September 25, 2012

Lens Lesson

Everybody sees life through the lens of his or her own history. Try as we might, it's almost impossible to view any person, event, or situation completely objectively, without the impact of our experience and memories. Sometimes it's more obvious than others; for example, when someone cringes every time her boss says "Can I speak with you privately for a minute?" it's not hard to figure out that she's carrying the memory of another boss that said the same thing right before he fired her.

Sometimes it's more subtle though. You might not realize that your exaggerated fear of gaining a few pounds developed the time your ex offhandedly mentioned that your jeans looked tight, right before the relationship ended. Similarly, it might not be obvious that your resistance to buying birthday and Christmas presents is the result of the time you gave what you thought was an exceptionally perfect gift, only to receive a devastatingly indifferent response. Such experiences become the lens through which you see weight-related or gift-related situations, and seeing through the lens influences how you behave (e.g., obsessing over the scale, refusing to buy gifts).

Lenses are often composed of thoughts: "I'm not good at choosing gifts." "Gaining weight is unacceptable." "I could get fired at any time." One of my jobs as a cognitive-behavioural therapist is to help clients become aware of their "lens thoughts" and develop alternative thoughts that help them act differently and feel better. I tell clients that when they they feel down, anxious, or otherwise unhappy about a given situation or event, they can ask themselves the following questions:

a) What was I thinking?
b) Is it a lens thought? 
c) What might someone else think in this situation?

Example:  I have a client who was bullied mercilessly in high school and now feels extremely anxious in social situations. When someone so much as glances sideways at her, she instantly interprets the look as one of disrespect, dislike, and scorn. The impact of her social anxiety is that she feels sad and isolated, never attending a work party and avoiding situations like parent/teacher night at her daughter's school. When she received an email invitation to her cousin's baby shower, her immediate thought was "Everyone will make fun of how I look;" she felt shame and dread, and quickly discarded the email. Going over the example using the three questions above, my client was able to identify the thought as a lens thought; she acknowledged that another person who received a baby shower invitation might think something like "Oh great, a party! Hmmm, what will I wear? " This allowed her to label her upsetting thought as a relic from high school, and to focus on choosing an outfit she liked.

Recognizing lens thoughts and putting someone else in your shoes can help you adjust your perspective and change your behaviour.  The next time an event or situation is bringing you down, try the lens lesson!

September 14, 2012

Career Justification

In my very first post, I wrote about the difference between psychologists and psychiatrists. Recently, I started thinking about the difference between psychologists and laypeople (i.e., non-psychologists) after a friend asked me why anyone would consult a psychologist. His argument: If I'm a smart person and I know what my problem is, why wouldn't I just work on it on my own? What can a psychologist do that I can't?

This is a reasonable question and it got me thinking about the advantages of consulting a psychologist versus working on your issues on your own. Here are some reasons you might want to consult:

a) Psychologists have fifty minutes per week to dedicate to your problems. This may seem short, but it's a devoted and concentrated period. Left to your own devices, you might ruminate for hours or discuss with friends for weeks, but you're unlikely to sit down to undistractedly confront your issues or problem-solve.

b) Like any professional, psychologists have specialized knowledge, including knowledge of the DSM criteria for validated psychological disorders. Psychoeducation is a huge part of psychotherapy, and you might be relieved to learn that your gruesome intrusive images are a common symptom of obsessive-compulsive disorder, or that during a panic attack, it's normal to feel like you're going crazy.

c) Psychologists have experience working with people whose problems are similar to yours, and so have a good idea of what might and might not be helpful for your issue.

d) A psychologist is someone to check in with. Even if you already know what your problem is and what to do about it, it's not always easy to stay on track. A weekly meeting with a psychologist can act as a strategy session, a check-in, and a one-on-one support group. 

e) Psychologists are trained to notice avoidance, incongruence, and behavioural patterns, and to not let you get away with your BS. So if you never do your therapy homework, giggle when you talk about your suicidal thoughts, or abruptly change the topic every time the topic of your parents comes up, a psychologist will notice and gently address it.

f) Psychologists know techniques and strategies that you don't know or might not have thought of, such as activity scheduling and the what went well exercise for improving low mood; behavioural experiments and cognitive restructuring for testing dysfunctional beliefs; Socratic questioning to ferret out cognitive distortions; mindfulness meditation for cultivating attention and awareness; and exposure hierarchies for addressing phobias.

Psychologists aren't just wise listeners who dispense advice; rather, like any professional, we have specialized skills and training. So in the same way that you might hire a lawyer, a carpenter, or a dentist instead of defending yourself in court, building your own back deck, or giving your kids a fluoride treatment, many people find it helpful to consult a psychologist. Not every problem or every person needs a psychologist, however, and while I've encouraged many friends, family members, and acquaintances to consult, I wouldn't recommend it to someone who prefers to seek help from loved ones or to deal with their issues on their own.

