Mindful Relationships Part 4: Presence as a Source of Passion

Passion in relationships is often thought of as a strong emotional or sexual connection to one’s partner. While this is often a start to many relationships, sustaining that intense enthusiasm can be difficult over time. In fact, relationships that are based on passion alone often struggle because they do not make room for the reality that our feelings often wax and wane.

Relationships founded on passion alone also tend to struggle with the fact that partners see an idealized version of one another and there is sometimes little room for the variety of feelings both positive and negative that one can feel for someone that they are in a long-term relationship with. Passion-based relationships can also can also struggle with a competitive or tit-for-tat quality that has partners playing for opposites sides rather than working together as a team (Walser and Westrup, 2009).

While having a strong emotional connection to your partner can feel amazing, it can be more helpful to build a sense of connection that is focused more on vitality rather than on raw emotion or sexual chemistry. In this case, vitality refers to a sense of liveliness or active engagement in the relationship (Walser and Westrup, 2009). This level of investment in the relationship can help your bond to stand the natural ups and downs that all relationships face as changes take place and stress comes and goes.

There are some helpful practices that allow you to focus on building a sense of connection and vitality in your relationship (adapted from Walser and Westrup, 2009):

Be mindful of the sound of your relationship. Pay attention not only to what your partner says but to the sounds of laughter, tears or the voice crack of pure excitement.

Appreciate your partner’s physical presence such as the warmth you feel as you sit next to each other on the couch or the calm you feel when experiencing a forehead kiss or touch on the shoulder.

Be thankful for the opportunity to grow old together including the ways in which you each age over time. For example, notice the laugh lines that mark the many smiles and good times that you have shared or even a few extra new pounds from a string of delicious meals shared. Be aware that aging with someone is an honor and a very intimate experience.

Notice the cute things that your partner does. This can take effort because we often attend more to the annoying things than the good ones. Maybe you will start to see things you have missed such as a funny expression or a loving, idiosyncratic gesture.

Take the time to ask your partner about something that he/she finds interesting or important and really listen to the response that is shared both verbally and non-verbally.

Lie next to one another with mindful awareness simply noticing what it feels like to be physically close or hold hands and simply notice the sensations of touching.

Learn about a hobby your partner enjoys and join him/her with sincerity and a curiosity about the joy he/she finds in this activity.

Purchase a small gift that your partner would find meaningful, thoughtful or symbolic. Let your partner understand that you see who he/she is.

Ask what you can do to support or help your partner and follow through. Check back to see how he/she felt about the experience.

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc. 

Mindful Relationships Part 3: The Slippery Slope of Integrity

We all know that living with integrity means matching our behaviors to our values. It means doing the “right” thing. Many times, having integrity is easy. But sometimes, upon closer examination, we may find that there are times when we slip unintentionally.

An example of slipping is when we withhold information from our partners because we don’t want to rock the boat or hurt their feelings. Maybe your partner does something that irritates you and when they ask why you seem upset you simply dismiss the question or offer a false reassurance that you are “fine”. This reaction may not seem like a big deal and if it happens once in a while it is unlikely that it will cause significant problems in your relationship. However, these innocent “white lies” can become a habit that can undermine your ability to fully engage with your partner. Clearly, your intention is good in the moment but the outcome of these repeated transgressions can actually lead to the opposite of what you are trying to accomplish. It also easy to see that one partner can go from a “white lie” that is not meant to hurt their their significant other to a full blown lie because they may not want to admit things to their partner that they know are hurtful or damaging, such as that they spent money that they should not have or talked with an old flame. 

Other examples of types of interactions that can undermine your integrity within your relationship are going along in a situation that you don’t agree with (e.g. riding in the car with your family while your partner is texting and driving) or not being honest about strong feelings you may have (e.g. feeling that you can’t trust your partner or that you are feeling frightened about something in your relationship). As you can see, all of these examples have the potential to erode the quality of your partnership.

