How come one day your computer melts down and deletes half your files and you cheerfully back up the remaining files and continue your day, yet on another day you have a tantrum when someone steps on your foot on the subway? Isn't losing your files inherently more upsetting than brief foot pain? What explains the difference in reaction?
The book I'm reading (The Mindfulness Solution; see sidebar) says that "what matters for our sense of well-being is our capacity to bear experience relative to the intensity of the experience." That is, our well-being depends on the intensity of our stressors, but perhaps depends even more on our capacity to bear stress.
Example: Last week, I was waiting outside for a friend to pick me up in her car to go for brunch. It was a lovely day and my friend was doing me a favour by driving, but I found the wait intolerable and spent most of the all-of-ten-minutes fussing and fuming. Thinking about it later and taking into consideration my capacity to bear experience, I was able to identify that I had been hungry, dehydrated,
underslept, and in physical pain. This explains why a non-intense stressor such as waiting for ten minutes felt intolerable. In contrast, this week I remained calm and relatively cheerful during a two-hour drive in Friday afternoon rush hour traffic to pick up a parcel from an incompetent courrier service in a distant corner of the city. I was well rested, I wasn't hungry or thirsty, and I wasn't in a rush; that is, my capacity to bear experience was high and I was able to take a deep breath, accept the traffic, and enjoy singing along with the radio.
The moral of the story is that sometimes when we're all worked up and certain that our situation is unbearable, it may simply be that our capacity to bear stressful experience is low at that moment. The good news is that we can improve our ability to bear stress and distress, both in the long term and in the moment:
In the moment: We can often increase our capacity to bear experience by decreasing physical discomfort. If you're waiting in a long line in a stuffy building, try putting down your bag and taking off your sweater. If you know that hunger makes you cranky and intolerant, carry a granola bar in your bag at all times. Use the washroom before you leave the house so you don't get stuck in traffic with a full bladder. Keep Advil in your desk at work so you don't suffer through the day with a headache. Consider calling someone to vent for a couple minutes or asking for help. Or, if you're overtired today, consider putting the situation aside until you can get a bit of sleep. Not being rushed also helps: it's easy to tolerate the bus being a few minutes late if you're not already running late for the first of five back-to-back appointments.
In the long term: Mindfulness is an attitude of acceptance, openness, and non-judgment in the present moment; mindfulness meditation--one of the primary practices through which mindfulness is cultivated-- is essentially practice bearing experience. During mindfulness meditation, you sit and pay attention to yourself and to your surroundings as they are, accepting what's happening without piling on secondary emotions and without telling yourself stories about what's happening. It's called meditation practice because it's practice for real life; when stressful situations come along, you're better equipped to bear the experience with equanimity.
Further good news: You don't have to meditate to be mindful--all you have to do is pay attention and differentiate between the fact of what's happening (e.g., my computer deleted my files; a guy stepped on my foot) and the stories we tend to tell ourselves about what's happening (e.g., my entire life's work has been deleted; that guy has no respect).
Showing posts with label Acceptance/ACT. Show all posts
Showing posts with label Acceptance/ACT. Show all posts
October 02, 2012
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.
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:
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.
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
|
Struggling
|
Don’t take action
|
Giving up
|
Letting go
|
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.
August 11, 2012
Letting Go
What is letting go?
We use the phrase "let it go" all the time, encouraging our friend to stop emailing his ex-girlfriend six months after the break-up or our partner to stop bringing up that thing we did that time. Letting go isn't easy--we're all attached to our ideas of how things should be, and we all have feelings, experiences, and relationships that we don't want to see end--but becoming too strongly attached or holding on for too long can create problems.
How does holding on create problems?
When we're holding on with all our might to a person, idea, or era, we become rigid and inflexible, and we miss out on opportunities. Think of the guy who passes up job offer after job offer while he continues to pour money into his failing start-up. Think of the former competitive gymnast who continues to train religiously into adulthood, trying to preserve her identity as an elite athlete. Think of the time you didn't enjoy a party or a vacation because you couldn't let go of your idea of how the party or the vacation should be or how you thought it was going to be.
The first step in letting go is to realize that you're holding on. There's a story about letting go that we tell in the mindfulness-based stress reduction course: in India, a clever way of catching a monkey was to attach a coconut to a tree, cut a small hole in it, and place a banana inside. The hole was large enough for a monkey to put his hand through to grab the banana, but too small for the monkey to remove his fist. All the monkey had to do to get free was to let go of the banana, but most didn't, remaining stuck to the tree. The moral of the story is that we often act like monkeys, not realizing that our own clinging is what's making us stuck.
