Author: Helen Turano

This week I’m thinking about anxiety as a disorder, and anxiety as  part of being human.

It’s part of the human condition that  can never be 100% sure of anything.  We can’t know that our loved ones to whom we said goodbye five minutes ago are safe.  We can’t know whether we will have an aneurysm or a stroke or a heart attack in the next hour.  We can’t be sure that scientists haven’t missed an asteroid heading for us.  A new epidemic could start at any time.

In CBT and Acceptance and Commitment Therapy, we have a paradoxical stance towards anxiety.  We encourage anxious clients to verbalize and accept the possibility of what they fear.   We also talk about the actual odds of these things occurring.   By definition, an anxious person worries a lot more than the ‘average’ person.   However, even though the likelihood of a feared event occurring may be tiny, it’s usually not zero.

Being anxious is being unable to tolerate uncertainty.

Anxiety and Mindfulness

My goal is to help clients to be able to live with the uncertainty of life.  When we are anxious, we fear the thoughts and images in our own minds.   Reacting to these makes them worse, not better.  If you call your spouse repeatedly to check that she is safe, this reinforces the belief that she is in a dangerous situation.    Reassurance-seeking lowers the fear temporarily, but reinforces the idea that checking is necessary.  It encourages overestimation of risk.

I teach anxious clients mindfulness skills.  Many people think that mindfulness is about having a peaceful, quiet mind.  However, this is more of a long-term result of practice.   For most people, mindfulness is about being able to notice whatever comes up.  This will include both fearful thoughts and images, and trivia about what you need to pick up at the supermarket, etc.  Mindfulness is training yourself to notice the thought or image, and let it drift away, neither pushing it away nor clinging to it.  The point is to notice, to be present to what is happening in your mind, not to escape.   Mindfulness helps you tolerate whatever horrors your  anxious mind brings up. This is what we call ‘exposure’ in CBT.

Anxiety and the Human Condition

In many situations that we worry about things over which we have no control.  Thus, there is no point in worrying.  Lack of control, is, ironically, freedom.

This is what links anxiety disorders with anxiety as the human condition.  We all worry because we are attached to things and to people.  “Enlightened” people of all traditions have accepted the potential for loss, and the anguish that goes with it.  They have the joy of freedom, but it is certainly not a kind of easy way out. The rest of us can benefit from going as far in this direction as we can.

Anxiety in Society

A few months ago, I was listening to the new NPR radio show “Invisibilia”  (a very interesting program about the mind.)    There was a discussion of the increase in parents’ fear over the last couple of generations. Kids in the ‘old days’ had whole neighborhoods to explore.  Now parents are afraid if they are out of sight/contact for more than a few minutes.  But  the dangers of this kind of freedom for kids are actually no greater than they were in the past.  The problem is that we are more aware of them because of the media.

There are costs for trying to reduce uncertainty to zero.  Kids cannot develop the same sense of competence, of knowing how to get around and explore and cope.  And how we react to situations shapes what our children believe is an appropriate response.   Parents can increase anxiety in children by modeling anxious behavior.    We can teach kids to believe that zero uncertainty is a viable goal.

How can we love and plan and dream and yet be at peace with having so little control over our lives?  And how can we model to kids that this is the only way to be happy?

Exposure, facing what you fear the most, in a gradual, supported way, is the key treatment for OCD.  It may involve writing scripts about feared outcomes and rereading them repeatedly, or tolerating an environment that feels disorganized in some profoundly disturbing way.  Always it is specifically tailored to your particular anxiety.  A trained therapist helps to fine-tune the exposure planning and get you started actually doing the exposures.

Acceptance and Commitment Therapy for OCD always includes exposure (ERP).

ACT teaches all of us ( not just those with OCD) to “defuse” from our thoughts.   The ability to make abstract associations (eg. a picture of an apple = an apple) fuels much of human achievement, but also makes us vulnerable to being “triggered” by our anxiety and depression.  A picture of a spider causes physical reactions in people with spider phobia.  A door knob in a public bathroom can be so strongly associated with HIV by a person with OCD that it takes enormous courage for him to touch it. “Defusing” from our thoughts means recognizing them as coming from our own minds rather than from objective reality.

