Anxiety is part of being human—but what if the way we try to get rid of it is exactly what keeps us stuck? That’s the big question at the heart of my conversation with Dr. Patricia Zurita Ona (“Dr. Z”) on the latest episode of Mind Tricks Radio (FULL TRANSCRIPT BELOW). Dr. Z grew up in Bolivia during times of political unrest, and those early experiences shaped her understanding of fear and uncertainty. Later, philosophy (and a fateful encounter with Dostoevsky’s Crime and Punishment) pulled her deeper into questions of human behavior, ultimately leading her to psychology. Her journey is as compelling as the insights she now brings to clients struggling with anxiety.
One of the standout ideas from our talk is Dr. Z’s emphasis on values-based living. Instead of chasing the impossible goal of eliminating anxiety altogether, she encourages people to build a life that reflects what matters most to them—even if that means carrying some anxiety along for the ride. She shared how Acceptance and Commitment Therapy (ACT) gives people the tools to notice their anxious thoughts without letting those thoughts run the show. Anxiety, she reminds us, doesn’t have to be the enemy.
Dr. Z has a wonderful way of making clinical concepts feel real and practical. She described the mind as an “Advisory Board”—a panel of nagging voices constantly offering warnings, critiques, and “what ifs.” Some of those voices are useful, but others keep us from taking risks or pursuing growth. The trick isn’t to silence the board (good luck with that!) but to learn which advice to take seriously and which to let float on by. This is where mindfulness and self-awareness come in—skills that anyone can practice.
We also dug into her personal experience of giving a TEDx talk, an event she described as both terrifying and deeply rewarding. For Dr. Z, it was the perfect example of ACT in action: choosing courage and values over short-term comfort. That concept—what she calls “workability”—asks a simple but powerful question: Is this choice moving me closer to or further from the life I want to live? It’s a shift that makes anxiety less of a barrier and more of a teacher.
Our conversation also tackled the difference between healthy “safety moves” and those that hold us back. It’s natural to avoid situations that feel threatening, but when avoidance becomes the default, life gets smaller and less fulfilling. Dr. Z’s approach reframes anxiety as a compass: if we follow our values even in the presence of fear, growth almost always follows, even if the outcome isn’t perfect. As she put it, sometimes things don’t go as planned—but that doesn’t mean the effort wasn’t worth it.
By the end of the episode, what emerges is a refreshing take on anxiety: it’s not something to banish but something to befriend. Dr. Z‘s blend of personal story, cultural perspective, and clinical wisdom makes this one of the most practical and inspiring conversations yet. Whether you’re battling public speaking nerves, everyday worry, or the big existential anxieties that come with being human, her message is clear: the goal isn’t a life without anxiety, but a life aligned with your values—even when anxiety tags along for the ride.
FULL TRANSCRIPT OF EPISODE 75
Dr. Aaron Kaplan:
Patricia, welcome to the show.
Dr. Patricia Surita-Ona:
Thank you so much for having me on your show, Aaron. I’m excited to chat with you today.
Dr. Aaron Kaplan:
Yeah, it’s great to meet you in person after watching your amazing TEDx talk on playing it safe moves and hearing your great story about the coffee maker and drinking coffee. Here we are drinking coffee as we’re doing this interview. It’s great to finally meet you in person.
Dr. Patricia Surita-Ona:
It’s lovely. I have listened into different episodes of your podcasts. I love your style. I love how you dive into different topics of psychology. So I am sure this is going to be a fun chat.
Dr. Aaron Kaplan:
Well, thank you. So before we get started on the topic we’re discussing today about playing it safe moves, I always like to spend a little time getting to know my guests a little bit better. And if we could take a few moments to talk a little bit about you and your background, where you’re from and some things about how you chose to become a psychologist and get involved with the work you’re doing, that would be a great way to get to know you.
Dr. Patricia Surita-Ona:
As you can hear, I have an accent. I am originally from Bolivia, South America. I grew up there, so I have strong roots with Bolivian culture, of course. And I was born in the midst of a dictatorship. My country wasn’t a dictatorship at the time I was born, and I witnessed two more dictatorships after that. I did not witness violence firsthand. However, I did witness very early how fear and anxiety can shape collectively people’s behaviors. And I have many memories of how people were very concerned about doing anything that could put them in danger or could make them feel unsafe. So I very early I witnessed how again, fear can narrow people’s behavior, how people have to be very careful. And even though it makes sense, of course, when there is a military regiment dictating everything you do, of course, it’s adaptive to be careful with your safety. However, sometimes people develop extreme hyper-visual and behaviors, right? And that’s the challenge with anxiety, with fear that can become so chronic, so persistent, so pervasive that we don’t realize, it becomes a way of being on the work. And so that was growing up and it was a very rich experience in many, many aspects. I feel very grateful for every childhood memory I have. And in high school, I started taking philosophy classes. And I remember reading this book, Crime and Punishment. Yes, Crime and Punishment by Dostoevsky. That’s right. It’s a classic, right? And the main character, Rodon Romanovich Raskolnikov, was struggling deeply with moral dilemmas, anxiety, what’s the right thing to do, what is correct, what is not. And I think Dostoevsky did an amazing job capturing the internal experience, the psychology of this person and the massive amounts of distress. And it was that book actually that led me more into psychology and led me more into being curious and interested on the psychological landscape and the complexity of being humans that we all carry. So I went into psychology, I started with philosophy first, right? I started reading all the existentialists, Jean Paul Sartre, Kierkegaard, you name it. Yes, I’m immersing myself into philosophy. I am becoming much more clear about psychology. It’s really what I want to pursue. So that was an interesting shift for me, an interesting path.
