Mental Wellness Month: How Do We Define Wellness?

By Annabelle Parr

According to the internet, January is Mental Wellness Month. Sounds like a good cause, right? Absolutely! But pausing to consider our definition of mental wellness is important. Because if you spend much time on the internet, it might have you believing that wellness and self-care are defined by bubble baths, weighted blankets, and being perpetually Zenned out. And bubble baths, weighted blankets, and being in touch with your inner Zen are great! But mental wellness and caring for ourselves are not quite that simple.

So from a therapeutic perspective, what exactly is mental wellness? If we define illness based on a list of symptoms, do we define wellness simply as a lack of said symptomology? Or does wellness have its own particular set of characteristics equally worth defining?

If illness is a sense of dis-ease, is wellness a perpetual state of ease?

Psychiatry and psychotherapy developed based on a model which was focused primarily on pathology and illness or “dis-ease.” Beginning with Sigmund Freud’s exploration of the unconscious mind and evolving toward a medical model of treatment centered around the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychotherapy has historically been centered around identifying and diagnosing a problem and working to treat it. And of course, this is a worthy mission, but it is an incomplete picture of the larger whole of life. Life is not simply about absence of illness, dis-ease, or discomfort. It is about engaging in life in a way that brings us meaning, purpose, and hopefully some joy as well.

Wellness is not about the absence of discomfort, but rather the presence of meaning.

From an Acceptance and Commitment Therapy (ACT) perspective, mental wellness is defined by our ability to engage in life in ways that bring us a sense of meaning, purpose, and vitality. Mental wellness is characterized by our ability to, moment by moment, make choices and take action in the service of our personally chosen values. And this might be surprising, but it is actually deliberately NOT defined by a lack of painful emotions, such as anxiety, fear, worry, and stress. Not only are these feelings and experiences an unavoidable part of being human, but they are directly and inextricably linked to our values.

“We hurt where we care.”

Steven Hayes, one of the ACT co-founders, noted that we hurt where we care. As Dr. Jill Stoddard pointed out in her book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry & Stress Using Mindfulness & Acceptance, when we look at the things that keep us up at night, the ones that weigh heavy on our minds and hearts, they probably do not include the fate of Netflix. We might enjoy a good Netflix binge, but whether Netflix will continue to thrive is probably not on our list of worries. Instead, the things that we worry about tend to be the things that matter to us on a deep level, such as our family, friends, work, home, etc.

Pain and values are two sides of the same coin.

In other words, when we look closely, the emotional pain we experience tends to point directly to what’s important to us. If we want a life that is full of wellness – full of those things that truly matter to us, that bring us joy, connection, passion, and purpose – we have to be willing to risk having difficult and painful feelings. We cannot have one without the other because it wouldn’t hurt if we didn’t care and vice versa. When we try to rid ourselves of all painful feelings, we also restrict our ability to engage with the things that we really care about. As much as we might wish otherwise, we cannot have joy without also risking pain. As Brené Brown said so well, we cannot selectively numb emotion. When we are unwilling to have pain, we will also be less able to experience joy.

Our emotions are not problems to be solved; the problem is when our behavior prevents us from engaging in life in functional and fulfilling ways.

From a diagnostic perspective, it is not simply the presence of anxiety that warrants a diagnosis; rather it is the functional impairment that the anxiety creates that helps determine whether someone meets criteria for diagnosis. Said otherwise, a diagnosis includes consideration of whether your experience of your emotions, thoughts, and sensations causes you to limit your behavior such that your life is restricted in significant areas, like work, school, and relationships.

Wellness is about how we respond to pain when it shows up.

Therefore, wellness is not defined by the absence of stress, anxiety, grief, worry, anger, or frankly any other emotion. Instead it is all about how you are able to manage difficult thoughts, feelings, and experiences and still continue to engage in life in a way that is fulfilling, meaningful, and guided by what is important to you. And ACT, beyond emphasizing the importance of values-based actions, has plenty of wisdom regarding how to increase psychological flexibility such that you are able to respond more effectively when discomfort arises.

If you find that your thoughts and feelings are holding you back from living your life in the way that you might want, ACT can help. For some excellent resources, check out our suggested reading and our suggested podcasts. For professional support, an ACT therapist can help guide you on your journey.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Redefining Passion with Acceptance and Commitment Therapy

by Annabelle Parr

Passion is supposedly a value touted by our culture: you should be passionate about your work, your partner, your children, your major, the things you fill your free time with, etc. But what does this actually mean? The way it is framed, it seems that passion is synonymous with happiness. It’s just one more layer of the larger societal message – fed and sold to us in myriad ways – that we should be happy on an ongoing basis, and that discomfort (anxiety, sadness, fear, stress, grief, etc.) is a sign that something is wrong and we need to fix it.

