Nurturing Psychological Flexibility: An Integrative Behavioral Health Approach to Anxiety Relief

Foreign. Welcome everybody to today's presentation on nurturing psychological flexibility. I am your host, Dr. Donnelly Snipes. We are going to be taking what I call an integrative behavioral health approach to psychological flexibility insofar as we are going to be exploring things that we can do physically, affectively, cognitively, environmentally and relationally in order to help improve our mood and help us deal with distress when it occurs. Psychological flexibility is basically our ability to respond to any situation that comes up. We can be flexible, we can bend one way, we can bend another, and it doesn't break us. When we talk about psychological flexibility or when I talk about it, what I'm talking about is the ability to mindfully notice how you're feeling in the moment and accept it non judgmentally and say, okay, reality is what it is. And for those of you who hate that phrase, I'm sorry, but I'm going to use it. It's one of my favorite. So accepting reality in the moment and, and then identifying behavioral, emotional and cognitive options you have that may immediately make you feel better, but do nothing to solve the problem or help you use your energy to achieve your goals. Or what I call toward behaviors, thoughts and feelings. Those things help you have the energy and resources to deal with life on life's terms, solve problems as they come up and sometimes just help you accept things that you cannot change. So let's talk more specifically about what we're talking, what we're, what I'm talking about here. Y' all know I use the acronym pacer. It stands for physical affective, which are your emotions, cognitive, environmental and relational approaches to or things that we can do. They are all interconnected. If you are feeling ill physically, it's going to affect how you feel emotionally, it's going to affect your ability to concentrate, it's going to affect your tendency to be patient in relationships, for example. There are a lot of things that are interconnected and we want to recognize that when we are examining our thoughts, feelings and behaviors. The things that I have listed here are what I call toward thoughts, feelings and behaviors. They're things that we can do in a preventative way to shore up our energy and make sure that we have the resources and ability to deal with distress when it happens. But they're also tools that we can use in the midst of distress to deal with it. So I'm going to talk about towards thoughts, behaviors and feelings mainly and I'll, I'll also share with you what some away examples might be physically and you know, I've Talked about this. I don't remember if it was this week or last week, but sleep, sunlight and circadian rhythms are so important. When we are tired, when we're not getting quality sleep, adenosine builds up in our brain which impedes our ability to be able to concentrate and effectively problem solve. Sleep is important. Sunlight is important because it helps us get that vitamin D that's responsible for so many different things in terms of mood and immunity and health. And our circadian rhythms regulate our cortisol levels. When you are trying to deal with life on life's terms, when you're trying to deal with distress, when it comes up, you have to have energy. And if your circadian rhythms are out of whack, your cortisol level levels may be all over the place or you may be experiencing hypocortisolism. So you may not be able to respond as efficiently. When any of these things are out of whack, your HPA axis is often also out of whack. So spending time and energy preventatively, proactively focusing on getting quality sleep, getting that 10 to 15 minutes of passive sunlight, and every day trying to focus and making a point of trying to regulate your circadian rhythms when you get up, when you go to sleep, you know, and also you'll notice when your circadian rhythms are regulated, you will start to get hungry at the same times and, and your body gets on this rhythm. A lot of hormones are controlled by that. So proactively improve your nutrition. A lot of times when we are experiencing distress, one of the away behaviors that we may engage in is gorging on comfort foods. And while that may make us feel better in the moment, you know, that brownie tastes really good or those M and M's, it doesn't do anything to provide the amino acids and the vitamins that our brain needs, that our body needs to make the neurotransmitters to help us deal with. With stress and distress, nutrition is important pain management. We want to do this both proactively and reactively. When we're under stress, we can tend to have more inflammation in our body, which can increase pain. We need to know how to deal with those flare ups when they happen. If we just ignore them, then it can cause more problems. We also need to know what we can do to prevent pain when possible. For example, sleeping with an appropriate sized, appropriate density pillow can make a big difference in your neck pain and your ability to get quality sleep. Having a good mattress, having ergonomics at the office, when I'm not talking to y'. All. I'm actually sitting on a big exercise ball because it forces me to have better posture and it actually reduces my back pain. Doing things proactively can help. When you're in pain, your HPA axis is activated. You're already experiencing underlying levels of stress, which means you have less energy to deal with distress when it happens. Proactive pain management Exercise is important. And you know, I know that's a bad word for some people. What I'm talking about in terms of exercise is moving your body. You can dance like a crazy person with the, with the blinds drawn. You can clean your house. You'd be surprised if you really get in there and do do a good cleaning. How much, how many calories you burn and how much you actually start breathing a little bit heavier. Even just vacuuming and dusting and things. If you're squatting and reaching and