I had no plans to write this article today on loss and suffering. But the more I ponder the life and legacy of “Papa” and the times we are in, I believe more and more it’s a message to share. When hurting and suffering takes over and the complexities of life are weighty, I believe we can learn courage and longsuffering from the passing of a man just last week.
Three years ago in December, my wife underwent brain surgery- she had just given birth to our first child three months prior. In a month, we spent more days in the hospital than out of it. Besides prayer and connecting with loved ones, there’s not a lot you can do. This piece is not about my wife, though, it’s about Joe.
When my wife was at the edge of life and death and a room meant for waiting became one for crying and praying, the support of family and close friends was powerfully existent. But here sat Joe, and his wife Marion. We barely knew them in the grand scheme of things; however, we were suffering, and they wanted to sit with me and the rest of our close ones.
I’ve since learned many stories about this Joe, tough as nails and sweet simultaneously, his impressive life incorporated a long-standing marriage with children and grandchildren, military service, and a faithful pillar in his church. I’m not sure how much, if any, of those things I knew at that time. I only knew he was there to sit. To wait. To be with us.
Grief and suffering are some of the most complex topics on the face of this planet. We all grapple with it philosophically and existentially. The answers are not easy. But there is one thing that typically does not fail in supporting: sit with it. Sit with others as they suffer. Let me share from one of literature’s eponymous books, The Book of Job (in the Bible). Job had a few great friends when he lost nearly everything, and their support was incredible- until they opened their mouths. In the end, everyone ended up saying all sorts of crap that was untrue and without understanding, Job included. The friends did well- for as long as they just sat with their friend.
That’s the gift Joe gave to me in my time of suffering- he sat with it. Though it may be a funeral today, it is truly rejoicing at a life and legacy of a good man.
A common question I get is, “What if I get overwhelmed before we meet next?” If we have ruled out serious risks dealing with safety, usually there’s a simple tool that can seriously help (while working the treatment plan). Through the study of the brain, human behavior, and feedback from clients, here is a ripcord to pull in your emotional parachute: Pause.
If you suffer from anything like OCD, social anxiety, boundaries in relationships, panic attacks, or just get overwhelmed at times, to get out of that trench your first step will always be some sort of pause- to gain a clear head and observe what's occurring.
Whether you’re a professional who wants to be a better leader (see “Harvard Business Review’s “The Power of Pause”) or a stay at home Mom or Dad (see Very Well’s “Avoid Burnout When You’re a Stressed Stay-At-Home Mom”) or just want to increase learning with a 10 second rest, learn the art of taking breaks.
For example, exercise. What’s a goal you’ve had for yourself? Build muscle, lose weight, get toned, run faster, workout longer, heart health? All of these goals will not see large jumps of progress in a day. If the only running you've done is in your car to Whataburger, it's going to take some time to train up to a marathon. Trying to run 26.2 miles the first day is almost a guaranteed injury. It’s really not any different with mental health. In order to be successful at anything, you must be realistic as to your definition of success for today. If you get overloaded and stressed, you will need to pause in order to get out of that mental hole, and if you have any long standing patterns of problems, you'll need a strategy that can only come out of pausing and evaluating.
As we enter into the most concentrated holiday season in the world- especially the U.S.- this means a concentration of other things, as well. Family time. Work deadlines. Change to daily structure. Sickness. Time off. So if you get stuck- stuck in your emotions, stuck in a tough conversation about politics at the dinner table, stuck in negativity over your life decisions, stuck in panic, do this one thing: Pause.
That’s right, pause, Santa Claus. Feeling anxious? Pause. Stuck in depressive rumination? Pause. Enjoying the moment? Yep, pause and reflect.
Here's my "Exposure Friendly Mindfulness" video and exercise if you want a tool to help. Blessings to you, and Happy Thanksgiving.
This post is intended for Christians looking to deepen their faith and mental health and may not apply to my entire reader base.
My daughter Hattie went into hoarding mode this Halloween. Within 5 minutes, she was in MEGA-CUMULATION mode. Emily and I got some good parenting moments; “Hattie, you can choose 2 items from that basket.” (We had to say that about 30 times.)
