Needing to Know for Sure - PDF

“I was blown away when I read this book. It perfectly describes my anxiety-­reddened patients who are so consumed with doubt and uncertainty, that they need constant reassurance to live their life. If you are filled with doubt; can’t make a decision without input from others; are constantly checking...

“I was blown away when I read this book. It perfectly describes my anxiety-­reddened patients who are so consumed with doubt and uncertainty, that they need constant reassurance to live their life. If you are filled with doubt; can’t make a decision without input from others; are constantly checking and rechecking; or lie awake dwelling, planning, and reviewing—rest assured, this is the perfect book for you.” —Ken Goodman, LCSW, board member of the Anxiety and Depression Association of America, and president of www.quietmindsolutions.com “Repeated checking or asking for reassurance even when know that you locked the door, turned off the stove, or prepared adequately for that meeting or test—often accompanied by feelings that something bad will happen if you don’t—is incredibly common. But at its most severe, in the form of obsessive-compulsive disorder (OCD), it can be crippling. Now, Martin Seif and Sally Winston, two of the foremost experts in the world working in this area, provide a very helpful and easy to implement set of interventions to overcome these annoying and sometimes life-interfering problems. I would recommend this book to my patients and to some of my friends.” —David H. Barlow, PhD, ABPP, professor emeritus in the departments of psychological and brain sciences, and psychiatry; and founder and director emeritus for the Center for Anxiety and Related Disorders at Boston University “Many times, the damage our own immune system does in response to a bodily signal is more destructive than the injury or antigen itself. So it is with the torment of doubt and uncertainty, and the rush to relief and reassurance. Seif and Winston have laid out the challenge and the solution to the self-inflicted torment of anxiety and distress about uncertain future threats. This volume will help people live.” —Jerrold F. Rosenbaum, MD, chief of psychiatry at Massachusetts General Hospital, and Stanley Cobb Professor in the department of psychiatry at Harvard Medical School “For those of you who have found yourselves caught in the endless cycle of reassurance seeking, this book is for you. Needing to Know for Sure provides much-needed guidance to help you know the difference between reassurance seeking and information seeking by giving you great examples and helpful facts throughout the book. Most importantly, the authors offer step-by-step guidance to get you disentangled from reassurance seeking and back to living your life by increasing your ability to handle uncertainty. I am excited to share this book with my clients.” —Kimberly Morrow, LCSW, anxiety therapist, author, national speaker, and co-owner of www.anxietytraining.com “Needing to Know for Sure is a terrific resource for anyone who wants to understand how futile attempts to eliminate uncertainty in life are at the core of any obsession. The authors’ clear expertise in OCD and anxiety is reflected in their believable examples of people trapped in the need to know. The book offers a great variety of tips and tools for abandoning unproductive reassurance and learning that life really is better with doubt.” —Jon Hershfield, MFT, author of Overcoming Harm OCD, and director of The OCD and Anxiety Center of Greater Baltimore “Seif and Winston have a talent for identifying and explaining commonly misunderstood aspects of human anxiety. Their last book explores the nature of unwanted intrusive thoughts, and offers useful concepts and tools to disempower and transcend the thoughts. In Needing to Know for Sure, the authors turn their attention to the various ways in which people try to cope with anxious uncertainty. We learn that, in the face of a threat, attempting to feel safe by resolving doubt is a natural human response. After all, who hasn’t double-checked to ensure their door is locked, or asked their physician for reassurance about a medical condition? But we also learn that, for some individuals, uncertainty can become intolerable and disabling. Fortunately, the authors provide a new, more effective approach to the problem. I highly recommend this book to anyone struggling anxiously to ‘know for sure,’ and to loved ones and health care professionals attempting to assist them.” —C. Alec Pollard, PhD, professor emeritus of family and community medicine at Saint Louis University School of Medicine, and director of the Center for OCD and Anxiety-Related Disorders at Saint Louis Behavioral Medicine Institute “If you’ve ever become paralyzed by worries like ‘Am I crazy?’ or ‘Will my kids be ok?’ then this book is for you. If you have OCD, it will help you stop trying to replace your negative thoughts with positive ones. This book will free you to accept all your thoughts, and give up the pursuit of certainty. The authors clearly explain the value of surrender, allowing worry without being dominated by it. If you care about someone with OCD, this book will show you how to stop offering unproductive reassurance and help this person embrace a challenging life.” —David L. Kupfer, PhD, clinical psychologist with a private practice in Falls Church, VA, with forty years of experience treating OCD “I love this book! It’s the only book specifically on reassurance, and it explains in great detail the categories of fears that keep reassurance going. If you compulsively seek reassurance, after reading this book, you may feel understood and empowered in ways that you haven’t previously felt. It offers helpful clarifications about unproductive reassurance seeking, unhelpful self-talk, and common categories of reassurance traps. The book’s examples make the concepts easy to apply in your own life. With their combined seventy-plus years’ experience, Sally and Marty’s style is deeply compassionate and deeply knowledgeable.” —Maggie Perry, PsyD, licensed psychologist, and founder of www.huddle.care “Can you answer ‘yes’ to any of the following six questions? Do you spend a lot of time and effort checking things and seeking reassurance? Do you need to know ‘for sure’ about areas or issues in your life? Do you constantly check your phone, email, or the internet? Do you keep checking locks, alarms, or appliances? Do you have endless internal debates with no resolution? Do you repeatedly ask others for reassurance? If you answered ‘yes’ to one or more of these questions, this book can be a huge shortcut to lifting the burden of anxiety and distress.” —Neal Sideman, self-help advocate, internationally known coach and teacher for people recovering from anxiety disorders, member of the Anxiety and Depression Association of America (ADAA), and cochair of the ADAA Public Education Committee “Uncertainty is at the heart of treating many anxiety disorders, and is especially relevant when treating OCD. Martin Seif and Sally Winston have written an excellent book that addresses this theme common to so many of the anxiety disorders. In clear and straightforward language, the authors lay out how our unwillingness to accept uncertainty creates anxiety, and offer a variety of very helpful suggestions for ­surrendering to and simply accepting that uncertainty is part of living. This is a book that I am certain to recommend to many of my clients for years to come.” —Robert W. McLellarn, PhD, founder and director of the Anxiety and Panic Treatment Center, LLC in Portland, OR “Filled with examples and step-by-step instructions, Seif and Wilson have written a book that I will highly recommend to my clients. Needing to Know for Sure clearly explains how to learn to give up on relying on compulsive checking and reassurance seeking, and embrace the beautiful uncertainty of life.” —Elizabeth DuPont Spencer, LCSW-C, clinician, trainer, supervisor, and coauthor of CBT for Anxiety “In this book, Martin Seif and Sally Winston explain how intolerance of uncertainty and reassurance seeking are major contributors to anxiety and other negative emotional states. They offer an innovative and easily understood perspective on the relation between intolerance of uncertainty and excessive reassurance seeking that has immediate clinical application. Using numerous case illustrations, diagrams, and plain language interpretation of the latest scientific evidence, Seif and Winston provide guidance in self-identifying, destructive forms of reassurance seeking. Later chapters offer detailed instruction on how mindfulness, distress tolerance, and exposure to uncertainty are effective in breaking the ties between reassurance seeking and anxiety. This is essential reading for anyone who has struggled with anxiety or found conventional treatment approaches unsatisfactory. You will walk away from this book with a new understanding of anxiety and fresh ideas for its treatment.” —David A. Clark, PhD, professor emeritus at the University of New Brunswick; author of The Anxious Thoughts Workbook; and coauthor, with Aaron T. Beck, of The Anxiety and Worry Workbook “The authors have been guiding lights in the community of professionals devoted to helping people recover from anxiety disorders for the past thirty-five years. Here, they pass on their best guidance and wisdom to people who continually fall into the traps of trying to reassure themselves that bad events won’t happen, only to find that they feel worse for all their efforts to be sure. Here is solid science, written in plain and empathic language, with lots of examples and specific steps you can use to tone down the voice of uncertainty. Come get some!” —David Carbonell, PhD, director of the Anxiety Treatment Center in Chicago, IL; “coach” at www.anxietycoach.com; and author of Panic Attacks Workbook, The Worry Trick, Fear of Flying Workbook, and Outsmart Your Anxious Brain “Doubt is distressing, painful, and threatening. Who wants that? But trying to get rid of your uncertainty is exhausting. And if you succeed in carving out a safe and controllable life, you have built a world that is small. Within these pages you will learn not only how to tolerate uncertainty, but the wonderful benefits that will motivate you to relax your guard. Here’s one of the many surprising lessons of Needing to Know for Sure: To create a fulfilling life, don’t invest your energy in getting rid of your doubts. Step forward into new adventures and bring your doubts along for the ride.” —Reid Wilson, PhD, author of Stopping the Noise in Your Head Publisher’s Note This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought. Distributed in Canada by Raincoast Books Copyright © 2019 by Martin N. Seif and Sally M. Winston New Harbinger Publications, Inc. 5674 Shattuck Avenue Oakland, CA 94609 www.newharbinger.com Grateful acknowledgment is made to the following creators from the Noun Project for use of their work in the figures in this book: to Berkah Icon for icons used in figures 1.1 and 3.1; to Arafat Uddin for icons used in figure 3.1; to vectoriconset10 for icons used in figure 3.1; and to Tatina Vazest for icons used in figure 3.1. Cover design by Sara Christian Text design by Michele Waters-Kermes and Tracy Carlson Acquired by Jess O’Brien Edited by Kristi Hein All Rights Reserved Library of Congress Cataloging-in-Publication Data on file In memory of Dr. Morton Winston Contents Contents Introduction Chapter 1: The Limits of Reassurance Chapter 2: How Voices of the Mind Can Set and Release the Trap Chapter 3: Recognizing Your Trap Chapter 4: “Are You Sure?” Chapter 5: Therapeutic Surrender Chapter 6: Breaking the Bonds of Compulsive Reassurance Seeking Chapter 7: Addressing Obstacles to Recovery Chapter 8: The Benefits of Tolerating Uncertainty Acknowledgments References Introduction Benjamin Franklin observed: “In this world, nothing is certain except