Tag: Anxiety Disorder

How Anxiety Can Limit Your Life Choices

by Nathan Chua

Anxiety is probably one of the most common complaints that people come to therapy for, which makes me wonder why this has not been a subject that I discuss more often.  I think a lot of my own anger issues stem from a deeply held anxiety about an assortment of issues in life.  I grew up in a home full of unpredictability and the sight of anger and acts of intimidation familiar.  It is therefore quite easy for me to feel anxious about any kind of turn of events that don’t go my way.  I became very strict with rules that I felt were needed to keep things in check even if much of these were out of my control.  

I recently came up with a metaphor that I hope people who suffer from anxiety due to a past traumatic experience, can benefit from.  This provides a simple imagery of what goes on in us when we become overly controlled by our anxiety in situations that could mean a lot to us if only we could “overcome” our difficult feelings.  Unfortunately, that is most of what we have learned from mainstream psychology for many decades now.  We should be able to bring anxiety down to certain levels in order to function and live meaningful and purposeful lives.  I will have to leave this discussion for another time.

The subject I wish to talk about is how we can understand what we do when we allow our anxiety to dictate our lives.  Sort of a step backwards to see the unworkability of the things we do when we experience anxiety.  Let’s say one day a person gets involved in an accident caused by a yellow car.  As we have minds that are capable of remembering much more than other animals do, that person’s mind will remind him of the terrors caused by yellow cars in his life.  In fact, even the word yellow can bring back all the sordid details of the accident.

Now let’s imagine that this person went for a pleasure trip someday where he enjoyed sightseeing so much that he forgot that there will be no options to get back to his hotel anymore other than riding a yellow cab.  Unfortunately, he or she or they would have to walk to the hotel in the middle of the night where there is less certainty that it will be safe.  Would the person summon the courage to take a yellow cab then?  If safety and enjoying the vacation is important enough, one can be forced to ride the cab and by forced I mean, by the person’s own free will, and how much more workable taking a yellow cab would be. 

Now here’s how this story can relate to our own histories of past traumas.  In Acceptance and Commitment Therapy or ACT, not being able to realize the different contexts in which real danger should be avoided is at the heart of what is called psychological rigidity or what I prefer to call behavioral rigidity or inflexibility.  

One thing that happens if we start following rules that our minds offer us to protect us in situations where there is an actual danger or threat, we begin to lose sight of other options available.  We hold on to limited patterns of behaving in dealing with the myriad of situations that happen as we go through different life stages or even daily challenges.  

If you are like many of us who have lived with imperfect parents or caretakers, there will be situations that will cause us to feel anxious.  But some of these situations can call for our willingness to open up to these difficult feelings in order to enrich our lives.  Noticing how our minds overgeneralize with rules is the key to breaking out of the limits our minds make.  Opening up to our past histories and noticing them as they are is key to what is possible.  

If we stay and see behind our difficult memories, there may be something that we can learn which is important to us.  In my case, I hated my own anger because I cared about being kind in the presence of that anger.  If you have been bullied or rejected, that hurts because you care about not being bullied or about being accepted.  There’s much to learn from what is painful.  Don’t run away.  Stay and watch how much your pain says about you and the beauty of all that you hold dear and care about.  In other words, don’t run away from your own humanity.  As it is often said in ACT, open up to your painful thoughts and feelings, and see what gifts lay behind.

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Living with Obsessive Thoughts

By Nathan Chua

If you take a closer look at the title of this article, you might see that one word is not capitalized.  First of all, it’s what I learned in English composition about how titles should be written.  Prepositions are supposed to remain in the lower case when inserted into a title.  Secondly and coincidentally, it is probably what would make the approach I use a bit different from what you would mostly encounter in other mainstream therapies.  I used the word, “with.”  I could have written something like, “Living FREE of your Obsessive Thoughts,” or “Living with LESS Obsessive Thoughts,” or “OVERCOMING Obsessive Thoughts,” or “MANAGING Obsessive Thoughts.”  However, that would just take me to the same agenda that is, as I said, mostly what you would expect from the mainstream.

The “”with” part is a big part of what I do in Acceptance and Commitment Therapy or Training (ACT).  You might now be worried or your mind is begging you to ask, “Are you into some kind of torture method?…Don’t you have a way of bringing me at least some relief from these obsessive thoughts?  Well, of course we all want relief, and that’s pretty much why people come to see a shrink.  But it’s in the “how” you get relief that makes it problematic.

The automatic reaction which is logical, reasonable, and sensible, is to come to therapy with the idea that I can somehow magically remove or lessen your obsessive thoughts.  As a renowned psychologist would say, and I paraphrase, “You just happen to be doing what’s reasonable, logical, sensible, and by the way, pathological.  It’s logical but it’s also nuts!”  

Now before you come to me for help, I want you to notice what it is that you have tried to get rid of those thoughts.  Have you taken pills?  Have you tried to reason out to yourself to relieve yourself of those thoughts?  Have you opted out of things you used to do, hoping that if you stop doing them, you wouldn’t be reminded of those thoughts?  

