Intrusive Thoughts

Intrusive Thoughts

Nearly everyone experiences intrusive thoughts. Intrusive thinking takes many forms, such as a quitting smoker imagining putting a cigarette to his lips or a worker’s fleeting wish for her boss to be in a car accident. While these thoughts can be distressing for anyone, intrusive thinking sometimes develops into a clinical problem.

What is an intrusive thought?

To mangle a supreme court justice, “you know it when you think it.” Technically, an intrusive thought can be a verbal thought, an image, an urge, or other less clearly defined mental forms. While people’s intrusive thoughts may not share every quality in common, their mental experiences often have key similarities.

Intrusiveness and Distress

First, by definition these thoughts seem intrusive. They tend to pop into mind unexpectedly and capture your awareness. We can’t stop there however – if you pay attention to the typical ebb and flow of your thoughts, it turns out many of our thoughts work this way! All kinds of mental experiences constantly pop into our awareness, like waves of different sizes rolling through your view at the beach. Which brings us to a second quality: distress. Intrusive thoughts usually provoke particularly negative feelings compared to the other waves rolling through our awareness. Whether it is sadness, guilt, anger, fear, anxiety, or other emotions, intrusive thoughts stand out in their emotional impact.

Before we move on, indulge me in a quick experiment. Bring to mind a thought you want to have. Got it? Now generate a thought you don’t want to have. Observe your reaction to both. If you are like most people, you probably let the wanted thought remain in your mind. The wanted thought may have persisted for a time until it drifted away. In contrast, you likely tried to push the unwanted thought out of mind as soon as possible. Were you successful at pushing it away?

Wantedness and Controllability

Ok, experiment over. During this exercise you just encountered our two final qualities for today: wantedness and controllability. (Un)wantedness describes how much a thought is desired or considered to be acceptable. Wantedness is more complicated than it may first appear. Imagine a pleasant scene in which you are laying on a beach. Warm sun beats down on your skin while cool, soft water laps at your toes. A fairly wanted image for most of us, right? Now picture that you are in the last 10 minutes of focused, stressful work before an important deadline. How welcome would the beach image be? For most people, the same exact image can be welcome or unwelcome depending upon the context.

In terms of controllability, thoughts vary in how easy versus difficult they feel to manage. Our minds are funny creatures; in the experiment above, you may have had difficulty pushing your unwanted thought out of mind. It turns out that this approach, called thought suppression, typically isn’t very useful and can even backfire. I’ve even spoken to one reporter about how intrusive thoughts spurred by smartphone notifications could be worsened by thought suppression!

Don’t worry if the qualities I’ve described above don’t resonate with you or feel complicated. They are only one way of considering intrusive thoughts and not comprehensive. I share them because I find them helpful for getting more specific about the intrusive thoughts someone may be experiencing.

Intrusive thoughts are a part of many mental health struggles

From anxiety and obsessive-compulsive disorder (OCD) to depression, panic attacks, and a ton of other problems, people report struggling with intrusive thinking. Why are intrusive thoughts so common in these problems? One answer is that intrusive thoughts often revolve around topics that are highly important to us. When your brain tags a topic as important, it also tends to generate thoughts about those topics more frequently. In other words, the ebb and flow of thought ‘waves’ that are constantly passing through our conscious mind may include more thoughts revolving around that clinical problem.

At the same time, intrusive thinking is part of a cycle. It is only natural that you may accidentally respond to intrusive thoughts in ways that heighten your distress. In this case, your responses to intruding thoughts may look different than other people who have the same thoughts. Conveniently, this last point offers one key route out of intrusive thought struggles.

How you view your intrusive thoughts matters

Research suggests that the way you interpret your intrusive thinking matters. For instance, someone who interprets an image of a family member in a car accident as a sign of their immorality (e.g., “Maybe this thought means that I really want the accident to happen; I must be an awful person!”) may have an elevated risk of O.C.D.. Someone who dismisses the thought’s meaning (e.g., “This thought is just a thought, it doesn’t have any meaning about me.”) may not have the same degree of risk. A number of effective treatments target this common thread: altering your view (and relationship with) intrusive thoughts. Importantly, this therapy model is appropriate across a number of diverse problems and provides a way to begin addressing intrusive thoughts. I will discuss these treatments in more detail during a future post.