death and taxes.” While we can all agree about death, there are some places without taxes. But the question remains: What can you actually be certain of? Can you know for sure that some catastrophic accident or illness will not ruin your life in the next day? Can you know for sure that you have not at some time overlooked some careless mistake that will cause harm? Can you absolutely guarantee that you will love your partner forever? Can you know for sure that all of what you take for granted is real and not a dream or an elaborate projected reality from a futuristic computer network? Actually, no! And while we all want to do the right thing, how can you can know for sure that your actions and feelings and motivations are moral, proper, or as they should be? In short, you can’t. We can’t guarantee certainty about anything, really. So most of us just carry on as if we could, allowing the illusion of certainty to prevail. Some of us, however, become haunted by needing to know for sure. Since you are reading this book, you know what we’re talking about. You become acutely aware of wanting to know something specific for sure—and develop rituals to try to nail down certainty. You check things, ask others for feedback or opinions, and try to reassure yourself over and over, which helps for a while but never lasts. You might become hypervigilant about something—perhaps an unwanted thought crosses your mind, and you suddenly feel compelled to prove it is not a warning, an urge, or a wish. Or a memory begins to feel fuzzy and you have to go back and check. Or a doubt arises and it feels compelling; you can’t let it go. You become hooked on the checking and reassurance. This book is about how to give up reliance on compulsive checking and reassurance seeking—the obvious and the not-so-obvious ways we attempt and fail to satisfy the need to know for sure. If you tend to automatically imagine the worst possible consequence and then spend an inordinate amount of time and effort trying to convince yourself that it won’t happen, or mull over your past actions, wondering whether your motives were pure enough, while scrutinizing your thoughts, behaviors, and attitudes to make sure you did the right thing or did it for the right reason, then uncertainty has become your enemy. The reassurance you get from others or from the things you say to yourself—“That will never happen,” “I’m sure I took care of that,” “That didn’t happen that way,” or “It won’t be so bad”—makes that feeling of dread go away for a bit, and you experience a moment of relative calmness. But only a moment. Because then that sense of “Am I sure?” roars back; your anxiety, guilt, and distress spike; you have new urgent questions and look for further reassurance. The cycle repeats. You are stuck. We call this compulsive, driven, unrelenting need for reassurance the reassurance trap. Are You Caught in the Reassurance Trap? Do you find yourself preoccupied with situations like these? Are you unable to get yourself to stop checking and reassuring? Are there areas or issues in your life where you need to know “for sure”? Does uncertainty about these things drive you crazy? Do doubts take over? Are you unable to accept or overlook them? Do you find yourself overthinking something that did happen or could have happened or might happen? Do you seek “empty” reassurance? (Empty reassurance is reassurance from someone who doesn’t know the answer any better than you do.) Do you find yourself checking repeatedly on the Internet, with friends and family, at work, and with authorities? Are you continually monitoring your body to make sure you are okay? Are you unable to stop constantly checking your email, texts, phone? Do you find it nearly impossible to stop checking locks, alarms, or appliances? Do you engage in constant self-talk to counter something you are worried about? Do you ask others for their opinions about something, over and over? Do you annoy others by over-apologizing or by never letting go of something? Do you lie awake analyzing or planning to try to be less anxious? Are you subject to endless internal debates that never resolve? Do you experience paralysis over decisions because no amount of reassurance or checking is enough? Do you often search for the one last piece of information that will finally settle a question or help you decide—and then when you find it, you realize that you are still looking for more? If your answer to any of these is yes, then this book is for you! If you repeatedly ask yourself, your friends, and “experts” (including Dr. Google) for reassurance, and all that checking or reassurance simply does not stick, then you are getting snared in the reassurance trap. Studies have shown that the need to know for sure—the problem many have with tolerating uncertainty—is the major reason why so many suffer from anxiety, stress, and misery (Anxiety Canada n.d., Beck 2015, Peterson 2017). The problem with trying to know for sure is twofold. First, it is an impossible goal. Second, the need for reassurance can become excessive, all consuming, and even torturous. It can stop you from living freely, from making both large and small choices, and from living without constant doubts. Checking to be absolutely sure can take over your life. And as you may have already figured out, compulsively addressing your doubts with this kind of checking and reassurance doesn’t make them go away! It doesn’t provide the relief for which you strive. In fact, it adds to your stress and anxiety. Your efforts don’t provide comfort because you are trying for the wrong solution: when you are stuck in doubt, greater certainty is not the answer. Despite how surprising and counterintuitive it may seem, your tendency to seek reassurance is more of a problem than your worry itself. The solution to your distress is to feel more comfortable and confident with uncertainty. Our message is that your present efforts are aimed in the wrong direction. And, as always, if you want end up in a different place, you need to try a different path. In this book, you will learn how to change your relationship to the anxiety you feel when you experience doubt. You will learn how to trust yourself and be willing to accept mistakes you might make and outcomes that can be less than ideal. This might seem like an impossible task right now, but the information we give you and the shift in attitude toward uncertainty that we explain will make it possible. To overcome your exaggerated need to know for sure, you will learn how not to bow to the internal pressure to seek reassurance. Remember that knowledge is power. We believe that the information contained in this book can give you the power to set you free. Getting the Most Out of This Book In this book, you will learn about reassurance—what it can do, and what its limits are. If you feel immobilized by your need to know for sure, you are working very hard to avoid uncertainty. Even though the rational part of your mind knows it’s impossible to avoid uncertainty, the experience of uncertainty seems intolerable. Freeing yourself will take some time and effort. But it will become easier. In chapters 1 and 2 of this book, you’ll learn about reassurance—why it’s sometimes productive and sometimes not—and exactly how it works. In chapters 3 and 4, you’ll learn about the different reassurance traps we can fall into, and the psychological and biological mechanisms that drive them; in chapter 5, you’ll learn about a profound and powerful therapeutic attitudinal shift. Chapters 6, 7, and 8 will help you continue to hone your newfound ability to navigate uncertainty by guiding you through exposure to what you fear and the obstacles that might arise as you work to release your reassurance traps. We have written this book to be read from the beginning to end. Please don’t just look at the last few chapters, because our intention—right from the start—is to teach you an entirely new way to look at your reliance on reassurance and your need to avoid uncertainty. Additionally, many of you who are caught in the reassurance trap may not realize it. Or you may recognize one obvious kind of trap but not realize that you are in several other, more subtle ones as well. You might see yourself as extra cautious, analytic, needing to figure it out, just plain afraid, or maybe neurotic or dependent. You might even think you have a memory problem, jealousy, hypochondria, or insecurity. We provide realistic examples derived from our clinical experience to help you identify your own self-defeating pattern of reassurance seeking. A New Attitude Will Release You Most of our distress about uncertainty is caused by the effort to fight uncertainty with reassurance. And you can have a much more fulfilling and gratifying life—with much less anxiety and worry—when reassurance takes its proper place. We will show you that most of your anxiety and distress is caused less by uncertainty in your life, and much more by your efforts to fight uncertainty and try to know for sure. This book can help you lift that burden. Chapter 1: The Limits of Reassurance There are times when you feel hesitant or unsure about something, so you seek a bit of reassurance—and it works! Then there are other times when you become so overwhelmed with the need to know for sure that you are making the right decision, or evaluating something properly, or not taking an unacceptable risk, that no amount of reassurance seems enough. Most of the time, about most things, you don’t feel trapped. So why are you sometimes trapped in endless loops of worry and reassurance, and other times not? To answer this important question, we need to first discuss normal reassurance. In this chapter, we will explain the profound difference between helpful and unhelpful reassurance and why it sometimes works and sometimes becomes a trap. Sometimes Reassurance Sticks, Sometimes Not Have you ever noticed that sometimes reassurance sticks and sometimes it doesn’t? For example, you might hear that your next-door neighbor just bought a car and got a great deal on it. Suddenly you become concerned that you did not get a good enough deal on the car you just bought. You check a few websites and find out that it was probably about as good as you could get—more or less. That ends the issue. No more checking. A few more examples: You put on an outfit and wonder if it looks okay. You check the mirror, wish that you’d lost a few pounds, tell yourself it’s fine, head out the door, and don’t think about it again. Or you have a thought that you might have forgotten to pay a bill; you check once and see that you did. No recurring doubts. These examples may seem trivial, but sometimes reassurance sticks with very important issues too. We are both psychologists who specialize in treating people with anxiety disorders, and patients often come into our offices after having a frightening panic attack. Their doctors have already told them they have no medical issues but are suffering from acute anxiety. We agree that they aren’t dying, they aren’t having a stroke or a heart attack, they don’t have cancer, and they aren’t losing their minds or going crazy. We reassure them by giving it the right name—a panic attack—and explain what it is, how it happens, and why it is not dangerous. They immediately feel relieved—sometimes to the point of not having any more panic attacks—and they learn to not fear anxious sensations. Within weeks of starting therapy, they rate themselves as “much improved.” For other patients, though, research and fact-finding and explanations just don’t do it. They come to us after a series of panic attacks. They also have gone to their doctor and been reassured that they are not suffering from any serious illness. We give them the same information: anxiety is the culprit, this is a panic attack, and it is harmless. However, the reassurance just doesn’t stick. Each time they feel their heart thumping or experience odd sensations, they