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Pain is Inevitable; Suffering is Optional

The goal of Acceptance and Commitment Therapy (ACT) is to create a rich, full, and meaningful life while accepting the pain that inevitably goes with it. This is done by changing one’s relationship to their symptoms in order to live a more value-driven life. Further, the goal is to accept what is outsideof one’s control, and commit to taking action to enrich one’s life. It can be summed up in one basic premise: pain is inevitable, but suffering is optional.

Oftentimes, trying to get rid of symptoms actually results in being more bothered by the symptoms. For example, try to not picture a pink elephant in your mind’s eye. What happened? You saw a pink elephant. This is just what happens when we try NOT to focus on any particular thing!

Being too focused on symptoms impacts our ability to life a value-driven life. We’re too busy and using all our energy on “symptom-reduction” rather than choosing to focus on what is meaningful in our lives, such as family, friends, relationships, advancing career, rest, self-care, and so forth. When we instead focus on our values, our symptoms can drift to the background, rather than take center stage.

ACT asserts that problems are essentially caused by two things: cognitive fusion and experiential avoidance. Cognitive fusion is when we become inseparable from our thoughts, and then our thoughts dominate our behavior. Experiential avoidance happens when we attempt to avoid, get rid of, suppress, or escape unwanted experiences (thoughts, feelings, memories, sensations, etc.).

Trying too hard to control how we feel simply gets in the way of a rich, full life. We can’t do important, value-driven things if we are always trying to get rid of symptoms. Control is the problem, not the solution.

What can we do about this? Practice defusion to get stuck from our thoughts and gain distance from them. Defusion is taking a step back and seeing our thoughts for what they are: nothing more or less than words and pictures. As I like to say, look AT your thoughts, rather than FROM your thoughts.
Thought Defusion PICTURE for blog post - Copy

Here are some ways you can attempt to defuse from your thoughts:

  • Say “I’m having the thought that…”
  • Use a silly voice to say the thought
  • Sing the thought like a song
  • Repeat the thought nonstop for 30 seconds until it sounds like gibberish

Another way to defuse from unhelpful thoughts is to practice mindfulness. What is mindfulnessMindfulness means paying attention with flexibility, openness, and curiosity. It allows you to be aware of your experience in the moment as opposed to being “caught up” in your thoughts. Mindfulness involves an attitude of openness; being curious about your experience rather than fighting with it. This is helpful because often times the more we try to fight the way we feel, the more we end up feeling it.
hexagon-4
 
The goal of ACT is referred to as psychological flexibility, which entails being present, opening up, and doing what matters. An important facet of psychological flexibility is acceptanceallowing thoughts and feelings to be present, regardless of whether they are pleasant or painful.

The fun part of ACT (in my humble opinion) is valued living: doing what we want to be doing with our lives. What’s important to us? What do we want to stand for? How do we want to behave and act on a daily basis? Our values are our compass; they guide our decisions and behavior. A good way to figure out what your values are is to imagine your retirement party or funeral — Who would you want to speak about your life and what would you want to hear them say?

Once you have figured out what your values are, then final step is to take committed action (effective action motivated by your values). One helpful way to do this are to make a public commitment; tell someone about it. This will create some level of accountability for you. Another thing you can do is create an action plan worksheet. Last, but not least, simply take the first, tiniest step. The first step is often the hardest, but if you can manage to get started, the rest will follow.

For more on Acceptance and Commitment Therapy, click here and here!

How to Dispute Irrational Beliefs

Albert Ellis is known as the grandfather of Cognitive Behavior Therapy. He combined humanistic, philosophical, and behavioral therapy to form Rational Emotive Behavior Therapy (REBT) in 1955. A main assumption of REBT is that people contribute to their psychological problems by the way they interpret events. Further, our emotions stem mainly from our beliefs, evaluations, interpretations, and reactions to life situations. REBT assumes that cognitions (thoughts), emotions, and behaviors interact significantly and have a reciprocal cause-and-effect relationship. Additionally, REBT postulates that people are born with a potential for both rational and irrational thinking.

