December 12, 2014

No Feeling is Final

When we're depressed, anxious, or otherwise feeling bad, it's often compounded by the belief that our mood is stable or permanent. Even if we remember that we felt differently yesterday, and logically conclude that we'll probably differently again tomorrow, it doesn't seem that way in the moment. 

I'm reading a book on mindfulness and psychotherapy (see sidebar), and a sentence that addresses the fear of enduring emotion jumped out at me: “No feeling is final.” I love it! It’s from a Rainer Maria Rilke poem (copied below) and it made my day. I happened to be feeling sad at that moment, and was pleased and relieved to be reminded that emotions are transient by nature.

Emotions trick us with their pain and intensity. We can feel so angry, so depressed, and so scared that it seems implausible that we'll ever feel differently. "No feeling is final" reminds us that emotions will move through and move on if we let them, easing the unnecessary secondary emotion (e.g., fear about anxiety; anxiety about anger). That doesn’t mean that the intense anxiety you feel during breakfast won’t return at lunchtime--or even as you do the breakfast dishes--but it does mean that the world has other emotions in store for you: sadness, happiness, envy, exhilaration, less intense or more intense anxiety, and a whole host of other feelings. The current emotion is not your new life

The next time you're displeased with your current emotional state, remember: no feeling is final.


God speaks to each of us as he makes us,
then walks with us silently out of the night.

These are the words we dimly hear:

You, sent out beyond your recall,
go to the limits of your longing.
Embody me.

Flare up like a flame
and make big shadows I can move in.

Let everything happen to you: beauty and terror.
Just keep going. No feeling is final.
Don't let yourself lose me.

Nearby is the country they call life.
You will know it by its seriousness.

Give me your hand.

June 10, 2014

Qu'est-ce qui t'appartient?

Recently I told one of my clients that his feeling of being manipulated by his partner didn’t mean that his partner was being manipulative. Within the same week, my sister informed me that my irritation with her didn’t mean that she was doing or saying anything irritating.

The assumption that your emotions accurately reflect reality is a cognitive distortion referred to as emotional reasoning. Examples include assumptions like “Because I dislike her, she must be a jerk” or “Because I feel intimidated by him, he must be trying to intimidate me.” Emotional reasoning is a backwards and often unhelpful method of interpretation; in interpersonal situations, it usually involves assigning responsibility for your emotions to the other person.

One of the best tools for disengaging from emotional reasoning is something I learned from doing therapy in French: the phrase “Qu’est-ce qui t’appartient?" which translates literally to what belongs to you. The idea is to consider the roles that your mood, history, and experience could be playing in the situation.

Keeping this concept in mind, my client and explored other possible explanations for his feeling of being manipulated (e.g., he has a hard time saying no; his previous partner was manipulative) and for his partner’s behaviour (e.g., she wanted to please him; she was trying to help). We concluded that his feeling of being manipulated was generated by his own history and context, rather than by anything that his partner did. In my own case, I was able to identify that my irritation was borne of my own fatigue that day and lingering hurt over a comment someone else had made the day before. Similarly to my client's situation, my emotional reaction had nothing to do with my sister.

When due to his history and experiences, my client feels manipulated by his partner who isn’t doing anything particularly manipulative, ca l’appartient.  When due to my history or context, I get irritated with my sister who isn’t doing anything inherently irritating, ca m’appartient. When, for example, due to your history and experiences, you experience recurrent jealousy in a relationship where there is no objective cause for jealousy, ca t’appartient.

Recognizing that part (or all) of your reaction belongs to you rather than being caused by someone else is a great first step in not being a jerk to others and in avoiding unhelpful automatic responses. 

The next time you’re upset, ask yourself qu’est-ce qui t’appartient? What happens?

May 25, 2014

Rest in the Not-Knowing

One of my clients is going through a period of uncertainty in several areas of his life. He's trying to determine whether or not to sell his business; he and his partner are trying to decide whether or not to try to adopt a child; and they are considering moving to another city. None of the issues are near resolution, and my client finds the uncertainty difficult to tolerate.

During our session this week, I suggested that he try to "rest in the not-knowing and see what happens." My comment startled me a bit because I don't usually say things like that. Rather, I'm likely to help clients weigh the advantages and disadvantages of each option, or to guide them in exploring the thoughts and feelings associated with each possibility. This time, I surprised myself even further by following up with "When we make space for not-knowing--rather than frantically trying to allevaiate our discomfort by settling matters immediately--possibilities that might not otherwise present themselves can bubble up to the surface."

As different as this is from some of my other therapy interventions, I'm confident that it's true. Last week I attended a six-day silent retreat, during which there was nothing to do but meditate. During this exceptional week, my mind and body were free from their usual tasks of working, socializing, shopping, cooking, exercising, organizing, planning, and scheduling. Thus liberated, my mind came up with a collection of new and helpful ideas and insights, none of which had surfaced over the course of prior months and years of stressful contemplation and rumination.

When I shared this experience with my client, he remembered that during his three-week vacation over Christmas, he had made a deliberate effort to limit his rumination over a work problem that had been causing him grief for months. He reported that the spaciousness of mind created by that decision had resulted in significant insights that allowed him to consider the situation with greater clarity, and to perceive options that hadn't been mentally available to him before. He concluded our session by assigning himself the therapy homework of tolerating not-knowing, rather than one of our usual CBT assignments like recording thoughts or making a list of pros and cons.

We can't go on a meditation retreat or take a four-week vacation every time we're facing a big decision, so how is the idea of tolerating not-knowing applicable in everyday life? The answer is that even without a retreat or a vacation, we can create mental spaciousness by sometimes choosing to put aside our lists of pros and cons and our step-by-step plans for arriving at a resolution. This choice protects the mental real estate that, given the chance, could house an insight or a creative solution.

The next time you notice that your mind is caught in endless or unhelpful speculation and deliberation, see if you can instead create some mental space for yourself by tolerating not-knowing. What happens? 

May 19, 2014

Something Will Happen

Take a second to think of the last time you were stressed out and plagued by what ifs? "What if I miss my flight?" "What if I hit 'reply all' instead of 'reply' on that last email?" "What if no one likes the dessert I made for the party?" "What if I made the wrong decision to end my relationship?"

Now think about what ended up happened on an occasion when your what if came true--when you did miss your flight, you did hit reply all, your dessert wasn't good, and you did break up with your partner too hastily? What happened?

You probably either caught a different flight or stayed overnight; your email overshare was probably problematic, embarrassing, or not a big deal; people probably ate your dessert or you went to the corner store to pick up ice cream instead; and you probably either got back together or got over it eventually. That is, something happened. 

In her book "Real Happiness at Work," American Buddhist teacher Sharon Salzberg writes that when her mind sets off a cascade of anxiety about a hypothetical scenario, she uses the phrase "something will happen" to regain her calm. I love this because it's true 100% of the time! Something always happens.

I wish I had known about something will happen last Christmas: I was taking a long trip with a connecting flight halfway across the continent and there was a blizzard on the eve of my departure. My mind frantically reiterated "What if my flight is cancelled what if my flight is cancelled what if my flight is cancelled??" As always, the answer was that, if the flight was cancelled, something would happen: I'd get a later flight, I'd fly the next day, I'd cancel the trip altogether, but no matter what, something would happen. And it did.

