Pacific Anxiety Group

Facing a fear ("exposure") is the most effective way to deal with anxiety, but how you do it really matters. If you don't think that exposure is working for you, consider some of these common issues:

1. Usually facing a fear just once won't do it- you're likely to need to practice repeatedly.
2. You may not have stayed in the situation long enough to really learn that you could handle it.
3. You may need to practice in a greater variety of situations to help you "generalize" your new learning that you can handle facing the fear. For example, if you're afraid of driving and you practice driving around your neighborhood, that may not help you to feel comfortable driving outside your neighborhood.
4. You may have done something to distract or comfort yourself while facing the fear, which sounds reasonable in theory, but could prevent you from fully engaging with the experience of facing the fear.

If you're still not sure what's getting in your way, it may be time to talk to a cognitive behavioral therapist who specializes in exposure therapy for anxiety so you can get some help in figuring out what's keeping you stuck.
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

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Maybe you've been thinking something like:
-I don't want to feel more scared or uncomfortable than I have to...it's easier to avoid my fears
-This isn't the right time, I'll get to it later
-I'm not sure how facing a fear is going to help
-I believe facing my fear could cause actual harm to me or to someone else
-I don't have the support I need to face my fears.
-I've tried facing fears in the past and it hasn't worked for me (stay tuned for next week's post for more on this one!)

Facing a fear ("exposure") is a powerful tool for dealing with anxiety, but it can be hard to get started. If you haven't been facing your fears, try to identify what's gotten in your way, and make a list of pros and cons of facing the fear. If facing the fear seems important to you, but you're not sure how to get over your personal barriers, a cognitive behavioral therapist who specializes in exposure therapy for anxiety may be able to help you work through obstacles and design a personalized plan.

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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

While standardized research studies have helped us to understand general treatment processes that are helpful, this doesn't mean that cognitive behavioral therapy (CBT) is a "cookie-cutter" or "one size fits all" approach. In fact, CBT is highly personalized- it's all about understanding how your thoughts, your feelings, and your behaviors are connected. You and your therapist will work together to help you understand your values and goals and identify what's keeping you from moving toward your goals. Your therapist may draw on their understanding of what usually keeps certain problems going (like anxiety), and what usually works to help address those problems (like facing fears in a supportive environment), and then will work with you to figure out the specifics that make sense for your individual experience and life situation.
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com
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A common myth about cognitive behavioral therapy (CBT) is that it's all about learning to "think positive." However, the actual goal of the "cognitive" part of CBT is balanced and realistic thinking. In CBT, the therapist and client work together to identify patterns of unhelpful thinking- maybe the thought is too extreme, or the client is jumping to conclusions without enough information, or is leaving out an important piece of information (we all do this from time to time!). Next, we try to identify the most accurate, balanced way to view the situation, taking into account all of the available information. We're not necessarily trying to turn the thought, "this is terrible and I can't handle it" into "this is great, no problem!" Instead, we might end up with a more balanced thought such as, "this situation is hard, although not as bad as I originally thought, and here are some things I can do to try to solve the problem." When our thoughts are balanced and realistic, we are less likely to feel overwhelmed by negative emotions, and more likely to be able to act in line with our values and goals.
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

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If you're noticing feelings of exhaustion, burnout, or self-critical thinking, ask yourself whether you may be expecting more than you can reasonably give. Even at the best of times, it's not realistic for us to give 100% in every area of our lives at all times. Also, context matters: when we're under stress (say, from living through a year of a pandemic), we will have fewer resources (time, attention, and energy) to spread across all of our different priorities. In this situation, something has to give, and it's an act of self-compassion to acknowledge that fact.

Where do you notice that you may be expecting too much of yourself? Can you identify areas where you can pull back your expectations in order to be more compassionate towards yourself?

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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

A great introduction to mindfulness meditation, or a good refresher for those who are familiar:

How to Meditate Meditation is a simple practice available to all, which can reduce stress, increase calmness and clarity and promote happiness. Learning how to meditate is straightforward, and the benefits can come quickly.

