How do you recognize avoidance when you are already stuck in an avoidance loop? Anna Lindberg Cedar MPA LCSW interviews fellow anxiety specialist, Anja Schmitz PhD, about how to stop avoiding your life and show up for what matters most. Dr. Schmitz was recently featured in the New York Times article "When Silicon Valley Goes To Therapy" and is a leader in the health tech space. She shares lessons learned from her research experience at the National Institute of Mental Health and direct work with individuals working to overcome debilitating anxiety. Listen in to hear Dr. Schmitz describe how to take small steps to train yourself out of an avoidance loop. This is not therapy. This Is Real Life. Learn more about therapy resources, self-care tips, and the Bay Area counseling practice: TherapyForRealLife.com 

--(Please excuse any transcript typos -- blame the AI! Thank you!) --

Anna Lindberg Cedar, MPA, LCSW: 

Welcome back to the Therapy For Life Podcast. This is not therapy. This is Real Life. I'm your host Anna Lindberg Cedar MPA LCSW.  I'm here today with Dr. Anja Schmitz to talk about avoidance. But before we get into that conversation Anja -- Are you sure? Is there anything else you'd rather do right now? Would you rather wash your hair, clean your room, clean your bathroom? Are you sure there's nowhere else you'd rather be?

Anja Schmitz, PhD:

That's a really great question! I'm really excited to be on the podcast. To be honest, it is a little bit intimidating. So I might have had a little pull to avoid this today. And I'm really glad I'm here. 

Anna:
So we'll get started! Thank you for making it. You know that you're talking to a real avoidance, -- or shall I say anti-avoidance expert -- if you're able to make it and sit through all of that to make it on a podcast, so thank you for being here. Anja, I'm really happy to have Anja on the show because I consider Anja, one of my most valuable peer mentors. This is where I'm going to brag about her a little bit. And I'm hoping she'll brag about herself a little bit more because she has such rich experience to draw from. But I first met Anja, in the health tech space, and I'm hoping she'll talk about that a little bit more. And we could have picked many different topics to talk about today, but we landed on avoidance. So Anja, could you share with our listeners, just a little bit about your professional background? And how is it that you came to be interested in the topic of avoidance? 

Anja:
Sure. So yeah, I'm a clinical psychologist, and I got most of my training actually in Germany. I started out there studying avoidance more in the context of personality traits. I did a lot of research around personality traits that have to do with anxiety. And ... typical things that people would do when you think about things like neuroticism is like avoid situations that make make them uncomfortable. So I did some research in that area and then moved to the US to do a postdoctoral fellowship at the National Institute of Mental Health and there I worked on a large family study on anxiety disorders and disorders, where we studied families and were interested in finding common themes that of what people inherently inherit from their parents that can show up then in anxiety disorders and in mood disorders. And avoidance is really a huge component in both of these large classes of psychological problems. So, a lot of what we do when we're trying to avoid psychological pain, whether that is anxiety or low mood is is leading us to avoid which then ultimately gets us stuck in a loop where the avoidance actually leads to more anxiety or even lower mood. 

Anna:
Well, here we are on the Therapy for Real Life Podcast. And as you know, the aim of the show is to try to translate therapy concepts into everyday self care strategies that we can all use. So you and I are used to talking kind of insider baseball clinical terms and we're already talking about anxiety and avoidance. And here you are, you're bringing in some of that past experience in explaining to people what what we really mean when we're talking about anxiety and avoidance. So I'm curious if you could share with me, what are the ways that people typically describe anxiety? I mean: I know I have people come into my office every day and anxiety is not always the first word that comes to mind. And usually that's the job of a therapist, right? -- is to help them put language and understanding to that. Yet, how do people usually describe anxiety when they first come to you as a therapist? 

Anja:
So yeah, I mean, the content can be really, really different from person to person, what they're struggling with in their everyday life. And most of all, it's you know, people describe it as something that gets in the way for them really doing what they want to be doing. So somebody for example, might say I feel really uncomfortable in situation Where I'm meeting new people aware where I have to speak up at work, when we're doing presentations, or it's really, really hard for me to go out and find friends. So the first step is always to kind of look at what kind of thoughts what kind of feelings are coming up for you in those situations that make it really, really hard for you to do the things that you would really like to be able to do.