Letting go can be exciting and liberating. The day the start-up guy files for bankruptcy is the same day he can accept an exciting new position; the day the gymnast hangs up her leotard is the same day she can register for the beginner's piano lessons she's been thinking about for years. The moment you let go of the vacation you hoped for, you can start enjoying the vacation you're having.
The next time you feel stuck, try asking yourself what's my banana? What can I let go?
We use the phrase "let it go" all the time, encouraging our friend to stop emailing his ex-girlfriend six months after the break-up or our partner to stop bringing up that thing we did that time. Letting go isn't easy--we're all attached to our ideas of how things should be, and we all have feelings, experiences, and relationships that we don't want to see end--but becoming too strongly attached or holding on for too long can create problems.
How does holding on create problems?
When we're holding on with all our might to a person, idea, or era, we become rigid and inflexible, and we miss out on opportunities. Think of the guy who passes up job offer after job offer while he continues to pour money into his failing start-up. Think of the former competitive gymnast who continues to train religiously into adulthood, trying to preserve her identity as an elite athlete. Think of the time you didn't enjoy a party or a vacation because you couldn't let go of your idea of how the party or the vacation should be or how you thought it was going to be.
The first step in letting go is to realize that you're holding on. There's a story about letting go that we tell in the mindfulness-based stress reduction course: in India, a clever way of catching a monkey was to attach a coconut to a tree, cut a small hole in it, and place a banana inside. The hole was large enough for a monkey to put his hand through to grab the banana, but too small for the monkey to remove his fist. All the monkey had to do to get free was to let go of the banana, but most didn't, remaining stuck to the tree. The moral of the story is that we often act like monkeys, not realizing that our own clinging is what's making us stuck.
Letting go can be exciting and liberating. The day the start-up guy files for bankruptcy is the same day he can accept an exciting new position; the day the gymnast hangs up her leotard is the same day she can register for the beginner's piano lessons she's been thinking about for years. The moment you let go of the vacation you hoped for, you can start enjoying the vacation you're having.
The next time you feel stuck, try asking yourself what's my banana? What can I let go?
June 05, 2012
Allowing
Emotions can be inconvenient. Sometimes we experience intense and difficult feelings at work, during a social occasion, or at some other awkward moment. It's not a convenient time to explore the emotions in depth or to sit and have a good cry, so what's the best strategy? Ignoring feelings? Suppressing them?
Like thought suppression, emotion suppression doesn't usually work; paradoxically, it can make feelings more intense. The trick is simply accepting that the inconvenient emotions are happening and allowing them to be present. It doesn't make feelings go away, but allowing eliminates the struggle against the feelings, freeing up your energy and attention for other things.
Here are two strategies for allowing:
1) Replace but with and. Say you're at a a great social event that you really want to enjoy, and you can't stop worrying about something stressful you have to deal with the following day. You're saying to yourself I'm at this great party, but I'm really anxious. Replacing but with and means telling yourself I'm at this great party and I'm really anxious. Whereas the original phrasing implies that there's no way you can enjoy the party with anxiety present, replacing one small word creates a new sentence that implies that the two can co-exist: you're anxious and also, the party is great.
2) Draw a picture. A client told me this story recently: At work one morning, he received a personal email that provoked intense sadness, fear, and jealousy. He tried to ignore his emotions and turn his attention to his tasks, but the feelings got stronger and stronger. The client needed to focus on his work; remembering the concept of RAIN, he decided to switch strategies and try allowing his feelings to be present. He wrote sadness, fear, and jealousy on three respective post-it notes and stuck them to the side of his computer monitor, illustrating each word with an emoticon-style face.
What happened? Emotion post-its turned out to be a great way of simultaneously defusing from emotions and allowing them to be present. The feelings/notes remained present in the corner of the client's mind/computer monitor, but the struggle to get rid of them was over, allowing him to redirect his attention. The feelings/notes became less and less distracting and after half an hour, the client was absorbed in his work. When he returned to his desk after lunch and saw the post-its, he laughed.
Neither replacing but with and or drawing a picture involves ignoring, suppressing, or denying feelings, and both strategies can help manage intense emotions at inconvenient times. Let me know if you try either of these tricks!