I hope this post is useful for learning basic information about intrusive thoughts. If you are interested in pursuing online therapy for a problem related to intrusive thoughts, please contact me for a free consultation. We can discuss whether counseling would be a good fit at this time.

Psychology-themed Halloween Costumes

Psychology-themed Halloween Costumes

Looking for some silly, spooky, psychology-themed Halloween costumes? Search no further! Your friendly therapists at Wellness Path Therapy have you “covered.” 😉

(Para)normal distribution.

What is “normal,” anyway?

Avoidance.

One of the “big baddies” harming psychological health. (OK, Ok… avoidance is not always bad).

Bobo doll.

Poor Bobo.

Freudian slip.

When those unconscious beliefs simply cannot be suppressed.

Fundamental attribution error.

Perspective taking for me, but not for thee.

Radical Acceptance.

As a wise blogger once wrote, to address those inner demons, sometimes we need to “let it be.”

Confirmation bias.

I’m pretty sure “confirmation bias” does not exist, and here’s a random study to prove I’m right.

Skinner’s pigeon.

Who’s ready for some ping-pong?!

Catastrophic thinking.

For those of us with negative attributional styles.

Your brain!

Because this is where the magic happens.

Wishing you and your loved ones a happy, healthy, psychology-themed Halloween!

Radical Acceptance: One Key to a Fulfilling Life

Radical Acceptance: One Key to a Fulfilling Life

 “I have a really difficult time letting things go. Instead, I am trying to learn to let things be.” Without fully realizing it, my client had skillfully described a concept so fundamental to psychological health that entire therapies have been developed around its essence: radical acceptance.

What is radical acceptance and why might it be helpful?

Acceptance is not wanting, wallowing, or resigning. It is not approving. It is not “giving up.” Acceptance—particularly radical acceptance—is simply the willingness to experience what already is without judgment.  It is the difference between acknowledging that the hill is steep vs. ruminating about the many ways we wish it weren’t.

radical acceptance example

“But why should we do this, Dr. Clerkin?” I frequently hear some version of this question, and I relate deeply to the dilemma. Often, I feel intense internal resistance when attempting to radically accept “what is” vs. “what I want.”

In my view, to understand the value of acceptance, one must first internalize the logic of dialectical thinking. Dialectics are another eponymous concept for a major psychological therapy. Quite simply: acceptance and change are two sides of the same coin. To truly change, we often must accept what we are thinking, feeling, and experiencing. To truly accept, we often need to change.

How’s that working for you?

One of my clinical supervisors, Dr. Ellen Astrachan-Fletcher, encouraged my colleagues and I to ask, “how’s that working for you?” when considering a given behavior or situation. If the answer is “good,” there is usually nothing to worry about. If we can put a different spin on things or change our interpretation to be a bit more positive, terrific. Able to directly modify the circumstances leading to our distress? Even better!

Frequently, though, we’ve done all the problem solving that we can. We’ve changed what is within our control, and we’ve taken different perspectives. Perhaps at this point, the most effective thing we can do—as my client so wisely stated—is to “let it be.”

Practicing Radical Acceptance

Practicing radical acceptance may involve turning toward vs. away from our emotions, acknowledging the reality of our current experience, or carefully considering what we cannot change. Learning to radically accept may also be fostered by seeking professional support.

With intentionality, radical acceptance of where we are in the present moment helps us to create a life that is rich, full, and meaningful. After all, when we are not constantly struggling to accept the reality of “what is,” we have so much more freedom to pursue our values and “what could be.”

Welcoming Elise Clerkin

Welcoming Elise Clerkin

I am thrilled to welcome Dr. Elise Clerkin to the Wellness Path Therapy team! Elise brings with her a wealth of experiences as a scientist practitioner, including working as a staff psychologist at the University of Virginia and as an associate professor at Miami University. Elise is an empathetic, authentic, well-trained therapist. She has a deep understanding of the science underlying human behavior, and an unusually strong capacity to perspective take. With clinical work grounded in behavioral and cognitive therapies, Elise is committed to helping her clients pursue their values, develop meaningful lives, and minimize suffering. 