I laugh often when she’s around food, toys, or playground equipment- like an old prospector she stakes her claim. She is offended that others dare lay claim to something she thinks should be hers! How dare they!
Now I’ll point the laughter at myself; I am not really that different. I’ve just become more savvy at being socially adept at my control attempts.
Hoarding of items to feel secure is a fairly natural response of our human nature, ranging in extremes. A scarcity mindset, i.e., “feast or famine” or to obsessively “protect what’s mine,” though, is selfish and self-focused. It does not “love your neighbor as yourself.” I recommend for myself today- and for you- to look in the mirror every once in a while and ask this tough question:
What drives you? Fear-based scarcity? GOD- as your provider? Something else?
A story may help illuminate the question. The Hebrew, ‘man hu’ means “It is manna,” and in English, “What is it?” This manna was an incredible food God provided refugee Israelites fleeing from a brutal autocracy that had enslaved them. It's all part of the incredible history of the Jewish people. God accomplished this over many years and utilized several key players, the most famous being Moses. In delivering Israel from Pharaoh and the Egyptians, God led them out through the leadership of a very imperfect man who likely had Social Anxiety Disorder, fulfilling incredible promises, miracles, and almost unbelievable wonders. It's one of the best deliverance stories, maybe in the history of history. If you haven't read it, please do so in the Book of Exodus.
So imagine being born into slavery, and you gain total freedom from an overbearing despot. But in order to get away, you must go through the desert. I feel tired and thirsty already.
In their refugee state, God promised the Jewish people refuge. But it wasn’t a magical transportation to heaven. Just days after they were freed, they felt the heat of the desert. They had to walk miles and miles. They complained. Only one of the seemingly unbelievable ways God provided for them was through fast, convenient, and sustaining food. It was manna (Exodus 16), which was given in the morning and quail at night. They were already complaing so much they said they wanted to go back to slavery because they had it better in Egypt (*face palm*). In addition to complaining, there was hoarding (Numbers 11) in desperation, lacking reliance on God. I can only guess fear would have been involved.
These details, with thousands of years of perspective can make it seem ridiculous to some when we read on paper or pixels. Why wouldn’t you just trust God when he frees you from slavery and performs many miracles before your eyes? I’m afraid my heart isn’t different. I am the same when I lack trust in God by faith.
What if you have an Anxiety or other Disorder that gives you an extra kick in the teeth? Something that makes these things extra difficult? First of all, God is patient (2 Corinthians 12:7-10; 1 Peter 3:9). Secondly, God asks us to seek Him by faith in all things, just like everyone else (Hebrews 11:6; 2 Timothy 2:4).
I have an anxiety disorder myself. And God has been incredibly faithful and gentle with me, while also lovingly disciplining me (see Hebrews 12), so that I keep seeking him. If you fall into a scarcity mindset [check out my post “Developing A Growth Mindset”], welcome to the club of being human, but if you also have a disorder that makes it even more difficult to walk by faith over fear, welcome to another club that is very large, indeed; close to half of all people qualify for one mental disorder at some point in their lives. Remember, God is patient. God also still asks us to seek Him by faith, just like everyone else. Sometimes walking by faith means praying, sometimes resting, sometimes therapy, sometimes talking, sometimes serving...you get the gist.
As with the Israelites during the Exodus, God accomplished many things over many, many years- and He still is. The Israelites feared, complained, got overwhelmed, and tried to stuff their pockets- directly lacking faith in what God was telling them and showing them. God was patient nonetheless, while he disciplined them. He’s asking us to faith. Faith that God is your provider. Not therapy. Not a nation. Not your employer. Not yourself. Not a president. Not a parent. Not your 401k.
Days out from the "great candy grab of 2020," my child's brain experienced the indelible impact of poignant pleasure: she asked daily after this if she could go to neighbor’s front porches!! As I raise her I am prayerful that she will learn well to take her fears and turn to God (and to never be ashamed to get help through CBT or medications). I pray she becomes aware of her God-given feelings and desires, and can ultimately be led back to the rock that is Christ- who is the realization of her greatest hopes and dreams.