run to the doctor for additional reassurance. Uncertainty and doubts resurface, causing additional anxiety and worry. They struggle in therapy, having additional panic attacks and increased anxiety, never really making peace with their doubts. “How can I know for sure that I’m not having a heart attack? I need a second (or third) opinion.” Their anxiety attacks continue unabated, and they run from doctor to doctor, therapist to therapist, trying to find out “for sure” what ails them. They make no progress and continue to search for reassurance. Here is another example. Sometimes frightening thoughts can respond to one informational reassurance—and sometimes not. A patient of Dr. W. reported that she was terribly distressed by the fact that pop-up mental images of her prior boyfriend kept intruding into their lovemaking. When she was told these were meaningless symptoms of her obsessive-compulsive disorder (OCD) and should not be dignified with attention and analysis, they faded away on their own. On the other hand, a young man with a sudden horrifying image of having sex with his toddler cousin was so stuck on the remote possibility that he could be a pedophile that hearing “This is just your OCD talking” was not helpful; he was avoiding children, praying for redemption, and seeking constant affirmation that he was not a pedophile. So, clearly, reassurance can come in two different types: one type is productive; the other is not. To get out of the trap, it is important to understand the distinction. Productive Reassurance The productive type of reassurance is instructive; it may involve researching a topic on the Internet or asking the opinions of others who are knowledgeable in an area, so that you know more about it, become familiar with the possible outcomes, and find a way to plot the best course for a decision. Anxiety loves ignorance, and ignorance is reduced by facts. Productive reassurance seeking is helpful. It has the capacity to reduce anxiety if it leads you to resolve or live with whatever uncertainty remains. You settle in with credible, responsible information when you get it, so you don’t find yourself looking for more and more information, more opinions, more research to eliminate every doubt. Productive reassurance sticks. If the information source is credible, that is all you need. You can tolerate the fact that there could possibly be something you have missed. You do not have to follow every link or google other options. Sometimes even just one piece of information can provide complete reassurance. As an anxious child, Dr. S. convinced himself that he was having every symptom of a terrible disorder he read about in a newspaper column. If only someone had told him one fact he had missed, he would have been greatly relieved. The disorder was menopause! Helpful Fact: A good rule for avoiding a reassurance trap is to limit the reassurance you seek to a single factual response from a credible source. Productive reassurance leads to an action plan: it helps guide you either to take a particular action (“I worry that my child will see inappropriate websites, and here is an app that gives me control over web surfing content”) or to avoid making some unfortunate decision (”I worry that I might have lead paint in my house, but I found out that lead was removed from paints in 1978—and my house was built in 1991”), or to take no action at all (“I had a weird thought—so what?”). The action or nonaction is the end of the story, even if some doubts might remain. Productive reassurance can be as simple as checking once that you have your keys in your purse or that you did in fact respond to an email. It does not raise new questions and doubts. Most importantly, productive reassurance doesn’t spin round and round. It doesn’t cover the same ground over and over again. It doesn’t lead to a cascade of asking other people or checking other sources or asking the same question in a different way. It progresses. It leads to an action plan. It’s important to note that productive reassurance doesn’t necessarily eliminate anxiety. Rather, it helps you clarify your position: to see what information you might need, and perhaps determine what action you might take—even if that action involves just leaving it alone and doing nothing. Here are some examples: Anxious thought: What if the pain in my stomach is cancer? Productive reassurance lets you look at the probabilities and take a responsible course of action. This might be reminding yourself that the last time you felt like this it was a minor bug, which allows you to wait a few days to see what happens. You can tolerate the thought of the possibility of a serious illness, but you can let time pass for a while. It does not feel urgent. You don’t feel frantic to get an immediate answer to the question. You have created a plan of action that you don’t have to keep revisiting in your mind. Anxious thought: What if I hurt my friend’s feelings? If you are concerned that you may have slighted a friend, the most direct type of reassurance is to simply ask that friend (only once!) if that is the case. For this reassurance to be productive, you must be willing to accept the response, despite the fact that you can never know for sure that he is telling the truth and not just being polite or avoidant. You must settle for the answer and move on. Doubts may linger, but you don’t dwell on them or let them take over. You can tolerate whatever doubts remain. Anxious thought: What if the plane crashes? With a thought like this, getting the facts—for instance, that flying is just about the safest form of transportation that exists (certainly safer than driving!)—can be quite reassuring. It may help you make a rational decision to fly to your destination, despite your worry. You have evaluated it as an acceptable risk. An important point, though sometimes difficult to grasp, is that productive reassurance does not make you feel absolutely sure about something. It’s a way of making the best guess, even while knowing that it is a guess. Productive reassurance is accepted alongside whatever doubts remain. It is not followed by an urgent desire for more reassurance. So you can tell whether reassurance is productive by the way it acts, not by the content of what it tells you. Productive reassurance helps you to proceed despite your anxiety and uncertainty. Being perfectly sure is not the goal. Helpful Fact: Productive reassurance can’t make you absolutely sure about something, but it helps you make the best guess. But there are limits to productive reassurance. If, after knowing the facts about flying, you remain unwilling to fly, this unhelpful attempt at reassurance may make it clear that your fear of flying is not a rational one, and that more facts will not help. Similarly, if you simply cannot accept your friend’s response that you did not hurt her feelings, or if you keep revisiting and changing your action plan, or you are back trying to allay doubts, more facts won’t help. This is evidence that what may have seemed initially to be legitimate fact-finding or problem-solving is now in fact a very different problem: getting caught in a reassurance trap. Helpful Fact: When you are caught in the need to know for sure, more facts won’t help resolve the issue. And once we’re caught in the need to know for sure, the reassurance we seek becomes unproductive. Unproductive Reassurance This type of reassurance does not lead to any reasonable action plan, and it fails to provide information that helps to resolve the issue. It doesn’t stick. It is never enough. It can start out innocently enough, like asking a friend for their opinion or reassuring yourself that a thought is silly, and it easily masquerades as productive, especially at first. However, this type of reassurance is not really about fact-finding; it is about reducing anxiety and avoiding uncertainty. It offers the illusion that feeling certain is possible and that this feeling of certainty should be pursued. Unproductive reassurance is your attempt to reduce anxiety, discomfort, and distress. It allows you to pretend, and therefore to feel the relief of imagined certainty, for a little while. You worry, for example, that your child might have a brain tumor because he is unusually irritable. A neighbor says “Not likely.” And you briefly feel better—as if your neighbor knows anything more than you do! But inevitably, the worry returns, and with it, the need to be reassured. Or you have had unwelcome thoughts about a mistake you may have made at work, and you scan your boss’s facial expression for reassurance. This briefly makes you feel less uncertain, until it crosses your mind that she may have just not found the mistake yet. Another way to look at it is to understand that unproductive reassurance is a failed attempt to reduce uncertainty. Helpful Fact: Unproductive reassurance temporarily creates the illusion of certainty. Identifying and refraining from unproductive reassurance seeking is one way of avoiding the reassurance trap. As shown in the following figure, there are three types of unproductive reassurance: hidden reassurance, empty reassurance, and checking reassurance. Each type tries to lower anxiety, reduce worry, and address uncertainty in a slightly different way. Hidden Reassurance Hidden reassurance is your attempt to lower anxiety without making it clear to others that you are looking for reassurance. Hidden reassurance can show up in a variety of ways. It can be deduced from your own attempts to reason with yourself, or it can entail creative ways of trying to divine what others might be thinking. It can also be experienced as planning or analyzing or obsessively trying to solve a worrisome problem. It may be so automatic and habitual that you don’t even realize you are seeking reassurance from someone else or from yourself. Sometimes you look for signs that what you’re worried about isn’t happening, hasn’t happened, or won’t happen in the future. For instance, you look at the technician who does your mammogram. Is she concerned or relaxed? Can the expression on her face tell you something? You are looking to be reassured, hoping to see signs that all is well. Or when your flight starts to get bumpy, you focus on the flight attendant. You are asking yourself whether he or she looks unafraid. You are looking for signs that the flight will be safe, that the turbulence won’t get too severe. The attendant’s calm manner allows you to feel that all will be well—at least for a moment. Sometimes looking for signs can be so subtle that you do not realize you are doing it. It may just seem like “seeking feedback.” If you are concerned that you have made a foolish or hurtful comment, or flubbed a presentation at work, you might search for approving nods or glances from those around you. You can carefully judge the next interaction for hints of hurt or disapproval. The problem is, you are subjectively determining the reaction of others, so you can always question your own guess. You can never be sure. It is a form of mind reading, a way of asking without asking. Hidden reassurance can also masquerade as “planning.” For example, you might lie in bed at night trying to come up with the best possible response to any twist or turn an anticipated conversation might take. You are trying to convince yourself that you will have a good script to use that will avoid a problem or achieve a goal, no matter what the other person says or does. Similarly, you can be “escape planning” for any possible thing that could go wrong—like reminding yourself where every bathroom is, just in case, or coming up with possible excuses to use if you get too anxious. You may already have realized that this kind of “planning” does not help in the long run and does not give you any confidence that you can think on your feet the next time. Sometimes hidden reassurance is a form of rational self-talk. Unfortunately, it does not stick. This can be