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psychology

4 Steps to Break the Anxiety Cycle

4 Steps to Break the Anxiety Cycle

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"Get a sofa bed." This unassuming project has been patiently biding its time in the murky depths of my Non-Urgent-Things-To-Do list. After having the girls, there's no extra room in our apartment to welcome the occasional guest.

In a classic two-birds-one-stone maneuver, I thought I would do a little online browsing for sofa beds (Yay! The satisfaction of progress!) while also procrastinating writing this blog post (Yay! The sweet sweet relief of avoidance!). Excellent. But then, in a paradoxical victory of sorts, looking at sofa bed videos brought me right back to writing this post.

More thrilling sofa bed updates in a moment. First, a little primer about fear vs. anxiety.

Fear vs. Anxiety

Fear is the emotional state that arises in response to an immediate perceived threat. It's basically nature's alarm to help you survive when your safety is threatened. Your body and brain change gears to give you the means to fight, flee, freeze, or take cover. To help you take protective action, your mind becomes more able to detect and focus on sources of danger (Barlow, 2002).

Anxiety is the emotional state that arises in response to an anticipated threat. You may feel apprehension, worry, and muscle tension. The experience of anxiety may be less intense compared to a state of acute fear, but it might be much longer lasting. This depends, in part, on what stories your mind is telling you (Forsyth and Eifert, 2007).

While fear is oriented towards the present moment ("The house is on FIRE!"), anxiety is focused on an imagined future (1) ("What if I make a mistake and the house catches on fire?!"). Used adaptively, anxiety can help motivate us to plan appropriately for the future and take action.

However, the creative human mind can also come up with brilliantly compelling stories about potential threats that are so distant or so beyond our realm of control that there’s nothing we can really do to take action right now. Like a deer in headlights, we can fixate on those disturbing stories and forget about any adaptive problem-solving. We can even get stuck in a maladaptive cycle of anxiety that feeds into itself without resolution.

The Anxiety Cycle: Mind-Body Looping

Clinical psychologist and meditation teacher Tara Brach describes stuck anxiety as a cycle of mind-body looping (Brach, 2013). Let's say the mind focuses on the perception that something might go wrong (e.g., “What if I write this blog post and it's stupid and irrelevant?”). If we get tangled up and carried away by that threatening thought, it generates physical sensations in the body as well (e.g., a slight tension and quivering in my stomach; my heart beat quickens a bit and my breathing is slightly more shallow).

In turn, the mind picks up these physical signals. The body’s felt-sense of fear tricks the mind into confirming that the potential threats are true stories (“Of course there’s some real danger here! Why else would I feel like this?”). With the mind on high alert for threats, we detect and focus even more on anxious thoughts...and the cycle continues.

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If the looping becomes habitual we might feel chronically anxious. Fixated on an imagined future we start missing out on anything enjoyable, useful, or interesting that’s available to us right here, right now in the present moment. So how do we break the cycle?

Experiential acceptance vs. experiential avoidance

There’s a kind of futon-type sofa bed I was checking out. If you want to open it up into a bed, you have to do something a little counter-intuitive. Just pulling outwards to try to pry it open won’t work. It just locks in place. You actually have to push the backrest inward, towards the seat first. This activates some kind of release mechanism and voila! The sofa opens up and you’ve just created some bonus space to rest.

Understandably, we want to avoid what we perceive as the aversive, unpleasant experience of anxiety. We want to NOT feel what we are feeling and we instinctively pull away from it. But this experiential avoidance doesn't actually get us away from the anxiety. If anything, it seems to lock the anxiety into place! So what if we try turning inward, towards the anxiety instead?

RAIN: A mindful 4-step practice

You can see for yourself what it’s like to turn towards your anxiety, lean in, and stay present using Dr. Tara Brach’s (2013) 4-step RAIN practice:

1) Recognize what is happening

Close your eyes and bring to mind something that arouses anxiety. To build confidence as you begin to practice these steps, start by choosing something that is only mildly or moderately anxiety provoking.

