Josh Hillebrand LCSW

Tag: health

  • 4 A’s of Acceptance for Difficult Emotions

    4 A’s of Acceptance for Difficult Emotions

    So much of the world says that if you’re feeling anxious, guilty, shame, angry, sad, or any other painful emotion, then something is wrong with you. Instead, you’re expected to be one hundred percent happy all of the time just like all the smiling faces you see on social media. But this is completely bogus and please throw it out the window. Every emotion – even the painful ones – is there for a reason and trying to give us important information. And going even further, the struggle to not experience these emotions often makes them even more intense and can drive our suffering up. So, the next time you’re feeling an emotion you’d rather avoid, try using the 4 A’s of Acceptance instead:

    A close-up photo of a woman who is crying.
    • Acknowledge the feeling: name it, label it, notice how this particular emotions makes your body feel, say “hello and how are you doing?” to it
    • Allow: give that emotion permission to be there, such as “Okay, anxiety and that corresponding racing heart I will let you be here right now”
    • Accommodate: pretend that painful, distressing emotion is a house guest and try to greet and host the emotion with a sense of hospitality. In practice, you can do this by imagining that you’re opening up space around the emotion as it is showing up in your body. So, if a sense of guilt is giving you a pit in your stomach, close your eyes and bring that pit to mind and then open up around the pit.
    • Appreciate: this can be one of the most difficult and also powerful steps of accepting difficult emotions. Try to connect with even a sliver of gratitude for what the painful emotion is trying to do for you. If it’s anxiety or fear, their likely trying to protect you from or prepare you for something. If guilt or shame, they may be trying to get you to connect with your personal values and to repair meaningful relationships. If it’s anger, it’s also likely trying to protect you, your loved ones, or something else important. If it’s sadness, it could be your body’s way of acknowledging and grieving the loss of something that mattered to you a lot.

    Acceptance can be a radically powerful way of being in the world and you can start practicing it today with your own private feelings. Imagine if we lived in a world where everyone was actively practicing acceptance of painful emotions on a daily basis: I sincerely believe there would be far less war, hate, injustice, poverty, climate change.

  • Cognitive Defusion

    Cognitive Defusion

    Let’s say you’re stuck on a difficult thought like “I’m a terrible person,” “Nobody likes me,” or “I’m going to sound like an idiot during my presentation tomorrow.” Traditional Cognitive Behavioral Therapy (CBT) might have you look at the evidence for and against these thoughts, and then identify a more adaptive thought. This can be a helpful approach for some people. But, if that doesn’t work for you, try out one of my favorite concepts and skills from Acceptance and Commitment Therapy (ACT): cognitive defusion.

    Cognitive defusion says we don’t need to spend time challenging thoughts. After all, sometimes this can just get us caught up in a back-and-forth with our own mind and result in more and more spiraling and rumination. The idea behind cognitive defusion is that we can use mindfulness to remind ourselves that our thoughts are basically just strings of words in our heads. Further, the skill can help us take a step back from the thoughts, noticing them with curiosity, and this can give us the space we need from these troublesome words. Once we have that space, we can choose something more productive to do with our time, which might look like enjoying another episode of The Pitt or Alien: Earth.

    A man is sitting crosslegged and is meditating.

    Here are some ways to practice cognitive defusion (some of these are more on the silly side but can be effective but use your own intuition for which ones to try out):

    • Repeat the thought out loud as fast as you possibly can for 60 seconds
    • Say the thought as slowly as possible (pretend to be the sloth character from Zootopia)
    • Sing the thought to the tune of your favorite song or the Happy Birthday song
    • If the thought is “I’m a bad person,” try saying “I’m having the thought that I’m a bad person” and notice if that shifts anything for you. Next, try saying “I’m noticing that I’m having the thought that I’m a bad person” and see if that shifts anything further. You could also try writing the thought out and follow the same pattern.

    Remember the goal is not necessarily to banish the thought from your consciousness forever. Rather, it’s to help you take a step back when you’re hooked on a thought so you can have more psychological flexibility in a sticky moment. If you have more of this type of flexibility, you could spend more of your time doing the things you actually care about rather than letting that thought distract you for the rest of the day.