particularly frustrating because it feels as if it ought to stick. Somehow the subsequent “yes, but” doubt always wins out, and the internal looping argument between your rational and irrational selves escalates. It doesn’t stick because whatever remains of not knowing for absolutely sure is not accepted, tolerated, or allowed. You can’t convince yourself, even if your reasoning is good, because you allow any uncertainty to keep you from settling down. Such self-talk is an attempt to cope with anxiety over uncertainty, but it does not actually succeed in reducing your anxiety. You find something to tell yourself to counteract your fear, but you don’t actually buy it for long. Here are some examples: “I love kids; I would never hurt them.” “You must have added up the numbers right; you always do.” Or “The last time I worried about this, I was wrong.” Unfortunately, this kind of unproductive reassurance—essentially arguing with yourself—tends to escalate the problem. Lists of pros and cons can function the same way. So can “replacing negative thoughts with positive thoughts.” Here is another example: You keep asking yourself “What are the chances that this bad thing will come true?” or “What are the probabilities that that would happen?” Or repeating to yourself over and over that there is only a.01-percent chance that the waitress coughed on your food or a one-in-a-million chance there will be a terrorist attack in this mall today. Most people who spend time in the reassurance trap already know that this kind of reassurance backfires. Here is a subtle variation: Suppose you have the fear that you might suddenly drive your car off a bridge. Your therapist has recommended facing your fear and driving over the bridge. If you reassure yourself by repeating to yourself “My therapist wouldn’t put me in danger,” this lowers your anxiety for the moment. The problem is, you then immediately wonder whether you have explained everything to him and whether he really knows his stuff; maybe you will be the exception that proves the rule. Helpful Fact: Calculating probabilities of a negative outcome is not helpful in the long run. A covert request for reassurance can come in the form of positive talk or affirmations made to others. The essential aspect is that the other person doesn’t object to the statement, so the reassurance can be assumed. Here are some examples, followed by the unvoiced request for reassurance: This will cure my problem. (Won’t it?) I didn’t offend him. (Did I?) I didn’t run over anyone. (You didn’t see anything, did you?) Love you. (Do you love me back?) I am really a good guy. (Do you agree?) This was a good therapy session. (Wasn’t it?) The person requesting this kind of reassurance is often a bit embarrassed to ask directly, since they believe it is something they should already feel confident about. The people they’re speaking to usually comply with the trap by kindly agreeing or at least letting the statement stand. Helpful Fact: Hidden unproductive reassurance is asking without asking, mind reading, and unhelpful self-talk. Empty Reassurance The second category of unproductive reassurance is empty reassurance: reassurance sought from someone who doesn’t know any more than you do how likely an outcome actually is. Often, asking for empty reassurance is a request for an answer to an unanswerable question such as what the future holds, or that some bad thing won’t happen—as if anyone can actually guarantee good luck or fairness or positive outcomes. It is hollow comfort. It has no rational value and unwittingly reinforces the trap. Dr. S. had a patient with many health fears. He once coughed in my office and then immediately asked if he could have lung cancer. This patient was asking me to reassure him that he didn’t have a serious disease, even though I had no more information than any stranger on the street. “Tell me the plane won’t crash.” “Tell me I will ace the test.” “Tell me this headache isn’t a stroke.” “Will I be okay?” “My son will get into a good college, don’t you think?” These are all examples of empty, unproductive reassurance seeking. Any question that starts with “Are you totally sure this will or won’t happen?” is a request for empty reassurance. Empty reassurance is pretty easy to get. We can provide it for ourselves with self-talk in an instant (“Of course! You are being silly; everything will be fine!”) And if you ask them, many people find it very hard not to offer this kind of meaningless response—it just seems kind of mean not to reassure someone who is asking for help with their doubts. So they supply temporary comfort, unknowingly ushering you right into the reassurance trap. Sometimes your need for empty reassurance becomes so great that you can act and feel like a reassurance junkie, which makes you feel foolish and can annoy and irritate friends and family. Checking Reassurance This form of reassurance involves behavior you engage in to make absolutely sure you have taken care of something that might be a danger later. “I need to make sure one last time.” Checking reassurances comprise a wide range of activities: checking the flame on the burner, the lights in the house, the iron on the ironing board, the locks on the doors and windows, the alarm clock, the weather report, the contents of your pockets or purse. It can happen at work or at home. It can include checking with someone else. Here are some examples: “Do I remember this right?” “Did I just hear what I think I heard?” “Did you see whether or not I took my medicine?” “Can you double-check to see if I checked this correctly?” A very common compulsive checking reassurance is reading and rereading and re-rereading information on the Internet, looking for unattainable certainty. Or checking texts and emails to make sure everything is okay or no one needs you urgently. Another is to apologize over and over to make sure that another person is not angry or upset about something you may have said or done. Some reassurance seeking by checking can seem far-fetched: Did that bump I heard while driving mean that I hit another person and didn’t notice it? Should I go back and check, just to reassure myself? Or maybe I should check the news tonight for reported accidents. Or they can even seem bizarre: I know it makes no sense, but let me just check one more time that I did not lock a child in the refrigerator. However, many checking compulsions feel like you are simply doing additional research. (“I need to check just one more time to make certain that these new carpets don’t give off deadly fumes—there is still another study I need to access,” or “I’m still doing my research about which school is the best one to enroll my daughter in—I’m already past the enrollment deadline, but I need to do just a little bit more checking.”) It can even start out as sensible, like making sure you have your wallet, keys, phone, and emergency anti-anxiety pills…just once…or maybe twice in case you thought you saw your wallet in there…but maybe when you checked you accidentally dumped it out…or you didn’t. Or more. It can go on and on. Checking reassurance has a way of mushrooming. It can turn a small task into an overwhelming one. It may start out as a simple Google search or asking one other person just to make sure. But researching or checking one question can lead to another, and this new apparent fact can raise additional doubts. This expands the project into entirely new directions and proliferating worries. You can even lose sight of the original question. People can become trapped in checking activities all day long, even when they know they are spinning their wheels and have lost perspective. People with checking reassurance problems may often refer to themselves as being “obsessed” with something. Actually, checking reassurances are identified as compulsions—not obsessions—in people with obsessive compulsive disorder (OCD), particularly when people know they are irrational but nevertheless feel compelled to check. Sometimes you know you are driving yourself (or others) crazy, but you can’t get yourself to stop. Trying to keep yourself from actually checking may lead to additional, but more subtle, reassurance seeking. For instance, you might substitute various forms of checking self-talk for overt checking behavior. This might include checking your memory of your last check or switching to “rational” self-talk. You may even try some reassurance technique you were taught in therapy or read in a self-help book. But reassuring yourself that you don’t have a memory problem or you “must have done it right” or you did check already or “what are the chances that…” lasts only until the next doubt arises. Some people with checking reassurance compulsions are automatically flooded with doubts as a task is ending: “Is the column of numbers added right?” “Did I really understand what I just read?” “Do I remember exactly what she said or what I am supposed to do?” “Did I really finish?” “Was I concentrating or focused enough?” They treat the doubts as warnings or signals or messages that something might be wrong, and they feel compelled to go back over and repeat things. They reassure themselves by either redoing the task (like rereading what they just read) or memory checking—going back over, in exquisite detail, what was said or done to make sure it is correct, completed, and accurately remembered or understood. Memory checking is done to make you feel reassured, but it invariably leads to increased doubts. In extreme cases, mental checking reassurance can blossom into stuck mental looping that develops a life of its own, distracts from the present moment, and causes immeasurable misery. Memory checking as a substitute for actual checking is also unproductive reassurance. One subtle form of memory checking happens while reading: you find yourself going back over what you just read, over and over, to make sure you remember or understand it fully, to be certain of what you just read. People with this form of memory checking often think of themselves as slow readers, but they are actually dealing with constant checking compulsions. When Reassurance Fails to Stick Now that we have explored the different types of unproductive reassurance one might seek, let’s look more closely at the person who comes to us for therapy after experiencing panic attacks but can’t seem to hold onto the reassurance we provide. What happens is that each explanation, each reassurance, each bit of information that she receives lowers the level of uncertainty and anxiety she experiences and gives her a momentary feeling of relief. (“Okay, so now I know that these horrible feelings of having a heart attack, or losing my mind, are just harmless but uncomfortable sensations of anxiety. I’m in no danger, and I can relax about it.”) Remember, reassurance isn’t always something you seek from others. It’s also something you seek from yourself. People use self-talk to try to get out of the reassurance trap by telling themselves something to make themselves feel certain—which can be as unhelpful as reassurance sought from others. Let’s see how this patient again gets overwhelmed with anxiety and uncertainty. Soon after the therapy session, she begins to wonder, “But then why do I have these racing feelings in my heart (or weird spacey feelings in my head), and how can the doctor know for sure that I’m not about to have a stroke, or that I am not going to faint? I just can’t be sure!” These fears take center stage; she goes back to her doctor or checks with Dr. Google (or both), and she experiences yet another panic attack. So she needs additional reassurance, additional medical tests, more reassuring information that her symptoms are indications of panic and not a life-threatening disease. She is relieved for a while, and then the entire cycle starts up again. Here’s another example: You might be terrified that one of your children might be in a car accident. So you text them