Something will happen also works for bigger issues. One of my friends has trying to get pregnant for a year with no luck so far. She frequently topples into the rabbit hole of "What if I don't get pregnant this month? What if I never get pregnant? What if two or three or five years from now, I still haven't gotten pregnant!" The answer is that something will happen. It might be eventual pregnancy. It might be a decision to consider adoption. It might be a change in how important pregnancy is to her. But no matter what: something will definitely happen.

Something will happen is the answer to any what if question. Next time you're fretting about being late, making a mistake, or any other what if scenario, answer your own question.

Does it help?

March 23, 2014

Impulsive Generosity

What if every time you had a generous impulse you followed it?

For many of us, generous impulses come up relatively frequently (“They said not to bring anything, but I’ll pick up a bottle of wine,” “I wonder if my mom’s still sick, I’ll call to see how she’s doing” “I could pick up the tab for both of us”). However, our generous thoughts are often immediately followed by reasons to not follow through, such as “I don’t have time” or “I can’t afford it” and sometimes by stingy reasons like “Well, what has she done for me lately?”

Last week I went to a talk by American Buddhist teacher Joseph Goldstein. One of his topics was the impact of generosity on personal happiness and quality of life. He told us that about a year ago, he decided on a new policy: every time he had a generous impulse followed by a non-generous reaction, he would simply watch the non-generous         thought--without judging the thought or himself--and then return to the original impulse and follow through. He said that, without question, this practice had substantially increased the joy and happiness in his life (and probably, the joy and happiness of others).

What would it be like to try this? 

In the past month, I had several generous impulses that I didn't follow through: “I should bring a baptism gift for my niece” followed by “She's two months old, she won't know the difference” and “I should offer to babysit for my friend's birthday so he can go out with his wife" followed by “If they need babysitter, they'll ask me.” When I look back at these instances, my reasons for not following through seem silly, untrue, or workable, and I regret my decision. 

In contrast, I can think of several instances when I did follow through on generous impulses: “I'll email my colleague to see how her PhD defence went" and "I could get my friend a copy of that book we were talking about” and it felt great. The urge to not follow through still came up ("I'm busy right now" "He'll probably order it online himself") but I did it anyway.

Think of the last time you had a generous impulse and followed through. How did it feel? What was the impact on the recipient of your generosity--and on you?

March 05, 2014

Unconditional Positive Regard

Unconditional positive regard is a term coined by influential American psychologist Carl Rogers. If you have unconditional positive regard (UPR) for someone, you support and accept that person regardless of his or her behaviour. It means that even when you don't respect or approve of what someone says or does, you maintain an overall attitude of acceptance and positive regard for him or her.

Rogers named UPR as one of three necessary and sufficient conditions for successful psychotherapy, along with therapist genuineness and accurate empathy. He believed that therapists who demonstrated UPR for their clients created a positive therapy environment conducive to client growth and development. According to Rogers, the demonstration of UPR allows clients to freely express thoughts, feelings, and actions without fear of offending or alienating the therapist. Therapists may still question clients' behaviour, but without condemning the client as a person.

What about outside therapy, though?

Unconditional positive regard can exist in parent-child or other family relationships, in close friendships, and in romantic relationships or marriages. It can't be assumed to be present but, if we're lucky, we have UPR in at least one of our relationships. Social psychologist David G. Myers referred to UPR in relationships as "an attitude of grace, an attitude that values us even when knowing our failings." He added "It is a profound relief to drop our pretenses, confess our worse feelings, and discover that we are still accepted... we are free to be spontaneous without fearing the loss of the others' esteem."

My experience is that that's exactly what it feels like. I can think of a handful of people who seem to have UPR for me, and the word relief accurately describes how it feels to spend time with them. I've told these UPR-extending individuals what I believe to be the most shameful and appalling truths about myself, and it didn't seem to change how they feel about me. I don't worry about my pride around them and even when I'm my worst self, it doesn't threaten the relationship.

I can also think of a handful of people for whom I have UPR. It's hard to imagine something they could say or do that would make me turn away from them permanently, or make me not try to understand their motivation. I love and/or respect them even when I dislike them.

Unconditional positive regard is lovely when it happens, but I think it's the exception rather than the rule. That is, I'd venture that most of our friends, and even many of our family members, could lose our esteem. There are usually only a select few loved ones for whom we really feel unconditional positive regard. It may be spontaneous or may develop over time.  

For whom do you have unconditional positive regard? Who has it for you? What does it      feel like?

January 08, 2014

Discretionary Burdens

The other day I read a magazine article about the concept of discretionary burdens. We've all heard of discretionary spending, i.e., elective spending on non-essentials, but what's a discretionary burden (DB)?

A DB is an optional task that we peg as an obligation, burdening ourselves unnecessarily. Picture this: It's Friday and a friend or colleague is describing her to-do list for the weekend and complaining about how tired and overburdened she feels: "I have to take my mom shopping and I have to make the cake for my friend's birthday dinner and I have to get in a couple hours at the office and I have to go to yoga and I have to put away the Christmas decorations..." You're exhausted just listening to her list, but you're also skeptical: Does she actually have to make a cake? Can't she just buy one? Does she have to go to yoga? What will happen if she doesn't go?

The good news about discretionary burdens is that, because they're discretionary, we can just as easily unburden ourselves! The hard part is that we don't always recognize the discretionary nature of our burdens. While it's obvious to us that our friend or colleague could easily buy a cake or skip yoga, it's difficult to recognize our own burdens as discretionary. Therefore, the best strategy for unburdening ourselves is to read our to-do list to an impartial friend and let him or her point out the DBs.

The next time you find yourself complaining (to yourself or out loud) about how this weekend, you have to take the kids to visit your parents, attend your cousin's bachelor party, pick out paint colours for the bathroom reno, hit the gym, and read a couple articles for work, ask a friend to help point out the DBs. If you're not comfortable doing so, imagine that your list belonged to a friend. From an outside perspective, which tasks would you identify as discretionary? Can the paint colours wait? Will your cousin care if you don't make it to the party? Do you actually have to work on the weekend?

Let me know how this works!

October 31, 2013

Stress Savvy

When I teach mindfulness-based stress reduction (MBSR) class, we spend a lot of time discussing ways that mindfulness can help us behave more adaptively when we're facing a challenge or stressor. I emphasize the idea of developing adaptive responses to stressors, rather than engaging in automatic and habitual stress reactions that invariably make things worse.

Everyone loves the idea of coping better with stressors, and most people have personal strategies that they apply during periods of particular stress; examples include exercising more, taking extra care to eat well and get enough sleep, going for a massage, spending more time with family, and spending less time with family. Such stress reduction/management strategies help us avoid slipping into the kind of automatic reactions that stress can produce (e.g., smoking, drinking, eating poorly, avoidance, withdrawal, picking fights). But the other night, one MBSR participant raised a key point: What if you don't know you're stressed out?