This colloquial use of the word passion seems to suggest that happiness is not a fleeting emotion like any other, but rather a superior, potentially permanent state of being to be achieved. After all, if you are passionate about something, it means you love it. All. The. Time. Right? 

Plot twist: passion literally translated actually means suffering—it comes from the Latin pati meaning to suffer

The true meaning of passion flips our happiness-obsessed culture on its head. If passion means to suffer, then saying follow your passion does not mean that you will be perpetually stoked to go to work. When we promote the value of passion with our partners, it doesn’t mean you will be forever on cloud-nine-oxytocin (a.k.a. love hormone)-high. When we advocate for passion when it comes to parenting, that doesn’t mean that you will think your kids are the cutest thing on the planet, incapable of doing any wrong, 24/7. When we say choose a major you are passionate about, it doesn’t mean every lecture is going to be life changing.

Okay, then what does it mean? Because surely we are not advocating for actively pursuing suffering?!

Passion, far from being about permanent happiness, is about choosing to commit in big and small ways, over and over again, to something that you have personally chosen to care about, so much so that you are willing to encounter not only joy and happiness, but also pain and suffering in its pursuit. After all, we hurt most in the areas that matter to us; if we didn’t care, it wouldn’t hurt. A life filled with passion is not a perfect life, but it is a full, juicy one.

Enter Acceptance and Commitment Therapy (ACT). 

This radical new view on passion is remarkably consistent with the goal of Acceptance and Commitment Therapy, which is to foster psychological flexibility: the ability to be open, aware, and engaged in our experience such that we are able to hold our experience gently, contact what is important to us, and choose to take action in the direction of our values even when we encounter discomfort.

The ACT perspective holds that pain is not the problem. Instead, problems arise in our lives when we are not willing to experience pain – suffering is magnified by our efforts to avoid it. Paradoxically, that first distorted definition of passion is likely to lead us further and further away not only from moment-to-moment happiness, but also away from a life guided by what matters to us, as we become increasingly restricted by our mission to try to avoid discomfort.

On the other hand, when we live our lives with real passion – a willingness to suffer as we pursue our personally chosen values – life opens up to us. When we are willing to feel anxiety, grief, sadness, fear, stress, pain, and anger (all those supposedly “negative” emotions), we are also more able to experience joy, love, connection, and yes, happiness. When we cut ourselves off from feeling half of our heart, we end up numbing the whole thing. When we are willing to feel the difficult and painful feelings, we gain access to a much deeper layer of the “positive” feelings as a result.

Obviously, all of this is a lot easier said than done. Our minds are wired to problem solve, and our culture tells us that emotions other than happiness are problems. But we do not have to stay small, stuck in a life graded solely based on the percentage of moments defined by happiness. Acceptance and Commitment Therapy can give us the tools we need to be more flexible in the face of pain so that we can go about pursuing a life rich with passion, in its truest sense.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Part I: Thriving through the Embrace of Life: To Thrive or to Suffer

Part I

Thriving through the Embrace of Life:

To Thrive or to Suffer

By Lauren Helm, M.A.

“My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor, and some style” ― Maya Angelou

If you were to ask yourself, “Am I thriving in life?” what would your honest answer be?  Is there a palpable fullness, or a vibrant, colorful aliveness that paints the story of your life? There are as many different ways to thrive as there are individuals on the planet, and each person likely has a unique story to tell about what thriving means to them. What does thriving mean to you? You may not have a ready answer, but perhaps you have a general sense of what the experience is like when you are living a life that is full, satisfying, and meaningful to you. Is the experience of moving forward in life in a deeply satisfying way your current reality? Or do you only catch glimpses or taste brief moments of thriving, without being able to maintain this as a steady flow? These are challenging and potentially uncomfortable questions to ask yourself.  It may seem that living a truly vital life is without reach, where it is possible for others to attain it, but you cannot.  

“Pain is universal, suffering is optional.”