Do thoughts like this sound familiar? If you catch yourself jumping to conclusions about what someone else is thinking or feeling, ask yourself:
"What's the evidence this is true/not true?"
"Are there any other possibilities?"
"What else could be causing this person's behavior?"
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

A good introduction to cognitive behavioral therapy for insomnia:

Anxious Thoughts? 5 Tips To Help You Sleep Difficulty sleeping can cause anxiety, which often leads to more trouble sleeping. Life Kit host Allison Aubrey talks to sleep experts about how cognitive behavioral therapy for insomnia can bring relief for people with chronic sleep issues.

This has been a tough winter and a tough year for many of us. Take some time to give yourself credit for what you've done well. What personal strengths have helped you to cope?
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

Today's tip: When we judge, we are going beyond the facts and adding a layer of evaluation (either positive or negative) on top of the facts themselves. Writing down the facts, minus the layer of judgment, can help us to defuse our own negative emotions and communicate more effectively. For example, take the judgmental statement, "It was rude that you didn't call me." We could re-word this as, "You said this morning that you would call when you were done with work. I did not get a call from you, and I felt worried and frustrated." Note that your list of facts can include how you feel about the situation, since it's also a fact that you feel that way! Just steer clear of applying labels to the other person or making assumptions about why they acted the way they did.

What changes do you notice to your own emotions when you re-word judgmental thoughts? Do you notice any differences in how others respond when you practice taking out the judgment layer?

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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

A great listen on how parents can help kids and teens cope with pandemic-related anxiety:

Kids Are Anxious And Scared During The Pandemic. Here's How Parents Can Help : Life Kit Kids and teens have had their lives upended by the COVID-19 pandemic. Here's what parents can do to help them stay positive and feel supported.

Have you ever made New Year's resolutions and then found that by February, you've forgotten or given up? People often fall into the trap of setting goals that are too general or vague. It can help to make your goal as specific as possible and to identify any action steps you can take right off the bat to set yourself up for success. For instance, "exercise more" is too broad- a more specific goal might be, "walk for 20 minutes starting at 8am on Mondays, Wednesdays, and Fridays." Next, think about the very first steps you can take to put your plan into action...perhaps setting a repeating alarm for 7:45am on those days, or ensuring you have a comfortable pair of walking shoes ready to go. If your goal is something like, "learn how to deal with my anxiety," a more specific first step could be "ask my doctor for a therapy referral."

What goals have you thought of so far, and how can you make them more specific?⠀
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

Pacific Anxiety Group is excited to host this continuing education event, featuring Dr. Nehjla Mashal! Check out more details and register at https://buff.ly/3a7Dh0J

Try adding the phrase, "I'm having the thought that..." to the beginning of an upsetting thought. For example, if you find yourself thinking, "I won't be able to handle the holidays," try re-wording this to "I'm having the thought that I won't be able to handle the holidays." This small change can help you get some space from upsetting thoughts and feelings, and may help them to seem more manageable and less intense.
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

Fact: The goal of cognitive behavioral therapy (CBT) is ultimately to help each client to become their own therapist- that is, to give clients a set of tools that they can use to continue making improvements after therapy and to deal with future problems. This may or may not mean continuing therapy until all symptoms are resolved- you might be ready to graduate from CBT once you have a good grasp of CBT skills and your symptoms have started to improve, even if some symptoms remain.