According to Ellis, we have an inborn tendency toward growth and actualization, yet we often sabotage our movement toward growth due to self-defeating patterns we have learned. We originally learn irrational beliefs from significant others during childhood, and we actively reinforce these self-defeating beliefs by repetition, and by behaving as if they are useful. But it is not useful to blame ourselves and others; instead, it is important that we learn how to accept ourselves despite our imperfections. Therefore, a major goal of REBT is to achieve unconditional self-acceptance and unconditional other acceptance; the more one is able to accept him or herself, the more likely he is to accept others.

The therapeutic process involves identifying irrational beliefs, and replacing such beliefs with more rational and effective ways of thinking. Changing one’s thinking results in changing one’s emotional reactions to situations. Ellis succinctly puts it this way, “You mainly feel the way you think.” Some examples of irrational beliefs that lead to self-defeat include: I must have the approval of all the people in my life, or else I am worthless. I must perform all tasks perfectly, or else I am a failure. It is better to avoid life’s difficulties than to try and end up looking foolish.

The A-B-C framework and method of disputing irrational beliefs is central to REBT theory and practice.

A = an event, behavior, or attitude
B = belief about the event
C = emotional & behavioral consequence or reaction (can be healthy or unhealthy)
D = disputing irrational or self-defeating beliefs
E = effective philosophy of replacing unhealthy thoughts with healthy ones
F = a new set of healthy feelings

A (the activating event) does not cause C (the emotional consequence); rather, B (the person’s belief about the event) largely causes C. D is the application of methods to challenge irrational beliefs by detecting, debating, and discriminating irrational (self-defeating) beliefs from rational (self-helping) beliefs. E is the new and effective belief system that consists of replacing unhealthy thoughts with healthy ones. In doing this, F (a new set of healthy feelings) is created.ABC Framework 11

In summary, Rational Emotive Behavior Therapy entails the following steps: (1) acknowledge that we are largely responsible for our own emotional problems, (2) accept that we have the ability to change these disturbances significantly, (3) recognize that our emotional problems often stem from irrational beliefs, (4) accurately perceive these beliefs, (5) see the value of disputing such self-defeating beliefs, (6) accept that we need to counteract our dysfunctional beliefs/feelings/behaviors, and (7) practice these methods to improve current and future circumstances.

References:
Corey, Gerald. Theory and Practice of Counseling and Psychotherapy. Belmont. Thomas Learning, Inc. 2005.

Ten Rules for Confidence

[from The Confidence Gap: A Guide to Overcoming Fear and Self-Doubt, by Russ Harris]

Rule 1: The actions of confidence come first; the feelings of confidence come later.
The concept of confidence is defined as “an act of trust or reliance” (trusting and relying on one’s abilities and competencies), rather than viewing confidence as “having a feeling of absolute certainty or assurance.” This is a better approach, because if you wait for the feelings of confidence to come before taking any sort of action, then there’s a chance you might end up waiting forever. That’s not very effective. Harris offers four steps to follow in order to become more confident in any action: (1) Practice the skills, (2) Apply them effectively, (3) Assess the results, and (4) Modify as needed.

Rule 2: Genuine confidence is not the absence of fear; it is a transformed relationship with fear.
People believe many myths about fear, such as: fear is a sign of weakness; fear is the enemy; fear holds you back; confidence is the absence of fear. But the truth is that when anyone steps out of their comfort zone, takes a risk, or faces a challenge, they will experience fear. That’s not a sign of weakness; it’s the natural human response. Fear doesn’t have to be viewed as an enemy, or something to hold you back, rather, it can be used as a motivating source of energy to be used for your benefit. It is not true that confident people don’t feel anxious or afraid, but perhaps they have figured out how to handle it and channel it effectively.

Rule 3: Negative thoughts are normal. Don’t fight them; defuse them.
Dealing with negative thoughts can be annoying, but the fact that we have them is actually a good thing! It’s a sign that our brains are working: trying to anticipate what could hurt us or harm us, trying to predict what might go wrong, etc. If your mind has negative or anxious thoughts, congratulations – you have a normal brain. Negative thoughts are not inherently problematic, they only become so if we get all caught up in them, give them all our attention, treat them as the gospel truth, allow them to control us, or get into a fight with them. The goal is defusion: separate from your thoughts and realize that they are simply words.