To learn more about Elise and her approach to therapy, please visit her bio and request a free consultation. 

Anxious about therapy? Me too, and I’m a therapist!

Anxious about therapy? Me too, and I’m a therapist!

Recently I was meeting a potential new client for the first time. They told me that they felt anxious about meeting with a therapist to consider counseling. In the course of our discussion, I revealed that I often feel anxious too when I begin therapy with a new client! In full disclosure, my anxiety feels manageable, which I know is not the case for everyone; my anxiety neither causes me distress nor gets in the way of my work. However, whether you are a client or a therapist, anxiety can be normal and helpful to reflect upon.

Why do clients feel anxious about therapy?

As a therapist, I attribute my anxiety to how important I view the beginning relationship. I want to make a good connection with someone new, and I have a strong desire to start doing our work together effectively. Each person is unique, and I know I will need to work hard to accurately understand their needs. For myself, these are good goals and my anxiety helps motivate me toward them.

On the client side, there are many additional possible sources of anxiety about therapy. Let’s name some of them:

  • Meeting a stranger (the therapist). For most of us, but especially folks who struggle with social anxiety, the situation of meeting a stranger may induce anxiety regardless of whether it is a therapist or someone else. You may feel nervous about whether your therapist will like you, judge you, or have a good impression of you. Please remember that good therapy is all about forming a strong connection and collaborating on your goals; your therapist is truly there to understand and empathize with you, and has received significant training to make this happen. If there is a mismatch, it isn’t your fault; it may just not be a good fit! Which brings us to…
  • Worrying about whether the therapist will be a good fit. If you decide to seek counseling, it is important for your therapist to fit what you are looking for. Seeking the right match for pursuing your mental health goals can be anxiety-provoking! The first therapist you meet won’t always be the best fit, and it is fine to honestly communicate your hesitations. Many therapists offer free consultations for exactly this purpose.
  • Discussing private, difficult topics. You may worry about being judged or whether information will stay private. Therapy is a strange place in some ways. There probably aren’t many places where you can talk as freely about mental health struggles, sex, relationship complexities, and other topics. As a result, breaching private or ‘taboo’ subjects may feel uncomfortable. Please be assured that therapists inhabit this space every day. We not only are used to discussing these topics non-judgmentally and confidentially, we encourage open, genuine discussion for the sake of your well-being.
  • Acknowledging to yourself that you need support. Change is hard, and sometimes the first step of a journey possesses outsized meaning. It may be nerve-wrecking to contact a therapist if such an action marks a commitment to move in a new direction.
  • Uncertainty. A lack of information about the future is often a trigger for anxiety. A new therapist and perhaps the process of therapy itself may be uncertain to you at the start. Again, anxiety is an expected reaction to uncertainty! For excessive anxiety, one of the skills you may work on in therapy is better tolerating the uncertainties of life.
  • Worry that therapy “won’t work.” Sometimes despite your hard work in therapy, it is possible that an initial course won’t reach your goals. This possibility can make you feel hopeless, but remember that doing therapy is like riding a bike. You often have to try and fall off several times before you learn how to ride. Just like you wouldn’t expect to ride a bike perfectly on your first attempt, shifting mental health patterns takes practice and time.

These sources of anxiety are not exhaustive, but some of the ones I most commonly hear from clients. It may be helpful to notice how each source of anxiety is about something important. In other words, these concerns didn’t arise from nowhere – they reflect valid needs, even if the amount of anxiety can sometimes become excessive.

Signs of anxiety about therapy

In addition to standard physical, thinking, and behavior-based symptoms of anxiety, you may experience signs that are uniquely tied to therapy. Do you avoid thinking about therapy? Do you notice yourself making (inadequate) excuses about your need for more support? Is there an anxious pit in your stomach when you think about therapy? Do you find yourself searching for a therapist but not taking the step of contacting one? An incredible aspect of being human is your capacity to observe yourself; take a good look at what messages your thoughts, emotions, and behaviors are sending to yourself!

