Do you hate feeling anxiety, doubt, or other “negative” emotions? Because these feelings can be unpleasant, the most common reaction is to try to push them away or get rid of them.
We must conquer the anxiety and destory it forever! But this approach actually just leads to more pain and frustration.
There is a better way! Join Dr. Aziz as he interviews an expert in Acceptance And Commitment Therapy. You will learn how to accept your feelings, free yourself from negative thinking, and take action based on your deepest values.
Click below to hear this episode!
Learn more about Marina Gershkovich and her online program for overcoming social anxiety!
The Power Of Acceptance
Hey welcome to today’s show which is called the Acceptance Paradox. This is a really fascinating concept and I go in-depth in it with my guest expert Marina Gershkovich who has been doing some really fascinating research about social anxiety, about the power of acceptance and about what I call the acceptance paradox. So we’re going to do that in just a minute. I do want to also share with you that we have a new hotline set up for the show that you call in with your questions. That’s why I’m getting more and more of my ask the shrink segments and how do I talk to her segments where I’m giving advice on how to create relationships or any questions you have related to social confidence.
You can access the hotline by calling 206-338-3176 and ask me your questions. You can also ask questions through the website of ShrinkForTheShyGuy.com. There’s a way to send a voicemail via the web to me that I will personally listen to and answer in an upcoming show. You can also send the questions and emails to . And of course you can also follow the show on Twitter @ShyGuyShrink, that’s Shy Guy Shrink and at Facebook, it’s Facebook.com/ShrinkForTheShyGuy. So get connected in any one of those ways.
You can find out about updates from the show, special segments and ask questions to be able to get your question answered on the show. I look forward to connecting with you. This is not kind of a one way me talking at you. This is actually a conversation I really love to tailor what I’m doing to meet the needs that you have to really help you overcome the challenges that you want to get the confidence that you need. So the acceptance paradox, here is the basics of it and it says, when you accept something, it diminishes and when you fight it, it grows bigger.
Another really simple way that this is often communicated is, what we resist persists. And so this is so common and so important. In fact, pretty this whole episode is dedicated to my interview with Marina because there are so much good stuff in there that teaches about this and she’s an expert in acceptance and commitment therapy which is a vey powerful modality that as the name would imply is very focused on acceptance because time and time again, I see so much of the anxiety we might have is about the anxiety.
Oh my God, what is someone saw that I was anxious. I shouldn’t be feeling anxious. What’s wrong with me, I need to get rid of this anxiety so I can feel better about my life, and there is this, harsh tensing rejecting energy that we have towards ourselves and particularly the anxiety in ourselves. And what this does is on the surface it seems like it makes sense, right? Like you got a problem, you extract the anxiety like a tumor and you throw it in to the biohazard bag and burn it and it’s gone forever. That doesn’t work that way with our emotion.
And the anxiety is a part of us and it’s telling us something that it needs to be dealt with in a different way. And the more you fight it, the more you hate yourself for it or wish he was not there, paradoxically, the more it stays the more it intensifies, the more it starts to control you and run your life. And the beauty of what Marina teaches is how you can feel the anxiety and move what you want anyway and have it be there but not running the show, not be the boss of you in a way.
So without further ado, let’s jump in to that interview with Marina.
Dr. Aziz: So today with guest expert interview is with Marina Gershkovich who is a PhD candidate in clinical psychology Drexel University in Philadelphia. And what’s fascinating about Marina is, she has found a need out there for people with social anxiety and debilitating shyness who need help, need treatment but for whatever reason aren’t getting it. And there are some interesting statistics about how long someone will wait to get help when they’re really struggling with social anxiety. And so she’s done some really interesting things to pioneer creative ways to reach people that need to help and provide them with the help and with the treatments.
So she’s created an online treatment training program. That’s an eight-week program, it’s got different modules to help people overcome social anxiety. So I’m incredibly excited to talk with you Marina about what’s in the program, how you came up with it and, you know, hopefully people listening can live with some practical tips to apply some of what you teach in your program. So thank you so much for joining us on the show.
Marina: Thank you so much for inviting me to be stick with you at this. I’m very excited to be here.
Dr. Aziz: Yeah. Well great! So let’s just start with, so what is the online program? Maybe just a brief kind of 30,000-foot-view of what exactly it is?