So what can you do to maintain your own integrity and strengthen your relationship? Here are some ideas (adapted from Walser and Westrup, 2009):

  1. Spend some time listening for the voice in your head or heart that guides you to make decisions that are in line with your own values. When you hear it, challenge yourself to follow your own advice.

  2. Give yourself a moment to think before you engage or answer a question in order to ponder whether your answer is actually aligned with your true values and feelings. Be mindful and try not to let yourself get away with simply saying what is easy. Keep in mind that you have the opportunity and ability to respond with integrity in every situation. Know that you can be honest and sensitive at the same time if you give yourself a moment to formulate your thoughts.

  3. Take some time to think about times in your relationship when your integrity slipped away (e.g. times when you may have lied or withheld information, times when you didn’t share your true thoughts or feelings). Think about what your own internal voice may have to say about those times now and how you might have wanted to behave differently if given the chance to do things over.

  4. Look for an opportunity to take as step closer to living with more integrity in your relationship. Reflect on whether there might be a feeling or concern you want to share with your partner. Take a chance and tell the truth about something you might have otherwise told a white lie about. See how these changes influence your interactions with your partner.

  5. Talk with your partner about times when either of you might be inclined to share a white lie rather than the truth. For example, if your partner asks how they look in a particular outfit. Talk about what the person asking is looking for (i.e. reassurance or honest feedback) and then move forward in those conversations knowing that you can provide an answer that matches what your partner needs and allows you to be honest. (e.g. you might say that your partner looks good no matter what they are wearing if they are looking for reassurance and you might give honest suggestions if they are looking for fashion advice)

Living and relating with integrity takes attention and mindfulness. Most of us don’t intentionally take actions or engage with those with care about in ways that undermine our values; however, as you can see, small actions repeated over time can have long term consequences that can have a lasting impact on the quality of your interactions. Take some time to notice how you can show up in a different way that is more closely aligned with what is important to you and you are likely to feel more satisfied in your relationship. 

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc.

Mindful Relationships Part 2: Valuing Authenticity

So we hear a lot about the importance of leading an authentic life. What does this really mean? Authenticity is about being genuine and trustworthy in the way that we interact with ourselves and the world around us. Sounds like a great approach in relationships but why do we struggle with this?

The reality is that it is a challenge to show up as your true self. This approach requires that we notice those external and internal factors that push us to compromise our value of authenticity. The pressure to appear as a certain kind of person in our interactions with others can interfere with our ability to keep in touch with our genuine sense of self. 

In relationships, this pressure may show up in our self-talk. We can find ourselves veering into “I’ll be whatever you want me to be” territory in order to keep the other person interested. When the inauthentic self shows up in those moments we may be inadvertently selling something different than who we truly are.

Let’s look at how this played out for Susie:

Susie met Trevor at a party. The two spent the evening with a group of friends laughing and telling stories. Susie was confident, witty and intelligent. The group clearly found her engaging and refreshing. She was being herself and her friends new and old enjoyed her company. At the end of the night, Trevor asked her out thinking that she would be a great person to spend more time with. On their first date, Susie was nervous and began to think about what type of person Trevor might find interesting. She was quiet and withdrawn. She let Trevor do most of the talking. She was agreeable and friendly enough. However, instead of letting herself show up as her authentic self, Susie became focused on figuring out what Trevor might find impressive about her and in turn became less interesting. The date was nice enough but certainly ended without the spark that Trevor had hoped for. 

We can see here that Susie lost the aspects of herself that were most appealing to Trevor because she had lost touch with her sense of self and became too focused on her date. Although this is a small example, it is easy to image all the ways in which each of us dull a bit of our own spark in the interest of appealing to others. 

Now, let’s take a look at Mitch:

Mitch and Anna have been together for several years. They are happily in love and recently got married. Mitch has been working at that same insurance company since college and has been feeling unfulfilled at work. Lately, he has found himself thinking more and more about alternative career paths and he has come to the realization that he may be happier if he returns to school to pursue his teaching credential. He has mentioned his dissatisfaction to Anna in passing and has found her to be rather disengaged from this discussion. Mitch has become increasingly concerned that Anna and their families will see him as less of a provider if he decides to quit his lucrative job and return to school. Instead of allowing his true feelings to be present and share them with his wife, Mitch finds himself trying to focus on other things to make himself happy.’

