Anxiety

Passages

Every passage tagged with this emotion in the Vela corpus. Search the body text, narrow by source or register, click through to a book’s profile to see how the passage sits with the rest of the work.

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• From Don't Feed the Monkey Mind: How to Stop the Cycle of Anxiety, Fear, and Worry (2017)

  If your family is going hang gliding, of course it’s reasonable to check on them, but if you notice that your texts and calls have increased in frequency and that without them you get very anxious, an expansive strategy such as limiting the number and times you can check may serve you. Whether you are over-checking your own safety status like Maria, or the safety status of others, simply reverse the monkey mind-set. Tolerate uncertainty and assume safety unless there is clear evidence of danger. Eventually, after much practice this will allow you to feel more comfortable, even when you’re not sure what will happen. Do you attempt to control outcomes by being overly cautious and prepared? Funny how that approach still makes us feel anxious. That’s because it feeds the monkey. Turn the strategy on its head and plan to be flexible, taking minimal precautions. For example, when you go on your next trip, whether it is a picnic at a park or a vacation to another country, underplan and under-pack. Choose to deal with any adversity that may crop up as an opportunity to practice resilience and creative problem solving. Your new expansive mind-set will sound something like, I choose not to plan every detail. I choose to not know how everything will turn out. I choose uncertainty and spontaneity. Here are some examples of I must be certain mind-sets and some alternative expansive beliefs to counter them. Monkey Mind-set: What I don’t know could kill me. I must predict and plan for what might go wrong. Expansive Mind-set: It is more important to live life fully in the present moment than to spend time predicting what might go wrong in the future. Monkey Mind-set: I must be certain that I and others I care about are safe. Expansive Mind-set: I will assume safety unless there is clear evidence of danger. Monkey Mind-set: If things don’t go as planned, my day is ruined. Expansive Mind-set: It is more important to practice flexibility and learn to cope when things do not go as planned.

• From Don't Feed the Monkey Mind: How to Stop the Cycle of Anxiety, Fear, and Worry (2017)

  live by them, the more anxious we will be, and the less likely we will be to take the risks that are necessary to take in order to live freely and follow our dreams. That morning in the backyard, I stopped and took a look at myself. To write this book is my heart’s desire, I thought. Why am I holding a pooper scooper instead? The monkey mind-set seldom takes us anywhere we want to go. In fact, it almost always holds us back from what we long for in life. You will recognize at least one, if not all three of these assumptions, as a central pillar of your own belief system. The first is particularly widespread. In fact, you can’t be anxious without it! Intolerance of Uncertainty The ability to plan for the future—to anticipate problems and opportunities —is one of the most important, if not the most important, adaptations of our Homo sapiens brains. Whether the issue is our health, our finances, or our family, we like to know what lies ahead. What if I get sick? Will the market crash? Will my loved ones arrive safely? These are our constant concerns, and we plan with them in mind. But when does reasonable planning turn into worry and obsession? Your monkey’s central mission—keeping you alive and safe within your tribe—is best accomplished by eliminating all uncertainty. The monkey motto is What you don’t know might kill you. From its perspective, the only time it’s safe for you to relax is when you can anticipate and control every outcome. Be certain or die!

• From Bold Move

  For example, if you see a random child crying, you will do something to soothe that child. If you walk into a meeting late and your office bestie passes you a wide-eyed glance of warning, you might proceed with caution and do your best to sneak a seat without catching your boss’s eye. If you are interrupted by loud knocking at your door and indistinguishable yelling indicative of anger, you may think twice about answering. These are only a few examples of the nearly countless tidbits of information that emotions can carry, but let’s now return to the maxim that emotions are valid but are not facts. While experiencing strong emotions is part of being human—and even if they carry some valuable information—they usually don’t carry all the information. For example, if we see someone rush into the room wide-eyed and panting, our heart might quicken and muscles tighten out of fear before we know whether the person is running from something scary, excited to share good news, or merely tired from finishing a four-mile run. So, while it makes sense that we should try to use our thinking brain whenever possible, that is not always how we respond to life, especially when we experience strong emotions. Emotions themselves are not good or bad; problems arise when we choose our actions based only on emotions as a means of avoiding experiencing discomfort. F*ck Your GoalsEmotions (although very helpful and necessary) can certainly prevent us from living our best life, but they are not the only reason we end up disregarding our values. Clinically, one of the reasons I see most people being stuck is the confusion between values and goals. Goals are what we plan to do, while values are intrinsic motivators that guide our actions. Many cultures throughout the world value goal achievement,4 and we often teach our kids to pursue goals—get onto the soccer team, study hard to get into a great college, work overtime to get a raise—but many times these goals are not anchored on personal values. For example, I told myself that I was driven by ambition, but I was actually living a life focused on only my next goal. For a while, this worked out for me. But the reality is, it eventually got me stuck pursuing goals, one after the other, while ignoring the emotional cost. My experience paying the price of blindly following goals is well supported by research.

