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Simply Soul-Full

A Conversation with Dr. Seth Gillihan: A Cognitive Behavioral Approach to Tackling Stress, Anxiety and Worry

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We are all, at this moment, living in a world that can feel alienating and vastly different from the lives we are used to living. We have all, on a global scale, been forced to change our daily habits and lifestyles in an effort to ensure the safety of the ones we love. What changes have you made and what important lessons have you learned from the changes you have made?

Strangely enough, a lot of things about my life aren’t that different from before. I’d been working from home and seeing clients by video conference since last fall, so this is a continuation of that. I’ve stopped going to the gym, of course, and I only go to the post office once a week. I really don’t go anywhere else anymore, except our family takes a walk or goes on a hike together every afternoon for an hour or so. That’s something I’ve really enjoyed and would love to keep doing—to spend that family time together each day. Before the social distancing restrictions I’d usually work up until I needed to start making dinner. Now I fit my work into the earlier hours of the day (thankfully I’m a very early riser). And I guess I’ve also realized just how easy we had it before! That we could go to the grocery store without thinking about our health and safety, or go to the gym, and that the kids were in school all day while we were working. It feels kind of like being sick and then getting well—you never realized how good it felt just to feel normal before getting sick. “Normal” is pretty amazing.

  • And, on that note- what changes are you unwilling to make? Why?

At this point I’m willing to follow the experts’ guidelines, whatever they might be, to help flatten this curve. I have to say, though, that that’s easier for me than for a lot of people who can’t work from home or who don’t have access to a yard or nearby walking trails. I don’t agree with people who are defying stay-at-home guidelines and not social distancing, because of the risk to all of us, but I think I get their frustration.

  • What advice, tips, counsel, recommendations, suggestions would you give to those who are suffering from fear, worry, anxiety, depression and stress that are certainly at an all time high during this health crisis?

Right, there’s never been a better time to guard our mental, emotional, and spiritual health. I think we need to be deliberate about how we take care of ourselves, and think about what our daily needs are. This is a good time to focus on basics, like daily movement, good food, sleep, time with people you care about (in person if possible, but through a screen if need be), and whatever spiritual practices a person has.

In terms of more specific practices, all of us can practice seeing the stories our minds are telling us. This is a really hard time just as it is, without the additional stress of anxious thoughts and predictions about the future. For example, if I have the thought, “My loved ones are going to die from COVID-19,” that can feel like an actual fact that will happen. But it’s just something that the mind invented. So if we can start to see through the mind’s stories and know that things might not turn out the way we fear, we can let go of some of that anxiety and dread. I’m not saying it makes everything easy and we can just think our way out of a stressful time, but it does lighten the load.

  • How would you explain “worry” to someone? Do you consider “worry” to be fear based?  Putting aside the true defining moments of “danger” and the very real physiological implications of fear- do you consider “fear” to be an emotionally based over-reaction to worry or vice versa?  What is the relationship between fear and worry?

Worry is a type of anxiety because it’s about something bad that could happen in the future. It usually starts with “What if…” and then throws some scary scenario at us. “What if I lose my job? What if I have to go to the hospital for some other reason, and get Covid-19? What if my mom gets sick?” That scary thought spikes our anxiety, so we do some thinking to try to make sure it won’t happen, or at least to imagine what could happen. Sometimes we actually feel a little relief after worrying, because it feels safe in some way, like we’re not ignoring danger. But any relief is short-lived, because we can’t pre-solve the future! So the anxiety comes back, and we worry again, and we often get into these ongoing loops of anxiety and worry that can just be running in the background all the time.

Usually when we say “fear” we mean what we feel when we’re actually in the presence of something dangerous. So I would feel fear if a ferocious dog ran at me, whereas anxiety is what I would feel if I imagined a big dog might lunge at me. Worry could happen even as I sit at home, like “What if I run into a big dog on my walk and it tries to attack me?”

  • How does mindfulness training help tame “worry?”

There are a few ways, and worry is really what brought me to mindfulness as a clinician, because it’s hard to treat with other approaches. Worry is always about the future, so by being mindfully present—in the present—we step away from that preoccupation with what might happen later on. What I know is what’s happening right now. The rest is a fantasy.