Become mindful of your anxious or worried thoughts and notice the different forms they take: planning, rehearsing, trying to figure something out, a voice or some sort of mental commentary or judgment, or some visual images. Once you've identified your worry thoughts, whisper "fear thinking."

2) Allow the experience to be there, just as it is

Instead of avoiding or struggling against your inner experience, experiment with just letting it be. You might even experiment with saying “yes” or “I consent” as if you are giving yourself permission to fully experience and mindfully explore whatever is there.

3) Investigate with interest and care

Drop into your body, bringing your awareness below the neck with curiosity, openness, and kindness. Where does the worry and anxiety show up in your body right now? Bring your awareness to wherever you feel the anxiety most strongly in your body and notice the physical sensations: any pressure, tightness, ache, heat, movement, or other sensations?

It takes a lot of courage and willingness to stay present with unpleasant sensations. You can support yourself through this exploration with slow, gentle breaths.

4- Nurture with self-compassion

What does the anxious part of yourself most need to hear to feel comforted at this time? You can explore the ways you might deliver a message of kindness and care to the vulnerable part of you. Using a gentle tone of voice, you might offer some words like “it’s ok, I’m with you” or “that’s then and this is now”. You can also offer a caring physical gesture of some sort, like softly placing your hand on your heart.

After completing the four RAIN steps, use your senses to ground yourself in the here and now. Feel your feet on the floor or feel any other points of contact where your body is physically supported in this moment. See the light, shapes, and colours around you. Hear the sounds and let them flow through you. Take some time to notice what has changed in your body and your mind.

Each time you practice these steps, you’ll be further de-conditioning the tendency to get stuck in a useless anxiety cycle. Unlike the “false refuge” of distraction or rumination, we can lean in and open up a “true refuge” (Brach, 2013)—an inner space that’s always available to us… even in the midst of suffering and discomfort. Even when special guests like anxiety show up.


Maryann Joseph is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or @ConnecteMTL on Twitter, or like us on Facebook.



References

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

Forsyth, J. P. & Eifert, G. H. (2007). The Mindfulness and Acceptance Workbook for Anxiety: A guide to breaking free from anxiety, phobias, and worry using Acceptance and Commitment Therapy. Oakland, CA: New Harbinger Publications.

Brach, T. (2013). True refuge: Finding peace and freedom in your own awakened heart. New York: Bantam Books.

T. Steimer (2002). The biology of fear- and anxiety-related behaviors. Dialogues in Clinical Neuroscience, 4(3), 231-249.


Notes

1) Although this is an important conceptual difference, there may be a great deal of overlap in the body’s physical response: the basic fear-based brain and behavioural mechanisms that evolved to protect us from imminent danger may be re-used to some extent for the fancier task of protecting us from distant or virtual threats (Steimer, 2002).

Understanding Borderline Personality Disorder: Part 2—BPD Treatment and How to Use It

Understanding Borderline Personality Disorder: Part 2—BPD Treatment and How to Use It

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In part I, I wrote about receiving a BPD diagnosis. A diagnosis opens the door to treatments that fit. This is an important first step, but what’s next? What do we know about treatments and how can they be helpful?

What we know about working with BPD

At its heart, BPD is pattern of strained relationships. This means that people with BPD have difficulty with relationships within themselves, with others, and with the world. At the root of these problems is a troubled relationship with emotions. People with BPD experience their feelings as more intense, urgent, and often unbearable. It is common for these individuals to experience a lot of distress, and come to mental health professionals feeling desperate for some relief.

As mentioned in Part 1, the intensity of the distress can have an impact on the relationship with health care professionals, leaving the parties involved feeling frustrated and helpless. As a result, and in an attempt to reduce the suffering, the person seeking help may end up being prescribed lots of different medications—many with unpleasant side effects. Although in some cases, certain medications might help with some of the symptoms, we have more recently learned that the best approach for treating BPD is not pharmacological, but rather involves effective psychotherapy (Paris, 2017).