• From Bold Move

  However, this time I have a book deadline, so I can’t do any of the usual things I do. David, on the other hand, tends to be calmer about these scenarios and he usually doesn’t fuss. Yet this time, he’s on the move, doing a ton. In the past few days alone, he has painted the deck railing, replaced electrical outlets, bought new covers for our bedroom set, re-arranged the garage, and on and on. At first, I was impressed by this magnificent display of domestic productivity, but last night at dinner I began to detect a hint of reactive avoidance, or “productive procrastination.” David is a professor at Boston University and his academic semester is about to start in three weeks, which means he needs to be prepping for his fall classes. So, at dinner last night I asked the question that had been burning in my brain: “How is the fall prepping coming along?” Now to be fair to David, he is married to “the avoidance guru,” so he sheepishly smiled, took a sip of wine, and told me flat out: “Yes, I’m avoiding it, but isn’t it nice how much I got done around the house?” We both laughed. It was nice, but I also know that he will be paying a price when our guests arrive. Eventually, he will have to prepare for the semester, and he’ll be upset if he’s stuck doing that instead of enjoying our family gathering. And so, he promised me (and himself) that he would tackle his avoidance ASAP. (As I write this, I can see him teaching Diego to play basketball outside: adorable, yes, but not really helping his upcoming semester. Avoidance strikes again!) But I don’t want to give the wrong idea: productive procrastination is not always a form of reactive avoidance. For it to qualify as such, it must be associated with a cost. For instance, my friend Janaina is the type of person who always has a long to-do list, but she somehow gets everything done and is not anxious about it. For Janaina, this is just how she lives her life. So, if that is you, no worries. What is avoidance for me might not be for you and vice versa. The Thief of JoyHave you ever been scrolling through Instagram, Twitter, or another onerous social platform when all of a sudden you bump up against something that is completely opposite from your worldview and it presses your buttons? Take your pick: vaccines, political affiliations, abortion, the latest celebrity scandal. The minute we bump up against something that is oppositional to our views, we feel cognitive dissonance. And guess what: our brains sense danger. And what do we do in those situations?

• From Don't Feed the Monkey Mind: How to Stop the Cycle of Anxiety, Fear, and Worry (2017)

  First, we overestimate the threat. What are the actual odds of another homicidal truck appearing the moment you step into the street today? The chance is practically nil, but you’re trusting a wild guess of the monkey: Woo-woo-woo! Looks likely to me! The second mistake is that we underestimate our ability to cope with both the negative emotions in the monkey’s alarm, and with the threat should it actually occur. Whether we’re crossing the street or climbing a ladder, accidents happen. When you attempt any task, you can fail. When you open your mouth to speak you may offend someone. But life doesn’t stop when threats manifest as reality. We cope. We recover. We can learn from our mistakes and move on. Nor should life stop when we’re feeling the negative emotions and sensations of the monkey’s alarms. But many of us have our lives on hold. The ambient background of anxiety keeps us paralyzed, unable to follow our dreams. We spend our days —and for some of us, nights—reviewing the past for errors and looking into the future to prevent making more. We debate decisions we’ve already made, recycle old concerns, indulge endless regrets, obsess over things we can’t control. It’s all in response to a constant stream of negative feelings and monkey chatter. Woo-woo-woo! Something is wrong. Do something! We try to manage things. We check our smartphones or turn on the TV. We pour ourselves a drink, we get a snack, we go shopping. We triple-check the report for errors. We say yes to things when we want to say no. We look up symptoms on the Internet to reassure ourselves the mole is not cancerous. These distractions and strategies offer only short-term relief. The monkey mind is always on the job, hypervigilant, waiting for an opening. If you’ve ever tried meditating, and given up in frustration, you know exactly what I’m talking about. The moment your focus wavers, the monkey elbows in with something compelling to feel anxious about and occupy your mind. When it comes to the monkey mind, the cliché resistance is futile is actually true. The monkey mind is an ancient brain-within-a-brain—simple, focused, and hardwired to be autonomous, beyond our direct control. The monkey is always there, even when you most want to enjoy the moment without it—when you’re alone just trying to relax, when you’re in your lover’s arms, when you are trying to pursue your dreams.

