Are you distracted from the truth that everything is basically okay? I often am.
I didn't get my favourite seat on the bus yesterday morning; it was snowing and there were no cabs when I left home to go out for dinner last night; I woke up this morning feeling anxious about work; a friend said something that hurt my feelings; the market didn't have the kind of cheese I wanted; and my hair doesn't look right as I'm getting ready to go out tonight.
I know what you're thinking: rough life, right? Yet each of these things bothered me, however briefly, and created annoyance or hurt or stress or disappointment.
When I teach mindfulness-based stress reduction (MBSR), one of the classes in the eight-week program is dedicated to coping mindfully with unpleasant emotions. In the discussion about mindful emotion regulation, we identify that negative feelings often stem from wanting--and not getting--things our way. That is, we want there to be taxis at the taxi stand, we want our favourite seat on the bus, we want our friends to be sensitive to our feelings, we want to look good all the time, and we want to be in a good mood. We want things our way.
It's easy to get so caught up in wanting what we want that the smallest deviations make us all worked up and unhappy. What's more, as soon as we get what we want, we usually want something else or something more. On the bus yesterday morning, I was initially pleased to get a seat on a very busy route that usually has standing room only. But no sooner did I sit down than I was distracted by the thought that I would prefer to sit further back. This morning I definitely was getting my way as I leisurely drank my coffee and read a magazine before heading to the gym--yet I was irritated and upset by my lingering anxiety. Although my Saturday morning was actually pretty lovely, I wanted it to be completely lovely. I wanted it my way.
What helped me snap out of it was one of the phrases we use in MBSR in the meditation related to painful emotions. Participants are asked to sit quietly and reflect on several questions, including the following: "Am I distracted from the truth that everything is basically okay?"
This question is great because in 99% of cases, the answer is YES. Yes, everything is basically okay and yes, I'm distracted from that truth. Yesterday, I was distracted from the pleasure of getting a seat on the bus by the existence of a "better" seat. Today, I was distracted from the truth that I was having a lovely morning by the prospect of the even lovelier one I wasn't having. Last night, I was distracted by the lack of cabs from the truth that I was happily headed to nice restaurant to enjoy a meal and a bottle of wine with good company. In each case, there's no question that the truth was that everything was basically okay.
The examples above are mostly minor upsets, but the lesson is equally applicable to weightier matters. Consider expecting
parents, for example: All they want is for their baby to be healthy. Once a healthy child is delivered, though, it's easy to
immediately switch to unhappiness with the hospital food and irritation
with the grandparents, forgetting the truth that everything is basically
okay.
Asking yourself "Am I distracted from the truth that everything is basically okay?" is a genius cross between getting over yourself and counting your blessings. The next time you're fretting, moping, or seething, try asking yourself the question. If you're like me, most of the time, the answer will be yes.
Let me know what happens!
PS: You can also try "Does everything have to be perfect in order for me to be happy?"
February 09, 2013
January 31, 2013
A Recipe for Depression
It's pretty much fact that people who are clinically depressed demonstrate distorted thinking. Their reactions to negative events are skewed and they're more likely to make attribution errors--that is, to assign distorted meanings and causation to the things that happen to them.
Three specific attribution errors have been demonstrated to be typical in people who are depressed; my non-scientific guess is that they also show up in non-depressed people and contribute to feeling bad.
1) Internal versus external. People who are depressed blame themselves when things go wrong. In contrast, people who aren't depressed are more likely to attribute negative events to external factors like bad luck, chance, or others' actions. For example, a depressed person who doesn't receive a call back after a job interview assumes she made a gaffe during the interview or didn't prepare well enough. A non-depressed person is more likely to acknowledge that another candidate may have had more experience, or that the position could have been given to an internal applicant. A depressed person who gets hit by a car blames himself for not being more careful, even though the driver was running a red light; if his child gets bullied at school, he blames himself for poor parenting even though the bullies are targeting other kids too.
2) Global versus specific: Non-depressed people typically view negative events as having only isolated or limited significance. In contrast, depressed people are more likely to conclude that a negative event has far-reaching or global implications. For example, a depressed person whose relationship didn't work out generalizes to other areas of his life and concludes that he has failed in every area; a non-depressed person is upset about the end of the relationship but can still acknowledge areas of his life where things are going well. A depressed person misses the bus in the morning and concludes that her whole day is shot; a non-depressed person acknowledges that the morning started poorly but figures that everything will be fine once she arrives at work.
