Interview – Controlling Intrusive Thoughts
I enjoyed being interviewed for this interesting article on whether intrusive thoughts can and should be controlled. These questions drove my research for many years and it is fun to see the topic covered!
I enjoyed being interviewed for this interesting article on whether intrusive thoughts can and should be controlled. These questions drove my research for many years and it is fun to see the topic covered!
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.
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:
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.
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!
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!
I wanted to share an excellent article about self-help books for anxiety at Good Housekeeping. I appreciated the opportunity to discuss and recommend some awesome reads, thanks to the article’s authors!
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.
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.
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:
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.
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.
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!
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.
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.
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.
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:
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.
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:
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.
I can’t prove it, but I firmly believe that people usually do what makes sense to them. While that statement may sound cliché, it holds powerful meanings that can clarify who we want to be and how we get there.
An obvious objection is that people behave in all kinds of harmful, self-destructive ways. If you are like me, you can easily remember actions that were against your values or with hindsight didn’t make sense. How do such actions compute? Let me be clear that people don’t think through each action and consciously say ‘ah yes, what a great, logical action to do.” Some of our most upsetting or harmful actions occur when we feel unable to take other paths.
To understand harmful actions, let’s do a thought experiment. Envision a family member who is making an unwise decision that will hurt them and you. Now imagine that with Star Trek-like technology, I *completely* switch you into their brain and body. ‘You’ (I use that term loosely) have shed every aspect of your own person; instead, you take on the family’s member’s experiences, genetics, learning, memories, relationships, current thinking and emotions, etc – in short, every atom of the person and their experiences.
Would the modified ‘you’ would end up making the same decision as them? I hope you agree that there is a high chance. Sure, unpredictable external and internal forces might have unexpected influences; nonetheless, on average you would likely head down the same path.
What can you take from the thought experiment? Let’s dig into the implications with the next pair of topics: understanding and acceptance.
One lesson from the thought experiment is that your behaviors may seem foreign at times, but they aren’t arising from nowhere. The more you understand your personal context, the more you can shed light on the black box that led you to the action.
Having a greater understanding of your actions can unlock a number of paths to change: turned inwardly, understanding helps you to identify 1) problems, 2) how your desired destinations are different than the present, and 3) what internal and external factors are contributing to problems. With the knowledge of 1-3, you can better take steps toward actual change. When oriented toward others, making sense of people’s “senseless behavior” often leads to greater mental peace and improved behavior. Imagine that your best friend has been ignoring your texts. With building irritation, you finally reach them, ready to give an earful. It turns out they’ve had a work emergency! Their boss resigned, and they are shouldering the extra load. Now how do you feel toward them? How would your behavior change? Again, understanding the causes of behavior is powerful.
Importantly, understanding ≠ excusing. We all make missteps and do ‘wrong’ according to our respective moral codes. Guilt, regret, sadness, and other emotions can motivate you to seek change and repair, as long as they don’t become excessive. As a result, understanding negative emotions about your behaviors can be a useful tool for taking appropriate responsibility. Negative emotions can help us move from doing what made sense in the moment to doing something better.
Several threads I’ve mentioned are prominent in Dialectical Behavior Therapy (DBT). DBT integrates the notion of dialectics, or contradictory ideas that each seem to hold truth. One central dialectic is between acceptance and change. DBT contends that to change, you first have to accept the reality of the present and allow it to exist without seeking to resist it (i.e., radical acceptance). While radical acceptance is an ongoing process, heightening your radical acceptance can paradoxically move you toward future change. Here I can’t help but insert a similar Maya Angelou quotation: “Do the best you can until you know better. Then when you know better, do better.” Rephrased inelegantly into the current context, one might say: ‘accept that what you are doing what makes sense to you; when you learn behaviors that make more sense, do them.” I’m clearly not a poet, but the point remains: from a stance of current, active acceptance, we can free ourselves to learn, try anew, and do better.