“Logic” appears to support many of our associations.  There’s a quick test to determine whether this is true.  Would a “regular”, non-obsessive, or non-depressed, or non-anxious person, react the same way I am reacting?  There is of course a miniscule possibility that an HIV-infected person with bleeding hands just rubbed the doorknob, and I with my cut hand may contact the virus. How likely is that, really?  The logic of “regular” people does not include zero tolerance for uncertainty, but obsessive logic always does. This technique can be adapted to apply to peer groups that share the person’s values, as in “Would most devout………….believers agree with your logic here?”

ACT teaches us that what goes on in our minds is a set of “private events”, enchained with our past and our fears about the future.   It’s our “stuff”, baggage that gets in the way of our perceiving our real lives.   We all have it, and when we learn to recognize its patterns it is much easier to learn to disengage from it.  This works for everyone, including people with OCD. It helps to externalize the thought contents. – Is this me or my OCD talking?

ACT helps increase people’s motivation to face exposure treatment, because it is about values.  A value is not a goal, like earning a degree or getting married.  If you value education and a loving intimate relationship, your actions in pursuit of them have meaning, regardless of what the actual outcomes may be.  Values are life directions.  They are also unique to each person.   –  For example, some people care deeply about the environment and little about spirituality, others the reverse, and some people care deeply about both.

We use discussion of values in ACT to help the client realize what he or she is missing.  What would you be doing with your life if this behavior (physical and mental) was not getting in your way?  What are the pros and cons of changing?  Of NOT changing?  (There are always apparent “pros” to not changing, and “cons” to changing, or you would change.)

It can be a hard road sometimes for people to find/remember their values.  It may take perseverance to help the person find something he or she wants enough to motivate him or her for treatment.

Exposure is acceptance, and it will change your relationship to your fears.  It is unlikely that they will ever “go away” entirely, even if you take medications.  But it’s a lot different to notice what your OCD is telling you (and so be able to disengage from it) than to be grabbed by a terror that causes physical anxiety symptoms.

Gradually, people learn to apply what they learn in exposure sessions more generally.  It’s not just that you get used to touching the doorknob. You now recognize that obsessive fears about contamination, being aggressive, “unlucky” numbers, etc., are ALL just your OCD and can, with perseverance and courage, be disregarded.

ACT teaches us that once you recognize your “stuff” it loses much of its power over you, and you are free to chose what you do with your life.

There are many different ways that OCD can show up in people’s lives.  Imagine that you had to live with one or more of these fears:-

That you were alone with the fear that you might molest, or had molested, your much-loved little son, and so withdrew from him;

That you could not tolerate being in the kitchen with your lover or mother  because there are knives there and you could stab her;

That you were never able to make a commitment  because you could not be certain that you really loved anyone, so you were alone;

That you could not use a public bathroom because of fear of contamination, so you couldn’t spend more than a few hours away from home;

That you could never get to work on time because you had to take hour-long showers to make sure your body was clean, and check repeatedly that the stove was off.  You lost your job.

That household tasks had to be done in a certain order, often repeatedly, so that you sometimes could not eat or drink until 3pm because of the intense discomfort that you felt if your surroundings were not “just so”.

That you had to take in everything on the page when reading, even the page number, so that you worked so slowly you were getting bad grades.

Imagine the shame and loneliness, the overwhelming sense of being “bad” and “crazy”, that many people experience when they have OCD but haven’t yet been educated about the illness.

Just knowing that there is a name for this illness, and that other people have it too, creates hope, and begins the process of changing the relationship to the distressing thoughts. Medications (usually high doses of SSRI antidepressants) are very helpful for OCD, and often essential if the patient is also depressed. However, people who prefer to avoid medications can often make a lot of progress with therapy alone.

The effective treatment for OCD is Exposure and Response Prevention (ERP).  Just talking is NOT effective. (Acceptance and Commitment Therapy for OCD will be discussed in the next post. It helps people understand their anxiety in a different way, and find the motivation to start and stay with exposure treatment.)