• From Tipping the Velvet (1998)

  Or would she - and this thought was a dreadful one - would she think her pretty, and like her more than me? Would she wish it had been Alice in the box for her to throw that rose to, and invite backstage, and call a mermaid ... ?Waiting for her that afternoon I was by turns anxious, gay and sullen - now fussing over the setting of the tea-table, now snapping at Davy and grumbling at Rhoda, now earning scolds from everyone for fretting and complaining, and generally turning what should have been a glad day for myself into a gloomy one, for us all. I had washed my hair and it had dried peculiarly; I had added a new frill to my best dress, but had sewn it crooked and it wouldn’t lie flat. I stood at the top of the stairs, sweating over the silk with a safety-pin, ready to weep because Kitty’s train was due and I must run to meet her, when Tony emerged from our little kitchen, carrying bottles of Bass for the tea-table. He stood and watched me fumbling. I said, ‘Go away’, but he only looked smug.‘You won’t want to hear my bit of news, then.’‘What news?’ The frill was flat at last. I reached for my hat on the peg on the wall. Tony smirked and said nothing. I stamped my foot. ‘Tony, what is it? I’m late and you’re making me later.’‘Well then, nothing at all, I expect. I dare say Miss Butler will tell you herself ...’‘Tell me what?’ Now I stood with my hat in one hand, a hat-pin in the other. ‘Tell me what, Tony?’He glanced over his shoulder and lowered his voice. ‘Now, don’t let on about it yet, for it ain’t been properly settled. But your pal - Kitty - she’s due to leave the Palace, ain’t she, in a week or so?’ I nodded. ‘Well, she won’t be going - not for a good while, anyway. Uncle has offered her a sparkling new contract, till the New Year - said she was too good to lose to Broadstairs.’The New Year!

• From Tipping the Velvet (1998)

  The Sappho with the cigar shook her head. ‘I have never heard of such a thing,’ she said.‘Well,’ answered Dickie impressively, ‘you will hear more of it, believe me.’‘Let us hear more of it now!’ cried Maria; and someone else called: ‘Yes, Diana, read it to us, do!’And so more candles were brought, and placed at Diana’s shoulder. The ladies settled themselves into comfortable poses, and the reading began.I cannot remember the words of it now. I know that, as Dickie had promised, they were not at all filthy; indeed, they were rather dry. And yet, her story was lent a kind of lewdness, too, by the very dullness of the prose in which it was told. All the time Diana read, the ladies called out ribald comments. When Dickie’s history was complete, they read another, which was rather lewder. Then they read a very saucy one from the gentlemen’s section. At last the air was thicker and warmer than ever; even I, in my sulkiness, began to feel myself stirred by the doctor’s prim descriptions. The book was passed from lady to lady, while Diana lit herself another cigarette. Then one lady said, ‘You must ask Bo about that: she was seven years amongst the Hindoos’; and Diana called, ‘What? What must she ask?’‘We are reading the story,’ cried the woman in reply, ‘of a lady with a clitoris as big as a little boy’s prick! She claims she caught the malady from an Indian maid. I said, if only Bo Holliday were here, she might confirm it for us, for she was thick with the Hindoos in her years in Hindoostan.’‘It is not true of Indian girls,’ said another lady then. ‘But it is of the Turks. They are bred like it, that they might pleasure themselves in the seraglio.’‘Is that so?’ said Maria, stroking her beard.‘Yes, it is certainly so.’‘But it is true also of our own poor girls!’ said someone else. ‘They are brought up twenty to a bed. The continual frotting makes their clitorises grow. I know that for a fact.’‘What rubbish!’ said the Sappho with the cigar.‘I can assure you it is not rubbish,’ answered the first lady hotly. ‘And if we only had a girl from the slums amongst us now, I would pull her drawers down and show you the proof!’There was laughter at her words, and then the room grew rather quiet. I looked at Diana; and as I did so, she slowly turned her head to gaze at me. ‘I wonder...’ she said thoughtfully, and one or two other ladies began to study me, as she did. My stomach gave a subtle kind of lurch. I thought, She wouldn‘t! And as I thought it, a quite different lady said: ‘But Diana, you have just the creature we need!

• From Don't Feed the Monkey Mind: How to Stop the Cycle of Anxiety, Fear, and Worry (2017)

  Chapter 2: The Three Assumptions One morning several years ago I sat down with my laptop to begin writing my first book: a workbook for teens with social anxiety. I’d never attempted to write anything of this scale before and I could hardly believe I was doing it. As a therapist I talked about anxiety every day with my clients, but writing about it was a different matter. As I reached for the keyboard my heart began to race and my stomach clenched up. I’m not really sure how to say what I want to say, I thought to myself, adding, and an author should be. Looking at my fingers hovering above the keyboard, I noticed that my nails needed filing. What if my premise isn’t fully formed yet? I continued. What if my conceptualization is unsuitable for a book, or worse yet, just plain wrong? If I am wrong the whole world will know that I am a fraud! I suddenly remembered an article I had meant to read. Would a bit more research give me some clarity? If this book isn’t good I’ll disappoint my editor, my readers, and my friends and family. I’ll let everybody down! I thought. At this point my hands were visibly trembling. Looking out the window I noticed that someone really should pick up that dog poop in the backyard. None of the tasks that were calling me away from my laptop were truly important or time sensitive. What made them suddenly compelling was that both my body and my brain were telling me that something was wrong. I was experiencing the very thing I considered myself an expert on: anxiety. I was hijacked. If we examine my anxious thoughts that morning, we can recognize three assumptions I had made. First, I thought I had to be certain about what I was going to write. Second, I thought that if I got anything wrong I would be exposed as a fraud. Third, I thought if the book wasn’t successful I would disappoint everyone. These three assumptions are universally shared by all anxious people. (Yes, reader, as you know if you read the introduction, I am one of you!) Because they echo the survival agenda of the monkey mind, I call them collectively the monkey mind-set. Intolerance of uncertainty: I must be 100% certain. Perfectionism: I must not make mistakes. Over-responsibility: I am responsible for everyone’s happiness and safety. These assumptions are impossible standards. The more we attempt to