Embedded in Maya Angelou’s words is a major question: how the heck do we begin to know better? I’ve already discussed how understanding and radically accepting your behaviors can be a start. However, you have plenty of other resources at your disposal to start to know better. For some folks it is conversations with friends and family; for others it may be therapy. For still others, it may be seeking out new cultural experiences, new structured learning, trying out new behaviors directly, or all of the above. The overarching goal is to uncover perspectives that allow new behaviors to “make more sense.”
Feel like you already ‘know better’ but still are doing the same old behaviors? You aren’t alone. Still quibbling with what it means for a behavior to make sense, or to be understood? I’m in the same boat, continually. Perhaps I will tackle these topics another day – for today, I’m present in my happiness that you and I are thinking meaningfully about understanding, acceptance, and change.
For many people, August and September mean the beginning of the school year. Whether you or a loved one is the student, the fall can bring on the “back to school blues” as you adjust. It’s important to attend to your needs and take proactive steps to cope with school adjustments.
Keep in mind that any major life transition frequently activates the bodily systems that underlie stress. Stress during life transitions isn’t necessarily bad; our bodily systems are amping up for a challenge appropriately! It is only when stress is chronic or results in experiences like panic attacks that it raises a red flag. Nonetheless, stress is draining. Do you end the day feeling like you’ve run a marathon? Exhaustion may be a sign that your body and mind have been on ‘high alert’ all day.
How else besides stress can the start of school trigger the “school blues?” The answer is that school can aggravate areas we already struggle with.
Think about what the start of school often involves for students and loved ones:
Any element by itself could result in symptoms of depression, anxiety, or sleep disruption for some. Combined? The risks multiply. Importantly, if you possess an area of your self that is already vulnerable, transition stress within that area can leave you uncertain and doubting yourself. For instance, what if you are someone who often worries that others are judging your appearance negatively? Coming across a variety of new classmates and instructors in dazzling new outfits may present plenty of opportunities to criticize yourself. Unfortunately, stress may also drain some of the very coping resources you would typically use to combat these insecurities.
While I’ve painted a rather dire picture of risks for school blues, let’s turn to the glass half-full side.
First, many back to school elements don’t need to be negative. Look at the list above again, but with an eye toward reframing them. You may find that some can be viewed as novel opportunities or challenges that you enjoy seeking out.
Second, this isn’t the time to forget your tried and true self-care methods. What has worked for you in the past? The momentary newness may cause you to forget about or hesitate to use effective coping strategies.
Third, just like you may have vulnerable areas of yourself, chances are that you have relevant self-areas you perceive as strengths. Are you excellent at organizing new schedules? Do you get energized about meeting other students, or about learning a new topic? Think of these self areas as buffers you can lean upon to maintain your confidence and mood. Research suggests for people with existing vulnerabilities, developing a longer list of areas you value about yourself may be beneficial. By reflecting upon your genuine strengths and vulnerabilities, you may protect yourself from the mental downsides.
If you would like help with this reflection or have other questions about the back to school blues, please feel free contact me for a free consultation. We can discuss whether counseling would be a good fit at this time.
You probably have at least a vague sense of what depression is. If I forced someone in the grocery store to tell me a symptom of depression, I’m guessing they might say depression involves feeling extremely sad (after they decided against chucking a few apples at me). Prompted by the setting, *maybe* they might also say that depression symptoms can include changes in appetite. Perhaps a bagger might chime in about energy loss, and so on. Indeed, these guesses would be on target: current diagnostic criteria for depression incorporate these three as well as five other relatively well-known symptoms (lessened enjoyment, change in weight, feelings of worthlessness or guilt, lessened concentration, and suicide-related thoughts or behavior). However, our understanding of depression goes much deeper than this simple picture.
Certainly, many depressed people experience the most well-known symptoms mentioned above. Even so, symptoms of depression often look different from this stereotypical picture – and in fact, from many other people’s. Cutting-edge research suggests that unique combinations of symptoms may be closer to the rule than the exception.