Like thought suppression, emotion suppression doesn't usually work; paradoxically, it can make feelings more intense. The trick is simply accepting that the inconvenient emotions are happening and allowing them to be present. It doesn't make feelings go away, but allowing eliminates the struggle against the feelings, freeing up your energy and attention for other things.
Here are two strategies for allowing:
1) Replace but with and. Say you're at a a great social event that you really want to enjoy, and you can't stop worrying about something stressful you have to deal with the following day. You're saying to yourself I'm at this great party, but I'm really anxious. Replacing but with and means telling yourself I'm at this great party and I'm really anxious. Whereas the original phrasing implies that there's no way you can enjoy the party with anxiety present, replacing one small word creates a new sentence that implies that the two can co-exist: you're anxious and also, the party is great.
2) Draw a picture. A client told me this story recently: At work one morning, he received a personal email that provoked intense sadness, fear, and jealousy. He tried to ignore his emotions and turn his attention to his tasks, but the feelings got stronger and stronger. The client needed to focus on his work; remembering the concept of RAIN, he decided to switch strategies and try allowing his feelings to be present. He wrote sadness, fear, and jealousy on three respective post-it notes and stuck them to the side of his computer monitor, illustrating each word with an emoticon-style face.
What happened? Emotion post-its turned out to be a great way of simultaneously defusing from emotions and allowing them to be present. The feelings/notes remained present in the corner of the client's mind/computer monitor, but the struggle to get rid of them was over, allowing him to redirect his attention. The feelings/notes became less and less distracting and after half an hour, the client was absorbed in his work. When he returned to his desk after lunch and saw the post-its, he laughed.
Neither replacing but with and or drawing a picture involves ignoring, suppressing, or denying feelings, and both strategies can help manage intense emotions at inconvenient times. Let me know if you try either of these tricks!
May 03, 2012
There's an App for That
Cognitive-behavioural psychologists encourage clients to not believe everything they think. One way to apply this suggestion is to imagine your mind as an email inbox and some of your thoughts as spam. In the same way that you don't take seriously every email informing you that you've just won £20,000,000, maybe you don't need to take seriously every thought that runs through your mind.
When you believe everything you think and react to your thoughts as though they were facts, you're experiencing what psychologists call cognitive fusion. Say I have a tough session with a client and I have the thought "I'm a bad therapist." If my heart sinks and a knot of shame forms in my belly, I'm fused with my thought--that is, I'm reacting as if the thought were a fact, rather than a mere string of words my mind created. What's problematic about fusion is that we can get so wrapped up in a fused thought that we fail to notice or incorporate any information that disconfirms it. For example, say a depressed client were fused with the thought "Life is hell." Cognitive fusion would maintain his grey-coloured glasses and prevent him from noticing anything pleasant about the world around him.
Cognitive defusion is used in psychotherapy to help clients unhook from painful and stressful thoughts. A lot of defusion techniques involve using mindfulness to see thoughts and emotions as transient external events, observing them in the same way you would observe a bus drive by or a pen fall to the floor. You might picture your thoughts like leaves on a stream, each one just floating into and then out of consciousness, or you might add the words I'm having the thought that to the beginning of your sentence, so that instead of saying to yourself "I'm an idiot," you would say "I'm having the thought that I'm an idiot." In so doing, you acknowledge that your thought is just a thought, not a fact.
Other defusion methods include saying the fused thought out loud over and over until it loses meaning, saying it in a silly voice, and singing it. I went to a conference a couple weeks ago where I attended a workshop on cognitive defusion techniques; the presenter showed us an iPhone application called Songify that he uses to help his clients defuse from thoughts. The app records you speaking, analyzes your speech, organizes it into a chorus and verses, and maps it to your choice of melody, adjusting your pitch and syncing your words with the beat. He played us a demo of a client saying "I'm a loser." It was impossible not to laugh at the electronic but melodic "I'm a loser" song and it really made the words seem like just words. Apparently the client felt the same way.
I tried Songify recently with colleague, testing some of the thoughts we sometimes find ourselves fused with. It worked! Not only did we have a good laugh, but hearing our thoughts sung out loud to a melody gave us some distance from them, letting us see them for exactly what they are--mind spam, rather than literal truths.
