Understanding Intrusive Thoughts

Just about everyone has intrusive thoughts. They are uninvited thoughts that jump into the mind and do not seem to be part of the ongoing flow of intentional thinking. Intrusive thoughts are common, but for most people they are quickly forgotten and create minimal or no discomfort. For someone who isn’t struggling with or worrying about intrusive thoughts, they provide weird, uncomfortable, or even funny moments…and then they are over. Sometimes they startle. Most intrusive thoughts—no matter how bizarre or repugnant—occupy only a few moments. People rarely mention them or think about them again. They’re just not worth mentioning (unless they are really funny).

There are times when anyone can be reminded of a previous intrusive thought and shake their head, Oh I remember that this is the elevator where I had that utterly weird experience of thinking that I was going to suddenly shout out an obscenity. Sometimes—for a while—elevators and thoughts about shouting out obscenities get temporarily stuck to each other. One is associated with the other. It means nothing. The human mind just makes associations like that automatically. The experience, while strange, is unimportant and goes away.

An unwanted intrusive thought starts as just an ordinary intrusive thought, weird, funny, or repugnant as it may be. But not wanting the thought, worrying about it, or fighting with it stops it from passing quickly.
Chances are, you don’t want it because you’re upset or turned off by the content.

But that is just the beginning. Because you worry about it, reject it, and try to push it out of your mind, it pushes back and becomes a recurring thought or image.

After a while, it starts to redirect your attention: It starts arriving with a “whoosh,” and feels awful, disgusting, or dreaded. It contains an urgent feeling of needing to get rid of it. The content of many
unwanted intrusive thoughts is aggressive, sexual, taboo, anxiety-provoking, or self-derogatory.

Your efforts to deal with it become all-encompassing and take up so much time, mental energy, and focus that your quality of life is degraded.

Unwanted intrusive thoughts tend to recur repeatedly and seem to increase in intensity over time. Eventually, along with an increase in the frequency and intensity of the thoughts themselves, you might start to doubt and fear your own intentions, morality, self-control, and sanity.

What to Do

Accept and allow the thoughts in your mind. Do not try to push them away. This is a complicated suggestion, but for the present, your job is not to distract, not to engage, and not to reason away.

Don’t allow yourself to start exploring the ideas or content of your thoughts. Don’t try to come up with a plan or solve any problem that appears to be created by your thought. When you do this, you’re
trying to figure out the answer to a problem that has no answer. Furthermore, it is not a problem!

Accept and allow means that you’re actively allowing the thoughts to be there, not wishing they were gone, because this attitude helps you grasp that the thoughts are unimportant. They do not require any
attention or response. You might even welcome the thoughts as another opportunity to teach the brain a different way.

Intrusive Thoughts are Normal

The fact is that everyone has passing weird, aggressive, or crazy thoughts. If every thought spoke to our underlying character, then 90 percent of people would be weird, aggressive, or crazy. That is because about 90 percent of people acknowledge having intrusive thoughts that they characterize as weird, aggressive, frightening, or crazy. And think about some of the horror movies and TV shows that are so popular these days. Perhaps you’re unable to watch them because they trigger too much fear. But remember that these awful, weird, aggressive, and crazy scenarios are thought up by normal, creative people. They are simply writing scripts that other people will want to watch.

It’s a myth that weird or nonsensical thoughts indicate loss of control over your mind or even mental illness. It’s also false that if you have repugnant intrusive thoughts, it could mean that you’re a perverted or disgusting person.

People with unwanted aggressive or violent thoughts may become fearful that they are violent or angry despite having no awareness of these emotions, and that their true feelings are indicated by these thoughts. Not only may they come to believe that they must be bad people at their core, but they may also feel an extra burden to exercise serious control over these thoughts.

The truth is we all have mental activity going on outside of awareness, and it’s interesting to wonder how certain mental events happen to pop up. But there is no truth to the idea that blips of intrusive 16 thoughts and images reveal underlying truths. It is not true that intrusive thoughts reveal motives, feelings, and intentions that are deeply meaningful or contain messages that need to be addressed when they differ from conscious thoughts, feeling, and intentions.

What to Do

Allow time to pass. Don’t urge it on. Observe your anxiety and distress from a curious, disinterested point of view. Do not keep checking to see if this is working; just let the thoughts be there. They are thoughts. There is no hurry. Allowing time to pass is one of the most important skills for recovery. Remember that any thought that produces a repeated feeling of urgency is a sign of anxiety. A feeling of urgency is discomfort, not danger. It comes automatically with the thoughts, but it is not a signal for action.

