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?
Showing posts with label X versus Y. Show all posts
Showing posts with label X versus Y. Show all posts
June 03, 2013
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.
February 19, 2012
Friendship versus Therapy
A friend called me today to ask for advice about a conflict in his relationship with a mutual friend. After listening for five minutes, I told him exactly how I thought he should handle it. He was grateful and I was pleased; I joked that I wish that I could do the same thing with my clients--that is, tell them what to do and make everyone happy. After we hung up, I started thinking about the difference between friendship and therapy. In both cases, I provide support, give advice, and, to varying degrees, facilitate insight and personal growth. So what's the difference?
One of the biggest differences is that, for two reasons, I rarely flat out tell a client what I think he or she should do. Why not?
1) It's risky. I know my clients in a very limited context. I've never been to their home or to their workplace and I haven't met their partners, children, friends, or colleagues. If I tell a client how she should, for example, discipline her daughter, handle her overbearing boss, or respond to learning that her partner reads her personal emails, it could easily backfire, causing significant distress for which I would be partly responsible. Further, my client and I may have very different values, and a solution that seems perfectly appropriate to me may be completely out of the question for her. I know most of my friends much better than I know my clients and we share a lot of the same values, making it less likely that I would give bad advice (and if I did, there would be no question of professional liability).
And the more important reason:
2) It's kind of like "Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime." The goal of therapy is to render the therapist obsolete; I want clients to gain enough insight into their behaviour and develop enough new skills for problem-solving and for managing stress and distress that they no longer need a therapist. Telling clients what to do does not facilitate learning, and so a client who asks for straight-up advice will often get the answer-a-question-with-a-question technique. For example, if a client asks "Do you think I should take antidepressants?" I'll ask "What are some things that helped last time you were depressed?" If a client asks "Should I leave my partner?" I'll say "What are some of your options?"
It can be challenging to not tell clients what I think they should do--especially if it seems obvious--but it's much more powerful if they figure it out on their own. And when clients surprise me by demonstrating that they learned exactly what I was hoping they'd learn (e.g., "None of my avoidance habits really work. I guess it's time to try something different," or "I notice that when I force myself to be active, even if I don't feel like it, my mood lifts"), it's therapy gold.
NB: There are two situations in which I would tell a client exactly what to do. The first is if I have a tip the client can use to solve a practical problem (e.g., If you're suffering from insomnia, don't get into bed until you're tired; if you keep falling asleep during your relaxation exercises, try doing them before instead of after lunch). The second is a suicidal or other serious crisis (e.g., "When we hang up the phone, call your husband; if he doesn't answer, go to the ER").
One of the biggest differences is that, for two reasons, I rarely flat out tell a client what I think he or she should do. Why not?
1) It's risky. I know my clients in a very limited context. I've never been to their home or to their workplace and I haven't met their partners, children, friends, or colleagues. If I tell a client how she should, for example, discipline her daughter, handle her overbearing boss, or respond to learning that her partner reads her personal emails, it could easily backfire, causing significant distress for which I would be partly responsible. Further, my client and I may have very different values, and a solution that seems perfectly appropriate to me may be completely out of the question for her. I know most of my friends much better than I know my clients and we share a lot of the same values, making it less likely that I would give bad advice (and if I did, there would be no question of professional liability).
And the more important reason:
2) It's kind of like "Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime." The goal of therapy is to render the therapist obsolete; I want clients to gain enough insight into their behaviour and develop enough new skills for problem-solving and for managing stress and distress that they no longer need a therapist. Telling clients what to do does not facilitate learning, and so a client who asks for straight-up advice will often get the answer-a-question-with-a-question technique. For example, if a client asks "Do you think I should take antidepressants?" I'll ask "What are some things that helped last time you were depressed?" If a client asks "Should I leave my partner?" I'll say "What are some of your options?"
It can be challenging to not tell clients what I think they should do--especially if it seems obvious--but it's much more powerful if they figure it out on their own. And when clients surprise me by demonstrating that they learned exactly what I was hoping they'd learn (e.g., "None of my avoidance habits really work. I guess it's time to try something different," or "I notice that when I force myself to be active, even if I don't feel like it, my mood lifts"), it's therapy gold.
NB: There are two situations in which I would tell a client exactly what to do. The first is if I have a tip the client can use to solve a practical problem (e.g., If you're suffering from insomnia, don't get into bed until you're tired; if you keep falling asleep during your relaxation exercises, try doing them before instead of after lunch). The second is a suicidal or other serious crisis (e.g., "When we hang up the phone, call your husband; if he doesn't answer, go to the ER").
