Maria Shriver's Sunday Paper Presents: The 4-Day Wellness Reset

The hopeful news is that we can break this. Dr. Smith walks us through the strategies, including how they've helped her during a challenging time, to help us gain more agency over our thoughts and mental freedom in our days.

A CONVERSATION WITH DR. JULIE SMITH

How do you describe overthinking, and how do you see it in your practice today?

It's certainly not a new phenomenon, but the term is new. People are using the word 'overthinking' to mean worry and worrying. It's this idea that you're churning things over and over that maybe haven't happened yet. Or it happens after an event, and you come away overthinking and worrying about what you said or how you've been judged. It's all part of a cycle: When you're worrying, you're triggering more anxiety, and then when you're anxious, you're more likely to worry. The two influence each other, and it's very easy then to end up stuck in this cycle of anxiety and worry, anxiety and worry.

This cycle can cause us a lot of suffering. How else can it impact us?

Where we get stuck is we often convince ourselves that it's necessary and constructive. So, when we're worrying, we almost feel like we need to be doing this because we're going to come to some resolution. But actually, worry in itself isn't constructive thinking. It's usually catastrophizing and running over and over worst-case scenarios.

My sisters live up in the north of the country, and when they're driving down to visit, I'll notice that I'll be thinking, What happens if they get in a car accident? What happens if this happens? How would I know? Your mind goes to those worst-case scenarios. And then you're going over and over it as if not thinking about it is neglecting it. And that's completely untrue: It's no more likely to happen just because you thought it.

If somebody were to say, 'Dr Julie, I can't stop overthinking,' what would you say is the first place to start finding agency over their thoughts?

The first thing is to not try to just stop overthinking. When you're trying not to think of something, you're already thinking about it. So, what we don't want to do is develop this internal battle or turmoil around trying not to worry. You can't win with yourself.

I like to use this idea in therapy: your mind is a stage in a theater, and all the actors that come on and off the stage at various times are your thoughts. The temptation is to be their director. You want to get up on the stage and say, 'You go there, and you go there, and I don't want you." Because we only want the nice, positive thoughts. But we can't do that. What we can do is have control over what thoughts get the spotlight. We can choose where we focus our attention, and that influences how we feel.

So, if I know my sister is driving down, I'll have that worst-case scenario thought. Well, I know that's one possible perspective, and if I give that thought the limelight, it will repeat the narrative it brings. Then I'm going to get more and more fearful, even though that thought has no access to the future. But I can choose to see there are other possible perspectives. There is the best-case scenario; there are other things in between or other thoughts completely to choose to focus on.

You say this is a great metaphor for what you call 'thought defusion' in therapy. What is that?

Thought defusion helps to give you some distance from unhelpful thoughts and emotions. It's this idea that when you have a thought, let's say a worry thought, and you put it right in front of your eyes, then that thought is all you can focus on, and you're going to take it on as if it's a fact. And remember, the power of any thought is in how much you believe and buy into it. But just by taking a thought from here to here, by putting that thought at arm's length, you're giving yourself a bit of distance from it. Then, what you're able to do is see it for what it is, which is one perspective. And that frees up lots of space to consider other perspectives.

In my sister's case, that's someone I really care about and it would be a nightmare if something were to happen. But there are other things I can also focus my mind on. It can be very helpful to use simple language. You can say, 'I notice I'm having the worst case scenario thought that my family is going to die in a car accident.' By tagging it at the beginning, you're acknowledging that it's one thought and something you're experiencing, but it's not fact. You're immediately giving yourself that little distance that allows you to either choose to go with it and spend all your time with it or redirect and do something else. The more times you choose to do something different, the more you create this new template for responding to anxious times.

Hearing that we have a choice in this matter is calming and freeing.

It is. Last summer, I had an experience with early-stage breast cancer. I was a week away from handing in the manuscript when I got the diagnosis. When you're faced with your potential mortality, the worst-case scenario thoughts come fast. So, I had to use those skills with such force because if not, I would be in turmoil. I had all the horror stories in my mind: What's going to happen to my children? But I knew I had zero agency when I was in that place. When you feel that way, all you're doing is looking for threats, and all your actions are based on trying to avoid each of those threats.

At the time, I just happened to be editing the chapter on when fear shows up. I rewrote it using lots of language around not being the prey and choosing to be the predator. I thought This cancer wasn't coming for me. I'm coming for it. So, what does that look like? That language then just slightly shifted the trajectory of my attention. And every time I started to worry, I took action. I would call to make appointments to get second opinions. I would seek out advice from medics. I would talk to my husband about managing things with our family. So, every time I engaged and primed myself with that thought process, I shifted from overthinking to positive action.

That's the power of shifting your attention and choosing your approach to something—even the most awful things.

You say there are questions we can ask ourselves to help redirect our attention when overthinking. Will you walk us through those?

Something we do in therapy when someone is struggling with anxiety is to acknowledge that in the same way that thoughts aren't facts, emotions aren't facts either. We tend to do what we call emotional reasoning, where we say it must be true because I feel it. Because I feel like a failure, then I am a failure. [However], how we feel is influenced by many other factors. So, it makes sense and can be helpful to turn toward it with curiosity and ask questions like:

• I'm feeling anxious, but is it warranted, given my situation? Is it proportionate to the situation I'm in? Maybe you're feeling panicked, but you're safe in your local shop.
• Is it likely?
• Is the situation changeable?
• Do I have any degree of agency in this, and what can I do?
• Where are the biases in my perception?

So again, it's giving yourself that arm's length so you can notice what you're doing.

And one of the most helpful things is when you find yourself in an emotional, distressed state, ask yourself:

• Is this helpful to me?

That's something I did with breast cancer. There were very dark moments when I was obviously upset and scared, but I had to ask myself: Is it helpful for me to be here in this emotional state, focusing on these worst-case scenarios? Probably not. It's not going to help me get through this in the way that I want to. So therefore, let's shift to something else. Let's try something new. 

Dr Julie Smith is a UK-based clinical psychologist, bestselling author, and content creator. After running her own private practice for almost a decade, Dr Julie began sharing her digestible, informative videos on social media in 2019, and she’s now amassed an audience of over 10 million for her mental health tips. Her books include Why Has Nobody Told Me This Before? and her newest, Open When… Learn more at drjulie.uk.