Slow down. Let it be. You are dealing with discomfort, not danger. Time allows your normal calming reaction to take effect, on its own, naturally.

PP. 6-7, 15-16 Excerpt taken from The Intrusive Thoughts Toolkit

Written by a team of mental health experts and grounded in evidence-based therapy, Intrusive Thoughts Toolkit provides fast-acting tools for soothing distressing thoughts in the moments when you need it most. With this take-anywhere guide, you’ll learn proven techniques to get unstuck from negative thoughts and feelings, adopt healthier thinking habits, and increase overall well-being. 

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For years, Linda spent every Christmas Eve at her beloved cousin Cynthia’s house. However, last summer their husbands got into an argument over politics at a backyard barbeque and Cynthia hasn’t spoken to her since. Linda is heartbroken and baffled that such a seemingly minor event has broken their relationship. With Christmas approaching, Linda feels more bereft than ever.

Linda is far from alone, although she feels alone in her anguish. According to Karl Pillemer, author of  Fault Lines, more than sixty-five million Americans are estranged from a family member. Even when the relationship has been shaky, people who have been cut off experience feelings of shock, guilt, rage, despair, and shame, among others (Sichel, 2004).

Here are five ways to cope if you or a client are dealing with the impact of family estrangement at the holidays and throughout the year.

1. Accept what is, right now, in this moment, both inside of you and in the world.

That doesn’t mean you like, want, or condone the estrangement or how it makes you feel. It does mean you practice, moment by moment, the reality of the situation. As the famous Swiss psychologist, Carl Jung, wrote, “What you resist persists.”

2. You need skills to practice number one: to accept.

One way is to draw on the wide range of mindfulness tools, often defined as being in the present moment without judgement or criticism. For example, when you’re starting to feel overwhelmed, try this: On your in-breath, repeat the words “I am,” to yourself.  On your out-breath, repeat the word “okay” to yourself. Repeat ten times, as often as you need to, substituting any words that feel right to you.

3. Do something new for the holiday, based on what is important to you as a person.

For example, Linda valued sharing a meal with others on Christmas Day, as well as helping others. Linda invited her new neighbors for Christmas breakfast, who just moved from several states away and were still unpacking. Did Linda’s pain disappear? Of course not. But she was able to focus on preparing pancakes mindfully with her senses, noticing the smell as they sizzled, and color of the crisp, brown edges. She focused on doing something that mattered to her.

4. Talk about it with a trusted friend or therapist.

Estrangement is a breeding ground for shame and keeping problems behind closed doors. Opening the door, even just a little, helps you feel less alone and damaged.

5. See if there is something you can learn from what happened.

That doesn’t mean you are to blame and that you should beat yourself up. Perhaps buried in the mess of estrangement you will find some kernel of wisdom about yourself, such as “I will work on being more patient,” that will serve you in the future. That is something you can control, while you cannot control the outcome of the estrangement.

There is no magic potion for the pain of family cutoffs. Consider practicing one of these steps at a time, whichever feels right, and see what happens.

Pillemer, Karl A. (2020).  Fault Lines: Fractured Families and How to Mend Them. New York: Avery/Penguin Random House.

Sichel, Mark (2004). Healing from Family Rifts: Ten Steps to Finding Peace After Being Cut off From A Family Member.  New York: McGraw-Hill.

Stephanie M. Kriesberg, PsyD, has practiced clinical psychology for twenty-five years. A graduate of the Ferkauf Graduate School of Psychology of Yeshiva University, she is trained in psychodynamic psychotherapy, cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT). In addition, she is trained in the practice of clinical hypnosis. Kriesberg is on the board of the New England Society of Clinical Hypnosis.

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You have worked hard to strengthen your abilities to cope and find joy within the normal challenges of life. And then, COVID-19 hits. Suddenly, life as we’ve always known it has changed radically. With the stress of managing this new reality we’ve been thrust into—sheltering in place, quarantined, out of work, homeschooling children, isolated, running out of money, and the unknown—no wonder so many of us are finding it difficult to control how we think, feel, and act.

Our emotional reactions to the unexpected challenges we’re faced with affect our thinking and influence our actions.

Three Primary Emotions

Three emotions—fear, happiness, and sadness—create the physical sensations first to arrive in reaction to a situation. These three emotions are unthinking, instinctive responses we all share, and are at the root of every other emotion. (I include anger as a secondary emotion and a direct outgrowth of fear.)