doing all that kind of stuff. Exercise, why is it important? Well, it helps increase oxygenation. That's good. It helps increase serotonin and endorphins. Those are good. And if you do it correctly, it also helps what I call shake out the kinks. It helps balance your muscles so you don't have muscle imbalances that are contributing to spasming and pain. Exercise has a lot of benefits. Again, it doesn't have to be super intense. It doesn't have to be at the gym. It doesn't have to be spoiled. Something that, you know, you really work up a sweat. Go out and play with your dog, play with your kids, go on a walk around the neighborhood. Whatever it is that you like to do that gets your body moving. That's all we're talking about here. Sobriety is one of those toward behaviors. And I know some of you are going, well, daggum it. That doesn't sound so like so much fun. Well, and, and it's not necessarily. Our away behaviors tend to focus on self medicating and escaping and numbing pain and distress with substances. However, when we sober up, those problems are still there. It's done nothing to actually affect the issue. And what we want to do is figure out how to deal with the issue and not just push it on down the road. Sobriety is important. And when I talk about sobriety, I'm not just talking about illegal drugs or alcohol. I'm also talking about nicotine and any other substances that people may use to self medicate. Substances that cause mood changes that have some psychoactive component to them add stress to the body. It will activate that HPA axis which again reduces the amount of energy you've got available to deal with any distress that comes along effectively. You can get angry, you can get feel aggressive and you can nurture those feelings. Remember, feelings are normal. We want to notice them with curiosity and accept them non judgmentally and say, all right, I'm feeling jealous, I'm feeling grief stricken, I'm feeling anxious. Alrighty here. Here we go again. It is what it is. What can I do to improve the next moment? Feelings in themselves are not problems. They are wonderful tools that prompt us to do something. So that's super awesome. Feelings become a problem when we feed them, when we feed the negative ones. When we get angry and we get stuck in that anger, telling ourselves we shouldn't feel angry or nurturing it by saying, telling ourselves how much deserve to feel angry and just piling on the thoughts that intensify that anger and that irritation, that's not helpful. That's not what anger is designed for. Anger is part of fight or flee. It's designed to give you energy to assess the situation, decide if there's a threat and if there is, take action to prevent any harm to yourself. That's what anger is about. Anger is not something we're supposed to nurture. What can we do for positive in terms of toward behaviors and thoughts? When we're talking about feelings, we want to add in happiness. You know, sometimes you can have stuff over here and, and you know, we can all name a couple of things right now that are probably on that distress list. All right, let's also add in happiness. Just because there is distress doesn't mean it excludes happiness. Add in the happiness. Give yourself something else to focus on that can help you feel better, even if just for a minute. You know, I spent some time this morning actually kind of going down a rabbit hole watching a video and maybe my husband can tell me share the link for it for the for fox rescue. But there's a fox rescue and this little fox is so cute. He giggles all the time. And you know, it was something for me to focus on that got my day started in a positive kind of light. But affective toward behaviors include adding happiness and also recognizing that we can do what Hayes calls living in the and radically accepting that pain and distress are part of life. They're going to happen. However we can experience that and have a rich and meaningful life at the same time. Whether it's physical stress, emotional stress, feeling overwhelmed and cognitively just kind of over it, distress may happen. It doesn't mean that you can't also have a rich and meaningful life. And we've talked in other videos about resiliency and hardiness, the concept of recognizing that your life is multifaceted. There may be things that are distressful that you may not have any control over, and struggling with those or feeding the distress is not going to change the situation. That's just going to drain your energy and steal energy that you might use for things that are important to you. So it's important to recognize that there are, you know, there's. There's this distress over here. We'll kind of put it in this column. But then there are other things in your life that are really going okay, if not awesome right now. And, and it's important to get the big picture and not just be solely focused on the distress part of it cognitively. Now, y' all know I am typically pretty cognitive behavioral in my approach, so obviously this has a longer list. But mindfulness is really important. We cannot address something until we know it exists, until we know it's a problem, or until we know that it's something we want to do. We need to be mindful of how we're feeling in the moment to. So we can address it. So we don't just go on autopilot and ignore it and suppress it and, you know, stick our fingers in our ears and go, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, yeah, until all of a sudden it's a huge issue. I, I make the analogy sometimes of mindfulness as tending to a wound. When you have a wound, you know, you go out and you cut yourself or something and it gets dirt in it because you did it outside. I don't know. If you don't treat it, if you just ignore it, what's going to happen? Well, most likely it's going to get infected, and then it's going to be a much bigger problem. Away behaviors are ignoring that cut on your arm instead of looking at it and go, well, that's unfortunate, and figuring out what to do next in order to keep it from getting infected, to keep