to be careful, check on them, install a GPS tracking app on their phones, make sure they check in with you upon arrival. Each time they text back saying they are okay, each time you see their location on your tracking app, you feel relieved and calmer. But no amount of checking or rational self-talk that they are probably just fine calms your fears. No amount of reassurance is enough. You remain worried about their safety, just can’t shake the feeling, and continue to bother them with excessive checking. The fact that nothing has happened yet is no guarantee that it won’t. It is not that reassurance doesn’t help at all; rather, it helps only for just a little while, and then serious doubts creep back in that require additional reassurance. You simply can’t know for sure that you are making the right choice, being careful enough or safe enough, or that you know the real truth about yourself, or have written a good enough paragraph. You still feel compelled to check again. You might have a lot of trouble following through with a decision. Or you might make a decision and then second guess yourself. You might be sure of your choice before you go to sleep, but wake up horribly worried that you made a huge mistake. Sometimes the consequences seem disastrous (“I waited so long to tell my doctor about the headaches I get that I might have let cancer grow past the point where it could be cured”), to important but not catastrophic (“I’ll never be able to show my face there again after that stupid suggestion I made”), or ultimately trivial (“What if I overlooked a grocery coupon?”) Here is a major point: Whether the outcome is objectively disastrous or trivial, your upset feels the same. You can’t stand not knowing for sure. We have heard so often from anxious patients: “I would rather just know I have cancer than be in this state of not knowing for sure and waiting for the test results. But then, even if it is a good result, I know I will worry that the test was not accurate and want another.” Helpful Fact: It is not the content of the worry or even the feared outcome that causes the most misery. It is the not knowing for sure and being unwilling to accept that knowing for sure is not possible. Now that you know it’s all about uncertainty, you can see why certain kinds of self-talk are problematic. Efforts we make to simply tell ourselves to be more certain (or to be more rational, or to stop focusing on the negative) just don’t help for long. Let us explain why. Coping Self-Talk Can Be Unproductive Reassurance Typical self-help/self-improvement advice includes ways to reassure yourself when feeling low in confidence, or anxious, or blue. Many include some form of intentional self-talk, sometimes called positive thinking, affirmations, or visualizations of positive outcomes. Often there are suggestions that you can actually banish doubts, boost self-confidence, or substitute optimism for worries—and this will make you feel better. Sometimes there is an almost magical component to this recommendation: that negative attracts negative and positive attracts positive, as if your outlook on the world can actually affect external reality. And conversely, that your negativity is the reason why things have gone wrong. Most people who are caught in the reassurance trap already know that this intense focus on positivity is not helpful and that attempts to make some thoughts go away by substituting other thoughts just does not work. Helpful Fact: “Replace negative thoughts with positive thoughts” simply does not spring you out of the reassurance trap. Self-Talk Can Be Helpful or Unhelpful Now that you know more about reassurance, it is easy to see that some self-talk can be productive reassurance and some can be unproductive. Knowing the difference is important, because hammering away at unproductive reassurance, quietly and desperately, in an attempt to feel more certain is a sure way to solidify the reassurance trap. Here are some examples of productive self-talk: I can put one foot in front of the other even while I feel scared. I can do this even though I’m not absolutely certain. It is okay to be anxious and also do this. I can go on without asking for reassurance, even though I would like some more. I am having my usual doubts right now. This is not a message or a signal. It is automatic. This is my best guess, and I’m going to take it, because I’m getting stuck. I am having the thought that [something bad]. So what! I can handle this feeling without checking anything. You’ll note that all these examples are about dealing with the uncertainty one feels by just letting the uncertainty be there. They’re not about seeking comfort from the anxiety; rather, they’re about dealing with the anxiety while proceeding forward. Here are some examples of unproductive self-talk. Notice that each statement is an attempt to eliminate uncertainty: Everything will be okay. I will check the weather to make sure my flight is safe. I won’t make any mistakes. God would never give me cancer or take my children. I can always leave if I need to. I am a fine person who would never do something like that. I must banish all doubts. Stop thinking that negative thing; think this positive thing. Helpful Fact: Self-talk can be helpful or unhelpful, depending on whether it consists of productive or unproductive reassurance. The figure distinguishes between productive and unproductive reassurance questions. Moving Forward In this chapter, we have examined the different types of reassurance, differentiating between productive and unproductive ones, and we’ve considered the ways you might seek it from others and from your own self-talk. In the next chapter, we’ll move to what happens when you’re in the reassurance trap. We’ll look at the two voices of the mind that can set the trap and the third voice that can get you out of it. Chapter 2: How Voices of the Mind Can Set and Release the Trap In this chapter, we will look at what can be observed inside our minds when we inadvertently create a trap while trying to get relief from anxious thoughts and feelings. The Natural Voices of the Mind We all have many voices inside our heads that dialogue with each other. Of course we don’t really hear those voices, but they’re present in the way we sometimes argue with ourselves, debate with ourselves, even fight with ourselves inside our head. Inner voices can soothe us, warn us, and worry us. How often have you said about something, “On the one hand I feel this way, but on the other hand I feel the opposite”? These represent opposing internal voices. It is remarkable and fascinating that we can have a variety of thoughts and feelings about the same thing at the same time. If not for this, our choices would seem much more clear-cut, but our lives would be far less interesting and exciting. Many people caught in the reassurance trap complain that their mind is too noisy and cluttered—that there are too many voices, speaking too loud and too fast. Many of our patients come to us with the wish that they could quiet their mind, turn down the volume, and make the inner debates go away. Silencing inner voices is not an option, but slowing down to listen to them and changing how you respond to them most certainly is. In a previous book, Overcoming Unwanted Intrusive Thoughts (Winston and Seif 2017), we introduced three characters who represent common internal voices of the anxious mind. The reassurance trap is driven and maintained by two of those voices, which we call Worried Voice and False Comfort. A third voice, which we call Wise Mind, observes without judgment, offers commentary, and leads the way out of the trap. Worried Voice Worried Voice is the one who comes up with the doubts, “what ifs,” and “yes, buts.” It is the voice of anxiety-provoking thoughts and feelings. It is incredibly creative and imaginative, and it leaps automatically and continuously toward awful possibilities and catastrophes. It wants to know for sure that everything is going to be okay. It begs for reassurance; it rebels when asked to accept any uncertainty or ambiguity. Worried Voice is an all-or-nothing thinker. It has a hard time waiting. Everything feels urgent and important in the moment. Worried Voice begs for relief from anxiety, demands attention and comfort, wails and escalates when left on its own. False Comfort The second voice, False Comfort, issues reassurance at the drop of a hat—at any hint of anxiety or doubts. It follows immediately after the “what ifs?” of Worried Voice. The mission of False Comfort is to give Worried Voice immediate relief from anxiety. It argues, suppresses, reasons with, and tries to distract from the messages of Worried Voice. It offers avoidance suggestions. The problem is that False Comfort provides unproductive reassurance. It therefore has no staying power and automatically retriggers another concern from Worried Voice. That requires False Comfort to step back in, and Worried Voice is triggered once again. Worried Voice always seems to have the last word: anxiety goes up, while tolerance for uncertainty goes down. Wise Mind Wise Mind is the third inner voice. It is able to rise above and separate itself from the unhelpful interplay between Worried Voice and False Comfort. Wise Mind has learned that doubts are a natural production of the human mind, that some thoughts are not worth considering or reacting to, and that nothing can be guaranteed. It can see that any quest for ultimate certainty is hopeless and produces more distress in the long run. It understands that most thoughts—even horrible “what if?” thoughts—are not danger signals. It also understands that the mind can issue false alarms, and it knows how best to react to a probable false alarm: not with immediate, urgent action, but by simply letting time pass. Wise Mind is mindful; it knows how to observe the mind without judgment, and it does not get entangled in the argument between Worried Voice and False Comfort. Wise Mind is not judgmental or critical, just wise. Wise Mind’s ability to observe the internal dialogue in real time is an essential component of breaking out of the reassurance trap. In particular, Wise Mind has the ability to discern, in a nonjudgmental and noncritical manner, the interplay of Worried Voice and False Comfort. When Worried Voice and False Comfort Argue In this section, we will show you how these voices interact, and why Wise Mind is the voice that will help you engage less in unproductive reassurance. Here is a typical dialogue between Worried Voice and False Comfort when you’re stuck in the reassurance trap. Worried Voice: I am worrying that I left the stove on. False Comfort: Don’t be silly! Of course you turned it off. You are an extremely safe and responsible person. Worried Voice: Yeah, but two years ago I was about to leave the house and I realized one of the burners was still on. False Comfort: Well, no one is perfect. Don’t be hard on yourself for one time. Worried Voice: But I might have burned down the whole house! I would be homeless. False Comfort: Seriously, what do you think the chances are of that happening? Highly unlikely! Worried Voice: But it only has to happen one time! I need to make absolutely sure the burner is off. False Comfort: Well, maybe you should leave work and check it just to make 100-percent sure. Worried Voice: Okay, but last time I left work to check on it, I got in trouble. And anyway, when I got back to work, I was worried that I had accidentally turned it back on because I was so upset with myself. Maybe I have a memory problem. It seems clear that False Comfort cannot get Worried Voice to stop asking for more and more reassurance. In fact, Worried Voice actually thinks of new things to worry about in response to False Comfort’s efforts to help. They are stuck together in the reassurance trap. This is the worry-reassure-worry again cycle that maintains and reinforces the trap. When you are in it, you lose perspective