Of these three primary emotions, which one were you most familiar with before the virus?

• Happiness
• Sadness
• Fear

Before the virus hit, perhaps you considered yourself a happy person.

And, now, which one would you say best describes your usual emotional state?

• Happiness
• Sadness
• Fear

Perhaps now you more often find yourself in the grip of sadness or fear.

Fear

Fear is a reaction to an imagined danger. Of course, COVID-19 is not an imaginary danger, though the fears you feel in association with it often center on outcomes that have not yet happened. Yes, negative outcomes may be breathing down your neck, but they might not have actually manifested in the present moment.

Sadness

Sadness activates sensations through your body to deaden the pain of not getting what you want or getting what you don’t want. Sadness, like fear, drains your spirit and your energy, interferes with your mental health, and often leads to physical complications.

Fear worries something bad will come true; sorrow believes it already has.

Happiness

We’re happy when we gain what we want. We’re happy when we avoid what we don’t want.

Similar to fear and sorrow, happiness shares the same propensity for being based on external circumstances. Happiness is a subjective state of mind; it can be gained and lost in a few moments, seconds, or hours.

While sorrow and fear can become actual ways of life, happiness is susceptible to turning to dust in the face of anything that goes against our wants and desires.

Exploration

As the news and the challenges you face turn bleaker, the emotions you feel turn dark. Negative actions, reactions, and adverse thoughts stem from fear grief and withdrawal stem from sadness. The pandemic is a prime testing ground and center of conflict, where all our sides are exposed.

We can’t do much about the virus besides taking precautions to keep our loved ones and ourselves safe. We can, however, do something about our emotional reactions to the virus and the challenges we face.

Journal what a good day feels like while you’re in the middle of productivity and feeling happy.

Journal what a low-energy, unproductive day feels like while you’re in the middle of a downturn and overcome by sorrow and fear.

An Affirmation

An affirmation—a pledge, mantra, or chant—repeated often and with meaning reprograms your brain in a way that best serves your emotional well-being.

When you’re in the throes of fear and sorrow, try repeating over and over again an affirmation that lifts your spirit, such as:

“I believe in myself.”

“I focus on what I’m grateful for.”

“I’m a hard worker and great at coming up with creative solutions to problems.”

“I override my doubts about my ability to manage the challenges I’m faced with by celebrating and giving thanks for my determination to get me here.”

“I watch for early signs of overwhelm and self-doubt so I can step in with my skill of rising above limitations.”

“When my fears threaten to turn me apathetic and sluggish, my imagination and belief in the miraculous stoke the fire inside.”

Create an affirmation for yourself that is stated in present tense, as if already true. Write it down and post the affirmation where you’ll see it—on the bathroom mirror, the refrigerator door, in the car, on your computer, and your phone.

By repeating your affirmation, you’ll slowly you find you’re able to unplug from the fear and unhappiness created by watching and listening to the news, and seeing firsthand the fallout from the pandemic. Experience what you’re feeling. Expose your dark emotions to the light. Accept the sensations. And then, flip the negative emotions to hopeful and happy feelings with the help of your mantra. As you do, you begin to control your emotions rather than be controlled by them.

Martha Alderson, MA, has been exploring and writing about plot and creativity for more than thirty years. Author of Boundless Creativity and The Plot Whisperer, Alderson works with best-selling authors, New York editors, Hollywood directors, artists, and performers from all over the world.

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From time to time, we all have clients who behave “problematically” during the session—for example, they may endlessly vent about their problems without letting the therapist get a word in, or continually blame all the people in their life without ever looking at their own role in their ongoing issues, or rehash the same stories week after week without any obvious purpose. And let’s be honest; haven’t we all at times simply gritted our teeth and tried to put up with this, and “get through the session,” rather than openly addressing this behavior with the client?

Usually we do this because we get hooked by feelings of anxiety and thoughts like, “It would be rude of me to interrupt,” or “She’ll get upset with me,” or “Maybe he just needs to do this.”

In these situations, it’s often helpful for us to be truly authentic with our clients and use self-disclosure to raise the issue. We could say something like, “I’m noticing something happening here, and I’d really like to bring it to your attention. My mind’s telling me you’re going to be upset or offended by what I say, and I’m noticing a lot of anxiety in my body, and a strong urge just to sit here and not say anything about it. However, I’m committed to helping you create the best life you can possibly have. So, if I sit here and say nothing about this, then I don’t think I’m doing my job properly; I don’t think I’m being true to you, as a therapist. So, I’m going to do what matters here, even though my heart is racing—I’m going to tell you what I’m noticing.”