To prepare for exposure, therapist and patient together make a list of situations which provoke the patient’s distress.  Gradually the patient exposes him or herself to the obsession-triggering situations, without doing any compulsions.  (Compulsions can be acts, such as excessive hand washing, or omissions, such as avoiding the person the patient fears she will hurt.  They can also be mental rituals to “undo” or “prevent” the feared harm, such as thinking about “lucky” numbers or ritualized, compulsive praying. ) Most people start with easier exposures and work towards the harder ones. The exposures can be done in session or at home.  Some exposures are done with “scripts”.  The client writes a story about the feared situation (such as molesting her cat) in the session, making it as detailed as possible, and reads it daily for homework.

Recently I headed out to walk around the neighborhood with an OCD client.  We walked on opposite sides of telephone phones and signs, and he trod on cracks in the pavement.   He laughed and said that I have a “funny job.” It’s true.  I’ve spun around telephone poles and led a blindfolded client around the streets and been to the cemetery and the hospital and eaten mushrooms and nuts in session.  I’ve not had a client who was afraid of stabbing just anyone  – (Often the fear is about harming loved ones specifically.) –  but I would be happy to sit with an OCD client with a knife in my office.  Clients really do get used to the feared situation, and learn that they can tolerate the anxiety, and what was so difficult in the beginning becomes quite tolerable eventually.

OCD often “runs in families”.  However, the particular form the obsession takes is usually linked to a deeply-held personal value.  People who love animals and children fear harming them.  Devout people fear breaking rules of their faith. People who are very responsible become obsessed with not omitting any precaution to avoid others getting hurt.  Health-conscious people fear contamination.  The  person with OCD gets “stuck” when he or she has a thought about something horrific or forbidden, or when he or she experiences intense discomfort because something is not arranged “just so.”   This is not because of some “unconscious” desire to do or contact whatever it is that is feared.  Research indicates we probably all have such thoughts, but that most people can so easily dismiss them as absurd that they barely notice them. The OCD client is so horrified he or she can’t let them go.

The next post in this series will be about Acceptance and Commitment Therapy for OCD.

This morning I’m writing about our tendency to take too much responsibility for other people’s lives.

The concept of codependence has been around since the ’80s.  Originally it was associated with the partners of alcoholics.  I think it has a much wider application.

In myself and other parents, I have noticed a tendency to personalize our adult childrens’ choices.  These don’t have to have anything to do with addiction. Often our disquiet about them is basically selfish.  Would my kids live on my doorstep or call more often if I had not made X or Y mistake?  In reality, X or Y  happened because we didn’t understand something about ourselves, our kids or the situation.  But we believe we “should” have known whatever it was that would have enabled us to make better decisions. It’s all about us and about our past, not our children and their future.

We all need to feel safe, to believe that we have some power over our lives, and to feel loved.   These needs can create inflexible self-concepts – always responsible, in control, loveable and loving.  We can’t bear to let go of these views of ourselves, so we deny behavior that doesn’t back them up, or ruminate about the behavior in an attempt to make believe it never happened.

What would it be like to let go of this stuff and live in the present?

Codependency With Partners

I also see a lot of partner codependency in my practice – the elevation of one’s partner to judge and jury deciding the value of one’s life.  –  If he or she doesn’t love me, I am worthless and will never be able to find and create a relationship with depth.

Many people are like this in early relationships as teenagers.   However, this thinking can also afflict adults who can see that their love object is a poor fit, irresponsible and even unlikeable.  They are half in and half out of the relationship for years, unable to make a real connection with other potential partners with whom a less fraught, truly loving relationship might be possible.   This is the underside of the value Western culture has placed on romance since the Middle Ages.  Often the person is painfully reliving the patterns of the past, the interactions with the semi-available parent who could never be pleased or made happy or healed.

Codependency: How ERP, ACT and CBT Can Help

How does Acceptance and Commitment Therapy help these forms of codependence?

Meditation helps us recognize the problem.  Then we must act.