Dr. Aaron Kaplan:
Yeah, well, that’s a really interesting story. And I think we have something in common here because when I was growing up, when I was a teenager, Dostoevsky and Crime and Punishment, it was probably my favorite book. And it’s definitely my top five favorite books of all time. So that’s amazing.
Dr. Patricia Surita-Ona:
Yeah, it’s a beautiful story. I think it’s really, it’s one of those books that capture what means to be human, how we wrestle every single day. And we struggle with decisions, whether they’re small decisions or big decisions, and how also we try to find meaning and purpose in anything we do. So it’s a pivotal book, right? And I think there is a lot of links between psychology and philosophy, of course, right? That’s just the history of these social sciences. But that was, that was my, I think, my initiation into psychology. I think that I think of myself as a people person. I just, I’m very curious about people. I am interested in what moves them, what drives them. So for me, it was very clear that maybe when I was around 15, 16 years old, that I wanted to be a psychologist, I wanted to be there working with people, learning with them. And I’m from there.
Dr. Aaron Kaplan:
Yeah. And also I have to say, you come from an absolutely beautiful part of the world. I visited South America a few years ago with my family and we were traveling in Ecuador and Peru, and we actually made it all the way to Lake Titicaca, which is very close to Bolivia, obviously. And unfortunately, I got COVID while I was there, so I couldn’t go to Bolivia. That sort of put an end to the trip at that point until we continued traveling in Peru. But I was really disappointed, but absolutely gorgeous in that part of the world.
Dr. Patricia Surita-Ona:
Oh, no, thank you. That’s incredible. You were down there. I think, I think Bolivia is a very magical country. If you are curious about the intersection of raw and nature, pristine nature and some urban centers, it’s just a place to go. Right. I think the culture is very rich and you, you know, we shared Lake Titicaca with Peru. So there is the Bolivian side and the Peruvian side. They are both very, very different. One is more developed than the other one. But when I think of Bolivia, it’s just so magical to be down there. I go, I go home every single year. I’m grateful I can do that. And there are many parks and many areas where you put, you go, there’s, let me say this again. There are many parks and many areas that when you walk into them, it feels like you are the first person who is there because it’s so rich. The nature is so rich that it really grabs your attention there. So I highly recommend to everyone listening to us to take a look to Bolivia and hope you guys can make it soon.
Dr. Aaron Kaplan:
Thank you, Patricia. So I am definitely going to make it down to Bolivia at some point. I have to go back. It’s just so gorgeous and beautiful there in the Andes. And I’m sure that Bolivia is just an amazing country as you described it. So pivoting a little bit. Let’s talk about anxiety. Now, you are a clinical psychologist, you’re a clinician and you see many patients who suffer from anxiety and end up in your office. And I’m just wondering how are you seeing people presenting with anxiety these days? And are there any particular patterns that are standing out for you that you’re noticing in your practice?
Dr. Patricia Surita-Ona:
Yeah, thank you for asking that question. You know, I think of anxiety as a start of our common humanity. I think that every single day that we are alive, there is going to be some form of worry, fear of anxiety, shaping our behaviors. I think from the moment we open our eyes to the moment of when asleep, we are going to experience some form of anxiety. It just happens that when we respond to anxiety as something that we have to get rid of, we have to minimize, we have to evolve, we have to ignore, then anxiety becomes a problem. So in my practice, I provide therapy and coaching services for anyone who is struggling with any types of anxiety, whether that’s perfectionist, procrastination, social anxiety, productivity, anxiety, performance, anxiety, panic, worry, OCD, obsessive-compulsive disorder, you name it. In the work that I do, we work with clients who are five years old to the fifth year old person who is struggling with some fear about taking a plane or fears of public speaking, you name it. So to answer your question, I think anxiety is everywhere because it is part of our common humanity. It just happens that if we don’t have that psychological skills to deal with it effectively, it can really become a terrible problem, an obstacle in our life. And so that’s in the nutshell a little bit, what I can say. In terms of partners, I think that’s a very interesting question. Because I think we have been told that what anxieties are separated from each other. You can have a phobia, you can have fears of abandonment, you can have perfectionist, but in reality, I think if we look at our own life, our anxieties don’t travel in isolation. They travel coexisting with each other, shaping each other, and they are shifted as our life and circumstances change as well. So I am a big proponent that we have to think of anxiety again as a collection of experiences that are hard for all of us. And research also has showed that research has established for the last 20 years that in a sort of a lot of comorbidity among different types of anxieties. So the factors in general are more related to how people respond to anxiety. Some people will engage into massive amounts of situational avoidance. If you are afraid of giving a speech, if you are afraid of interviewing, you may apply for a job, you may avoid giving a presentation in public, you name it. There are some people also that engage in other responses that are more private. They are engaged in rumination. They are complaining in their mind past mistakes that they did, or they are anticipating terrible scenarios. No one is going to like me, they are going to think I’m an idiot. So I think the patterns that we see are more based on how people respond to the anxiety they are dealing with. And as you hear in the 10 days talk, that’s what I call plain, it’s safe moves, which academically are known as safety behaviors.