So my next question is, “Have those attempts worked?”  Have you been able to remove such obsessions that your mind gives you?  Well, you could say yes they have, but if you come to me, then ask yourself, “What for?”  Most likely, you are reading this or coming to see me because the thoughts have remained.  Yes, they did leave you for a while, but they seem to catch up with you sooner or later.

So let’s do one of my favorite ACT exercises to help you live WITH your obsessive thoughts.  On a piece of paper, write down all the difficult obsessive thoughts that you have.  You may even include some feelings or bodily sensations that come with those thoughts.  

Now, do this.  Put it in your pocket and answer a few questions.  

  • Do you have to want to put this paper in your pocket, to put it in your pocket?
  • Does it take a lot of effort to put it in your pocket?
  • Do you have to change anything that you have written in this piece of paper in order to put it in your pocket?
  • Do you have to believe in what you wrote in this piece of paper to put it in your pocket?
  • Do you have to pretend to put the paper in your pocket in order to put it in your pocket?

If all your answers here are no, then put it in your pocket.  If you answer yes to any, think about why your answer is yes.  Are you trying to suppress these thoughts?  Are you playing the role of another person you think will represent who you are?  Are you trying to argue with such thoughts?  How many of these have you already tried before?  Have they worked to get you to live the life you want or be the person you want to be?

If you’re one who answered no, then put this in your pocket to remind yourself that you are willing to have this because it is in your own best interest to have all these thoughts in your pocket and still do what’s important to you.  

Let me end with a quote from a book that also quotes a regular person who had attended an ACT group.  This is one of a number who described what willingness meant to them and to their lives:  

“Why willingness? Because it is a normal human process to feel pain, and it is inhumane and unloving to try to hold myself to a different standard,” from an anonymous ACT training participant, taken from a book co-written by Steven C. Hayes. 

Are you a walking diagnosis?

by Nathan Chua

In my more than a decade’s work, one of the most common questions I get from people inquiring about mental health services is, “Can you give me a diagnosis?”  These come in many forms.  Some call already with a prior diagnosis from another practitioner, “I had been diagnosed as a borderline personality, is there anything different about the way you treat people like me?”  Even as I had training from that very same school of thought, I had always had my reservations about the practice of diagnosing.  I had been diagnosed once, and I know how it feels and I know that it really wasn’t helpful.  It is as if knowing what people have can make them somehow more aware of their tendencies and therefore allow them to be more cognizant of their actions.  

Does knowing one’s diagnosis really help?  Let’s take a look at what a diagnosis really comes up to, by taking this to an absurd level of analogy.  If one were diagnosed to be bipolar, would they go around eating in restaurants and meeting people and saying, “Hi, I am Nathan.  I am a bipolar disordered person!”  Would they introduce themselves in every situation the same way?  Like would that be how you would tell someone about yourself in a group class?  From this, we can notice that we all act differently depending on the situations that we are in. We act differently when we are at work and when we are at home.  We act differently when we are stressed and when we are relaxed.  

Based on my experience, I have seen how this happens to people who had been dealt with a veritable life sentence of being attached to a label.  At times, even worse, pinned with an inaccurate one at that.  

As human beings we have evolved into a group of cells and individuals that thrive and survive through cooperation.  One of the scariest parts of being human is to become isolated from a group.  Being creatures who survive in communities, we have yearnings to belong.  In the wild, the isolated human’s fate is most probably becoming a dead human sooner than later.

Belonging is important to us.  There was even a famous study in the past that showed how much humans require nurturing and caring.  Babies cannot survive just being fed through a bottle.  They need touching and the physical and mental stimulation that comes from a caregiver.

However in the age of social media and the rest of the modern accoutrements we enjoy, the mind has hijacked this inner yearning to belong.  Our problem-solving minds are excellent in categorizing people.  The way to this felt sense of belonging has turned into being special instead of being one with others who share the same doubts, fears, and inner perturbations.  You and I can see this in how special people want to project themselves in their social media accounts.  The way to belong is to become special!  Do you notice the oxymoron here?  

The other way the mind hijacks this yearning to belong is the complete opposite of the abovementioned example.  Our thoughts turn us into especially vulnerable individuals that need special attention.  I have bipolar disorder so you better be extra kind and loving around me. 

Like traits, all these diagnoses serve more to put us in boxes of categories.  Experts have seen how countries that had adapted this system of classification (or what we call our DSM, Diagnostic and Statistical Manual for Mental Disorder) get worse results.  What we used to think were just the shy nerdy types in school have now turned into walking diagnoses that need special attention and worse, medication.  We had forgotten an era when that shy, quiet girl in class can turn into the next world class stage performer.  

So let’s get back to how I started this blog post.  What do I say when asked about whether or not I can give a diagnosis?  I just tell them that I don’t.   

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