In the 1990s, Marsha Linehan developed a treatment specifically to help individuals with BPD understand and change their relationship with themselves and the emotions they experience as mixed and intense. She called it Dialectical Behaviour Therapy (DBT), to highlight the importance of the “dialectical”, or “the plaid” which refers to working with opposite forces. For example, this can mean accepting one’s emotions and experiences as valid, while simultaneously working to change behaviours that have negative consequences (to read more about the “Plaid” and DBT, check out Michelle’s Blog post). With robust research support, DBT has gained significant recognition. It is effective, accessible, and popular, which has led many health care professionals and people seeking therapy to equate BPD treatment with DBT.

Although DBT has virtually become synonymous with BPD treatment, it is not the only psychological treatment available and appropriate for BPD. Many other approaches to therapy use other lenses to address BPD difficulties and have been shown to be effective. Mentalization-based therapy (MBT) is a particularly good fit because it aims to help people understand their internal experiences in order to change their relationships with themselves, with others, and the world. Similarly, approaches that focus on emotions (e.g., Emotion-Focused Therapy-EFT) or relationships (e.g., Transference-Focused Psychotherapy-TFP) have also garnered research support as effective in addressing the challenges that arise with BPD (Paris, 2017).

While there are lots of 3-letter treatment options, each with its own angle, there is not much evidence to suggest that one unique type of therapy addressing personality-related difficulties is actually superior than others for BPD (Livesley, Dimaggio & Clarkin, 2015). Among many researchers and clinicians specializing in BPD, there is some consensus that the best approach is to offer therapy that integrates relevant ideas from all approaches (Livesley, 2017; Nelson et al., 2017). When it comes to therapies addressing personality disorders, no one “brand name” does better than others (Paris, 2017). This is good news, because it means most therapy approaches for BPD work, and integrating more than one is even better.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

What’s important in BPD treatment

Knowing that integrating relevant ideas from different approaches is what seems to work best, how do we know which ideas to integrate?

First, since an intense experience of emotions is often what drives a lot of the difficulties, working to identify, understand and manage emotions is critical. Managing emotions might mean learning to take a step back, observe, and experience—survive the emotion without reacting. This process also helps reduce impulsivity by creating a space to be purposeful rather than immediately acting on urge. I like to think of it as having conversations with emotions. With time, these conversations shift the relationship with one’s internal experience and reduce the chaos.

Another piece of the puzzle is shifting one’s relationship with other people. This may involve learning about other people’s emotions and intentions, and about the subtleties of relationships more broadly. It often involves understanding physical, personal, and emotional boundaries (For more on boundaries, check out this blog post) as well as what makes a relationship sustainable.

There are other elements that we know contribute to progress in therapy for BPD regardless of the content of therapy or approach. This list includes having a consistent and predictable structure (e.g., regular, weekly therapy sessions), building motivation for change, and working toward self-reflection (Livesley, 2017).

Beyond all these factors, if you are looking for therapy that works, good fit with a therapist and investment in the journey itself are crucial to making therapy work. What does this therapeutic effort look like and what does this all mean about being in therapy when you have BPD?

How to be in therapy when you have BPD

  1. Give the process a chance. Lots of big feelings might come up as you begin, challenge yourself to get started even when it’s a substantial effort that feels uncomfortable at first.

  2. Once you’ve found a fit, stick to it and be consistent in order to build momentum. At the beginning, go weekly—even when you don’t feel like it, or if you have some other reason not to go. Therapy is a big investment of time, money, and emotional energy. If you allow yourself to build momentum and persevere, you will make it a valuable (and cost-effective) experience of personal growth.

  3. Tolerate difficult emotions as they come up: Showing yourself you can survive intense and difficult emotions is an important part of the process.

  4. Trust your gut, yet still challenge yourself. Ask yourself what your emotion is telling you, and whether rolling with the discomfort could possibly be beneficial to you. For example, it might look like facing your fear, giving a person a chance even if you’re angry, or getting out of bed even though you’re sad.

  5. Focus less on the what and more on the how. Listen to the words of your stories and take a step back to understand the big picture in what’s going on. Use this often in your therapy.