If you experience a regular sense of enlivenment, this is excellent. The chances are, however, that life has peaks, and it has its valleys too. In our society, we may often misconstrue what it means to live fully and thrive. Often we equate successful living with happiness. If we feel pain, we assume that something is wrong, and we must immediately fix the situation in order to feel happy again. Unfortunately, pain simply is going to be experienced throughout our lives. It will occur, again and again, in various domains, including our relationships, career, and other life experiences. We will experience psychological pain   (i.e. painful thoughts and emotions) and physical pain (e.g. back pain or migraines). Does this mean that we will never be able to truly thrive, or live a deeply rewarding life? Certainly not! Pain, in and of itself, is just that – the experience of discomfort (in its many forms). Though it may not sound pleasant, pain is not the problem. Rather, our reactions or responses to the pain, is what leads to suffering. Suffering is pain’s more dramatic and pervasive cousin – suffering often wrenches, grips, and gnaws at us—and typically stems from our efforts to move away from our pain. It draws in all of our attention and sucks away all of our vital energy or life force. Generally speaking, to suffer is not to thrive.

It is within our nature to attempt to avoid, escape, or prevent pain. As a species, this is how we survived and persevered. However, in our modern day society, we are rarely threatened by actual physically dangerous situations that we need to remove ourselves from to survive (e.g.  if you see a rattlesnake, you turn and walk the other way instead of stepping onto it to avoid the painful bite which may also lead to physical damage). Many painful experiences that we currently face are internal experiences – the worried thought that your boss is negatively evaluating you, the anxiety in the pit of your stomach when the bills are difficult to pay, or the sadness that results from the loss of a friendship. Often, the mind reacts to these painful events in more or less the same way that it would react to a painful physical experience (such as stubbing a toe) – avoid this pain, and get rid of it right away, or else survival is threatened! Unfortunately, as our minds get to work at problem-solving how to control and get rid of a painful thought or a painful emotion, it often unsuspectingly steps onto the path of suffering.

“Tell your heart that the fear of suffering is worse than the suffering itself. And no heart has ever suffered when it goes in search of its dream.” – Paulo Coelho 

As the mind begins to systematically focus more and more time, attention, and energy to ridding itself of painful thoughts and emotions (like anxiety, sadness, guilt, anger, etc.) a paradoxical effect occurs – it begins to feed the beast. The very labeling of an emotion or a thought as “bad” creates a spiraling effect of distress. For example, if you experience anxiety, and then believe that it is a bad or harmful thing to experience anxiety (i.e. it is threatening), then you will likely feel an increase in anxiety or distress (because now you are anxious about anxiety), and also begin to do whatever you can to get rid of this threat (the escalating anxiety). You may try to control it by distracting yourself with drugs or alcohol, or perhaps you try to control it by avoiding whatever triggers the anxiety in the first place (e.g., not going to a party for fear of being disliked). Though this may reduce anxiety in the short-term and you may experience some brief sense of relief, the anxiety is unlikely to permanently disappear. In fact, it is guaranteed to reappear and your mind will likely respond to the reappearance of anxiety in a similar way, becoming like a rat on a wheel, running with all of its will and might to escape the relentless pursuit of anxiety (or any other uncomfortable thought or emotion). Thus, suffering grows, as more and more time and energy is needed to escape growing discomfort that returns again and again. Most importantly, the more attention is spent on avoiding, the less it is spent engaged in areas of life that may be important to you. “Life” can be put on hold while you invest your energy in “managing” the pain of life. Sometimes, in more minor cases, this works. But often, it can become a bottomless pit, and we can lose our way. To merely survive does not mean to thrive.

Though many of us would rather not fully acknowledge that this process occurs in our lives, it often characterizes the human condition. However, with awareness and recognition, we can begin to consciously alter how we respond, and thus begin to craft a way of living that supports thriving and fullness.

Part 2: Thriving through the Embrace of Life: Learning to Open through the Pain is the second segment of our blog which continues the discussion of thriving versus suffering, and introduces an alternative approach to responding to emotional or physical pain or discomfort.

If you'd like to speak with someone at the Center for Stress and Anxiety Management for help learning about how to thrive and relieve psychological suffering, please click here.

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References

Harris, R. (2006). Embracing your demons: an overview of acceptance and commitment therapy. Psychotherapy in Australia, 12(4), 70.

Tags: anxiety, cognitive behavioral thearpy, anxiety therapy san diego, anxiety therapy, acceptance and commitment therapy, worry, ACT, Center for Stress and Anxiety Management,therapy in san diego, emotion regulation, anxiety disorders, values, steven hayes, CSAM, meaning, fulfillment, mindful, suffering, thriving

The Case for a Value-Driven Life

By Lauren Helm, M.A.

“Values are what you want your life to be about, deep in your heart. What you want to stand for. What you want to do with your time on this planet. What ultimately matters to you in the big picture. What you would like to be remembered for by the people you love.” – Dr. Russ Harris

What guides you in deciding how to act from moment-to-moment, and day-to-day?  When you come to a fork in the road, how do you decide which direction to go?