Anna:
I think something I'm hearing as you talk about that, when you describe the experience of anxiety is for a lot of people there's a real kind of mystery quality to it. Some of the examples you give -- going out with friends and family meeting people for the first time going for a job interview -- A lot of times, people will describe those situations with real frustration like why "Why can't it just be easier for me?" and there's even self-critical thinking. I don't know if you find this to be true. There's a lot of Kind of self critical thinking that goes along with that discomfort that you're describing, whether that's that's an emotional kind of discomfort or a lot of people will describe the physical signs of anxiety before they describe it as anything else. What's your experience been with that? 

Anja:
Yeah, absolutely. And that's, you know, when we're thinking about other things that people might be afraid of, like, for example, there's physical sensations that sometimes come up or they describe it as as having a panic attack or, like really, you know, being paralyzed by these overwhelming feelings and sensations that are happening for them. Often people feel really isolated with that and like they're the only person here is experiencing these kind of feelings and sensations so people can be like really self critical and hard on themselves and don't understand. Why am I suffering from this? Why is this so difficult? For me, I'm kind of think like, I should be able to handle this, this shouldn't be so hard for me. So they really try to not experience anything that showing up for them internally, when they're in those situations that are difficult. So help me understand how do people get stuck in that loop when you're describing that really uncomfortable sensation that people can have? Maybe there are certain triggers that trigger that, that anxiety, whether it's social or otherwise, how does that how does that turn into avoidance? Yeah, so it's really the natural pull that we have on where we know how we how we solve problems in the real world. And we're trying to do that with our internal worlds, which unfortunately can really backfire. So if we go go back to to our examples, like somebody might have a trigger, that's more of a social nature, right. So it might be going to a party or meeting people for the first time. So when they, when they walk towards that trigger, like a lot of anxiety is coming up. So their mind basically is labeling the situation as something that is dangerous and that they should get out of as fast as possible. So the fight and flight response, which I'm sure you've already mentioned, podcast is going to like really get going, which adds all of these uncomfortable feelings that then people in turn are getting really anxious about having the anxiety so they're afraid when they notice that their heart is starting to be really fast, that they're getting sweaty, they might fear that other people notice that, that they're getting anxious and that they might not be able to think straight or that those physical symptoms might be a sign of Something physiologically really being wrong with them. So that fuels the cycle of anxiety. So we have a trigger first, then we notice that we're getting anxious and then we're getting anxious about getting anxious, which makes the fight and flight response go even stronger. So our natural poll is to get rid of those feelings and avoid those feelings because it's really, really uncomfortable and our mind has labeled them as something that's really dangerous and that we shouldn't be experiencing. Unfortunately, when we do that, when we then avoid social situations, avoid going to those parties avoid meeting new people, we don't have a chance to learn what would actually happen if we put ourselves into that situation. And if we're able to sit with those feelings if we're able to actually tolerate the distress that's coming up in those situations... 

Anna:
The way that you're describing fight or  flight to me really sounds like the way you would describe an old outdated iPhone that has really old technology. Maybe that made sense at the time when the iPhone was first invented. But let's say you leave that iPhone on the shelf. And you know, every quarter, a new iPhone update comes out, but you are not updating that information. So your old technology -- that fight or flight -- is responding as if there was a tiger or a bear in the room. But you don't have the updates to know actually, this is modern society and we have other ways to solve our problems besides running away. 

So what can you share with our listeners, Anja, about some of the best ways to avoid avoidance? How do you break that cycle and actually do the things that are important to you? Right because people you know what this show talks a lot about burnout prevention. When we talk about burnout prevention, you know, what you want to make sure you don't burn out from depends on what's important to you. So we can't avoid the things that are important to us. How do we break that loop? 