All change is a form of exposure (as in Exposure and Response Prevention, another form of Cognitive Behavior Therapy which complements ACT).    ERP is effective but challenging.  We treat people who are afraid of contamination by having them touch the “dirty” doorknob, then make and eat a sandwich without washing their hands.  They have to sit with the anxiety.  There is no way of knowing for sure that they will not get sick.  In the same way, we can’t be certain in advance that focusing on our adult children’s actual needs and not our own will make us happier, or that taking the risk of trusting a non-abusive partner will lead anywhere except loneliness. Change involves risk.

Many years ago I borrowed from the library a book about relationships by a rabbi. (I didn’t write down what it was called and now can no longer remember.)  It discussed the patriach Jacob, who was unable to accept that his son Joseph, who became a great minister of Pharaoh in Egypt after being sold into slavery by his brothers, had a “story” of his own, independent of what would have made Jacob happy and comfortable.   I always remembered this because it seemed to me to say a lot about loving and its pain.  It’s not love to see others as (even much loved) accessories in our own story.  It is just as true that we are only a part of theirs.

From the opposite perspective, it’s also important to remember that we have not just a right but also a responsibility to create meaningful  “stories” of our own.  When we are enchained  by a partner’s varying level of affection for us, or our perspective on the right choices for our adult children, we are avoiding the harder road of creating meaning for ourselves in the moment.  It’s not easy to act as though we have value when the “demons on the boat” (an ACT metaphor for self-critical rumination) tell us we don’t.

We all have our stories.  None of them is THE story.  Let’s create our own stories and let other people own theirs.

This morning is a good time for me to write about how to sit with anger and frustration.

One of my very reliable clients has had a difficult time making it to evening appointments due to snow and traffic delays.  (I’m writing this on February 28th, so many readers will understand.)  We decided to meet today (Saturday morning).  I don’t do this all year, but my income has been down because of the weather and there’s nothing special I have to do today.

I get to the office this morning  and…my client does not show up.  I text her to find out whether she is on her way.

Now I notice that, for the second time, a text does not go through.  Also, my scheduling app is not working, and my phone can’t connect to the Internet.

AAARG!  My client probably texted me to say she couldn’t make it.  Who knows how many other texts I did not get. What’s weird is that I got a text from a colleague that came through OK last night, and also one from a number not in my contact list, and obviously not for me.

An intermittent problem……the very worst kind.

I Google the problem and it looks as though I may have to call Apple.  And I know that that could lead to having to drive for 45 minutes and wait in line for 45 minutes at the store…..I could waste my whole day….

This is the type of frustrating situation that I (and many other excessively goal-oriented people) have difficulty coping with.  Shoulders tighten and thoughts turn immediately to how it shouldn’t work this way, I spend too much of my life doing “IT”, and on and on.

Interestingly, this ties in with what I planned to work on with my client this morning.

Marsha Linehan, the developer of Dialectical Behavior Therapy, has come out with a new book of skills.  I just got it and haven’t had time to read much yet.  But already I’m finding it helpful to myself as well as clients.  I had found a couple of worksheets to give to my client for homework.  They fit my personal needs perfectly right now.

I can easily see several alternative ways to look at my texting situation.   I am probably not aware of a development in technology or security that requires that I take some action. The only reason I am described (by my daughter’s technologically expert boyfriend) as “good for my age” with computers is because of the many hours I have spent throwing myself against technological barriers in hopes of breaking them down. (Of course, this metaphor describes my usual IT attitude. – I can get ridiculously desperate about the small stuff).

Linehan’s new skills book inspires me to talk to  my client about nonjudgmental/mindful ways of looking at her frustrating work situation.  Could the nonprofessional attitudes and practices there be due to others knowing no better?   Does it help her to be angry? If she worked at being mindful and nonjudgmental at work, would she be less tense, happier, more productive? Is she doing regular mindfulness practice every day to make mindfulness easier to practice when she needs it?

Things happen to people that are incomprehensibly awful, that can take a lifetime to “sit” with.  I am not attempting to minimize the challenges that people can face in letting go and moving on.  Marsha Linehan also talks about “Radical Acceptance”, but that is a topic for another post.  This one is about living with the minor frustrations of life, which can so easily result in our making ourselves and others miserable.

