Encouraging activism is a form of therapy

We live in a time of crisis fatigue. It seems that every time you read the news, something horrible is coming to light. It’s getting to the point where reading the news each day is like rubbing sandpaper over a barely-healed wound. No wonder why so many people avoid it. In my work as a mental health occupational therapist (OT), it’s not surprising that the state of the world comes up in a lot of my clients’ concerns: People the world over are rising up against corrupt governments with unfortunately little change in policy to show for it. There is clear evidence of increasing drought and other effects of climate change and yet people and governments still deny the science behind it. Alt-right and Neo-Nazi groups are gaining traction in various countries. The cost of living is rising at a rate that is not commensurate with wages. People are expected to work longer hours and pack more into their workdays just because there “isn’t any funding in your sector” or because “the job market is so poor.” And what do I have to say to this? They’re right. Therapy is largely the pursuit of changing the way one interprets or reacts to events and occurrences in the world, to find a healthier, more productive way of dealing with them. But what happens when the world is on fire? Like, literally on fire?

IG: @darmfield

There is no way to CBT yourself out of feeling despair for the state of the world when the evidence is quite clear. There is no way to adequately desensitize oneself to horrible occurrences in the news so that the result isn’t numbing/dissociation or retraumatization. The correct response to these events is outrage and a feeling of hopelessness, and no amount of distress tolerance skills will make those feelings go away.
So what do we do? I have been coming up against these issues more frequently in my work with people, especially young people.
A big response from large corporations to increasing incidences of disability due to mental health issues has been to “prioritize worker wellbeing” by instituting programs for mindfulness, massages, yoga, etc. in the workplace. This is all well and good, but it puts too much onus on the individual. It tells the individual, “The way you’re dealing with the stressors of everyday life is insufficient. Here, try this meditation app. Don’t worry, we’ll pay for it.” While individual action is of course important, and I believe that therapy has been and can be an effective form of motivating this in others, focusing on these approaches alone ignores the fact that there are systemic issues at play.

Yes, therapy can be important in helping you stay out of fight-or-flight mode, from completely shutting down, or feeling feelings that are completely unmanageable. But what does therapy have to do with addressing income inequality, corruption in government, lackadaisical or absent climate policy, and systemic oppression? What do we do when the appropriate response to these issues is in fact anger, despair, or dissociation?
If therapy is about helping people reinterpret or process things in such a way that leads to more productive and helpful outcomes, what is the role of therapy in helping people channel feelings of anger, hopelessness, and despair caused by real world events? I’ve been thinking a lot about how I need to do encourage more top-down change in my life. And of course I need to do more to become more politically active in my life and hone in on a few areas that I can put my efforts towards. (I still have to figure this out.) But in addition to pushing myself to become more politically active, I’ve decided on something else: I’m going to do my best to enable the people with whom I’m working to fight for systemic change, if that’s something that would help them. I’m no expert on activism and how to push for systemic change, but I am very lucky to have many people in my life who are very involved, and I can speak to them to learn more. Furthermore, occupational therapists are encouraged to be advocates for their clients, and our very models of practice take (in my opinion) a much more holistic view of challenge and change than many other health professions. The backbone of occupational therapy is about helping people find meaning in life through activity, no matter what challenges they are dealing with. I believe that is is the most practical application of existential philosophy. So if people think that it would be meaningful to do something about the systemic issues that are creating challenges in their lives, I don’t think that encouraging activism, concurrently with more individualistic forms of therapy, would be out of our scope of practice. If therapy involves changing the way one interprets or reacts to events and occurrences in the world to find a healthier, more productive way of dealing with them, then helping people become more active in pushing for systemic change is therapy. The fire in us, rather than burning us up, can turn us into crucibles.

Excitement and anxiety - A matter of control (Or: An unconventional approach to managing anxiety)

A lot of people tend to conflate the ideas of fear and anxiety. We often even use the words interchangeably. But it's important to make a distinction here. Fear is about an actual or present threat, whereas anxiety is about the threat of a threat. 

What tends to happen in anxiety disorders is that the threat of a threat is disproportionate to the likelihood of there being an actual threat. We get anxious about things happening that are not very likely to happen. We overvalue the threat of a threat, even if it’s not likely that the actual threat will occur. 

This disproportionate overvaluing of the threat of something bad happening happens for a lot of reasons. 