• From Bold Move

  She would almost immediately demand exclusivity, which would freak them out, at which point Filomena would just break it off in her own (reactive) manner. But things were starting to change for her. At the time of our first meeting, she had been dating Ted for a few months and felt that she was starting to fall for him. Distressingly, she felt he was starting to pull away a bit, and the stressful push-pull of her dating life had led her into my office. Filomena explained to me that out of all the people she had dated in her young life, Ted seemed to be the one with whom she felt the most comfortable: he was reliable, respectful, and always made her feel secure. “Sounds lovely. So . . . what’s the problem?” I asked. “Well, I have a lot of trouble being away from Ted. I know that we should have our own friends and interests, but I get so scared, you know? He had been telling me that he wanted a little time to himself so he could hang out with his guy friends a bit more, and I wanted to make him happy, so we tried a few times . . . but it was a disaster. I just got really upset and anxious and even when I didn’t want to, I would send multiple text messages. The most recent time this happened was last Friday night; I knew he was out with his friends playing pool, but even though I knew where he was and who he was with, I freaked out.” At this point, she pulled out her phone and began reciting their text exchange. “‘Hey,’” she began, “‘how are you?’ Smiley face emoji. No reply. I try not to text him again because he had asked me to give him some space but two minutes go by and I can’t help myself. So, I text, ‘Are you guys having fun?’ Lots of emojis.” “What are you feeling at this point?” I asked. “I’m super anxious, wondering why he isn’t responding. And I’m worried, too. What if he’s not responding because he got in a car accident? A drunk driver or something. I can’t help it, but I keep having this image of him dead in a ditch somewhere. Or maybe he’s hooking up with some other girl! So I start texting him a ton . . . ‘Hey Ted, are you okay? Why aren’t you answering me? Are you upset? Did I do something wrong???’” She stopped abruptly, realizing how this behavior must look to an impartial observer. “I know this looks silly, but it made so much sense to me at the time. I needed to know things were okay and each text made me feel a little relief, but when he didn’t answer, it just got me more anxious, so I kept texting.” “Did you ever hear from him?” “Eventually I got a text back from him.”

• From Bold Move

  And if you have, you are not alone: we have all been there. Companies with thousands of employees around the world have conducted surveys to measure rates of burnout, with McKinsey & Company noting that 49 percent of individuals report feeling at least somewhat burned out9 and Deloitte noting that 77 percent of individuals report having experienced burnout in their current position.10 Usually by the time we hit burnout, we have been avoiding for a while. We’ve gotten into the habit of ignoring what matters most to us, and we end up feeling worse and worse. The worse we feel, the harder it is to get back on track, and when we encounter an obstacle of some kind, moving forward feels impossible. Making a Choice (Without a Compass) Is PainfulThe obstacles we face often come in the form of a turning point or fork in the road where values collide and a decision needs to be made. For example, it’s 9 a.m., you are due for a meeting with your team, but your kid wants a hug and a kiss and all your attention. Do you end up late for your meeting to attend to your kid, or do you disappoint your kid and focus on work? Family and work collide often for many of us, and when they do, we sometimes make a decision that is designed only to make us feel better fast in that moment (aka avoid). In the same sense that we can’t travel east and west simultaneously, we can’t do two things at once. No matter what we do in life, when it comes to work, family, and health, when you focus on one, you are not doing another. Our time and attention and energy represent the pieces of a zero-sum game, and once we spend some of that limited currency, it is gone forever. Just as I can’t buy a sandwich and a pizza with the same ten-dollar bill at the same time, one must make choices when deciding what to chase down in life. And when we are stressed, anxious, and stuck in a long pattern of avoidance, we often make decisions based on how we feel in the moment, our emotions, and perhaps not on what might be best for us long term. After all, we all want to feel better soon. This is just how my client Ricardo lived day to day. Ricardo describes himself as a true family man. When I met him, he beamed as he talked about his two children and his wife, their early days as a family, and the cherished family vacations. Ricardo immediately took out his phone to proudly show me pictures of his children, who were seven and five at the time. Family was the most important thing to Ricardo—his true north, he told me. This family-centric monologue puzzled me because when Ricardo sought me out, he had just been served divorce papers by his wife.

