Thoughts / anxiety

Getting comfortable with uncertainty

We have returned. Again. After an extended break.

I didn’t fall off the Internet. As it turns out I just had a pretty amazing year. 2018 ended up being one of the best yet, but making space for all the new things meant that we got a bit slack on the Hope Street Cards front. But we’re back.

As with all beginnings, it can be natural for us to reflect on what has been and what will be. In reflecting on my 2018, I think one of the reasons I had such a stellar year was because somehow I became okay with uncertainty.

Rationally, we all know that life is mysterious. Unpredictable. Uncertain. We have very little idea what is going to happen or what surprise might be in store for us. Other than death – and maybe taxes – there’s very little else we know. But still, we run ourselves ragged trying to obtain some form of certainty about the future.

Well at least I did. And I still do sometimes. But it’s possible that by coming to accept another certainty in life – that there is no certainty – I lived much more fully in 2018.

As a rule us humans prefer certainty to uncertainty. Studies have shown that people would rather definitely get an electric shock now than maybe be shocked later. And we show greater nervous-system activation when waiting for an unpredictable shock (or other unpleasant stimulus) than an expected one. Where people differ is in the degree to which uncertainty bothers them.

For those of us who are prone to experiencing anxiety we will find it difficult to sit with uncertainty. When we struggle to sit with the uncertainty of what might happen in the future, we often are not present in the moment. Instead our minds will be in the past or the future. Worrying. Planning. Obsessing. Predicting. Controlling.

If we are not able to sit with the uncertainty of what will happen in the future it means that we are usually not present in the moment, not connected to that solid sense of inner being. Rather we are in the past or the future, worrying about a perceived emotional or physical threat to ourselves.

In order to feel more secure, we might try to control life as much as we can, trying to fit the future to our expectations.

We might – quite naturally – fall prey to powerful fantasies about what might bring us calm and certainty. When we go on holiday there will be peace. We just need to hold on for a little while longer. Or once we get our house as we’d like it: with everything in its place, no more clutter, new appliances and more storage. Then we’ll feel better. Or maybe it will come when we get a better job, work for a bigger organisation, get paid more. Or (and this one we might keep a little more to ourselves), there might be calm, certainty and wellbeing when we find just the right person to fit into our life. Someone who properly understands us; is kind playful and sympathetic; is thoughtful and compassionate; and whose eyes we could stare into for days. Maybe then.

Yet despite the promises of these fantasies, none of them work. Because even when we are on holiday, or enjoying our well-ordered house, working in the job of a lifetime and staring into a loved one’s eyes, there will still be uncertainty about what happens next. Because of how clever our minds are, we will always be able to imagine so much more than what we already have or something that might be so much worse than what we already have.

One of the downsides of the mostly awesome phenomenon of human consciousness is the ability to worry about the future. We know it exists, but we don’t know what will happen to it. Charles Darwin observed that due to their inability to conceptualise the future, animals just don’t get overwhelmed with anxiety life we do. Sure they experience the fight or flight response to enable their survival, but the trigger is plain and simple fear in that moment. The fear is largely proportionate to the tangible threat involved. Human anxiety, on the other hand, stems from an existential awareness of what the fear means – that the future is unknown. And no holiday, new house or job, or other person can take this away.

So, how did I come to terms with all this over the past year? I pursued a lot of things that I had fantasised about doing in the past, but I didn’t pursue them with the underlying goal of creating calm and certainty. Instead I submitted to straight-out surrender and acceptance. A surrender to the present moment as it is. And an acceptance that struggling to sit with uncertainty is a beautiful sign that I am alive and the future will come.

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Experimenting with Worry

For something fun - and to avoid having to write a blog myself – I set some of our Hope Street Volunteers on an adventure. Maybe less adventure, more psychological experiment. An experiment around worry.

“I’ve had a lot of worries in my life. Most of which has never happened.” Mark Twain.

We all worry from time to time. We generally do not have immediate control over the things we worry about. We typically tend to worry about undesirable future events, or about things that happened in the past that we wish turned out differently. The problem is, some of us have a tendency to worry about things more than is helpful.