One reason is that the diagnostic criteria don’t capture all key symptoms. For instance, one scientific paper described all the ways professionals have measured depression. The author identified 52 different symptoms that professionals have suggested might be part of depression! Part of the variation is likely due to poor measurement. However, symptoms like irritability, anger, pessimism, and crying can be parts of depression that aren’t adequately described by the standard 8-item list. Like the better-known eight symptoms, any possible symptoms of depression could always be part of another mental struggle, medical issue, or other separate cause. Thus, figuring out what symptoms are and aren’t part of your depression is an important puzzle.
A second way you may be unique concerns how troubling you find various symptoms. If you’ve ever experienced depression, you know that not all symptoms are equally bothersome. For someone who is a restaurant critic, a lack of appetite may impair their ability to work effectively. For a sales associate, their lack of concentration may be causing them to lose potential clients. In addition to experiencing the symptom itself, each person may find a symptom uniquely upsetting or impairing.
A final complexity stems from the mathematics of how symptoms combine. Even if you only use the standard eight symptoms, “depression” could still present in numerous ways. For example, current criteria suggest a person must have five out of eight symptoms for a diagnosis. It turns out there are 93 different ways a person could be experiencing ≥ five out of the eight symptoms!
Above all, the lesson to take about symptoms of depression is that each person needs to be carefully understood as an individual. The good news is that you are well-positioned to seek such an understanding and handle whatever struggles your symptoms may be causing. At Wellness Path Therapy, I consider you to be the expert on your own experiences. You are the only person who has been there minute-by-minute, experiencing what it is like to be you your entire life! By combining your expertise with professional support in understanding symptoms, you can get to the bottom of what is happening. If you are considering professional help to address your symptoms of depression, I encourage you to reach out to me or other therapists to begin your therapy journey.
Stress has an unfair reputation. Sure, few of us enjoy feeling stressed. Yet picture a world without stress. Amidst an argument with a partner, you would feel entirely unperturbed. When an important work deadline nears, you would feel…nothing. As you scrambled to pay next month’s rent, your mind and body would be completely unbothered. At first glance, you might think this lack of stress would be nice. But think again; an important role of stress is how it activates our mental and bodily systems to respond effectively to challenges. In other words, normal stress plays helpful functions. It activates your sympathetic nervous system, which coordinates additional bodily resources toward a challenge. Without stress, it would be much harder to effectively handle the difficult situations that arise in everyday life. Knowing about this helpful side of typical stress allows us to distinguish it from chronic stress.
While typical stress is experienced by everyone from time to time, chronic stress reflects ongoing exposure to stressors. Your body’s built-in system for responding to stress activates beyond what is healthy, putting you at risk for longer-term illnesses. Further, your body does not fully activate its typical recovery and relaxation systems following stress. To distinguish between ‘everyday’ and chronic stress, let’s use a silly example.
Paul, a former chef, dislikes snacks that leave remnants of the snack on a person (think of cheese puffs). He has good reasons for his dislike, and becomes quite stressed whenever he encounters such a snack. Several times a month he encounters coworkers’ lunches that leave him feeling stressed out. When this happens, he typically experiences unpleasant emotions and his thinks negatively about ‘stressful snacks’ for a few hours. However, he is generally able to address the situation and bounce back quickly.
Unfortunately, Paul is now moving due to his partner’s change in jobs. When they move into the new company housing, he is horrified to find that his unit is surrounded by several snack factories. When he looks closely, he notices that the ground has a coating of snack ‘dust’ – he is literally living amidst stressful snack residue! What’s more, his partner is now provided with ‘stressful snacks’ for free and has taken a liking to them, often eating them at home. Now nearly every time he steps foot near his house, he feels stressed. He doesn’t feel like he can relax or get away from thinking about the snacks.
You don’t need to feel stressed about cheese puffs (I hope this is rare!) or be experiencing an extreme situation like Paul’s to have chronic stress. The key is the repeated, ongoing nature of stressors. The exact symptoms of chronic stress take forms as varied as the individual. One way of considering the symptoms of chronic stress is to separate them into physical, emotional, and thinking components. Common physical symptoms include aches, tension, fatigue, and stomach difficulties. On the emotional and thinking side, people may feel highly irritable, anxious, sad, and worried. They may have a difficult time distracting their thoughts from stressful topics, and may feel exhausted or hopeless when thinking about the stressors. Overall, the experience of chronic stress often feels overwhelming.