January 29, 2012
Public versus Private
Last September, I started a clinical internship at a chronic pain centre in one of Montreal's hospitals. A few weeks ago, I started a concurrent training program at a private psychology clinic. The differences between these two experiences are striking:
Physical environment and space. The pain centre is housed in a small wing of a large hospital, and there is a distinct lack of space. The clinic director and associate directors have their own offices, but the part-time doctors, visiting fellows, residents, and psychology interns shift around as needed, sharing offices and computers. The rooms in which we see patients are relatively barren, with fluorescent lighting and hospital beds; on busy days when no rooms are free, psychology staff have been known to see patients in the conference room and the kitchen.
In contrast, the office at the private clinic is lovely--exposed brick, plants, and tasteful, comfortable furniture. The handful of therapists all take turns using the office, but when I book it, it's mine and there's no risk of having to conduct psychotherapy in the kitchen.
Multidisciplinary collaboration. At the pain centre, we have biweekly meetings to discuss patients as a team; rheumatologists solicit advice from anesthesiologists, internists seek advice from psychologists, and I learn a lot. If during a session with me, a patient has a question about medication or another component of his medical treatment, I can usually snag a doctor in the hall and get him or her to join us for a few minutes. Sometimes pain centre doctors come into the psych office to see if one of the psychologists or interns is free to sit in on an appointment with a patient and provide an on-the-spot psych evaluation.
Private practice is much less multidisciplinary. At the private clinic, I'm by myself or with my supervisor, who is a psychologist. If I need to, I can (with the client's consent) contact his or her GP or psychiatrist, but it's not usually necessary.
Social support and interaction. At the pain centre, after my patient leaves, I usually go across the hall to discuss the session with my supervisor. I might get stopped on the way by the patient's doctor, wanting to know the result of my psych evaluation; by a anesthesiology resident who wants to know more about CBT; or by a fellow psych intern who wants me to read over a report she's written.
At the private clinic, when the client leaves, I'm by myself. I can call my supervisor at any time, but I'm physically alone and it's easy to see why some therapists find private practice lonely.
Patients versus clients. At the pain centre, we use the term patient rather than client. To me, this term fits because the pain centre is part of the public healthcare system (i.e., it's not for profit, services are free, and everyone has access) and because it's primarily a medical clinic. The advantage: many patients have been waiting months for an appointment and are therefore grateful to be seen and unfazed by an extra hour in the waiting room or by psychotherapy in the kitchen. The disadvantage: some patients aren't keen on seeing a psychologist, agreed to it only because their pain centre doctor insisted, and have no qualms about missing appointments without calling.
In private practice, I see clients--people who have researched and chosen the clinic where I work from among many options, and who are paying to see me. This creates a different dynamic, wherein the client is more of a consumer. A therapy hour is always fifty minutes, both client and therapist are expected to be on time, and clients are unlikely to miss sessions without calling. Unlike in the public system, all of my clients are people with the time, money, and motivation to seek psychotherapy.
Although I'm new to both positions, I suspect that the differences I've observed reflect global differences between working in a hospital or other public clinic and working in private practice. There are clear advantages and disadvantages to both milieux, and it's not hard to see why nearly every psychologist I know works in both.
Physical environment and space. The pain centre is housed in a small wing of a large hospital, and there is a distinct lack of space. The clinic director and associate directors have their own offices, but the part-time doctors, visiting fellows, residents, and psychology interns shift around as needed, sharing offices and computers. The rooms in which we see patients are relatively barren, with fluorescent lighting and hospital beds; on busy days when no rooms are free, psychology staff have been known to see patients in the conference room and the kitchen.
In contrast, the office at the private clinic is lovely--exposed brick, plants, and tasteful, comfortable furniture. The handful of therapists all take turns using the office, but when I book it, it's mine and there's no risk of having to conduct psychotherapy in the kitchen.
Multidisciplinary collaboration. At the pain centre, we have biweekly meetings to discuss patients as a team; rheumatologists solicit advice from anesthesiologists, internists seek advice from psychologists, and I learn a lot. If during a session with me, a patient has a question about medication or another component of his medical treatment, I can usually snag a doctor in the hall and get him or her to join us for a few minutes. Sometimes pain centre doctors come into the psych office to see if one of the psychologists or interns is free to sit in on an appointment with a patient and provide an on-the-spot psych evaluation.
Private practice is much less multidisciplinary. At the private clinic, I'm by myself or with my supervisor, who is a psychologist. If I need to, I can (with the client's consent) contact his or her GP or psychiatrist, but it's not usually necessary.