While I was writing this post my ability to text returned. (I downloaded a new version of iTunes, and all appears to be well.)

Meanwhile, I had something to write about in my blog.

More about ACT, DBT, and related topics in future posts.

References are to: Marsha Linehan, “DBT SKills Training Handouts and Worksheets,” Second Edition, Guildford Press, 2014.

This afternoon I am writing about a ordinary burden with which I and many of my clients struggle  – “should” thoughts.

Readers of previous blog posts will recall my writing about the grimmer thoughts that plague us – thoughts about being inept, life being meaningless, etc.  Today we are looking at the stuff that gets in the way of our being happy, not in a dramatic way, but like a slow and constant drip of anxiety that drains the juice out of life.

There are situations where we follow other people’s values because we don’t know or can’t stand up for our own.  My problem is usually not being able to figure out what’s most important to me at a particular time. What “should” I do?

It’s always worst on unstructured days like today when I get out of bed later than I “should” have, and skip meditating because having so much time with my eyes closed will supposedly stop me from getting to sleep that night.  (How do contemplative monks and nuns and people on long meditation retreats sleep then?)

We are in between seasons; it’s not yet spring.  Feet of icy, grubby snow are still lying about and closing off most walks.  It’s a bland, ordinary early March day in New England, an uninspired kind of day.  I want to write but nothing much comes, want to hang out with my family but everyone’s busy, want to go shopping but fear it would be “retail therapy”.

Should I go to the Boston Flower Show, go to church, stay home and do laundry or rearrange my house? The part of my life that was filled every minute with children and household necessities is over, which grieves me but also frees me to do….what?

The only “activity” that always works out feeling OK is being mindful.

Feel the keys clicking so satisfyingly under my fingers.  How blessed I am to have had my education and my life experience (even the parts that hurt to look back upon, that I would change if I could.) I am here now and that is good.

Years ago I read a biography of J.R.R. Tolkien – of course I can no longer recall which one – which cited criticism a journalist had directed at him.  He never went anywhere. He didn’t travel.  It struck the biographer – and me – as a ridiculous way to think about a man of such epic imagination.

Perhaps the years in the trenches during World War One made him appreciate home.  He had explored in his study and teaching great swathes of the past – the worlds of the Anglo Saxon poets and the writers of sagas – which were far more gloriously strange than anything likely to be encountered in 1950s Europe.

Perhaps he didn’t need the endless stimulation we tend to crave. That enormous creativity had to come from an ability to just be, to sit with whatever he needed to bear, difficult marriage, war trauma and all. Nothing so new and compelling could have come out of restless activity.

One of my clients recently let me know about Pico Iyer’s TED book and talk, “The Art of Stillness”, a beautiful meditation on “Going Nowhere” by a man who has traveled the world.   He writes about a book containing many photographs documenting the same view, taken over the course of a year.  (“Motionless Journey” by Matthieu Ricard.) He sees this as an inner journey through time.   He makes me think of Tolkien and his explorations, guided by Anglo Saxon and Old Norse and Old Icelandic.  I am grateful for my own education in history, which set me on a road of joy and delight that I have followed ever since.

Underneath the “shoulds”, when we sit in silence, we unearth our lives.

Pico Iyer, “The Art of Stillness”, TED talk and TED book, 2014.

Matthieu Ricard, “Motionless Journey,” Thames and Hudson, 2008.

I have always been a person who loved winter.

As I write the snow is falling and coating the iced-up banks that first fell in February.    It’s March 1st, and daffodils are coming up in Wales where I was born.  When the temperature hits the 40s on Wednesday, for the first time this year, we will all be thrilled.  A part of me longs for spring, and a part needs to remain here, in the cold.

I know I’m not alone in my odd tastes.  While in Martha’s Vineyard years ago, I discovered Daniel Waters selling his books of poetry at a craft fair at the Grange.    One of his collections is called “Needing Winter”.  It’s wonderful. – He knows exactly what I mean.