Dr. Aaron Kaplan:
So this concept of playing it safe moves, I know that was the topic of your TEDx talk and a big part of your presentation about the work that you do. Let’s dig into that a little bit more.
Dr. Patricia Surita-Ona:
Yeah. Yeah. I think that is helpful to clarify. What is a safety behavior? What is a plain, it’s safe move? So here’s the idea. Every time what experience anxiety, we are compelled to do something. No one wakes up and says, I am excited to be anxious today. I’m super happy to be anxious today. We don’t like feeling anxious. And in general humans, we don’t like to experience discomfort. So what do we do? We do all types of things to minimize, get rid of, suppress, replace anxiety. Those responses can be very observable, can be overt, right? Or it can be very private. But all those responses are named safety behaviors. A safety behavior sounds very serious to me. So that’s what I like to talk about, plain, it’s safe. So plain, it’s safe behaviors or plain, it’s safe moves or safety behaviors. Responses to manage and deal with anxiety that feels uncomfortable. Now, it is important to clarify that, of course, sometimes plain, it’s safe. It’s the right thing to do. Sometimes can be very adaptive. The example I will have is that if I am walking on the street and I’m walking with my child that is five years old and I see a car driving really fast, I am going to be anxious. I’m going to be anxious about something happening to my kid. So I may fall my kid quickly. That is a safety behavior that’s very adaptive in that situation, right? However, it wouldn’t be adaptive if I want to apply for a new job. It’s important for me to disseminate science, but I am afraid of being judged as an idiot and I convinced myself that I shouldn’t apply to this. That safety behavior is not adaptive. So that’s to say that we all play it safe. We all play it safe. But our safety behaviors are going to define the quality of our lives. Sometimes it can be adaptive and sometimes it can really shrink our lives. So we have to pay attention to that consequence of playing it safe.
Dr. Aaron Kaplan:
Yeah. So anxiety is kind of interesting, right? Because it does serve a purpose. It’s part of our psychobiology for a reason. It obviously we need to be able to feel some anxiety or stress when there’s an actual danger and back in prehistoric times when there were saber tooth tigers and woolly mammoths, we needed to be able to respond to those kind of dangers and the anxiety probably motivated us to be able to mobilize our internal resources and run or fight back or whatever. But over the thousands and thousands of years, humans have evolved a frontal lobe when we’ve developed executive functioning and we have the ability to be able to say whether or not there is the actual danger is really dangerous or if it’s our anxiety mechanism is getting triggered when there’s no actual real danger to us. Right. And sometimes I think that that’s difficult because sometimes it’s hard for people to distinguish what the difference is between the proportion of how dangerous something is to the actual danger. So my question for you is how do people tell whether or not the danger is a real danger or the thing that they’re fearing is something that they actually need to fear or whether it’s blown out of proportion. And in other words, when the responses, the behaviors that people have to the perceived threat is adaptive or when they are implementing a playing it safe move when it’s actually not working in their best interests, how do you distinguish the difference between those two things?
Dr. Patricia Surita-Ona:
Yeah, you know, I am smiling as you’re asking that question because that’s a question I get a lot. How do we know? Do we know when it’s adaptive and it’s not? As you know, I’m a practitioner of acceptance and commitment therapy act, which is an evidence based approach that has over hundreds of randomized clinical trials and its effectiveness has been established for many psychological struggles. So within this particular framework within act, we invite people to think about what we call workability. Workability basically is looking at whether your responses to any type of internal experience that is uncomfortable takes you farther away from your values or closer to your values. So, for example, I love to speak about the application of act to anxiety based struggles because of my own personal history, because of what I do, but because also I believe that these psychological skills can be so transformative in a person’s life. And I can speak that, you know, from first hand experience for me, learning active skills has been extremely transformative. In some way, I could say my life before active skills and my life after active skills. Right. When I when I think about my own fears. So it is possible that, of course, when I’m giving a big talk, a TEDx talk you saw and you watch, it’s very anxiety provoking. Yeah, all the elements of giving a TEDx talk can be really scary.
Dr. Aaron Kaplan:
Right. It’s a very rigorous process. Right. Yeah. Nerve racking, terrifying for a lot of people to do public speaking like that. You’re really courageous and brave to do that, by the way.