Social support and interaction. At the pain centre, after my patient leaves, I usually go across the hall to discuss the session with my supervisor. I might get stopped on the way by the patient's doctor, wanting to know the result of my psych evaluation; by a anesthesiology resident who wants to know more about CBT; or by a fellow psych intern who wants me to read over a report she's written.
At the private clinic, when the client leaves, I'm by myself. I can call my supervisor at any time, but I'm physically alone and it's easy to see why some therapists find private practice lonely.
Patients versus clients. At the pain centre, we use the term patient rather than client. To me, this term fits because the pain centre is part of the public healthcare system (i.e., it's not for profit, services are free, and everyone has access) and because it's primarily a medical clinic. The advantage: many patients have been waiting months for an appointment and are therefore grateful to be seen and unfazed by an extra hour in the waiting room or by psychotherapy in the kitchen. The disadvantage: some patients aren't keen on seeing a psychologist, agreed to it only because their pain centre doctor insisted, and have no qualms about missing appointments without calling.
In private practice, I see clients--people who have researched and chosen the clinic where I work from among many options, and who are paying to see me. This creates a different dynamic, wherein the client is more of a consumer. A therapy hour is always fifty minutes, both client and therapist are expected to be on time, and clients are unlikely to miss sessions without calling. Unlike in the public system, all of my clients are people with the time, money, and motivation to seek psychotherapy.
Although I'm new to both positions, I suspect that the differences I've observed reflect global differences between working in a hospital or other public clinic and working in private practice. There are clear advantages and disadvantages to both milieux, and it's not hard to see why nearly every psychologist I know works in both.
August 04, 2011
Will Power versus Rules
If you want to make a difficult behaviour change, forget about will power and try making a rule instead.
I just finished reading The End of Overeating: Taking Control of the Insatiable American Appetite by David A. Kessler, a book about the psychology and physiology of compulsive eating and the role of the food industry. In the 'self-help for overeaters' section, the author recommends that, rather than counting on will power, overeaters should implement strict and absolute rules to eliminate struggle when faced with foods that trigger overeating. According to Dr. Kessler, absolute rules eliminate the need for will power! Here's why: Will power is invoked in the moment. The second you're faced with a desired stimulus (let's say cake, but it could also be a desirable but unnecessary purchase, or reading your favourite news sites and blogs rather than starting to work in the morning), will power pits the force of your desire for the reward (food, purchase, Internet) against the force of your determination to resist, creating discomfort.
In contrast, a rule is a long-term principle created in advance and not in the presence of the desired/rewarding stimulus. A rule (e.g., "No dessert") is based on experience and on a rationale (e.g., that much sugar makes my heart race and gives me a sugar hangover the next day; I want to maintain my weight; I know if I have one piece, I'll end up having seconds and thirds) that allows you to inhibit your normal behaviour (see cake, eat cake), without struggle ("I want it--no, I shouldn't have any--but it's a party and I deserve it--but what about my weight--okay, maybe a small piece"). Having an absolute and completely integrated rule allows you to avoid the impossible task of remembering your rationale at the moment you're faced with the desired stimulus--the rule is so internalized that it's a given.
A budget rule is another example: say you and your partner decide that travel is one of your most important values, and that in order to save money to travel, your rule is to never eat out when you're in town. When you receive an invitation to go out for dinner, you don't debate or agonize or argue over it, because the decision is pre-made: you're not going. No struggle and no will power necessary!
The distinction between rules and will power caught my attention because this year, I stopped eating grains--no pasta, bread, rice, and no most desserts--and have been training (running) harder than ever before. Observing me decline brownies and skip social occasions to go for long training runs, a few people have commented on my will power. This comment makes me feel uncomfortable because it rings untrue: if I have so much will power, why don't I stop eating family-sized bags of Nibs in one sitting, repeatedly interrupting my work to check my email, and scratching mosquito bites until they become scars?
The concept of rules provides an explanation: I am following two completely integrated and internalized rules: 1) No grains; 2) The training schedule is law. These rules are congruent with the definition provided by Dr. Kessler: both were created in advance (in January and years ago, respectively), for rational personal reasons (related to physical and mental health) based on my experience and consistent with my long-term goals, and they allow me to inhibit my default behaviour (i.e., eat any and all available baked goods; sleep in/prioritize social life). So when I turn down a fresh cinnamon bun, it's not because I have will power (which implies that I struggled with the decision), it's that my rule dictates that cinnamon buns aren't even an option. Same with following my training schedule: I don't struggle over getting up early or skipping your party to run; it's not hard and it doesn't involve will power. (Think about vegetarians who used to enjoy meat. I don't think they struggle every time someone offers them a burger; they're just following their very integrated rule.)