A False Alarm is Better than a Miss

Evolutionarily speaking, a false alarm is better than a miss. Meaning, that every time you see something in your peripheral vision, there is a possibility that it could be an attacker coming to get you. On the other hand, it could be a kitty coming up to say hi. But from an evolutionary perspective, it’s better to jump at a shadow that doesn’t represent an actual threat, rather than missing jumping at a shadow that does present an actual threat. In the first case, you feel a little silly, “Oh dear me, what a to-do,” and in the second case, you maybe die. 

The thing is, most of the time, there isn’t an attacker coming to get us. Of course, this totally depends on your context, socioeconomic status, identity, and things like that. For sure there are people in this world who are at a greater risk of experiencing daily violence than others. However, I would argue that for those experiencing anxiety disorders especially, the worry about the threat of something bad happening still outstrips the likelihood that it will happen. 

Something else that makes this even more true is confirmation bias, a psychological phenomenon by which we are more likely to seek out evidence that confirms our hypotheses, or in the case of anxiety disorders, that confirms our anxieties about the world. So if you went to a party once and felt ostracized and had a really horrible time, you’re more likely to think that that will happen every other time you go to a social event. You’re less likely to remember the times that you’ve had social interactions that were actually pleasant. This also isn’t helped by the fact that emotional memory is a lot more salient to us, so if you felt super anxious at that party where you had a bad experience, you’re more likely to remember that feeling of anxiety than a time where a social event felt a bit more neutral. 

Okay, so we’re somewhat hardwired for anxiety. Great. Just what the hell do we do about this?

There are many schools of thought and therapeutic approaches that people can take towards dealing with anxiety. 

Common Approaches

Two of the most common approaches include cognitive approaches like Cognitive Behavioural Therapy or CBT, which puts an emphasis on being aware of and changing your thinking in order to change your emotions and behaviour, and mindfulness practices (like we see in dialectical behavioural therapy, or DBT) which encourage us to sit with difficult emotions and view them non-judgmentally as passing internal formations, rather than being an actual indication of an actual state of the world. 

I use these types of approaches in my clinical work a lot. Like, every day a lot. I’m not going to talk too much about those here, but if you’re interested in hearing more about those, then maybe leave a comment below or reach out.

I do want to talk about an approach that I try to use personally, and have had some success with in my clinical practice. 

Before I talk about this, let’s talk about some neuroscience and psychology and stuff. 

Excitement and Anxiety are Physiologically Similar

From a physiological, neurochemical, and hormonal perspective, excitement and anxiety look very similar. Both states involve activation of the limbic system in the brain. These brain structures are part of a chemical cascade that stimulates your adrenal glands to release a hormone called cortisol, which gets your body ready to act and respond to something in your environment, often called the fight-or-flight response. Both involve increased heart-rate, rapid breathing, sweating… They do look pretty similar. It’s known as arousal congruence, because both are states of physiological arousal. 

So why do they feel so different?

At first pass, it’s pretty obvious that anxiety is about something bad, whereas excitement is about something good. But what about things that are both? Like rollercoasters, first dates, performing on stage…? Therein lies the potential for both good and bad - tummy flip, good; falling to your death, bad - but I’d like to propose something else. 

A Matter of Control

In my understanding, really the only difference between anxiety and excitement is the sense of control that you have over your environment. 

For example, in Mihaly’s Czizentmihayi’s work in Positive Psychology and Flow States, he points out that the relationship between the degree of a challenge (external factors) and our capacity (internal factors) can make the difference between whether we find a task calming, boring, anxiety-provoking, or exciting. So when the external challenge is high, and our internal skills are high, that’s challenging and fulfilling, even exciting. But when the external challenge is high and our internal skills are low (or they are perceived as being low), that’s anxiety-provoking. Conversely, when the external challenge is low and our internal skills are high, that’s boredom. 

So when we feel that we are capable of handling the challenges that are in our environment, that’s exciting. But when we don’t feel capable, we get anxious. Unfortunately, in anxiety disorders we often undervalue our skills and perceive ourselves as not being as capable as we actually are. So even when we perceive the environment as outstripping our skills, and we perceive a lack of capability and control, that might not actually be the case.

Given that 1) Anxiety and excitement are actually very similar, 2) The difference appears to be your perception of capability and control, and 3) Sometimes our sense of capability and control is undervalued - what can we do about this?