• From Bold Move

  In attachment theory, Filomena’s insistence on getting a response is described as protest behavior . Protest behavior is any action that is taken to reconnect with a partner or get their attention.31 I often think of protest behavior as a reactive form of avoidance because every client I’ve worked with who has a similar situation to Filomena describes this desire in a way that feels viscerally urgent. It’s almost the psychological equivalent of “the squeaky wheel gets the oil,” only instead of oil, they get a brief hit of emotional relief. They react by protesting and it relieves anxiety momentarily, but as you can see for Filomena, it was causing significant conflict in her romantic relationship. And our friend Filomena is not alone: results across 132 studies suggest that individuals with an insecure attachment style, like Filomena, often experience less satisfaction in their relationships.32 Have you ever noticed a similar urge in your relationships? Perhaps an urgent desire to frequently affirm and reaffirm your connection to your partner? You might not send a flurry of texts, but instead might ghost your partner or give them the silent treatment. Maybe you try to make a parent or friend feel jealous. As her clinician, I could understand where Filomena was coming from, but as a human, I deeply empathized with Filomena because I also was very anxious as a young child. I remember being twelve years old and begging my mom to let me stay home from school one day because I was convinced that, if I left, I would come back hours later only to learn that my mom had left me behind. These challenging experiences form us, and sometimes it’s up to our adult selves to create a new path forward. It’s easy to think of these situations as unfair, and perhaps they are, but it’s more useful to look at them as an opportunity to break old habits that no longer serve us so we can forge a healthier mode of being—so we can become bold. And that is just what we will learn how to do in the next chapter . Learning at Any AgeThe good news for all of us is that we can continue to strengthen our emotion regulation skills throughout our lives. We now know that the brain continues to change throughout its lifespan33 and emotion regulation is a skill that it is never too late to learn. Researchers have shown that there is no difference between younger adults and older adults when it comes to their potential to learn to regulate emotions.34 So, for the Old Dogs out there, it’s not too late to learn new tricks.

• From Bold Move

  The conflict arose around financial matters; specifically, Robert believed that, somehow, I had been paid from the wrong fund and because of this I had drained his bank account. This might be confusing to understand if you’re not in academia, but our salaries come from a variety of sources: say, 50 percent from Grant X, 25 percent from Grant Y, and so forth. This system is challenging to manage, and mistakes are often made. Without going into needlessly boring details, the long and short of it was that I had negotiated with Robert that he would pay my full salary from one account—his—while I worked for him. A few days after I quit, I got an email from Robert suggesting that there was some kind of mistake and that I needed to give a large percentage of the money back—namely, an amount of money that would have been equal to an entire year of my salary! This whole thing spiraled into the predictable quagmire of emails and phone calls and arguments and conflict and became the single worst episode from my long career. The kind of situation that keeps you awake at night, anxious all day, and mentally and emotionally exhausted for weeks on end. A really fun time! Here is a glimpse of the situation from inside my brain: It’s early January, I wake up at 4 a.m., I cannot sleep—my brain is racing with a million thoughts: Why is he doing this? What did I do wrong? I know I negotiated for my full salary. This is unfair. I have worked hard for so long, trusted him for so long: Why would he think I stole from him? Doesn’t he trust me? What am I going to do if I really end up being asked to pay this back? I don’t have this money! What does this look like for my family and our finances? Maybe I will take on more clients in the evenings—but I am so tired, I can’t possibly do more. As I write this and let the pain come in again, tears flow from my eyes. This happened nearly two years ago, and still tears are there. My heart shrinks, my breaths are shallow, and I feel like running away from this memory. . . . But as I stay with this pain, many other memories come up: memories of moments when I felt oppressed, when I was told to defer to the majority, either explicitly or implicitly. The faces of the people involved flash in my mind, and more tears come. In the end, I have a knot in my throat, as if I can’t speak.

• From Bold Move

  He would see something such as other guys with attractive girlfriends, which would trigger his brain to perceive danger in the form of “I am a loser,” which immediately brought up his discomfort—or, as he called it, panic. To make himself feel better fast, he would post one photo after another after another. Posting photos would temporarily and quickly relieve the panic, but because it is reactive avoidance, it does not keep the panic down for long. So, does being on social media mean that we are reactively avoiding? Posting rapid-fire on social media is one way we react to soothe our difficult emotions. But when it comes to our engagement with the online world, there are other emotional responses people might have when scrolling. For some, negative feelings can lead to retreating completely: people may avoid social media altogether to minimize the fears around being compared to others (with apologies for the editorializing, this probably isn’t a bad strategy, akin to just avoiding fast food). In fact, research shows that one reason individuals create so-called Finstas (fake Instagram accounts) is to escape social scrutiny.7 Alternatively, some of my clients retreat and avoid things such as writing a college essay by just scrolling for hours on social media. If you find yourself more in the retreating spectrum and you still want to engage with these platforms, I suggest you work on the skill of Shifting (covered in part II of this book) to change your relationship with social media. Texting to Soothe AnxietyWhen it comes to romantic relationships, patterns of avoiding through reacting often show up early. Let’s take Filomena as an example. Filomena was adopted from Ecuador at an early age by two loving, yet much older parents. She had no siblings and described herself as always having been mildly anxious. Her mom told me that Filomena always had considerable difficulties being apart from them. From an early age, she would often get upset whenever her mother would leave the house, panicking and wondering whether she’d ever come back. Filomena shared with me that she always feared abandonment (a common fear among adopted children) and attaching to people was hard for her, as she often felt as if the other shoe would drop any minute and she would be left all alone. By the time I met Filomena, she was in college and, by all accounts, had been doing well both academically and socially. But there was one domain of her life that was getting her stuck again and again: forming romantic relationships. Filomena had started dating in college, at first casually, but she told me that she couldn’t do the “casual” thing—it just made her too anxious. So, she tried to get serious with a few guys, but while it felt comfortable for her, the swiftness with which she began calling them her “boyfriend” would make them distance themselves from her just as quickly.

