Your Anxiety May Be Coming From These 2 Blindspots

One thing I’ve noticed when working in the mental health space is that people’s anxiety can sometimes arise from their 2 key blindspots.

Their unconscious competence and their unconscious incompetence. The “very good” and the “very bad”.

The things that they have naturally talent in, they are underutilising and the things they are not good at, they are over exposed to. There is a mismatch leading to being a “fish out of water” with “secondary anxiety”.

The key pivot point is to make those unconscious processes more conscious.

I wonder if you are aware of your own unconscious processes.

Finding Wise Mind Balance with DBT

In DBT Dialectical Behaviour Therapy, the word dialectical can relate to the idea of holding 2 opposing ideas (often opposites) and integrating them.  This is often refer to as the “wise mind”. 

But in reality, in Family Medicine, I think we often have to hold multiple opposing ideas (not just 2) and trying to integrate them all don’t we?

For example, with every consult, we have to integrate what is evidenced based, what is workable, what fulfils the patient’s agendas and makes them happy, what fulfils our agendas and makes us happy, what fulfils the community’s agendas and makes society happy, which decision is best for the here and now, which is best for the future based on past and present patterns, what’s best for the individual, what’s best for their families, and what’s good for one body system may come at the costs of other body systems.

There is tension among all of the above so trying to find a Venn Diagram for that is not easy especially given our inherent blindspots.

I wonder how much we all struggle with the above and whether some “DBT types of upskilling” can help. 

Every Doctor Faces This Dilemma Daily — No One Talks About It

As a Doctor, we often have to make decisions that considers all 4 of the following criteria.

1. It’s pragmatic and workable in the real world with all the limitations of the real world.

2. It makes logical sense and correct factually and evidence based.

3. It makes patients happy.

4. It makes you happy and helps you to sleep at night.

The problem is, when we can’t find the intersection of all 4 domains, we often neglect/suppress 1,2 tor 3 of the criteria leading to long term issues.

If we neglect No4, we risk burnout.
If we neglect No3, we risk complaints, loss of therapeutic relationship, and increased risk of being sued perhaps. 
If we neglect No2, we risk not following evidence based and good guidelines.
If we neglect No1, we risk inaction and being impractical.

We all have our blindspots and depending on which blindspots, dictates which problems we are likely to face. Some are good with the thinking stuff (No1+2). Some are good with the feeling stuff (No3+4).

Part of good self care require good self awareness and self understanding.

I wonder if you can work out what your blindspots are by reversing engineer your recurring troubles.

The Missing Half of Metacognition: Thinking About Feelings

I recently been invited as a guest speaker to explore and share ideas around metacognition with fellow GP supervisors.

Traditionally, I think metacognition often refer to the “Thinking of thinking” but it’s also important to include the “Thinking of feelings”.

One can also frame this as the “Mindfulness of thinking, feelings/emotions”. Focused and engaged with our thoughts and feelings but not too fused/hyperfocused and not too detached/dissociated either. It’s the “sweet spot”.

In this mental state, the aim is to process the information and find the “Venn/intersection” of both thinking and feelings. I think this is especially important in healthcare as we have to deal with both “things” and feelings.

Hence the saying… 

Follow your head and take your heart with you OR for some…

Follow your heart but take your head with you. 

It’s a real challenge of course especially if there is a mismatch in the development of one’s “thinking” vs “feeling” abilities.

What If Mental Health Education Started With Emotional Literacy?

I am a Primary School Doctor on Fridays helping kids and their families with struggles around poor emotional health.

One can frame this as their “EQ” perhaps. EQ for Emotional Quotient (also often called Emotional Intelligence).

Some struggle mainly with processing the “feelings of others” leading to predominantly social anxiety.

Some struggle mainly with processing their own feelings/emotions leading to shame, anxiety, anger, emotional dysregulation, self doubt, and depressed mood.

Some especially with ADHD/ASD wiring, can struggle immensely with both.

Counseling whether it’s in the form of CBT. Psychoeducation, ACT, DBT. EFT, IPT are simply ways of teaching “Emotional Literacy”.

I hope that if we can frame “therapeutic frameworks” as “emotional literacy”, more kids can have access to the above skills at a school level, and if as a society, we are more emotionally literate, then less mental health issues perhaps.

Internal vs External Emotional Language: Why Both Matter

The 2 important functions of an emotion is to communicate with others through the “language of emotions” and also to communicate with ourselves through our own emotions. This forms a significant part of our non verbal communication externally and internally.