it from getting worse. People who are using their away behaviors just kind of, you know, put, put a sleeve over it or something and, and ignore it. So eventually it's going to get infected and be a problem. A lot of our other issues, if we just ignore them and that's different, we're going to talk about distress tolerance in a minute. But if we ignore them and refuse to address them, they're probably going to fester and eventually they're Going to come back and bite us in the butt. And they're going to be much bigger issues than if we would address initially. So mindfulness is important. Being aware of what's going on in your life, what's going well in your life, what you're enjoying, but also being aware of distress when it comes up and checking. Is this a problem in this context right now, Positive self talk can be super helpful as opposed to negative self talk. We talked yesterday about turning fear into power. And one of the issues or one of the steps for turning fear into power is to get rid of that negative self talk. Shut down those negative voices in your head, those negative tapes, that inner, inner critic that you've got, and develop positive self talk. Focusing on the things that you can do, focusing on the things that you're good at. You're not going to be good at everything, but focusing on the things that you are good at and that you can control instead of focusing on the can't. And, and sometimes it's important to sort of trick your brain. And I used to do this with my children sometimes when they were feeling particularly oppositional and they were in a no mood and I don't want to do that, I don't want to do that, I don't want to do that. And I would ask them something that I knew would get a yes because all of a sudden they got out of the no response. They, they were just automatically saying no to everything. And I got a yes response and I was like, hallelujah. But once I broke that, then they started being more cognizant of what they were doing and what they were saying instead of just saying no to everything. Because that was the, that was the zone they were in, so to speak. Positive self talk can be super helpful. 15 minutes a day if you can, but if you can't, even a minute or two in the morning when you're brushing your teeth telling yourself, all right, today's going to be a good day. I've got this, you know, I'm prepared. Driving to work, heck, take a, take a break from, from work, go to the bathroom. And not out loud, obviously, because people think you're weird if you're sitting in the toilet stall talking to yourself. But you know, just take a break somewhere where you can get some privacy and mentally go over some positive self talk to remind yourself of the good stuff that's happening. Factual reasoning, one of my favorites. Do the research, please do the research. I don't care what it's about, if it's about your health, if it's about your politics, if it's about your finances, if it's about your dog's health, do the research yourself and figure out what are the facts in this context. You know, if I'm talking about something, it may be applicable in one scenario but not in another. I'll give you. Cats and dogs are physiologically very different. They're different creatures. Obviously dogs can handle some over the counter medications that are extremely toxic to cats. So I can't just assume that because they're animals, they can, you know, they can all take the same thing. What are the facts in this context when I'm dealing with this animal? When a dog gets a cold, it's not nearly as devastating because dogs seem to eat whenever as it is when a cat gets a cold. In this context, when my cats get an upper respiratory infection, I know that's a big deal because they won't eat if they can't smell. So paying attention to context, what's the context of this problem? So, you know, looking at the facts, figuring out what's going on, is it a, is it a problem? Is it a threat in this context at this time? If so, okay, what is the probability of a negative outcome? All right, and regardless of how probable it is, what can I do to mitigate any possibility of experiencing negative effects? And we talked about this in terms of getting sick yesterday or the day before. What are the facts in this context? As a woman under 50 with no preexisting conditions, is it likely that I am going to end up in the ICU if I should get the flu? Probably not, because I have all those other things. Now for my daughter, who happens to be obviously younger than me, but she has lung issues, you know, what is the probability that she might have a problem if she gets sick? Well, that's higher. Okay, so I'm looking at the facts of what's going on. I'm looking at the probability. For me, it's not a big deal. For her it might be. What are the mitigation strategies? Because you can't prevent anything that I can think of a hundred percent of the time. But what can I do to lessen the chances that I would contract the flu since I know that if she gets it, she is at a higher risk for negative outcomes. And, you know, washing your hands, wearing a mask, social distancing, you know, we all know these things. So that's where it's important and empowering to use that factual reasoning, not to be emotional and say, oh my gosh the sky is falling. You know, I, I'm afraid of getting the flu. So that must mean that if I get the flu I am going to die. Well, no, that's the catastrophic fear mongering that a lot of the media wants us to believe. And that can be when you're talking about swine flu. That can be when you're talking about a variety of things. You know, I'm not just zeroing in on one thing. That's why it's important to do your research and examine what the risk factors are in the context. Cancer is the same way. What are the facts in this context? As a woman with no pre existing conditions, who is of healthy weight, that exercises on a regular basis and eats relatively healthy with no red meat, you know, and I have, well, can't say that anymore. But given those circumstances, what is the likelihood that I am