Notice how, in doing this, we are explicitly modeling mindfulness, self-acceptance, authenticity, courage, and commitment. And by now, we’ll have our client’s full attention!

Then, with an attitude of openness and curiosity, unhooking ourselves from any judgments or criticisms, we can compassionately and nonjudgmentally describe the behavior we’re noticing and point to the fact that it’s preventing useful work in the session. From there, we may explore the purpose of this behavior. If relevant, we can explore whether it plays out in other relationships outside of therapy—and, if so, what are the consequences? We may also inquire about the client’s thoughts and feelings in response to our observation—and do some work around acceptance, mindfulness, and self-compassion if necessary.

Here’s a shorter version: “I’m wanting to talk about something that I think is going on, and my mind’s telling me that I’m going to come across as rude or insensitive … however, I don’t want to let my mind talk me out of it because I think it’s really important … so, is it okay with you if I share what I think may be happening here?”

For most of us, it’s nerve-racking to have these conversations with clients; however, almost always, it paves the way for important, authentic, courageous therapeutic interactions.

Book Titles: ACT Made Simple, Second Edition

Russ Harris is an internationally acclaimed acceptance and commitment therapy (ACT) trainer and author of the best-selling ACT-based self-help book The Happiness Trap, which has sold over 600,000 copies and been published in thirty languages. He is widely renowned for his ability to teach ACT in a way that is simple, clear, and fun—yet extremely practical.

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“We don’t make love much anymore. I’m rarely in the mood. My partner doesn’t want sex as often as I do.”

If you work with couples, you will hear this a lot.

What I call “Marriage, Inc.” has taken over the love life of many modern families. Careers. Kids. Rushing around with a to-do list. Fatigue. When your couples fall into bed at the end of the day, they are just too tired for sex.

Don’t worry—even if you are not a sex therapist, you can help your clients with this common problem.

Normalize

Often your clients will be beating themselves up, feeling there is something wrong with them because their sex drive has decreased. Reassure them that they are fairly typical. I often share that research indicates that the majority of long-term couples start to make love from a place of sexual neutrality. That means they begin when neither of them is in the mood—they begin just because they think sex is important. As they caress and kiss, their bodies warm up and they get turned on.

Educate

Explain the difference between desire and arousal. I call these the two keys to starting the erotic engine. Desire is the psychological urge to be sexual—deciding, in your mind, to make love. Your clients can take a mental mindfulness break and begin to imagine how good they will feel after connecting sexually—they will feel closer, more loving, physically relaxed; they will enjoy the pleasure of sex. This is the desire key. Arousal is the physiological aspect of being turned on. Clients can begin to relax their bodies and turn the arousal key by taking a warm shower, touching their skin, and caressing each other.

Coach

I encourage my clients to never say “I’m not in the mood” ever again. I quickly explain that it’s okay—and in fact typical—to not feel in the mood for sex when your partner suggests hitting the sheets. I then point out that “I’m not in the mood” is a definite no. Instead, I coach them to say something that leaves the possibility of sex open—something like, “Hmm, not right now, but ask me after dinner.”

Encourage

Sexual desire disconnect is a painful topic, and often couples will feel defeated and demoralized. Encourage them to think of sex like exercise—if we schedule it and do it even when we are not really in the mood, we always feel better afterward and are glad we got to the gym. Help your couples take the pressure off by suggesting that they take ten minutes to explore mindful erotic touch without intercourse. No matter how tired they are, they can gently explore each other, focusing on the sensations in their fingertips. They can tease each other’s bodies and create pleasure—warming up the engine for a drive tomorrow.

Book Titles: Buddha’s Bedroom

Sharp, frank, and fearless, Cheryl Fraser, PhD, is a Buddhist psychologist and sought-after relationship expert. She has helped thousands of couples jump-start their love life and create passion that lasts a lifetime.

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It comes as no surprise anymore that social media can be our lifelines. Any number of feeds keep us connected, through selfies and Snapchats, from Instagram to Facebook. Research is increasingly showing that social media is altering our brains, making us addicted to the dopamine hits we get from “likes” and “loves,” as we binge-watch Netflix while mindlessly scrolling and keeping up with the Kardashians. Meanwhile, international researchers have found that going off of social media for as little as one week can significantly boost our happiness levels.

We know social media is stressing us out. We know about Facebook depression. But we can’t stop scrolling! What is going on with us? It’s called a silent epidemic that can be as impactful on our health as our physical well-being—loneliness. It seems counterintuitive that with 1,000 friends, we feel utterly disconnected. How can it be?

