Dr. Jeff Cohen: How to Cope With Anxiety Amid Trying Times
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DownloadColumbia University professor and psychologist Dr. Jeff Cohen takes us on a tour through the world of anxiety and what we can do to combat it. Amid the uncertainty of 2020 and beyond, learn helpful tips to live a less anxious life.
“I often think of mindfulness as giving us a space to choose how to act versus just reacting.”
Stan Hall:
The true WELLth podcast is made possible by Brighton Jones. Brighton Jones is the financial wellbeing firm that helps you align your wealth, your passions, and your purpose. Learn more about how you can live a richer life at brightonjones.com.
Dr. Jeff Cohen:
I often think of mindfulness as giving us a space to choose how to act versus just reacting. So mindfulness is becoming aware of our thoughts and feelings. Imagine that you had to cross a room full of furniture and all the lights were off, so with mindfulness, we’re turning the lights on. Now, you might not like the furniture, you might not like the thoughts or the feelings that are inside you, however, you’re going to be a lot more effective from getting from one side of the room to the other.
Stan Hall:
Hello and welcome to the true WELLth podcast, the show where we interview experts and pivoters around the four areas of wellbeing, emotional, social, physical, and financial.
Stan Hall:
Today’s guest is Dr. Jeff Cohen. Dr. Cohen is a psychologist on faculty at Columbia University where he works with patients, as well as teaches an undergrad class on mindfulness. Today, Dr. Cohen is going to provide us an intro into how better to control our thoughts to live the life we want to live. Let’s dive in.
Dr. Jeff Cohen:
I guess I got into psychology because I was just really curious about why humans do what they do. At first, I dabbled in philosophy with a class and realized, “Hey, this is a little bit too speculative. I’m looking for something a bit more empirical.” So for me, psychology seems to be the empirical study of human behavior.
Stan Hall:
Dr. Cohen, obviously the world of mental health is extensive, and I know we could spend hours just gleaning information from you on the subject, but I would really like to steer our conversation today around anxiety, since it seems to be a common trait amongst us all with the amount of uncertainty this year has thrown at us. Could you maybe start by telling us what exactly is anxiety and why do we manifest it?
Dr. Jeff Cohen:
Yeah. Great question. So like all emotions, we have anxiety and also fear for a reason. Fear is the body’s natural response to a threat. So if you’re walking down the street and a bus is coming towards you, fear is the emotion that motivates you to get out of the way. So emotions communicate to us and organize us for action.
Dr. Jeff Cohen:
Emotions also communicate to other people much faster than words. Assume we were walking together, this bus was coming towards us, you actually don’t see the bus because it’s behind you, but you’re looking at my face and I can see the bus. You’re going to see that look of fear in my face and you’re going to move out of the way much more quickly than if I would say to you, “Hey, Stan, get out of the way.” It’s going to be instant. So the function of fear is really to help us avoid threat.
Dr. Jeff Cohen:
Within the fear umbrella, we also have anxiety. I tend to think of anxiety as a bit more apprehensive. So instead of there’s a bus right here, let’s get out of the way, anxiety is worrying, “What if one day I get hit by a bus?” Now, anxiety can be really helpful if we’re worried about an upcoming interview we have or a test we have to take for our students. It can certainly motivate us to study. It can motivate us to prepare.
Stan Hall:
But in general, it would be fair to say that the anxiety, when left unchecked, leads us to being irrational and emotional though, right?
Dr. Jeff Cohen:
Sure. Sometimes an emotion doesn’t quite fit the facts or it’s too intense. So when we have too much anxiety or too much fear, we might find ourselves avoiding, including avoiding things in life that are really meaningful to us.
Dr. Jeff Cohen:
So imagine a child who was bit by a dog and now doesn’t want to visit any of his friends who have a dog. It makes a lot of sense given his learning history. And also, he really wants to hang out with his friends, and this fear of dogs is getting in the way. So that’s the case where the anxiety, though understandable, isn’t helpful and it’s not effective for this kiddo in terms of hanging out with his peers. That’s where we can be helpful as psychologists and treat anxiety with cognitive behavior therapy, which is the gold standard treatment for anxiety disorders.
Stan Hall:
So you brought up CBT, and I’ve been hearing a lot about cognitive behavioral therapy as it stands for, in articles I’ve come across on wellbeing. Could you maybe give us an explanation of what it is?
Dr. Jeff Cohen:
CBT comes from a tradition of behaviorism. Behavioral therapy was developed by Skinner and others in the mid-20th century. And then in the 70s and 80s, people like Aaron Beck came along and realized that, “Hey, cognitions, thoughts, these influence our behaviors. If we can change cognitions, we can change how people act.” And then more recently, people like Marsha Linehan and Stephen Hayes have realized that some thoughts are really sticky, some thoughts are not so easily changed. So in some of our newer acceptance-based behavioral therapies, we focus on just noticing a thought as a thought and engaging in actions that are meaningful to us. So, whereas in traditional cognitive behavioral therapy, we try to evaluate the helpfulness of a thought or the accuracy of a thought and then change an unhelpful thought to be more helpful, in newer versions, the acceptance-based versions, we just notice the thought as a thought.