Since I want to get this blog published before winter is gone, there is no time to write to him and request his permission to quote him, so I can’t.  Suffice it to say that he understands the connection between winter and peace.

In the depths of winter we are pared down.  I am lucky enough to work for myself, and have an office a half a mile from my house.  There is no need to “go” anywhere.  My husband is retired and cooks me wonderful meals.  We have a gas fireplace which stands in for a sauna, two cats who look for a lap, knitting and Netflix.  Clients cancel so my caseload is low.  I can study and catch up and dream.  I started the blog I had planned for a year, and began to trust that I really would keep on writing.   Introverts like me love this stuff.   There’s time to create because social contacts are fewer. This is the happiness of winter.

Then there’s the other, harsher side.   Daniel Waters roots  the glorious flowers of summer in winter’s deprivations, in the need to accept lack and loss. There’s a power in winter, a kind of book-of-Job complement to all our ills, a larger perspective that makes them easier to bear.

Like night, winter is rejected by the modern world, an inconvenience, something to be minimized and ignored.  Winter doesn’t expect anything of us.  We can let go of the need  to be happy, productive, positive, etc, etc, etc.  It encourages us to be slow, meditative, to sit with sorrow and pain both physical and emotional.  There is nowhere to go except within the house and the self. If we can accept it, we escape the pressures of our culture for a while.

When I must sit with my own particular demons, I prefer that it be cold and dark.  Then I have time.  There is no need to be up and doing, cheery and bright in the southern sun, pushing aside everything in me that is broken, and not fixed, and  not perhaps fixable, except in some larger context that I cannot grasp.

Winter creates space within the heart.  How can people bear to avoid it?

Only by sitting through winter can I be ready for spring.

“Needing Winter” by Daniel Waters, a poet, printer, and printmaker, is published by Indian Hill Press, West Tisbury, MA.  I recommend it highly.

I no longer cook often for my whole family.  Bereavement, and my adult daughters moving away, has taken away a role I loved.

Like everyone, I am most prone to feel the ache of loss when I am not working and have nothing in particular to do.  That used to make Sunday afternoons hard.

My fallback position when in distress has always been to look for the answer through reading.  It didn’t help.  I would think about the past, and begin to feel worse and worse.

There is a wonderful YouTube video by Joe Oliver (based on a metaphor by Russ Harris) called “Demons on the Boat” which you can watch lower on this page.  It’s a cute cartoon about a man who has demons in the hold of his sailboat.  He makes a deal with them to leave him alone, but whenever he tries to sail to shore, they come up on the deck and abuse and intimidate him.

Now I was not trying to “sail to shore” on those Sunday afternoons.  It was more that lack of structure in my day had stopped avoidance from working.  My “demons” were out in full force, and they were well named, because the theme of these kinds of thoughts is always that life is meaningless and hopeless, that I can do nothing right, etc.

Even though I was often sad, I also found happiness during “downtime”  by taking up photography.

I know this sounds like a ridiculous cliche. “Get a hobby!”  It’s not a way to avoid the necessary pain of grief.   But it can work for depression that lingers on.

ACT is about finding what life directions you value and pursuing regardless of how you feel.   Being creative wasn’t my most important value. – Flying out to see my grandchildren often and finding spiritual meaning again meant much more to me.  But sometimes it’s the “lesser” values that really help give direction.  I couldn’t visit the kids every weekend, and spiritual reading can actually make things worse when what’s needed is doing rather than thinking.

When I turned to photography I was remembering something that happened years earlier.  Because I failed Art in the British equivalent of 8th grade – (Does this say as much about the teacher as about me?) – as a young adult I thought any attempt to be “artistic” was pointless.  However, I loved gardens, so later on when I needed to make a plan for mine I started to read about garden design.  To my delight, I found that you can LEARN to do it.  I studied intensely.  I worked too hard physically (with bad effects on my knees).  Eventually I had a garden that my family and friends loved, a source of comfort and delight.  And, when a family member was ill years ago, I would design borders in my head at 2am, keeping the “thought demons” at bay when I could not sleep.