3) Fixed versus changeable: Whereas non-depressed people often adopt a 'this too shall pass' attitude toward negative events or situations, people who are depressed view the same problems or situations as unlikely to change or improve. A depressed person feels lonely and believes she'll always be lonely; a non-depressed person acknowledges that she's going through a period of feeling alone but that it won't always be this way. A depressed person whose washer and dryer break in the same month that his cat gets sick and his transmission dies can't imagine a future wherein such things aren't happening to him; a non-depressed person knows that he's just having an unusually bad month. A depressed person who fails her exam because of poor study habits wonders if she should just give up on school altogether; a non-depressed person figures she can probably get help and learn new study habits.
In depressed people, attribution errors are problematic because they promote hopelessness and maintain depression. In non-depressed people, attribution errors just make us feel bad unnecessarily. In both cases, the first step is to realize that we're falling for these errors in thinking. The next time you're feeling down about some negative event, ask yourself if you're making an attribution error. If you think you might be, ask yourself: Is it really my fault? Am I overgeneralizing? What can I do about it?
NB: For other good questions to help you out of negative thought patterns, see here.
Three specific attribution errors have been demonstrated to be typical in people who are depressed; my non-scientific guess is that they also show up in non-depressed people and contribute to feeling bad.
1) Internal versus external. People who are depressed blame themselves when things go wrong. In contrast, people who aren't depressed are more likely to attribute negative events to external factors like bad luck, chance, or others' actions. For example, a depressed person who doesn't receive a call back after a job interview assumes she made a gaffe during the interview or didn't prepare well enough. A non-depressed person is more likely to acknowledge that another candidate may have had more experience, or that the position could have been given to an internal applicant. A depressed person who gets hit by a car blames himself for not being more careful, even though the driver was running a red light; if his child gets bullied at school, he blames himself for poor parenting even though the bullies are targeting other kids too.
2) Global versus specific: Non-depressed people typically view negative events as having only isolated or limited significance. In contrast, depressed people are more likely to conclude that a negative event has far-reaching or global implications. For example, a depressed person whose relationship didn't work out generalizes to other areas of his life and concludes that he has failed in every area; a non-depressed person is upset about the end of the relationship but can still acknowledge areas of his life where things are going well. A depressed person misses the bus in the morning and concludes that her whole day is shot; a non-depressed person acknowledges that the morning started poorly but figures that everything will be fine once she arrives at work.
3) Fixed versus changeable: Whereas non-depressed people often adopt a 'this too shall pass' attitude toward negative events or situations, people who are depressed view the same problems or situations as unlikely to change or improve. A depressed person feels lonely and believes she'll always be lonely; a non-depressed person acknowledges that she's going through a period of feeling alone but that it won't always be this way. A depressed person whose washer and dryer break in the same month that his cat gets sick and his transmission dies can't imagine a future wherein such things aren't happening to him; a non-depressed person knows that he's just having an unusually bad month. A depressed person who fails her exam because of poor study habits wonders if she should just give up on school altogether; a non-depressed person figures she can probably get help and learn new study habits.
In depressed people, attribution errors are problematic because they promote hopelessness and maintain depression. In non-depressed people, attribution errors just make us feel bad unnecessarily. In both cases, the first step is to realize that we're falling for these errors in thinking. The next time you're feeling down about some negative event, ask yourself if you're making an attribution error. If you think you might be, ask yourself: Is it really my fault? Am I overgeneralizing? What can I do about it?
NB: For other good questions to help you out of negative thought patterns, see here.
January 21, 2013
Enough is Enough
How's it going with your New Year's resolutions? If you're on track, good job! If you're less on track, read on:
Sometimes we're reluctant to take a baby step toward change or toward meeting a goal because the step seems too small. For example, say you resolved to quit smoking or to develop a regular meditation practice. And you decided to start by cutting back by two cigarettes per day or by meditating for five minutes every morning. Although these objectives are minor, you may find yourself not meeting them--because they feel almost too minor.