Good question! After all, we can't implement our stress reduction/management strategies if we aren't aware that we're stressed out. We've all had the experience of making a poor decision, hurting someone's feelings, or otherwise saying or doing something mindless or maladaptive only to later realize that we were completely stressed out at the time. This is where mindfulness enters the picture to help us know ourselves better and recognize our patterns.

Here are two questions we can ask ourselves--right now--that can help us recognize earlier that we're stressed out.

1) What are the first signs that I'm stressed out? For some people, the first sign is physical: shoulder tension, belly agitation, headache, or a feeling of pressure in the chest. For others, the first symptom of stress is mental, e.g., ruminating over an issue long after it's been resolved, getting really indignant over a minor issue. For others, the first sign is behavioural, e.g., they know they're stressed out when they find themselves eating out of the container standing up. One MBSR participant reported that his first sign is that he starts being rude to cashiers, taxi drivers, and other strangers--people he usually greets with "Hi, how are you?"

2) Under which conditions am I the most likely to get stressed out? Examples include "When I'm hungry," "When I'm tired," "Toward the end of the work week," "When I've been fighting with my partner," "When I'm in a rush," "When I feel like my authority is in question."

Knowing the answers to these two questions is mindfulness gold. If you can identify that eating out of the container is a sign that you're stressed, the next time you find yourself standing in front of the open fridge with a tub of yogurt in one hand and a spoon in the other, you'll know it's time to implement your stress reduction/management strategies. If you can identify that you're prone to mindless stress reactions when you're tired, the next time your children or loud neighbours keep you up all night, you'll know to consider how to best care for yourself the following day so you don't fall prey to mindless stress reactions.

Knowing the signs and conditions that indicate stress for us doesn't eliminate our initial stressors, but can help us avoid the added stress generated by mindless reactive behaviour.

What are your signs and conditions?

September 29, 2013

Pattern Projection

Mental health tip: Experiences can make you feel the same way without being related.

When we go through a string of negative experiences (e.g., socially, professionally, romantically), our tendency is to review them as a group and search for patterns. This can be a worthwhile exercise: identifying patterns helps us establish what went wrong and determine whether or not there's something we could be doing differently. On the flipside, though, identifying a pattern where none exists can be quite unhelpful:

One of my clients has been looking for work for months and becoming progressively discouraged. Last week, after another promising interview failed to result in a job, he concluded that since "this keeps happening," he must be doing something wrong. At first glance, this seemed like a reasonable hypothesis; but when we took the time to explore the evidence for the idea that "this keeps happening," we failed to find a pattern. The most recent position my client interviewed for was filled by an internal candidate. The job before that fell through after the organization didn't received the grant needed to fund the position. Prior to that, my client was offered a part-time contract position that he declined because his daughter has a chronic medical condition and he needs health benefits to cover her medical costs. For the position prior to that, my client was short-listed but the first-choice candidate simply had more years of experience. In short, although none of the leads resulted in a job, there was no pattern.

One of my friends had two painful romantic experiences in the past six months. In the first case, a close friend for whom he harboured romantic feelings admitted that she'd always had a thing for him, too--and then promptly met and fell for another guy. In the second case, my friend ended a promising new relationship after a frank discussion revealed that the woman he was dating doesn't want to have children. These back-to-back experiences left my friend feeling pretty discouraged; he concluded that "this keeps happening" and that therefore there must be something wrong with him. Thinking of my client and his job search, I encouraged my friend to consider the possibility that he was projecting a pattern onto a patternless pair of experiences. He thought it over and acknowledged that the first situation was attributable to bad timing and the second to long-term incompatibility. That is, even though both relationships ended, there was no pattern.

How does realizing there's no pattern help? Finding patterns where none exist generally involves distorted thinking, including overgeneralization ("this always happens"), personalizing ("it's happening because of my own personal flaws and has nothing to do with external factors"), disqualifying the positive (e.g., my client ignoring the fact that he was offered a contract position; my friend dismissing the heartening facts that both women returned his feelings). Distorted thoughts make us feel bad, whereas identifying and reappraising our distortions alleviates the pain. 

Why do we project patterns onto patternless experiences? My theory is that we assume that experiences that make us feel the same way are related. My client felt discouraged and rejected each time a position didn't work out. My friend felt lonely and hopeless both times the relationship ended. But the respective HR departments made completely independent decisions not to hire my client--based, it turned out, on entirely different rationales. They weren't related. The two women my friend dated didn't know each other and didn't know of each other, and the relationships ended for entirely different reasons. They weren't related.

Both my client and my friend felt less discouraged once they stopped projecting a nonexistent pattern onto their experiences. The next time you're looking for a pattern in a string of negative outcomes, consider the possibility that there is no pattern in the experiences, only in the way you feel about them.

Does it help?

September 03, 2013


Lovingkindness is a Buddhist practice that involves wishing well to ourselves and others. It encompasses generosity, good will, friendliness, compassion, and benevolence, and is often cultivated through meditation. When I teach mindfulness-based stress reduction (MBSR), we do a lovingkindness meditation in the session devoted to relationships and relationship conflict. The rationale is that practicing lovingkindness helps cultivate patience, kindness, and acceptance--which can have only positive consequences for our relationships.

The lovingkindness meditation involves sitting quietly and "sending" well wishes, starting by sending them to ourselves. When I guide the meditation, I say the following phrases out loud, one by one, and participants repeat them silently.

May I be safe and protected
May I be happy and peaceful
May I be healthy and strong
May I live with ease and the joy of wellbeing

We then send lovingkindness, in turn, to someone we love, someone toward whom we feel neutral, and someone with whom we're experiencing conflict.

May he/she be safe and protected
May he/she happy and peaceful
May he/she healthy and strong
May he/she live with ease and the joy of wellbeing

I warn MBSR participants beforehand that they might not necessarily feel loving or kind during the meditation--in fact, that they may feel resistant or unwilling--but it doesn't matter. Compassion is being cultivated even if we don't feel it in the moment, and it's always interesting to observe what happens when we practice lovingkindness, even if what happens is struggle.

What's the impact of lovingkindness meditation?

Many people cry when they first send lovingkindness to themselves. Self-compassion isn't always easy and, for some, it's the first time they've ever expressly wished themselves peace, ease, and joy. MBSR participants variably describe the experience as a warm sensation in the chest; a feeling of the heart opening up; a softening; and a movement towards seeing themselves as fallible but worthy and okay.

What's more, the lovingkindness mediation seems to provoke a similar softening toward others, including people with whom we're experiencing conflict. Following the lovingkindness meditation, MBSR participants report that they feel more open and compassionate. Even if they experienced resistance to sending lovingkindness to the person causing them distress, they still feel less angry and confrontational, and more prepared to interact with that person.

How does lovingkindness work?

One way that the lovingkindness meditation seems to work is by snapping us out of the endless cycle of you jerk you idiot how could you I can't stand you. When we're angry or otherwise upset with someone, it's easy to get stuck in a cycle of rumination, telling ourselves stories about how wronged we were, how hurt we are, and how awful that person was to do what he or she did. Whether we're upset with ourselves or with someone else, sending lovingkindness forcibly snaps us out of the rumination cycle. 