Dr. Jeff Cohen:
Now, all of this is in the service of value to action. So, what are values? Values are what makes life meaningful to us. So I like to use the value of going West. For instance, I could spend my whole life going West. I could get to California, Japan, the middle East, Europe, and then back to New York. Likewise, a person might have a value of being a caring friend. That’s a lifelong value. Now, along the way there could be action steps, what we sometimes call committed actions, such as remembering to call friends on their birthday or taking friends out for dinner and just listening when a friend needs support. Those are all action steps that bring to life the value of being a caring friend. So both the acceptance and the change-based behavioral therapies are all about living the life that you really want to be living.
Stan Hall:
I love that. I would venture to say so many of us, I think, have these goals that are somewhat thought out in our heads, but I think all too often, they become aspirational or only hopeful because our actions get in the way of our own intentions. We end up setting ourselves up for unrealistic expectations.
Dr. Jeff Cohen:
Yeah, that’s so accurate. I think the reason why is many of us believe that our thoughts are facts. It actually turns out that our thoughts are not facts. And it also turns out that we often ascribe intentionality to other people. How often have we interpreted somebody else’s behavior or motives in a way that was unhelpful and maybe even inaccurate? With our newer CBTs, our mindfulness-based CBTs, we’re really practicing being non-judgmental because judgements add to reality and thoughts are often judgments. So in doing this work of being nonjudgmental, we strive to see reality as it is without adding or subtracting to it. And by adding and subtracting to it, I mean, by adding judgments.
Stan Hall:
The concept that thoughts or judgments that warp and influence our reality is not a concept that I believe comes naturally to most, and it hearkens back to stoic philosophy. Though, CBT wouldn’t be invented for another 1800 years, Marcus Aurelius wrote at length of monitoring your thoughts and not treating them as infallible. Paraphrasing here, “The happiness of your life depends upon the quality of your thoughts. Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth. Our life is what our thoughts make of it for the soul becomes dyed with the color of its thoughts.” Aurelius is not making a call to hardcore skepticism, but he is highlighting the importance of our decision to choose which thoughts we want to hold onto because ultimately, an unexamined mind, like a garden, will overgrow and become entangled if not intentionally tended to.
Stan Hall:
Dr. Cohen, I’d like to switch gears here and talk a bit about the moment that we’re currently living in. Conjecturally, I feel this pandemic has given all of us anxiety and stress in ways we weren’t ever used to, and uncertainty seems to be really the only constant. I can’t even think of a single person who hasn’t been affected in some way.
Dr. Jeff Cohen:
This pandemic is really impacting financial security, our welfare, the welfare of loved ones and importantly, I believe the pandemic is disrupting the timeline we expected our lives would take. We’re also experiencing stressors that we have not had to confront before, so understandably this is a threat. So it makes sense for people to feel more anxious, more stressed, there’s all different ways to cope with the pandemic and with anxiety.
Dr. Jeff Cohen:
Marsha Linehan, the developer of dialectical behavior therapy, suggests that although there’s an infinite number of really painful problems in life, there’s just four main ways to cope with any problem. The first is to solve a problem. Now, if that’s possible, I’m all for it. The second is to change how you feel about it. The third is to accept it. And the fourth is to make it worse. In which case, I guess folks wouldn’t be listening to this podcast or coming to therapy.
Dr. Jeff Cohen:
So it turns out that, unfortunately, the pandemic does not appear to be a problem that can be easily or quickly solved, and most of us are not in a position to solve it. We may be able to change how we feel about it by changing how we’re thinking, maybe shifting thoughts to those of gratitude can be helpful. So maybe rather than thinking I’m stuck at home, you might think, “I’m grateful to have this extra time to spend with loved ones.”
Dr. Jeff Cohen:
I will just note that toxic positivity, which is trying to see everything through rose-colored glasses and changing all of our thoughts to be positive is not helpful. It’s actually invalidating ourselves and our experience. The fact of the matter is that things are really hard right now, and this means trying to change our thoughts may paradoxically make things worse. That’s why acceptance-based cognitive behavioral therapies versus change-based behavioral therapies might be more helpful in this moment in time.
Dr. Jeff Cohen:
So given we cannot solve the pandemic and we can’t always change how we think or feel about it, acceptance of our current reality is a key way to cope with the pandemic and the related anxiety and stress. So acceptance is simply to acknowledge the facts of the world as they are and to acknowledge the demands of the present moment. It’s the act of confronting the uncomfortable truths of our reality.