I think what might take will power is the initial creation of the rule--making the rule and sticking to it until it becomes entirely integrated. The two rules above are the only ones I've succeeded in internalizing to the point that there's no struggle. Among myriad others, I've tried "11pm is bedtime," and "no email checking until lunchtime" without success.
NB: The use of absolute rules isn't entirely positive, and rules aren't for everyone. I think they may be more helpful for abstainers (people who are successful with a 'cold turkey' or all-or-nothing approach) than for moderators (people who can successfully indulge moderately or occasionally). (Read about this distinction here.) Further, the inherently rigid nature of rules can create problems (e.g., following your training schedule to the letter even when you're injured; following your no-dinners-out rule even when it's your best friend's milestone birthday party).
What are your rules? Do they work?
I just finished reading The End of Overeating: Taking Control of the Insatiable American Appetite by David A. Kessler, a book about the psychology and physiology of compulsive eating and the role of the food industry. In the 'self-help for overeaters' section, the author recommends that, rather than counting on will power, overeaters should implement strict and absolute rules to eliminate struggle when faced with foods that trigger overeating. According to Dr. Kessler, absolute rules eliminate the need for will power! Here's why: Will power is invoked in the moment. The second you're faced with a desired stimulus (let's say cake, but it could also be a desirable but unnecessary purchase, or reading your favourite news sites and blogs rather than starting to work in the morning), will power pits the force of your desire for the reward (food, purchase, Internet) against the force of your determination to resist, creating discomfort.
In contrast, a rule is a long-term principle created in advance and not in the presence of the desired/rewarding stimulus. A rule (e.g., "No dessert") is based on experience and on a rationale (e.g., that much sugar makes my heart race and gives me a sugar hangover the next day; I want to maintain my weight; I know if I have one piece, I'll end up having seconds and thirds) that allows you to inhibit your normal behaviour (see cake, eat cake), without struggle ("I want it--no, I shouldn't have any--but it's a party and I deserve it--but what about my weight--okay, maybe a small piece"). Having an absolute and completely integrated rule allows you to avoid the impossible task of remembering your rationale at the moment you're faced with the desired stimulus--the rule is so internalized that it's a given.
A budget rule is another example: say you and your partner decide that travel is one of your most important values, and that in order to save money to travel, your rule is to never eat out when you're in town. When you receive an invitation to go out for dinner, you don't debate or agonize or argue over it, because the decision is pre-made: you're not going. No struggle and no will power necessary!
The distinction between rules and will power caught my attention because this year, I stopped eating grains--no pasta, bread, rice, and no most desserts--and have been training (running) harder than ever before. Observing me decline brownies and skip social occasions to go for long training runs, a few people have commented on my will power. This comment makes me feel uncomfortable because it rings untrue: if I have so much will power, why don't I stop eating family-sized bags of Nibs in one sitting, repeatedly interrupting my work to check my email, and scratching mosquito bites until they become scars?
The concept of rules provides an explanation: I am following two completely integrated and internalized rules: 1) No grains; 2) The training schedule is law. These rules are congruent with the definition provided by Dr. Kessler: both were created in advance (in January and years ago, respectively), for rational personal reasons (related to physical and mental health) based on my experience and consistent with my long-term goals, and they allow me to inhibit my default behaviour (i.e., eat any and all available baked goods; sleep in/prioritize social life). So when I turn down a fresh cinnamon bun, it's not because I have will power (which implies that I struggled with the decision), it's that my rule dictates that cinnamon buns aren't even an option. Same with following my training schedule: I don't struggle over getting up early or skipping your party to run; it's not hard and it doesn't involve will power. (Think about vegetarians who used to enjoy meat. I don't think they struggle every time someone offers them a burger; they're just following their very integrated rule.)
I think what might take will power is the initial creation of the rule--making the rule and sticking to it until it becomes entirely integrated. The two rules above are the only ones I've succeeded in internalizing to the point that there's no struggle. Among myriad others, I've tried "11pm is bedtime," and "no email checking until lunchtime" without success.
NB: The use of absolute rules isn't entirely positive, and rules aren't for everyone. I think they may be more helpful for abstainers (people who are successful with a 'cold turkey' or all-or-nothing approach) than for moderators (people who can successfully indulge moderately or occasionally). (Read about this distinction here.) Further, the inherently rigid nature of rules can create problems (e.g., following your training schedule to the letter even when you're injured; following your no-dinners-out rule even when it's your best friend's milestone birthday party).
What are your rules? Do they work?
Subscribe to:
Posts (Atom)