Marina: Sure. So just a little bit about my background, over the last four years, I have worked as a project coordinator for out in-person treatment study for social anxiety disorder t Drexel here in Philadelphia. And in my work here, I was struck by the number of individuals contacting the clinic to express interest in the treatment but who are unable to come in due to their incredibly high levels of anxiety. And moreover, I came to realize that many others cannot receive adequate treatments of the limited availability of clinicians who have expertise treating social anxiety and also because of financial cost. And we have treatments that have been demonstrated to work in treating this disorder. But research shows that only 20% of people with social anxiety seek and receive treatments.
Dr. Aziz: Wow!
Dr. Aziz: That’s a more dismal, dismal than I realized.
Marina: Yeah. It’s pretty shocking. And so part of my research, I was motivated to find ways of hoping to deliver treatments to those who need it. And technology provides us with the ability to do just that. So the program that I’ve developed, it’s similar to an online class, it consists of eight weekly modules that individuals complete in a sequential order and the modules or the mini lessons, they include multimedia components such us videos, illustrations, homework or finance. So it’s not just a traditional self help that we think of like creating a book.
It’s also different from traditional in-person therapy and that you can actually watch a video illustrating a concept instead of just discussing it, so, and the fact that it’s just an engaging program that’s based on a treatment that has been shown to work.
Dr. Aziz: Well that’s great. And I know that you — I was reading an article about you online and said something about a pilot study that you guys have done. So is this is something you’ve actually tested with people and seen what the results were?
Marina: Yes, absolutely. So, for the pilot study, after developing this program, I wanted to see if one, participants were satisfied with the program in terms of the content, ease of use, those kinds of things. And then secondly, I was also very interested to see if this program would work in decreasing symptoms of social anxiety. So the program itself is eight weeks long and asks the individual to log on at least once a week. But what I’ve also realized is that a lot of self-help programs, no matter how effective they are, if people don’t do them, they don’t work.
So, for this reason, I wanted to increase accountability by including brief therapist support. So in this pilot study, I addition to logging on to the program, individuals would speak with the therapist for 10 to 15 minutes a week. And this time is not meant to be a therapy session but just a time to clarify concepts and to provide help with homework assignments. The other noble thing about this project was that this therapist support was provided through video conferencing.
Dr. Aziz: Hmm, okay.
Dr. Aziz: So, that help to access the people that we’re too far of a distance or that’s reluctant to come in?
Dr. Aziz: Yeah.
Marina: Exactly and video conferencing has not yet been studied as a supplement to internet programs. And my rationale for using video conferencing was that it provides the face to face with another person, it provides accountability not just to an anonymous person or a computer but to a therapist that patient could be and this in itself could also be viewed as a mini exposure. And. And, you know, exposure has been shown to work for treatment of anxiety disorders.
Dr. Aziz: Yeah, I mean that makes so much sense and I think we all have the experience of getting some sort of self help or self improvement program and then, I don’t know, being excited and motivated for the first week or two and then something just comes up or we —
Marina: Exactly, life takes over.
Dr. Aziz: Exactly. Yeah.
Dr. Aziz: So this is a great way to make sure that they are continuing to work with it because exactly what you said like these things do exposure and another things do have in a profound effect if they are conducted out and just really invested.
Marina: Yeah, exactly. So, in the pilot study that we did, the results were very positive and promising. For people with mild to moderate levels of social anxiety, the program resulted in decreased symptoms. In fact, some people no longer met criteria for this disorder when they finish the program.
Dr. Aziz: Well that’s great.
Marina: Yeah. And for those who’s symptoms were initially more severe, the program serves just kind of the first step in getting them to play where they could feel more comfortable at seeking in-person help. So what’s exciting is that the effect was very similar to an in-person treatment studies. This program with just 15 minutes of therapist time was just as effective as a traditional in-person 60-minute session with a therapist.
Dr. Aziz: Well that’s great. And they could do it on their time and —
Dr. Aziz: — practice at stuff without needing to drive and come in. So, that’s exciting.
Dr. Aziz: But, which makes me curious is learning a little more about what’s in the program specifically. I came across a really interesting image that I believe you had actually drawn and created yourself that was a metaphor of anxiety being like a game of tug of ware with a big monster. And can you share a little more about this metaphor or how you teach this?