Part of my job as a cognitive-behavioural therapist is to help people identify the thoughts that prevent them from moving forward. One thought that shows up repeatedly is "It's not enough." For example, a patient's goal might be to introduce regular exercise into his routine in order to counter anxiety and improve physical health. If his usual day involves no exercise at all, we'd probably plan to start with something like five minutes of walking every evening. My patient might express enthusiasm about the plan--but then end up going out walking once or twice, and then quitting. When asked what happened, he might reply that five minutes just didn't seem like enough. Similarly, severely depressed patients sometimes resist the validated strategy of planning small pleasurable activities, because it seems like calling a friend, taking a bubble bath, or going to the movies just isn't enough to counter depression.
The scourge of "enough" is not limited to the clinical setting. It comes up for me regarding writing. More than once, I've set the goal of writing for fifteen minutes every day, only to abandon it because it doesn't seem like enough. Similarly, I have a friend who has already abandoned her New Year's resolution to address her credit card debt with weekly payments of $15--because $15 is just not enough.
Here are a couple tips that might help when you're set to abandon your goals because your small steps seem inconsequential:
a) "Enough" is arbitrary. Why is cutting back by two cigarettes per day insufficient? Would three be enough? Four? Where credit card debt is concerned, would $20 per week be acceptable or would it have to be $25 to meet the enough threshold? Who decides? Recognizing that our thresholds for enough are arbitrary and idiosyncratic can help us adjust our expectations and commit to small steps.
b) "Not enough" is how you get to "enough." Even if five minutes per day of walking isn't enough to immediately reduce my patient's anxiety or improve his physical health, it's a step toward enough. How will he get to twenty minutes per day if he doesn't start with five? Similarly, meditating five minutes per day may not seem like enough, but it's a step toward it. Recognizing that not enough is practically a required stop on the way to enough can help us persevere with small goals.
If the concept of enough is getting in your way, hopefully these tips will help you get back on track with your New Year's resolutions. Keep me posted!
January 16, 2013
Capacity for Empathy
How come sometimes you can listen to a colleague complain or to a friend vent for hours on end, never wavering in your sympathy, empathy, or active listening skills--but on other occasions, your patience wear thin after minutes?
Last fall, I posted about our capacity for composure, suggesting that composure is a limited and fluctuating resource dependent on physical comfort, mindfulness and the intensity of our stressors. Since then, I've been thinking about empathy--the often (but not necessarily) sympathetic identification with or experiencing of another person's thoughts, feelings and experiences. Empathy is a key component of friendships and of patient-therapist relationships, and a resource that may also be fluctuating and limited in nature.
For example, consider the time I lost my patience with my friend who kept repeating herself and unwisely retorted "I get it, already!" Not exactly empathetic! In retrospect, I can identify that it was the last week before the Christmas holidays and that we were spending the evening together after a long day of back-to-back therapy patients. That is, my capacity for empathy was low.
I was once on the receiving end of a breach in empathy on the part of my own therapist: I was complaining about something I wanted but felt was impossible to have and my therapist lost his patience and snapped something like "Can't you see that what you're looking for is right in front of you? Open your eyes!" I was pretty taken aback at the time but when I later learned that he had received some extremely distressing news about five minutes before our session, I understood a bit better. My therapist's capacity for empathy was very low during our session; otherwise impeccably appropriate, he slipped up and said something unhelpful and out of place.
For therapists and lay listeners alike, capacity for empathy seems to depend on a few things. First, similar to capacity for composure, having your basic physical needs met is key. It's hard to listen helpfully to someone else's problems when you're starving, exhausted, or have a raging headache. Second, capacity for empathy suffers when there's too much demand: if your best friend's marriage is breaking up and your sister just lost her job, you might not be a very good listener for your colleague who wants to discuss his toddler's bed-wetting. Third, it can be difficult to have empathy for others if you're having your own problems. If you were just diagnosed with a serious illness, your capacity to empathize with a friend's existential angst is probably pretty low.
Therapists need a pretty endless supply of empathy. To maintain capacity for empathy, in addition to attending to our basic physical needs, we need peer support (i.e., don't work all alone all week in your private office with no one to provide social interaction or peer support) and should avoid scheduling too many patients in one day, or too many patients in a row without a break. Further, awareness of how our personal lives are affecting us will allow us to monitor and minimize the impact on our work. Keeping these tips in mind can help us avoid exhausting our empathy reserves.