Rule 4: Self-acceptance trumps self-esteem.
Having high self-esteem means evaluating oneself positively. The trouble is that it gets hard to do this when one is not successful, or when one makes mistakes. On the other hand, self-acceptance means accepting oneself in spite of deficiencies. It involves letting go of all self-judgments. It doesn’t mean that we stop paying attention to the way we behave, and the impact of our actions; it simply means that we let go of blanket self-judgments. When we make a mistake, we reflect on it and assess our actions. Harris puts it well when he poses: “If beating ourselves for every mistake we make was productive, wouldn’t we all be perfect by now?”

Rule 5: Hold your values lightly, but pursue them vigorously.
Values are one’s guiding principles of behavior, according to what is important to them in life. Harris likens values to a compass: they give us direction, guide our journey, and help us stay on track. (Goals are what we want to achieve along the way). Examples of values include: adventure, authenticity, connection, contribution, courage, creativity, flexibility, honesty, humor, intimacy, open-mindedness, respect, self-awareness, spirituality, and trust. One reason to hold your values lightly is the tendency for them to turn into inflexible requirements, such as, “I must be adventurous at all times.” Remember, the goal is to live by guiding values, not rigid rules.

Rule 6: True success is living by your values.
This means using one’s values to set goals, and to sustain movement toward set goals. You don’t have to wait until you achieve a goal in order be successful; you can be successful right now through living by your values. Maybe a goal of yours is to become a doctor because you hold the value of helping others. It will take you several years to actually become a doctor, but you can do many things to help people along the way.

Rule 7: Don’t obsess about the outcome; get passionate about the process.
Process is the way you go about doing something, whereas outcome is the result of what you’ve done. The idea here is not to give up on your goal(s), but to shift the emphasis to engaging fully in the process, and embracing it as an opportunity for learning, rather than obsessing about the outcome.

Rule 8: Don’t fight your fear: allow it, befriend it, and channel it.
Russ Harris Speaks of using “The ABC of Fear-Whispering” for dealing with fear (A=allow, B=befriend, C=channel). Trying to fight against or avoid an emotion oftentimes just makes the unpleasant emotion stronger. So, instead of fighting your experience of fear, try simply allowing it to be. Harris encourages befriending one’s fear: building a positive relationship with it. You don’t necessarily have to like it, but haven’t you ever been friendly to a person whom you don’t necessarily like? It’s kind of like that. Also, fear is worth befriending if it helps you live by your values, achieve your goals, perform at your peak, and live a richer, more meaningful life. Fear is kind of like nervous energy, but it can be less scary if you frame it as feeling “excited” or “pumped” instead. Think to yourself, “How can I make good use of this energy? What can I channel it into?” Use your fear to your benefit. And remember, you can have fear and confidence at the same time. If you recall Rule 2: Genuine confidence is not the absence of fear, it is a transformed relationship with fear.

Rule 9: Failure hurts – but if you’re willing to learn, it’s a wonderful teacher.
In the words of John Dewey (American philosopher): “Failure is instructive. The person who really thinks learns quite as much from his failures as from his successes.” Just like fear, failure is a fact of life. It’s also a natural part of learning; we reflect on what didn’t work, and think about what might work better next time. It is productive to acknowledge what went “wrong,” while also appreciating what went well. It provides good feedback from which to learn!

Rule 10: The key to peak performance is total engagement in the task.
Peak performance requires practice, defusing from reasons not to do it, making room for discomfort or fear, and fully engaging in the process. The key to peak performance is having focused attention on the task at hand. This requires mindfulness: defusing from unhelpful thoughts, such as, what you look like, what others are thinking, judging your performance, thinking about past or future events, etc. While you can’t eliminate unhelpful thoughts or feelings, you can make space for them while remaining focused and engaged in what you are doing in the present moment. It is in this state of mindful, focused action that we perform at our best.

A Look at Test Anxiety

Interview with Kansas City Blogger Local

High school and college students are no strangers to the effects of anxiety and depression.  This segment of the population however, faces a unique type of anxiety and depression that the general population rarely comes in contact with.  Test anxiety is a major issue for students the Kansas City metro area.  We met up with one local counselor to discuss test anxiety and how to deal with it.