  6. Open up to talking about your emotions in therapy, especially when they have to do with your therapist. Tell them if you’re scared to talk about something, if you’ve felt sad or hurt after they said something, if you’re angry with them, etc. Lots of old and new feelings can come up in the therapeutic relationship. It’s your opportunity to work out the messy parts with someone who is qualified to help you.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Livesley, W. J., Dimaggio, G., & Clarkin, J. F. (Eds.). (2015). Integrated treatment for personality disorder: A modular approach. Guilford Publications.

Livesley, W. J. (2017). Integrated modular treatment for borderline personality disorder: A practical guide to combining effective treatment methods. Cambridge University Press.

Nelson, D. L., Beutler, L. E., & Castonguay, L. G. (2012). Psychotherapy integration in the treatment of personality disorders: A commentary. Journal of personality disorders, 26(1), 7-16.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.



 Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Understanding Borderline Personality Disorder: Part 1—What is BPD and How to Get Help That Fits

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

In my July Blog post, I referred to what happens when certain personality traits are too high or too low, causing life difficulties. Borderline Personality Disorder (BPD) is one psychological diagnosis or label that mental health care professionals and clinicians use to describe a specific pattern of problems. Typically, this pattern involves intense, chaotic relationships with both the self and others. Even though some of the traits involved are amplified versions of normal personality traits, many people with BPD will experience problems that are serious, and that most people never experience (Paris, 2017). Although there are some commonalities and a general pattern, individuals with BPD do not all have the same problems or experiences.

Let’s think of Jessica for example. She was recently diagnosed with BPD. She’s always felt something was “off”. She suspected early in life that she wasn’t feeling the way others around her felt: her emotions have always been so intense, it was as though she was walking around with no skin. She’s noticed she reacts impulsively to these intense feelings, which change from one moment to another. One moment she can be thrilled, the next, filled with sadness or rage. Along with these strong emotions is also an emptiness inside that she’s not sure how to describe to others.

Sometimes she feels her life is not real and asks herself “what’s the point?”. She often thinks of suicide, wondering if it’s the only way to stop her suffering. She’s even attempted to end her life a few times by taking pills, with mixed feelings when hospitalized and treated for these overdoses. She questions who she is, often feeling like a bad person who isn’t worthy of love. When she gets into a relationship, she’s afraid the person will leave and looks for ways to prevent this, or to have her partner reassure her that they won’t. Eventually, the ups and downs and efforts to avoid being broken up with cause a lot of stress in the relationship and it ends.

Jessica has received many diagnoses by health professionals in the past, including Generalized Anxiety, Depression, Attention Deficit and Hyperactivity Disorder, and Bipolar Disorder. She has tried therapy numerous times and felt frustrated because nothing seemed to “stick”. Recently, a new psychiatrist she was seeing diagnosed her with BPD.

Receiving a BPD diagnosis

It’s important to remember that a diagnosis, especially one of BPD, is not an identity: it describes a cluster of problems in someone’s life—what’s not working for them. Receiving the BPD diagnosis can be the key to getting the right help. When Jessica first got diagnosed, she went home and looked it up online. She was angered to find that much of what she was reading suggested there is something wrong with her personality and that she would be “difficult to treat”. She felt ashamed and angry with her psychiatrist, who she had no intention to return to see. She felt as though another health professional had let her down.

Despite this, she also felt some relief that she could make sense of what’s been going on, and eventually decided she would go for another visit to ask a few questions. Although she was hesitant, she told her psychiatrist how angry she was and was surprised that this led to a conversation during which she felt understood and even hopeful about the future.

Jessica learned that this diagnosis would allow her to get more specialized help, and together she and her psychiatrist came up with a plan. With treatment that fits (and some patience), Jessica can go from being diagnosed with BPD to no longer meeting any of the criteria and leading a more satisfying life. It’s also important to remember that when the label no longer describes someone’s current problems, it no longer applies.

Unfortunately, because of stigma around BPD, many people are reluctant to accept or disclose their diagnosis, which can get in the way of receiving appropriate help.

Photography by      Joanna Rosciszewska

Photography by Joanna Rosciszewska

Why the stigma?