Well, as mentioned, cognitive approaches like CBT and approaches like DBT that incorporate mindfulness can be effective. 

But let’s talk about a less conventional approach.

Anxiety Reappraisal

Allison Wood-Brooks, a professor at Harvard University, published a pretty interesting paper in 2014 about this phenomenon. She and her team ran a bunch of experiments which involved karaoke singing, public speaking, and doing math problems - situations and tasks in which many people feel anxious. One group was encouraged to relax and calm down - a pretty typical response to trying to manage performance anxiety. A second group was actually encouraged to reappraise their anxiety as - you guessed it - excitement. 

And guess what? Not only did people in the Anxiety Reappraisal group report feeling subjectively less anxious, they actually performed better on the test metrics! Isn’t that wild?! All they did was use positive self-talk, like you see in CBT - they told themselves “I’m excited”, or received messages from others saying things like “Get excited” - and they were able to feel less anxious, more excited, and actually do better on their tasks! 

The theory behind it was that since excitement and anxiety are arousal-congruent, changing the content of their thoughts to something more positive would help them actually appraise the situation as more of a challenging opportunity rather than something anxiety-provoking. 

The way I see it is, the reappraisal and self talk about being excited helped people turn it from a situation where they felt out of control and incapable to a situation that presented a challenge that was within their grasp. If you change the content of your thinking to fool yourself into interpreting your arousal response as excitement rather than anxiety, you must be in control because excitement means that you don't feel out of control. 

So, this is super compelling to me and as someone who does a fair bit of public speaking (and karaoke, for that matter). I’m going to try this next time I’m in a performance situation. 

Outside of your typical performance anxiety, there might even be implications for dealing with social anxiety, which tends to have a component of performance anxiety. Through Anxiety Reappraisal, we can try to turn “Oh god will I say something stupid in public?” into "I'm so excited to meet new people!" This might even be helpful for people who have phobias, such as agoraphobia. We can try to turn "It's so unsafe out here" into "I'm so excited to explore!" 

The implications for generalized anxiety disorder (GAD) are a bit muddier. I'm not sure how this would work with a more generalized sense of anxiety when there isn’t a clear event or object present to reframe. However, like any mental illness, GAD is exacerbated by triggers. So there may be an opportunity to reframe thinking about specific triggers using this technique.

So that's an unconventional approach to dealing with anxiety that I hope, at the very least, you found interesting. Remember, the difference between anxiety and excitement is a matter of control - perceived or actual. It's up to you what you do with this information.

Thanks for reading, please comment below if you have anything to add! Respectful discussion and debate always welcome. 

My year-long psychological experiment on myself

People have mixed feelings about New Year's resolutions. Some people swear by them, others say that it's less likely that you will actually follow through on them compared to other goals, for various reasons. Maybe you feel too much pressure. Maybe you're not actually ready to make that drastic of a change. Maybe it's because by sharing goals publicly and being acknowledged for it, you reap the benefits of the reward-induced dopamine rush without actually having to put any work in, and are therefore less likely to follow through.

I actually have a pretty decent track record with New Year's Resolutions (if two instances constitute a track record, which, now that I think of it, probably don't). I quit cigarettes one year, which as far as resolutions goes, is a tough one to beat. 

This past year I think I did alright, though. 

The point of resolutions is to manifest significant change in one's life. Whether resolutions focus on a specific activity (eg. getting back into fitness) or constitute more of a lifestyle change (eg. working on my confidence), they're targeted towards creating significant change through one specific assertion or idea. It helps make making change more digestible, more actualizable. 

Goals that are related to specific activities are probably much easier to follow than ones that target lifestyle changes. As someone who went into this year seeking a bit of a lifestyle change, I figured that in order to make it happen, I needed to whittle down my desire for a lifestyle change into one super-easy-to-stick-with, specific activity. 

Truthfully, I went into this year feeling a little hard done by. In short, I felt that I was being duped by life, in a way. There were so many things I wanted to get into or devote more time towards, and I felt I had no time in which to do so. This was probably compounded by being still a bit swept up in the whole culture of interpreting being overwhelmed as a badge of honour. I kept thinking, "I want to do these things, but I don't have enough time."

But as soon as I had that thought, the thought that inevitably followed was, "Well, there are 24 hours in a day. You're just not spending your time the way you want to." That led to, "You are not making these things a priority (over things like work, socializing, being on the internet, etc.)." 