Ben: Hello there.  This is Ben Hartman from Blogger Local Kansas City.  We’re out in Leawood with Molly Pierce, a Kansas licensed professional counselor  and owner of True Self Counseling.  We’re meeting with her today to discuss some of the upcoming anxiety that is related to the school season being in full swing.  There are a lot of tests coming up.  We met with Linden at Get Smarter Prep the other day, and she was actually talking about the ACTs coming up on September 21st.  Molly, if you can just tell us a little bit about yourself and True Self Counseling, that would be awesome.

Molly: Aright.  I started True Self Counseling in 2010.  I really have a passion to help people deal with common everyday problems, such as anxiety, depression, and communication/relationship problems.

Ben: Okay, so you deal with individuals, and then you deal with people in relationships, and then some group counseling as well?

Molly: Yes, absolutely.

Ben: You have a test anxiety clinic going on over at Get Smarter Prep.  Tell us about it.

Molly: It’s a one hour clinic in the evening to help students prepare to manage their anxiety, to get the best score that they can on their ACT or SAT.  With the ACT test coming up, we actually just did a test anxiety clinic last week.

Ben: Is it open to only people that go to Get Smarter Prep already or is it open to the general public?

Molly: This was the first one we did, and it was just Get Smarter Prep students, but I’m sure that outside people would be welcome to come.  There’s just a $25 fee.

Ben: Okay, so this is something that you guys are developing and working on, and it seemed successful this time?  There was a good turnout?

Molly: It did seem successful.  It seemed like the students really benefited from it.

Ben: There’s kind of two sides to being anxious about tests, the side where it’s impending and you’re stressed and you’re trying to learn as much you can before it comes.  Then for some people, afterwards there’s the anxiety of not having gotten the goal they strived for and being let down by or disappointed by their performance.  Can you maybe talk a little bit about the difference in the problems face on either side of the test?

Molly: Sure.  A lot of the students are getting the help they need in learning how to solve the problems on the exams and they feel confident in that aspect, but they really get freaked out about being timed and running out of time, and then there’s just this train of negative thoughts of like, what if I run out of time?  What if I fail?  Then I’m not going to get into the school I want to get into, and into my preferred profession.

Ben: It’s a compounding cycle?

Molly: Yes, it can go down this compounding hole of anxiety.  Same thing for after the test if they don’t get the score they were hoping for.  It’s almost like this sense of impending doom that now they can’t pursue the career that they want.

Ben: Yes, that their life is over.

Molly: Their life is over, even though they can really just go retake the test and go on with life.

Ben: Yes.  For some people, they feel like it speaks about them and tells people outwardly something they don’t want to convey.

Molly: That is absolutely true.  A lot of people equate their self-worth with how well they perform whether it’s on the test, or in sports, or relationships, or jobs, or whatever, so not getting a good score can actually make people feel pretty bad about themselves.

Ben: Yes.  There’s that misconception that the test score you get is a reflection of your worth, and those things are really completely exclusive.

Molly: Exactly, and that type of thinking really leads into depression and just feeling bad about yourself.

Ben: For some people that didn’t come to the clinic what could you recommend?  What are some tips that people can follow to get in their habitual nature that will help them avoid getting test anxiety or help them in reducing test anxiety?

Molly:  Anxiety is really a twofold issue.  There are the physical symptoms of anxiety, so when you feel like your breathing is getting short and shallow, and you might feel tingly.  You might feel butterflies in your stomach.  One thing you can do is deep abdominal breathing, which really calms your body and soothes the physical symptoms of anxiety. 

The other aspect of anxiety is the mental part of it.  It’s the thoughts, so if you’re thinking, oh my gosh, I’m so nervous.  I’m going to do horrible. I’m going to fail. That thinking is not going to be helpful, so you need to identify that negative thinking and change it into more positive and accurate thinking, such as I’ve prepared for this test.  I know what I’m doing.  It’s going to work out, and so forth.

Ben: Okay.  Do you have any recommended reading for people that need some encouragement, that need to help to and reinforce a better positive mental frame of mind before a test?  

