Disrupting the Cycle of Avoidance Coping

Procrastination, self-isolation, wishful thinking, passive aggressive behavior, and alcohol use. Sound familiar? These behaviors are all common examples of avoidance coping. When we are engaged in this common form of maladaptive coping, we are not directly addressing our problems, interpersonal conflicts, or difficult emotions. Rather, we are disengaging and distracting ourselves so that we might feel better in the short-term, only to suffer more in the long-term.    

The temporary relief we experience through avoidance coping leads to further stress and anxiety by negatively reinforcing avoidant behavior and leading to more avoidance. Before long, we can find ourselves trapped in a cycle of ongoing avoidance and increasing distress.  

Understanding reinforcement is very helpful for understanding the cycle of avoidance coping.

Generally, reinforcement is anything that makes a behavior more likely to reoccur. Negative reinforcement involves the removal of something negative as a means of reinforcement. In the case of avoidance coping, we are removing our immediate anxiety or emotional distress through avoidance, thereby negatively reinforcing avoidant behavior. 

Now that we understand reinforcement, we can begin to examine our avoidance coping and the role of negative reinforcement in perpetuating the avoidance cycle.

However, before considering how you engage avoidance coping, it important to note that there is a time for healthy distraction. When we find ourselves overwhelmed or when there are no apparent solutions to a problem, we often need a break to reset and take care of ourselves. Likewise, stress relief strategies like relaxation techniques should not be mistaken for avoidance. These are subtle, yet important distinctions, as the goal of these activities is to help calm your nervous system or take a necessary break so that you can more effectively deal with challenges. 

Step 1: Recognize

Avoidance coping is not always easy to recognize. Take a moment to consider the ways in which you may be avoiding people, places, or other activities.

What are some of your typical behaviors or habits when you feel anxious or distressed?  

What are some things you do when you are anxious or uncertain in your relationships?  

In what ways are your choices influenced by avoidance? 

It is often easier to see how we engage in avoidance coping with large life-changing decisions or with specific types of challenges such as interpersonal conflicts.  However, in addition to the larger or more obvious challenges we face, it is also helpful to examine the smaller ways we use avoidance coping in our daily life.  

Sometimes avoidance coping is disguised as a preference. For example, we may avoid a social gathering because we don’t like the food menu or decide that we prefer email while avoiding a more direct discussion of a challenging topic.  

At other times we may make small compromises or subtle choices to reduce our distress without being aware of the ways that these choices negatively reinforce our avoidance. For example, should I sleep in versus get up to exercise or should I return a phone call to a friend versus watching television. Although small, these decisions can impact our quality of life and feed into avoidance coping.    

Step 2: Strengthen cognitive coping skills 

Practice identifying your automatic thoughts and cognitive distortions. Automatic thoughts are the thoughts most connected to our immediate feelings and reactions. Cognitive distortions or biases are negative thinking patterns that best describe the nature of our automatic thoughts. Common distortions include all-or-nothing thinking, overgeneralization, should statements, jumping to conclusions, personalization, and emotional reasoning. 

Think of your thoughts as a talk radio station and turn up the volume. Notice what thoughts automatically come to your mind when you are experiencing a strong emotion. Choose a cognitive distortion to label your pattern of automatic thoughts.

Labeling automatic thoughts typically allows for you to step outside of your thought process and observe your thoughts from the perspective of a participant observer. This slows down automatic thoughts and allows for space to consider alternative thoughts and behaviors.  

Consider the evidence for and against your automatic thoughts or conclusions. How accurate are these thoughts? How can you soften your thoughts to make them less extreme? Even if your feared outcome occurs, how will you feel in a week, a month, or a year from now? Remember the bigger picture. Remember that thoughts are not facts.

Step 3: Practice grounding skills 

Deep breathing – Breathing techniques can be one of the most practical and easily accessible ways of reducing stress in the moment as they can be used at almost any point throughout the day. Practice taking a slow deep breath from your abdomen and silently count to five. Next, hold your breath for a moment and again count silently count to five. Finally, exhale slowly as you silently count to five one more time. 

Five senses grounding – Use your five senses to ground yourself in the present. Notice five things you can see, four things you can feel, three things you can hear, two things you can smell, and one thing you can touch.  

Step 4: Seek social support

Avoiding social support or asking for help is extremely common. Yet, most people appreciate the opportunity to be supportive, so it is wise to let go of any worries that you might be a bother if you reach out for support. In fact, other people usually benefit from providing support and connecting with others in this way.