Well, for one, highlight reels don’t help. When we are exposed to the “best of” our friends’ lives each time we log on to social media, it can significantly skew our view of reality. Someone is on vacation to a tropical paradise at any given point in time. And if they are not, they are #throwback happy, reminding us of that one Greece vacation they took five years ago. This is the first step and setup to experiencing one’s own life as perfectly mundane. A #FOMO (fear of missing out) constantly nags us at the back of our minds, making us wonder if we need to be globe-trekking despite the real need to stock away for retirement.

Step two, we connect and bond over these photos virtually, in a way that is superficial at best. They brag, we compliment, while secretly feeling miserable, and the cycle repeats. Not exactly the stuff of strong bonding. From there, many of these supposed friends are ones we rarely interact with in real life. Or worse, when we do, there is much awkward silence, as we’ve read about their life before seeing them. It’s like going to lunch with a voyeur!

Amy: I went to Cabo last month with my girlfriends for a bachelorette party.

Monique: I know. You also got a spray tan beforehand, bought a bikini from Victoria’s Secret, and went to that swim-up bar at your hotel.

Amy: Um, yeah…

Step three, we are so busy creating a glamorous picture-perfect life that we fail to be vulnerable and hence find something real worth connecting over. It’s true that few want to be friends with Suzy Sunshine, who has what appears to be a picture-perfect life. Even though it may all be a façade, it is hard to build bridges when no one is opening up about meaningful life experiences. Struggles and hardships are what bring us closer together. This is part of what makes military service members so powerfully bonded. This doesn’t mean we need to be venting and creating false problems in our lives, just that we need to be more well-rounded and genuine in our interactions and how we portray our lives.

The reality is that social media is not a necessary evil. We can choose a life without it, or at least one where we better manage our time and are more mindful of what messages we put out there. Maybe you take a social media sabbatical or do a tech-free weekend (both of which I detail in my book, The Social Media Workbook for Teens). Taking a step back and really assessing your relationship with social media and social acquaintances at large can be transformational. It is easy to sit behind the safety of our screens and pat ourselves on the back that we are being “social” when we leave a comment on a photo. But that takes minimal effort and does not force us to really put ourselves out there. Invite a friend for coffee, practice yoga in a studio instead of on your laptop at home, and stop scrolling. You’ll be amazed at the rich and vibrant life that is out there when you lift your eyes up from your screen.

Goali Saedi Bocci, PhD, is a licensed clinical psychologist in private practice, published author, millennial expert, TEDx speaker, and media personality.

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While many parents, teachers, and even teens themselves may view procrastination as a weakness or a sign of being lazy, nothing could be further from the truth. Procrastination is driven by complex emotional needs that vary depending on the individual. I’ve identified four basic types of procrastinators, each with its own motivation for avoiding tasks that need to be done, and its own motivation for engaging with them as well.

The Perfectionist

The perfectionist values excellence above all and sees every task as a performance to be judged by teachers, parents, and/or peers. Any mistake, however small, could be cause for criticism or rejection. When the perfectionist is not certain a task can be done 100% correctly, without mistakes, the task will be put it off.

The Warrior

The warrior is drawn to full engagement and loves to pit him or herself against a problem or foe—as long as it is interesting or exciting, that is. The warrior feels as though survival depends on moving away from tedium toward stimulation. Tedious tasks are postponed and easily forgotten.

The Pleaser

The pleaser is motivated by personal connections. The pleaser will prioritize requests from others, even if it means putting off the tasks that they need to do. When they say yes to tasks that, in their hearts, they really didn’t want to commit to, they will wind up putting those tasks off as well.

The Rebel

The rebel values autonomy, desiring to be valued for unique character and contributions. The rebel’s core fear is being anonymous. By following orders, the rebel risks losing identity, and thus status in the tribe. To establish his or her own person, the rebel resists taking orders even when it doesn’t further personal goals.

When teens recognize their procrastination type, the stigma of “lazy” is reduced, making way for self-compassion. In my book, The Teen’s Guide to Getting Stuff Done, I outline a clear path for each procrastination type, with specific motivational tools to help them own the tasks they need to get done and meet their goals. The first tool is the The Procrastination Type Quiz, a great way to open a dialogue with the teen procrastinator client.