Dr. Jeff Cohen:
Now, to radically accept is to acknowledge reality completely and totally with body, heart, and mind. So it’s to accept reality entirely and with every fiber of our being. That’s what makes acceptance radical. Now, acceptance is not approval and it’s not giving in and it’s not giving up. It’s also not agreement. It’s a choice that we make repeatedly to open ourselves to the reality of the present moment. So before I tell you how to actually practice acceptance, let’s talk about why you would want to bother.
Dr. Jeff Cohen:
So, what would it help with? So it turns out that denial of the pandemic doesn’t actually solve the anxiety or the emotional problems that so many of us are facing. In order to solve those problems, we first need to acknowledge them. And unfortunately, problems intensify and ordinary pain turns into extraordinary suffering when we deny reality. In fact, we often say that pain is the admission ticket to life, and pain plus acceptance equals ordinary pain where pain plus nonacceptance equals extraordinary suffering. So emotions that are suppressed and avoided only become bigger. No emotion lasts forever when it is fully accepted and experienced.
Dr. Jeff Cohen:
So acceptance of our emotions, our thoughts, and our struggles is a powerful way to cope in the context of the pandemic. So, how do we do this? Well with the body, with the heart, and the mind, and I can break down each of those three domains.
Dr. Jeff Cohen:
With the body, try turning your hands upwards to accept reality. We call this willing hands. It’s just a physical position of hands unclenched, palms facing up, and fingers relaxed. Willing hands really helps because the hands are communicating to the brain that you’re working on accepting reality as it is. Half smiling is another way of accepting reality with the body. This means to relax the facial muscles first and then form a half smile with the lips in a serene way. It’s important to note that half-smiling is not tensing nor grinning nor hiding or masking emotion. It’s not about signaling to others and it might actually be so subtle that only you notice it. So like willing hands, the half-smile is to communicate to your brain that you’re practicing acceptance. So I suggest to the people I work with that they try willing hands and half smiling when they first wake up in the morning, when they have a free moment, and when they’re struggling with the pandemic.
Dr. Jeff Cohen:
Now, with the heart. Acceptance involves opening the heart with compassion to this one moment. This means being willing to experience feelings and the feelings of others with kindness. We call this willingness. So this means being willing to experience feelings of sadness related to ourselves and the state of the world and welcoming the sadness into our heart, rather than attempting to escape from the emotion. We welcome it.
Dr. Jeff Cohen:
Willingness is also the practice of saying yes to the universe exactly as it is from the depths of our heart. The paradox here is that the less willing to have something, the more we have of it. So I remember when I was in grad school, a friend of mine was collecting data for his dissertation, and it involved a physiological measure and he had an anxious participant, and he told that participant, “Hey, you got to get your heart rate down. If I don’t get this data, I’m never going to finish my dissertation and I’m going to lose funding and I’m never going to get out of here.” Now, do you think that participant’s heart rate went down or up? So willingness is just being willing to have all of it, all of our emotions.
Dr. Jeff Cohen:
Now, how do we accept a reality with the mind? Well, let’s just note that accepting reality is like facing a fork in the road where one path leads to acceptance and the other path leads to non-acceptance. So Marshall Linehan says turning the mind is actively choosing to walk down the path that leads towards acceptance rather than rejecting reality. So in order to turn the mind, first you have to know that you’re not accepting reality. So for instance, notice, if you find yourself saying, “It shouldn’t be this way, or “why is this happening”, in fact, it turns out that everything is as it should be.
Dr. Jeff Cohen:
Now, things are not as we wish them to be, but to say things shouldn’t be the way they are is to deny the reality of the world and to deny the causes. Everything is as it is given the causes in the universe and in the world, even if we don’t know or don’t like the causes.
Dr. Jeff Cohen:
So in turning the mind, you have to look for signs of nonacceptance saying it shouldn’t be this way, then make an inner commitment to accept reality as it is. Maybe you just remind yourself that you’re accepting reality in this one moment to change it in the next moment, or maybe you’re accepting reality because you cannot problem-solve here and to continue to do so just turns ordinary pain into extraordinary suffering. So you make a commitment to accept reality and then you have to do it again and again and again. So each of us will face many forks in the road as we continue to cope with COVID, and each time is really an opportunity to turn the mind towards acceptance.
Dr. Jeff Cohen:
Finally, mindfulness is also how to accept reality with the mind. Mindfulness is the practice of accepting each moment as it is without pushing it away or clinging to it. Now, mindfulness can include a formal meditation practice where we set aside a period of time to do nothing but meditate and it can also include paying attention to something we’re already doing, such as the food we’re eating. So to practice mindfulness means to fully accept the reality of this moment and everything that’s present here and now, and that includes the pandemic. If you think about it, all that really exists is this one moment. The future is yet to happen and the past is already over, so mindfulness is to be present to life.