• From Bold Move

  Yet here he was in my office, describing his crippling feelings of anxiety. He had always been a somewhat anxious person, but lately his anxiety had felt unbearable. As I sat across from him, he leaned forward and, in the same manner one might expect him to deliver a mandate to his employees, said to me: “Doctor Luana, I hear you’re the best, so you need to make this anxiety disappear. I can’t think straight, and I need to fix this so I can focus on strategic planning for next year.” We started simple. “What is this anxiety like?” I asked him. “Like I’m about to explode!” “Explode? Really?” “Yes! Explode!” His tone surprised me and stood in stark contrast to his polished image. He continued. “I’m surprised I haven’t combusted yet. My heart pounds, I feel dizzy, it’s hard to focus, the world closes in . . . all at the same time. I feel like I’m about to have a heart attack. But I have had my heart checked a million times, and there is nothing wrong with it.” “How do you manage these nearly combustive moments?” I asked. “I do whatever it takes to make myself feel better. At work, I cancel meetings or have my COO run them, telling people I have another important meeting with an investor.” Jake looked ashamed and small, all of that hard-won confidence gone without a trace. In a quieter voice he told me, “I lie, but I just don’t know what else to do in that moment. When I get home, I’m often so drained by anxiety that I’ve just stopped exercising altogether. I try not to have that glass of wine, but honestly, I don’t last past 8 p.m., and by the second glass, I feel so much better. Then I’ll spend hours in front of the computer, working.” He paused. “Well, I tell myself I’m working, but I’m really just staring at the computer, zoned out, drinking to drown my anxiety. Then I eventually fall asleep and wake up even more anxious than the day before. This is too much! I’m telling you, you need to get rid of this anxiety. I can’t stand it anymore!” Jake understood—correctly—that he was at a breaking point, but he misunderstood the reasons why. If I magically took away Jake’s anxiety, he believed he would be fine and would be able to engage with his work without a problem. To some extent he is correct: a lot of unpleasant emotions (anxiety, fear, sadness) will paralyze us and keep us stuck. But would Jake be better off if all of his anxiety disappeared? He would likely be able to focus more on work. But would he be concerned enough about his wife’s safety to remember to have the car’s brakes checked? Or would he have the motivation to put in extra hours to prepare for a big business pitch?

• From Bold Move

  Janet laughed and said, “I can see the white elephant.” This phenomenon is what psychologists call thought suppression . Unfortunately, trying to suppress your thoughts only makes you think about them more and more.6 And when the same pesky, unhelpful thoughts keep coming back, they can fuel our avoidance. Janet was stuck in a TEB spinning cycle. Whenever she would consider doing something like asking for a raise (situation) , she would say to herself, “The quality of my work is not perfect” (thought) , which made her feel anxious (emotion) , and as the cycle continued, she would end up crying and ultimately trying to avoid thinking about her job by grabbing her phone and scanning social media (behavior) . The problem is that by trying to avoid her thoughts, she made them come back stronger, which made her feel even worse and led to the long-term consequence of her avoidance tactic. I never met a person whose brain didn’t speak to them in a “less than ideal” way from time to time. Hell, my brain does it daily: John is really mad at me because I didn’t respond to his text three days ago. David will kill me for planning yet another party without consulting him—he will be furious for days. I should know better than to plan a vacation in the middle of a book deadline; I am so impulsive. No matter how hard I try to finish this book, it will never get done. How can Diego have such loud anger outbursts? He can’t regulate his emotions—it is all my fault!!! . . . The list goes on and on and on . . . at times louder, other times very quietly, but the brain is always saying something—at least mine is! And these thoughts . . . they even have names . Knee-jerk thoughts, which happen automatically and yet are very painful, are what psychologists call cognitive distortions .