going to get cancer now? The fact that both of my parents and my grandparents, both of my grandparents, both sides ended up dying of cancer, you know, that that's kind of a problem that indicates a higher risk for me. So then I say, what can I do to mitigate that? What can I do to mitigate my risk? Problem solving and skill development. We can nurture this even when, and preferably when we're not under stress. People who don't have good problem solving skills, their away behaviors tend to be reactive to the situation and they tend to not focus on problem solving but numbing feelings. So problem solving is super important and it's super helpful in the moment, but it's also super helpful to work on, to be creative in your daily life even when you're not experiencing distress. I used to do an activity with my students when, when I taught at UF and I would break them into groups and each group would have something different. One would have a coat hanger, another would have duct tape, another would have chewing gum, another would have a, a paper clip. And I would ask them to think about what are all the different things that you could use this for besides what it's intended for. And it was an exercise to try to get them out of the box. And this is a fun activity to do if you've got kids at home, just to encourage some creativity to think about. Okay, what could you do? Or give them a box. Kids love boxes and you can get those just at just about any store. You know, when they get product in that comes in boxes. So you can get boxes for free and for cheap that you can, that kids can decorate and think about different ways they can use it, but that encourages them to develop more flexible problems problem solving skills to get more creative in. Okay, thinking about at a pen, you know, how many different ways could I use this besides just writing with it? Radical acceptance, and we've talked about this some already, is a cognitive strategy of just accepting what is. You don't have to like it, you don't have to approve of it, but accepting what is. And there was a great meme on my Facebook feed the other day. I wish I would have put it on here to share with you guys. But the difference between acceptance and non acceptance. It's a rainy day and somebody says it's a rainy day. I wish it weren't a rainy day. It's stinks that it's raining. It's going to be wet outside all time, all the time. They're thinking about all of the, the rain and the problems and why they're unhappy that it's raining. That's not doing anything to solve the problem that's draining their energy because they're just perseverating on it. Radical acceptance means when there's a rainy day looking outside and going, it's raining. The end, end of story. Not thinking about the good or the bad, just accepting that it is an attitude of gratitude and optimism can be incredibly empowering in situations. I've given the example before of somebody who gets frustrated because I've heard the saying before and it's so true. Cleaning a house when you've got dogs is like brushing your teeth and eating Oreos at the same time. It just, you, you don't feel like you ever make any progress and that can be frustrating when you want to have a clean house, you've got friends coming over or something. However, an attitude of gratitude and optimism would say, you know what, yeah, I'm not going to have the perfectly clean house. There's always going to be dog hair. But if I didn't have these animals in my life, that wouldn't be a problem. But I would much rather have these animals in my life. I am. They bring so much joy that, you know, I can overlook this. So an attitude of gratitude really looks at focusing on the good aspects of every situation and it can be obnoxious sometimes if you know, you're in a mood and putting on those rose colored glasses. But I encourage people, if they feel stuck in a negative mood, to force themselves just for a minute or two to put on the rose colored glasses and see if they can find anything in this situation to be grateful for or Optimistic about like it's going to end soon. Hardiness and resilience, we've talked about that. These are skills to help you bounce back after a stressor. And people who don't have good hardiness and resilience tend to get stuck in those emotions. In those away behaviors. They get stuck spinning their wheels because they don't bounce back. It's like taking a watermelon and throwing it off the balcony. You know, usually it goes splat instead of bouncing. We want to be a basketball, not a watermelon. Distress tolerance and there are a lot of people who have difficulty differentiating and distress tolerance are activities that help you distract yourself from negative feeling states for a moment until you can get into your wise mind. That's different than avoidance. Avoidance says I'm not gonna, I'm gonna pretend that doesn't exist. And you just, you ignore it like that gaping wound on your arm that you're not cleaning and you're not tending to. Distress tolerance is something that allows you to take a breath, calm down, re regulate that HPA axis for a second until so you can get into your wise mind so you can think more clearly and problem solve more effectively. And so the biggest difference between distress tolerance and avoidance is the duration. Distress tolerance is only going to be a few minutes probably. And avoidance is enduring. You don't want to nurture negative self talk or cognitive distortions either. So when you're not on in distress, it's helpful to become aware of your thinking patterns and any cognitive distortions and start addressing them. But it's also helpful to have strategies to address thinking errors or cognitive distortions or when you are in distress. For example, recognizing when you're using extreme language like this always happens or this will never end. Environmentally and relationships prior to distress, it is helpful to make sure that you are in an environment that's characterized by physical and emotional safety. Go figure. Definitely when you're under stress, the safer