A second way that lovingkindness seems to work is by interrupting our tendency to demonize others. When someone upsets us, our minds can turn him or her into a monster who is purposely trying to hurt us or make our life difficult. My experience has been that when I force myself to wish for safety and protection, happiness and health for someone who's hurt me, two things happen: First, my mind retorts I DON'T WISH THAT, I HATE HER; second, I realize that I actually do wish those basic experiences for all people--even someone who's hurt me. This realization shrinks that person from a monster back to a human who is hurt or struggling, dealing with her own issues, and probably doing the best she can--not expressly trying to hurt me or ruin my life.

Developing compassion for ourselves and others via lovingkindness makes us more accepting and forgiving, whether we're dealing with a longstanding conflict or with someone who cuts in line at the grocery store. Lovingkindness doesn't have to involve formal meditation, but can be practiced any time you're self-flaggelating or ruminating about a conflict with someone else. Simply take a quiet minute or two to repeat the phrases above to yourself, and see what happens.

NB: An extra trick that helps me develop compassion is to picture the person with whom I'm in conflict in bed at night. Imagining him curled up under the covers in his pyjamas helps me remember that he--like me, like everyone!--crawls into bed at night wearing comfortable clothes and seeks rest. He is as vulnerable and human as any other person (and is not staying up all night plotting ways to make me miserable!).

July 24, 2013

For Better or for Worse

Warning: Mindfulness isn't always fun.

Often when I recommend mindfulness practice to a friend or client, we end up talking about the joys of being more present and less distracted, the wonderful feeling of really connecting during a conversation, or the gratifying experience of actually paying attention to what you're seeing, reading, or eating. Mindfulness is associated with pleasure, and rightfully so.

Mindfulness isn't always that pleasurable, though. Being mindful involves willingness to be present and aware of all of our experience--even when it isn't fun or exciting, and isn't what we hoped for. This includes awareness of what's going with the people around us and what's happening in our environment, but it also means being aware of what's going on inside us, i.e, our thoughts, feelings, and body sensations.

But what if what's going on inside is unpleasant? Do we really want to be aware of hateful or embarrassing thoughts, unpleasant body sensations, and painful feelings? My answer is yes and here's why:

It's a beautiful sunny day and I'm working from home and actually being quite productive--yet I don't feel good. I woke up with belly and chest pain, and the physical sensations and accompanying anxious mood persisted through meditation, breakfast, errands, and several espressos. Because I've been practicing mindfulness for a few years and because I meditated this morning, I know what's wrong: I'm upset about a conflict with a friend that happened last week, an issue I thought was resolved. Because I checked in with my thoughts, feelings, and body sensations, I know that I feel sad and uncertain, that there's a paring knife slicing through my chest and something heavy and round sitting behind my belly button, and that my mind is repeating "It's your fault" over and and over.

You might be thinking that all of this sounds quite unpleasant and you're right. The physical sensations hurt, it was uncomfortable to realize that I'm still upset about the conflict, and it's irritating that the discomfort is present on an otherwise nice day. In this case, mindful awareness is only making me aware of physical and emotional pain. So why am I glad to have tuned in to it?

Despite the discomfort, awareness of my distress is worth it because the awareness
a) helps me avoid making it worse, and b) helps me decide what to do. A few years ago, if I woke up with this feeling I might have eaten an entire jar of peanut butter for breakfast, gone to work in a zoned-out state of anxiety/peanut-butter stomach discomfort, been short with my colleagues, called my sister at work to complain about my undiagnosable free-floating anxiety, come home and automatically gone for a run whether or not I felt like it, and then gone to bed and woke up feeling even worse the next day. I might even have spent time with the friend I'm in conflict with and acted passive-aggressive or self-effacing without realizing it.

In contrast, today I noticed that something was weird as soon as I woke up. I purposely selected a guided meditation designed to help me look closely at my feelings and physical sensations, which made it clearer what was wrong. I made a good breakfast, decided to work from home, and strategically chose to work in the living room rather than the kitchen to avoid my habit of mindless overeating when I'm stressed. I resisted the temptation to call my friend and frantically make amends. I'm making decisions based on the fact that I know I'm upset; in so doing, I'm exercising self-compassion and avoiding making things worse.

Mindful awareness that I don't feel well doesn't take away the not feeling well. None of this is pleasant and I would much prefer to enjoy this gorgeous day without symptoms of anxiety and without a stressful conflict. But given that this seems to be what's happening today, I'd rather know about it.

Mindfulness can be unpleasant, but not as unpleasant as mindlessness and its repercussions.

July 21, 2013

Strike When the Iron is Cold

In a conflict, is it best to strike while the iron is hot and try to identify and resolve the problem as it's happening? Or is it better to address it later, after you've cooled off a bit?
A couple weeks ago, I attended a mindfulness retreat. During a discussion of mindful stress management, the teacher informed us that in the moment of a stress reaction (e.g., mind racing, heart pounding, blood pressure skyrocketing), access to the rational and reasonable part of our brain is essentially cut off. While this initially seemed counterintuitive, it makes sense in evolutionary terms: When we face a threat, all of our body's resources are allocated to the fight-or-flight response, helping us either fight with all of our might or escape. Survival is the only objective and our attention narrows to focus exclusively on the threat; the part of our minds that can consider and deliberate isn't needed.

This resource allocation system is adaptive when it helps us escape from a sabre-tooth tiger or lift a car off a trapped child; however, our minds and bodies do the exact same thing when we're facing everyday hassles, delays, slights, and other stressors. Not recognizing the stress reaction, we often push forward with conflict resolution and problem-solving, making things worse. 

Earlier this week, I received what I perceived to be an unprofessional, insulting, and just plain mean email from a colleague. My body immediately launched a stress reaction--hot face, pounding heart, tensed muscles. My mind racing with righteous indignation, I dialed my colleague's number and then, remembering what I learned at the retreat, hung up and decided to step away from my desk. Sitting in the lunchroom a few minutes later, I observed what was happening in my mind ("Who does she think she is! That's so mean! After all I've done for her!") and in my body (see above), and dug around to see which emotions were present (hurt, anger, frustration). This information led me to believe that I was having a stress reaction and helped me decide to put off respond to the email for 24 hours. This decision definitely led to a more satisfying resolution of the conflict!

The concept of addressing conflicts and problems once you're temporally and emotionally removed from them isn't new. But learning that half of our brain is missing when we're in the throes of a stress reaction really hits home: It explains why it's so hard to think when we're upset and why, when we're mad or scared or sad, we can't consider alternative perspectives, and often miss information that's easy to see once the stress reaction passes. But how can you tell when you're having a stress reaction? This is where mindfulness comes in: Sit or stand still for a minute and become aware of your thoughts, emotions, and body sensations. Tune into how you're feeling and then use the data to decide what to do.

NB: Strike when the iron is cold applies equally to the other parties involved in your conflict. That is, you may be calm or have moved beyond your stress reaction but you need to be sure that the other party has too. You don't want to problem-solve or conflict-resolve with someone who's missing half their brain!

