, CBT encourages you to increase your cognitive and behavioral flexibility (working towards developing a wide range of thinking and responding).

Cognitive Restructuring

Cognitive restructuring is a CBT intervention that helps individuals get “unstuck” from the “mind traps” that thinking errors create. Socratic questioning is often used to help facilitate cognitive restructuring and get at the truth. This approach is usually built into CBT therapy sessions to help change problematic thinking patterns.

Here is an example of methods you might use with a therapist to "restructure" a problematic thought:

1. Identify and write down the "hot" or emotionally-charged thought elicited in response to a particular situation.
2. Challenge the thought (i.e. “Is this a realistic thought?” “Is it helpful?”) and write down your answers.
3. Explore and write down the objective evidence for or against the thought (i.e. What are the facts? Has this happened before?) to discern whether the thought is accurate or not.
4. Identify other possible alternative explanations that are based on the facts in order to put the thought in perspective.
5. Generate and write down a new, balanced, and more helpful thought about the triggering situation from which to act on. 

Decatastrophizing

To more specifically target catastrophic and probability overestimation, thinking traps that fuel anxiety, decatastrophizing is a cognitive restructuring technique that is very helpful for providing perspective and relief. Decatastrophizing helps to reduce the believability of catastrophic thoughts, which as mentioned above, often feel much more likely to happen than they actually are.

If you feel trapped in an anxious thought loop, you may try using decatastrophizing. A therapist trained in decatastrophizing can help you work through catastrophic thoughts that are particularly difficult for you to unhook from.

The first step of decatastrophizing is to more clearly uncover the catastrophic thoughts and negative core beliefs that are often lurking beneath surface-level anxious thinking. Specifically, the downward arrow technique is used to dig below the automatic thoughts that we are consciously aware of to get at the core negative beliefs that are driving our anxiety. For each thought that is uncovered, it is followed up by a "What If" prompt, such as "If that were true, then what would that mean? What does your mind tell you will happen?"

Here is a hypothetical example of how the downward arrow technique might be applied for someone struggling with social anxiety is as follows:  

• Client: "I feel super anxious about going out with this new friend because I'm afraid I'll say something stupid."
• Therapist: "If you did say something stupid, then what would happen?"
• Client: "If I say something stupid, then they may think I'm stupid, and not like me."
• Therapist: "If that were to happen, then what would that mean?"
• Client: "If they thought I was stupid and didn't like me, then that might mean that I am unlikeable"
• Therapist: "What does your mind tell you would happen then, if you were unlikeable?"
• Client: "Well then no one would like me. I would have no friends. Actually, my mind is telling me that I would never be able to make friends."
• Therapist: "And then what? What would that mean? What's the worst case scenario?"
• Client: "If I didn't have friends, it would feel like I've lost everything - I would be miserable. I think it would also mean that there's something wrong with me. Something fundamentally flawed to make me unlikeable. That would be terrible"
• Therapist: "And on an emotional, experiential level, how likely does it feel that this would actually happen? How real does it feel?"
• Client: "Oh, like 98-100%"

By uncovering core catastrophic thoughts, and probability overestimation, we get a sense of what the client was actually guarding against by not going out with her new friend - facing the fear that she was fundamentally flawed, and thus would not be able to retain any relationships in her life. Usually, catastrophic thoughts and core beliefs like this drive entrenched anxiety and other painful emotions. By clearly identifying what thoughts are really behind our emotional and behavioral reactions, we can more directly and effectively challenge them. 

The second phase of decatastrophizing can then move into nonjudgmental questioning and testing of these thoughts. Questioning the actual likelihood that these anticipated outcomes will come true by evaluating factual evidence that supports or does not support these thoughts, helps our minds begin to absorb in important information: whether or not we are likely to face these worst case scenario outcomes at all. Additionally, by bringing emotionally-charged thoughts more fully into our conscious awareness, and seeing what they are really made of, their believability and charge is diminished. Another component of decatastrophizing entails inquiring about and planning for how you would be likely to respond, even if the worst-case scenario were to happen.

• Therapist: "Based on the facts of your past experience, have you ever experienced having everyone dislike you before? Have you lost all of your friendships and relationships with others?"
• Client: "Well, no, I've lost a few friends before, but that wasn't because they thought I was stupid, as far as I know, we just realized we didn't have a lot in common. I guess I've never lost all my friendships, especially not all at once or forever - I've always had at least someone in my life, or connected with someone new later down the line."
• Therapist: "Based on the evidence, how likely would you say it is that you would actually lose all relationships in your life?"
• Client: "Haha, well in reality, it seems like it's pretty unlikely. Probably like 0-3% likely to happen."
• Therapist: "What would have to happen for you to actually lose all relationships in your life, so that you were never able to make any more friends?"
• Client: "Gosh, I guess it would have to take something really big...actually, I'm not really sure there would be something that would guarantee I had no friends, unless I just stopped wanting them entirely, which I don't really see happening..."
• Therapist: "And if you actually did lose all of your friendships at one point, how could you potentially cope and respond? How have you gotten through something similar in the past?"
• Client: "I probably would keep making the effort to put myself out there the best I could. Maybe make sure to go to events with people that are more likely to be nonjudgmental, and have similar interests in me. If I had trouble with it emotionally, I could go back to therapy and or support groups. It would be really hard, but I'd find a way."
• Therapist: "What's a new way of looking at this upcoming time out with your friend?:
• Client: "Well, now I realize more fully that I don't actually risk as much as I thought I would. If it goes well, great, but if not, it's not the end of the world. I feel in my gut that I will always have the connection I need, with someone. I guess it's worth the risk to go and try out this experience, and who knows, maybe I'll have some fun?"