• From Bold Move

  Everything you will read in this book is grounded in what is known as cognitive behavioral therapy (CBT). CBT is generally considered the gold standard of mental health treatment.1 It is one of the most heavily studied treatments, with, according to Stefan Hofmann and colleagues, hundreds of studies conducted worldwide.2 CBT has been shown to effectively treat anxiety, depression, eating disorders, insomnia, anger and aggression, stress, and substance use. Children, adults, and older adults around the world have benefited from CBT. But you do not have to be suffering from a mental health condition to benefit from CBT, because it has also been studied as a way to build resilience.3 There are many different flavors of CBT. For example, you may have heard of dialectical behavior therapy (DBT),4 acceptance and commitment therapy (ACT),5 cognitive therapy (CT),6 or cognitive processing therapy (CPT).7 All of these approaches have different emphases and slightly different strategies, yet they all fall under the CBT umbrella. The skills in this book draw from all of these approaches. One common denominator across all these approaches is the reliance on a shared foundation known as the cognitive triad . The cognitive triad is a way of conceptualizing the relationship between t houghts, e motions, and b ehaviors in any given situation.8 Through my research, I have adapted this concept to what I call the TEB cycle (see figure below).9 The TEB cycle shows that what we tell ourselves (thoughts) affects how we feel (emotions) and what we do (behaviors). The cycle can move in any direction—usually very rapidly. The TEB cycle can be a very helpful way to understand how avoidance keeps us stuck but also serves as a technique to get us unstuck. The Thoughts, Emotions, and Behaviors (TEB) Cycle [image file=Image00003.jpg] You don’t have to be stuck in avoidance for your brain to spin in the TEB cycle: spinning is just a part of life, especially when your brain senses danger. But in situations that are not part of a long-term avoidance cycle, the spinning tends to resolve itself. For example, just this morning, my son’s school called to let me know he had fallen on the playground. My inner experience of this news went as follows (see figure below): Situation: A call from Diego’s school appears on my caller ID. Thoughts: Is he injured? What happened? Did something really bad happen? Dr. Luana’s Spinning TEB Cycle Situation: Diego’s school phone number appears on my cell [image file=Image00004.jpg] Emotions: My heart pounds faster, I feel anxious and a little short of breath. Behaviors: I answer the phone and immediately ask, “What happened?” and the kind teacher tells me that Diego fell on the playground and hit his head. Emotions: Heart pounding out of my chest, fear, and anxiety. Thoughts: How bad is this? How hurt is he? Behaviors: I ask the teacher to slowly describe to me in detail what happened.

• From Bold Move

  Why am I so miserable when I have achieved so much? I don’t have the right to feel miserable given how fortunate I am. If I quit this job, who will I become? But long-term stress has a way of showing up in your body too. According to the American Psychological Association, stress directly affects the musculoskeletal system, cardiovascular system, respiratory system, endocrine system, gastrointestinal system, nervous system, and reproductive system.5 At the risk of being alarmist, it’s worth noting that stress can lead to death. Studies conducted in England have shown that even low levels of distress are related to a 20 percent increased risk of mortality.6 In early 2021, the physical effects of stress finally hit me. I was home, working on a research grant, when all of a sudden I started to lose sensation in part of my face. My first thought was: Okay, I am just a little stressed, this is a simple physiological reaction, calm down, there is nothing going on, this is just anxiety , but after a few minutes I had lost all feeling in half of my face and panic began to set in. Oh my God . . . I’m having a stroke! A few tears dripped down my face as I tried not to lose it, and I kept saying to myself, Is this anxiety or am I really having a stroke? With the last bit of my thinking brain that was available to me, I called my doctor’s office and reached a nurse. I described the symptoms: numbness on the right side of my face, a little tingling in my legs and arms, a heartbeat of 150 (while seated at my desk). Despite her attempt to temper her voice, the nurse on the line seemed alarmed and my brain immediately went to . . . Oh my God, I am having a stroke! I’ll lose everything I worked so hard for, this is the end! Tears were now streaming down my face as I struggled to speak with the nurse, who urged me to get to the office as fast as I could. My brain was spinning, and all I could do was get David to drive me. As we drove, my thoughts swirled and I saw my entire life pass in front of me. I was quickly evaluated by my primary care doctor, who determined that I could be having a stroke.