According to research, a number of treatment methods can be helpful for chronic stress. Therapists may help you to learn relaxation techniques, new ways of thinking about stress, or consider how to modify the stressful situations. With counseling, you may learn how to better lean upon the social support you need or engage in practical problem-solving focused on solutions. Across methods, you can learn to feel more in control of stressful situations and better able to cope with stressors.
If your level of stress is distressing or is impairing your functioning, it may be time to consult a professional. Listen to your friends and family – they may notice the outsized impact of stress before you do! A therapist can help you to evaluate your stress and provide support for getting back on track.
To grasp what panic attacks are like, picture the following: as you are walking upstairs, you suddenly notice weird sensations in your body. Your heart begins racing and a dread fills your stomach. Your chest is rapidly tightening up. Breaths of air don’t seem to come quickly enough as a horrible fear takes over your brain: are you having a heart attack? Your feeling of panic becomes almost unbearable as you lay on the floor and try to keep it together. What is happening?
Minutes or hours later, the panic lessens again. But what had been a happy, normal day is now wrecked by your exhausting experience. At Wellness Path Therapy, this is the type of experience that many clients have reported before beginning therapy.
You may not have needed that description to imagine a panic attack. Panic attacks are quite common, with over 1 out of 10 Americans experiencing one each year and even more panicking during their lifetime. Panic attacks look different from one person to the next. For some people, they may feel highly concerned about situations like driving, crowds, public transportation, or exercise. Others may focus on avoiding situations that they fear could trigger panic.
Panic attacks themselves involve the activation of our nervous systems, which include both physical sensations and scary thoughts. Common physical sensations may include racing heart, sweating, dizziness, tingling or numbness, nausea, and shortness of breath. However, you may not know that frightening thoughts are also part of our nervous system’s reaction to perceived danger. These scary thoughts often focus on physical sensations. For example, “what if this dizziness means I am having a stroke?” or “I’m going crazy, I know it!” Our bodies generally react to such scary thoughts with even more panic.
Experiencing even a single attack can be overwhelming. So how do you know when panic is becoming a problem? The simplest answer is that if your panic is bothering you, you can talk with a professional to figure out what is happening. Our job is to help you with exactly these types of questions.
To better understand the impact panic attacks may be having on you, professionals distinguish between panic attacks and panic disorder. Among other differences, panic disorder occurs when your panic attacks keep recurring unexpectedly. You may find yourself worried about future panic attacks or changing your behavior to try to avoid them.
It is also important to rule out other medical, medication, or substance-related causes for panic attacks. For instance, someone may be experiencing panic attacks due to steroid medication, marijuana use, or as part of an emerging condition like diabetes. In these examples, your health professional can do a thorough assessment of the possible causes for your panic attacks and help you determine what types of support are most appropriate.
There is good news about panic: it is treatable! Research shows that not only do many people benefit from panic treatment, it is one of the mental health areas we are best at addressing. The leading treatment for panic is cognitive-behavioral therapy, which teaches you new skills for thinking about physical sensations. The treatment also helps you to ‘face your fears’ through exercises that intend to bring on sensations of panic attacks. It may seem counterintuitive, but we want you to approach rather than avoid panic. This process reteaches your brain that the physical sensations during panic aren’t truly dangerous. In other words, experience (through practice) is truly the best teacher! I am in awe of the way my clients bravely engage with this treatment despite how (literally) scary it is; it is wonderful to see their hard work paying off as they find relief and happiness.
I hope this post is useful for learning some basics about panic attacks and treatment. If you are interested in pursuing online therapy for panic, there is research suggesting it is effective. Please contact me for a free consultation and we can discuss whether counseling would be a good fit at this time.