Dr. Patricia Surita-Ona:
Thank you. Thank you. It was worth it. It was worth it. But when you walk into the stage, you have this humongous light on your face. Right. All the and it can be a little bit disoriented. Right. For the first two to three minutes and your mind tells you all types of things. Oh, my gosh, you’re going to make a full of yourself. Why are you doing this? You shouldn’t be doing this. So for me, sometimes not all the time when I’m giving these large talks, my mind, of course, tell me all types of blah, blah, blah, chop, chop, chop. Right. If I listen to those thoughts and I take those thoughts as the absolute truth, I wouldn’t be giving any talk. I wouldn’t have said yes to this podcast interview. Right. I could have tell you, you know, it’s not my thing, right? Thank you so much. But, you know, I am just too busy, right? I wouldn’t have applied to me to give a TEDx talk. So when I look at my values, my value is dissemination of active skills for anxiety. But if I avoid what is triggering to me, we will say that that behavior is not workable because it takes me farther away from doing something that is very important to me. But when I’m giving the talk, when I am participating in these interviews, even though it can be tricky, can be time consuming, I can be a little bit anxious. Right. It is a behavior that takes me closer to how I want to be. I want to be a person that express the word about active skills for anxiety. So what capabilities are examining and looking at the impact of our behaviors in regard to our values? So that is why when I think about the TEDx talk, it was absolutely net of racking for sure from the beginning to the end. But it was absolutely worth it. And I will do it again and again and again.
Dr. Aaron Kaplan:
Yeah. And I think that’s actually it’s a really good example, because if you think about it, preparing to do something like that, to do a TEDx talk or a big public speaking event and you were anticipating like, I’m going to go up there. I’m going to be on stage. There’s going to be all these bright lights, all these people listening to me. What if I make what if I mess up? It’s very anxiety and stress inducing. And I just tell myself, God, who who needs this kind of stress? Who needs it? I’d rather just stay home, make a nice second cup of coffee, pet my cat, sit on the couch, relax. That’s a lot more pleasant than getting on that stage in that hot spotlight. And having to do this presentation. But obviously you’re saying to yourself, going up and doing that, despite the fact that it’s likely to be uncomfortable for me and a lot less comfortable for me than if I stayed home and played it safe, is more in alignment with my values. And I’m actually doing something that I’ll feel really good about later. So it’s worth it, even though it’s uncomfortable, it’s worth it to me. So I think it’s really important to recognize that sometimes what it ends up being best for a person is not necessarily what’s going to be the most comfortable thing for them at the time. And I think that’s pretty courageous, actually, as I said before, to make the choice to do something that’s in alignment with your values rather than playing it safe, which is, I think, a big part of your message.
Dr. Patricia Surita-Ona:
That’s right. That’s right. You’re tapping into something important within act. We teach clients skills based on six psychological processes, based on the hexaflex. One of these components is values. It’s really exploring what really adds meaning to our life, what we want to be in the world and what to show to the people we care about, how we want to relate to our bodies. And one of the things that happens is that there is a huge difference when you acknowledge that anxiety is part of your life. Versus when you look at situations in which being anxious is worth it for you. Hundreds of years ago, I was working with a client with fears of driving on a bridge, driving on the freeway. And for things happening in life. And my client made the choice of driving over the bridge in San Francisco because that was the only way that could visit his man who was in the hospital. When they’re in the hospital. So it was that value of being present there with his mother that helped him engage in this behavior that was very, very scary. So I think that in life, living our values, it’s not as easy as it looks. It’s not phallography, it’s a butterflies. It’s actually all about what you were saying. It’s bravery, it’s courage. It’s facing our things right on on the face. It’s saying yes to what feels so uncomfortable in the service of having a rich life, and that’s not easy at all. I think it’s hard work.
Dr. Aaron Kaplan:
Yeah. And let’s take a look at the other side of this, like maybe in your clinical practice, for example, people who you find are complaining that they’re playing it safe more times than not. How do they usually show up? Do they have particular kinds of psychological distress, existential crises? Are they depressed? Like, how does that present itself when people are playing it safe and kind of aware that this is how they’re living their life?
Dr. Patricia Surita-Ona:
That’s a great question. So one way to think about this is going back to two notions of what is primary pain or secondary pain, sometimes people call it clean pain or dirty pain. But just to this translate basically in our experience and our responses to anxiety. When we feel anxious, when we have a panic sensation, when we get scared, that’s unavoidable. That’s being human. That’s very uncomfortable. But this primary pain, it’s unavoidable pain that we all are going to experience. But when I go into always suppressing my fears, always trying to replace my anxiety with something positive, when I go to avoiding situations that can be too anxious to me, then I’m going to feel sad, depressed. If I manage my anxiety by drinking alcohol or drinking scotch or getting high all the time, I want to feel the consequences of developing a pattern of using substances. So all that is what we call secondary pain. And to your question, I see in the challenge with anxiety, the biggest thing is that people start living in authentic lives, lives are like meaning, lives are like joy, because anxiety by nature is going to narrow your repertoire. It will shrink every single thing you do. Because at some point, your mind is going to tell you, oh, it’s a scare if you leave the house. It’s a scare if you have that hard conversation. Watch out if you upset your friend. So avoidance is the most common response to anxiety. But with anxiety, the price that we pay is to live in authentic lives. So that’s, I think, the hardest thing that I have seen people over the last 18 years working in other sorts of psychologists, I have seen many people really suffering because their responses to anxiety has reduced their lives little by little. We want to be careful with that.
Dr. Aaron Kaplan:
I imagine that many people are suffering and coping with some level of depression around this, either major depressive disorder or a low lying dislymic kind of disorder, just sort of feeling not good about how they’re living the life, not in an authentic sort of way and just not feeling so great about themselves. So I imagine they must manifest like that in some ways.