Everyone experiences difficulties at some point. Therefore, it is also helpful to let go of any thoughts that suggest your concerns are insignificant or that you are somehow incapable or weak. Social support is an essential human need. Ultimately, reaching out to connect with others benefits everyone and helps us all grow stronger together. 

Step 5: Approach Coping

Once we are aware of avoidance coping in our lives and we are better equipped to use coping skills and seek support, we can feel more empowered to make different decisions and move toward challenges. We can also feel better equipped to manage any difficult emotions or anxiety that arises when we face a challenge or conflict.

Turn toward something you typically avoid. Rather than criticism, try to respond to yourself with kindness and approach your reactions with curiosity. When we open ourselves up to vulnerability, personal growth and authentic human connection will follow. Ultimately, even small changes in our avoidance can readily add up to significant improvements in our self-confidence and quality of life. 

Dr. Thomas Lindquist, Psy.D.

Licensed Psychologist

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Channeling Your Inner Tortoise: Slowing Down to Reduce Stress

“Nature does not hurry, yet everything is accomplished.” 

-Lao Tzu

Rushing can increase stress, interfere with meaningful communication, and reduce our capacity for pleasure and enjoyment. Although rushing is sometimes inevitable, constant pressure to rush from one thing to the next leads to chronic stress and burnout. Both our physical and mental health can begin to suffer as a result. Slowing down can significantly reduce our stress and lead to greater resilience and overall well-being.   

Practices for slowing down:

Consciously slow down your activity level by 25 percent. Bring your full attention to the pace of your actions. Notice when you are moving at 100 percent and intentionally slow down to 75 percent. Notice how it feels to move more gently and intentionally. 

Set aside additional time to complete a task. If you think you will need an hour to go grocery shopping, set aside two hours and allow yourself to approach the task at your leisure. Give yourself ample time to avoid feeling rushed. Take longer than necessary and ignore your watch.  

Give your phone a break. Practice resisting the urge to get on your phone for a few minutes each day or give your phone a time out. When you are waiting in line, riding an elevator, or eating lunch, try to resist the urge to take out your phone and start looking through email or social media. Attempt to sit with any feelings of impatience or boredom and resist the impulse to distract or engage in more work. Take a moment to relax your body and allow your stress to dissipate.  

Get Bored. Stepping away from complex tasks or social media and sitting around quietly or gazing out of the window actually allows more space for creativity. You might also consider finding several more mundane tasks and allowing yourself to embrace feelings of boredom as a way to slow down and sit with whatever thoughts and emotions arise. As you expand your capacity to sit with boredom, you may find that it not only gets easier, but that it can be enjoyable as you get a mental break from the stress of more demanding tasks.  

Momentary Connections. Slow down long enough to momentarily connect in a deeper way with everyone you meet. Imagine what it might be like to be in their shoes. Look them in the eyes and wish them a good day. Share a kind word of encouragement or a friendly smile.  

Mindful eating. Take time to eat more mindfully. Focus your attention on the food you are eating and slow down your pace. Notice the tastes and textures of your food. Add something enjoyable to your lunch and slow down again to pause and savor the tasty treat.  

Acting “as if.”  Acting “as if” is a powerful Adlerian and cognitive constructivist therapy intervention that can be applied to your daily life. Think about somebody you know who always seems calm and centered. You might also think of role model, favorite author, or spiritual leader. After bringing this person to mind and thinking about the way they approach the world, act as if you are this person. Pretend you are auditioning for a movie to play this person and give your best performance. Acting “as if” can begin to shift your thoughts, behaviors, perceptions, and emotions in a new direction of calm. 

Notice your environment. Slow down long enough to take note of a few things in your environment. Noticing sounds is a good place to start. Pause and sit silently for a moment while you note the sounds in your environment. Noticing light, reflections, and shadows are also fun and interesting ways to slow down and engage more intentionally as you ground yourself in your environment. 

Breathe from your diaphragm. Place your hand on your stomach and notice as it rises up and down slightly as you breathe. This practice slows down breathing and stimulates the parasympathetic nervous system, which is the system that produces a calm and relaxed state.  

Use imagery to connect with a calm and relaxing place. Close your eyes and imagine your favorite vacation spot, such as a warm sunny beach, calm lake, or a treasured hiking trail. Imagine all of the sights and sounds as well as the feeling of the warm sun and soft breeze. Allow yourself to relax and rest here in your imagination for a few minutes. 