Being great with one does not mean that we can be great with the other. In my mind, they are two forms of “emotional intelligence”. One is more important for “social intelligence” and the other is more important for “self intelligence”.

In counseling work, the challenge I often see is that many can struggle greatly in these domains and hence, impacting relationships and/or self esteem.

I wonder if you have seen what I have seen. 

Emotions Are a Language — We Just Have to Learn How to Speak It Better

Many of the folks I see have emotional regulation troubles and with that, they may want to avoid talking about it and/or working on it. It’s uncomfortable and “not safe”. The problem is, by avoiding it, it’s hard to get better at it.

It’s like a language. The pattern is, growing up, this language is often not well spoken in the family. When we express it incorrectly, we may get strong negative feedback or even shut down so learning to speak “emotionally” well and fluently is difficult. Modelling is also important in learning any language and some may not have great role models in this domain.

So how to regulate a feeling/emotion in simple terms?

If we are too emotive about something that is unhelpful for the context, we may need to learn how to “down regulate” that by noticing it, defuse from it or “zoom out” from it. “Zoom out” just right like easing off the pressure of the gas pedal. Not too much that we are detached or dissociated from the things that matters.

If we are not emotive enough about something that matters, we may need to learn how to “upregulate” that by noticing it and “zoom into” our values, self motivate and taking action.

Simple but not easy.

The rate limiting step is often learning to be mindful and holding space for feelings and emotions of self and others. This can give us “emotional clarity”. Once we have “emotional clarity”, processing feelings/emotions becomes easier.

Why We Need Emotions: 3 Core Functions

When doing psychoeducation around feelings/emotions, it is often important to highlight to patients the 3 main key functions of an emotion.

1. It activates us into action. Without it, there may be less “urge” or compulsion to act. No action may result in no/little outcome or impact and at the same time, action can be helpful or destructive depending on context.

2. It helps us to communicate with others in a more holistic and non verbal kind of way. Nothing needs to be said and communication can still occur. 

3. It helps us to communicate with ourselves and guides us to move towards a life that matters to us, our values/conscience, and to the people we care about.

Without it, we may be lost and without meaning and purpose.

The problem is, if we do not know how to process our feelings/emotions properly and avoid it due to discomfort, we may become lost, stuck with unresolved conflict, and not able to live a life truer to self.

Part of therapy is to become more aware, acknowledge and equip ourselves with better emotional literacy, to improve our emotional wellbeing and our overall biopsychosocial health. 

Holding Space for Pain Without Getting Lost in It

One of things I try to teach Medical Students and Registrars is mindfulness/holding space for the feelings and emotions of our patients especially with the “uncomfortable painful ones”. It’s very important for counseling work and can actually be very difficult for many of us to do.

Not too fused or “zoomed into” the feelings and emotions of our patients but not too detached either.

Too fused or “zoomed into” the feelings and emotions of our patients and we may “catch it”, suffer with our patients, burn out and get compassion fatigue.

Too detached or “zoomed out” and we may risk losing empathy, connection and miss the subtle emotional agendas behind their presentations.

Mindfulness with “the feelings of others” is the “sweet spot”. Not too close but not too far either.

I wonder if you can relate this to our interactions with our patients. 

Emotional Literacy: Intuition vs Emotion

In counseling work, when providing psychoeducation, one of the key fundamentals of emotional literacy is understanding the difference between an “intuition” and an “emotion.”

They are both feelings, but knowing the difference may help us better understand our feelings — and in turn, better regulate them.

For those who are less feeling-oriented and more logic/thinking-oriented, I often use the analogy of “facts” versus “opinions or judgments about those facts.”

In the feeling language, intuition is like a fact, whereas emotion is like an opinion or judgment about that intuition.

So, a fact (or intuition) tends to be more steady and reliable as information — it offers greater clarity.

An opinion or judgment about the fact (or intuition) is often less steady, more changeable, more subjected to biases, and creates an urge or compulsion to act. It is less reliable as information, but much better for driving action.

Therefore, whenever you feel an urge to act, that’s usually an opinion, judgment, or emotion — something more emotive. The stronger the urge to act, the stronger the opinion, judgment, or emotion.

In Acceptance Commitment Therapy ACT, we may refer to this as Fusion. To lessen Fusion, we can learn the skill of Defusion.

When the feeling is steady, with no strong urge to act but rather a mindful awareness, that may be more factual or intuitive. It is less emotive.

In ACT, we may refer to this as Defusion or Mindfulness.

I wonder if you can relate to these concepts and ideas.