  • Do You Have An Addictive Personality?

    Do You Have An Addictive Personality?

    I’ve worked with a lot of people who were certain and very worried that they have an addictive personality. When people use this label, they’re referring to something like “it’s easy for me to get hooked on something and I have a hard time getting of it.” The so-called addiction can take on a life of its own despite one’s better judgement (or doing something over and over without a mindful, intentional quality of mind). However, in my experience, it’s not just a personality issue. There’s usually something else going on beneath the surface. Here are some of the questions I help people consider when they’re worried about having an addictive personality:

    A close-up picture of paper currency and different types of pills.
    • Substance Use Disorders: Perhaps someone is struggling with a substance use disorder. This can definitely be a difficult and uncomfortable question to sit with. Reflect on what your relationship is like with substances such as alcohol or marijuana or other drugs. Do you continue to use substances even if they’ve done more harm than good, such as getting you into health (both physical and mental), legal, or relationship issues? Maybe your body gets more of a hit or rush or buzz or high from substances compared to others or maybe it takes more of the substance to get a hit or rush or buzz or high than compared to others. Both of those could suggest genetic traits that would increase your vulnerability to a substance use disorder. If you need to use larger quantities or use more frequently, these could also be signs of a substance use disorder.
    • Neurodivergence: Impulsivity and sensation seeking are qualities often associated with an addictive personality. But, they’re also common for people who are not neurotypical. In The Neurodivergent Mind by Jenara Nerenberg, she describes that people with neurodivergence often need to find the right level of stimulation. Everyone has a sweet spot for stimulation. Both understimulation and overstimulation can be distressing and result in reduced mental health and in short term efforts to cope that might not work out so well in the long run. If you think you might have an addictive personality, perhaps its a sign that you have a neurodivergent mind and you’re doing your best to find activities or other sources that provide you with the right kind of stimulation you need to feel regulated. I’ve especially seen this in people with under-cared-for ADHD, they get hooked on certain activities and substances. Part of my work with these folks is to help them keep what is working, identify what’s not, and help them find the right kinds of stimulation that can fit into their daily lives.
    • Emotional Coping: are you using substances to cope with stress or painful emotions like guilt or anxiety? If you weren’t raised in an environment where the adults around you modeled how to regularly practice emotion regulation (such as a family that either never even talked about emotions or one that thought emotions are more of a weakness best left avoided), then perhaps your “addictive personality” type is really an attempt to find external ways and methods of coping with internal emotional and mood states.
    • Disconnection from Values, Meaning, and Sense of Purpose: Someone who is disconnected from their values, meaning in their lives, or a sense of purpose might attempt to cope by engaging in behaviors that could make them think they have an addictive personality. Think of thrill seekers who like jumping out of airplanes for fun or perhaps people who experience many and frequent short-term intimate relationships or people who are “addicted” to their work lives (AKA workaholics) might be struggling with an existential sense of emptiness. On the surface, this might look like an addictive personality but could be a sign that these deeper questions would benefit from exploration.

    Again, these are some of the factors that could contribute to someone experiencing an addictive personality. If any of this resonates with your own experience, feel free to comment and share!

  • How to Cope with a Crisis: The TIPP Skill

    How to Cope with a Crisis: The TIPP Skill

    When you experience a crisis – something sudden, unexpected, and immediately threatening, your body will do its job and automatically protect you by sending you into fight, flight, or freeze mode. This can be good and useful if you’re in a situation that demands immediate physical action like jumping out of the way of a car or running out of a burning building. You won’t even have to think, your body will do the work for you.

    However, let’s say you are no longer being immediately threatened and/or you’re having a difficult time calming down even after the crisis has passed. Or, maybe it’s simply no longer helpful to be in crisis mode. You’re going to need a skill to help bring the prefrontal cortex – the most recent part of the brain that evolved and which is responsible for executive functioning, planning, consideration of long-term consequences and benefits – online.

    A woman is yelling and is holding her head with both of her hands.