For non-therapists, the tips for maintaining the capacity for empathy are no different: in addition to making sure your basic physical needs are met, don't spread yourself too thin empathy-wise (e.g., if you spent the morning consoling your sister over her job loss and your friend calls to discuss his relationship woes, you might want to limit the length of the conversation or call him back later). Remember that your empathy reserves may be low if you're dealing with your own serious problems, and feel free to hoard most of your empathy for yourself during those times. Keeping these tips in mind can help you avoid breaches in empathy and maintain your reputation as an empathetic listener.
Last fall, I posted about our capacity for composure, suggesting that composure is a limited and fluctuating resource dependent on physical comfort, mindfulness and the intensity of our stressors. Since then, I've been thinking about empathy--the often (but not necessarily) sympathetic identification with or experiencing of another person's thoughts, feelings and experiences. Empathy is a key component of friendships and of patient-therapist relationships, and a resource that may also be fluctuating and limited in nature.
For example, consider the time I lost my patience with my friend who kept repeating herself and unwisely retorted "I get it, already!" Not exactly empathetic! In retrospect, I can identify that it was the last week before the Christmas holidays and that we were spending the evening together after a long day of back-to-back therapy patients. That is, my capacity for empathy was low.
I was once on the receiving end of a breach in empathy on the part of my own therapist: I was complaining about something I wanted but felt was impossible to have and my therapist lost his patience and snapped something like "Can't you see that what you're looking for is right in front of you? Open your eyes!" I was pretty taken aback at the time but when I later learned that he had received some extremely distressing news about five minutes before our session, I understood a bit better. My therapist's capacity for empathy was very low during our session; otherwise impeccably appropriate, he slipped up and said something unhelpful and out of place.
For therapists and lay listeners alike, capacity for empathy seems to depend on a few things. First, similar to capacity for composure, having your basic physical needs met is key. It's hard to listen helpfully to someone else's problems when you're starving, exhausted, or have a raging headache. Second, capacity for empathy suffers when there's too much demand: if your best friend's marriage is breaking up and your sister just lost her job, you might not be a very good listener for your colleague who wants to discuss his toddler's bed-wetting. Third, it can be difficult to have empathy for others if you're having your own problems. If you were just diagnosed with a serious illness, your capacity to empathize with a friend's existential angst is probably pretty low.
Therapists need a pretty endless supply of empathy. To maintain capacity for empathy, in addition to attending to our basic physical needs, we need peer support (i.e., don't work all alone all week in your private office with no one to provide social interaction or peer support) and should avoid scheduling too many patients in one day, or too many patients in a row without a break. Further, awareness of how our personal lives are affecting us will allow us to monitor and minimize the impact on our work. Keeping these tips in mind can help us avoid exhausting our empathy reserves.
For non-therapists, the tips for maintaining the capacity for empathy are no different: in addition to making sure your basic physical needs are met, don't spread yourself too thin empathy-wise (e.g., if you spent the morning consoling your sister over her job loss and your friend calls to discuss his relationship woes, you might want to limit the length of the conversation or call him back later). Remember that your empathy reserves may be low if you're dealing with your own serious problems, and feel free to hoard most of your empathy for yourself during those times. Keeping these tips in mind can help you avoid breaches in empathy and maintain your reputation as an empathetic listener.
January 05, 2013
I Love Ya, Tomorrow
Last month, I went to see Annie on Broadway. Annie is the story of a plucky orphan living in New York City during the Great Depression. She escapes from the orphanage on a quest to find her birth parents and ends up adopting a dog, meeting then-president Roosevelt, and getting adopted by a billionaire.
One of the things that makes orphan Annie so beloved is her unshakable and infectious optimism; despite being destitute and having been abandoned by her parents, she always keeps her chin up. Several times during the show, Annie belts out her signature song, Tomorrow: "When I'm stuck with a day/that's gray/and lonely/I just stick out my chin/and grin/and say/tomorrow, tomorrow/I love ya, tomorrow/you're only a day away!"
Watching the 12-year-old actress playing Annie sing her heart out at centre stage, I was overwhelmed by emotion and optimism. I decided to adopt Annie's anthem as my personal theme song, convinced that the simple wisdom of Tomorrow could help me cope with everyday hassles and major life stresses. I sang the song in my head for days, confident in its optimistic message.
The following week, a friend who had been going through a tough time called me up for tips on using mindfulness to manage strong unpleasant feelings. She told me that her current strategy was to try not to think about it, to pretend the feelings weren't there, and to tell herself that tomorrow would be a better day--but that is wasn't working.