Dr. Jeff Cohen:
Turning towards mindfulness is really a continual practice that takes effort, so each day we can practice acceptance with our body, our heart and mind. Each day that we do that gives us permission to cope with the demands and the realities of the pandemic, and it’s affected us in ways that few have expected. This was what at the outset seemed like a brief crisis and now it’s stretched on through the summer and into the fall and seems likely to continue for the foreseeable future. So when the life that we’re living is not exactly as we want it to be, acceptance is the key skill to cope.
Dr. Jeff Cohen:
Acceptance also allows us to continue life living, excuse me, acceptance allows us to continue living life in a meaningful way, aligned with our values despite these difficult times.
Stan Hall:
Thank you. Thank you so much for the conversation today, Dr. Cohen. If someone was interested in perhaps finding a therapist or looking for resources on CBT, where would you suggest they start?
Dr. Jeff Cohen:
Absolutely. So I would recommend looking abct.org. Again, abct.org. That stands for the Association for Behavioral and Cognitive Therapy. This is a great resource to identify therapists who are experienced in providing cognitive and behavioral therapies, including mindfulness-based behavioral therapies across the United States.
Dr. Jeff Cohen:
You can also ask your insurance company or your primary care doctor for a referral to someone who specializes in cognitive behavioral therapy or mindfulness-based behavioral therapies. The other mindfulness-based behavioral therapies are sometimes referred to as acceptance and commitment therapy, which is just about accepting our thoughts, and emotions, and committing to the values and the actions that matter to us in life. Dialectical behavior therapy, which is particularly helpful for folks who think about not being here or suicide. The dialectic just means that every truth has an opposite truth, and those two things come together in synthesis. The primary dialectic is out of acceptance and change. This means I’m doing the best I can and I can do better. “If I just focused on change, I start to feel a lot of shame and really bad about myself, and it’s too hard to change. And now if I only focus on acceptance, that’s okay although eventually I never get to the life I want really want to be living.” So this balance of acceptance and change is really the hallmark of the latest cognitive in behavioral therapies.
Dr. Jeff Cohen:
The Association for Behavioral and Cognitive Therapies website has a directory, so I would go there and click find help. Also, in Columbia psychiatry, we also specialize in cognitive behavior therapy and mindfulness-based therapy such as acceptance and commitment therapy and dialectical behavior therapy. You can look us up just by typing in Columbia psychiatry.
Stan Hall:
My takeaways for this episode are, one, fear can be helpful, but only to a point. Also, fear can be triggered by those around us. And in the case of a bus barreling toward us, fear helps kick our muscles into gear to get out of the way. But fear is also persuasive to your thoughts. It’s important that you police fear and your own thoughts so that you’re never asking, “What if a bus hits me?” Because once it takes root, fear and anxiety can keep you from living a life you want to live.
Stan Hall:
Two, not all thoughts are created equal. Though we have little agency over what thought may pop into our heads, we can work through mindfulness to hold onto thoughts that don’t carry anxiety baggage with it. Some thoughts may be stickier and harder to let go, and that’s where working with a professional can be incredibly helpful for someone looking to change their own narrative. Just as you wouldn’t expect to become an accomplished tennis player without a coach, your mental fortitude is no different. The right expert can help you on the path to live a life you want to live.
Stan Hall:
Three, acceptance is an important skill, especially when the world you live in is so uncertain. Accepting outcomes is tough. It’s almost involuntary to utter a phrase like, “Why is this happening to me?” But Dr. Cohen’s point of, in fact, everything is as it should be really stuck with me, especially with externals that you may have no control over. And I can say that from experience, and a few stressful Zoom calls last week, the open hands relaxation technique is really a good hack.
Stan Hall:
To learn more about Dr. Cohen, visit our show notes page at truewellthpodcast.com. You can also follow him on Twitter, @DrJeffCohen, or get in touch with him through Columbia.
Stan Hall:
If you enjoyed today’s episode, we’d be much obliged if you left us a review or recommended this episode to a friend. Every little bit goes a long way in elevating the concept of wellbeing to a larger audience. To get in touch with the team, visit truewellthpodcast.com. Again, that’s true WELLth, W-E-L-L-T-H.com. Until next time.
Stan Hall:
The true WELLth podcast, made possible by Brighton Jones. Whether you want to save for the future or celebrate today, give back to the community or explore the globe, Brighton Jones believes your values are every bit as unique as your fingerprints. Brighton Jones aligns your time and resources to those values so you can go after the things that you truly care about. Explore your richer life at brightonjones.com.
Stan Hall:
Today’s episode was edited and produced by Stan Hall, alongside the rest of our true WELLth team, Michael Stubel, Marc Asmus, Lindsey Hurt, Tara McElroy, and John Dougherty. To get in touch with the team, visit truewellthpodcast.com.