Book Titles: A Teen’s Guide to Getting Stuff Done

Jennifer Shannon, LMFT, is author of The Shyness and Social Anxiety Workbook for Teens, The Anxiety Survival Guide for Teens, and Don’t Feed the Monkey Mind. She is in private practice in Santa Rosa, CA, and is a diplomate of the Academy of Cognitive Therapy.

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As a psychologist, I have found that working with men who are experiencing severe depression presents a series of unique challenges. Not only are they often in the midst of real crisis—such as going through an unwanted change in relationship status, job, or medical condition—but they are often in such horrible emotional pain, they are convinced they are helpless. They firmly believe there is nothing they can do to positively impact how they feel. This hopelessness will often manifest as a cynical, despairing voice they direct not only back at themselves, but also at the process of psychotherapy. In addition, as one of the primary symptoms of severe depression is impaired concentration, their ability to focus is often limited.  Given the extraordinary stress they are under and the intense pain they are in, I don’t blame them.

A primary way I have found to be helpful is to encourage a severely depressed man to separate himself from his depression. That is, I strive to teach a man that these are actually two distinct things. On the one hand there is the man himself, which comprises his hopes, his dreams, the things he is good at, as well as the things he is lousy at, etc. On the other hand, there is this separate thing which is the bio/psycho/social syndrome of severe depression. The syndrome of severe depression includes all the DSM symptoms, such as significantly lowered mood, loss of interest, impaired sleep, chronic body aches, amotivation, difficulty concentrating, feelings of helplessness and hopelessness, as well as any suicidal ideation.

To help make this point clearer, I have in my office a large, stuffed gorilla-looking animal which I call The Beast. I will put this Beast directly next to the patient, point to him and say, “Here is you,” then pointing to The Beast, “here is your depression.”

I do this because I want to find a way for them to take action against their very syndrome of depression.

As I build my rapport with the patient, I will do my best to offer them support as they try to cope with their terrible situation. As the same time, I will try to get them to see that while they are truly going through hell, and this outward crisis has indeed made them horribly stressed, what has actually made them horribly depressed is the way their Beast has tricked them into dealing with their stress. That is, their Beast is getting them to do things that are making them feel much worse.

Like a Category-5 hurricane, a patient’s own severe depression needs “energy” to survive. Thus, it will try to get them to do a certain set of behaviors which always result in the patient feeling much more miserable. These are the very behaviors that “feed” their Beast. An example of this, for many men, is that their Beast will encourage them to get a drink. Not just one drink, but to go and get drunk. The alcohol molecule, which is classified as a depressant compound, always creates a rebound during the following twenty-four to seventy-two hours when their symptoms of depression become significantly worse. This is because flooding their brain with ethyl alcohol (ETOH) negatively impacts their brain’s production and synthesis of serotonin, as well as the other neurotransmitters which regulate their mood. During this period all their problems will seem worse and their feelings of hopelessness and helplessness will dramatically increase, which is exactly what their Beast of depression wants.

In my office I also have a mini-Beast. This is a smaller version of the big-Beast, which I hand to my patient and encourage them to put on their shoulder. This mini-Beast, I explain, is their depression, which may be toned down at times but is actually going through their life with them. This mini-Beast is watching everything they are doing. It is not only watching, but it is waiting for them to run into stress. Not just any kind of stress, but the kind of stress they believe they can’t handle. At that moment, their mini-Beast springs into action and begins whispering in their ear, trying to get them to engage in behaviors that will give The Beast significantly more energy.

I will explain to the patient that the only goal of the mini-Beast is to try and become the big-Beast. Typically, their mini-Beast says things like, “Man, you need a break. You need to blow off some steam.” It will try to get them to do things like getting drunk, stoned, gorging on sugary foods, or zoning out on electronic screens. Their mini-Beast is trying to get them to do these seemingly self-soothing behaviors because they will quickly become avoidance and numbing behaviors that always lead to a rebound in their depressive symptoms.

Identifying maladaptive coping strategies is, of course, just the beginning of the work. It is also essential to teach the patient about how his Beast of depression which has enveloped his mind is a depressive fog comprised of the classic cognitive distortions. These distortions include all-or-nothing thinking, catastrophizing, and over-generalization. I explain that his Beast is trying to get him to use these distorted thinking styles because it knows that the more he does, the more unsolvable his problems will appear, and the worse he will feel.

My focus in working with severely depressed men is to get them to think about what things they are currently doing to “feed” their own Beast. I then teach them small, direct, and specific strategies and behaviors that they can use every day to take energy away from their Beast. As many depressed men are caught in a cycle of hating themselves, redirecting their anger toward an outward manifestation of the depressive syndrome can often help them feel greater control and engender real feelings of hope. The key I have found is to highlight not only what “feeds” their Beast, but to get them to specifically identify what small behaviors they can do every day that take energy way from their Beast.