Also, Candy is nice, too. I’ll take both, please. :)
Teddy pumped the sanitizer bottle for the second time in three minutes. “I know, I know, it doesn’t help when I haven’t touched anything else, but I want to be sure. You never know these days, right?” Freda waits to enter gatherings and meetings until everyone else has shown up- “It just helps me know I won’t run the risk of embarrassing myself.” Hassan skips driving over tall bridges. “Maybe it adds time to my commute, but I once heard of a bridge that collapsed, so you never can be too careful.”
Clinically, Safety Behaviors (aka “False Safety Behaviors”) are “unnecessary actions taken to prevent, escape from, or reduce the severity of a perceived threat” (APA PsycNet, 2020). Pursuing safety in a healthy context is valuable and will keep you alive- this is why work sites have a key motto: “Safety First.” However, notice the word “unnecessary” in the definition of a safety behavior.
If you feel fatigued, are a procrastinator, overwhelmed, anxious all the time, or just "stressed out," safety behaviors may be at play. When people start to have problems with my opening examples, they may still think that their behaviors aren't necessary to consider or aren't harmful in any way. I know! It's really tricky to differentiate at times, especially when many things we do, depending on context, can be helpful OR harmful. But imagine if there's 1,000 little examples in a day of double-checking, reassurance seeking, second-guessing- every extra second spent, movement taken, or second-guess made leads to extra stress, processing, and/or energy. When a person has a disorder like Generalized Anxiety, PTSD, Specific Phobia, Social Anxiety, and more (in OCD call them by a different term: compulsions), safety behaviors must be addressed for robust recovery.
We can categorize safety behaviors into several different types.
Any of the above might be healthy for any one person. It must be functionally assessed (what is the function of a behavior or thought?) to determine if it’s helpful or pathological (disordered). Using sanitizer after touching doors in a pandemic looks different than outside the pandemic. Checking in on your Amazon order status with an important order may help you plan your day. Having a baby monitor you look at for fun or in case of emergency can offer flexibility and safety. But for every positive example of these, there's an example that feeds fear: compulsive sanitizer use, online checking, or obsessive fear about a baby's health. You have the opportunity to evaluate your own head and heart (and may I suggest having some help with friends in the know, a therapist, a mentor).
Let's take Social Anxiety Disorder. Jenny learned to "cope" with her social fears starting in adolescence by just saying she was shy when around people. She would avoid gatherings where she had to interact with people she didn't know well, get her family to talk for her, and always carried her phone in case she needed to put in ear buds and look down. When she got to college she began to realize that events and activities she wanted to do felt really difficult. Making friends was a substantial challenge and led to shame and anger at herself and others. She couldn't place her finger on it, but felt embarrassed when talking with others and would often feel hot, her face became flush, and she would slip on her words. Her answer was to avoid and go back to her dorm to listen to music, quickly feeling better. She would later replay interactions in her mind and would run multiple mental scenarios before any social interaction. Jenny didn't realize that these were avoidance, distraction, and mental rumination/checking. They are safety behaviors, and they made her anxiety worse- much worse.
In therapy, your history will be gathered and rapport ideally built with your counselor. People who come to see me are so often relieved they're not alone, crazy, weird, or bad for struggling. How treatment goes depends on the person and their condition being treated, but transdiagnostically, when safety behaviors impair or limit a person, well want to do three key things:
Here's a personal example of how I've integrated this CBT work into my own life. I have the actual ability to speak and teach in public, write articles, and provide quality therapy. At any given time, I have had/do have various triggers to fear. For example, I gave a talk that was highly rated by all attendees (5 stars by 95%). One person literally stood up and started openly disagreeing during the talk over one quote (from an evidence based source) I had shared. I still don't know what the problem was, because it was ultimately inconsequential to the big picture, but something apparently 'hit a nerve.' Though I was still friendly with the person came redirected to talk afterwards (they didn't take me up on the offer), I unfortunately let this impact me for a bit, avoiding talks for about 9 months after, ruminating on what I did wrong and could have done better, and scanning groups of people in case my "heckler" was ever there again. I was living in fear and giving into safety behaviors.