Here we can see that Mitch is feeling self-conscious about his job choice and instead of exploring his own desires and sharing them with Anna, he is taking the path of least resistance and finding other ways to channel his energy. While this approach may keep the peace in the short run, we can see how the long term implications could cause feelings of dissatisfaction and even resentment later on. Again, this is just one example but it illustrates the tendency each of us can have to want to stick with the status quo rather than tackle a difficult discussion, hence giving up a bit of our true self. 

Both of these are clear examples of how our internal voices and external pressures can get in the way of expressing our genuine feelings, hopes and desires. It can be hard to get out of our own way and let our true sense of self shine through. However, as we can see, our desire to be pleasing and avoid conflict often leads to the loss of our authenticity.

So what can we do? Here are some ways to think about and practice cultivating a greater sense of authenticity in your relationship (adapted from Walser & Westrup, 2009):

  • Begin by reflecting on areas where you could increase your level of authenticity. It can help to find a quiet time to think about areas in your relationship where you may be struggling to be authentic. Ask yourself the following questions:

    • What may be leading to this struggle? Is it fear or some other emotional response?

    • What might happen if that emotion was not dictating your behavior? What might you do differently?

    • Are there some small ways that you might be able to change your behavior so that you can get closer to being more authentic?

    • Are there particular conversations that you may be avoiding that, although challenging, may create a path toward a more genuine interaction and a greater sense of intimacy?

    • What are your hopes and desires for yourself? How might you share those with your partner?

  • Consider changing some of your actions in the following ways:

    • Practice reflecting on and expressing your own likes and dislikes

    • Challenge yourself to share your thoughts and feelings

    • Remind yourself that when you are being truly authentic there are times when disagreements are sure to happen

    • Look for ways in which being authentic helps to you achieve a greater sense of intimacy

    • Reflect on whether you are being true to your own thoughts and values as you make decisions and interact with your partner

  • Spend some time examining your core values. Click here for some helpful ways to examine what is most important to you.

Taking some time to find your own authentic voice can have a powerful impact on how you show up in your relationship and can lead to a stronger and deeper connection with yourself and your partner. 

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc.

Mindful Relationships Part 1: The Honeymoon Trap

Experiential avoidance is a term, used in Acceptance and Commitment Therapy (ACT), that refers to the mental acts or behaviors that we perform in order to stay away from feelings or thoughts that we don’t like. For example, it you have a feelings that you don’t like, such as sadness, you are likely to try to find a way to get rid of that feeling. Along with this feeling, you are likely to also experience a range of thoughts such as, “I shouldn’t be upset,” or “Just snap out of it.” What people often do next is to try to avoid whatever it is that may be upsetting them. It makes sense, right? If something feels bad then we just stay away from it and then we can feel good and happy all the time.

Any chance you see a problem here? The challenge lies in the fact that “negative” feelings are a part of our experience as humans. No matter what we do, we are going to have to come in contact with the full range of emotions that we are capable of feeling. So why do we do avoid negative or uncomfortable emotions? Because we are told all the time that we should just do what feels good. All you need to do is to turn on the television to see, that as a culture, we value being happy and are given a multitude of ways to buy our way into that feeling. Relationships are no different.

According to Walser and Westrup (2009), the “story” that society gives us for what a good relationship can be explained like this: “A good relationship is a happy relationship. And a happy relationship is one in which you feel happy, your partner feels happy, your family is happy about your happiness, and even the dog is happy!” Walser and Westrup (2009) go on to say that, “Good relationships aren’t about being happy. They’re about vitality and about manifesting life to its fullest within the relationship.” So what does this mean? It means that you and your partner will feel the happy feelings such as joy, pleasure and love as well as pain, sadness, anger, fear, anxiety and more. This means that in order to be in a successful relationship, we need to be willing to work with our partners as we we travel the myriad of human emotions. 