When you believe everything you think and react to your thoughts as though they were facts, you're experiencing what psychologists call cognitive fusion. Say I have a tough session with a client and I have the thought "I'm a bad therapist." If my heart sinks and a knot of shame forms in my belly, I'm fused with my thought--that is, I'm reacting as if the thought were a fact, rather than a mere string of words my mind created. What's problematic about fusion is that we can get so wrapped up in a fused thought that we fail to notice or incorporate any information that disconfirms it. For example, say a depressed client were fused with the thought "Life is hell." Cognitive fusion would maintain his grey-coloured glasses and prevent him from noticing anything pleasant about the world around him.
Cognitive defusion is used in psychotherapy to help clients unhook from painful and stressful thoughts. A lot of defusion techniques involve using mindfulness to see thoughts and emotions as transient external events, observing them in the same way you would observe a bus drive by or a pen fall to the floor. You might picture your thoughts like leaves on a stream, each one just floating into and then out of consciousness, or you might add the words I'm having the thought that to the beginning of your sentence, so that instead of saying to yourself "I'm an idiot," you would say "I'm having the thought that I'm an idiot." In so doing, you acknowledge that your thought is just a thought, not a fact.
Other defusion methods include saying the fused thought out loud over and over until it loses meaning, saying it in a silly voice, and singing it. I went to a conference a couple weeks ago where I attended a workshop on cognitive defusion techniques; the presenter showed us an iPhone application called Songify that he uses to help his clients defuse from thoughts. The app records you speaking, analyzes your speech, organizes it into a chorus and verses, and maps it to your choice of melody, adjusting your pitch and syncing your words with the beat. He played us a demo of a client saying "I'm a loser." It was impossible not to laugh at the electronic but melodic "I'm a loser" song and it really made the words seem like just words. Apparently the client felt the same way.
I tried Songify recently with colleague, testing some of the thoughts we sometimes find ourselves fused with. It worked! Not only did we have a good laugh, but hearing our thoughts sung out loud to a melody gave us some distance from them, letting us see them for exactly what they are--mind spam, rather than literal truths.
April 08, 2012
Acceptance versus Resignation
What does it mean when a friend, family member, or therapist tells you that you need to try to accept a situation you're struggling with? Is this reasonable advice, or is it just annoying and impossible?
Acceptance is a key concept and a good step toward effective coping with a tough situation, but it has to be properly explained. Friends and psychotherapy clients to whom I propose acceptance of their respective difficult situations say things like, "If I accept that I drink too much, if I accept my partner leaving, if I accept my chronic pain, doesn't that mean I'm just giving up--that I'll become an alcoholic, that I'll be alone forever, that my pain will take over my life?"
No.
Acceptance does not mean passive resignation. Resignation means giving up because you've decided that there's nothing you can do about your situation, whereas acceptance simply means that you accept that your situation happened. It doesn't mean that you like what's happening or that you don't wish it were different, but once you give up the resistance and denial, you can take the energy you were spending on struggling and use it to decide how to respond or what to do next. In this way, acceptance can be liberating.
Examples:
I had a client who had a problem with binge drinking at social gatherings. When he attended events with unlimited alcohol (e.g., his work Christmas party, a wedding with an open bar), he invariably drank way too much and either made social faux pas or became physically ill and left early, both outcomes that caused him significant distress. Friends had suggested various practical strategies to him, such as setting a number-of-drinks limit in advance, not sitting near the bar, and alternating each drink with a glass of water; the strategies worked well, but he rarely applied them. Why? Because applying a strategy required acknowledging to himself that he had a problem; instead, before a party, he would tell himself that he could handle it, that the open bar wouldn't be a problem for him this time. After some work on acceptance, my client was able to accept the fact that he had a binge drinking problem; he began using the strategies consistently, significantly decreasing his distress and effectively eliminating the problem behaviour.
I had a client whose partner left her. She was unable to accept that the relationship was over, and spent a ton of energy on begging and threatening phone calls, emails, and texts, trying to get her ex to come back. The months during which she couldn't or wouldn't accept the end of the relationship stalled the necessary grieving process and prevented her from moving forward. When she finally accepted that her relationship was over, she was still sad and disappointed, but she also felt some relief--the struggle to hold onto the relationship was over, freeing up mental space that she used to look for a new apartment, consider dating again, and start settling into her new circumstances.