Compared to other disorders, BPD is a fairly new diagnosis, with treatments having only been developed in recent decades. There are times individuals with BPD feel like their experience is unbearable. Their symptoms often reflect the intensity of their distress; When Jessica went to see the psychiatrist, she had cut herself badly and said she wanted to give up on life. Although her psychiatrist identified her diagnosis, some health care professionals may not recognize BPD or know how to help, leaving all parties feeling frustrated. In fact, people with BPD are often not diagnosed or treated at all. Sometimes, they are offered treatments that do not fit their problems. Since intense emotions are part of the experience, speaking about what’s most painful with a health care professional, who is often a stranger, can be quite challenging.

It is not surprising that there would be friction between someone consulting for a situation that feels urgent and impossible, and a health care professional who isn’t sure how to help. Sometimes, the clinician may themselves react unfavourably when feeling unsure or helpless. As you can imagine, these reactions would not be well-received by someone in distress who already feels let down.

In fact, it is likely that someone seeking help for these symptoms has already had many frustrating experiences in the health care system. As a result, they might express anger (even rage) or withdraw from treatment, which in turn might lead to the clinician distancing themselves even more. This can become a continuous self-fulfilling cycle and can help explain some of the frustrations that people with BPD as well as clinicians face (Aviram, Brodsky & Stanley, 2006). Unfortunately, cycles like this one perpetuate the stigma and contribute to a reluctance toward both pursuing treatment (on the part of those seeking help) and providing treatment (on the part of clinicians).

Maybe you relate with parts of (or all of) Jessica’s experience, and you’ve experienced these frustrations yourself. If you’ve been feeling helpless, hopeless, and chaotic on the inside (and maybe outside too), or like no diagnosis has made sense so far: Remember there is the right kind of help out there—help you can use to help yourself.

What to do if you think you might have BPD and want to consult:

1- Take a deep breath. Remember these are words to describe problems you are experiencing, and that having these words means you can communicate to get the help you need.

2- Look for someone who is qualified to assess and work with personality in therapy, or ask for a referral to someone who does. You can look online, or ask your GP or most health care professionals.

3- Be prepared to speak with someone by taking note of what’s most important to share about what you are experiencing.

4- When meeting a health care professional, observe whether you are feeling intense emotions, and challenge yourself to be open—to stick around and share your experience as best as you can, even if lots of uncomfortable emotions rise to the surface. Ask yourself: how can I help this person help me? Sharing your difficulties and what you are looking to work on are some ways to collaborate.

5- Give the person time to get to know you and figure out how to help. They may not know right away.

Don’t give up on getting the help you’re looking for. Sometimes, it takes meeting with a few different professionals before you feel you’re on the right track.


Danit Nitka received her PhD from the Clinical and Research Psychology program at Concordia University in Montreal, Quebec, and is a psychologist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Aviram, R. B., Brodsky, B. S., & Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard review of psychiatry, 14(5), 249-256.

Paris, J. (2017). Stepped care for borderline personality disorder: making treatment brief, effective, and accessible. Academic Press.

The Art of Not Knowing

The Art of Not Knowing

Having goals, dreams and desires implies looking forward and planning ahead. However, focus on the future is often accompanied by worries about hypothetical situations. Indeed, the things we care about the most are often ambiguous and unknowable. Because humans are hard-wired to prefer certainty to uncertainty, we experience this ambiguity as highly uncomfortable, even distressing. Considering that the future is uncertain and that being faced with the unknown is uncomfortable, we tend to develop strategies to avoid or reduce uncertainty. These may work in the short term. When intolerance to uncertainty becomes the rule, however, striving to eliminate it altogether paradoxically contributes to increased anxiety and suffering, and ultimately impedes our ability to reach our goals (Dugas, Gosselin & Ladouceur, 2001).

According to Kelly Wilson and Troy Dufrene, authors of Things May Go Horribly Terribly Wrong (a perfect title for a book on uncertainty), the first step to changing the way we relate to the unknown is to become aware of the myriad strategies we engage in to neutralize ambiguity (Wilson & Dufrene, 2010).