You may ask, What happens if we just stay in the happy, honeymoon phase forever? Well, there are a few problems with that. The first, is that these negative feelings give us valuable information. If you forget that you were sad, angry and hurt when someone in your past did something that upset you, then you may find that you allow people back into your life that may treat you that same way again. A simple example relates to the feeling of anxiety. Without the mechanism that creates anxiety, humans would never have survived because we would have lost that famous “fight or flight” response that has protected our species since the beginning of our existence and has helped us escape basic threats to our well-being such as predators or dangerous situations. 

Another problem is that we cannot experience the good without the bad. A classic example is that with love comes pain. In order to truly love someone, you will feel the pain of losing them at some point. If you have ever met a couple who has been together 50 or more years, you can see that they know this deeply. Hilary Stanton Zunin says it best when she explains that, “The risk of love is loss, and the price of loss is grief. But the pain of grief is only a shadow when compared with the pain of never risking love.” So, we learn that in order to really experience the wonder it is to feel this deep human experience that we call love, we must be willing to also feel the pain of loss. 

In addition, we know that we cannot go back and undo something that has happened. This means that you can’t erase hurt feelings once they have been felt. So, despite your best efforts to forget that you felt sadness when you broke up with your first love or that you were hurt when your partner forgot an anniversary or some fact or event that was important to you, it is impossible to do so. These experiences are part of what make you who you are and they influence the choices that you make. 

Like experiences, our thoughts also cannot be erased. So, once you have the thought that something was hurtful you can’t simply unthink it. If you say to yourself, “She is so inconsiderate.” You aren’t going to forget that. It is actually more helpful to just observe it. You can then either accept it and move on or you can take some time to challenge the thought because you know that it was just a quick reaction that doesn’t really reflect your overall opinion. 

So where does this leave us? The most important thing to take away is that being in a relationship means experiencing the ups and downs. This does not mean that you have to stay in an unhappy partnership. What it does mean is that you don’t have to beat yourself (or your partner) up because you may be struggling. Simply start by thinking about whether this is the person that you want to be with in both the good moments and the hard ones. If so, then it can help to simply be mindful and notice what kind of moments you may be having at different times throughout the day or week. 

As we move forward in this series, we will begin to use the principles of Acceptance and Commitment Therapy (ACT) to begin to explore how focusing on your values, accepting yourself and your partner, being more open and present and committing to what is most important to you, can help to create a more meaningful connection in your relationship. 

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc. 

Part 2: Who’s in Control Anyway? Cognitive Defusion to Move in Valued Directions

In a previous blog I talked about cognitive defusion, a key concept from Acceptance and Commitment Therapy (ACT). I presented some exercises designed to help you create distance from your thoughts. In this post we will explore the impact of fusing with thoughts and how we can use cognitive defusion techniques to help us live our lives authentically.

Almost all form of psychological distress or angst is rooted in our tendency to merge with thoughts and treat them as if they were literal truths. Because we get so caught up with what is happening in our thoughts, we often lose track of what we truly value in life. For example, if someone has a panic attack at a mall, they may find that they are consumed with how they will panic and be embarrassed the next time they go to the mall. When fused with these anxious thoughts, the person is likely to avoid going to malls and their lives become a bit more constricted. However, there are limitless situations where one could panic and be embarrassed and one’s life can grow increasingly narrow and focused on avoiding the pain of panic and embarrassment.

Cognitive defusion techniques are designed to help us create some distance from our thoughts so that we can have a choice in our behaviors. Here is an exercise I often use myself and to help create some distance from thoughts. The Passengers on the Bus exercise which is commonly used in Acceptance and Commitment Therapy (ACT) helps us gather some perspective on our thoughts by treating them as objects. To illustrate the Bus Exercise, I will use a fictitious client.