In this example, by the end of the exercise, the client's negative beliefs were put in perspective and objectively evaluated, given her the chance to obtain healthy distance from the thought that she may risk being rejected not only by this new friend, but all others in her life. The downward arrow technique and thought-challenging could have also been applied to the belief that the client was fundamentally flawed or unlikeable, which caused her to feel unsafe in herself and her relationships. There are many ways that these cognitive restructuring strategies can be used to help free ourselves from the anxiety-labyrinth created in our minds.

Acceptance & Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) guides individuals in becoming aware of not only their thoughts, but also their enmeshment, or fusion, with these thoughts. Cognitive fusion refers to how much we believe our thoughts, and thereby grant them power and “reality” in our lives. We often forget that every thought filters how we see the world, and dramatically impacts our direct experiencing of life. Regardless of how “true” our thoughts may be, they are still just thoughts.

Cognitive Defusion

Thus, ACT therapists help individuals practice cognitive defusion, reducing our entanglement with our thoughts. In other words, by taking our thoughts less literally, we learn how to become less attached to and controlled by our thoughts. We learn how to see them for what they really are. A thought is just a thought, an electro-chemical reaction. Thousands and thousands of thoughts stream through our minds per day. With ACT, we learn how to give them less power over us, and take back the power of choosing which thoughts we want to listen to (for example, being guided by a thought that supports us in acting in valued ways, as opposed to avoidant ways). With ACT, we focus less on changing the thought itself, and more on changing our relationship with the thought. We learn to relate to thoughts as just thoughts, products of a very active mind, instead of products of reality. Holding our thoughts lightly, seeing them from a healthy distance, and responding to them nonjudgmentally can allow us let them go so that we can get out of our minds and back into our lives.

Cognitive defusion techniques are practices that help us achieve this aim. These techniques may include exercises such as:

• Labeling your thoughts "I am having the thought that..." or "I notice that my mind is having a judgmental thought."
• Singing your anxious thought out loud (or in your mind) to the tune of a silly song (like Twinkle Twinkle Little Star or any other song of your choice) 
• Thank your mind for the thought, such as "Thank you mind for that thought. I appreciate your contribution but I got this."
• Repeating an anxiety provoking word over and over in your mind until you begin to hear it as just a word
• Ask what the thought is in the service of. Is it in the service of your values or in the service of avoidance of discomfort?
• Watch your thoughts: Imagine your thoughts are like a news scroll reel, constantly streaming information that you can watch from a distance.
• Practice mindfulness of your thoughts, such as using the Leaves on a Stream mindfulness meditation.

These are just a few ways that cognitive defusion can be promoted, helping us to take our thoughts less seriously, leaving them with less power over us. When our thoughts have a less powerful hold on our experience, they become less threatening. We then have more freedom to invest our attention and energy elsewhere. For a more comprehensive list of cognitive defusion techniques, visit this list on the Association for Contextual Behavioral Science's website.

Additionally, ACT asserts that we have limited control over which thoughts or emotions we experience. The problem is less in the content of our thinking or feeling, and more in what we do with these thoughts or emotions, or how we relate to them. In other words, we can change our relationship with our thoughts so that we can focus our energy on what is truly worthy and important to us, instead of using most of our energy on trying to simply manage or reduce unpleasant thinking. 

In sum, awareness of our thinking patterns is often the first step, and changing how we approach our thoughts is the next step along the way of healing and wellness.

These two approaches may resonate differently for different people. Both CBT and ACT are evidence-based treatments for anxiety, and can help those who struggle with the reign of anxiety get back into living full and meaningful lives.

If you are interested in having assistance with unhelpful thinking patterns, Dr. Lauren Helm is trained in both CBT and ACT. 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

Barlow, D. H. (2004). Anxiety and its disorders: The nature and treatment of anxiety and panic. Guilford press.

Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.

Beck, A. T., Emery, G., & Greenberg, R. L. (2005). Anxiety disorders and phobias: A cognitive perspective. Basic Books.

Ellis, A. (1962). Reason and Emotion In Psychotherapy. New York: Lyle Stuart

Hayes, S. C., & Smith, S. (2005). Get out of your mind and into your life: The new acceptance and commitment therapy. New Harbinger Publications.

Sibrava, N. J., & Borkovec, T. D. (2006). The cognitive avoidance theory of worry. Worry and its psychological disorders: Theory, assessment and treatment, 239-256.

Whalley, M. G. (2015). Self-help tools for panic. Psychology Tools

Resources

http://www.webmd.com/balance/guide/how-worrying-affects-your-body

http://www.apa.org/divisions/div12/rev_est/cbt_gad.html

Cognitive Distortions and Restructuring Handout:

http://www.reconnect.salvos.org.au/common%20mindtraps.pdf

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

Are Expectations Healthy for 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.

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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.