Dr. Patricia Surita-Ona:
And I think that’s also what happens, that people know when something is, it’s not working in their lives, right? But facing your anxiety, your fears is a hard thing. But I think answering your question is one of the hardest things when you see wonderful people, wonderful human beings, very interesting, very smart, very kind, very generous, but without repertoin the life that is very narrow. They don’t have many friends. They don’t have many connections. They are not doing activities that are important to them. Their life has been organized around avoiding, avoiding being anxious, avoiding things that makes them anxious. So that’s a really, really hard thing to witness in life and to experience that.
Dr. Aaron Kaplan:
Yes, it sure is. So, Patricia, I’d like to talk with you about this intriguing concept that you’ve labeled the advisory board, I guess the advisory board that takes up residence inside one’s head and gives advice, whether it’s good advice or not such great advice, but it’s an intriguing concept and it’s a great title. Can you tell us a little bit about this advisory board and how that fits into this context of the playing at safe moves we’ve been talking about?
Dr. Patricia Surita-Ona:
Yeah, thank you so much. Thank you. That’s a very, that’s a very sweet question. No one has asked me that. Thank you so much. And so when I was working on the TEDx talk, as you know, you only have 70 minutes, 14 to 70 minutes, and they are very strict. Right. You cannot go 17 minutes and two seconds. No, it has to be 17 minutes. And I was thinking, how can I convey the application of active skills for anxiety, the active skills for safety behaviors? So I knew I needed to share a story because that’s what I think translates many of these psychological concepts. I also wanted to share something personal. My own one of my anxious moments because I have a collection of them in my life. Right. So share the story about indecision regarding a coffee machine. But as when you’re thinking about this talk, also, I wanted to give people some concrete ways of looking and hearing how active skills can be applied. And one of the things that act as a lot is it’s guiding us to have a different relationship with our mind, a relationship in which we become observant of our thoughts, a relationship in which we can look at our thoughts on the distance versus quickly acting on them, versus quickly responding to them. Right. There’s different psychological processes really focused on that, like contact with the present moment, diffusion, mindfulness. But the idea here is that you can learn to notice that your mind is part of who you are, but it doesn’t have to dictate your behavior. You can learn to watch your thoughts as letters, words and images put together. So I was playing with different metaphors to capture that. But by somebody born of a time felt like one of those ideas that can capture the mind. It’s not our enemy. It’s never working against us. It’s always trying to protect us as a very nagging friend. We all have friends that we say, like, I’m thinking about doing acts, I’m thinking to try to be split, watch out, right? Don’t do that. I remember a friend of mine years ago, I was having a conversation about traveling to Machu Picchu. And my friend said, I’m very happy for you, Patricia. I think you should go, but just make sure you don’t die with pulmonary down there. I’m like, oh, boy. Right. Thank you. So that’s right. That’s right. So we all have friends of a little, you know, there one on the nagging side, right? So I would mind as an advice that they bought if we think about it. So give us advice that can be very interesting, very helpful and it’s workable. Some still as things are like, what? What did my mind say? I have a thought. So the advice of work captures the nature of having a mind that is always trying to protect us sometimes in a very, very nagging and annoying way. But fundamentally, we also can acknowledge that advice, that advice of the world is never quiet. It’s all the time going blah, blah, blah, chop, chop, chop, chop, non-stop. Right. Our task is to check when do I listen to my advice anymore and when I don’t? Right. Which thoughts I’m going to choose to respond and which ones I’m not. Given that we have thousands of types of thoughts a day, it’s incredible. It’s impossible that every single thought is going to be workable or helpful or is going to add meaning into our life. So we have to choose. What is that to say that in the advice of metaphor captures one of the big psychological processes of diffusion and perspective taking from the act mobile, which is learning to watch at your mind as another organ you have that has a life on its own. You have it when you use to choose to respond to that in a way that expands your life, not shrink it.
Dr. Aaron Kaplan:
Yes, right. And again, I think that advisory board metaphor is a really good one. And we have similar things to that. Like in cognitive behavioral therapy, we talk about automatic thoughts or this idea of core irrational beliefs, this sort of buzz in the background of thoughts that you have that aren’t necessarily the right ones or the true ones. It’s one version of reality that you’re thinking in the background. And I think it’s really important just to acknowledge that just because you think something, it doesn’t mean that thing that you’re thinking is true or that even if there’s some aspects of it that might be true, it might not be in your best interests to follow that advice. So just because you think something doesn’t mean that thing that you’re thinking is the right thing. And I guess that’s part of your task is to take a listen to everything that’s going on inside your head, listen to that advisory board and then decide for yourself whether or not that advice is in your best interests or not. So it’s a great concept.