Everyday Mindfulness. We can practice everyday mindfulness by bringing our attention more fully to the present moment and focusing on our senses in the here-and-now while completing everyday tasks. Much like mindful eating, you might try practicing mindfulness while taking a shower or brushing your teeth. Bring your attention to the warm and calming sensations of the water on your skin, the smell of the soap or shampoo, or the taste of the toothpaste. 

Take time to reflect. Start a gratitude journal or practice sharing your gratitude and appreciation with others at the end of a long day.  

Dr. Thomas Lindquist, Psy.D.

Licensed Psychologist

Visit us at lindquistpsych.com

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Using Behavioral Activation to Improve Your Mood

It is not uncommon to skip or cancel plans because we are feeling down or unmotivated. It is also not uncommon for us to wait to feel better or feel more motivated before taking action. Although canceling plans to focus on taking care of ourselves is sometimes the right decision, avoiding activities that can help us stay active and socially engaged can hinder our ability to bounce back from a period of low mood.  

Behavioral activation is a well-researched intervention commonly integrated as part of the treatment strategy for depression. When we experience symptoms such as loss of motivation, decreased pleasure or enjoyment, or feelings of worthlessness; we are often much less likely to engage in activities we typically enjoy. Although this might initially provide relief, continued avoidance of such activities often leads to a worsening of our mood, increased anxiety, and feeling more disconnected from others. Behavioral activation helps to disrupt this cycle of avoidance by helping us create a road map with goals for increasing our engagement in meaningful and pleasurable activities.   

Determining which activities to increase is often the first step. Activity tracking and monitoring is one helpful place to start, particularly if you are uncertain about which activities will be most beneficial for you. Start by recording what you do every hour and rate your mood on a scale from 0-10, with “0” indicating low mood and “10” indicating good mood. After tracking and rating your actives, you can select which activities resulted in an improved mood. Some behaviors, such as exercise, can typically be used right away as we already know this to be helpful to most people.

In addition to monitoring our activities and rating our mood, we can also explore our values to determine what leaves us feeling more connected to meaning and purpose in our lives. For example, you may value health and therefore find meaning through fitness and nutrition, or you may value family and find meaning though planning and engaging in activities as a family. You may value other things such as  community, social justice, spirituality, or the arts. Focusing on activities that align with your values is likely to be beneficial.  

In addition to values, it is important to consider what brings you pleasure. Although there can be overlap, pleasurable activities are often done for inherent enjoyment and satisfaction. Create a short list of the activates that bring you pleasure and use this to help guide your behavioral activation plan.  

The second step is to select a few of the activities from your list and incorporate these into your daily or weekly routine. In setting goals, it is important to be realistic. Therefore, it is usually best to start with 2-3 of the easiest activities to increase the likelihood of your follow through. Consider any barriers that might arise and make a plan or schedule to remind yourself of your goals. If you are struggling, very simple or small activities are the best places to start. In some cases, you may simply engage more frequently in your current pleasurable activities and use mindfulness to connect more intentionally.

It is also helpful to pay attention to your mindset and self-talk. This strategy will be less helpful if you are unnecessarily critical of yourself or judgmental about your efforts. Practice self-compassion and avoid being discouraged if you do not complete your goals or if the experience is less helpful than you had hoped. Remind yourself that it is often not just one activity or experience, but a collection of positive experiences and pleasurable activities over time that is most impactful.   

Dr. Thomas Lindquist, Psy.D.

Licensed Psychologist

Visit us at lindquistpsych.com

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Befriending Our Emotions

“You can’t stop the waves, but you can learn to surf.

-Jon Kabat-Zinn

Take a moment and recall the last time you felt a strong emotion. What do you remember? What did your body feel like? What thoughts came to mind? What did you feel like doing? What did you do? Pause and close your eyes for a few moments to reflect on these questions.   

It is common to try and get rid of our feelings, particularly when we experience strong emotions of sadness, anger or fear. However, trying to get rid of emotions can actually make them more distressing and difficult to manage. Befriending our emotions through mindfulness as well as skills aimed at fostering emotional intelligence (i.e., recognizing, labeling and expressing emotions) are both helpful practices for engaging more effectively in our emotional lives. 

