You arrived at psychotherapy with the intent of reducing or eliminating anxiety and depression. You have probably heard that there are tools, techniques, and coping skills that will either help you manage anxiety or cure it completely. Other people around you seem to be less anxious and seem to use methods like meditation, yoga, nutrition, sleep, and exercise to stay calm and healthy. For some reason, the more you try these methods, the more anxious you feel. Or, you’re having trouble consistently engaging in these behaviors, even though you commit with your whole heart and you completely believe that they would be helpful for you. This is the anxiety effort paradox.

What do overcoming anxiety, falling asleep, sneezing and feeling happy have in common? They all require surrender! You have to surrender to the process to allow it to either pass or to happen.

The opposite of this is called paradoxical effort, where the more effort you put towards a certain outcome, the further you get from it. Paradoxical effort keeps you stuck, unable to move through uncomfortable thoughts, feelings, and sensations.

Let’s use sensations as an example: Panic attacks occur when you perceive a threat, have the fight-or-flight response, and add an oh, no, I shouldn’t be having these sensations! reaction. When this happens, your amygdala will give you more adrenaline. You’ll keep having more and more of those sensations until it subjectively feels out of your control. In this case, paradoxical effort is: the more you try not to have sensations, the more sensations you have.

As you’re learning to work through panic attacks, you might learn that you need to invite in your sensations in order for them to decrease. Yet, if you secretly hope that when you invite in your sensations, they go away, you will get caught in paradoxical effort and have more sensations.

This also happens with sleeping. One thinking pattern that maintains insomnia is thinking, I need to sleep tonight or I will be exhausted and unable to perform tomorrow. If you worry and worry about this as you try to sleep, you won’t be able to relax enough to fall asleep. Paradoxically, you have to let yourself surrender to the possibility that you might not sleep, you might be exhausted tomorrow, and you might not be able to perform, in order to relax enough to sleep. If you try to trick yourself into thinking this, but you are not actually willing to surrender to being tired tomorrow, you won’t be able to relax enough to sleep.

These paradoxes can make you feel crazy, but your mind is working perfectly. Cells have evolved to fight off infection. Minds have evolved to fight off discomfort and distress. When your mind detects thoughts, feelings, or sensations that cause discomfort and distress, it searches for the source and tries to get rid of it. If the source of discomfort and distress is an actual problem, like hunger, you are typically in luck in the modern world! Eat something and the thought, feeling, and sensation will go away. If the source of discomfort and distress is not an actual problem, but instead another thought, sensation, or feeling, trying to fight it off will get you caught in a loop and it will get worse. Modern life makes us believe that if something causes discomfort or distress, we should be able to do something to make it go away. It works for basically everything except the private experiences of your consciousness. The more you fight with your mind, the worse you will feel.

If you try to use mindfulness to suppress or control your thoughts and feelings, they will increase and grow stronger. Mindfulness in any given moment is not meant to alleviate psychological suffering. A habit of mindfulness practice over time will likely reduce your overall sensitization and make it easier to notice that your thoughts are just thoughts in any given moment. In the moment of suffering, though, mindfulness is a therapeutic attitude that helps you stay committed to what you were already planning to do without making your internal experience worse.

If this doesn't seem to be working for you, you're likely struggling with paradoxical effort. It's not that you aren't trying hard enough or being lazy about your mental health or your treatment. You're probably trying too hard to use the right strategies and coping skills. Because you are also hoping that the strategies will make your thoughts and feelings go away, it's getting worse. Oops. It was paradoxical effort.

Paradoxical effort can be the issue with your struggle with yourself. It may also be the issue for areas of your life that involve other people or values-based activities.

Here are some examples of how paradoxical effort might backfire in your life:

• When trying to be perfect in relationships makes you socially isolated and lonely.

• When fear of saying the wrong thing becomes suppressing your opinions and personality.

• When trying to do your job perfectly becomes burnout.

• When fear of harming the children you love becomes avoidance of those children.