Marina: Absolutely. So the tug of war metaphor is not unique to out program. It’s commonly used in the acceptance and commitment therapy which the program is based on. The illustration was my own but the metaphor is commonly used in the therapy. And the idea is that we cannot always eliminate our anxiety, no matter how hard we try. But we can change how we relate to our anxiety. So, imagine your anxiety as this big ugly monster. Imagine that you are in a tug or war with him. You’ve got one end of the rope and the monster has the other. In between you, there is a huge bottomless tips.
The monster is being mean. He is yelling mean things to you. So you’d naturally like to get rid of him, you’d like to get rid of your anxiety. So you’re pulling on the rope as hard as you can but the monster keeps pulling on the rope and brings you even closer to pit. So what’s the best thing to do in that situation? Pulling harder comes naturally but the harder you pull, the harder the monster pulls. So, the harder you try to get rid of your anxiety, sometimes the more anxious you become so you’re kind of stuck.
So the alternative might actually be to drop the rope.
And dropping the rope means that monster is still there but it also means that you are no longer tied up in a struggle and suddenly you have your hands and feet to be free to go and do something more productive with your life than to engage in this tug of war. So, one thing to know is that a lot of times people say, well, what do you mean? Do you mean I should just give up? And that’s not what we mean at all. Instead, it’s not I believe recognition, it’s more empowering because now you’re in control of your life and the focus of your life is no longer about the monster or your anxiety.
So, since we think of people struggling with social anxiety, most of this they might spend avoiding situations because they don’t want to be in a situation that provokes the monster to come up.
Dr. Aziz: Exactly.
Marina: They are trying to avoid feeling anxious. So they almost limit their lives to go around the monster, to not feel, to not hear him yelling. But instead what we’re saying is, then the monster is in control of your life by avoiding things that you want to be doing but not living the life that you want to live because of your anxiety. The monster is in control. So that’s kind of a new of a different way of thinking about anxiety.
Dr. Aziz: Absolutely because I think a really common idea with social anxiety is well, when I am more confident and when I’ve overcome this anxiety, then I’ll go start that conversation with that person or go to that party or gathering or do something that is not comfortable to me. And what I hear you suggesting is that it’s about choosing something and then moving towards it even though there is anxiety. Is that right?
Marina: Exactly. You got it. And one other exercise that we tend to do in therapy is the and-but exercise. And in this exercise, you know, you substitute the but with and. And it sounds very simple. So, but it’s very effective. So if somebody might say, I want to go to the party but I’ll be anxious. Instead what we’re saying is, let’s substitute that but for and. Let’s bring that anxiety with us. So, I want to go to the party and I’ll be anxious. So this way, anxiety is no longer a barrier in your life.
Dr. Aziz: So then this leads to a really interesting question which I get a lot from people is I think what comes along with social anxiety is the sense of shame around that anxiety. If I am anxious and people see that I’m anxious then, you know, they won’t respect me at work, my boss will think less of me, people of the opposite sex or that I’m drawn to will think I am unattractive and there’s all this meaning associated to anxiety that makes it really dangerous in a way, socially dangerous from the perception of someone with social anxiety.
Dr. Aziz: So what would you say in response to that fear?
Marina: Yeah, absolutely. So the way that we think of it, coming from the acceptance and commitment therapy, so all these fears are just thoughts. And it’s essentially the monster yelling at you saying, you know, when you go in there, you won’t be able to perform, people will see that you are anxious and there is no way of actually testing this out because we’re also still creatures. We can’t always know what the other person is thinking unless we ask them. And a lot of time we won’t. So, it’s almost better to envision those thoughts as for what they are.
They’re just thoughts and instead of them having this control and power over you, deciding what’s important to your own life, is it important for you to go to that job interview even if you might blush or you might be anxious and some people might see that you. So kind of almost blooming out and thinking about what’s important to you in your life and have that drive your behavior instead of being absorbed by these thoughts that the monster is drawing at you.
Dr. Aziz: Yeah. And that’s interesting question is like what’s important to you in your life and I’d imagine that goes into values and what someone values. Can you say more about how someone can find those values and choose to follow them and in spite of their fears?