Dr. Patricia Surita-Ona:
That’s right. I think many models of psychotherapy have tap into that, right? There is many mindfulness based approaches, act is one of them in which we really have a knowledge that the classic models are trying to look at the mind as this dictator of what we do, they are not very effective because we’re never going to win against our mind. The mind is all the time going to come with it coming up with a lot of thoughts and content. It’s like playing a chess game sometimes with your mind, right? And that is why accepting is a biggest skill also within that because we have to accept fundamentally all the internal noise that comes in our bodies and our minds, the feelings that come in our way, instead of wrestling with them, trying to replace them or checking what is true and what is not true. Right. Again, we’re never going to win against our mind. And we may have like many battles in which something clicks and feels like this is right, right? This is that is correct. But it’s going to be in an hour that the mind is going to come up with another thought and another thought is going to question. So it’s much more helpful, much more effective to look at the workability of thoughts. If I go along with this thought, is that going to expand my life? Or is that going to shrink my life? If I do exactly what this thought is asking me to do, do I become the person I want to be or do I get farther from my values? So those questions, looking at our workability, getting off our behaviors is much more helpful in our everyday life and to deal with anxiety effectively.
Dr. Aaron Kaplan:
So Patricia, let’s dig a little deeper into this idea of how to get unstuck from the playing at safe moves. And I know you talked about this important one of the mindfulness, which I know is a big part of act and call it metacognition or just being more self-aware of your thinking. But that’s obviously very important. If we don’t know our thoughts, we’re not aware of our thoughts. We can’t change anything or it’s vitally, it’s vitally important to be aware, of course. But after that, if we dig a little deeper, what is the next steps? How do people then go from being mindful to becoming unstuck? What’s the process there?
Dr. Patricia Surita-Ona:
If we are clear about how we’re playing it safe and the things I’m doing, the response to my anxiety to manage it, then the next thing will be to step back and ask the question, who I want to be in this life? What matters to me? Who I want to be in this relationship? How do I want to relate to my health? What type of neighbor I want to be in my community? So it’s really going to what we call values and engaging in a series of values based exploration exercises. I know that values is a very popular word these days. Everyone throws values here and there. Within act, we think of values as ongoing patterns of actions, so we think of them as verbs. My value will be being caring, being compassionate, being connected. Because we think that in your day life, you cannot ever check off your values from your to-do list because they’re always working towards them. If my value again is disseminating active skills, I’m never going to be done with that, their particular paths that I can check off on my to-do list. But the value of dissemination is always a guiding principle for me. If my value is being caring with my friends and with my relatives, there are different ways in which I can show caring. I can send them an email. I can ask them to go for dinner. I can be there when they are struggling. I can send them a switch text from time to time. All those behaviors, I can check off on my to-do list, but the value of being caring, I’m always going to be working to that. So it is important to step back and look again, what is adding into my lab? What matters to me? And then check if it’s plain and safe, move, expand or contract. Is this plain and safe behavior helping me to be close to my values or not? Looking at the workability. The reason why this is important is because it is very common to get messages that to deal with your anxieties, you just have to face them, face your fears all the way. Just do it. It will work easy like that. Everyone will have done it. It’s actually hard. It is hard to make bold moves. It’s hard to be courageous. Right. So we want to have a foundation that helps us to say I am willing to face my fears in the name of my values. That’s a very different conversation with ourselves. A different way of being in the world. So that is why stepping back and looking at what matters to me. What is who I want to be in this life. The next part will be checking how we are relating to our thinking. Are you one of those people who quickly responds to every single thought that pops up into your mind? Are you one of those people that tends to overthink and stuff, right? You’re anticipating things in the future. You’re preoccupied with things that happened in the past. Are you a person that if the thought says you need to do this, you need to avoid this situation? You quickly go along with that. Because if so, you may want to try all the exercises to really look how you can practice having those thoughts without doing anything. That sounds very, I don’t know, that sounds very new edgy, I will say. But mindfulness, perhaps, is one of the ways that has teaches that we can become the containers of our thoughts, our feelings and sensations. So we have to set a knowledge in that the mind has a life on its own. That not because we think it’s true. For us, for you, for myself, because of what we do, we get it, we live it, we breathe it. I think for people listening to us, it’s a very counterintuitive thing. Think many times. What? I don’t have to respond to my thoughts, but I’m thinking about it. It’s important. Thinking a lot about something doesn’t mean it’s important. Thinking a lot about something. It’s just pure noise many times. So it’s taking really how we’re relating to thoughts. And then we also have to check our willingness to say yes to the yucky stuff that comes with anxiety. Again, you have heard me saying this, but I think it’s experience for most people. We don’t like to be anxious. And it’s not just humans. All the species also don’t like to experience anxiety and discomfort. Right. So by nature, we’re going to play it safe. But we have to check am I willing to say yes to this sensation, to this feeling, to this answer stuff in the service of being the person I want to be. And that is such an individual question, visual choice that we all have to check for ourselves and answer that in the moment. So knowing that being willing to face our anxieties, our fears and worries has nothing to do with how large is the step you take or how small is the action. It’s about saying yes to your fears, full intention. So that’s the next thing, you know, managing effectively or getting any stack from problematic, plainly safe moves, requires looking at your values, checking how you’re related to your thinking, checking how you’re willing to experience anxiety and then taking steps, taking actions. If that’s a matter of the action is a small or is a big one, it’s more about your intentionality. It’s more about saying, I know when I’m driving on the freeway, I’m going to be, you know, I’m going to have shortness of breath and I’m going to feel like pulling over and I’m going to remind myself that I’m doing this because I want to visit my mind because I want to be next to my mom as she’s in the hospital. I know that my mind is going to tell me that I’m going to have a car accident. I’m going to watch the thought, take a deep breath and continue driving. So all that to say that getting on a start, it is possible, but requires this micro skills for all of us. It’s not just a one size fits all and it’s not it’s not about just do it. Just go in the car and dive on the freeway. I think that can be quite scary for people. It’s the opposite. It’s really learning life skills to check what matters to you. Are you relating to your mind? How are you responding to your anxieties? Are you willing to say yes? And then which action you’re taking with full intention? Not with the agenda of getting rid of anxiety, but knowing that that action is going to come with anxiety as two sides of the coin, doing what matters with also the anxiety that comes with it.