and develop emotional tunnel vision, focusing only on your goal of needing to be absolutely, positively, 100-percent sure. Wise Mind Steps In Here is where Wise Mind can make a difference. Notice what happens when Wise Mind steps into this conversation. Wise Mind: Okay, give me an example of something in life that is risk-free. (Both Worried Voice and False Comfort are silent…) Wise Mind: That’s right, you can’t think of anything, because nothing exists that is risk-free. So why are you trying to be absolutely, 100-percent sure that you didn’t leave the stove on? A guarantee is not possible. Worried Voice: But I can’t stand not knowing. Wise Mind: Worried Voice, you have trouble seeing that you are taking your thoughts too seriously. Thoughts are just thoughts, even if their content is frightening. You tolerate not knowing for sure all kinds of other terrible things all the time. You just had this particular thought pop up, and it scared you. False Comfort: He gets so upset. I am just trying to help. Wise Mind: I understand. You think that you have to reassure him every time he brings up something to worry about. But it hasn’t worked so far, so why would it work in the future? You are making him think he just can’t handle any anxiety or doubt. And you are reinforcing the idea that such thoughts are valid warnings. Let’s allow one check and then deal with the uncertainty that remains. In the long run, this is how you bypass the misery. In this dialogue, Wise Mind has shown Worried Voice and False Comfort a path out of the reassurance trap. This might be a difficult path, involving tolerating some uncomfortable feelings, but Wise Mind has pointed in the right direction. Conversations between Worried Voice and False Comfort are the driving force behind the creation of the reassurance trap. Wise Mind is the way out of it. Helpful Fact: The interaction between Worried Voice and False Comfort drives the reassurance trap. Wise Mind is the way out of the trap. Here is another conversation between Worried Voice and False Comfort. The content of the worry is quite different, but the pattern is the same: Worried Voice is still asking for reassurance, and False Comfort is bending over backward to provide it. Worried Voice: I worry that there is something wrong with my brain. I don’t think I can concentrate properly. False Comfort: Your brain? You are a very smart person. You are fine. Worried Voice: Yeah, well I hope I’m not getting dementia. That terrifies me. False Comfort: Dementia? They ask you who is the president and what you had for dinner last night. If you know those, then you are just fine. Worried Voice: That’s too easy. Maybe I’m forgetting and I don’t know what I’m forgetting. It starts slow, you know. I couldn’t remember the name of that movie star yesterday, and I lost track of what I was reading last night. False Comfort: Stop those negative thoughts! Think positive! You did your job today, your drove your car, you seem fine to me. I’m sure of it. Just stop thinking about this. Worried Voice: But I keep noticing things. Like I wasn’t absolutely sure of the date when I was signing the check. I can’t handle going senile. False Comfort: Just count backward from one hundred. If you can do that, you know you aren’t senile. Anyway, you are only forty-seven. What are your chances of dementia? Worried Voice: There is early onset dementia. It happens. How can you be so sure? False Comfort: Well, you could get tested. Then you will be certain you are okay. Worried Voice: OMG! What if I fail? You are not helping!! Once again, Worried Voice and False Comfort have continued to provoke each other. Worried Voice ends up more anxious than when the dialogue started, and False Comfort is just throwing out one unproductive reassurance after another. Wise Mind Steps in Again Now let’s see how Wise Mind might handle this. Let’s imagine a conversation between Wise Mind and False Comfort: Wise Mind: (to False Comfort) Do you realize that each time you try to reassure Worried Voice, you make him even more upset? False Comfort: Of course, but I don’t want to give up on trying to soothe him. I just have to find the right way to reassure him. Maybe I could send him this list of symptoms I found on the Internet. I have to keep trying. Wise Mind: Actually, if you want to be most helpful to your friend, you might try to help him cope with uncertainty. False Comfort: What does that mean? Wise Mind: Worried Voice is afraid he is losing his mind. That’s an anxious thought. He wants to be ­absolutely certain that’s not happening. Even 99-percent certainty isn’t enough for him. False Comfort: I know! That’s the problem. I can’t give him absolute certainty. Wise Mind: Exactly! And every time you try to reassure him, you make that thought seem like an issue worth addressing. Even though absolute certainty is impossible, I suggest you tell Worried Voice how much you care about him—how much you want to soothe his worries—and that the best way to help him is this: to encourage him to be willing to have some uncertainty in his life. Worried Voice: (He has been listening!) Wait, don’t do this to me. I need False Comfort! Wise Mind: The fact is, no one can be absolutely certain they are not becoming demented. But most people don’t get stuck on the thought, because they don’t want to waste energy and distress trying to answer, for sure, an unanswerable question. It means being uncomfortable for a bit—but it passes. Once again, Wise Mind has pointed out a path whose goal is increased tolerance of uncertainty rather than trying to find some way to know for sure. When You Seek False Comfort from Others The conversations we have to try to reassure ourselves are not always internal. Worried Voice will also try to seek reassurance from other people who try to calm and soothe you, providing you with unproductive reassurance that functions just like False Comfort. Here is a dialogue between Worried Voice and her supportive friend as they leave a party. Although the friend is trying hard to be supportive, and to reassure Worried Voice, you can see that every reassurance from this friend results in yet another concern raised by Worried Voice. Worried Voice just can’t be sure that the reassurance given by her supportive friend is correct. Worried Voice: I think I just made a fool of myself. I’m humiliated… Supportive Friend: No, you didn’t; you were great at the party. Worried Voice: You really think so? Great, I feel better. Supportive Friend: Yes, and your outfit was a hit. Worried Voice: Oh, so you didn’t hear what I said to that guy? Supportive Friend: What guy? Worried Voice: The one who walked away from me after two minutes. Supportive Friend: I don’t think you could have turned him off so fast. I’m sure he just had other people to speak with. Worried Voice: But I said the dumbest, stupidest thing to him. That I liked tall people! And I know I started to blush! I’m so stupid. Supportive Friend: That wasn’t so bad. You are smart and kind. Don’t beat yourself up so much. Worried Voice: That’s what you think. But you can’t tell me I didn’t blow it with this guy. I’m such a dork! Supportive Friend: No, you are not! And anyway, he was probably a jerk. You’ll find someone, I promise. Worried Voice: I’m never going to get together with a guy. Are you really sure I’ll find someone someday? I can’t tolerate the thought of dying alone! Look at what has happened here. No matter how supportive, reassuring, and encouraging the friend tries to be, no matter how many kinds of Empty Reassurance she offers, Worried Voice always comes up with something to be upset about. This is often what happens when someone who is caught in the reassurance trap speaks with friends in her Worried Voice: it is hard for friends to withhold reassurance. They tend to try to be kind and supportive, which often does not help. Now let’s look at this from an entirely different perspective—that of Wise Mind. How do you imagine this dialogue would go if her Wise Mind took over from Worried Voice and started handling the urge to be reassured? Let’s imagine it is Wise Mind instead of Worried Voice who is seeking support. Here’s one possibility: Wise Mind: You are a supportive friend, but your efforts don’t seem to be helping. In fact, I feel worse. Supportive Friend: You are right. I am making you even more upset. What am I doing wrong? Wise Mind: I know I ask for reassurance way too much. I need to be reminded that I can’t be sure about every interaction, I can’t deliver a flawless performance at every party, and I certainly can’t predict the future. Supportive Friend: But that just sounds mean. Wise Mind: You can do it gently. As my friend, you can give me room to feel upset. You could even say “I wish we could know your future, but none of us do, really. No point in bleeding before you are cut.” You could remind me that I can handle these feelings. You could also just give me a hug and say “Yeah, it’s those thoughts again!” and steer me to carry on with what we were doing—which I believe was after-party ice cream? Here, we see Wise Mind counseling the friend to help Worried Voice let go of its need to be sure—and normalizing the uncertainty; after all, that’s something we all feel. And it’s something most of us can deal with, even when it feels like we can’t. Helpful Fact: Wise Mind is what will get you out of the trap. It will remind you that while uncertainty feels bad, it’s something you can deal with. Components of the Trap Now let’s take a closer look at what is actually happening when the conversations between Worried Voice and False Comfort are spinning their web. Helpful Fact: Understanding how the trap is set is the first step in extricating yourself from it. Two psychological processes—negative reinforcement and paradoxical effort—take a normal desire for reassurance and turn it into a trap. Negative Reinforcement Reinforcement is a psychological term for a consequence that makes it more likely that a behavior will occur again, more frequently, longer, and stronger. Training a dog to sit is a great example of reinforcement. Get the dog to sit while saying the word “sit.” It sits, and you pet it, say “Good dog!” and give it a biscuit. Every one of those actions on your part—petting, praising, and feeding—provides reinforcement. Your dog will eventually learn to sit whenever you say the word “sit.” This kind of reinforcement is often called reward. To be effective, reinforcers must immediately follow the action you want to strengthen. If a dog sits and you wait five minutes to give it a treat, there is no association created between the action and the reward. This represents what psychologists call the principle of contiguity. Reinforcement works best when given right after the action you mean to reinforce. Rewards like petting the dog and giving it a treat, saying “Thank you” when your child does something good, getting a bonus at work—these are all examples of positive reinforcement. They feel good while they reinforce. They provide incentive to repeat what just happened. A positive reinforcer can be physical (a piece of candy), emotional (a smile or a kind word), or behavioral (a pat on the back, a hug or kiss) (Klatt and Morris 2001). It can even be just a thought (“I am looking forward to getting to the restaurant and ordering my favorite dish”). And it is possible to reinforce (and therefore increase) the strengths not only of overt behaviors, but of emotions and thoughts as well (Ellis 1977). Sometimes reinforcement is quite subtle. Studies have shown that people who are asked to write down a list of adjectives while sitting in front of a researcher will write down many more positive adjectives if the researcher smiles with each positive adjective. And the reverse is true as well. If the researcher smiles whenever the subject writes a negative adjective, there will be more negative than positive ones. The subject may not be aware of the influence the reinforcement is