Worrying is different to thinking. Thinking is a good thing.  It involves reflection and analysis that leads to greater clarity and purposeful action, when action is necessary. Worrying, on the other hand, is essentially problem solving gone awry. What starts out as concern over an issue, eventually turns into preoccupation; that’s worry.  Worrying is also a common go-to in times of uncertainty.

The unfortunate truth is that we will probably never be able to completely stop worrying. However, we can develop control over how we deal with our worries when we experience them. We can learn to worry more effectively. And this is where the experiment came in – Scheduled ‘Worry Time’.

Scheduled Worry Time is a Cognitive Behavioural Therapy (CBT) technique whereby we are encouraged to set aside time specifically to ‘work through’ the things that we may be worried about. The time is scheduled for the sole purpose of considering what is causing us to feel anxious, nervous or concerned. At first, this technique may seem both difficult and counter-intuitive. However, with persistent practice, it can help us to significantly reduce the level of worrisome thoughts.

The ’Worry Time’ Experiment steps were pretty straightforward:

  1. Schedule ‘worry time’ each day for one week. Put it in your calendar. Start by setting aside 10-30 minutes during the morning or afternoon.  This will be your worry time.  It’s best not to schedule worry time right before you go to bed, for obvious reasons.
  2. During that 10-30 minute window, write down all of your worries that you can think of. Don’t put pressure on yourself to solve them during that window, but if your mind naturally goes there, that’s fine.
  3. Between worry times: if you start to worry, tell yourself to let go of those thoughts until the next designated worry period. This will feel hard at first, and may require a lot of reinforcing self-talk (e.g., telling yourself over and over to let go of thinking about your worries until it’s the appropriate time). Try not to worry about worrying outside of your worry time! You won’t be perfect with this exercise, nobody is.  But, your intention and effort will make a difference.

Simple. To see if it had any psychological benefit whatsoever, let’s hear from our first Human Guinea Pig (and favourite Creative Person) - Trudy!

I come from a short lineage but absolute world-class heritage of worry. Just ask my sister or Dad (but don’t, they don’t like attention and it will stress them out). I’m a different type of worrier - and I’ve even got the incredibly trendy patch on my jacket to prove it.

Maybe 10 or less years ago, I think I developed this idea that I was here to fix shit. Whilst this felt like a practical role at the time, I now realise that it was just like being a character where I saw that people around me were being eaten up with worry, and if I just fixed things, there would be less to worry about. Nowadays, I try really hard to allow people to worry for themselves, which is good, but my worry has morphed into another weird role.

Over the last few years, I thought this had initially developed into behaviour that allowed me to ‘avoid confrontation’ but in actual fact, it’s this fancy prediction trick, where in a situation that requires me to put myself first, and raise an issue that I would like changed, my imagination tells me that in correcting this, the sky will positively fall. Avoid it, and it’ll just simmer down and things will be fine. So I don’t have to tell the person who I think is not being nice to me, because they’ll yell at me. And I don’t have to tell the person who is making me feel uncomfortable, because they’ll tell me I am being sensitive. And I won’t tell the person who is eating with their mouth open that it weirds me out, because they’ll just burst into tears. I’m constantly worried that people will not accept my needs, and this will make things worse. So I just decide that it’s too hard, and I swallow the worry and live through it. I know this is silly. I watched enough of the early seasons of Ally McBeal to know that I’ll eventually implode if I keep this behaviour up. And in most instances, after I implode, people around me will be all like "Whoah, where did Trudy go? Did that just happen coz she didn’t tell me that my behaviour was hurting her? Awkward. She should have just told me."  

I had originally concocted a plan for this experiment, where I was going to share my worries with someone else, and we were to dedicate our allotted 30 minutes to each other. Given that this friend was in a completely different timezone, this didn't work out as well as we’d hoped. But it did make me think I was holding onto worry for another moment for the first week. It was a pretty freeing feeling, as I compartmentalised it for a later moment (I also had decided that she was going to solve everything for me as well, so I really put it off).  