June 17, 2013


Two weeks ago, I attended a psychiatry conference on mindfulness in cultural context. Many of the talks were about contemplative practices from cultures outside North America, and one in particular caught my attention:

The Japanese practice of Naikan (tr: inner-looking or introspection) is a structured method of reflection designed to help people broaden perspective, gain insight about themselves and their relationships, and increase appreciation of the kindnesses of others. Practicing Naikan involves sitting for long periods and reflecting on the following three questions as they relate to various significant others (e.g., parents, children, partners, friends, teachers):

What have I received from this person?
What have I given this person?
What troubles and difficulties have I caused this person?

The objective of Naikan is to generate a realistic view of our behaviour and of the give and take in our relationships. The obvious fourth question (What troubles and difficulties has this person caused me?) is purposely excluded, with the rationale that most of us are already quite adept at pinpointing and obsessing about the inconveniences caused us by others--and that our focus on this aspect of our relationships is responsible for much day-to-day stress and unhappiness. 

What happens when we practice Naikan? Research demonstrates that the practice increases our sense of connectedness with others and improves quality of life. If we once believed ourselves to be alone or to be "self-made," recognition of the kindness and contributions of others increases feelings of security, connection, and gratitude. Insight into the troubles and suffering we've caused others can create change in our behaviour and in our relationships.

In traditional Naikan retreats, practitioners sit in silent isolation for fourteen hours per day for two weeks reflecting on the three questions. This is described as a profound and life-changing experience, but when a week-long retreat isn't accessible or desirable, we can try daily Naikan. Daily Naikan practice means taking time at the end of the day to reflect on the three questions as they relate to the day’s events. What did I receive today? What did I give today? What troubles and difficulties did I cause today? Even trivial-seeming instances of give and take such as "My colleague brought me a coffee" and "I cut off a guy in traffic" are included.

Daily Naikan may not be as profound an experience as a week-long retreat, but I noticed that just keeping these questions in mind as I went about my daily life in the past two weeks changed my perspective. I was more mindful of the kindnesses I received and more aware of the hassles and difficulties I caused--with the end result that my behaviour was more flexible and more giving. I drove a friend to the airport, agreed to give a presentation as a favour to a supervisor, and offered my apartment to visiting friends so they won't have to book a hotel. I softened my stance against a colleague who gets under my skin, changed my schedule to accommodate a client, and called up friends just to see how they're doing. The first two Naikan questions helped me appreciate the love and guidance I receive and less apt to focus on the support or attention I don't receive. The third Naikan question helped me recognize times that I was needy, irritating, or rude--which will help me change my behaviour.


NB: Naikan has clear parallels to the What Went Well exercise and other positive psychology exercises such as keeping a gratitude journal--and the same reported outcome: improved quality of life. Naikan can also be considered to be a form of mindfulness practice in that it involves attention and awareness, and making an effort to see ourselves and our circumstances clearly.

June 03, 2013

DSM-5: Pathologizing versus Dismissing

After years of working groups, expert task forces, and public opinion, the American Psychiatric Association has finally published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is the bible of mental illness, listing every diagnosable problem from autism to post-traumatic stress disorder to attention deficit/hyperactivity disorder to cocaine addiction. It's widely used by psychologists, psychiatrists, and general practitioners to categorize symptoms, differentiate between disorders, and communicate with other professionals.

Despite its widespread applications, use of the DSM is controversial because detractors fear that the manual pathologizes normal behaviour. This is a reasonable concern: for example, homosexuality was listed in the DSM up until 1986, an inclusion that effectively labelled homosexuals as mentally ill. Today, DSM-5 is criticized for new additions such as binge eating disorder, skin-picking disorder, and premenstrual dysphoric disorder (PMDD).

While concerns about pathologizing are legitimate, it's easy to go too far in the opposite direction and dismiss psychological problems that cause real and significant distress. For example, binge eating disorder (BED) is a controversial new diagnosis in DSM-5. It's the first time that binge eating has been recognized as a problem independently of more familiar eating disorders such as anorexia and bulimia. In his article about the 'worst changes in DSM-5,' psychiatrist Allen Frances dismissed the diagnosis of BED, attributing binge eating to gluttony and the wide availability of good-tasting food.

This is irritating. Not only is Frances' attitude flippant and dismissive, his statement ignores several of the diagnostic criteria for binge eating disorder. To be diagnosed with BED, you have to overeat at least once per week for a period of three months, but you also have to experience a lack of control over eating, marked feelings of distress, and three of the following: eating much more rapidly than normal; eating until uncomfortably full; eating large quantities when not physically hungry; eating alone out of embarrassment for overeating; and feeling disgusted, depressed, or guilty after binge eating.

The characterization of binge eating as gluttony or overindulgence doesn't account for the distress, isolation, and shame involved in BED. There's a difference between overeating with friends or family on a special occasion, and regularly standing in front of your fridge one hour after dinner, furtively shoving cold leftovers into your mouth and feeling helpless to stop. The criterion of 'distress or impairment in functioning' applies to most DSM diagnoses: scratching mosquito bites the week after camping is not the same thing as regularly picking at skin blemishes until they're bloody and infected (skin-picking disorder), and occasional tearfulness following ovulation is not the same thing as the monthly mood swings and deep sadness and despair that characterize PMDD.

While so-called fad diagnoses can divert attention and resources away from serious illnesses, and hastily slapping a diagnosis on anyone who reports a symptom now and then is obviously harmful, let's not go too far in the opposite direction, dismissing symptoms and denying treatment to people who are suffering. The changes introduced in DSM-5 mean that individuals who binge eat, pick their skin, or experience monthly episodes of distressing unstable mood post-ovulation may now have better luck convincing doctors that the problem is real, explaining themselves to loved ones, and getting their insurer to pay for treatment.

What's wrong with that?

May 11, 2013

Positively Stressed

Mental health tip: Just cause it's positive doesn't mean it isn't stressful.

One of my friends is planning her wedding. She just sold her condo and she and her fiance are moving into their new house next month. Meanwhile, she was offered a promotion at work and her first short story was accepted--pending revisions--for publication in a national magazine, pending revisions. We recently met for dinner after not seeing each other for a couple months and when she told me all her news, I said something like "Wow, you must feel on top of the world!" Instead, she tearfully confessed "I'm so stressed out I can barely breathe. I've been taking sleeping pills almost every night to try and get some rest, and worst of all--I know I should be happy and enjoying all this!"

One of my mindfulness students is about to finish medical school. After four arduous years, he's going to graduate next month and is nailing down his plans to move to another city for his dream residency. In the meantime, he's training for his first triathlon and he and his girlfriend are expecting a baby in the fall. When he told me all his news, I remembered my friend and said, "Wow, that's a lot of stuff. You must be kind of stressed out." My student tearfully admitted that he hasn't been eating or sleeping well and is constantly picking fights with his girlfriend. "The worst part," he said, "is that I know I'm so lucky and that I should be happy instead of stressed out!"

What's going on here?

Both my friend and my student were compounding their stress with the erroneous belief that positive events should create only positive feelings. This idea meant that they were adding guilt on top of stress, making it worse.

Two things that helped:

a) Sharing the definition of 'stressor' that I use in teaching mindfulness-based stress reduction: "Any threat, demand, pressure, or change in the environment that requires the organism to adapt." Notice that this definition does not assume that stress is caused by negative events, but rather by pressure and change.

b) Introducing the Holmes and Rahe stress scale. Developed by two psychiatrists, this scale yields a total stress score based on life changes and experiences in the past year, including things like marriage, retirement, Christmas, change in personal habits, and change in number of family reunions.