Jonas A. Horwitz, PhD, received a doctorate in clinical psychology from Virginia Commonwealth University, where he conducted extensive research on adults who wrestle with chronic depressive disorders. He is a member of the American Psychological Association, the North Carolina Psychological Association, and the American Academy of Psychotherapists. He maintains a private practice in Durham, NC.

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Teen Mental Health Awareness and Burnout

           I first had the opportunity to spend time with Ariana King—Ari—while consulting with San Luis Obispo High School’s Reach Club, and again while filming a short segment at the school for The Today Show. This segment was focused on the importance of mindfulness, stress reduction, and mental health awareness and support.

           When meeting with Ari, I intended to focus on getting her teen’s-eye view on what I thought to be the most egregious issues surrounding teen mental health—depression, anxiety, suicidality, and self-harm. Instead I was quick to find another crucial piece of mental health awareness, what you might call a silent sleeper: assessing and managing burnout. Teens may be burned out before they even walk onto a college campus or start their careers. I was gobsmacked that teens call in sick to school to catch up on their sleep, or need to “schedule” sleep during weekends or nontraditional sleep times.

           At the start of a school year, many blogs focus on managing back-to-school stress. However, the importance of promoting teen mental health and combating burnout—yes, burnout—is a significant area to hone in on. Teens are susceptible to burning out because chronic and prolonged exposure to stress increases the risk for them to develop dysregulated emotions—difficulty in modulating their emotions. Because of their prolonged period of brain plasticity, they are developmentally vulnerable to the effects of stress exposures.

The Hidden Time Zapper and the Need for Sleep

           Ari shared that mental health is measured by how stressed you are. Teens today are managing a lot of stressors and are impacted by how well they are able to handle the many different stressors. Managing AP classes and competitive sports is part and parcel of life for many teens today. The other piece is social, both face-to-face and online. This generation of teens is preoccupied by comparing scores on tests such as the SAT and ACT, adding pressure to keep up with their peers. One big issue Ari and her friends are having right now is applying to colleges. The pressure of grant and scholarship applications, obtaining required references, completing college applications, and writing essay upon essay, while competing with the upper echelon of high school students who are all working just to get to the next stage of their lives can be a tipping point. Many teens are scheduled from the minute they wake up well into the hours of the night—and the following morning. Teens need to sleep eight to ten hours a night, but they are typically getting between seven and seven and one-quarter hours.(1)

Social Media: Kleenex for the Twenty-First Century

           I was curious to know whether social media played a role in mental health awareness or in how teens share their struggles with one another. I learned that most of Ari’s peers who are currently dealing with depression and anxiety post that on their “finstas” (fake Instagram accounts) and that these accounts show more of the “real you” than their main Instagram accounts. They will often post a photo with a long paragraph about what is going on in their lives. On Snapchat, sometimes teens will talk about depression or anxiety on their “private story,” posting something like “Bad day, need to talk.”

           She told me that most teens will share their deeper mental health problems online and not face-to-face. It appears that it feels safer for teens to share when they are having a difficult time online rather than face-to-face. The question it raises for me as a mental health professional is, will they get the help they need? What I take away from interviewing Ari is that there are many teens spending a lot of time in their own heads, in their thoughts, interacting with their social peers on a screen. When do these teens get the opportunity to feel their feelings and get support for those feelings? When do they get hugs, Kleenex, or a shoulder to lean on? I am not saying that feeling safe to share on social media is wrong for them; yet I wonder about missing that face-to-face support I got when I was in high school.

Noticing Burnout Before You’re Burned Out: Finding Your Antidote

           Ari noted that, like adults, she has a never-ending to-do list and feels the pressure to keep up with that list, adding that even if she isn’t working on something, she is thinking about what she needs to be working on and having a feeling of being behind. She said, “Life is about a lot of catching up … and getting stuff done.”

           I am inspired by Ari’s transparency in sharing with me. She is an achiever; a highly productive teen with a beautiful heart and warm personality. I hope she, and other teens like her, bring mindfulness into their lives, to slow down when possible, to breathe, and most importantly to look for the red flags that signal burnout: overscheduling, a never-ending to-do list, exhaustion, sleep deprivation, irritability, frustration, other mood changes, lack of interest in engaging in previously interesting activities, lack of motivation, changes in performance, problems with friends or family, and decreased self-care.