Finally, acceptance is a big issue for chronic pain patients. Unfortunately, chronic pain can often only be managed, not cured, and at some point, most patients are told that some degree of pain will always be present and that they need to accept it and find ways to adapt. This is hard, and many patients continue to consult specialist after specialist, seeking a different diagnoses or new treatment options. Eventually, with or without psychological help, some patients come to accept the diagnosis of chronic pain; they are then able to take the time and energy spent on resistance and medical consultations and redirect it toward improving quality of life and learning to live well despite pain.
Acceptance sounds easy but isn't. It takes significant strength and motivation to let go of how you think things should be or how you wish they were, and to work wisely and effectively with your reality, especially when you don't like it. Accepting can be the hardest and bravest thing you can do.
Acceptance is a key concept and a good step toward effective coping with a tough situation, but it has to be properly explained. Friends and psychotherapy clients to whom I propose acceptance of their respective difficult situations say things like, "If I accept that I drink too much, if I accept my partner leaving, if I accept my chronic pain, doesn't that mean I'm just giving up--that I'll become an alcoholic, that I'll be alone forever, that my pain will take over my life?"
No.
Acceptance does not mean passive resignation. Resignation means giving up because you've decided that there's nothing you can do about your situation, whereas acceptance simply means that you accept that your situation happened. It doesn't mean that you like what's happening or that you don't wish it were different, but once you give up the resistance and denial, you can take the energy you were spending on struggling and use it to decide how to respond or what to do next. In this way, acceptance can be liberating.
Examples:
I had a client who had a problem with binge drinking at social gatherings. When he attended events with unlimited alcohol (e.g., his work Christmas party, a wedding with an open bar), he invariably drank way too much and either made social faux pas or became physically ill and left early, both outcomes that caused him significant distress. Friends had suggested various practical strategies to him, such as setting a number-of-drinks limit in advance, not sitting near the bar, and alternating each drink with a glass of water; the strategies worked well, but he rarely applied them. Why? Because applying a strategy required acknowledging to himself that he had a problem; instead, before a party, he would tell himself that he could handle it, that the open bar wouldn't be a problem for him this time. After some work on acceptance, my client was able to accept the fact that he had a binge drinking problem; he began using the strategies consistently, significantly decreasing his distress and effectively eliminating the problem behaviour.
I had a client whose partner left her. She was unable to accept that the relationship was over, and spent a ton of energy on begging and threatening phone calls, emails, and texts, trying to get her ex to come back. The months during which she couldn't or wouldn't accept the end of the relationship stalled the necessary grieving process and prevented her from moving forward. When she finally accepted that her relationship was over, she was still sad and disappointed, but she also felt some relief--the struggle to hold onto the relationship was over, freeing up mental space that she used to look for a new apartment, consider dating again, and start settling into her new circumstances.
Finally, acceptance is a big issue for chronic pain patients. Unfortunately, chronic pain can often only be managed, not cured, and at some point, most patients are told that some degree of pain will always be present and that they need to accept it and find ways to adapt. This is hard, and many patients continue to consult specialist after specialist, seeking a different diagnoses or new treatment options. Eventually, with or without psychological help, some patients come to accept the diagnosis of chronic pain; they are then able to take the time and energy spent on resistance and medical consultations and redirect it toward improving quality of life and learning to live well despite pain.
Acceptance sounds easy but isn't. It takes significant strength and motivation to let go of how you think things should be or how you wish they were, and to work wisely and effectively with your reality, especially when you don't like it. Accepting can be the hardest and bravest thing you can do.
March 28, 2012
Mindfulness
Last January, I wrote about how mindfulness was taking the psychology world by storm. One year later, interest in mindfulness hasn't abated; if anything, it's grown--in my personal world, in the mental health field, and in Western culture at large.
What exactly is mindfulness again?
Mindfulness involves purposeful attention and awareness in the present moment, with acceptance and without judgment. Let's look more closely at the four key components of the definition, all of which overlap:
What exactly is mindfulness again?
Mindfulness involves purposeful attention and awareness in the present moment, with acceptance and without judgment. Let's look more closely at the four key components of the definition, all of which overlap:
- Being in the present moment: Being mindful means being present no matter what you're doing. It means that when you talk with someone, you listen and actually hear and respond to what he or she says, rather than thinking about what you did earlier in the day, or only half paying attention while you smile and nod automatically. It means that when you eat dinner, you actually taste and appreciate your food, rather than reading while you eat or fantasizing about dessert or about what you're doing later.