• From Bold Move

  Below are some examples of common triggers for different buttons. But keep in mind that this is unique to you, so make sure to come up with your own examples. [image file=Image00015.jpg] But when you don’t know which buttons do what on your personal DJ mixer of emotions, it’s hard to change how you act. So, it’s important to first identify what types of scenarios hit our green buttons and which scenarios hit our red buttons (see reflection below). After all, if you don’t know which button is causing negative feedback, you can’t really fix the problem. To do so, you must create an inventory of situations that function as your reactive triggers. These are the types of situations that people colloquially refer to as things that “push our buttons.” Reflection Identifying Your Hot Buttons The first step in learning to Approach is to make a list of the situations that tend to trigger reactive avoidance for you. This reflection is designed to help you slow down the process between a triggering event and your response, and as such, I would suggest that you focus only in the past week. If you can catch your reactive patterns here, you are better equipped to implement a solution. Situation Describe a situation that pressed one of your buttons. [Your Notes] Emotions Name the emotions you felt during this time. [Your Notes] Intensity Name the intensity of your emotions: blue, green, yellow, orange, or red. [Your Notes] Current actions to manage emotions What do you do when you feel this emotion? [Your Notes] Is this avoidance? (yes or no) [Your Notes] Remember, for an action to be reactive avoidance, you must have engaged in it because you felt discomfort, and the response itself was designed to make you feel better fast. But you notice that this reaction tends to keep you stuck. Angad’s Hot ButtonsIf you recall, Angad often compared himself with others, especially on social media, and when he felt anxious, scared, or fearful, he would post several photos to try to prove to himself (and others) that he was cool. However, his actions were purely reactive and never made him really feel better, and so he found himself feeling embarrassed and a little icky afterward. To help Angad understand his reactive avoidance, we worked on first identifying his personal hot buttons. But before we began, he asked me one important question that I often receive from my clients: “Won’t tracking my hot buttons make me feel worse?”

• From Bold Move

  Emotion dysregulation happens when our emotions become intense and we lack the skills to handle the situation. Emotion dysregulation has been linked to unhealthy risk-taking, relationship challenges, and negative physical health outcomes.6 Researchers conducting a large international study with 12,461 participants who had an acute myocardial infarction (i.e., a heart attack) found that 14 percent of individuals reported being angry or emotionally upset one hour before symptoms began.7 After conducting additional analyses, the research team concluded that being angry or emotionally upset correlates with an increased risk of having a heart attack. Additional research studies have shown that anger is also associated with the increased likelihood of having a stroke.8 In other words, when our internal pressure cooker explodes from strong emotions, not only do we pay an emotional price but we may also pay a physical one! For some of us, there are additional barriers we might have faced that can further hinder our ability to learn how to manage emotions. Childhood maltreatment is one example of a “double hit,” whereby the child faces increased stressors that cause intense emotions yet lacks an adult role model to demonstrate how to effectively respond to those emotions. A recent review of thirty-five studies found that children who experience maltreatment have fewer emotion regulation skills and are more likely to avoid in response to stressors later in life.9 When researchers tried to understand the brain processes related to maltreatment and emotion regulation, they found that adolescents who were maltreated as children actually recruit more parts of the prefrontal cortex to regulate their emotions than adolescents who were never maltreated as children.10 In other words, turning on the thinking brain to regulate emotions is actually a lot more work for children who experience maltreatment. Think of it like running ten miles—a marathon runner is going to be able to complete the run more easily (and with less effort) than someone who only runs when they’re late for the bus. Another more common barrier to developing emotion regulation skills is the experience of what researchers call adverse childhood experiences (ACEs).

• From Bold Move

  The pause gives you an opportunity to override your preprogrammed fight, flight, or freeze response, evaluate the situation, and make a bold move instead. The pause creates the space that we all need to be able to move away from avoidance. Luckily, science shows that there are many ways to activate your prefrontal cortex, and one is by writing, including writing down your TEB cycle. 11 Why? Because to write, we need to use our thinking brain, just like we need it for math, science, and figuring out directions. So, by forcing your brain to shift from emotions to thinking, you are flipping the switch in your brain. The pause that you create by completing your TEB cycle is your first step to transform anxiety into power. But to get there, you must practice, again and again. Let’s do our first practice right now using a situation that fits all of us— reading this book (see the reflection below). By now, you are more than forty pages into the book, and I bet your brain has had a lot to say about it so far, such as This is interesting, I don’t avoid; what is she talking about?, and I never knew that my brain reacted the same to a lion as to my fear of asking for a raise. Depending on your particular thought(s), your emotions will be very different. For example, if your brain is finding the book interesting, you might feel hopeful. Alternatively, if your brain is saying something like, This book makes no sense; I don’t avoid, you might feel frustrated. Depending on your thoughts and feelings, your behavior might look very different: some of you might have kept reading, others might have been distracted again and again, others might have put the book down. So, let’s practice by writing down your responses in the circles in the reflection, trying as best as you can to separate thoughts, emotions, and behaviors. If you completed the reflection, congratulations! You just finished your first “prefrontal cortex workout.” In this book, everything I share with you is skills driven, which means practice is necessary. In my office, I often tell my clients, “What you put in is what you will get out of it.” The reality is, you cannot train your brain to become bold—to pause and overcome avoidance—without practice. Just like you can’t build muscles without exercising. So, I invite you to practice completing your TEB cycle often, if not daily, when you are first learning it. I have seen countless clients get immediate relief from their discomfort and gain insight on their avoidance patterns by doing just this practice alone. You will notice that the more you practice, the more you are able to activate your pause button, slowing down your brain and creating the space to be able to choose your response.