One instance I can recall, during a time when I was still holding off to talk to my friend, I had actually not given the worry the time that I normally would. Concerned about an impending conversation, when it actually came to the time it got forced upon me, I’d not had the chance to entertain the imaginary situation that would have occurred, and so when the band-aid was ripped off, surprisingly, the conversation just happened, like normal. And it went fine. Even without all the worry time alloted to it. The sky didn't fall.

This - to me - was a big worry, and it became your general ‘proof is in the pudding’ example. After this, it felt like my worries paled in comparison, and really, if that went okay, how relevant were my imaginary scenarios?

Using designated worry time then felt practical. It felt like I was using time efficiently. And by efficiently, I mean it gave me more time to aimlessly scroll through instagram.

Would you recommend this practice to a friend who was worrying a lot? Do you think this might be useful as a strategy for someone experiencing anxiety?
Given that my only advice to friends when they worry is to just put their happiest shoes on, because that will instantly make them feel better, I can imagine this might be an option for providing a bit more evidence-based support.

What do you think the purpose of this experiment was?
To reinforce to me that I’m not a psychic (believe it or not).

Remember if you're interested in volunteering to be a part of similar adventures / psychological gifts / human experiments that don't have any ethical clearance, send us an email (hopestreetcards@gmail.com).

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When Mental Illness and Comedy AND Irritable Bowels Meet for Laughs: Felicity Ward

Some evenings seem like the most perfect meeting of worlds. Take for example, this evening. I wanted to see Felicity Ward - comedy AND mental health humour guru. And the best person to invite? Well, my delightful friend with Crohn's Disease, of course. Anxiety and poo. Ticks all round!

I reached out to a few comedians, this Melbourne Comedy Festival, to chat about the use of mental health as a topic in stand up. Felicity was super busy, but took the time to email me her apologies, and this evening I got to go along to her show, What if there is no toilet? to get all the answers I was looking for anyway. 

Felicity's current show is very much centred on her multiple diagnoses - generalised anxiety, evolving depression and irritable bowel syndrome (IBS) - or as Felicity acknowledges, the "triple threat" - and her experiences as they evolve over the last couple of years.

Diagnosed with IBS in childhood, the show reveals the development of other diagnoses, and the connectedness of these toilet related anxieties with her own mental health. And shit (excuse the pun), it's not hard to believe it. We hear about that ongoing battle between the geographical locations of toilets. And paying to use toilets. And weird bathroom attendants in UK nightclub toilets. And sensor lights in toilets. We hear about 'Beryl' - the anxious voice that presents herself to Felicity in all kinds of situations. We hear those common thoughts that all too often run through people's minds - "I'm just tired. I'm just 1 sleep away from being great. Just 1 sleep, and this 15 years of tired will all be gone". And it's not surprising. It sounds exhausting. 

Felicity talks really candidly about so many things about her experience with mental illness. Having sat down with a few comedians this month, I get that a lot of professional comedians often believe it easier to reveal significant stories to strangers rather than loved ones. And Felicity really does nail this. She speaks a lot about failing to see her own safety behaviours and symptoms, and avoiding speaking out with loved ones. Even about playing down the symptoms when she eventually sought out professional help. But she also notes, that at some point there is the realisation that in fact mental health issues don't simply plateau when nothing is done about them, they actually keep deteriorating. (Literally, I'm quoting Felicity's therapist here when I say "Avoidance is the maintenance of every problem"). 

Felicity had me on so many levels during this gig. She took the piss out of people wearing ugg boots outside. She educated the audience on appropriately using the smiling poo emoji. She sang. She swore. She wore a dress my sister would've really got a kick out of. She even made an analogy between those people caring for loved ones with a mental health issue with Danni Minogue - coz they just keep sticking around.

What if there isn't a toilet? talks mental health, and talks about it without bullshit. Early in the piece, Felicity does call out that, yes, this show is about mental health, and it isn't to be taken too seriously. This is proven pretty obviously when - half way through - Felicity wears a moustache made of toilet paper, whilst she tells her story about an incredibly (incredibly) short run of self harm, just to make it seem less serious. And she even calls out the audience for the quiet that sets in when she goes into it.