Molly: Sure.  There’s lots of good reading out there on anxiety and changing negative thinking.  One book is the Anxiety and Phobia Workbook  by Edmund J. Bourne. Another good one is When Panic Attacks, which is written by David Burns, and he really does a lot in the treatment of anxiety and depression.  He’s pretty big in that world.

Ben: Okay, so that would be some good recommended reading?

Molly: Absolutely.

Ben: We will check back in with you soon so we can learn about some of the group work you’ve been doing over at the  Leawood Church of The Resurrection on the topics of depression and anxiety.  Thanks for your time, and we encourage our readers to check out your test anxiety clinic over at Get Smarter Prep as well as many of the services you offer.

Molly: Absolutely, and really, anyone struggling with anxiety, depression, marital issues can feel free to check out True Self Counseling to see if we might have services that are helpful for them.

Ben: Definitely. Thanks for your time, Molly.

Molly: Thank you.

My Declaration of Self-Esteem

I am me.

In all the world, there is no one else exactly like me.

There are persons who have some parts like me, but no one adds up exactly like me. Therefore, everything that comes out of me is authentically mine because I alone chose it.

I own everything about me – my body, including everything it does; my mind, including all its thoughts and ideas; my eyes, including the images of all they behold; my feelings, whatever they may be – anger, joy, frustration, love, disappointment, excitement; my mouth, and all the words that come out of it, polite, sweet or rough, correct or incorrect; my voice, loud of soft; and all my actions, whether they be to others or to myself.

I own my fantasies, my dreams, my hopes, my fears.

I own all my triumphs and successes, all my failures and mistakes.

Because I own all of me, I can become intimately acquainted with me. By doing so I can love me and be friendly with me in all my parts. I can then make it possible for all of me to work in my best interests.

I know there are aspects about myself that puzzle me, and other aspects that I do not know. But as long as I am friendly and loving to myself, I can courageously and hopefully look for the solutions to the puzzles and for ways to find out more about me.

However I look and sound, whatever I say and do, and whatever I think and feel at a given moment in time is me. This is authentic and represents where I am at that moment in time.

When I review later how I looked and sounded, what I said and did, and how I thought and felt, some parts may turn out to be unfitting. I can discard that which is unfitting, and keep that which proved fitting, and invent something new for that which I discarded.

I can see, hear, feel, think, and do. I have the tools to survive, to be close to others, to be productive, and to make sense and order out of the world of people and things outside of me.

I own me, and therefore I can engineer me.

I am me and I am okay.

V. Satir, “A Goal of Living”

Boundaries: A concept commonly misunderstood by many, but imperative for healthly relationships

Insights from Dr. Henry Cloud & Dr. John Townsend
Summarized by Molly Pierce, MA, LPC, NCC

What are boundaries?
What does a boundary look like?

Boundaries help us to define what is NOT on our property and what we are NOT responsible for. We are not, for example, responsible for other people. Nowhere are we commanded to have “other-control,” although we spend a lot of time and energy trying to get it!

People with poor boundaries struggle with saying no to the control, pressure, demands, and sometimes the real needs of others. They feel that if they say no to someone, they will endanger their relationship with that person, so they passively comply but inwardly resent. Sometimes a person is pressuring you to do something; other times the pressure comes from your own sense of what you ‘should’ do. If you cannot say no to this external or internal pressure, you have lost control of your property and are not enjoying the fruit of ‘self-control.’

Boundaries can take on many different shapes and forms for different people. However, some of the common factors of boundaries include geological distance, time, emotional distance, other people, consequences, feelings, attitudes & beliefs, behaviors, choices, limits, talents, thoughts, desires, and love.

Geographical Distance:
Sometimes physically removing yourself from a situation will help maintain boundaries. You can do this to replenish yourself physically, emotionally, and spiritually after you have given to your limit, as Jesus often did.

Time:
Taking time off from a person, or a project, can be a way of regaining ownership over some out-of-control aspect of your life where boundaries need to be set. Adult children who have never spiritually or emotionally separated from their parents often need time away…They need to spend some time building boundaries against the old ways and creating new ways of relating that for a while may feel alienating to their parents. This time apart usually improves their relationship with their parents.