Getting married, moving, changing jobs, morphing from student to professional, and preparing for a baby certainly all qualify as demands, pressures, or changes requiring adaptation, and almost all of them are listed in the Holmes and Rahe scale. My friend and my student were relieved to know that just cause it's positive doesn't mean it isn't stressful; acknowledging that positive stress is still stress allowed them to cut themselves some slack, decreasing the unnecessary additional stressor of guilt.

The next time you're feeling stressed out in the midst of an avalanche of good news or positive events, remember that just cause it's positive doesn't mean it isn't stressful.

NB: This first step will probably in itself make you feel better. However, an important second move is to take concrete steps toward stress reduction. My friend booked a massage, cancelled her bachelorette, and negotiated a week's vacation prior to beginning the new position at work. My student registered for a 10k race rather than a triathlon, and decided to stop collecting new baby gear until after the move. 

May 03, 2013

Sunday Neurosis

You know that creeping anxiety that develops on Sunday as the weekend draws to a close?

It's not just you! So many friends, patients, and mindfulness students have mentioned the "Sunday night feeling" recently that it merited a Google search. It turns out that Sunday-specific anxiety is a ubiquitous phenomenon: sources as diverse as Psychology Today and Victor Frankl--an Austrian psychiatrist famous for finding meaning in his concentration camp experience--have written about the Sunday feeling, with Frankl coining the term "Sunday Neurosis."

Sundays can be difficult for multiple reasons, including the following:

1) They're unstructured. Although we complain about workday constraints, many of us prefer routine and schedules. Saturdays are often filled with errands and chores, but Sunday is often a looser, lazier day--which is not comfortable for everyone.

2) We have to return to work the next day. Even if we're relatively happy with our job, the looming return to the office can be enough to stimulate apprehension. If we aren't happy at work, or left tasks undone on Friday, the Sunday feeling can intensify to dread.

3) We're still carrying childhood school anxiety. For many, the sad Sunday feeling has its roots in childhood, when we faced homework, the end of two days of play, and an early bedtime. If we were bullied or otherwise unhappy at school, Sunday night angst could intensify to outright fear.

4) We didn't accomplish all of our weekend goals--including relaxation. As Thursday and Friday roll around, we often build up our expectations of our precious two days off and generate unrealistic to-do lists. For example, we plan to--over the course of two days--catch up on reading, go to the market, visit our parents, sleep in, take the kids to the park, finally fix the leaky shower head, do a bit of freelance work, clean out the closets, and cook a couple dishes to freeze for dinner later in the week. Above all, we plan to relax and unwind--while accomplishing everything on the list above! Failure to meet our improbable goals contributes significantly to Sunday angst.

How can we decrease or manage Sunday Neurosis? Here are some solutions:

1) If your Sunday Neurosis is generated by unrealistic expectations for your two days off, try treating your weekend to-do list as a loose game plan, not a strict program. Better yet, identify two or three priorities and let go of the rest. For example: this weekend I will grocery shop, have dinner with a friend, and call my mom. Or: this weekend I will clean the bathroom (not the whole house), register the kids for summer camp, and take one hour to sit and read for pleasure.

2) If your angst is generated by the unstructured nature of Sundays, make a loose schedule for your day. For example, plan to go to the gym in the morning, catch up on personal email in the afternoon, and do laundry after supper before relaxing with an hour of TV. You don't have to schedule every minute of your day, but a general plan can alleviate anxiety created by lack of structure.

3) If your Sunday Neurosis is related to the upcoming return to the rush of the week, consider ways you can use your day to alleviate weekday stress. You might feel better about Monday if you took some time on Sunday to do laundry, make lunches, run errands, and otherwise prepare for the upcoming week. Getting the household to bed on time can also help.

4) If your Sunday stress is the result of a focus on Monday, try practicing mindfulness. Monday may feel looming, but today--now--is actually still the weekend. If your Sunday feeling is an echo of grade-school angst, remember that today--now--is 2013 and you're not in grade six anymore. Don't miss what could actually be a lovely day off by launching your mind back to elementary school or forward to tomorrow.

5) If your Sunday Neurosis stems from the upcoming return to work, consider some of the things you like about your job or are looking forward to. Are you going for lunch with colleagues this week? Finally submitting a big project?

6) If work-related Sunday apprehension persists, take the time to identify what is making you unhappy about your job and whether or not you can do something about it. For example, if having to be at work at 8am on Monday triggers your Sunday angst, can you negotiate to arrive at 9am and stay an hour later? If you feel isolated at work, is there a way to introduce more social contact into your workday?

Any combination of these strategies may be helpful in treating the uncomfortable Sunday night feeling. Since we tend to believe that our neuroses constitute a personal and idiosyncratic problem, just knowing that Sunday Neurosis is a common and known phenomenon may be helpful for some.

What's your strategy?

April 20, 2013

It's Your Call

Mental health tip: Just call.

When you miss a deadline or make a mistake at work, it is better to call or email? If you can't make your friend's dinner party after all, or remembered your sister's birthday only the following day, is it better to call or text?

Often when we're handling a stressful or delicate situation, we opt to email or text instead of calling. We tell ourselves that we're saving time, but usually the decision is motivated by avoidance. That is, we're anxious about the annoyance, anger, or disappointment that our communication may generate, and try to decrease our anxiety by avoiding the recipient's real-time reaction.

Is this a good strategy? Consider this story that a friend told me recently

Last Friday, a colleague missed an important commitment at work--an obligatory weekly meeting that staff in her small office cannot miss without an exceptional reason. She had a good excuse to miss the meeting, but it was personal and she didn't want to discuss the details with our boss. Anxious about his reaction to her absence, she decided to email the day before to say that she would miss the meeting for personal reasons. 

This was the first point where a phone call would have been preferable. My colleague sent the email and waited to feel relief, but none came. Instead, she became more and more nervous as she imagined our boss's angry response. Three hours later, she received a brief reply saying of course she could miss the meeting--if she really felt she needed to. The tone of the email was ambiguous and she felt flustered and panicked. This was the second point when my colleague could have picked up the phone, but the desire to avoid facing our boss was too strong. She didn't call and instead treated herself to a weekend of lingering stress.

How would calling have helped in this situation? First, my colleague would have been able to explain herself clearly, assuaging her concerns about being perceived as a slacker or malingerer. Second, she would have been able to gauge our boss's reaction, which is difficult over email. Third, the issue would have been resolved in minutes. Instead, she fretted all weekend--only to learn on Monday that our boss had been entirely unconcerned!

The question of calling versus texting or emailing is not limited to work situations, but is equally relevant in the social realm. When we're running late or have to miss a social occasion altogether, or don't want to tell our partner that we forgot to pick up milk--again--we use text messages to avoid directly witnessing negative reactions.