I had always expected my nerves would calm down a bit after giving talks for 5-10 years. But unfortunately, I hadn't yet integrated CBT work in safety behaviors into my life, and so my stress remained stagnant, though I did engage in my goals (which involves public speaking). At the almost 15 year mark of giving talks, I now work on cutting out rumination at times I don't need to be thinking (going to bed, in the bathroom before a presentation, etc.), saying yes to any talk that's within my goals and expertise, and so forth. And the result is striking. My most recent presentation I gave had me observing to my wife, "Hey babe, this is really cool- I had a couple hours this morning where I didn't even think about it!" Nor was I very stressed. This takes time and growth.
You don't require a clinical diagnosis to grasp the value and benefit of catching and releasing safety behaviors. In fact, there's so much potential for the tools that almost anyone can benefit from them, whether you want to learn to work quicker, be more gentle with yourself, increase your processing speed and/or general "bandwidth" of stress tolerance.
In Conclusion. So in our world (especially the Western world) where safety is everything, go ahead and take a pause and evaluate some of your thoughts and behaviors. Ask for feedback from someone you respect (or find someone who can speak honestly to you). Do you have any limits in any sphere of life from checking, reassurance, safety aids, avoidance, or mental maneuvers? Do people say you're "tightly wound," perfectionistic, demanding, or unrealistic? Are you overly cautious? Are most people around you doing things you'd like to do but just can't? Go find the ways you "play it safe" but don't need to, and your life will be better for it.
APA PsycNet. (n.d.). Retrieved November 10, 2020, from https://psycnet.apa.org/record/2019-52029-002
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99, 20–35.
Blakey, S. M., Abramowitz, J. S., Buchholz, J. L., Jessup, S. C., Jacoby, R. J., Reuman, L., & Pentel, K. Z. (2019). A randomized controlled trial of the judicious use of safety behaviors during exposure therapy. Behaviour Research and Therapy, 112, 28-35. doi:10.1016/j.brat.2018.11.010
Behaviour Research and Therapy, 112, 28-35. doi:10.1016/j.brat.2018.11.010
Korte, K. J., Norr, A. M., & Schmidt, N. B. (2018). Targeting Safety Behaviors in the Treatment of Anxiety Disorders: A Case Study of False Safety Behavior Elimination Treatment. American Journal of Psychotherapy, 71(1), 9-20. doi:10.1176/appi.psychotherapy.20180001
Riccardi, C. J., Korte, K. J., & Schmidt, N. B. (2017). False safety behavior elimination therapy: A randomized study of a brief individual transdiagnostic treatment for anxiety disorders. Journal of Anxiety Disorders, 46, 35–45.
Salkovskis, P. M., Clark, D. M., Hackmann, A., Wells, A., & Gelder, M. G. (1999). An experimental investigation of the role of safety-seeking behaviors in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy, 37, 559–574.
Schmidt, N. B., Buckner, J. D., Pusser, A., Woolaway-Bickel, K., & Preston, J. L. (2012). Randomized control trial of False Safety Behavior Elimination Therapy (F-SET): A unified cognitive behavioral treatment for anxiety psychopathology. Behavior Therapy, 43, 518–532.
Telch, M. J., PhD. (n.d.). False Safety Behaviors: Their Role in Pathological Fear. Retrieved November 10, 2020, from https://labs.la.utexas.edu/telch/files/2015/08/Safety-Behavior-Handout-latest-8.1.15-1.pdf
Wells, A., Clark, D. M., Salkovskis, P., Ludgate, J., Hackmann, A., & Gelder, M. (1995). Social phobia: the role of in-situation safety behaviors in maintaining anxiety and negative beliefs. Behavior Therapy, 26, 153–161.
I recorded a full length episode for the OCD Stories with Stuart Ralph, based in London, this summer. He just dropped the final version. You can listen FREE on all streaming platforms.
One of my goals was to speak in a way where most people could connect or find something beneficial in this podcast. I hope you enjoy!
A Psychotherapists' thoughts on healthy living.
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