Emotional Distance:
Emotional distance is a temporary boundary to give your heart the space it needs to be safe…People who have been in abusive relationships need to find a safe place to begin to ‘thaw out’ emotionally. You should not continue to set yourself up for hurt and disappointment. To continue to open yourself up emotionally to an abusive or addicted person without seeing true change is foolish. Forgive, but guard your heart until you see sustained change.

Other People:
Fear of being alone keeps many in hurtful patterns for years. They are afraid that if they set boundaries they will not have love in their life…Many people have been taught by their church or their family that boundaries are unbiblical, mean, or selfish.

Consequences:
Just as the Bible sets consequences for certain behaviors, we need to back up our boundaries with consequences. God does not enable irresponsible behavior. Consequences give some good ‘barbs’ to fences. They let people know the seriousness of the trespass and the seriousness of our respect for ourselves. This teaches them that our commitment to living accordingly to helpful values is something we hold dear and will fight to protect and guard.

What’s Within My Boundaries:
We may be moved with compassion to give to someone in need. But sometimes a person may manipulate us into giving more than we want to give. We end up resentful and angry.

Feelings:
The Bible says to ‘own’ your feelings and be aware of them. They can often motivate you to do much good. Feelings come from your heart and can tell you the state of your relationships. They can tell you if things are going well, or if there is a problem. If you feel close and loving, things are probably going well. If you feel angry, you have a problem that needs to be addressed. But the point is, your feelings are your responsibility and you must own them and see them as your problem so you can begin to find an answer to whatever issue they are pointing to.

Attitudes & Beliefs:
People who have never questioned their attitudes can fall prey to the dynamic that Jesus referred to when he described people holding on to the ‘traditions of men,’ instead of the commands of God (Mark 7:8; Matt. 15:3). People with boundary problems usually have distorted attitudes about responsibility. They feel that to hold people responsible for their feelings, choices, and behaviors is mean. However, Proverbs repeatedly says that setting limits and accepting responsibility will save lives (Prov. 13:18, 24).

Behaviors:
Behaviors have consequences. As Paul says, ‘A man reaps what he sows’ (Gal. 6:7-8). To rescue people from the natural consequences of their behavior is to render them powerless. Parenting with love and limits, with warmth and consequences, produces confident children who have a sense of control over their lives.

Choices:
We need to take responsibility for our choices. This leads to the fruit of ‘self-control’ (Gal. 5:23). We need to realize that we are in control of our choices, no matter how we feel. This keeps us from making choices to give ‘reluctantly or under compulsion,’ as 2 Corinthians 9:7 says. We have been so trained by others on what we “should” do that we think we are being loving when do we things out of compulsion {or reluctance}. Setting boundaries inevitably involves taking responsibility for your choices. You are the one who makes them. You are the one who must live with their consequences. And you are the one who may be keeping yourself from making the choices you could be happy with.

Limits:
What we can do is set limits on our own exposure to people who are behaving poorly; we can’t change them or make them behave right. We are not being unloving. Separating ourselves protects love, because we are taking a stand against things that destroy love. We need to be able to say no to ourselves. This includes both our destructive desires and some good ones that are not wise to pursue at a given time.

Talents:
We should not be chastised for being afraid; we are all afraid when trying something new and difficult. However, we should confront our fears and do the best we can. Not confronting our fear denies the grace of God and insults both his giving of the gift and his grace to sustain us as we are learning.

Thoughts:

1. We must own our thoughts.
Many people have not taken ownership of their own thinking processes. They are mechanically thinking the thoughts of others without ever examining them.

2. We must grow in knowledge and expand our minds.

3. We must clarify distorted thinking.
Taking ownership of our thinking in relationships requires being active in checking out where we may be wrong. Also, we need to make sure that we are communicating our thoughts to others. Many people think that others should be able to read their minds and know what they want. This leads to frustration.

Desires:
We need to own our desires and pursue them to find fulfillment in life.

Love:
Many people have difficulty giving and receiving love because of hurt and fear. Having closed their hearts to others, they feel empty and meaningless.

We need to take responsibility for all of the above areas of our lives. These areas all lie within our boundaries. Taking care of what lies within our boundaries isn’t always easy; neither is allowing other people to take care of what lies within their boundaries. Setting boundaries and maintaining them is hard work, but is well worth it for a healthy you and for your relationships.