I put on my mindfulness teacher cap and suggested a new strategy: rather than ignoring or avoiding the unpleasant emotions, I proposed that my friend try to identify and acknowledge them, and even try to cultivate curiosity about her uncomfortable feelings. I reminded her that mindfulness means accepting and working with whatever's happening in the present moment--even when we don't like it.
After we hung up, though, I felt conflicted. What about Annie? What about "I love ya, tomorrow?" Mindfulness explicitly advocates being in the present moment, and optimism is generally future-oriented. So on bad days, can you live mindfully in the present and still comfort yourself with the prospect of better days to come?
I had to think about it, but the answer is yes. While mindfulness means residing primarily in the present moment, it doesn't mean never thinking about or looking forward to brighter days. The key is to be optimistic about the future without avoiding the present.
Example: Say you wake up feeling anxious. You head to the office as usual and dive into your work, doing your best to ignore the continued roiling in your belly and tightness in your chest. If you avoid addressing the feelings and sensations and just tell yourself that tomorrow will be better, you're being optimistic, and you may be right--you probably will feel better tomorrow--but you're also avoiding experiencing your feelings. In contrast, say that rather than plowing through the day ignoring your symptoms, you decide to use half your lunch hour to sit quietly, identify what's going on, and practice experiencing your emotions. You can still be optimistic and remind yourself that tomorrow will probably be better, but you're not avoiding your emotional experience (a strategy that doesn't usually work it the long term).
Second example: Say you and your partner are going through a rough patch. And say you reassure yourself with vague optimism about the future of the relationship, rather than exploring your feelings and identifying the problems. With this blind optimism strategy, you can avoid uncomfortable or unpleasant feelings, but the relationship problem might remain. Say that instead you optimistically hypothesize that you and your partner love each other enough to make it through a rough patch, and decide to try to identify the problem, investigate your feelings about it, and discuss it with your partner. Such optimism combined with your mindful acceptance of the problem will probably lead to an open conversation, increasing the likeliness that your hypothesis will come true.
I was relieved to determine that Now this is happening and I love ya, tomorrow are not incompatible and that I can keep Tomorrow as my bad-day theme song without renouncing mindfulness. So if you're having a tough day, go ahead and remind yourself that you probably won't feel this way tomorrow. The only catch is to not use optimism about tomorrow to avoid experiencing today--unpleasantness, discomfort, and all.
One of the things that makes orphan Annie so beloved is her unshakable and infectious optimism; despite being destitute and having been abandoned by her parents, she always keeps her chin up. Several times during the show, Annie belts out her signature song, Tomorrow: "When I'm stuck with a day/that's gray/and lonely/I just stick out my chin/and grin/and say/tomorrow, tomorrow/I love ya, tomorrow/you're only a day away!"
Watching the 12-year-old actress playing Annie sing her heart out at centre stage, I was overwhelmed by emotion and optimism. I decided to adopt Annie's anthem as my personal theme song, convinced that the simple wisdom of Tomorrow could help me cope with everyday hassles and major life stresses. I sang the song in my head for days, confident in its optimistic message.
The following week, a friend who had been going through a tough time called me up for tips on using mindfulness to manage strong unpleasant feelings. She told me that her current strategy was to try not to think about it, to pretend the feelings weren't there, and to tell herself that tomorrow would be a better day--but that is wasn't working.
I put on my mindfulness teacher cap and suggested a new strategy: rather than ignoring or avoiding the unpleasant emotions, I proposed that my friend try to identify and acknowledge them, and even try to cultivate curiosity about her uncomfortable feelings. I reminded her that mindfulness means accepting and working with whatever's happening in the present moment--even when we don't like it.
After we hung up, though, I felt conflicted. What about Annie? What about "I love ya, tomorrow?" Mindfulness explicitly advocates being in the present moment, and optimism is generally future-oriented. So on bad days, can you live mindfully in the present and still comfort yourself with the prospect of better days to come?
I had to think about it, but the answer is yes. While mindfulness means residing primarily in the present moment, it doesn't mean never thinking about or looking forward to brighter days. The key is to be optimistic about the future without avoiding the present.