Felicity acknowledges that there are few places that people with mental health issues (and we do a rough audience tally during) can laugh at themselves and their experiences. Comedy has got to be at least one of them.

I like to think that one day, we won't need our comedians to provide disclaimers such as 'Show may contain traces of mental health', and that our conversations with mental illness will be awesome everywhere. But in the meantime, I'm happy for Felicity to introduce us to such conversations, and I look forward to one day passing the toilet paper.

We're nearing the end of the Comedy Festival, but Felicity Ward's What if there is no toilet has 4 more shows up until Sun 17 April, before taking it to Sydney April 23 & 24. Don't miss out.

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Why the 'hope' in Hope Street Cards?

I’m going to be entirely honest here. It wasn’t brilliant genius that led me to the name of this little card business. It was a bike ride home on a miserably cold Canberra evening. The idea for Hope Street Cards had been with me for some time, however I had been struggling with finding a name that wasn’t naff, lame or tacky. I mean, my sister’s hipster reputation was at stake here! I remember having a very negative internal dialogue with myself that evening regarding the state of the weather and catching myself attempting to disrupt these thought patterns as I cycled into my street. Thinking ‘Oh well, at least I get to live on a street called ‘Hope Street’’. Full disclosure. I got the name from my address at the time.

The more I thought about it though, the more totally appropriate it was. Because there really is not much more important a thing than hope.

I find it really difficult to concretely define or describe hope with the poetic justice that I feel it deserves. The dictionary says that ‘hope is an optimistic attitude of mind based on an expectation of positive outcomes related to events and circumstances in one’s life or the world at large’. Thanks dictionary. The psychologist Charles Snyder associated hope to the existence of a goal, combined with a determined plan for reaching that goal. Thus an essential ingredient for future planning, motivation and change. But it just feels like so much more than that.

Viktor Frankl, Austrian neurologist and psychologist, chronicled his experiences as a concentration camp inmate in his book ‘Man’s Search for Meaning’ (1963). Frankl’s observations and writings led him to discover the importance of finding meaning in all forms of existence, even in Auschwitz, which create a reason to continue living. He stated “It’s a peculiarity of man that he can only live by looking to the future” (p. 115). He warned that “the sudden loss of hope and courage can have a deadly effect” (p. 120) and observed that “the prisoner who had lost his faith in the future – his future – was doomed” (p. 117). Prisoners who Frankl observed as having lost hope reportedly died within a short time. That’s pretty massive.

And more recent, empirically-validated research backs the importance of hope up. Hopeful individuals have been found to make healthier lifestyle choices in areas such as exercise, eating and drinking (Peterson, 1988). They recover from illness and injury more effectively (Snyder, Rand & Sigmon, 2005) and have increased life expectancies (Maruta, Colligan, Malinchoc, Offord, 2000). They manifest less depression and anxiety symptoms (Cheavens, Feldman, Gum, Michael & Snyder, 2006) and experience increased positive mental health, personal adjustment, life satisfaction (Gilman, Dooley & Florell, 2006; Kwon, 2002) and sense of meaning in life (Feldman & Snyder, 2005). Obviously the benefits of possessing a hopeful approach to life are numerous and noteworthy.

During my first year of clinical psychology training, the importance of ‘instilling a sense of hope’ in conjunction with the client was taught as one of the key ingredients for providing successful psychotherapy. Some consider hope as one of the four most significant common factors in good therapy outcome (Hubble, Duncan & Miller, 1999). Irvin Yalom a guru in the world of psychotherapy teachings identified the instillation of hope as the first curative factor in effective group psychotherapy. Esso Lette observed: “Hope is crucial to recovery, for our despair disables us more than our disease ever could”.