Emotions are important. Foremost, emotions communicate important information to us and to others. For example, anger may tell us we have been mistreated or sadness may tell us we have lost something important or need support. Emotions also assist us in organizing our experiences and actions. Again, fear may organize us to confront a wrongdoer or sadness may allow us to withdraw from busy activities so that we can have space to grieve. Experiencing painful emotions can also help us empathize with others and sharing vulnerabilities fosters closer relationships. Emotions also provide color to our lives as we experience moments of joy or feel proud of our accomplishments. In either case, both “positive” and “negative” emotions are important. Understanding and engaging with our emotional life is ultimately a significant strength.

Mindfulness

Mindfulness is a helpful way for us to practice befriending our emotions. Just as we practice being mindful of our breath or the sights and sounds in our environment, we can also practice being mindful of our emotions. 

We can practice being more mindful of our emotions as we experience them or by taking note of our emotions and practicing being present and connecting with our emotional experiences at a later time. We can also practice monitoring when we become self-critical. In both cases, the increased awareness and self-compassion that accompanies mindfulness practice will be useful for better understanding what our emotions are telling us and responding to our emotions in ways that are more intentional.

Practicing mindfulness of emotions is often challenging as judgement or criticism is likely to arise or we might struggle to remain present with intense or upsetting emotions. It is helpful to remember that the most important part of this practice is simply turning toward and becoming more aware of your emotions.

Emotional Intelligence 

As we become more aware or mindful of our emotions, we can use the five RULER skills developed by Dr. Marc Brackett, Ph.D., to regularly check-in with our emotions throughout the day, label our emotions, and express how we are feeling:

Recognize: How am I feeling? Cues from our bodies (posture, energy level, breathing, and heart rate) can help us identify feelings. 

Understand: What happened that led me to feel this way? As feelings change throughout the day, think about the possible causes of these feelings. Identifying the things (people, thoughts, and events) that lead to uncomfortable feelings can help us both manage and anticipate them in order to prepare an effective response. 

Label: What word best describes how I am feeling? Although there are more than 2,000 emotion words in the English language, most of us use a very limited number of words to describe how we are feeling. The primary or basic emotions include sadness, happiness, fear, anger, surprise, disgust. However, there many words we can use to label our emotions. A brief internet search will provide more options and you might consider printing a list to practice labeling.

Express: How can I express appropriately what I am feeling for this time and place? There are many ways to express each of our feelings. For example, many descriptions for sad, such as lonely, heartbroken, disappointed, hopeless, unhappy, troubled, or miserable.  

Regulate: What can I do to maintain my feeling (if I want to continue feeling this way) or shift my feeling (if I do not want to continue feeling this way)? Having short-term strategies (taking deep breaths or stepping back to allow distance) to manage emotions in the moment as well as long-term strategies (reframing negative experiences or seeking social support) to manage emotions over time is an important part of emotion regulation. 

Emotions are not a sign of weakness. They are not here to hurt us, nor are they the cause of our hurt. It is our reactions to our emotions through self-criticism and blame, or our harmful behaviors toward ourselves or others, that causes pain and suffering. If we are able to befriend our emotions and welcome them with compassion into our lives, we might find ourselves situated at a place of greater insight and freedom as we greet each new friend with a receptive heart.  

Dr. Thomas Lindquist, Psy.D.

Licensed Psychologist

Visit us at lindquistpsych.com

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Compassionate Curiosity

“In addition to a sense of humor, a basic support for a joyful mind is curiosity.”

-Pema Chödrön

Compassionate curiosity is an approach for developing self-observation skills and expanded self-awareness described by Gabor Maté, a Hungarian-Canadian Physician and expert in addiction, stress and child development. The practice involves a gentle and compassionate investigation into our emotions, thoughts and behaviors. The purpose is not to rationalize or justify our behaviors in order to protect our self-esteem, but rather to open ourselves up to seeing things as they are and develop the mind’s capacity to act as its own impartial observer.  

Here are a few questions to practice compassionate curiosity:

When you struggle to accomplish a goal, practice asking: Why do I experience this as a struggle? Have I felt this way before? Why is this so important to me?

When you feel angry, practice asking: Where does my anger come from? Does my emotion have a message? Do I feel an urge to resist or change my feelings? What about this situation is causing so much anger? Is this a pattern? What else do I feel? What am I not feeling?

When you doubt yourself, practice asking: Why do I feel so doubtful? Where does this all come from? Have I been here before? What messages do I hear in my head and where do those come from?