• When checking on your sensations creates more of them.

• When trying to fall asleep becomes sleeplessness.

These are all opportunities to surrender.

In order to get out of the trap that is paradoxical effort:

• Surrender to being imperfect.

• Surrender to the possibility that you'll say the wrong thing.

• Surrender to the possibility that you're a bad person and that you have the wrong motivation or intention.

• Surrender to the possibility that your sensations are indicating a catastrophic problem and you are being irresponsible.

• Surrender to the possibility that you won't sleep all night and you will be exhausted tomorrow.

Surrendering to these possibilities doesn't make them true. It reduces the extra psychological suffering due to fear and bracing.

Trying too hard to cope correctly doesn't just make your anxiety and OCD worse in the moment. It also creates the opposite outcome in your life.

If you are fueled by anxiety about your performance, checking will lead to burnout and you will be more likely to make mistakes. The reason it's worth it to refrain from checking in any given moment is so that so that you make fewer mistakes long term. Sacrifice the present performance for the chance to have higher performance long term.

Similarly, a spiritually scrupulous person needs to stop praying in an anxiety driven way in order to live out spiritual values. A conscientious person needs to stop checking on being conscientious in order to be conscientious long term. A health-conscious person with checking behaviors needs to stop checking in order to enjoy the gift of good health.

So, how do you relate effectively to your distressing thoughts, feelings, and sensations?

Treatment can’t and shouldn’t mean that you are never in distress again. Becoming anxious is a normal, healthy adaptive reaction to doing challenging things with uncertain outcomes. I would never want to take the capacity to become anxious away from you. Instead, I want to teach you to respond to anxiety and other forms of distress in a way that helps you rather than hurts you.

When you feel distressed, here are your steps to relate to it effectively:

#1 – Label the feeling as a feeling

#2 – Switch from content to process.

#3 – Do the opposite of avoidance: Open up to your sensations.

#4 – Actively allow the emotion. Ask for more of it.

Let’s discuss how to adopt an attitude of active, willing acceptance.

There is a right way to self-monitor. In order to practice the steps above, you’ll benefit from seeking out triggering situations and watching your experience. You’ll want to observe the following aspects of your experience:

1) What was the trigger? Was it internal or external?

2) What sensations do you feel?

3) What thoughts are you having?

4) What is your reaction to the sensations and the thoughts?

5) What types of avoidance do you want to engage in?

6) Did you engage in avoidance/neutralization/compulsions?

7) If yes, what did you do? If no, why didn’t you engage in the behavior?

You should try to answer these questions as soon after (or during!) the episode as possible. Try to answer in as few words as possible, as if you are a scientist taking notes in a lab.

Observing with an attitude of compassion and curiosity

When you go about observing your emotional states, your attitude and intention matter. Some parts of you may feel very motivated and excited by the idea of observing your thoughts and feelings. If you have suffered a lot and felt stuck in your internal experience, making a plan can fill you with hope and efficacy. There might be another part of you who doesn’t want to observe what’s happening and would prefer to hide from yourself and others. Expect that. It is a normal part of the process.

Notice that you will retrigger yourself if you add fear, shame, or self-criticism to your observation process. The moment you are triggered is an opportunity.

You have the chance to use it for greater self-understanding and eventually, calmness, compassion, and connection.

This moment is also an opportunity for you to feel more fear, more shame, helplessness, hopelessness, and worthlessness.

The attitude with which you approach the task predicts whether you grow from this moment or experience more suffering.

Therefore, when you experience fear, shame, self-criticism or any other reaction that makes it hard to stay with the emotions as emotions, use your higher intelligence and redirect yourself back to the attitude and intention you chose. After all, your fear, shame, and self-criticism are also secondary processes. If you can redirect themselves back to the initial experience during those states, you are practicing well.

Just do it.