Example: Say you wake up feeling anxious. You head to the office as usual and dive into your work, doing your best to ignore the continued roiling in your belly and tightness in your chest. If you avoid addressing the feelings and sensations and just tell yourself that tomorrow will be better, you're being optimistic, and you may be right--you probably will feel better tomorrow--but you're also avoiding experiencing your feelings. In contrast, say that rather than plowing through the day ignoring your symptoms, you decide to use half your lunch hour to sit quietly, identify what's going on, and practice experiencing your emotions. You can still be optimistic and remind yourself that tomorrow will probably be better, but you're not avoiding your emotional experience (a strategy that doesn't usually work it the long term).
Second example: Say you and your partner are going through a rough patch. And say you reassure yourself with vague optimism about the future of the relationship, rather than exploring your feelings and identifying the problems. With this blind optimism strategy, you can avoid uncomfortable or unpleasant feelings, but the relationship problem might remain. Say that instead you optimistically hypothesize that you and your partner love each other enough to make it through a rough patch, and decide to try to identify the problem, investigate your feelings about it, and discuss it with your partner. Such optimism combined with your mindful acceptance of the problem will probably lead to an open conversation, increasing the likeliness that your hypothesis will come true.
I was relieved to determine that Now this is happening and I love ya, tomorrow are not incompatible and that I can keep Tomorrow as my bad-day theme song without renouncing mindfulness. So if you're having a tough day, go ahead and remind yourself that you probably won't feel this way tomorrow. The only catch is to not use optimism about tomorrow to avoid experiencing today--unpleasantness, discomfort, and all.
January 01, 2013
At Your Service
If I had a friend who began every sentence with an apology, I might eventually point it out and ask her to knock it off. If a colleague told the same anecdote three times over the course of one lunch hour, I might tell him to quit repeating himself, or else intervene and change the subject.
But what if these things happened with my patients? What's the difference between conversations with friends and conversations with patients?
The difference is that with patients, everything I say or do should be in the service of the patient. With the friend and colleague in the examples above, I'd speak up to save myself from boredom and crankiness; with patients, my personal feelings are expressed if and only to the extent that expressing them would be helpful to the patient.
Example: Say I had a self-effacing patient who was driving me crazy by beginning every sentence with an apology. By the end of a session, I might want to snap "Quit apologizing!" but that would be a mistake. A better intervention would be to gently say something like "I've noticed that you frequently begin your sentences with an apology." Whereas the former comment expresses personal irritation, the latter is a simple and therapeutically relevant observation; the latter comment also allows for follow-up questions such as "Is apologizing something you also do with other people?" "How do you think your habit impacts your conversations?" and "How might you perceive someone who apologized all the time?" If later the patient and I were hypothesizing about how other people might perceive his constant apologizing, I could ask him for ideas (e.g. "People might think I have low confidence; they might think I'm being fake"), and then maybe add something like "Some people might find it endearing; others might find it frustrating." But my personal impatience would not be relevant.
Second example: Recently, I recently expressed frustration with a friend who kept repeating herself. She was struggling with the decision to move her elderly mother into residential care; despite my validation of the struggle and the decision, my friend continued to repeat just how much she loved and respected her mother, what a good parent her mother had been, etc. Finally I lost my patience and exclaimed "I get it, already--you love your mom!" This wasn't very helpful for my friend; a more helpful response would have been something like "Yes, you've mentioned that a few times. It must be really important for you to make that point clear."
With a patient, this kind of neutral comment is even more important, and often elicits useful information such as "I didn't know if you heard me the first time I said it because you just nodded but didn't say anything" or "I guess I feel guilty, like I'm just getting rid of my mom now that she's become a nuisance, or worried you'll think I'm a bad daughter" or "Really? I already said that?" With patients, these answers can prompt valuable conversations about validation, guilt, and social skills, respectively.
In therapy, comments like "Quit apologizing!" and "I get it!" are not appropriate because they imply a responsibility of the patient toward the therapist (e.g., to not be boring, to not waste my time), and because they express therapist feelings in a way that isn't relevant or helpful. But are there occasions when a therapist should express her true feelings? The answer is yes, but the same rule applies: only in the service of the patient.
Example: A depressed patient tells me he's bad at communicating and I respond that I've noticed that he's actually quite forthcoming and articulate in our sessions.
Example: A panic disorder patient tells me that he felt silly jogging on the spot in my office to try to induce panic symptoms for an exposure exercise, and I tell him that I was just thinking how brave he was to engage in an exercise designed to bring on symptoms that terrify him.