When you are anxious, practice asking: How am I interpreting my anxiety? Does my response seem reasonable given the current circumstances? Is there anything that I can do right now, or should I focus my attention elsewhere? What did I learn about coping with distress?

When you engage in an unhealthy or harmful behavior or habit, practice asking: How did I get here again? Why did I engage in this behavior? What purpose does this serve or what need am I trying to meet? What are some other ways I can meet my needs and take better care of myself? Do I want to change my behavior? 

Compassionate curiosity allows for us to explore our reactions, feelings, and behaviors with the goal of better understanding ourselves so that we can feel more empowered to select from a broader variety of choices, cope more effectively, and live more intentionally.  

Dr. Thomas Lindquist, Psy.D.

Licensed Psychologist

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Fire in the Guest House

When is the last time you recall feeling distressed or anxious? When did you become aware of your anxiety? Most of us struggle with some worries as we navigate daily challenges and anticipate obstacles. However, when we find ourselves worrying about worrying as well as the potential negative impact of worrying, it can start to become disruptive to our lives.  

Particularly with anxiety, it is helpful to understand the fight-or-flight response, also known as the acute stress response, as we consider how our reactions to distress can lead to further distress. You may have heard descriptions of this response before as well as the important role it played in helping early humans remain alert to dangerous predators. 

When we experience acute stress or perceived danger, the sympathetic nervous system sends a message to the adrenal glands, which results in the release of stress hormones. This release causes immediate physical reactions, such as increased heart rate and blood pressure, in preparation to fight or flee from a threat. Meanwhile, our brain endlessly searches for an explanation or solution. If our brain perceives or misperceives smoke, it sounds the fire alarm and elevates our response. Throughout this process, it is not uncommon to interpret our physical sensations and anxious or distorted thoughts as further evidence of danger, causing our brain to continue receiving a false alarm signal. A cycle can develop wherein our reactions to our reactions become self-perpetuating as we continue to perceive danger and register false alarms. 

Stop worrying about it! Just kidding. In fact, there is plenty of evidence that trying to suppress a painful emotion or distressing thought actually causes it to last longer and perpetuates distress. The more we fight or attempt to control, the more we feed our anxiety. Although we cannot stop a natural emotional response by sheer will, there is a lot we can do to modify our reactions.

Engaging the parasympathetic nervous system is often an effective way of calming ourselves and slowing down the acute stress response by telling our brain that the smoke is not a fire.  

Calming your nervous system

Deep breathing – Breathing techniques can be one of the most practical and easily accessible ways of reducing stress in the moment as they can be used at almost any point throughout the day. Practice taking a slow deep breath from your abdomen and silently count up to five. Next, hold your breath for a moment and again count silently count up to five. Finally, exhale slowly as you silently count up to five one more time. 

Five senses grounding – Use your five senses to ground yourself in the present. Notice five things you can see, four things you can feel, three things you can hear, two things you can smell, and one thing you can touch.  

Mental grounding – Describe your environment to yourself in detail. Describe the objects, colors, shapes, temperatures, smells, etc. Count to ten using the alphabet rather than numbers or count down from 100 by sevens. Create a top ten gratitude list or imagine embracing a loved one.   

Physical grounding – Focus on the feeling of your feet on the floor and your body in your chair. Take a moment and lay down on the floor to connect with a sense of grounding and stability. Carry around a grounding object such as a small rock or other item of personal significance. Get up and stretch while focusing on your muscles and releasing any tension. Clench and release your fists or various other muscles groups. Focus on your breath and repeat a soothing word or phrase with each exhale.    

Cultivating a mindful & accepting stance

Cultivating a mindful and accepting stance towards anxiety or emotional distress is often the most difficult part of changing your relationship to anxiety. However, it can also be quite profound. It begins by stepping back or letting go of attempts to control or fight, which is not to be confused with giving up or feeling helpless. Rather, the goal is to practice a different way of reacting that involves curiosity and compassion, while working to reduce judgement and self-criticism. When viewed through a lens of radical acceptance, this relationship can be seen as an invitation. The following poem illustrates this shift in the way we can relate to our anxiety, low moods, or other emotions.

The Guest House

This being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,

Some momentary awareness comes

as an unexpected visitor.

Welcome and entertain them all!

Even if they’re a crowd of sorrows,

who violently sweep your house

empty of its furniture,

still treat each guest honorably.

He may be cleaning you out

for some new delight.