During my very early training this knowledge made me feel slightly relieved. Being overwhelmed by anxiety at providing psychological treatment whilst feeling entirely inadequate, underprepared and paranoid I would end up ruining someone’s life, I thought, ‘well at the very least I think I can help someone feel hopeful’. And for the most part I could. There was one time though, when that sense of hope was so incredibly difficult to cultivate. Where the empathic response I had to a client’s traumatic past and current internal experiences left me feeling devoid of hope. I too felt hopeless. And it was gut-wrenching. And terrifying. And so incredibly sad.

That experience really affected me, because the guiding principle of recovery from a mental illness is hope – the belief that it is possible for someone to regain a meaningful life despite a serious mental health condition. And that recovery is not a linear process. Or an end result. It’s a process, ongoing adventure, one step at a time, that sometimes looks and feels like one big mess and is completely different for everyone. And it’s really, really, really hard work. Because there’s so many things you have to do that you often just don’t want to do (e.g., get adequate sleep, exercise, challenge unhelpful thinking patterns). And you have to do these things with no absolute certainty that doing these things will make you feel better. You need courage and commitment and a bucketload of hope.

But for someone who is experiencing a mental health condition there can be an overwhelming sense of hopelessness, so where can that foundation for recovery come from? At the launch of Hope Street Cards, Clinical Psychologist Jo beautifully described the benefits of having someone else “hold on” to that hope for you, when you yourself can’t. And I totally agree. At my darkest times my therapist – let’s call him Dr M – has held the hope for me. I’m not even sure he knows he’s doing it. But he will refuse to engage with me in any particularly ridiculous notions of my self-worth I might have. He does this very subtly and tenderly, but it is a gentle reminder that he doesn’t believe in such thoughts, he believes in me. And at times this has been enough.

At other times it’s been my family and my friends who have carried that hope for me. Just by being there they provided the gift of faith that I might be able to live well again. And what does that gift feel like? I think Emily Dickenson may have described hope best: “Hope is the thing with feathers”. And those feathers tickle your heart a little.

 

Smart things I quoted:

Frankl, V. E. (1963). Man’s search for meaning. New York: Pocket Books.

Yalom, I. (1985). The theory and practice of group psychotherapy. New York: Basic Books, Inc.

Peterson, C. (1988). Explanatory style as a risk factor for illness. Cognitive Therapy and Research, 12, 117-130.

Snyder, C. R., Rand, K. L., & Sigmon,D. R. (2005). Hope theory: A member of the positive psychology family. In Snyder, C. R. and Lopez, S. J. (Eds.). Handbok of positive psychology. (pp. 257 -267). New York: Oxford University Press.

Maruta, T., Colligan, R. C., Malinchoc, M., & Offord, K. P. (2000). Optimists vs. pessimists: Survival rate among medical patients over a 30-year period. Mayo Clinic Proceedings, 75, 140-143.

Cheavens, J. S., Feldman, D. B., Gum, A., Michael, S. T., & Snyder, C. R. (2006). Hope therapy in a community sample: A pilot investigation. Social Indicators Research, 77, 61-78.

Gilman, R., Dooley, J., & Florell, D. (2006). Relative levels of hope and their relationship with academic and psychological indicators among adolescents. Journal of Social and Clinical Psychology, 25, 166-178.

Feldman, D. B. & Snyder, C. R. (2005). Hope and the meaningful life. Theoretical and empirical associations between goal directed thinking and life meaning. Journal of Social and Clinical Psychology, 24, 401-421.

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Why Hope Street Cards?

I have always loved to send a card. When I moved out of home, over 15 years ago to attend Uni, my sister – Trudy – and I began the ‘card game’. The premise is pretty simple. Send each other really, really good cards as frequently as possible. We’ve been playing it ever since. It’s a fabulous game for so many reasons. Firstly, it involves surprise mail in the post. Breaking up the monotony of the bank statements and electricity bills. Secondly, it is hilarious. The range of quirky, funny and downright ridiculous cards that are available for sale is incredible. And thirdly, it will ALWAYS make you feel a little bit better than however you were feeling just moments before. Always.

cards
Card sources: Popsy Greeting Cards, An April Idea, La La Land and Able and Game 

As a result, we both have an excellent working knowledge of the current Australian greeting card market. And for your make-you-feel-better-in-the-general-sense card, it’s really pretty good.