It's your call. 

September 04, 2012

Anecdote: Jon Kabat-Zinn

I recently attended a CBT conference where I participated in a mindfulness meditation workshop led by Jon Kabat-Zinn. Kabat-Zinn is the founder of the Center for Mindfulness and the Stress Reduction Clinic at the University of Massachusetts medical school and the founder of mindfulness-based stress reduction; he is widely credited with having pioneered the integration of mindfulness and Western medicine and psychology.

At the conference, I had the pleasure of speaking with Kabat-Zinn during the workshop lunch break.  During the hour, a small and funny incident related to mindfulness and acceptance occurred:

Kabat-Zinn, the two other workshop attendees sitting with us, and I had finished eating and were discussing mindfulness applications. It was a hot day and the noon sun was beating down on our unprotected table. After a few minutes, Kabat-Zinn suggested moving to a nearby empty table in the shade. This prompted teasing from me and the two others: after all, the non-judging aspect of mindfulness prescribes not labeling some experiences (e.g., being in the sun) as bad and others (e.g., being in the shade) as good; mindfulness also involves letting go and accepting experience as it is, rather than struggling to change things all the time.

Teasing aside, this tiny incident demonstrates an important point about acceptance and about problem-solving. Acceptance doesn't mean that you don't do anything about your problematic situation--it just means that you try to maintain a non-judgmental and relatively objective perspective about what's happening (e.g., It's really hot and sunny at this table versus Oh my God I'm melting, I'm in hell); you try to maintain an awareness of your reaction to the problem (e.g., I'm having a hard time concentrating because I'm physically uncomfortable); and if there's a reasonable solution (e.g., switching tables), you go for it.

In the problem-solving quadrant, being unable to concentrate because of the heat was a "taking charge" type of problem, and there was nothing unmindful about switching tables. If we had sat in the sun sweating and being unable to connect due to physical discomfort, we would have been mistakenly placing the problem in the "giving up" quadrant and failing to take action in a situation over which we had control.

This is a minor but poignant example of identifying the type of situation and making a mindful choice about what to do. That it happened with a renowned authority on mindfulness only makes it more fun for me to retell.

September 02, 2012

Problem-Solving Solutions

Many of us know the basics of problem-solving: define the problem, brainstorm possible solutions, choose and implement a solution, evaluate the outcome, start over as needed. But despite knowing these steps, we can still find ourselves implementing a poor solution, avoiding a problem and not seeking solutions, and struggling with problems that don't have solutions.

I learned a problem-solving framework at a positive psychology conference I attended recently. It doesn't solve your problem, but it identifies the type of situation you're dealing with so that you can address it effectively by either problem-solving or letting go.

Here it is:

In your control
Not in your control
Take action
Taking charge
Don’t take action
Giving up
Letting go

a) Taking charge: Once you figure out that your problem belongs in this quadrant, this is the best kind of situation. You realize that you can take action, and so you do. For example, if you're unhappy at work, you either address your needs with your boss or look for a new job. If you're frustrated because you never have time to exercise or see friends, you stop and identify what's getting in the way, and look for ways to reorganize your time.

b) Giving up: When you're in this quadrant, you have some degree of control over your problem but you don't realize it, and so you feel helpless and resigned. For example, say you've been unhappy with certain elements of your romantic relationship for years, but don't bring it up with your partner because you feel like it's too late. Or that you've steadily gained weight over the course of a few years and are unhappy with your appearance, but conclude that it's your destiny to be overweight and that there's nothing you can do about it.

c) Struggling: Not having control is frustrating and anxiety-provoking, and we often respond to these emotions by trying to control the uncontrollable. For example, say your dog is dying and rather than accepting the facts, you repeatedly gouge your savings for expensive treatments that prolong his life by days. We're particularly prone to fruitless struggle when we try to control other people: for example, say you've rented a cottage for a week's vacation with your extended family, and you--and only you--believe it's important for everyone to eat three meals per day together; you spend a good part of your week cooking, assigning and organizing meal duty, and struggling to get your reluctant parents, kids, and siblings to the table for breakfast, lunch, and dinner--at the expense of your own enjoyment of the vacation.

d) Letting go: In this quadrant, you realize that there's little you can do about your problem, and you use that knowledge to let go and accept the situation as it is. Letting go can be as minor as finally accepting your freckles and putting away the foundation you carefully applied every morning for ten years, or as major as realizing that your baby doesn't know or care about your carefully-designed birth plan, and is probably going to arrive in his or her own way and on his or her own time.

I just learned this problem-solving framework, but I suspect that the more we can address problems by taking charge or letting go, the happier we'll be. Taking charge allows us to feel competent and act effectively; letting go can create a sense of relief; and knowing which quadrant we're in prevents us from attributing weight gain to destiny, sticking with a miserable job, trying to control childbirth, and hiding our pretty freckles.