Example: A socially anxious patient reaches over in the middle of our session to pluck a stray hair off the arm of my sweater and then immediately asks, "Was that weird? Should I not have done that?" and I respond that her act didn't seem out of the realm of normal social behaviour, but that the timing was surprising and the gesture had taken me a bit off guard.
In each of these example, my comment is authentic and is designed to validate, bolster, and/or reflect reality to patients whose perspective may be unhelpfully distorted.
But what if these things happened with my patients? What's the difference between conversations with friends and conversations with patients?
The difference is that with patients, everything I say or do should be in the service of the patient. With the friend and colleague in the examples above, I'd speak up to save myself from boredom and crankiness; with patients, my personal feelings are expressed if and only to the extent that expressing them would be helpful to the patient.
Example: Say I had a self-effacing patient who was driving me crazy by beginning every sentence with an apology. By the end of a session, I might want to snap "Quit apologizing!" but that would be a mistake. A better intervention would be to gently say something like "I've noticed that you frequently begin your sentences with an apology." Whereas the former comment expresses personal irritation, the latter is a simple and therapeutically relevant observation; the latter comment also allows for follow-up questions such as "Is apologizing something you also do with other people?" "How do you think your habit impacts your conversations?" and "How might you perceive someone who apologized all the time?" If later the patient and I were hypothesizing about how other people might perceive his constant apologizing, I could ask him for ideas (e.g. "People might think I have low confidence; they might think I'm being fake"), and then maybe add something like "Some people might find it endearing; others might find it frustrating." But my personal impatience would not be relevant.
Second example: Recently, I recently expressed frustration with a friend who kept repeating herself. She was struggling with the decision to move her elderly mother into residential care; despite my validation of the struggle and the decision, my friend continued to repeat just how much she loved and respected her mother, what a good parent her mother had been, etc. Finally I lost my patience and exclaimed "I get it, already--you love your mom!" This wasn't very helpful for my friend; a more helpful response would have been something like "Yes, you've mentioned that a few times. It must be really important for you to make that point clear."
With a patient, this kind of neutral comment is even more important, and often elicits useful information such as "I didn't know if you heard me the first time I said it because you just nodded but didn't say anything" or "I guess I feel guilty, like I'm just getting rid of my mom now that she's become a nuisance, or worried you'll think I'm a bad daughter" or "Really? I already said that?" With patients, these answers can prompt valuable conversations about validation, guilt, and social skills, respectively.
In therapy, comments like "Quit apologizing!" and "I get it!" are not appropriate because they imply a responsibility of the patient toward the therapist (e.g., to not be boring, to not waste my time), and because they express therapist feelings in a way that isn't relevant or helpful. But are there occasions when a therapist should express her true feelings? The answer is yes, but the same rule applies: only in the service of the patient.
Example: A depressed patient tells me he's bad at communicating and I respond that I've noticed that he's actually quite forthcoming and articulate in our sessions.
Example: A panic disorder patient tells me that he felt silly jogging on the spot in my office to try to induce panic symptoms for an exposure exercise, and I tell him that I was just thinking how brave he was to engage in an exercise designed to bring on symptoms that terrify him.
Example: A socially anxious patient reaches over in the middle of our session to pluck a stray hair off the arm of my sweater and then immediately asks, "Was that weird? Should I not have done that?" and I respond that her act didn't seem out of the realm of normal social behaviour, but that the timing was surprising and the gesture had taken me a bit off guard.
In each of these example, my comment is authentic and is designed to validate, bolster, and/or reflect reality to patients whose perspective may be unhelpfully distorted.
December 11, 2012
Don't Believe the Hype
Although most of us would agree that worry, anxiety, and depression are unpleasant, these experiences are sometimes associated with positive beliefs. This is problematic because such positive beliefs make these mental health scourges resistant to change.
Example: Generalized Anxiety Disorder (GAD) is a disorder characterized by chronic worry and subsequent anxiety and physiological symptoms (e.g., muscle tension, headaches). People with GAD habitually create worry chains of worst-case scenarios, often starting with "what if" (e.g., My boss asked to see me, what if I made some kind of serious mistake, what if I get fired, how will we pay our bills? or My head hurts, what if it's something serious, what if it's fatal, who will take care of my kids?).