The list below may be helpful to begin thinking about which intolerance to uncertainty tactics we engage in the most and to prompt reflection on what uncertainty means to us.

1. Observe: How do I relate to uncertainty?

Approach Strategies:

  • Worrying to “solve” uncertainty. Worries are often plans, predictions and preparations for hypothetical situations that are ultimately ambiguous and unknown. It may feel “productive” to worry, but when the topic of worry is out of one’s control, such as for future events, worrying about it becomes an “intolerance to uncertainty strategy” and only leads to more worry.

  • Reassurance seeking. Asking for reassurance and seeking advice are also common ways to dispel uncertainty and to attempt to “feel certain”. Ex: Asking a loved one if they love you multiple times a day, asking multiple sources about an upcoming decision, getting second and third opinions…

  • Searching online. Digital and social media technology provides the luxury of quick and easy access to unlimited answers to our innumerable everyday questions. Through immediate and constant access to information, technology use in many contexts can take the form of reassurance seeking and, ultimately, reduces spontaneous daily exposure to uncertainty. Recent research actually shows that intolerance to uncertainty is a rising phenomenon that correlates with the rise of digital technology such as smartphones. Ex: Googling health questions as they occur, searching through someone’s or one’s own social media, excessive online-researching before making a decision (Carleton et. al, 2019).

  • Double checking. Double-checking may also easily become triple-checking or more. Ex: Repetitive checking of one’s bank account and email, repetitive-checking that the door is locked, double-checking the route to get to a destination.

  • Perfectionism, not delegating and overprotecting. To reduce uncertainty and to gain a sense of control, some may try to do everything themselves, over-prepare and not delegate to others. This may also take the form of perfectionistic tendencies relating to the idea that if everything is perfect, the outcome will be predictable and positive. People may also apply these strategies in the context of their relationships with significant others by being overprotective and doing things for them.

Avoidance Strategies

  • Procrastinating, choosing not to choose and indecisiveness. Putting off beginning a task that has uncertain outcomes. Will I be able to succeed? Am I good enough? Having trouble making decisions that have unclear outcomes and that include uncertain elements. These strategies may serve to minimize one’s experience of the discomfort of not knowing (Rassin & Murris, 2005).

  • Avoiding new opportunities. Avoidance of the experience of uncertainty may take the form of avoiding new experiences altogether. Ex: turning down a promotion for fear of not being good enough, not going to a party with new friends, not travelling to unknown places.

  • Cognitive avoidance. Efforts to not think about uncertain topics until it is absolutely necessary.

Beliefs about uncertainty

  • It feels irresponsible or dangerous for there to be uncertainty in life.

  • Uncertainty means that something bad will happen.

  • Belief that you cannot tolerate not knowing how things will go (“I will not be able to manage”).

  • Feeling that it is preferable to be certain that an outcome will be bad, than to not know the outcome.

As mentioned, everyone uses some of these strategies some of the time. Intolerance to uncertainty becomes most problematic when reliance on these types of strategies interferes with what’s most important to us.

2. Observe and notice: What are the costs?

The second step is to become aware of how regular use of these strategies interferes with one’s goals, relationships and general wellbeing. We may ask ourselves the following questions:

  • Are worries about the future getting in the way of my enjoyment of the present moment?

  • How much time am I spending trying to “solve” uncertainty? What else could I be doing?

  • What meaningful experiences am I avoiding or putting off due to intolerance to uncertainty?

  • Does my intolerance to uncertainty affect my relationships with loved ones?

3. Observe, notice and feel: Sitting with it. The final step implies doing the opposite of efforts to move away from uncertainty. In fact, it involves leaning into it and requires the willingness to experience its discomfort. If the only thing that is certain in life is that life is fundamentally uncertain, then acceptance of uncertainty, in all its discomfort, is necessary. Allowing oneself to simply experience ambiguity is not to love it, but to learn that it is both uncomfortable and tolerable.