Anja:
Yeah, first of all, I really love that analogy of the, of the iPhone. And that that the software is a little outdated. So yeah, as I'm sure you know, in the context of, talking about the fight and flight response explained is, how that's like a really, really ancient response that, yeah, is designed to keep us safe. But the method it's trying to do that in our modern world, is not really the most effective way of dealing with that. So yeah, it's a really good question of : How do we break that loop of avoidance? So the first step is really creating awareness around what is happening to you and learning How to observe yourself from up from a little distance to, you know, take take a step back and get a little curious around ---, Okay, what kind of thoughts are actually coming up for me in this situation? What am I really afraid of is going to happen? And what kind of feelings and what kind of sensations are coming with that? And then we can do a lot of education around for some people, it's already really, really helpful to know how the fight and flight response works. And that that is like a really natural and normal thing that's kicking in, even if it's not where we really need in the situation because as you said, there is no bear we need to run away from or fight in that moment, but just knowing Okay, this is just my fight and flight response picking and this is just this ancient` part of my brain the amygdala that's running the program of I am in danger. And we need to do something about it. 
And just to give a name one of the, you know, one way to describe the skill, Dialectical Behavior Therapy would call the skill you're using right now called Cope Ahead, which is basically a therapist's way of saying "Sports Psychology." Because when you think of how great sports players play their games, they sit around and they imagine what the game is going to look like first, and they're not imagining that the pitcher is gonna throw them the easiest pitch in the world, they're imagining that they're going to send me a curveball, and it's going to be really hard. And I'm going to have my heart pounding out of my chest. So I know that's going to be hard, and you're planning your response. So when anxiety comes up, and you're really on one comfortable, you're not going to be surprised by that. So what are the skills that people can use once they recognize the signs of anxiety popping up and they know, okay, this is totally normal. But I'm still freaking out. What do I do about it? 

Right, right? So So once you're once you've noticed that anxiety is showing up, and you've made that decision, is this just my anxiety response that's kicking in? Or is there a real problem that we need to be solving, then you can learn how to actually go towards anxiety instead of avoiding it. Because every single time you avoid those internal feelings, you're basically teaching your mind this is really a problem. This is really something dangerous. So we want to break that, that you're reinforcing the idea that anxiety itself is something that's dangerous. So we call that exposure which we can do in a planned way or we can also Notice that when it's just happening to us throughout our lives, so the anxiety just comes up in a situation that's, that's difficult for you something that life is throwing it here, you make that decision. Is this anxiety? Or is that a problem that I need to be solving? If it's a problem you need to be solving, you can go and take that action. If you've decided this is anxiety, you can learn how to bring acceptance to that and float and feel that feeling. So you try to stay with your internal experience. You try to not push it away, you're trying to not rationalize or engage in a discussion with your anxiety is just letting it be there. 
I think that's really important. I want to break down what you're saying a little bit more because when you say exposure, right, I think a lot of people at this point have heard you know, they have a basic idea. Standing of exposure therapy, so I might be afraid of spiders. And so exposure therapy would help me first look at pictures of spiders, talk about spiders, maybe start watching movies about spiders. And eventually, if I'm really brave and want to get over this phobia, I might pull that spider in my hand.

Anna:

In, in the examples we're talking about here with really uncomfortable feelings. We're not talking about holding spiders, we're talking about holding really uncomfortable and sometimes painful internal sensations and feelings. And what we're really describing, you're the one who you know, as part of your peer mentorship has taught me so much about this. You're, you're describing experiential avoidance. And what we know about experiential avoidance is when when you avoid part of your experience, you end up throwing out the baby with the bathwater, right? When you throw up those uncomfortable sensations, you end up avoiding your life. Right? So when we're talking about exposure, that's a clinical way of saying, showing up for your life, whatever, whatever that is. And I have a recent example to draw from, but I'm sure you can think of 10 more among the clients that you see. I just went on my second, I can't believe I did it again. I'm a little proud of myself humble brag here. I went on my second five day Silent Retreat. And for me, that was a huge dose of exposure. And the biggest thing I was exposing myself, too, in the beginning was boredom. It was just straight up worrying. And yet when I built that endurance sitting there in in quiet for five days, wow, I did learn a lot about myself. There are a lot of thoughts and feelings and memories and sensations that came up in that time that I would not have had the chance to get to know about myself. So we're not talking about five days of silent retreats. That's maybe too much for some folks, and especially some of these uncomfortable feelings that we're talking about. But how do you do mini micro exposure or, you know, you're describing a sensation of going towards rather than going away, which is a sign of that fight or flight? How might you channel that idea of going towards how would someone do that in a really practical way?