having. However, there is another type of reinforcement that works in the brain in exactly the same way as positive reinforcement. It is called negative reinforcement. If positive reinforcement is adding pleasure—something that feels good—then negative reinforcement involves taking away displeasure—reducing pain, distress, or anxiety. Just like positive reinforcement, negative reinforcement will strengthen an action and make it more likely to occur. Just a note of clarification here—negative reinforcement is not the same as punishment. Punishment reduces the strength of a behavior—it stops you from doing something. (An example of punishment is saying “Bad dog!” when you find your dog chewing on your shoe. This reduces shoe chewing.) Negative reinforcement, in contrast, is a strengthener. It works by providing relief or stopping pain. For example: I’m driving my car and it starts to rain. I have difficulty seeing the road with a wet windshield, and that makes me feel worried, tense, and grumpy. It is an unpleasant feeling. I turn on my windshield wipers. I am able to see the road quite clearly, and I immediately start to feel much better. This reduction of discomfort reinforces my tendency to put on the windshield wipers when it starts to rain. Negative reinforcement has taught me to use my windshield wipers. This is relevant to what we are discussing because unproductive reassurance provides negative reinforcement. Here is how it works: If you worry, and you receive unproductive reassurance, then your worry will immediately—but temporarily—go down. Your distress is reduced, and—here is the surprising part—your relief from worry is a form of negative reinforcement! And what is reinforced? Recall the principle of contiguity we just mentioned: just before your worry and doubt got reduced, you were worrying and having doubts. So worry and doubt are reinforced! To be clear, it is not that you want to worry. And it is not at all obvious to you that the temporary relief is making you worry again. But your worrying and your feeling of doubt is actually negatively reinforced when you get unproductive reassurance. That is why the relief is only temporary. You worry longer, stronger, and more frequently. Doubts feel stronger and more persistent. This is one essential part of getting stuck in the reassurance trap. Helpful Fact: Negative reinforcement is an essential component of the reassurance trap. Paradoxical Effort Paradoxical effort—the second essential component of the reassurance trap—refers to effort that works backward. The harder you try to not do something, the more it gets in the way. As a little experiment, right now, try not to think of a zebra for the next thirty seconds. Don’t think about its stripes, and don’t imagine a picture of it. Don’t even think of the word zebra. Try it now. We’ll wait. What happened? Most people will think of a zebra, just because we ask them not to. That is an example of paradoxical effort, and it applies to a large number of tasks. Here are just a few: Putting a lot of effort into falling asleep immediately. Trying not to notice an argument going on near you. Trying to relax in the dentist’s chair when she says to you, “Just relax. This shouldn’t hurt, but let me know if it does.” Working harder and harder to concentrate on not messing up your golf swing. Trying to ignore the stain on your shirt that you just noticed. Seeking reassurance to banish uncertainty is an example of paradoxical effort. The more we feed the need to know for sure, the hungrier it gets. Not only does unproductive reassurance not reduce the doubts you feel, but it can actually function to increase doubts; yes, unproductive reassurance can actually increase anxiety. The effort we put into fighting uncertainty makes us more aware of it. Your own Worried Voice becomes louder and more consuming. Reassurance seems to become less helpful. And, just like an alcoholic who needs more and more alcohol to feel its effects, you start to rely more heavily on reassurance to soothe your worries. Ultimately, paradoxical effort can be summarized by the phrase “less is more.” There are times when anything you do to try to make something better works in the opposite way and ends up making the situation worse. Paradoxical effort tends to occur when there is an attitude of urgency, intensity, and intolerance of discomfort or distress. Learning to Drop the Rope Think of the game of tug-of-war. Let’s say you are evenly matched with your opponent and you are struggling back and forth. The more you pull, the more strongly he pulls back. No matter how hard you try, he matches and beats you. You are getting exhausted and want the game to be over. A different way of winning is to stop trying. Try dropping the rope. See who ends up falling down. It is the other guy (Harris 2009). When it comes to the cycle of negative reinforcement and paradoxical effort, sometimes doing nothing is preferable to every other option. Other ways of putting it are “what you resist persists” and “what you fight, fights back.” Helpful Fact: What you resist tends to persist: resistance is not a way out of the reassurance trap. When you are caught in the reassurance trap, the more you try to avoid worry thoughts and the discomfort, distress, and uncertainty they bring, the more those worry thoughts poke their way into your awareness. Worried Voice and False Comfort become trapped in a tug-of-war. When Wise Mind suggests dropping the rope by expending less effort, letting go of the need to “fix it,” and accepting doubt, you are surrendering the struggle. This springs the trap open. Helpful Fact: Surrendering the struggle springs open the trap. Notice the way Wise Mind does this in the following dialogue: Worried Voice: I’m afraid that I’ll never be able to stop worrying. What if it eventually drives me crazy? False Comfort: Try not to think of that. Take your negative thought and switch it to positive one. Worried Voice: Do you think I haven’t already tried that?! I just can’t do it! I’m sure there is something wrong with me! It works for other people, but not me. False Comfort: There is nothing wrong with you, I guarantee it. Worried Voice: How can you know for sure? People can just have nervous breakdowns. False Comfort: I’ve known you since you were a baby. I just can’t be wrong. Maybe you should take a tranquilizer. Worried Voice: That’s what I’ve been worrying about! Even you think I am losing it. I’m terrified of tranquilizers; you can get addicted! I’ll lose control; I’ll damage my brain. I can’t go on like this for one more second! False Comfort: Well, forget the tranquilizer then. How about coming for a walk in the woods with me? We can talk about anything else except what you are worrying about. We just have to keep your mind off it. Come on, let’s go now! Worried Voice: That never works. I just walk and have battles in my mind. And now I’m worried that you are going to give up on me. Wise Mind: (speaking up) Can we please step back and take a look at what is going on here? This urgency you are both feeling is an illusion. It is an aspect of anxiety. In this moment, there is no immediate danger. You don’t have to work so hard. False Comfort: But we are suffering! Wise Mind: I know you are trying to help, but you are scrambling to reassure Worried Voice with guarantees that you can’t back up. You are providing empty reassurance and distraction, neither of which lasts for long. Trying to push away worry and doubts this way only makes them more intrusive and stronger. You are playing an exhausting tug-of-war that can’t be won. Believe it or not, all this effort to find the best answer is wasted energy. Worried Voice: Will you catch me if False Comfort stops helping me and I fall down? Wise Mind: I have faith that you will be able to tolerate feeling anxious. And I think it will just be for a while. Better to allow whatever worries your creative mind comes up with, and remember they are just thoughts with no power of their own if you don’t fight them. The way to win here is to step back and let go. Putting the Trap Together The reassurance trap cycle depicted in the following figure is self-reinforcing and can go on indefinitely. Because unproductive reassurance can be subtle, and anxiety makes you feel an urgent need for relief from uncertainty, often it is not immediately obvious that you are caught in a trap. It takes a different perspective—a mindful perspective—to recognize that you are stuck there, and to understand that it is driven by the negative reinforcement of unproductive reassurance and the paradoxical effect of effort where none is needed. And since this trap is self-reinforcing, the only way to extricate yourself from its grasp is to counter the forces that keep it going. That requires a mindful approach. Mindfulness is a state of open attention to the present, in real time, moment by moment. The mindful experience involves observing your thoughts, sensations, and feelings, leaving behind judgment or evaluation. There is a part of you that can stand back and look at your experience—in real time—with perspective and objectivity, without judging. This is your own Wise Mind. We each have our own Wise Mind, and we can all get better at hearing its voice. We will show you that cultivating this part of yourself will be extremely helpful in breaking out of the reassurance trap. Wise Mind offers these positive actions: (1) accepting the anxiety of uncertainty, (2) embracing a mindful perspective, (3) disentangling yourself from the content of your thoughts, and (4) letting time pass. Mindful observation offers a helpful perspective on anxious thoughts by making it more clear that they are just vivid imaginings; sometimes the inherent humor or absurdity of the trap becomes evident and the feeling of uncertainty loses its power. Helpful Fact: A mindful approach will help you avoid falling into the reassurance trap. Moving Forward In this chapter, we have shown you the processes that form the reassurance trap—negative reinforcement and paradoxical effort—and we have explored how two voices of the mind, Worried Voice and False Comfort, interact to get you into the trap, as well as how a third voice, Wise Mind, can get you out of it. Before we explore that in more detail, however, let’s take a look at the specific reassurance traps you might be struggling with. All reassurance traps are driven by difficulty accepting uncertainty, but knowing which category your particular traps might fall into can be helpful in identifying your own areas of sensitivity and your own ways of inadvertently seeking unproductive reassurance. Chapter 3: Recognizing Your Trap In this chapter, we will look more closely at the four major categories of reassurance traps and present real examples from real people who are stuck in the trap (with identifying details changed). Some traps are more obvious than others. Most of you tend to get ensnared in several different ones, either at the same time or during different periods in your lives. The many ways people elicit unproductive reassurance can be quite creative and subtle; there are also plenty of traps that are not explicitly described in this book. Ultimately, while particular traps may initially seem very different from each other, the mechanisms behind them work the same way: they are all driven by having difficulty accepting uncertainty. Extricating yourself from any of them will require that you make very similar changes in your attitude toward uncertainty, and that you modify very similar patterns of thinking, acting and avoiding. Our goal is to teach you the most efficient way to make those changes. Reassurance traps fall into four general categories: Do No Harm Guarantees Forever Banish All Doubts Don’t Mess Up Let’s look more closely at each of them along with their common subtypes, shown in the following figure. As we describe them, try to think about your own traps, and clarify for yourself which of these