  • How to sit with uncertainty? When resisting the urge to engage in strategies to reduce uncertainty, take a moment to explore your internal experience. Identify what you are feeling. Observe the sensations in your body, notice the feeling of your breath. Notice your thoughts. Remember, no matter how intense your thoughts and emotions become, they are temporary and they will pass. It may be helpful to remind yourself of the following coping statements: “This too shall pass”, “I do not know and it is okay”, “It is uncomfortable and I can feel it”, “It is uncertain, I do not need to solve it”.

  • For more information on sitting with difficult emotions, see this blog post.

4. Be flexible. The objective of these steps is not to eliminate our response of discomfort towards uncertainty. It is alright and normal to worry and feel anxiety at times. Rather, the objective is to become aware of how consistent efforts to not feel discomfort get in the way of engaging in experiences that are unknowable and likely to also be highly meaningful such as connecting with others and moving towards goals (Wilson & Dufrene, 2010).

Building tolerance to uncertainty is like strengthening a muscle. The more you work it out, the stronger it becomes!


Rhea Marshall-Denton is a Ph.D. candidate in clinical psychology at the Université du Québec à Montréal, and a therapist at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram, or like us on Facebook.


References

Carleton, R. N., Desgagné, G., Krakauer, R., & Hong, R. Y. (2019). Increasing intolerance of uncertainty over time: the potential influence of increasing connectivity. Cognitive behaviour therapy, 48(2), 121-136.

Dugas, M. J., Gosselin, P., & Ladouceur, R. (2001). Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognitive therapy and Research, 25(5), 551-558.

Rassin, E., & Muris, P. (2005). Indecisiveness and the interpretation of ambiguous situations. Personality and Individual Differences, 39(7), 1285-1291.

Wilson, K. G., & Dufrene, T. (2010). Things might go terribly, horribly wrong: A guide to life liberated from anxiety. Oakland, California: New Harbinger Publications, Inc.

Intuitive Eating – another fad? Or something more…

Intuitive Eating – another fad? Or something more…

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You may have recently heard the words “Intuitive Eating” or “Mindful Eating” in the news, on social media, or in a post on your favourite blog. The Globe and Mail even wrote a lengthy article in early January stating that intuitive eating is the new “non-diet” of the year. But what exactly is intuitive eating, and can it really help you improve your relationship with food and your body?

Intuitive eating is an approach to eating that shifts away from rules, rigidity around eating, and dieting. It encourages listening to your internal cues for hunger and responding by eating food that you enjoy and that makes you feel good both physically and emotionally. We have now seen that intuitive eating has been shown to improve both our physical and psychological health over the long-term (Bacon, 2010; Van Dyke & Drinkwater, 2014). If intuitive eating doesn’t sound all that fancy, it’s because it isn’t. Intuitive eating is essentially a much-needed back to basics approach, where we are encouraged to focus on our individual needs and preferences as a guide to developing a balanced relationship with food. You won’t find any “good” or “bad” foods in this approach, nor will you be encouraged to cut certain items out of your routine. The idea here is to stop looking outwards for a diet guide on how to take care of your body, and to begin looking inwards to better figure out what YOU need to feel good.

A good parallel here is when you think of an infant’s relationship with food. Infants cry when they’re hungry, and typically slow down their feeding when they’re full. Then they cry again when they’re hungry, and the cycle continues. Infants don’t ask themselves “how many calories are in my milk?” or “I can’t be hungry yet, I just ate!” or even “the other babies aren’t eating this much, why am I?!” – they simply listen to their bodies, feed when they’re hungry, and stop when they’re full. Pretty cool, right? Unfortunately, between infancy and adulthood, we’re inundated with messages about what we should or should not eat, how we should or should not look, and how anything less than the “thin ideal” or a “clean diet” is ground for shaming ourselves and others. As a result, we’ve naturally lost our inner compass, our inner guide that helps tell us what we need and want to feel satisfied.

Essentially, you and only you can tell yourself what your body needs, and it’s time to start listening.

So, how do we go about transitioning from focusing on external cues for eating to focusing on our internal needs? The following is a brief guide that will help you begin your intuitive eating journey, alongside some helpful reading recommendations to dig deeper into this subject.