- Awareness: Mindfulness means being aware of what's going on inside and around you, a kind of "waking up" to your life. The idea is that we sleepwalk through a lot of our days, without questioning our habits, routines, and reactions, and without noticing the impact they have on us and on the people around us. Mindful awareness means that when you find yourself doing something unusual or unhelpful, (e.g., eating when you're not hungry, drinking too much, overreacting to an innocent comment, avoiding your email inbox), you notice your behaviour and ask yourself "what's that about?"
- Attention: Being present and aware requires focused attention. You can't be in the present moment if your mind is off in the past or the future, and you can't be aware of yourself, others, or your environment if you aren't paying attention. Part of being mindful is cultivating the ability to focus your attention on what's happening now. Minds naturally drift away from the present, but with greater awareness and with meditation training, you develop the ability to notice when your mind drifts off and the discipline to bring your attention back to the present. These skills are cultivated by guided meditation exercises that use various anchors (e.g. the breath, body sensations, sounds in the environment) to increase your capacity for sustained and focused attention.
- Acceptance and non-judgment: In addition to being aware and attentive to what's happening as it's happening, mindfulness implies a kind of equanimity and acceptance of experience. The idea is that whatever's happening--pleasant or unpleasant--is already happening, and that struggling against the experience or labeling it as awful is unhelpful. We can develop equanimity in the face of any event or outcome by accepting the raw experience, rather than piling on layers of resistance and secondary emotions. Importantly, acceptance doesn't mean resignation; it doesn't mean that you have to accept everything that comes your way and never try to change or improve your circumstances. Rather, it means being aware and accepting of the facts. Accepting that your bus is late, that your partner forgot your birthday, or that you lost your job--rather than denying or resisting--frees up your energy and attention to decide what you want to do about it.
August 15, 2011
Rain Check
Earlier this summer, I took a six-week workshop about dealing with emotions using (among other things) mindfulness and CBT strategies. Of the things I learned in the workshop, my favourite was that the word emotion comes from a Latin root that means to move through or to move out.
I love this! It reminds me that emotions are transient in nature, and that the way out is through (that is, that experiencing tough emotions makes them dissipate much more quickly than does avoiding them). But what's the best way to move through (and therefore, beyond) painful feelings?
There's an acronym that can be used to deal mindfully with uncomfortable emotions: RAIN. It's often taught in Buddhist meditation circles, but you definitely don't have to be Buddhist or even into Buddhism to use it. All you need is to be willing to try it, even when it's hard.
R is for Recognition, the first step to mindfulness in the midst of powerful or painful emotion. Recognition means that you take a second to acknowledge and label the emotion, asking yourself what exactly you're feeling and naming it (e.g., fear, guilt, anxiety, shame). Identifying and labeling emotions forces you to step outside the swirly vortex of feelings, at least briefly. It normalizes emotions and reduces their power.
A is for Acceptance, which means deciding that whatever you're feeling is okay. Give yourself permission to experience any emotion under the sun. You don't have to like the emotion or be happy that you feel that way, but you also don't need to judge yourself for it (creating secondary emotions). When you have a feeling that you find hard to accept (e.g., rage at a loved one), it can help to think of the emotion as your own secret. No one can see how you feel inside; you get to decide whether or not to act on it or express it, and if you don't, no one will ever know how you felt. The idea of your emotions as secret can help you accept them, whatever they are.
I is for Investigation. One way to be mindful with your emotions is to stop trying to think about what they might mean or how you can get rid of them and to instead explore how they feel in your body. In the investigation step, you adopt an attitude of curiosity about how the emotion manifests itself physically, what it feels like inside you. Ask yourself how you know you're feeling a particular emotion: what tells you that you're disappointed, anxious, or scared? Is your face cold, are your limbs prickly, or your belly made of lead? All emotions have some kind of physical manifestation and bringing your attention to it forces you out of your head, away from avoidance, and into the present experience.
N is for Non-identification. This means remembering that the definition of emotion involves movement, and adopting a "this too shall pass" attitude. It means creating some space around the emotion, rather than being one with it. Think of it as a visitor who dropped by. You can open the door and let it in, and acknowledge that it's present. You can even sit in in the living room and serve it tea, but you don't have to identify with it or get tangled up in it. The emotion isn't who or what you are.
The next time you feel your emotions taking over, try letting it RAIN!
I love this! It reminds me that emotions are transient in nature, and that the way out is through (that is, that experiencing tough emotions makes them dissipate much more quickly than does avoiding them). But what's the best way to move through (and therefore, beyond) painful feelings?