Example: Earlier this week, I had to cancel plans with a friend for the second time in a row. I didn't want to face his hurt or irritation so rather than calling, I texted to say I couldn't get together that evening after all, but how about Friday instead? He responded quickly: "ok." I waited for a further text, but none came, leaving me feeling uneasy and uncertain. Was "ok" equivalent to "No prob, see you Friday! :)" or did it mean something closer to "WTF?! :(" Remembering my patient's story, I called my friend instead of texting back. It turned out that he was at work--which explained the brevity of his response--and had to work late and was happy to postpone our plans.

How did calling help in this situation? First, I had the chance to fully explain why I had to cancel plans again, preventing my friend from perceiving me as inconsiderate. Second, I was able to assess his reaction, which was impossible from his ambiguous text. Third, rather than fretting about it until Friday, the situation was resolved in minutes.

Text messaging and email are great tools when used appropriately, but problematic when used in the spirit of avoidance. The next time you notice yourself texting or emailing when you know you should call, remember that avoidance maintains anxiety, and ask yourself if you'd feel better if you made the call. Even if your feared outcome comes true--e.g., your sister is hurt about her birthday, or your partner is cranky about the milk--at least you know where you stand and can start making amends. 

April 05, 2013

Friday Post-Mortem

This week I saw an exceptional number of psychotherapy patients in five days, and I noticed a few things:

a) It took a lot of energy and, even though I enjoyed many of the sessions, I was noticeably drained by the end of the week.

b) I joked around in therapy more than usual and told more quasi-personal anecdotes.

c) My patients didn't necessarily like it.

I've been thinking about how the first two observations are related and I think I've cracked the code: Therapy takes a lot of energy because you have to be thoughtful and mindful and helpful and insightful, but an additional element that takes considerable energy--for me, at least--is not being totally myself. It's not that I'm a blank automaton with my patients, but in therapy, I don't make express opinions or preferences, make jokes, seek support, gossip, compliment, or reassure, and I rarely give advice. If a patient is telling an anecdote and I've experienced the exact same thing I don't say "Oh my God, me too!" If a patient is recounting a dilemma, I can't tell him what I'd do if I were in his shoes.

I think the extra jokes and quasi-personal anecdotes this week represent a kind of resistance to the additional hours of personality suppression. When a patient mentioned that the hospital security guard made a weird comment to him, I said "Yeah, he's done that to me too a few times, he's kind of an 'unusual' guy," rather than "What was that like for you?" When a patient reported that she didn't work out this week, I said "Yeah, it's not always easy to get to the gym after work, I've had weeks like that," rather than "What were some of your obstacles?" These responses weren't particularly out of line, but they weren't particularly helpful either. 

Finally, I think that this kind of over-sharing is confusing for the therapy relationship, and here's why: I'm particuarly likely to joke or to reveal glimpses of my personal life in session with patients who are similar to me--patients who have the same sense of humour or the same personal conflicts as me, who live in the same neighbourhood as me and have a similar lifestyle, or who share my cultural or academic background. But although I know that we have a lot in common, patients aren't aware of our similarities. So if I suddenly mention that I too am attending a Passover seder this year or that I too experience daily frustration with the ongoing construction at the subway station nearest both our homes, it comes out of the blue. It's also worth remembering that I've had therapists who shared personal details about themselves with me, and that I disliked it and preferred to maintain our one-way relationship. My own patients may not feel this way, but it's my responsibility to err on the side of reticence.

Reining in your own opinions and preferences and experiences isn't easy and explains why therapists can feel isolated despite interacting with people all day. For the therapist, psychotherapy doesn't meet the need for communication because it's not reciprocal. All the more reason to keep up my usual strategy of calling up a friend or family member for a brief chat when I have a break in my day, and why I like the idea of mixing private psychotherapy practice with other pursuits. 

March 25, 2013

Worst-Case Scenario

What's the best strategy for coping with anxiety generated by hypothetical scenarios and "what if" questions (What if I hit 'reply all?' What if I made a mistake at work? What if I offended my friend?) Should we reassure ourselves that the scenario didn't or won't happen (we didn't hit reply all, we didn't make a mistake or offend anyone), or should we imagine the worst-case scenario?

You'd think that imagining the worst-case scenario would make us feel worse but counterintuitively, following anxiety-provoking "what if" thoughts to their conclusion can sometimes provide greater relief.

How does this work? The key principle is this: avoidance maintains anxiety. When we reassure ourselves that our stressful or scary thoughts probably won't come true, we're essentially avoiding the possibility--pushing it away and dismissing it. Avoidance is often effective in the short term, but the stressful what ifs return in full force after a few minutes, leaving us thinking "Okay I know I probably didn't hit reply all...but what if I did?" The possibility is still there so the anxiety remains.

When this happens, it can help to consider what would happen in the what ifs came true. Examples:

1) After some hemming and hawing about whether or not to make the trip, I booked an expensive airplane ticket to attend an engagement celebration in another city. As soon as I pressed 'purchase' on the airline website, my mind raced to "What if it's not that weekend after all? What if they change the date?" I tried to reassure myself that the party date was unlikely to change, but the anxiety remained. What worked was asking myself what if it were changed--then what? Answer: I'd be stuck with an expensive plane ticket I couldn't use and I'd be out $500.

2) I received an email from a supervisor concerning a decision I'd made about a project we're working on together. Before even reading the message, my mind reacted: "What if she thinks I made a bad decision?" Instead of reassuring myself that my supervisor probably doesn't care that much, I asked myself what if she did disagree--then what? Answer: My supervisor would be unhappy with one thing that I did.

3) I was running late and arrived only minutes before teaching a class, without time to review my notes as I usually do. My mind leapt to: "What if I'm unprepared and the class doesn't go well?" When it didn't work to reassure myself that not reviewing my notes wouldn't affect my teaching, I switched strategies, asking myself what if the class doesn't go well--then what? Answer: One of the classes in the eight-week course would be inferior to the rest and students might be dissatisfied with the one class.

In each of these situations, exploring the worst-case scenario was more effective than reassurance in alleviating my anxiety. Why?

a) Knowing the worst-case scenario puts an end to the what ifs. The answer is clear.

b) Knowing the worst-case scenario allowed me to figure out how to deal with it, and how to not make the same mistake in the future. I determined that if the party date changed, I'd try to sell my ticket online but that next time I'll double-confirm the date before booking. I realized that my supervisor disagreeing with one decision isn't the end of the world, but that next time I'll check with her first. I concluded that sub-par teaching wasn't something I was willing to risk, and that it was worth it to start class a few minutes late in order to review my notes.

Considering the worst-case scenario might not alleviate anxiety in every situation but next time reassurance isn't helping, try it out and see what happens!

March 15, 2013

Stress Reduction for Normal People

Last post, I wrote about the benefits of taking time out for relaxation, meditation, or other forms of non-productive downtime. But what if you want to be less stressed, and more relaxed and mindful in everyday life without setting aside time to officially relax or meditate?