Alice is a divorced 45-year-woman who has been working as a registered nurse on the oncology unit at the local hospital for many years. She is caring and efficient at her job and has had many opportunities to expand her professional role. Recently she was offered a position as a trainer and manager, but she has been unable to make a decision to take the position due to her severe phobia of public speaking. Alice completes the “Passengers on the Bus” exercise as part of therapy.

First, Alice is asked about what matters to her most in life, what she wants her life to be about. Without hesitation she says that she wants to help as many people as possible. She acknowledges that this new position she has been offered would be an opportunity to help teach young nurses to be competent healers.

Alice then identifies what is holding her back from taking the next step in her career – the thoughts, feelings and memories that are her passengers on the bus. She identifies intense physical sensations of panic as she speaks with more than three people (passenger 1) accompanied by thoughts like, “If people see how nervous I am they will think I’m a complete freak” (passenger 2), “Maybe I don’t really know what I’m doing” (passenger 3) and a really old voice that says, “You’ll never amount to anything” (passenger 4).

Alice will try anything to quiet the denigrating voices and intense panic because she just wants these experiences to go away. She has managed to avoid situations where she’ll be asked to speak for years and this has worked to reduce her anxiety, but it is always there, lurking. In addition, Alice feels a low level sense that she’s missing something vital in her life. She knows that she is not moving in the direction of her values.

In the final step of the exercise, Alice is to imagine that these passengers on the bus can yell and be loud and try to intimidate her but they cannot do anything to actually hurt her. She actually has a choice, she can fight with the passengers or simply allow them to be while continuing to drive her bus in the direction that is important to her. In this way, Alice can choose to pursue mentorship opportunities while also experiencing anxiety about public speaking and self-doubt.

After reading this try to apply the Bus Exercise to some troublesome thoughts in your own life. Try to think of a situation you’ve been avoiding due to difficult internal experiences. Can you picture these experiences as passengers on your bus that are welcome to come along for the ride? By reestablishing your role as the driver of the bus, you can create space to live in line with your values.

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Part 1: You Are Not Your Thoughts: Cognitive Defusion to Change Your Mood

“As a man thinkith, so is he,” is a profound statement. Though perhaps not its original intent, this phrase highlights our tendency to become so embroiled with the content of our thoughts that we lose many other aspects of ourselves. The concept of cognitive fusion refers to our tendency as speakers of language to merge our thoughts about events with the events themselves. Put another way, we lose sight of the fact that we are actually thinking and accept the content of our thoughts as reality. While this is useful for a great many tasks, it means that we often lose touch with many aspects of the present moment such as touch, texture and bodily sensations. When we interpret our thoughts as reality in this way, they have tremendous power over us.

Depression, one of the most common mental health issues in the United States, is characterized by negative thinking. Common depressive thoughts are, “Nothing ever goes right for me,” “What’s the point?”, “I’m a failure,” “I can’t handle it anymore.” These negative thoughts become the reality of the world we construct.

One of the most effective psychological treatments for depression, cognitive behavioral therapy, focuses on using techniques to change the content of negative and maladaptive thoughts. Newer cognitive therapies, such as Acceptance and Commitment Therapy, have refocused on helping people change their relationship to thinking using a technique called cognitive defusion.

Cognitive defusion is a process by which we can gain a greater perspective of language and thinking. This creates distance from thoughts and allows for greater freedom and flexibility. Cognitive defusion exercises are particularly useful when you find yourself trying to control your thinking, are generating reasons to justify an unhealthy behavior or are so attached to being “right” that it harms your life in some way. Below are some strategies you can try to gain some perspective on your own thinking;

1.     Create distance from your thoughts. Try to preface problematic thoughts with, “I am having the thought that ….I am a loser.”

2.     Repeat a troublesome thought out loud over and over until it loses its meaning.

3.     Try singing your thoughts or saying them in funny voices.

4.     Visualize a river with leaves floating along. Picture calmly placing each thought on a leaf and watch as it floats down the river.