Dr. Aaron Kaplan:
So that’s a really interesting and important way of looking at the treatment of anxiety and what we do with working with anxiety in a clinical setting is not to see anxiety, the goal to be completely ridding oneself of anxiety. Although, of course, that sounds nice. It’s not realistic in most places in most cases. People to completely be anxiety free in every situation for the rest of their life. But I think the idea that realizing that one can overcome the limitations of anxiety, minimize the amount of anxiety they’re feeling, hopefully. But whatever anxiety they continue to have is not limiting their ability to reach their goals and that they’re in alignment with their values. And that’s sort of a different way of looking at it than the goal being to just completely rid oneself of anxiety completely, because I know that’s a really daunting task if somebody feels like in a clinical practice, they come in and they say, Doc, please get rid of all of my anxiety. It’s a lot of pressure for everybody to achieve a goal that’s probably not realistic. But it is realistic for one to learn how to lower, minimize their anxiety and then learn to live with the anxiety they have and overcome the limitations that that’s causing. So I think that’s really important. And I know in your practice, because we’re talking so much about values here, I imagine that you must spend a fair amount of time when you’re working with patients, especially in relation to the ACT model, which I know that you use quite a bit in your practice, spending time with your patients, identifying what values are important to them and how and in what ways anxiety might be limiting their ability to reach those values. So that’s part of the clinical practice, I imagine, in your office is spending time with patients doing that.
Dr. Patricia Surita-Ona:
Yeah, yeah, that is true. Let me just go back a little bit to what you say when you have your clients coming and saying, Doctor, I want to get rid of my anxiety. I want to be anxiety free. That’s a really good point, because yes, I have here the same thing, right? I have here the same thing for years. And I think the challenge is that we have been exposed to the idea, to these messages that anxiety is bad, that we shouldn’t ever feel anxious, we shouldn’t feel sad, that we shouldn’t feel jealousy, that we shouldn’t feel envy, that those are negative anxieties that we have to get rid of. So I think that has been part of the information era, right? And what happens with those messages is that are so embedded that they are denying again our common humanity. You have hear me saying this on the TEDx talk and I see this many, many times in many ways to be human is to be anxious. So I think part of the work that we are doing is normalizing that no human being, no excellent therapist is going to help anyone to get rid forever from anxiety. Right? That’s impossible, right? That’s impossible.
Dr. Aaron Kaplan:
We’re not magicians.
Dr. Patricia Surita-Ona:
We’re not magicians, right? Not even with a shell of artificial intelligence, we’re going to be able to do that.
Dr. Aaron Kaplan:
Patricia, I’d like to ask you a question that I ask a lot of guests, especially ones who come on and talking about anxiety and the treatment of anxiety. And it’s a fairly common thing that comes up in clinical practices. I’m sure that you’ve seen it many times before in your practice. And that is as clinicians, I know we’re always trying to work with our clients to have them take risks, step outside of their comfort zone, talk back to that advisory board, try different things, new things. And oftentimes the results are great for the patients, right? They have a good experience and it helps them reframe the way they think about how they’re approaching the world and how they’re approaching themselves. But sometimes the experience doesn’t go so great. They step outside of the comfort zone, they take a risk and they’re not super happy with the result. It doesn’t go the way they’d like it to go and they’re not satisfied with it. So what do you say in those situations with patients who come back and they say, Doc, I tried what we talked about and it didn’t go so great. What do you do in that situation?