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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

Fact: When we avoid, we feed into the cycle that keeps anxiety going. It is often more helpful to confront triggers, gain practice with experiencing and tolerating the anxiety, and learn new ways of coping. For example, let's say driving starts to trigger your anxiety. It would probably limit your life a great deal if you began to avoid driving, and driving certainly wouldn't get any easier if you avoided it! Instead, if you face the anxiety over and over by getting lots of practice with driving, it's likely that it will get easier over time as you learn that you can handle the situation.
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Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

Fact: Cognitive Behavioral Therapy (CBT) targets cycles of thoughts, feelings, and behaviors that maintain a problem...in other words, the things that keep the problem going. While it can be helpful to understand where a problem came from in the first place, this is often not enough to achieve change. We also need to understand how to change the patterns that keep the problem going. In CBT, we work to understand how thoughts, feelings, and behaviors are connected, and we identify unhelpful cycles so that we can understand what we need to change in order to break the cycle. Sometimes we fall back into old patterns during times of stress, so in CBT, clients learn to quickly identify and disrupt problematic cycles in order to be prepared for the future.

Need support? We offer video therapy. Get connected at PacificAnxietyGroup.com

It's OCD awareness week! Check out the International OCD Foundation's full schedule of events at

OCD Awareness Week | International OCD Foundation Join us in raising awareness about OCD (Obsessive Compulsive Disorder) with special programming all week.

The 1 Million Steps for OCD Walk is coming up this Saturday! Check out this great event focused on raising awareness and ending stigma:

VIRTUAL 1 Million Steps 4 OCD Walk The Virtual1 Million Steps 4 OCD Walk provides a supportive community, increases awareness, and raises funds for the IOCDF and its Local Affiliates, enabling them to continue their mission of providing resources, funding research, and instilling respect. Walk with us and let's see how far we can go!

Have your daily life and your plans for 2020 been turned upside down? Perhaps you've experienced thoughts like "This isn't fair" or "It shouldn't be this way." As true as these thoughts may seem, spending too much time with them can make us feel even worse- "should" thoughts can add an extra layer of distress on top of any negative feelings we might already have about the situation. Often, "should" thoughts add a layer of anger that increases the intensity of how bad we feel, and can get in the way of effective problem-solving. If you're noticing a lot of "shoulds," try experimenting with some other things you can say to yourself. For example, you might remind yourself, "This is part of my story now," or say, "This is where I am. What can I do to make it better?"

What are your most effective ways of dealing with "shoulds"?

We all avoid things from time to time...everything from washing the dishes to starting a tough work project to making a dentist appointment. If you notice yourself avoiding, ask yourself why. Are you taking a deliberate (and time-limited) break for self-care, or are there feelings of anxiety that are pushing you to avoid? Is there anything that's going to get easier if you wait to tackle the task, or will it be just as hard or harder if you keep putting it off?

Sometimes our worries have many layers. For example, you might be worried about whether others could tell that you were feeling anxious in a meeting. If you consider what bothers you most about that, it might be the fear that others think you're not good at your job. The worry underneath that one might be the fear that you're actually not good at your job, and the worry underneath that might be the fear that you'll get fired and be unable to support yourself. Identifying the bottom layer of worries helps us to clarify 1) whether the worry is realistic; and 2) what action we can take, if any, to address the worry.

Have you ever found that your mind is anxiously spinning in circles but you don't seem to be really getting anywhere? Writing down worries can be a surprisingly powerful tool. For one thing, once the worries are down on paper, this frees up some mental real estate- now that there's a physical list, there's less pressure to go over and over the worries in our minds. Seeing a written list can also help us to figure out whether the worry is realistic. Sometimes, once we've written down a worry, we start to realize that the thing we're afraid of isn't all that likely to happen. Other times, it does still seem likely- this is an opportunity to validate the anxiety that you're feeling, figure out whether there's anything constructive you can do about the worry, and make a plan.

This is a particularly tough time for many of us, and it's easy to focus on what we're missing or our fears about what's to come. In dealing with loss and fear, it's especially important to find balance by acknowledging what we have. Who are the people in your life for whom you are most grateful? What has smoothed your path (even just a little bit) recently?