types and subtypes apply to you. Do No Harm In the Do No Harm trap, you feel you must make absolutely sure that you will never hurt anyone or do anything that could possibly—even unintentionally—damage the feelings or the physical well-being of anyone. This trap can be divided into four subtypes: intrusive harming thoughts, always be careful, religious scrupulosity, and secular scrupulosity. Intrusive Harming Thoughts We think of ourselves as having control over our minds. We can certainly pivot our attention from one thing to another, but modern brain research has shown that we actually have relatively little control over lots of the thoughts that pass through our mind. Many thoughts just pop up—some of them useful and creative, but others just worthless. At some time or other, just about everyone has experienced weird, strange, random, unkind, violent, or outrageously funny thoughts. Most of us forget about these thoughts, and they get washed away in the normal stream of consciousness. However, sometimes thoughts become stuck. Unfortunately, stuck thoughts—which psychologists call unwanted intrusive thoughts—often have violent, sexual, or embarrassing content. Typical of this trap are intrusive thoughts of suicide, homicide, or pedophilia, or impulsive, crazy, and violent thoughts that are utterly unwanted, unbidden, and the opposite of the person’s values and wishes. (We explain this process in Overcoming Unwanted Intrusive Thoughts [Winston and Seif 2017].) Briefly, thoughts get stuck by means of the energy you put into trying to resist them, the excessive importance you attribute to them, and basic misunderstandings about thoughts themselves. Unwanted intrusive thoughts are the opposite of wishes, but they feel as if they have power and meaning. If you have unwanted intrusive thoughts, you may be terrified that you might actually do the things that get stuck in your mind. You may hear these harmless thoughts referred to as harming obsessions. Naturally, you look for reassurance—absolute reassurance—that you would never do those things. Or you might believe that these thoughts are meaningful indicators of your true nature or subconscious desires, so you become ashamed, secretive, and afraid that these awful repeating thoughts mean something awful about you. You need to be certain that you are not a bad person. You crave reassurance, and you keep trying to reassure yourself that you are not the sort of person who would do or want or believe the things that go on in your mind. But the reassurance does not take away the thoughts or the fear of them. What It Looks Like “I need to be sure I’ll never hurt a child.” Charlie—a gentle, kind, and generous human being, father of two—has persistent thoughts that he might molest a child. Charlie avoids changing his children’s diapers and never bathes them unless some other adult is in the room with him, watching what he is doing. He often asks his reassurance buddy “Did you notice whether I did anything strange with my children?” When he needs to be around young children—at swimming pools or playgrounds—he makes sure that he is always holding onto something in each hand. He reasons that he can’t reach out and grab a child if his hands are full, and this is a major source of his reassurance. If he has to be alone with his children, he makes videos of their interactions so that he can check to make sure there has been no inappropriate contact. Charlie believes 99.9 percent that he would never molest anyone, but he is tormented by his intrusive thoughts, and he needs to be absolutely, positively, 100-percent sure. Notice that… Charlie’s creative methods of avoidance and checking have not led to any greater willingness to tolerate even the tiniest hint of uncertainty. He was attending to the horrifying content of his intrusive thoughts as if they were important, instead of treating them as just meaningless passing phenomena of no importance. Helpful Fact: Intrusive harming thoughts are often driven by internal and external checking compulsions, and they elicit unproductive empty reassurance. “Are you sure I will never hurt myself?” Jennifer is a young woman who teaches art in a local elementary school. She is married with two children, not depressed at all, and enjoys her life as a wife, mother, and teacher. But she has been plagued by intrusive thoughts about suicide since she was fifteen. Jennifer has extremely high standards for herself, and whenever she does something embarrassing, she has the thought, “Now I have to kill myself.” She then calls and texts her husband, her mother, and her sister, asking for reassurance that she won’t really do anything like that. She wants them to argue with her when she says that “some people are just headed for self-destruction, and I might be one of them.” Jennifer is adamant that she is not depressed, loves her husband and children, and is alternatively perplexed and terrified about her long-term struggle with the intrusive thought that she has to kill herself. Notice that… By focusing on the possible meaning of the thought instead of its automatic pop-up nature, Jennifer becomes more and more entangled with it and feels the need to seek repeated unproductive reassurance. The long discussions, which attempt to banish all doubt about these thoughts being unimportant, serve only to reinforce them. In fact, often discussions that seem helpful and constructive at the time end up creating more concerns and further the desire for additional reassurance. We call these faux helpful discussions co-compulsing. Helpful Fact: Discussions about the meaning of an intrusive thought instead of its automatic pop-up nature provide unproductive reassurance. Always Be Careful The always be careful reassurance trap involves the need to repeatedly check something until you feel absolutely sure that you won’t do or haven’t done anything harmful or potentially harmful or neglectful. It asks you to meet the impossible requirement of never making a mistake. Checking can be focused on what you are doing in the moment or on your memory of actions you have taken or might have taken. Checking reassurance is the means by which the trap is cemented. What It Looks Like “One can never be too careful!” Alan leaves the office last, and he needs to be sure that everything has been turned off: computers, copiers, lights. He says, “It’s the only way to make sure there aren’t any electrical fires in the building.” So he checks several times before leaving. He tries to get a vivid image in his mind that everything has been turned off. He goes back into his memory to make sure that the office is dark. If his memory isn’t sufficiently vivid, he opens the door and starts the checking once again. Recently he has started to take selfies of himself turning off the equipment so he can feel more sure that he did. Similarly, to avoid inadvertently sending out an email with obscene or insulting language, he checks all of his emails, reading them carefully over and over. Sometimes he gets “stuck” on an email and doesn’t feel sure enough to send it no matter how many times he checks. “I wonder if I’m skipping a word, or maybe spacing out when I should be concentrating. I just can’t trust myself 100 percent.” Alan has missed deadlines because of this reassurance trap, and orders have been canceled because of these delays. This father suffers from a common trap psychologists call “hit and run OCD.” “Could I have committed vehicular homicide?” On the way to work one day, Tyrone thought about his daughter going to school, and he had the horrific thought, “What if my daughter gets hit by a car getting off the bus?” He felt a whoosh of anxiety going through his body, and then the equally painful thought: “What if I accidentally hit someone while I was driving?” Tyrone immediately felt that he had to pay absolute, 100-percent attention to his driving, for fear that he might run over someone in the street. On the way home, his fear mushroomed, as he imagined that every bump and every unusual sound from the car might possibly indicate that he had hit some innocent pedestrian. He began to circle around the block if he felt something unusual, checking to make sure that there wasn’t a body on the street. Sometimes he “had to” get out of the car and check for blood behind parked cars. He checked local news for accident reports every night. He needed to be absolutely sure that he didn’t “commit vehicular homicide.” His constant need to reassure himself made him late for everything. Notice that… In these two examples, the thought that a possible attention lapse could turn a normal activity into a dangerous one triggers this trap. “What if” catastrophic thoughts take over, followed by rigorous scrutiny and checking to make sure no harm occurs. Religious Scrupulosity The religious scrupulosity trap involves an overwhelming fear of offending God. Most religious people make an ongoing effort to live their lives in accordance with their beliefs and values. However, if you have an out-of-proportion fear of offending God, breaking religious rules, or committing a sin, then you might be caught in this reassurance trap. If you need repeated reassurance that you haven’t been less than perfectly pious or have allowed an impure thought or violated religious rules or committed a sin; if you are silently repeating prayers to undo thoughts, or constantly trying to convince yourself you are in good grace—you could be caught in this reassurance trap. Religious practice is based on faith—which is a feeling, not a fact. Since nobody can know without any doubt the exact meaning of religious texts or what God might intend for each of us, there are no certain answers to many religious questions. Even those who profess 100-percent certainty about their religious convictions are referring to a feeling. If your mind tends to get stuck on negative possibilities, trouble with doubts, and an intense desire to live according to your religious values, this can be a particularly difficult issue. Religion itself does not cause scrupulosity any more than teaching someone about ordinary hygiene causes them to start washing their hands for hours on end. In fact, religion and religious scrupulosity have very little to do with each other, despite the fact that they may seem so connected. Religion is about feeling comfort and peace and enjoying connection to God and to other people. It is a source of guidance for behavior, not a tyranny of impossible rules. Scrupulosity makes you feel disconnected from God and others and provides nothing but ongoing worry and misery. Although religious practice may feel compulsory, it is often clear to others that it is utterly out of proportion. Religious faith and living according to one’s values help us live a meaningful existence. Scrupulosity takes away from that meaning. Helpful Fact: Religion doesn’t cause scrupulosity any more than ordinary hygiene causes compulsive washing. Here is someone who formerly enjoyed daily prayer, but it turned into a driven compulsion, and she got caught in the scrupulosity trap. “We must pray with the right devotion.” Cheryl is a young woman raised in a Christian household where religion was a centerpiece of family life. Asking herself “what would Jesus do?” provides guidance. As an adult, Cheryl had a short prayer she said before bed that she learned as a child. After she had two children of her own, however, she suddenly had the thought that she was responsible for their souls. To guarantee that they sleep in a state of grace, they must recite their prayers with the proper feelings, focus, and devotion. She prays with them while watching them closely, and if they are impatient or seem distracted or skip over parts of the prayers, she has them repeat it. It now takes over an hour, kneeling by the bed, trying harder and harder to have the right feeling, which has become ever more elusive. She wishes that she could be more casual about prayer, but the risk