you feel, the more you'll be able to direct your energy to solving the problem as opposed to hyper vigilance. So this is one of those skills that's beneficial preventatively and reactively. Positive sensory environments are helpful and that kind of goes along with safety. But being in an environment that nurtures happiness, where you feel comfortable, where, where there are pleasant sound and it's not, you know, excessively noisy and things like that, a negative sensory environment, you know, distressful light, too much noise, noxious smells, any of those things add stress. Which means your body is already coping with distress. So it has less energy to deal with anything else that comes along. A positive sensory environment is better than that. It's not just neutral, it's not just not stressful, but it actually adds a sense of confidence and courage and contentment, you know, whatever you want to call it. You know, you walk into that room and you feel happy. I have a corner in our living room that I have a reading chair and I have a tapestry on the wall that has the serenity prayer and I have some pictures on a bookshelf and stuff. And it's just a very serene cor for me, that is a positive sensory environment. You may not be able to do it in your whole house or in your whole office, but if you can have a place in those spaces that is a positive sensory environment, Even if it's just a little corner, that can be helpful if not making sure that you have, you know, what we talked about the other day in terms of a rescue bag with you, sunglasses to block out light, the ability to plug in a desk lamp if the ballast in the fluorescent light above your desk starts going out. Noise canceling headphones. If you're able to do that in your work environment or your home environment to block out excess noise. I mentioned to you guys the other day four dogs and wood floors. It can get really noisy at times. So for me it's important to be able to have a place I can go where it's not quite as ruckus. Sometimes self esteem development is super important. So you're not relying on others to tell you that you're okay. When you feel good about yourself and you are able to look in the mirror and go, I am a good person and I am lovable and all that stuff. Then if somebody is rejecting toward you or toward your thoughts or your feelings, you may not like it, but it's not as devastating as if your entire self esteem is riding on getting approval from other people. And in that vein, once you've got that good relationship with yourself, it's also important to nurture healthy, positive relationships with other people. Surround yourself, literally or figuratively with healthy. And when I say healthy, you know, good boundaries, all that kind of stuff. Positive relationships, not people who tend to be negative, not people who feed those negative thoughts and feelings and nurture that distress. You want to have somebody who nurtures courage and strength and excitement in life and sees unpleasant things or sees problems as, as challenges or opportunities as opposed to crises. So some of it is semantic, but all of these things are important to help you not only stay healthy and recharge so you have the energy to deal with the stress when it happens. But it's also important to have these tools for when there is stress. The other or last analogy, I'll make, you know, go back to cell phones because I think a lot of people have cell phones so they can relate. When you go into an area where the towers are really overloaded and there's no WI fi, your battery drains a whole lot faster. Okay? So you want, before you go into those areas, you want to make sure your battery is charged up as much as possible so it can handle the excess drain required by, you know, having overloaded towers and no WI fi. Same sort of thing in life. When you are getting ready to go into an environment, whether it's work or, you know, family reunion or whatever it is that, you know is going to be a drain on your energy, you want to make sure that you're charged up, but you can't always plan for that. Sometimes, you know, at our house, out, out in the middle of nowhere, sometimes the power goes out. And so I am completely reliant on the towers for any sort of Internet connectivity to figure out the weather or what have you. So, you know, I'm not going to be able to plan for that ahead of time. Which is why it's important to plan proactively. Use your energy to make sure that you are as healthy, physically, affectively, cognitively as possible and nurture those relationships that can be there to support you. Are there questions about psychological flexibility or behaviors, thoughts and feelings when you are going about your daily life? It doesn't even necessarily apply to when you are reacting to distress, but when you're going about your daily life and you're making a choice about what to do, ask yourself. Real simple. Ask yourself, is this a good use of my energy that's going to help me move toward my goals, or is it something that I'm just either spinning my wheels or worse yet, using energy on something that's going to make me move further away from my goals? I appreciate, as always, everybody being here with me this morning. I know it's been a really long week for people. We are almost at the end. Tomorrow is Friday. So I'm really looking forward to that and I am hoping to see you again tomorrow if there are topics, as always, if there are topics that you would like me to cover more in depth, please feel free to let me know. You can message me at support all ceus.com and that's support a L-L L C E U S.com and also, you know, we have almost a hundred thousand I think. No, not almost a thousand. There we go. We have almost a thousand videos on the YouTube channel. So there's likely some information on some topics that you may be interested in. And again, I'm happy to go over those topics again more specifically in these live discussions at 9:30 every weekday morning. So everybody have an amazing day, have a positive restful day, and I will see you tomorrow.