Ari’s Antidote

           Being a competitive student athlete is Ari’s burnout antidote. She finds that exercise—tennis, running, and rock climbing—help her mental health. She says she looks forward to these activities, which allow her to get out of her head. She likes being part of a team and the support and camaraderie that accompany it. I gave Ari a copy of my most recent book, Mindfulness for Student Athletes, and she let me know that she enjoyed the activity Sport Sense Awareness. “It takes you out of the stress of the competitive moment and just allows you to be focused on what you are doing in that specific moment,” she said. “For tennis, being aware of your senses really helped me focus on simply watching the ball hit my racket rather than being distracted by other things.”

Download “Sport Sense Awareness” Now

Five Anti-Burnout Mindful Takeaways

1. What activity or activities nourish and support your mental health? Do one of them as soon as you can.
2. Next time you are feeling stuck in your head, unplug and take a short walk, scan your body, pet a pet, engage in something that gets you out of your head and into your life.
3. When you are feeling a lot of pressure from your to-do list, worries, and the like, talk to a friend or family member. Talk; try face-to-face communication, or at the very least, video calling.
4. When possible, nap or sleep if you are tired.
5. Think of five things you are grateful for anytime day or night. Once you think of these, notice how you feel.

(1)Mindell J. A. and J. A. Owens. 2003. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Philadelphia: Lippincott Williams & Wilkins.

Gina M. Biegel, MA, LMFT, is a psychotherapist, researcher, speaker, and author in the San Francisco Bay Area who specializes in mindfulness-based work with adolescents. She is founder of Stressed Teens, which has been offering mindfulness-based stress reduction for teens (MBSR-T) to adolescents, families, schools, professionals, and the community for over a decade. She created MBSR-T to help teens in a large HMO’s outpatient department of child and adolescent psychiatry who were not receiving relief or amelioration of their physical and psychological symptoms with the use of a multitude of other evidence-based practices. An expert and pioneer in bringing mindfulness-based approaches to youth, she is author of Be Mindful and Stress Less, The Stress Reduction Workbook for Teens (first and second edition), and the Be Mindful Card Deck for Teens. She also has a mindfulness practice audio CD, Mindfulness for Teens, to complement the MBSR-T program. She provides intensive ten-week online trainings worldwide, and works with teens and families individually and in groups. Her work has been featured on The Today Show and CNN, and in Reuters, The New York Times, and Tricycle. For more information, visit her website at www.stressedteens.com.

Ariana King is a senior at San Luis Obispo High School (SLOHS), and a member of the school’s Reach Club. She plays tennis for the SLOHS team and plays violin in the San Luis Obispo Youth Symphony. Outside of school, she likes to climb, run, go to the beach, spend time with family and friends, and play guitar.

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The two most common reasons teens procrastinate are: 1) lack of motivation, and 2) feeling anxious and overwhelmed. With lack of motivation, the teen will tell herself that she will start the task later, actually believing she will feel more like it then. If the cause of the procrastination is anxiety, the teen will tell himself that he needs to wait until he is more clear-minded and relaxed in order to do a good job.

Using the 5-Minute Jump-Start can help both of these types of procrastinators, and it is a tool that you can do with a teen while they are in your office. You can ask them to bring in a project they have been putting off, or you can give them a task. I sometimes have them read a poem and then write an “essay” about it.

Here is how it works. Ask the teen how motivated they are, on a 1-3 scale, before they start the task. 1=low motivation and 3=high motivation. If anxiety is their issue, ask them how anxious they are, using the same scale. Next, have the teen set a five-minute alarm on their phone. Have them start the task and stop it when the timer goes off. Afterwards, have them re-rate their motivation and/or anxiety. In almost all cases this works like magic to increase motivation and decrease anxiety.

For homework, have them practice this tool as many times as possible during the week. Continue to model it in the next and future sessions. Setting a short horizon on the initial work session will make starting any task less anxiety-provoking for a teen, and once a task is begun, inertia is broken. In my book, A Teen’s Guide to Getting Stuff Done, I say, “The most fuel is burned getting a plane off the ground. Once you are airborne with a task, you’ll have momentum, and your destination will feel more doable.”

Jennifer Shannon, LMFT, is author of The Shyness and Social Anxiety Workbook for Teens, The Anxiety Survival Guide for Teens, and Don’t Feed the Monkey Mind. She is in private practice in Santa Rosa, CA, and is a diplomate of the Academy of Cognitive Therapy.

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