Dr. Patricia Surita-Ona:
That’s a great question. That’s a great question, I don’t. I think in the work I do, I don’t jump into pushing people to face their fears right away. It’s important for me to create this foundation, right? Some of these skills that we have discussed here. But also as we are working in these micro skills to deal with brain and safe moves and to deal with anxiety, I talk a lot about the attachment that we have to how things supposed to be. We have attachment to the idea that I shouldn’t feel anxious. We have attachment to the idea that I will only be happy if I’m not anxious. I will only be happy if I don’t have this panic sensation on my chest. I will only be happy if I don’t make any error, if I don’t fail in this particular project, right? So I think I invite my clients to check, are you holding into the sad like this, like very rigidly, or you’re holding with openness and lightly. I’m holding with openness and lightly means that I can notice a thought. I can watch the thought. I can let it be without making the source of you. I need to do more. I need to do it. I need to make sure I don’t make a mistake, right? So I think it’s our attachment to outcomes and our attachment to how we’re supposed to feel in a particular situation, to how things supposed to be to add our suffering. So in my work, when we are practicing some of these values, these exposure exercises or acceptance exercises, I check again, we check what is the intention behind this exercise. Why are we willing to do this? Why is it important for you to do this when you know you’re going to be anxious, when you know your mind is going to tell you all types of things? And all is this to help people to go back to really the goal here is to value based living, the goal is not to get rid of anxiety. So the frame in the context in which we guide our clients to face these fears is important. But yet, of course, sometimes some things, you know, sometimes some things go wrong. Sometimes we have terrible outcomes. And for me, in the work I do, it is important to model curiosity for how things will go. We don’t know. In the work of I do, even though I believe that every person I work with is capable of managing their anxieties effectively and having joyful and rich lives, I’m also careful that I’m not this chit-leaver saying everything is going to be fine, everything is going to work out great, right? Because we don’t know. I am going to say that we don’t know. All we can do is approach things with openness. But the thing is that when you approach things with openness, with our attachment, you liberate yourself from using all your energy, thinking and thinking about how to get a particular outcome of managing your anxiety because you are more present. Right? So the outcomes could be very different and really good in general. Right? So I think when things go south, when things go well, I approach even those moments with curiosity. Right? So, OK, what was sad for you about that? OK, what did you notice? What do you mind telling you? What is my telling you now? I don’t call on to those events as something tragic. It really means that in life, everything is trial and error. We don’t know. We just don’t know how things are going to go. Right? So that will be a thing. But the most important part is to create a frame for the context of change. Right? This is not about just facing our fears right on just because it’s about checking why I’m doing how I am doing. What is my intention behind this exercise? Knowing that even when I have my intentions and my commitment to this exposure exercise or to this acceptance exercise, I don’t know how it’s going to go. Right? So I think that will be one way of thinking about this. What do we do when things go south? We approach them with curiosity, we approach them with kindness, we approach them with compassion, but we also approach them as part of being alive. We’re fierce and the outcomes of our actions don’t come organized in the schedule. We never know how things are going to go. We just never know. It’s a full uncertainty experience. Right? So we also have to remember that we don’t have control. We don’t have control of hundreds of things. We simply do our best by being clear with our values and taking the steps in the best way possible we want to be.
Dr. Aaron Kaplan:
Right, Patricia. Thank you. I think that’s a perfect response and I totally agree with you. And I think that most people would agree if they look back on their life and they look back at the decisions that they’ve made it, most people would say that they would have regretted not trying and making an effort than trying and failing. Because nothing’s worse for people than to look back in their lives and say, I played it safe and I didn’t try. And then I don’t know whether or not things would have worked out for me or not. At least I tried and now I don’t regret having made the effort. I think most people would agree with that. And then if you try and you fail or things don’t work out for you, then you can say, well, you know, I did my best. I tried, didn’t work out this time. Sometimes it worked out, sometimes it doesn’t, but you never know unless you try. So I think that’s really important with this.
Dr. Patricia Surita-Ona:
Yeah, that is so true, Aron. I think that it’s our attachment to how things are supposed to be externally and internally that really adds a lot of suffering to our life. Right. And many, many Buddhist philosophies have talked about this. Right. But the other thing that is coming to my mind as you were talking is that research has found that when you are using active skills by engaging in values based behaviors, by facing your fears and anxieties in the service of who we want to be, people experience an improvement in the quality of their life and also they experience a reduction in their anxiety symptoms. So in the past, I was being criticized about not working on the symptoms of a person of anxiety, but research has showed the opposite. When you help a person, when we guide clients to expand their life repertoire by helping them to face their fears, that also tackles the anxiety symptoms because then they are not so preoccupied with this catastrophic thought that more present with experience of connection than the thought that is in their head. Right. They are more present with experience of having an ice cream than the fear of contamination in the back of their mind. Right. So it is hard work. It’s definitely hard work, but it’s also very, very powerful. It’s very, very impactful in a person’s life.
Dr. Aaron Kaplan:
Absolutely. Well, Patricia, this has been a really interesting and fascinating conversation about your ideas around playing it safe moves around acceptance and commitment therapy act and this idea about values based decision making and fear and avoidance and all that. I’ve really, really had a fun time talking with you about all of this. You’re clearly very, very well versed in these topics. I’m sure you’re a fantastic, fabulous clinician and you’ve written some amazing books. And so thank you so much for the excellent work you do and for being here talking with me today. I really enjoyed it. I’m wondering if you could just leave us with any ideas. Do you have any last final thoughts you’d like to leave us with about this topic before we conclude?
Dr. Patricia Surita-Ona:
Yeah, thank you. Thank you again for your kindness having me in your show. I think if I have to think about final words for this episode, I will invite every person listening to us to watch what their advisory board is doing in a given moment and to check, do I respond to the thought? Or do I let it go? If I respond to this thought, is this helping me to be the person I want to be? Or is it taking me farther away from my values? I think that will be the biggest message. I think in a nutshell, it’s living out in micro moments in our life.
Dr. Aaron Kaplan:
Very wise words and very sage advice. Thank you, Patricia. And thank you so much for coming on MindTricks Radio. It’s been a pleasure having you here today.
Dr. Patricia Surita-Ona:
Thank you so much for having me, Aaron. It has been a true honor to be in your show. And I hope that with time we can do this again.
Dr. Aaron Kaplan:
Oh, I love that. We definitely will.