There's an acronym that can be used to deal mindfully with uncomfortable emotions: RAIN. It's often taught in Buddhist meditation circles, but you definitely don't have to be Buddhist or even into Buddhism to use it. All you need is to be willing to try it, even when it's hard.
R is for Recognition, the first step to mindfulness in the midst of powerful or painful emotion. Recognition means that you take a second to acknowledge and label the emotion, asking yourself what exactly you're feeling and naming it (e.g., fear, guilt, anxiety, shame). Identifying and labeling emotions forces you to step outside the swirly vortex of feelings, at least briefly. It normalizes emotions and reduces their power.
A is for Acceptance, which means deciding that whatever you're feeling is okay. Give yourself permission to experience any emotion under the sun. You don't have to like the emotion or be happy that you feel that way, but you also don't need to judge yourself for it (creating secondary emotions). When you have a feeling that you find hard to accept (e.g., rage at a loved one), it can help to think of the emotion as your own secret. No one can see how you feel inside; you get to decide whether or not to act on it or express it, and if you don't, no one will ever know how you felt. The idea of your emotions as secret can help you accept them, whatever they are.
I is for Investigation. One way to be mindful with your emotions is to stop trying to think about what they might mean or how you can get rid of them and to instead explore how they feel in your body. In the investigation step, you adopt an attitude of curiosity about how the emotion manifests itself physically, what it feels like inside you. Ask yourself how you know you're feeling a particular emotion: what tells you that you're disappointed, anxious, or scared? Is your face cold, are your limbs prickly, or your belly made of lead? All emotions have some kind of physical manifestation and bringing your attention to it forces you out of your head, away from avoidance, and into the present experience.
N is for Non-identification. This means remembering that the definition of emotion involves movement, and adopting a "this too shall pass" attitude. It means creating some space around the emotion, rather than being one with it. Think of it as a visitor who dropped by. You can open the door and let it in, and acknowledge that it's present. You can even sit in in the living room and serve it tea, but you don't have to identify with it or get tangled up in it. The emotion isn't who or what you are.
The next time you feel your emotions taking over, try letting it RAIN!
July 05, 2011
Emotions About Emotions
Mental health tip: Don't have emotions about your emotions.
Psychologists differentiate between primary or "clean" emotions and secondary or "dirty" emotions. The first are the emotions you feel in direct reaction to what's going on. You feel sad because your cat died, or jealous because your colleague got the job you wanted, or lonely because you're alone. Secondary or "dirty" emotions are the ones you feel in reaction to your primary emotions. You feel guilty that you're sad about your cat when your friend's brother just died, or ashamed that you're jealous of your colleague's new job instead of happy for her, or embarrassed that you're not good at spending time alone.
Secondary emotions indicate a struggle against or judgment of the initial emotion. They are the direct result of thinking I shouldn't feel this way. This reaction is common; one major culprit is the widespread belief that happiness or contentedness is the norm, and that strong or negative emotions are bad or abnormal or harmful and should be avoided at all costs. Despite ample evidence to the contrary, many of us believe that happiness is the normal baseline, and use this belief to berate ourselves for feeling bad.
The idea of happiness as normal is being challenged by a relatively new therapeutic approach called Acceptance and Commitment Therapy (ACT). ACT is based on, among other things, acceptance of difficult emotions, thoughts, and impulses. A primary objective of ACT is to use mindfulness to accept difficult or negative experiences (emotional or other) as normal, and to let go of the struggle to be free of them.
If you're thinking "Isn't this kind of incongruent with CBT, where you're supposed to identify the distorted thought that created the negative emotion and adjust the thought so you can get rid of the emotion?" the answer is yes. This is a critical debate between CBT and ACT. Proponents of ACT think that CBT is too focused on changing or getting rid of negative emotions, promoting the idea that pain, anger, and anxiety (among other emotions) are bad or abnormal.
I believe in both. If your unpleasant emotion is the result of a distorted thought, then by all means: identify the distortion, modify the thought, and enjoy the accompanying shift in feeling. However, if you're experiencing a primary emotion in reaction to something that's really happening, consider that strong negative emotions are normal and part of what makes you human. Try saying to yourself "I should feel this way. Given what's going on, of course I feel this way." Give yourself a break and don't pile on that unnecessary second round of judging emotions.