Anja:
That's yeah, that's a really good question. And it always depends on what your mind is throwing at you basically. So if we imagine again, that somebody is afraid of theirs as our social situations we, we can plan exposures, based on what they're afraid is going to happen when they do it. And we can, we can make a hierarchy basically. And as you said, think ahead of Okay, what and how much of those uncomfortable feelings of that anxiety is going to show up when you're putting yourself into different situations and we can really write that down and all the details what we what we want to be doing. And then commit to doing that action that we like to start at a place that's, you know, where we say like, Okay, I'm going on a scale from one to 10 were, you know, bring you and about a six of your worst anxiety that you can imagine. And then we practice going into those situations. So that's really inviting the anxiety and we expected to show up and actually if you would come back the next session, and would tell me like under Yeah, I didn't feel any anxiety. Isn't this amazing? I wouldn't be like, Oh, yeah, I mean, that's like, nice to hear that your fear of consequences didn't come true. Or then you didn't feel as much anxiety but actually really bummed out for you. Because you didn't catch your practice. And you have to do it again. Yeah, I mean, well, we'll have to find a different place for you, where you can actually get that practice of intentionally bringing anxiety in and really inviting it in and being like, yep, I'm going to seek you out. I'm going to go with you on a little field trip and we're going to go to this party together. You can even like imagine it as as a little monster, or a little person that you have sitting on your shoulder while you're going into that situation. And you can kind of see you know, what's anxiety going to throw at you were kind of, thoughts  is it a going to articulate? How can you respond to that in a really helpful and effective way?

Anna:
I really like the way that you describe that. It's, it's kind of like the difference between anxiety management and really, you're describing a kind of anxiety, acceptance. Where does acceptance come into this for you? 

Anja:
Absolutely. So, as you said, like anxiety management is something that actually a lot of people come in with and tell me like I want to, I want to know how to manage all those feelings and sensations and people have tried a lot of things in terms of lifestyle changes, taking medication, avoiding caffeine, doing more exercise, and all these things can be really, really helpful and getting your baseline anxiety down and it's not going to really get rid of the anxiety because you're still getting caught up in that loop of avoidance and you're actually using them as weapons against the anxiety. And there's always a point where that stops working. So we call that paradoxical effort, the more effort we're putting into getting rid of the anxiety, the more it's going to show up. And that's actually true for a lot of feelings that we experience as being uncomfortable. So, all of those sensations and feelings that can be anger, for example, also, the more we're trying to get rid of that and push that away, the stronger it's going to come back. So avoidance at excuse me, acceptance is is really the key here. That can help you gain a whole different relationship to your anxiety and to your anger or other uncomfortable feelings that are showing up for you. So when it's showing up, it's actually not that distressing. 

Anna:
I really like the way that you described that. So I know that you are very busy person. And in fact, just a few moments from now you're going to run into your next session. So I don't want to take too much of your time. But I do want to ask your advice about something if people are listening to the show, and they're trying to get a better understanding of avoidance patterns in their own life. And they're maybe thinking about going to therapy for the first time, but they're not sure if they're quite ready. They're kind of on the fence. What would you encourage them to think about or know or understand about starting the therapy process, if they're still feeling unsure?

Anja:
So that's a really, really good, good question. I mean, first of all, I would want people to know that they're really not alone. Often anxiety can be a really isolating experience. And just knowing that there are lots of other people out there that can really relate to that experience and feel trapped in the same way can be can be really helpful to also bring some compassion to your own experience. So it's, it's really, really common, and it's something that many people experience and it's one of the most treatable conditions that we know in terms of psychological suffering. So we have really, really good tools to help people who experience excessive anxiety who really feel trapped by their anxiety and getting trapped in that loop of anxiety and avoidance. So there are really really effective ways of helping you.

Anna:
Thank you, Dr. Anja Schmitz, for sharing all your expertise. I think you've done a great job delineating anxiety and avoidance. I think we all can understand. Okay, that's something that we can all relate to. And it's good to put a word to it. Thank you so much for your time. 
Thanks so much, Anna, for having me. As I said, I had a little bit of anxiety before we started like, it's my first podcast, intimidating. And yeah, I so appreciate your inviting me and it was really, really fun to talk with you about anxiety and avoidance. Thank you so much. What a pleasure.  If you have questions about self care resources or questions about therapy, feel free to visit TherapyForRealLife.com .  Have a great day!