Many of us may be unaware of the processes that underlie our daily actions and the forces that shape how and why we make the decisions that we do. Often we may just go through the motions, paying little attention to what we are doing and what is happening around us. We go through the routines:  get up in the morning, have breakfast, brush teeth,  go to work, come home, make dinner, go to sleep…and repeat. Sometimes we may reflect on the day and wonder where our time went, feeling almost as though we were not really there. Have you ever driven somewhere, only to realize once you’ve arrived that you barely remember driving at all? It can be as though we were merely on automatic-pilot, with little attention devoted to “steering” ourselves throughout our lives.

And yet, there are times when life really DEMANDS our attention; when it quite literally forces us to focus on the issue at hand. Life is full of flux and change; there are sorrows and pain, joys and celebration. What then? How do you decide how to respond?

When we have little conscious awareness of who we are and who we want to be, we can act quite haphazardly. Automatic-pilot does not necessarily turn off.  If something stressful or threatening happens, we may react reflexively. Perhaps a loved-one makes a comment that rubs us the wrong way, and we lash out. Maybe we have been assigned an important project, and the deadline looms in the near-future, but we automatically procrastinate and avoid thinking or doing anything about it until the last minute because it is anxiety-provoking.

In a sense, automatic or reflexive behaviors can be thought of as “mindless.” There is little conscious or intentional thought behind them. They are like habitual ways of responding to life. However, not only does a “mindless” approach not create the fullness of life that many people desire, it also can get us into trouble when challenging situations arise. For example, most of the time we automatically avoid uncomfortable or painful situations. It makes sense that human beings would avoid pain. Avoidance of pain or threat has allowed us to survive as a species –  avoidance of tigers and bears kept us alive. However, in our modern age, we rarely, if ever, encounter predators that threaten our survival. Threat and discomfort tends to show up for us in our jobs, relationships, traffic, social activities, etc. What if “mindless” avoidance of discomfort costs you a sense of meaning in life? What if it interferes with or prevents you from engaging in activities or life experiences that are deeply rewarding to you, albeit challenging or difficult at times?

If this has been your experience, it may be time to pause and clarify your values. Your values help define who you want to be in each moment. What you value is what gives your life meaning. When we are disconnected from our values, we can go through life somewhat aimlessly and “mindlessly.” But when we take the time to learn about what is really important to us, we can give ourselves a great gift. By knowing your values, you can begin to craft your day-to-day experience in a much more conscious, intentional way. In a way, it can be a creative process. You get to decide during each metaphorical fork in the road, who you want to be and what you want your life to be about.

“What if what was at stake is a kind of self-liberation -- the liberation to be about what you most deeply would choose to be about--- not to avoid guilt, or get applause, or otherwise objectify yourself but just to be in the world how you choose to be in the world.” - Dr. Steven Hayes, co-developer of Acceptance and Commitment Therapy

Dr. Jill Stoddard likes to ask, “What is this in the service of?” This is an exceptionally helpful question to ask yourself during the mundane activities of life, and during the momentous ones. Is what you are doing serving to avoid discomfort? Or is what you are choosing to do serving you in living a valued-life? The practical nature of identifying your values is that you can begin to create action-plans and goals that line up with your values, instead of goals that purely focus on fending off the pain that inevitably is a part of life. The fact is, pain IS a part of life, and so is joy. Life is a myriad of experiences. We can live meaningful lives when things go smoothly, and even when life feels like a bumpy ride. It is up to us, however, to decide if we want to consciously respond to life and take back the steering wheel. We can begin with our values. Who do you want to be today?

If you'd like to speak with a professional at the Center for Stress and Anxiety Management about clarifying your values and living a more meaningful life, please click here.

Check out these free resources on values and related topics: 

http://media.psychologytools.org/Worksheets/English/Values.pdf

http://www.thehappinesstrap.com/upimages/the_complete_happiness_trap_worksheets.pdf.pdf

http://www.thehappinesstrap.com/free_resources

Follow us! Subscribe to the CSAM RSS feed, and follow us on Facebook or Twitter (@CSAMSanDiego). 

References

Harris, R. (2007). The happiness trap: Stop struggling, start living. Exisle Publishing.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. Guilford Press.

Tags: acceptance and commitment therapy, ACT, Center for Stress and Anxiety Management, values, steven hayes, CSAM, meaning, fulfillment, mindful, pain, life, Russ Harris, personal values, mindless, avoidance, automatic pilot