NB: The examples above of primary or clean emotions are not the only acceptable ones. If you feel relieved that your cat died or angry because you're lonely, that's okay too! When we feel less intuitive emotions, that's when we're even more likely to start layering secondary emotions, and probably when it's most important not to.
Psychologists differentiate between primary or "clean" emotions and secondary or "dirty" emotions. The first are the emotions you feel in direct reaction to what's going on. You feel sad because your cat died, or jealous because your colleague got the job you wanted, or lonely because you're alone. Secondary or "dirty" emotions are the ones you feel in reaction to your primary emotions. You feel guilty that you're sad about your cat when your friend's brother just died, or ashamed that you're jealous of your colleague's new job instead of happy for her, or embarrassed that you're not good at spending time alone.
Secondary emotions indicate a struggle against or judgment of the initial emotion. They are the direct result of thinking I shouldn't feel this way. This reaction is common; one major culprit is the widespread belief that happiness or contentedness is the norm, and that strong or negative emotions are bad or abnormal or harmful and should be avoided at all costs. Despite ample evidence to the contrary, many of us believe that happiness is the normal baseline, and use this belief to berate ourselves for feeling bad.
The idea of happiness as normal is being challenged by a relatively new therapeutic approach called Acceptance and Commitment Therapy (ACT). ACT is based on, among other things, acceptance of difficult emotions, thoughts, and impulses. A primary objective of ACT is to use mindfulness to accept difficult or negative experiences (emotional or other) as normal, and to let go of the struggle to be free of them.
If you're thinking "Isn't this kind of incongruent with CBT, where you're supposed to identify the distorted thought that created the negative emotion and adjust the thought so you can get rid of the emotion?" the answer is yes. This is a critical debate between CBT and ACT. Proponents of ACT think that CBT is too focused on changing or getting rid of negative emotions, promoting the idea that pain, anger, and anxiety (among other emotions) are bad or abnormal.
I believe in both. If your unpleasant emotion is the result of a distorted thought, then by all means: identify the distortion, modify the thought, and enjoy the accompanying shift in feeling. However, if you're experiencing a primary emotion in reaction to something that's really happening, consider that strong negative emotions are normal and part of what makes you human. Try saying to yourself "I should feel this way. Given what's going on, of course I feel this way." Give yourself a break and don't pile on that unnecessary second round of judging emotions.
NB: The examples above of primary or clean emotions are not the only acceptable ones. If you feel relieved that your cat died or angry because you're lonely, that's okay too! When we feel less intuitive emotions, that's when we're even more likely to start layering secondary emotions, and probably when it's most important not to.
January 28, 2011
Resolutions Resolved
One month after New Year’s, a lot of us are assessing how we’re doing with our resolutions. If you’re happy with your progress, nice work. If not, two different psych concepts might help:
1) Timing: A basic principle of behaviour change is that, to be effective, the reward or punishment for a given behaviour has to occur close in time to the behaviour. For example, giving the dog a treat an hour after it rolls over or sending your child to her room the day after she misbehaves is not effective. The timing principle explains why lifestyle-related behaviour changes like losing weight, getting fit, or quitting smoking can be hard. The delay between behaviours like skipping dessert or working out and the rewards of losing weight or seeing changes in your physique is too long. The same holds for punishment. Lung cancer 15 years from now is not an effective punishment; it would be much easier to quit if a cigarette this morning gave you cancer this afternoon.
What to do: close the distance between the behaviour and the reward or punishment by creating interim rewards or punishments. For example, decide that eating three healthy and balanced meals today means you can watch an extra episode of whatever show you’re hooked on before bed. Get your partner to agree to give you a half-hour massage on Saturday if you go to the gym three times this week and to hide your laptop (or crochet needles, chocolate, camera, other important item) for 24 hours if you smoke more than one cigarette per day. Adjust the rewards and punishments until they work for you!
2) Values: Why do you want to quit smoking, lose weight, or spend more time with friends this year? Values describe what’s meaningful to you, what you stand for, and how you want to relate to and interact with other people and with the world. Values provide direction and motivation; connecting with them can help you commit to behaviour change and give you the sense that your hard work is worth the effort (in fact, there exists an entire school of therapy based on mindfulness and commitment to taking action guided by values). For example, remembering that I value my physical health will help me exercise and eat well even when I don’t feel like it; connecting with my value of close family ties will help me keep my resolution to spend more time with my family, even when it’s inconvenient or requires expensive travel.
Let me know if this helps!
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