The dark thought, the shame, the malice.

Meet them at the door laughing,

And invite them in.

Be grateful for whoever comes,

because each has been sent

as a guide from beyond.

-Rumi

How might you come to treat your emotions, including anxiety, as guests? When you notice anxiety or worry, take note of your reactions. Practice monitoring your reactions to your reactions. Are you judgmental or self-critical? Do you try to control your reactions? Do you shut down or avoid the situation that prompted your anxiety? 

Ask yourself, “Is there anything I can reasonably do now to change the situation, or should I focus on adjusting my reaction and coping more effectively?” How can I relate differently? Can I react from a place of acceptance? Can I react without judgement or criticism?  

Notice and continue practicing kindness and compassion toward yourself and your experiences. Emotions, including anxiety, are part of being human and not a sign of weakness.   

Dr. Thomas Lindquist, Psy.D.

Licensed Psychologist

Visit us at lindquistpsych.com

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Receptive Awareness

Attention is of central importance for navigating a chaotic world. It is also of central importance for practicing meditation and mindfulness. In meditation, paying attention to the breath is often taught as a starting point as beginners are encouraged to bring their attention back to the breath each time their mind wanders. Over and over again, attention is directed back to a focal point in what is termed concentrated awareness

In addition to meditation, mindfulness has been defined as purposely bringing one’s attention to the present moment or as a mental state achieved by focusing one’s awareness on the present moment. Although acceptance and nonjudgement are also important aspects of mindfulness, the role of concentrated awareness is often primary.  

Directing of our attention through concentrated awareness is clearly important for meditation and mindfulness. It is also essential for a self-regulation more generally. However, there is another type of attention or awareness that often gets overlooked.  

Receptive attention or receptive awareness, in contrast, is much less about directing our attention and more about opening space and welcoming experience. It is about following the flow of our experience and simply remaining aware of what is happening. Rather than constantly telling ourselves to concentrate on the present moment, or direct our attention to the present, we are encouraged to develop a state of receptivity to the present moment.

Resting in receptive awareness is also an antidote to the challenges of our inner critic and our negative thoughts patterns or cognitive distortions. When we practice receptive awareness, there is less space for judgement and more space for acceptance. The attachment or identification we often experience with our thoughts and feelings becomes less pronounced and we can begin to connect with a sense of existence outside of these identifications; a resting consciousness where we can experience of ourselves simply as a human being.  

Ultimately, both concentrative awareness and receptive awareness are important for meditation and mindfulness. It is often helpful to begin with concentrative awareness and allow yourself to shift into a state of receptive awareness once you experience a sense of being grounded in the present moment.  

Begin with concentrative awareness by directing your attention to the present moment:

Focus on the surrounding sights and sounds in your environment.

Focus on the sense of being grounded in your chair with your feet on the floor.

Focus on your breath as you breathe naturally. 

Cultivate receptive awareness by letting go of a central focal point and opening yourself to whatever arises.

Imagine sitting in a small house. Your awareness is the air and space all around you. The air shifts and changes as a breeze blows through an open door or window, circulates around you, and continues back out another window. You rest grounded in the stillness, with no need to take any action, while remaining open to the next breeze.  You are aware and receptive to whatever comes next.  

As you can see, both types of awareness have an important role. However, concentrative awareness often gets all of the attention. Yet, receptive awareness is an important step for expanding your meditation or mindfulness practice and loosening your attachment to passing thoughts, feelings, and expectations.  

Dr. Thomas Lindquist, Psy.D.

Licensed Clinical Psychologist

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Counterfactuals & The ‘what if, would have, could have’ gang

Counterfactual thinking is a concept that refers to our tendency to imagine various alternatives to life events that have already occurred. Typically, this involves a scenario that is different from what actually occurred and consists of thoughts such as, “What if” or “If only I had done … then I could have prevented this.”  

In this way, counterfactual thinking focuses on how the past might have been different, or how the present could be different, if only this occurred, or if only we had done something differently.  

When added to its cousin, rumination, which involves continuously thinking about the same thought or worry, a very unhelpful pattern can emerge. Before we know it, we can easily find ourselves ruminating about how things could have been different if only we had acted differently. In psychology, this type of counterfactual thinking is referred to as self-referent upward counterfactual thinking.

Self-referent upward counterfactual thinking (“If only I had…”) can contribute to a number of difficulties. As you can imagine, this pattern can easily take a toll on our self-esteem and lead to self-blame and guilt. It can also contribute to symptoms of depression and anxiety.  