Today's tip: Rumination means dwelling on upsetting thoughts and going over and over things in a repetitive mental loop. While it's natural to think about unresolved problems over and over as we try to solve them, rumination is an unproductive thought process: often when we ruminate, we're wondering why we got into a bad situation in the first place, or going over our past failures, or rehearsing what we wish we'd said during that argument, instead of making a specific plan to solve the problem. It can be especially easy to get stuck in rumination if there's not a clear solution to whatever problem we're dealing with. Rumination has a big effect on mood, and usually makes us feel quite low. If you notice that you're ruminating, ask yourself, "What's one step I can take right now to solve this problem, or get more information about how to solve it?" If there's nothing you can do at the moment to address the problem, try to mindfully redirect your attention to an activity that will absorb you and keep your mind engaged. If you struggle with frequent rumination, it may be helpful to talk to a therapist to better understand your personal triggers and patterns of rumination, as well as how you can best interrupt rumination to create more space for healthier patterns.

For many people, COVID-19 is having a huge impact on mental health. It can be hard to take the step of reaching out for help even under normal circumstances. Although many therapists are offering sessions over video right now, many people are unsure how they would find the time, space, or privacy for a video therapy session, especially those in crowded living situations and parents who are juggling jobs with homeschooling and caring for children. What creative ways have you found to make sure you have privacy for therapy?

We've been writing a lot about the cycle of depression this week. When depression pulls you to withdraw and avoid, you can break the cycle by pulling against this urge...in other words, by getting more active. That said, it can be hard to get started. It's great if you can pick activities that are fun, but a) some of these activities may not be options right now, and b) sometimes nothing sounds fun when you feel depressed. While it's important to try to re-engage with things you used to enjoy if possible, even if they don't seem fun at the moment, it's also helpful to focus on building connection and accomplishment.

Think about how you can connect with people you care about, whether by lending an ear to a friend who needs support, setting up a video call with family, or playing an online game with someone you know. Saying hello and wishing a good day to a stranger (perhaps your local pharmacist or grocery cashier) can also help build a sense of connection, as can contributing (time or money) to a community organization.

Next, what could give you a sense of accomplishment? It doesn't have to be a big accomplishment, and also doesn't have to be work-related...daily acts of personal care like washing your hair can feel like big victories when you're feeling depressed. Cleaning and organizing, starting with a small area, can also build your sense of accomplishment and control. Exercise is also fantastic for making us feel accomplished.

Remember, as you get more active, it's ok if you're not having fun all the time, if this feels like a lot of effort, and if you need to start with small goals...this is about accumulating small positives over time to chip away at depression. What are you doing to build enjoyment, connection, and accomplishment?

PAG is offering a free online support group to help parents navigate challenges in coping during COVID-19. Upcoming topics:

May 22: I'm so bored!: Helping kids find fun and adventure during the shelter-in-place

Register at PacificAnxietyGroup.com

Today's tip: Stress, anxiety, and depression can make regular daily tasks (let alone bigger projects) seem overwhelming. If there's something you feel like you can't do, try flipping the question around: "If I can't do that thing, what CAN I do?" Maybe it's a different work task, maybe it's something simple like taking a shower, or even just getting out of bed to sit at your table. You don't need to make any commitments at first other than just doing that one thing. Once you've done it, take a moment to notice that success. Then, perhaps ask yourself, "Ok, what's one more thing I can do?"

Today's tip: Depression can get us stuck in a cycle: when we feel depressed, we pull back from people and activities that we used to enjoy, often because nothing seems fun or we just feel too tired. Often, the more we pull back, the more depressed we feel...it's like being in a dark room with the curtains closed so that no light can get in. Breaking the cycle means trying to open those curtains a bit to let some light in, even when depression makes it hard. When you're trying to break the cycle, it's great if you can do something that's actually fun, but activities that give you a sense of control or accomplishment can also lift mood (you may not love cleaning the bathroom, but you'll probably feel good about yourself after you do it). It's important to remember that no one activity is going to be the magic wand that makes depression go away...this is about accumulating positives over time to chip away at depression. Of course, if you're sheltering in place, you may need to be more creative about how you pull against depression. What can you do to break the depression cycle?