    To help jumpstart the prefrontal cortex, so to speak (actually, these skills will help down-regulate the body by activating the parasympathetic nervous system). I’d recommend one of my favorite skills from Dialectical Behavior Therapy (DBT), the TIPP skill. But please note you should consult with a medical doctor before using any of these skills if you have a heart condition, are pregnant, or have another health condition that you’re concerned about:

    • Tip your body temperature by putting an ice pack on your forehead, hold your breath, and bend forward so your head is between your knees for 30 seconds. Repeat for several rounds until you begin to notice your body down-regulating. For a more intense version, you could submerge your face (just up to your ears) in a pot of ice water and hold for 30 seconds.
    • Intense exercise: if you have space, do some sprints, or try some burpees, or even just jump up and down for several minutes. Anything to get your heart rate up like you are doing some serious exercise.
    • Progressive Muscle Relaxation: squeeze both feet and curl your toes in as tightly as you can without causing pain and hold for a few seconds and then release and notice the difference. Repeat at least two more times. Then do the same thing with your calves, your upper leg muscles, your core, squeezing shoulders up to your ears, clench your hands into tight fists, squeezing your face so you’re making a tight facial expression. It’s important to pause and notice the relaxed feeling after every “squeeze” round.
    • Paced Breathing: try Box Breathing where you inhale for four counts, hold for four counts, exhale for four counts, hold for four counts, and repeat. Or, try inhaling for about six counts and exhaling for eight counts (you can change the numbers as needed but just make sure the exhale is longer than the inhale). My own opinion is that it’s more helpful to aim for long, quiet inhales and exhales through the nostrils only while keeping the mouth closed.

    Once the body is in a calmer state (even if not totally relaxed), you will be able to think more clearly in order to consider your next steps.

  • Exposure and Response Prevention (ERP) for OCD

    Exposure and Response Prevention (ERP) for OCD

    One of my specialties is treating Obsessive Compulsive Disorder (OCD) with a type of therapy called Exposure and Response Prevention (ERP). This is one of the most researched treatments for OCD. To understand how it works, you also have to know a bit about how OCD works.

    OCD is characterized by obsessions and compulsions. Obsessions are unwanted intrusive thoughts and compulsions are any action or behavior that attempts to provide relief from the obsessions. But, as people begin using compulsions, they often have to do more and more to cope with the same obsessions. I’ve worked with many people who started treatment when it felt like they were spending most of their waking hours engaged in compulsions. This left them feeling burnt out, stressed, depleted and like they didn’t have any time or energy for all the good stuff in life.

    A person without their head or face visible is washing their hands.

    The unwanted intrusive worries that characterize obsessions can usually be categorized into different themes. Here are some examples of different OCD themes:

    • Contamination OCD: you might have intense worries about germs and use compulsions like excessive hand-washing, doing the laundry several times a day, going through a bottle of hand sanitizer in a few days or less
    • Harm OCD: worries about impulsively hurting someone else or hurting oneself, blurting something inappropriate out loud, etc. Compulsions might include avoiding sharp objects, biting the tongue, staying away from subway platform edges and keeping your hands in your pocket.
    • Pedophilia OCD: intrusive thoughts that you might be a pedophile even though you really aren’t. You might have compulsions that tell you to avoid going anywhere near kids or tricks to get the thoughts to go away (which usually only works temporarily)
    • Religious/Morality OCD: worries about being immoral, doing something profane or sacriligious, having “bad thoughts” about religious figures. Compulsions might include avoiding religious practices and activities, or over-engaging in religious practices such as praying for forgiveness or mercy because of the “bad thoughts” multiple hours a day.
    • There are many more themes too!

    ERP works by helping clients approach and expose themselves to the distressing stimuli (i.e., we’re going to stand on the edge of the subway platform, we’re going to touch the inside of the public trash can). It also helps clients learn skills to decrease compulsions (this is the Response Prevention aspect of ERP). This can be one of the most challenging types of therapies for anyone to do and requires a skilled therapist trained in ERP to support clients as they seek change. While these exposures can be intense in the short term, they provide longer term freedom and flexibility from a life controlled by rigid OCD rules and compulsions.