A 2020 study of counterfactual thoughts in the journal Behavior Therapy found that self-referential upward counterfactuals were associated with prolonger grief and depression symptoms following a loss. In contrast, engaging in a slightly different form of counterfactual thinking, nonreferent downward counterfactual thinking (“It could have been worse…”) was actually helpful in promoting a healthy bereavement process. Related research on posttraumatic stress further supports the adaptive role of this type of counterfactual thinking and suggests a positive relationship between nonreferent downward counterfactual thinking and healthy posttraumatic growth.

Nonreferent downward counterfactual thinking involves thoughts such as, “If … had happened, the current situation could have been much worse.” Here we see a shift away from an orientation to oneself as well as a change in the way the situation is appraised. There is a focus on how things turned out better than they could have been and there is room to focus on the future. This type of counterfactual thinking (“It could have been worse…”) can actually be adaptive as we focus on positive aspects of an outcome and avoid self-blame.  

Strategies to address counterfactual thinking

Labeling – The first and most helpful thing you can practice is labeling. Notice what you are thinking and label it. Are you imagining scenarios about how you could have done something differently? Label this as a self-referent counterfactual (“If only I had…”) and acknowledge it as unhelpful. Alternatively, you can simply state, “I’m doing it again,” which is a personal favorite.  

Participant Observation  – Pause and question your thoughts with curious attention. Ask how did I come to this conclusion? How can I be so sure? Is there any possibility that there is another explanation? What or who else might have contributed to this outcome? In a week or a month from now, is it possible that I will see things differently? What is most important right now?

Awareness – Increased awareness is both a precursor and outcome of labeling our thoughts. As you expand on your awareness you will likely experience a greater sense of agency or control over your thoughts. You may also have more room to consider alternatives. Likewise, you are more likely to see thoughts as mental events, rather than as facts.  

Mindfulness meditation with notation – Awareness of your thoughts and feelings is generally regarded as adaptive. We can practice extending our awareness through a nonjudgmental and curious mindset, while using notation to label our thoughts and feelings. Take a few moments to sit quietly and observe what thoughts come to mind. Note each thought as a thought and each feeling as a feeling. Allow yourself to check-in with the thought or feeling. After you have noted it, let it pass knowing you have given it adequate space and attention. You can note counterfactual thoughts using the same process. 

We all have a tendency for counterfactual thinking and rumination. If we can practice labeling and becoming aware of our thought patterns and our feelings it is possible to gain some control over our automatic thoughts. We can then shift our thinking in a more productive direction.     

Broadly speaking, counterfactual thinking is not inherently unhealthy as it has inherent adaptive functions, such as regulating affect, preparing for the future, changing behavior, implementing goals and experiencing self-efficacy. However, problems can arise when we engage in a specific type of thinking (self-referent upward counterfactual thinking) and ruminate on what we “could have or should have done” in the past.  

With this in mind, we can practice labeling and relating to our thoughts differently when we find ourselves coming out of a difficult situation, recent mistake, or a loss. Shifting towards nonreferent downward counterfactual thinking, “it could have been worse,” and introducing self-compassion, “I did the best I knew how to do at the time,” are healthy ways of promoting your resilience and well-being.  

Dr. Thomas Lindquist, Psy.D.

Licensed Clinical Psychologist

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Gremlins, Speeding Trains, & Thunderstorms

It is easy to become overwhelmed by our thoughts. People often describe getting stuck, spiraling, fighting, pushing, or otherwise becoming involved in what often becomes an unsuccessful attempt to control or get relief from distressing thoughts. All of us are prone to negative thought patterns or cognitive distortions, which often operate outside of our awareness and work to limit our psychological flexibility. Eventually, limited flexibility in our thinking can contribute to overly rigid or narrow beliefs about ourselves, others, and the world around us.  

There are a number of techniques that are helpful in shifting our relationship to our thoughts and promoting greater psychological flexibility. Cognitive diffusion techniques are one great way to help us change how we interact and relate to our thoughts.  

Cognitive diffusion refers to techniques used in various cognitive therapies and elaborated on in acceptance and commitment therapy. One goal of these techniques is to help improve our ability to cope with distressing thoughts and feelings by allowing us to take a step back from our largely automatic thought patterns and experience our thoughts from a different perspective. These techniques also give us a concrete way to practice and develop skills to reduce the distress that typically accompanies persistent worry.    