Don’t let anxiety deter you from the support you need

The average amount of time people wait to begin therapy is 11 years! That is over a decade of unnecessary struggle. Much of that wait results from problems with the mental health treatment system such as health disparities, therapist availability, and cost. However, your anxiety about therapy is one factor that remains more in your control. Whatever your anxiety level, you can still choose to begin therapy. In other words, you can decide to begin therapy WHILE feeling anxious about it rather than avoiding therapy BECAUSE you feel anxious. Don’t let distressing emotions keep you from living the choices you want!

Sleep Procrastination

Sleep Procrastination

Night can become a time when people counterintuitively resist sleep. When you are feeling stressed or anxious, your mind is on alert that ‘something is wrong.’ Without a clear plan for how to address the problem, you may find yourself “doomscrolling” on social media, dwelling on relationship missteps, or snacking. Whether you call it sleep procrastination, revenge bedtime procrastination, or something else, the end result is staying up later than you intended. Often, the next morning is filled with exhaustion, grumpiness, and regret.  

What causes sleep procrastination?

People often procrastinate with their sleep for reasons that seem to make sense in the moment. For instance, after a long day of work, sleep may feel less appealing than alternatives like watching another show on Netflix or texting with friends. It may also be challenging to sleep when someone is still ‘coming down’ physically and emotionally from intensive experiences. If you have ever tried to sleep immediately after a heated discussion, it is the same idea. Your mind and body tend to desire transition time to regulate themselves before sleep. Of course, for any person there may be a variety of other psychological, substance-related, and medical reasons why they have difficulty going to sleep.

Basic sleep and well-being tips may help with addressing the problem

One way to address sleep procrastination is to be proactive about your needs. Even if your time available is brief, prioritize your emotional needs before you go to bed. Do you need to schedule a few minutes to talk through your day with a partner? Can you carve out (and stick to!) time for a wind-down activity like showering or reading? Forcing yourself to go to bed without addressing your emotional needs can paradoxically backfire and lead to sleep procrastination.

Sleep specialists have long emphasized the importance of “sleep hygiene” for people with disorders like insomnia. Many sleep hygiene tips are useful for anyone having sleep difficulties. The more you institute a consistent sleeping routine that associates your bed with sleep, the more successful you may tend to be.

Questions to ask yourself include:

  • Is my bedroom too hot, cold, noisy, or uncomfortable?
  • Can I go to bed at a more consistent time every night?
  • Does my caffeine or alcohol use disrupt my ability to wind down and sleep?
  • During the day am I physically active and exposed to natural light?
  • Am I using my bed for purposes other than sleep and sex?

Setting up your sleep environment and routine for the purpose of sleep allows your mind to more strongly expect sleep when you are in bed. If you are having ongoing difficulties with falling asleep, you might consider only going to bed when you feel sleepy. Unable to sleep after 15 minutes? Leave your bed to engage in non-stimulating activities, then enter bed again when you feel sleepy.

Sometimes sleep procrastination is part of a more serious sleep problem

The tips above are not intended to be professional advice for someone struggling with a clinical problem. If you are distressed about your sleep or concerned that it is significantly affecting your life negatively, it may be time to consult a professional.

Types of Therapists in Ohio & Virginia

Types of Therapists in Ohio & Virginia

Choosing a therapist can be a daunting experience. You pull up Google or Psychology Today to investigate options and get lost in an alphabet soup. PhD’s, MSW’s, LISW’s, LCSW’s, PsyD’s, and more! There are also similar-sounding terms such as psychologists, psychiatrists, therapists, and counselors. Despite working in the field for nearly two decades, I still get confused at times! I’m providing today’s brief explainer to clarify some of the similarities and differences amongst providers. Please note that my explanation covers therapists in Ohio & Virginia; while many ideas hold true elsewhere, laws and regulations vary across states!

‘Talk therapy’ versus medication

A major distinction is between ‘talk therapy’ versus medication. I am a licensed clinical psychologist (PhD), and given the similarity of this title to ‘psychiatrist,’ I often get calls from people understandably confusing the two. Clinical psychologists, along with other mental health specialists, provide talk support that many people call ‘therapy’ or ‘counseling.’ In contrast, psychiatrists are medical doctors who also have specialized mental health training. While some psychiatrists may offer (usually brief) talk therapy as well, they typically focus on medications. For many problems there are effective treatments using either or both modes simultaneously (e.g., seeing a talk therapist and a psychiatrist at the same time for depression). Don’t be led astray by assumptions about talk therapy vs. medication; for instance, both directly change the brain’s functioning.