Marina: Yeah, absolutely. And again this is a big component of acceptance and commitment therapy. We spend a little bit of time talk to patients about what they value in their life. And a lot of times even people without social anxiety, we forget what our values are. Some of these values are not very clear to us from the beginning. So, you know, we are so absorbed in the day to day hustle and bustle of things that we forget why we’re doing the things that we’re doing. And instead, when we talk about values, we say, you know, let’s take a step back and let’s really think about what you want your life to be about.
And with people with social anxiety, we take a look at what their currently doing and a lot of times though engaging in behaviors that are really only meant to control the anxiety or try to get rid of it and we ask them, is that what you want your life to be about? Do you want at the end of your life somebody will say great job, you’re successful in getting slightly anxious, less anxious at the end of it.
Dr. Aziz: Yeah that’s —
Marina: Or yeah. Go ahead.
Dr. Aziz: I’m sorry, go ahead continue.
Marina: Or do you want people to say, you know, if this person did all of these wonderful things, you know, they were philanthropists, they’re really in the charity, they really did that, they volunteered, so that’s a contrast to what we typically do. So, as part of the values work, what we tend to do is just down and start thinking about different domains in our lives and what we want to accomplish and kind of the behaviors that we can be doing everyday in service of that value.
Dr. Aziz: Absolutely. And what I like to ask people that I’m working with is uncovering what those values are and making a list which is really fun and having them prioritized, what do they value most, what’s they’re most passionate about, whether they really live the most, if they live the life that they truly want, what would it involved and they get sort of excited about it and then what I’d love to do is say, what are the values that you’re living right now?
Dr. Aziz: And at the top of the list which is exactly what you described, it’s management of anxiety which is really the value of trying to maintain safety in a way and not necessarily sort of a basic needs level of healthy safety. I mean, overly safe. Like I want to make sure that no one ever has a negative thought or idea about me ever.
Dr. Aziz: And that’s a value and when they can see that contrast, it starts to highlight that they’re not living how they really deep down want to live and intend to live.
Marina: Absolutely and I think, in addition to wanting to be in control of how other people perceive them, it’s also this kind of drive to always be comfortable and anxiety makes us uncomfortable. And, you know, the value of being comfortable tends to override all of these much more important values in life.
Dr. Aziz: And so what would you say in that situation of someone is like, okay, I see that it is important to do it in spite of the anxiety but I mean, this anxiety is so intense that I just lock up like is I, you know, in that conversation, I’ve had experiences where I get so overwhelmingly anxious that I freeze, my eyes bug out of my head, I start sweating and it’s just a terrible experience, so even, you know, how do I do it in spite of the anxiety when the anxiety, you know, just really demolishes me.
Marina: So I would say, one is to do it gradually. So, don’t go into a situation that makes you super, super anxious right away. Work up to it. So, with exposure, you want to really, you know, create a list of situations that make you anxious and do it in a gradual way. And then in terms of the techniques that you would use in the moment when you’re doing this is to notice your anxiety but to be willing to experience it. So, a lot of times when people lock up or experience these physical symptoms and they really fire out of control is when we notice the anxiety and then we try to fight it.
And that almost makes things worse. So, instead what we say is, notice your anxiety and not just allow it to be there. And we talked about willingness and willingness is a way of almost welcoming the anxiety no matter where it’s at. Are you welcoming the anxiety if it’s low, are you welcoming the anxiety when it’s high. And I think this brings in kind of this mindfulness component where you’re just observing it without judging and without trying to change your internal experience.
Dr. Aziz: It sounds like you stop making anxiety the enemy that must be obliterated at all costs.
Dr. Aziz: Wow! And this — I mean, it’s just some really helpful information here to reorient how you deal with emotions and, you know, one, not seeing them obstacles that must be cleared before you can take action as one thing I’m hearing you say. And the second thing is that maybe they’re not even things that need to be gone rid of or eradicate in the first place that we can actually be with them. And what kinds of experiences do people have when they do start accept their anxiety so in that instance where they were really scared in the past and they’re locked up, if they started to accept the anxiety more, what kinds of things do you notice have happened?