Cognitive diffusion techniques work by allowing us to change the way we interact with our thoughts by creating an alternative context that diminishes the believability and impact of distressing thoughts or worries. Below are several examples you can try today.

Cognitive diffusion techniques

Label a thought as a thought, rather than a fact.

Label a thought as a mental event, rather than reality or truth. 

Label a thought as a cognitive distortion (all-or-nothing thinking, overgeneralization, jumping to conclusions, anticipating disaster, catastrophizing) or as a “helpful or unhelpful” thought.

Say a thought out loud until it becomes a repetitive sound with little meaning.

Sing your thoughts or say your thoughts in an odd voice (perhaps not in public).

Write your thoughts on paper and repeatedly rewrite your worries until they become less powerful.

Using your imagination

Imagine your thoughts as passengers on a bus or an airplane. In this exercise, pretend you are the driver or pilot and your thoughts are noisy and disruptive passengers. They may be an annoying distraction, but you must keep your attention on the road or the runway ahead.    

Imagine your thoughts as a train passing you by as you stand on the train platform. Begin by noticing the thought train coming in the distance and the wind rushing past while you remain steady on the platform. The train passes and you remain grounded and still.  

Imagine your thoughts as clouds or as a passing thunderstorm. We cannot control our thoughts and feelings as they come and go, much like the weather. Watch your thoughts transform into clouds and pass into the distance. The blue sky always remains behind the storm.

Imagine certain thoughts as images of animals or imagined characters (monsters/ gremlins)

Example: Thoughts about making mistakes at work could be imagined as a work   sabotaging gremlin with bright green fur, squinty eyes, and a sinister smile. Imagine your gremlin laughing as it happily collects your thoughts into a sack. Tell the gremlin     to take a hike.   

Cognitive diffusion usually alters the believability of negative thoughts and the resulting discomfort or distress associated with negative thoughts (see Hayes, Strosahl, & Wilson, 1999). As you might have observed, there is also a component of exposure as you are able to engage and remain present with your worrisome thoughts or fears as the level of intensity dissipates.   

Although some of these techniques might seem silly at first, they can be quite helpful in allowing us to change our relationship to our thoughts. As you practice one or more of these techniques on a regular basis you may experience greater freedom and acceptance around your worries and fears. Tell the Gremlin to take a hike as you wait patiently for the speeding train to pass during the thunderstorm.   

Dr. Thomas Lindquist, Psy.D.

Licensed Clinical Psychologist

Visit us at lindquistpsych.com

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Advice from Your Future Self

Try the following experiment. Imagine yourself five-to-ten years into the future. Close your eyes and picture what you look like. Try as much as possible to connect with this future version of yourself. Reflect on the wisdom and life experiences you might have gained. What memories would you hold close to your heart? How is your life different now? After you have taken a few minutes to imagine yourself in the future, open your eyes and look across the room to an empty chair or sofa.  

Bring to mind an image of your current self, sitting alone, deep in thought. What would your current self be thinking? What are your current worries and concerns? What are your current hopes and dreams? How does your current self feel? Is the image of your current self smiling or tearful?  

Now give your future self the power to communicate to your current self. What would you say? Would you offer reassurance or advice? What messages would you want to share with your current self?  

When I engage in this experiment several messages come to my mind:

Slow down. Be mindful. Listen more. Let go and worry less. Look at the bigger picture. Remember this moment. You have already arrived. Get outside and run fast. Say I love you more often. Feel loved more often. Allow yourself to make mistakes. Forgive. Play with your children. You’re doing a great job. Breath. Take it all in – the good and the bad. You only live once.  

Take a moment to complete this exercise for yourself. What messages do you have for your current self? Write down a few messages and reflect on these throughout the coming days.  

As you reflect you may begin to notice your sense of connection to the present becoming stronger. You may become more aware of impermanence and change. You may notice a deeper sense of appreciation for what you currently have in your life and the people you care about. You might notice a shift in your mindset as you connect more deeply with your values and what truly matters to you. 

You can return to this exercise again and again. You can also use this exercise as an opportunity to express self-compassion and give encouraging words to yourself. Give yourself advice from your future self and allow current self to more fully appreciate and connect with the present. 

Dr. Thomas Lindquist, Psy.D.

Licensed Clinical Psychologist

Visit us at lindquistpsych.com

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