The more I thought about this, the less comfortably it sat with me. "I'm not making it a priority." How can I want to make something a priority, and not be making it a priority? Either I want to make it a priority, and I do, or I want to make it a priority, I don't, and then I shut up about it. I thought, if I was going to try to make a change in my life such that I ended up spending my time better, saying "I'm not making this really important thing a priority" instead of "I don't have time for this really important thing" would maybe do the trick. It was a simple enough exchange. 

So, I decided that for the entire year of 2018, I was not to say, "I don't have time." Instead, I had to say, "I'm not making it a priority." 

Easy enough, right?

At first it was actually really fucking difficult. I kept catching myself with the words "Not enough time" on my teeth, biting it back at the last second. At first, I couldn't control the way my thoughts ran. My thoughts still said, "But that's BS, I really don't have enough time, life is unfair, I should be able to devote more time to blah blah blah, etc. etc. etc." I had to outwardly grit my teeth and say, against all inner instinct, "I'm not making X a priority." 

Learning a new language? 
Improving my music skills? 
Meditation and mindfulness?
Writing more songs?
Journaling?

Not making it a priority. 

As you can probably tell, it did not feel good to say that about things I wanted to be a priority in my life. 

Sometimes I even tried to cheat, by saying things like "I am not able to make it a priority." But I always caught myself and back-pedalled, because the "I'm not able" still made me seem and feel like a victim of circumstance. I would walk it back and say "No, actually, that's not true. Here's what I meant to say..."

Little by little, the content of my thinking started to change. I can't really explain it. But basically, eventually that sense of being wronged and of annoyance that accompanied that phrase instead became anger, which became despair, which became determination to change. There were probably a few other stages in there but I can't pin down what they were.

With that simple change in language, over time, I was able to flip the intent behind my thoughts.  

I should add that at the same time, I was doing another simple activity that aligned with my resolution and probably helped me a lot as well. My awesome roomie Carina got me a big mug for Xmas 2017 with "2018 Moments" written on it, and she encouraged me to just write down little day-to-day memories and put them in the mug over the course of the year. (She had done this the two years previous and then dumped them all out at the beginning of the following year to review and remember.) This helped me be more cognizant of more of the times in my life that I felt were memorable and worthwhile, and not just focus on what I felt I was missing out on. 

I was also starting to listen to a lot of positive music at the time as well. Stuff that made me feel amazing, stuff that was a joy to listen to though headphones while walking down the street. Songs that would make me break out into a smile, that put a bounce in my step, that made me silently mouth the lyrics, whistle a phrase, or get lost in an incredible groove. (For some of my 2018 favourites, check out this, this, this, and this.) Carina has a whiteboard up near our front door, so I would often also write inspiring and smile-inducing lyrics that added one extra boost to my day on my way out the door in the morning.    

                                                                                                                                    
I also finally decided to make use of my Line-a-Day Journal that my cousin Danielle got me years ago, and commit to writing one goddamn line a day about what happened that day. (How much more manageable can you get?)

And little by little, I started to feel differently about things. I started to look at time differently. I started to spend my time differently. I got back into stuff that I was neglecting. I started making concrete steps towards a major life change that I'd only pined about previously. 

In short, it's been a good year. 

This isn't to make it seem that everything is now perfect. There is still so much I want to work on and still many more steps I need to take. And that's also not to say that everyone who tries these methods will be able to make the change they are seeking. But I wanted to share this little experiment that I did on myself because:

1) I have found it to be effective, and 
2) I found it to be super manageable. 

I am a big believer in neuroplasticity and cognitive reframing - the power of the brain to rewire itself and change its own thinking patterns, respectively. I have in the past found CBT to be effective in helping me change destructive thinking patterns. I also witness its effectiveness in the clinical work I do with others. It takes commitment, and it feels so forced and downright wrong at first, but I have found that if you stick to a small, manageable change, just commit to it with the knowledge that these methods do work, you can make remarkable changes with simple changes. 

Sorry for getting all After School Special on y'all. 

Anyways, I'm going to continue with all of the above for this year. Haven't come up with a resolution but I have some pretty big goals for this year. 

Thanks for reading! Hope you're able to take something from this, and I hope that you're able to move forward in whatever way makes sense to you in the years to come.