The ‘umbrella’ of therapists in Ohio & Virginia

When it comes to talk therapy, distinctions become even more confusing. It is time for us to separate out everyday language from more technical professional meanings.

Counselors vs. Therapists vs. Psychologists

In everyday language, counseling and therapy are used interchangeably to mean mental health support. In other words, there are many types of providers who fit beneath broad ‘umbrella’ terms such as counselors or therapists. I tend to use such everyday language myself – for instance, throughout this post, I’ve been using the everyday meaning of ‘therapist.’

However, in a technical sense, the terms are not the same. On average, counselors, therapists, and psychologists tend to have different educational backgrounds, regulatory requirements, and methods of approaching treatment that may impact your experience. Of course, there is great variation among each type of professional as well, so the general trends will not apply to every provider you meet.

Commonalities and differences across providers

In general, all counselors, therapists, and psychologists tend to have training in how to impact your general well-being. In providing support, all seek to be:

  • Empathetic
  • Active listeners
  • Good communicators
  • Ethical

Counselors, therapists, and psychologists also tend to overlap in their techniques and theories. No one provider type has a monopoly on mindfulness, cognitive-behavioral therapy, or other common approaches, although certain approaches seem to be more frequent among some provider types.

In addition to commonalities, providers have important differences. The largest involves the degree of training before beginning practice. Educationally, counselors usually require at least a bachelor’s degree. Therapists typically require a master’s degree after their bachelor’s, and psychologists require a doctoral degree above and beyond their master’s. While I want to emphasize the diversity of educational paths that counselors, therapists, and psychologists may travel, providers can differ by as much as 5-7 years or more in their training and supervised experiences.

Another important difference involves regulatory requirements. Most types of counselors and therapists need to obtain a license, but not all. In Ohio & Virginia, the term “psychologist” is legally protected and regulated by state boards of psychology. There is a high bar for claiming that one is a psychologist. For instance, when I became licensed in Ohio, I needed to prove not only that I had completed my (7-year-long!) Ph.D., but also that I had successfully completed a year-long internship practicing therapy, several thousand supervised clinical hours, a national psychology practice exam, and an oral exam testing knowledge of relevant Ohio legal code. To maintain my license, I complete continuing education each year and maintain my activities in line with the standards of the board. Again, most counselors and therapists have their own regulatory and continuing education requirements; just be aware that the number and rigor of requirements may differ.

A final distinction involves the methods that providers use in therapy. The story is once again one of overlap; any two psychologists may differ just as much as one provider type differs from another. That said, in general counselors tend to have training relatively more focused on practical methods and suggestions for specific issues. Therapists tend to incorporate a greater emphasis on mental diagnoses, with increased conceptualization of the underlying problems. Finally, psychologists are skilled in diagnosis, identifying the root causes of mental health disturbances, and applying research evidence to clinical work. Psychologists will bring extensive theoretical grounding to their work and are relatively more likely to work with severe mental illness.

Finding the right provider

All of these distinctions mean little if you can’t find someone to support YOUR needs. Finding therapists in Ohio & Virginia deserves its own post, but here are several important things to look for:

  • Interpersonal fit: Do you feel comfortable and supported? Will you be able to discuss difficult topics with this person?
  • Attention to science: We are fortunate to live in a time where we have ever-improving knowledge about which approaches are more likely, on average, to work for particular issues. Your therapist should not blindly apply scientific findings without individualizing your care, but ask: is your therapist in touch with evidence about what works?
  • Cultural responsiveness: You have a unique combination of values, identities, preferences, and experiences that make you “you.” A good therapist will work as a team to understand you and design an individualized treatment plan.
  • Credentialing/Experience: Regardless of the type of therapist, is there an indication that they are trustworthy and have sufficient training and competence to help you?

Hopefully after reading this explainer you feel more empowered to determine who is a good fit for you. The right provider for you may be a counselor, therapist, psychologist, psychiatrist, or someone else! Indeed, my most trusted colleagues come from a variety of mental health backgrounds. As you seek a provider, please ask them the questions that will allow you to find the person.