I realized that photography could do the same thing as garden design for me.   It has happy associations.  I remember “helping”  my father develop and expose film in his darkroom in the garden shed.  I already had a camera that had belonged to someone I loved.  Photography is a (much) cheaper hobby than gardening (or perhaps I’m a newbie and not yet tempted by expensive extra lenses! )  and you can do it all year.

In the “Demons on a Boat” video, the sailor decides he will head for shore.  He realizes that though he can’t get rid of the “demons”, they can’t stop him from doing whatever he wants.  He doesn’t have to wait to feel better first.  We can do something positive, even when suffering.  And ironically, once we accept that we have to put up with our negative thoughts, their power will tend to diminish.

Have I “recovered” from feeling depressed on Sunday afternoons?  The feelings are sometimes still there, but now I have something fun to do.  Even though I have lots to learn about photography, I put my photos up on my website.   When you do something that you value, you can be happy even when you’re sad.

Here’s a link to “Demons on a Boat”.

Have you ever tried to change your habits by keeping track of them?

A few  years ago, because of my own mistake, I ended up without health insurance for a month.

This may, to less fortunate people, appear to be rather minor, especially since I was not sick and had no reason to suppose I would need medical care.  However, I immediately began to catastrophize.  Images of car accidents, hospitalization, loss of my house and impoverished old age filled my mind.  And of course the fact that this situation was my own fault positively encouraged rumination.

I was complaining a lot to my husband and became very irritable with him.  I was ashamed of acting like this.

What should a behavior therapist do when this happens?  I got out an old journal, in which I had last written jottings about the garden several years earlier.  I decided to set up a chart so I could track how much anxious/irritable behavior I had shown each day.  I also asked my husband to track me.  (I am grateful to be married to someone I can trust to do this with kindness but reasonable accuracy.)

First I had to set up a scoring system.  I decided that saintly/enlightened people (who would not be disturbed by misfortune),  and people who are naturally laid-back and relaxed or in denial, would score 10 out of 10.  This did not seem like a realistic goal for me.  In order to avoid discouragement, I planned to give myself a score between zero and one.  One would be a good score, with no obvious signs that I was distressed or unfounded criticism of my husband.  We were tracking how I behaved, not how I felt or what I was thinking.

I looked back at the journal as I wrote this post.  My husband always scored me higher than I scored myself.   My worst day was a 0.3 from him, when I overreacted to his spending (not a lot) of money on the house without telling me first.  How could he spend when my financial future was so uncertain?

In the beginning I was nervous about driving, but did it anyway.  I live close to my office, but sometimes had to drive a distance.  (At that time I had a client with Body Dysmorphic Disorder whom I used to meet at a department store makeup counter miles away for exposure treatment.)

With repeated exposure to driving my fear of accidents grew less.   I was even able to laugh when I realized that I would be eligible for my new insurance to pay the local trauma center within a few days.  Why was I thinking about this, when I had had two fender-benders in a long driving career?

By the end of the month the lack of insurance still concerned me intellectually, but it was not disturbing emotionally much at all.

What were the important points about change I learned from all this?

First, the importance of recording.  When you track something, you want to “do well” at the activity being tracked.  (The exception, of course, is if your standards are so high that you abandon the whole project in disgust after a few days.)

Second, the changes were important to me.  I believed I should do better than to complain to and snipe at a person I love because my own life was somewhat off track.

Third, the focus was on what I did and not on what I was thinking.  It wasn’t particularly helpful to me to challenge my thoughts.  I was already fully aware that they were irrational.

Because what I was focused on was not how I felt but how I acted,  I actually could control the score I got.  Once I figured out that my making a visible effort to change was actually strengthening my marriage, I started to feel rather proud of myself.  I would rise above mere worry about insurance! My anxiety and irritability went way down.

Catastrophizing easily creeps back into my thoughts.  But this experience confirmed for me that if you act differently, thoughts and feelings will follow.

Those of you familiar with Acceptance and Commitment Therapy (a newer type of Cognitive Behavior Therapy) will recognize that this story illustrates some key ACT principles.  I will write more about this in the next post.