Mindfulness is also about opening to reality with acceptance, rather than trying to force everything to work out the way we want it to. So a mindful response to a worry thought might be, “Yes, that could happen, and I would need to deal with it if it did.” So if I think, “What if I get COVID-19,” I don’t argue with that thought or tell myself, “I can’t get this virus.” It could happen, and I can’t prevent it with my mind. What’s true is that it’s a possibility and I would need to manage it if it happened.

The other thing mindfulness can really help with with worry is letting us see when we’re doing it. A lot of the time we don’t even realize we’re worrying. We just think we’re taking care of possible problems or that we’re anxious, but we don’t recognize worry as an active process of the mind that we might have some control over. As we practice greater awareness of the mind’s processes, especially in meditation, we can get better at knowing when we’re engaging in worry.

  • What techniques would you suggest for those who need to “find peace” in the midst of the storm?

I would start first thing in the morning and spend a few minutes quietly breathing and being with yourself before launching into the day’s challenges and bad news. Approach the day from a place of connection to yourself and to what’s important to you.

Also, make sure you ask the right questions. We ask a lot of worry-type questions, like “Is everything going to be okay today?” And those kinds of questions just raise our anxiety, because we don’t have true control over the answers. Better questions are things like, “What kind of person do I want to be today? How will I respond to the challenges I face? Who can I show love to today?” We can focus on things we truly care about and actually have some control over.

Bedtime and sleep are so important, too, as a break between the stresses of today and the cares of tomorrow. So treat sleep as a sacred space, really a place to practice trust as you let go of the day that was and the day that will be. Give yourself an hour or so at night to wind down before bedtime, and let go of problems as much as possible. We don’t have to carry our troubles with us all night. That’s often easier said than done, but we can really start to question this assumption we have that we need to be thinking about our problems all the time. Trust and let go as you move toward sleep, and see what happens.

  • How about giving everyone a brief “look” into how you and your family have been dealing with the issues that are confronting all of us. As the father of two young children-what and how are you handling their fears, worries, isolation and stresses? What is the one thing that, as a family- you are determined to keep alive after this crisis is over?

We’ve actually got three little ones, ages 12, 9, and 5. They’re all handling this amazingly well, with virtually no complaints. It’s kind of heartbreaking really, how sweet and adaptable they’ve been. All the time together seems to have helped them really bond. They get into fights with each other, of course, but maybe actually fewer than before. We’re making a point to have them “get together” with their friends as often as possible, which of course is always through a video chat, and I’m sure they’re enjoying the screen time. But they miss their friends. And we have them spend time outside each day and exercise, occasionally with an exercise video if the weather is too wet to get outside. Thankfully this is happening in the spring here and not in the dead of winter—that would be a bigger challenge, if we really couldn’t venture out.

One thing that’s been sad is that our youngest was having a lot of nightmares, pretty much every night. I think it’s hard for her to process everything that’s happening, so we were often having to go in and help her settle after having a bad dream. My wife and I try to limit how much we talk about the pandemic with the kids around, but also we try to normalize it so it doesn’t seem like this scary secret that the adults are worried about. They all know there’s a pandemic and that we need to social distance and now wear masks in public.

Sometimes it’s challenging having everyone home all the time, especially when I’m trying to work or record a podcast and there’s no quiet space in the house. But I remember that everyone is healthy and we’re together, while so many people are suffering and saying good-bye to their loved ones. So I want to carry with me that gratitude for everyday life, with those I love, and to remember that my real work is to show and to share love.  

Seth J. Gillihan, PhD, is a licensed psychologist and host of the weekly Think Act Be podcast. He is author of The CBT Deck, Retrain Your Brain, and Cognitive Behavioral Therapy Made Simple, and co-author with Dr. Aria Campbell-Danesh of A Mindful Year.  Seth’s newest publication CBT Deck for Anxiety, Rumination & Worry is available now.

Seth provides resources for managing stress, anxiety, and other conditions on the Think Act Be website, and offers courses on the Think Act BeOnline School. When he’s not working, Seth enjoys working in his garden, cooking vegetable-rich meals, and going for hikes with his wife and three kids. He lives near Philadelphia.

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