Marina: So, a lot of times when people are more accepting of their internal experiences, what happens is that they’re able to carry on the conversation because they are no longer paying so much attention up to this monster of anxiety instead they’re paying more attention to what the other person might be saying. They are paying attention more to their environment. So they’re able to engage in behaviors that are again consistent with their values of doing things that are important to them. So, by being mindful of this monster and no longer fighting it, it’s no longer your enemy, it’s just somebody you take along with you. You know, sometimes people do notice that their anxiety is lower once they stop fighting it but that’s not necessarily the goal.
The goal of this treatment is not necessarily to make the anxiety lower because right now we’re just changing the way that we are related to our anxiety. As a side effect, it might become lower but that’s not necessarily all that important because we’re welcoming the anxiety no matter what because we’re not going to let it be a barrier to our life.
Dr. Aziz: Interesting and such a radically different way that we can relate to our own feelings in the day to days. So I think that’s really helpful for people to hear and, you know, for me, to get remind of and it’s just such a good reminder that, you know, what then look cliché at this point but we were resist persists.
Marina: Yeah, absolutely.
Dr. Aziz: And we fight that monster and fight those feelings. We might think we’re doing ourselves a favor because we’re trying to protect ourselves from something uncomfortable but what ends up happening is you just locked in a battle that can last months or years whereas a feeling can move through pretty quickly if we just open to it and accept it.
Dr. Aziz: So that’s really interesting. You’ve mentioned a number of times acceptance and commitment therapy, do you have any recommendations for us a basic intro that is not too heavy and, you know, psychological terminology and just a really simple introduction for acceptance and commitment therapy especially as it relates to anxiety or social anxiety, any recommendation for us?
Marina: Yeah. Get out of Your Mind and Into Your Life by Steve Hayes is definitely a good starting point.
Dr. Aziz: And a great title as well.
Marina: Yeah, exactly.
Dr. Aziz: So yes, I encourage anyone who is listening, who is draw to this program to really go through the acceptance and commitment therapy is very powerful and it forms a lot of the work that I do with people and just even as you listen to this conversation, you might start to realize there can be a relaxing or a shifting in your body, in your chest to your stomach. There is something that just unwinds when we realize we don’t have to fight ourselves or be at odds with ourselves and that’s what I love about the acceptance and commitment therapy approach.
So, I think this is really helpful. Thank you so much for coming on the show and sharing your insights of what has worked and also just a message of hope like look, this is something that you can overcome and you’ve done it with people, you’ve helped people online, it’s really there are so many ways that people ca overcome this and that the only thing that gets in the way is as you said is just thoughts, just the ideas that stops us.
Marina: Absolutely. We sometimes get in the way of ourselves but we don’t have to struggle. So there is definitely a treatment that’s available that can work for a lot of people.
Dr. Aziz: That’s so good. Well, thank you so much for coming on the show Marina and I hope someone reaches out and I look forward to hearing more about further research that you do and hearing more about your program as it develops.
Marina: Thanks so much. I was a pleasure speaking with you.
Dr. Aziz: So with the last bit of time that we have today, we’re going to get into your action step.
Dr. Aziz: Today’s action step is to apply what you’ve learned in the interview that I did with Marina and basically to say yes to anxiety. Apply what you learn, focus on acceptance, use some of the techniques that you heard in this interview and focus on acceptance and taking action in spite of the feeling rather than fighting the anxiety so much. Instead of saying I’m not going to take action until I fix this anxiety and make it go away, really breathe, feel, allow it to be there, drop the rope, stop fighting it and say what is it that I really value that I really want to do and then commit to taking that action even though there that anxiety.
And see if you can just have a little acceptance for yourself and for that anxiety. And see what that does for you. In my experience when I’ve shared this with people and I’ve done some with people in confidence coaching, it’s led to very powerful results especially in people who’ve been locked in the pattern of resistance and fighting their anxiety for years, all of a sudden when they realize that it’s not a battle they have to win, they don’t have to destroy and eradicate their anxiety to create the life that they want, that they can go after what really matters to them in spite of it and let it be there and eventually it kind of — it’s not really a big of a deal, then something magical happens, something opens up in their lives.
So I want that for you. So work on acceptance, let go of needing to change the anxiety and just let it be there and go after what you really want in your life. And until we speak again, may you have the courage to be who you are, to accept yourself for who you who are and ultimately to go after what you really want and really value in this life. I’ll talk to you next week.
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