Worry vs. Problem Solving

Worry is one of the most common problems that brings clients in to work with me.

So what is worry?

Worry is triggered when our minds jump into the future and imagine bad outcomes, even if these outcomes are very unlikely. For example, imagine that you have to prepare and give a big talk for work. If you are a worrier, you will probably start noticing that scary mental images start “popping” into your mind, such as images of everyone in the room looking really bored, walking out, or being disrespectful.

The next step in worry occurs when we respond to the original mental image by trying to figure out ways that we can stop these feared outcomes from happening. I will prepare a lot. I will make sure to have well organized notes.

On the surface this kind of mental preparation seems quite helpful. The problem is that the anxious mind will immediately start thinking of reasons that these coping plans won't work. But what if I prepare hard and I still find that I haven't prepared enough? ...But what if I forget to take my notes with me?

So now we have a whole bunch of new problems to mentally solve. Okay I 'll leave my notes on the kitchen counter to remind me to take them. Again, this seems reasonable, except now your anxious mind will immediately produce an image of you being so stressed out that you walk right past your counter and forgetting your notes. And on and on it goes. Possible solution; possible problem with that solution. Until all of these different scenarios begin to spiral and multiply. Its exhausting.

On the other hand there's problem-solving. It starts in a similar way. We have a problem: we have a big presentation to give and we aren't fully prepared yet. But unlike with worry (which we tend to do while we are doing other things like shopping for groceries, watching TV, having a conversation with our partner etc etc) we decide that we are going to engage in problem solving as an activity unto itself. Another difference is that, unlike worry, we do problem solving on paper. This may sound a little unnecessary at first. But I am amazed at how important this is, because getting the problem out on paper makes it more concrete and tangible. And this helps us to stay on track and not to spin off into outer space the way that we do when we are worrying.

Once we define a problem on paper the next step is to brainstorm alternative actions that we might be able to take to solve it. For example we could set ourselves a plan of certain number of hours of preparation for the talk, we could lay our notes on the counter the night before, we could make a plan to go over the presentation in a mock rehearsal with some colleagues in advance etc etc. Once we have generated a reasonable number of alternatives, we go through the pros and cons of each one. And then we select one or a handful of these to try. And in another key difference from worry; we then actually put these strategies into place instead of staying stuck in mentally “planning”. And finally, we evaluate how well the chosen strategies worked so we can decide what to do next.

By learning to problem solve instead of worry, we end up solving the solvable problems in our lives sooner, more effectively, and with much less suffering along the way. Even more importantly, over time this strategy can help us begin to trust more deeply that even when bad things do happen, or even when the coping strategies that we try out at first don't work, we are much stronger and more able to cope then anxiety wants us to believe.

If worry is something that you struggle with in your life and you do end up working with me there's a good chance that I will end up presenting these ideas again and inviting you to experiment, with my guidance and support, in using the power of problem-solving to overcome the very real suffering that worry can help to create.

The Transformative Power of Effective Goal Setting

In this blog entry I want to write a little bit about setting effective goals.

This might not sound like a very sexy topic . But in my experience, both as a therapist and as a person, it's one of the most important topics around.

By setting goals I don't mean so much what particular goals we set (although this is also very important) but the process we use to set goals. This topic is passionate for me, and very closely connected to a story that I'd like to share.

About 15 years ago, when I was first beginning to train as a therapist, I had the opportunity to be a student co-leader in two consecutive cognitive behavioral therapy (CBT) groups for depression. SMART goal setting was one of the basic interventions used in this group program. When I first looked at the manual, I remember thinking to myself “Oh this goal setting stuff, it's so basic. I already know this stuff and so does everyone else. So why are we wasting valuable time on a skill that everyone already know?”

All these years later I couldn't see effective goal setting any more differently. To me now, effective SMART goal setting is a very potent mix of mindfulness, self compassion, and commitment. Let me explain why I say this.

The process of SMART goal setting requires you to do a number of things. The first is to decide what it is that you want to change in your life, for example to get into better shape. The second, in the spirit of friendly curiosity (which is the essence of mindfulness), is to simply notice and record how you have been doing in the chosen area in the last week or so. And the third is to set goals for the coming week from a self compassionate stance which accepts that whatever you discovered during the recording phase is what you are able to do at this particular point in our life and then starts setting goals from there (as opposed to the more familiar, judgemental stance in which we set goals instead based on what we think we she really “should” be able to do).

This sounds very simple and as a concept it is. I just explained it in 100 words or so. But in practice I have come to see that for many people this process is actually remarkably difficult. And I have come to believe that this difficulty is largley because of one thing, a defecit of self compassion.

As I led the first CBT group all those years ago I began to notice that the group seemed to break more or less into two separate subgroups.

There was a subgroup who allowed themselves to simply note what they seemed to be capable of doing, no matter how simple that was, started from there. For example, someone in this sub-group might say something like this to themselves “ I've always been an athlete. Before I got depressed a year ago I used to get to the the gym at least 4 days a week. But since I've been really depressed my monitoring tells me that in the last week I have done no exercise at all. I'm going to really give this SMART approach a try. I'm going to start where I am. This week I will go to the gym and ride an exercise bike for 10 minutes. I'll see how that goes and then take it one step at a time after that.” People who did this would usually get to the gym and achieve their goal because they were starting from a place of self compassion. As a result, they would feel a sense of success. This feeling of success would fuel them to set a slightly higher goal for the second week, of spending perhaps 15 minutes at the gym. Over time, this feeling of success would create a positive cycle, so that often by the end of the 8 weeks they had fully recovered from their depression, and had also armed themselves with a powerful tool to stop depression from coming back.

On the other hand, the second subgroup never really bought into the self compassionate stance that SMART goal setting  requires. They would tend to say something like this to themselves at the beginning of the group “I'm an athlete. A year ago I went to the gym 4 days a week. I haven't been to the gym at all in the last 6 months. So I'm going to “cut myself a break”. I will “only” make myself get to gym three times this week instead of four.” These people tended to get to the gym maybe once, like the people in the first sub-group. But rather than feeling a sense of success around this very real accomplishment they would instead feel like failures. This would lower their motivation for the second week. Often they would respond to this by getting even harder on themselves and say something like “Well I failed to get there 3 times last week so I'm really going to push myself and get there 4 times this week”. Which of coure they wouldn't. So while members of the the more self compassionate sub- group had a gradual but accelerating upward spiral, these people tended to stay pretty much where they were when started, continuing to set unrealistic goals and then punishing themselves as faliures.

I was so struck by what I had observed that, despite my intial skepticism, during the second CBT group I decided to set goals alongside the group members. I had recently been diagnosed with Type 2 diabetes. I was about 40 pounds overweight and was very unhealthy. I had been telling myself for years that I “should” get to the gym four times a week, without getting there hardly at all. So during my first week co-leading the new group I set a very different goal: walking around my neighborhood for 10 minutes, twice during the week. By the end of the group I was running for 20 minutes, four times a week. I had lost 10 pounds and was well on my way to losing another 40. I have kept (most of) that weight off for all of these of these years, and even more importantly, I have much more energy then I did when I was 30. These are accomplishments that I'm really proud of.

So , if we end up working together, I hope you'll understand if I end up talking excitedly about SMART goal setting with you, because I've seen the the power of this apparently simple approach to help transform people's lives. Including my own.