5.     Picture yourself as a mountain, with changing seasons, storms and all kinds of weather. The mountain remains rooted and grounded, unchanged by passing storms. You can be like the mountain and observe thoughts, feelings and sensations.

For people struggling with depression negative thoughts can be overwhelming. Hopefully, the above cognitive defusion techniques can help to create some distance from thoughts and allow greater flexibility to move in valued directions. In the next installment I will demonstrate how to use these techniques with common negative thoughts.

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives. 

Multiple Sclerosis and Anxiety

Multiple sclerosis (MS) is a common neurologic disease that affects approximately 2.3 million individuals around the world. Emotional disorders, such as anxiety, are more common in people diagnosed with MS than in the general population. In fact, approximately 40% of people with MS will experience impactful anxiety in their lifetime. 

What Ways Do People With MS Experience Anxiety?
Anxiety is an umbrella term. There are many different ways people can feel or experience anxiety. Some examples include: generalized anxiety, social anxiety, panic attacks, phobia, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). Panic attacks, specific phobia (an intense fear of a particular thing, such as injections or spiders), and obsessive-compulsive disorder (OCD) are more common in MS than in the general population. However, the most common form of anxiety in MS is generalized anxiety, which is characterized by chronic daily worry. If chronic daily worry reaches a certain threshold of intensity or frequency, and it interferes with your ability to function day-by-day it can be diagnosed as an anxiety disorder. This is called generalized anxiety disorder (GAD). 

A Little More About Generalized Anxiety
Generalized anxiety disorder can be difficult to diagnose and treat because many of the symptoms overlap with common symptoms of MS.  Let’s look at the diagnostic criteria for GAD in more detail:

A diagnosis of GAD is made when an individual experiences excessive, uncontrollable worry and 3 or more of the following symptoms on most days for at least 6 months:
•      Restlessness, feeling “keyed up” or “on edge”
•      *Fatigue
•      *Difficulty concentrating or feeling like your mind goes blank
•      Irritability
•      *Muscle tension
•      *Sleep disturbance: difficulty falling asleep, staying asleep, restless sleep, or unsatisfying sleep

At least 4 of 6 of the GAD symptoms can ALSO be symptoms of MS (*starred above). Thus it can sometimes be difficult to distinguish between what is MS, what is anxiety, and what is both!

So Why Is Anxiety More Common In MS?
Overlap of Symptoms. As we noticed above, a partial explanation is the overlap of symptoms. Because anxiety shares some similar symptoms with MS it is “easier” for someone to meet a diagnostic threshold, or meet the criteria for an anxiety disorder.  However that is not the whole story!

An Emotional Response. Living with a chronic progressive condition, like MS, can be very stressful; there is inherent uncertainty. One might be led down a rabbit hole of worries. You might worry about the disease itself (e.g., Will my disease progress? How fast will it progress? What symptoms might I have in the future? When will I have my next exacerbation?). These thoughts might lead to worries about how MS could impact daily life, work, and family. Anxiety is most common when there is uncertainty about your health condition, especially when newly diagnosed or during relapses.

A Symptom of the Disease. More research is needed to understand the physiological factors that contribute to anxiety in MS. However, there is some evidence that the Fight or Flight Response is disrupted in people with MS who experience anxiety. The Fight or Flights Response is a function of the hypothalamic-pituitary-adrenal axis – a complex system that controls our reaction to stress. Finally, certain medications commonly used in MS have been linked to increased anxiety.

How Do I Know If I’m Anxious?
A questionnaire called the GAD-7 (https://adaa.org/sites/default/files/GAD-7_Anxiety-updated_0.pdf) can help to screen for anxiety. A score of 10 or more on the scale means that anxiety is interfering with your daily life and should be discussed with your medical provider.

Since there are overlapping symptoms between MS and anxiety, it’s best to consult with your health care provider. Your provider will help determine if what you are experiencing is, in fact, anxiety. They can also help you decide the best treatment.