Exposure has to be done the right way, meaning that the person engaging in exposure has to have the right perspective. If you decide to just do it, it is true that the task will be achieved and for some people in some circumstances that in and of itself is important. However, just facing the fear does not mean that you are willing to experience the thoughts, sensations, and behavioral urges that accompany the fear. If you continue to resist those thoughts, sensations, and urges, whatever task you are attempting will feel very burdensome. Fighting against the urge to avoid and trying to ignore feared sensations and catastrophic thoughts will be exhausting.

The right attitude to embrace during exposure is one where catastrophic thoughts, uncomfortable sensations, and the urge to avoid are all expected and understood as part of the process. They are not signs and they don’t have meaning. When they arrive, you don’t fight to make sure they don’t get worse. Rather the attitude towards one’s thoughts, feelings, and sensations is something like, Oh. It’s fine that you’re here. I was expecting you. I’m going to continue doing what I was doing.

I already expose myself to what I fear.

The issue here is experiential avoidance. In this case, you have been embracing just do it for some time and you wouldn’t consider completely avoiding because you care too much about the task. However, if you interpret anxious thoughts, sensations, and urges as dangerous, then you can be sure that you are using experiential avoidances to keep your anxiety at bay. Examples of experiential avoidances include worrying, safety behaviors, reassurances, and checking.

Exposure isn’t curing my anxiety disorder.

If you are engaging in exposure, but not getting relief from your anxiety, assessing your attitude toward the exposure is important. Are you using the exposure to make the anxiety go away? Do you have the hope that if you practice exposure enough then you won’t feel anxious anymore?

Exposure should be used to learn the attitude of acceptance. If exposure exercises are not changing your attitude toward anxiety, they are unlikely to help you get long-term relief from it.

Unconditional self-acceptance is the act of treating oneself with approval and worthiness, regardless of what’s happening. It does not mean approving of or wanting suffering. It means that while you are suffering, you still deserve respect and have worth and you treat yourself as though that’s true. One way to think about self-acceptance is in terms of time: your past, current, and future self.

Accepting your past self means acceptance of who you were and how that influences who you’ve become. It means compassion towards your mental illness and its consequences. The consequences of mental illness are very real and very painful. As you start to understand your mental illness — its symptoms and your response to those symptoms — you may feel sadness and grief.

You may feel sadness about how much you’ve suffered, how you’ve avoided, what you missed out on. You might have completely missed milestones, like some opportunities related to dating, family life, friendship, education or work. You might have experienced the circumstances that you hoped for but suffered through them.

You may feel anger. Many people experience anger about having a mental illness. You may wonder why it happened to them and feel angry about the extra work it takes to live with mental illness. Many people also feel angry about the people or circumstances that contributed to their mental illness.

You may feel embarrassed or ashamed. Perhaps you’ve said or done things in your past that you now regret. Without the awareness of your illness or the treatment you needed, you may have acted very differently than how you value. You may feel stigmatized and ashamed that you have mental illness altogether.

Sadness, anger, embarrassment, and shame may be rooted in the past, but you feel them in the present. In the present, you have the symptoms of the illness: the fatigue and loss of interest, the anxiety, the unwanted intrusive thoughts, the guilt, worthlessness, and hopelessness. You also have your reactions to your illness over time, which may include all of those same thoughts and feelings.

Accepting your current self means allowing your emotions in the present moment. This means allowing thoughts, sensations, and behavioral urges as private experiences, but not messages, signals, or threats. In the present, you also have your feelings about your illness and about yourself as a person with an illness. You may have sadness, anger, embarrassment, and shame towards yourself or about other people and the world. To heal, you also have to accept those feelings.

Accepting your future self means tolerating and hopefully even embracing the uncertainty of the future version of yourself. Mood and anxiety disorders are chronic, episodic illnesses. Once you have had one episode, it’s likely that you will have another episode under stress. Coping with mental illness requires that you build enough awareness to predict your stressors and relate to them effectively, while treating yourself with acceptance and compassion for suffering the way you are in the first place.