Here are a few simple things that I've been trying lately:

1) Not jaywalking. A lot of us automatically cross the street as soon as it's clear, regardless of the colour of the traffic light. Last year, as part of a one-month mindfulness challenge, I resisted jaywalking for 30 days, and enjoyed it. I recently returned to this practice and have concluded that not jaywalking decreases stress and promotes relaxation and mindfulness in three ways: a) It's relaxing to realize that no matter how rushed you feel or how important your destination, you actually can afford to wait twenty seconds for the light to change; b) The twenty seconds of waiting at a red light is an opportunity to get out of your head, check out your surroundings, and ground yourself in the present (I sometimes say to myself things like "Here I am, this Tuesday morning at 9:15 in March 2013, walking to the bus stop"); c) It's relaxing to cross the street without having to suddenly sprint to avoid a car that came out of nowhere.

2) Going out without your phone. I'll admit this usually only happens by mistake, but it's undeniably relaxing. Cell phones are really good at taking us out of the present moment. When I pass an adorable kitten in an apartment window, I can notice and appreciate it and experience an awesome moment of kittenness. When I take out my phone to take a photo of the kitten and text it to my sister with a cute comment, I'm no longer present. Similarly, if you're having brunch with a friend but keep checking your phone for updates on dinner plans, you're not really experiencing brunch with your friend because your mind is already at dinner. Not having your phone on you can admittedly be inconvenient sometimes, but there are few things that actually can't wait; wouldn't it be nice to sometimes, instead of returning a call or posting on Instagram while we wait for the bus, actually just... wait for the bus?

3) Moving more slowly. If you don't jaywalk or engage in compulsive cell phone use, you probably still have the nearly universal habit of moving more quickly when you're stressed. I observed this on a recent morning when I was rushing around trying to eat breakfast, pack my lunch, brush my teeth, and get out the door. My movements were speedy and frantic and inefficient (e.g., picking things up and putting them down in the wrong room, banging my shoulder on the door frame), and I realized that moving my body on fast-forward was reinforcing the URGENT! LATE! message from my mind, amplifying my stress. In moments like this, simply returning to a normal pace lets your body send your mind a different message, instantly decreasing stress. 

Let me know how these work out!

March 10, 2013

Dying to Relax

One of my mindfulness-based stress reduction (MBSR) students has three kids, a husband, and a demanding job. On occasion, she stops at a cafe on her way home from work to have a cup of tea and take a 30-minute breather before launching into her evening of dinner, homework, lunches, and bedtimes. When she makes the stop, she notices that she feels relaxed and grounded afterwards, and that she's more patient and present with her husband and kids. Despite the obvious benefits of the cafe pit stop, she hasn't made it a regular habit; it's too hard to justify "doing nothing" for half an hour when she could be completing one more task at work or getting a head start on dinner before her husband gets home. It feels indulgent, selfish, and like a waste of time.

This client isn't the only person who finds it hard to be unproductive for a few minutes, or who feels like they simply don't have time to relax. Friends, patients, and MBSR students struggle to find a few minutes per day to breathe, meditate, read, or simply be. So do I. How can we spend fifteen minutes sitting quietly and watching our breath when we have emails to send, texts to answer, and dishes to wash? How can we read a novel when we have a backlog of articles to read for work and the laundry isn't done? Not only is there a lot to do, but often each item on our to-do lists feels absolutely urgent--as if it needs to be checked off right this minute.

Even though we intuitively know that down time is good for us, many of us are unaccustomed to being unproductive, and find relaxing difficult to prioritize. When you're struggling between sending one more email and having a quiet cup of tea before bed, or between your morning meditation and getting to work a few minutes early, consider the following:  

a) Non-productivity is productive. The minutes you "waste" relaxing or meditating return to you several-fold in productivity. The relationships between relaxation and productivity and between meditation and productivity are well established--but research aside, most of us have experienced how much better we work when we're relaxed, when we're well rested, when we're able to focus. This is one reason that successful companies like Google, Sun Life, Ford, General Mills, and Twitter have established mindfulness training programs for employees.

b) Dying to relax. In his book Wherever You Go, There You Are (WYGTYA; see right sidebar), MBSR founder Jon Kabat-Zinn refers to meditation as "dying" to the world for a few minutes. He reminds us that if we died right this minute, our personal agenda would dissolve immediately. That is, some of our projects would be absorbed by others, but most of our oh-so-important goals and must-be-done-right-this-second tasks would simply evaporate. JKZ says "So if this is true, maybe you don't need to worry about it in any absolute way. Maybe you don't need to make one more phone call right now, even if you think you do. Maybe you don't need to read one more thing or do one more errand. Stopping for a few minutes--dying on purpose--to the rush of time, you free yourself to actually have time for the present. You become more alive now, and once you do decide to go again, it's more deliberate, more vivid, richer."

I love this! A friend recently reminded me of this passage from WYGTYA, and I used it the other night: I was getting ready for bed after an evening of baking, and as I turned out the kitchen light long past my bedtime, I noticed that there were still crumbs on the kitchen table. As I picked up the dishcloth, I stopped to ask myself what would happen if I died and the table didn't get a second wipe. Answer: nothing. Result: I put down the dishcloth and got in bed. Reminder: sometimes you just don't need to do one more thing.

Do the ideas of productivity via relaxation or meditation, and dying to our responsibilities mean we should all spend our days relaxing, meditating, and not answering emails or cleaning up after ourselves? That our personal agendas aren't important? No, of course not. But next time you're considering eating lunch at your desk, remember that taking a real lunch break isn't a waste of time. Next time you're sending work emails from your phone while you brush your teeth before bed, consider that managing your inbox at 11pm might not be as urgent as it feels.

NB: If you want to try adding ten minutes of mindfulness meditation to your day but aren't sure how, I recommend this free and easy guided program. 

February 26, 2013


Lately I've been feeling impressed by the courage of my patients and my friends.

Once a month at the clinic where I work, two members of the team conduct a psychological evaluation with a new patient, while a group of medical residents and psych interns observes. Each time, I'm struck by the courage of the patient who sits before the group and describes in detail the manifestations and origin of the presenting mental health problem, the distress or impairment it causes, current and past relationships, and goals for treatment. How brave is that!

I was similarly struck a few weeks ago when a colleague told me that her patient with panic disorder willingly ran up and down the stairs inside the clinic, trying to expose himself to the terrifying breathlessness that triggers his panic attacks. I feel the same respect when a patient with chronic health anxiety successfully writes, records, and listens to an exposure scenario describing himself dying of cancer, or when a painfully shy patient reports that she successfully completed her plan to initiate a conversation with one of the other parents in her son's class.

It's not just my patients who are impressive: my friends are, too. A few months ago, one of my friends was diagnosed with schizoaffective disorder, a difficult-to-diagnose mix of depression, mania, and psychosis that neatly explains symptoms he's been experiencing for years. Following the diagnosis, he took his mental health into his own hands--seeking out a support group and tirelessly navigating the overwhelming bureaucracy of the health care system until he found a doctor who understood the diagnosis, prescribed medication appropriately, and addressed his concerns about side effects. Another friend recently began psychotherapy to deal with a procrastination problem that has plagued her for years. A third friend called me up for a referral for a couples therapist so that he and his partner could address some issues they were unable to resolve on their own.

My friends' and patients' initiative touches and impresses me. There's still a stigma attached to mental health care and there are still people who believe that seeing a psychologist or psychiatrist or taking medication is a sign of weakness. I'm pretty sure that acknowledging a problem and seeking help demonstrates the precise opposite.

Think about it.