But a couple of years ago the son of a close friend of mine attempted suicide. And I didn’t quite know what to do to show my support. As someone who had worked in the mental health sector for a number of years, I knew the right things to ask her about the situation. I asked how she was sleeping. I checked on the level of care and treatment he was being given. I said I was sorry and I asked if there was anything I can do. But as a friend I wanted her to know that I cared and that I was thinking of her. And so I joked with another friend that Hallmark should release a “I’m so sorry your child tried to kill himself” card. But it really wasn’t funny at all. I had never in all my greeting card buying experience come across a card specifically for any type of mental illness and that didn’t seem quite right. And thus the seed for Hope Street Cards was sown.

That same year my Mum was diagnosed with breast cancer. And whilst I was able to visit her on occasion, the 1000 kilometre distance between us made providing support somewhat more difficult. So I took to doing what I do best – sending cards. And I was blown away with the range of cancer-related cards available. From the “Fuck Cancer” card to the “If cancer was a man, I’d kick him in the balls” to the sympathetically appropriate “Sorry about your tit”. And I sent these cards off with delight.

But it was all very interesting. There was a time not that long ago when cancer was taboo. We wouldn’t tell someone we had it, let alone go out of way to support someone with it. But it appears we’re not scared anymore. And that’s great. But why the injustice? When I google mental illness card I get something quite disturbing – a card with a picture of a sticky tape dispenser. And the words – Put yourself back together! How come I can send hilarious, supportive and hopeful cancer cards, but can’t find an appropriate mental illness card. And so now the Hope Street Cards idea had formed and now I was a little angry that mental illness was not only suffering from stigma in the greater community, but also in the business of get well cards.

And then not long after I got sick. Another episode of a recurring mental illness. My third. Off I went to a private psychiatric hospital. Again. And this time I felt another anomaly. Often when I get admitted to hospital I feel the odd one out. A mental health worker becoming the mental health patient. But this time I noticed that I was one of the very few patients in the hospital who had flowers next to their bed. Who regularly received mail. Had visitors attending at all available times. And had cards of support adorning the walls. I was a statistical outlier in this hospital. I had outward displays of social support everywhere. And the research supports this.

Studies have shown that only 1 in 4 people who have experienced a mental health issue will receive a get well card during their illness, despite 80% of these individuals reporting that a card would have been beneficial to their recovery. And social support has been found to have numerous beneficial effects on recovery. Low levels of social support has been found to increase the chances of experiencing a mental illness episode and decreased chance of recovery. Whereas high levels of social support have been correlated with shorter major depressive episodes in women and predict 6-month symptom recovery. Furthermore, studies of individuals who have experienced ‘severe’ mental illnesses (schizophrenia, schizoaffective disorders, bipolar disorder or affective psychosis) found that both social network size and social support were correlated with better recovery and a reduction in symptoms. Despite this, studies have repeatedly shown that psychiatric inpatients receive about half as many cards and gifts when compared to medical inpatients. So I am just incredibly rarer and lucky. The result of having friends and family who didn’t shy away and were willing to show their love and support no matter what. And I gained so very much from this love and support. I had hope. And I knew I was loved. And being stuck in an episode of mental illness, these things were vital for me. I could not be more grateful for the support I received from those around me during this time and it is one of the reasons that I am where I am today.

And so here we are with Hope Street Cards. A very small attempt at making it a little bit easier for a friend or family member to support their loved one with a mental illness. Our dream is that each Hope Street Card enables the donor to learn more about mental illness and to show a loved one they care and will support them through their recovery in a non-judgmental, empathic and hopeful way. Showing someone that you’re thinking of them and that you care can really go a long way.

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Hope Street Cards in Victoria!

The awesome team at the Melbourne Leader had a chat with Trudy this week about our upcoming business launch. Meeting at our creative headquarters in North Fitzroy (aka Trudy's place), the full article can be read here

melbourne leader hope street cards
Photo credit: Martin Reddy (Source: Melbourne Leader)

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