Why Should Anxiety Be Treated?
It is important to treat anxiety. If left untreated, anxiety can interfere with your ability to successfully function in day-to-day life. Anxiety is also associated with: increased pain, poor sleep, more fatigue, MS exacerbations, and pseudo-exacerbations. Anxiety can almost always be treated with counseling (psychotherapy) and/or medications.

Psychotherapy
Cognitive-Behavioral Therapy (CBT) is very effective in treating anxiety disorders. This type of therapy helps you identify and alter maladaptive thinking patterns (cognitions) that reinforce worry and anxiety (e.g., “If I have another exacerbation, I’ll lose my job!”). This therapy also helps you identify and modify actions (behavior) that trigger or reinforce worry and anxiety (for example: avoiding feared situations or objects like injections, doctor appointments, or MRIs).

Acceptance and Commitment Therapy (ACT) is another effective treatment, especially for GAD. The primary goal of ACT is to find ways to pursue your chosen values, despite difficult and potentially unchanging life circumstances (e.g., a diagnosis of MS). 

Medications
Medication does not cure anxiety, but can keep symptoms under control while you learn coping strategies, or until life stressors decrease.  Medications most commonly used for anxiety include: •       Antidepressants: SSRIs, Tricyclics, or MAOIs
•       Anti-Anxiety Medications: benzodiazepines, buspirone
•       Beta-Blockers (prevent the physical symptoms that accompany certain anxiety disorders such as  increased heart rate)

Other strategies for reducing anxiety
•       Mindfulness based stress reduction (MBSR) – Free guided podcasts can be found on the UCLA Mindful Awareness Research Center website (http://marc.ucla.edu/body.cfm?id=22)
•       Deep breathing
•       Regular exercise

How Do I Find Treatment?

If anxiety seems to be a problem for you, talk to your health care provider. He or she can refer you to a mental health professional.  If you are diagnosed with MS, or are the family member/care provider of a person diagnosed with MS, the National MS Society can help. Check out their website (www.natioanlmssociety.org) or call the MS Navigator Program at 1-800-344-4867. Additional resources are listed below.

Resources

National MS Society: Emotional Changes in MS. http://www.nationalmssociety.org/about-multiple-sclerosis/what-we-know-about-ms/symptoms/emotional-changes/index.aspx

National MS Society: Stress

http://www.nationalmssociety.org/living-with-multiple-sclerosis/healthy-living/stress/index.aspx

National MS Society: Exercise is Medicine

http://www.nationalmssociety.org/chapters/was/programs–services/exercise-is-medicine/index.aspx

NIMH: Treatment of Anxiety Disorders

http://www.nimh.nih.gov/health/publications/anxiety-disorders/treatment-of-anxiety-disorders.shtml

 Shadday, A. (2007). MS and your feelings: handling the ups and downs of multiple sclerosis. Alameda CA: Hunter House.

Meghan Beier, PhD is a Rehabilitation Psychologist and Clinical Researcher at the University of Washington Medicine Multiple Sclerosis Center. Dr. Beier obtained her Ph.D. from Yeshiva University, and completed a 2-year Multiple Sclerosis rehabilitation research fellowship in the Department of Rehabilitation Medicine at the University of Washington School of Medicine, which was funded by the National Multiple Sclerosis Society. Her research and clinical focus is the cognitive and emotional symptoms common to multiple sclerosis. 


REFERENCES

1.         Haussleiter IS, Brune M, Juckel G. Psychopathology in multiple sclerosis: diagnosis, prevalence and treatment. Ther Adv Neurol Disord. 2009;2(1):13-29.

2.         S D, Burke T, Bramham J, O’Brien MC, Whelan R, Reilly R, et al. Symptom overlap in anxiety and multiple sclerosis. Mult Scler. 2013.

3.         Eifert G. Acceptance and Commitment Therapy for Anxiety Disorders: Three Case Studies Exemplifying a Unified Treatment Protocol. 2009;16(4):368–85.

Disclaimer

This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.

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