Step 1: Learn to accept our bodies as they are, let go of diet culture

  • This is a really difficult step, and yet it’s essential. Letting go of thin ideals and shaming our bodies allows us to not only feel more connected and comfortable in our skin, it also lets us stop trying to control our eating behaviours with the goal of shrinking our bodies. If we can accept our bodies as they are, food can become about meeting our needs and experiencing pleasure, as opposed to an attempt to control and punish our bodies under the guise of ‘health’. When we try to use food to control our body size, i.e. when we try to diet, we have to retain that level of restriction in order to keep pushing down our weight. There is no freedom to ask ourselves what do we like, what are we in the mood for, how much would we like to enjoy? Instead, we are focused on “what am I allowed to eat?” in order to maintain this control. This approach ultimately backfires for most people as well, resulting in binge eating in an attempt for our bodies to finally feel that their needs are met. For these reasons and more, letting go of diet culture and accepting our bodies is crucial.

Step 2: Start getting curious about your personal hunger cues

  • We spend so much of our time assuming we should or should not eat because of the time of the day, because of what others are doing, or because of what we have eaten previously. None of this is focusing on what our body is asking for, so start by simply being mindful of your bodily cues for hunger. Do you feel a growl in your stomach? Do you suddenly have fantasies about different meal options? Does your concentration decrease slightly?

Step 3: Ask yourself what it is you’d like to eat.

  • What are you in the mood for? What do you have available? There is no right or wrong answer here, only you know what you’d like to eat!

Step 4: Eating mindfully.

  • Try to slow down, taste the flavour, the texture, and the temperature of your food. Notice how your pleasure for certain flavours changes throughout the course of your meal. Check in with your fullness cues. Are you feeling full half way through your meal? Are you still hungry at the end of your meal? Use these cues to guide yourself in either slowing down and finishing your meal or adding an extra snack to ensure that you’re satisfied.

Step 5: Be compassionate, non-judgemental, and flexible with yourself

  • Each meal is a learning opportunity. Sometimes we don’t feel full during a meal but then feel stuffed 30 minutes later. This helps us learn for the next time that we might need a little bit less of this specific recipe, or that we want to eat more slowly in the future. There is no “bad” or “good” way of doing this, it is simply a curious and open learning experience each time.

  • There are often reasons that we eat that are independent of our fullness cues, such as when a meal is really delicious and we’re willing to feel extra full in order to keep enjoying it, or when we know we’re only going to have a small window to have a meal during our workday. All of these situations are part of the fabric of intuitive eating. The idea is not to do this “perfectly” – in fact, that’s the exact opposite of the idea. The goal is simply to start becoming more curious about what your body needs and why it’s asking for what it needs in any given moment.

  • Become curious about other reasons that we might be eating, such as to hold onto pleasure, push back boredom, or cope with difficult emotions. These different motivations for eating are not problematic, they’re simply worth noticing. If we’re eating for reasons that are unrelated to our hunger and energy needs, then we might wish to expand on other ways to have those needs equally met, so that we have options in the future.

Ultimately, intuitive eating is about finally allowing yourself to accept and celebrate your body, and beginning to re-acquaint yourself with your inner guide for how to strengthen your relationship with food.


Tobey Mandel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Van Dyke, N., & Drinkwater, E. J. (2014). Relationships between intuitive eating and health indicators: Literature review. Public Health Nutrition, 17, 1757-1766.

Gagnon-Girouard, M. P., Bégin, C., Provencher, V., Tremblay, A., Mongeau, L., Boivin, S. Lemieux, S. (2010). Psychological Impact of a "Health-at-Every-Size" Intervention on Weight-Preoccupied Overweight/Obese Women. Journal of Obesity, pii: 928097. doi: 10.1155/2010/928097

Tribole, E., & Resch, E. (2012). Intuitive eating: A revolutionary program that works. Third Edition. St. Martin’s Press.

Bacon, L. (2010). Health at every size: The surprising truth about your weight. Dallax, Texas: BenBella Books, Inc.