Although most GAD patients say they're sick of worrying and wish they could stop, it's well established that most people with this disorder have positive beliefs about worry. Among other things, they believe that worrying offers protection from feared outcomes (e.g., if I worry about my son being in a car crash, it's less likely to happen), that worrying is a positive personality trait (e.g., I'm the family worrier, it's how I show my love), or that worrying shelters them from potential future negative emotions (e.g., if I worry about losing my job, it won't hurt as much if I actually do).
Positive beliefs about unpleasant psychological symptoms aren't limited to GAD. A depressed patient told me that during her childhood, she and her siblings and their divorced parents scoffed at happy-seeming nuclear families, assuming that the happy families were either faking or stupid or both. As an adult, my patient still believed that being happy was synonymous with being phony and dumb and that being depressed meant that she was smart and authentic. I had a patient with an eating disorder who believed that her bulimia made her dramatic and interesting. Whenever she attended a social function involving food, she would refer to her "serious eating issues," generating instant curiosity and solicitousness. She believed that recovering from her eating disorder would make her boring and pedestrian. Finally, I used to believe that anxiety made me productive. I spent years resisting mindfulness and other enormously helpful relaxation techniques, believing that I'd never accomplish anything if I weren't anxious.
In such cases, the best strategy is not to simply tell people that their beliefs are wrong, but to get them to test the beliefs. My depressed patient took inventory of the people she knew who seemed happy. She found that many of them were both intelligent and genuine, demonstrating that her belief wasn't altogether accurate. My GAD patient practiced not worrying when his son made the five-hour drive to visit; he noticed that not only did his son arrive safely, but he enjoyed their visit more because he wasn't a worried wreck by the time his son arrived. My bulimic patient made a list of people she found interesting and noticed that none of them had eating disorders--and that two of her friends who also suffered from eating issues hadn't made the list. She also made a list of the qualities that she admired in herself, and identified a number of interesting and enviable traits that weren't related to her eating issues. For myself, I took a closer look at whether or not I was actually more productive when I was feeling anxious. I noticed that while anxiety occasionally propelled me into action, it more often drove me to produce unrealistic to-do lists that raised my stress level and stifled productivity. I also observed that on days when I was more relaxed, I was happily productive.
It's counterintuitive that we want to hold on to being anxious, worried, eating disordered, and depressed, and it can be frustrating for friends, family members, and therapists who want to help us make change. In such cases, exploring beliefs about symptoms helps. Worked for me!
Example: Generalized Anxiety Disorder (GAD) is a disorder characterized by chronic worry and subsequent anxiety and physiological symptoms (e.g., muscle tension, headaches). People with GAD habitually create worry chains of worst-case scenarios, often starting with "what if" (e.g., My boss asked to see me, what if I made some kind of serious mistake, what if I get fired, how will we pay our bills? or My head hurts, what if it's something serious, what if it's fatal, who will take care of my kids?).
Although most GAD patients say they're sick of worrying and wish they could stop, it's well established that most people with this disorder have positive beliefs about worry. Among other things, they believe that worrying offers protection from feared outcomes (e.g., if I worry about my son being in a car crash, it's less likely to happen), that worrying is a positive personality trait (e.g., I'm the family worrier, it's how I show my love), or that worrying shelters them from potential future negative emotions (e.g., if I worry about losing my job, it won't hurt as much if I actually do).
Positive beliefs about unpleasant psychological symptoms aren't limited to GAD. A depressed patient told me that during her childhood, she and her siblings and their divorced parents scoffed at happy-seeming nuclear families, assuming that the happy families were either faking or stupid or both. As an adult, my patient still believed that being happy was synonymous with being phony and dumb and that being depressed meant that she was smart and authentic. I had a patient with an eating disorder who believed that her bulimia made her dramatic and interesting. Whenever she attended a social function involving food, she would refer to her "serious eating issues," generating instant curiosity and solicitousness. She believed that recovering from her eating disorder would make her boring and pedestrian. Finally, I used to believe that anxiety made me productive. I spent years resisting mindfulness and other enormously helpful relaxation techniques, believing that I'd never accomplish anything if I weren't anxious.
In such cases, the best strategy is not to simply tell people that their beliefs are wrong, but to get them to test the beliefs. My depressed patient took inventory of the people she knew who seemed happy. She found that many of them were both intelligent and genuine, demonstrating that her belief wasn't altogether accurate. My GAD patient practiced not worrying when his son made the five-hour drive to visit; he noticed that not only did his son arrive safely, but he enjoyed their visit more because he wasn't a worried wreck by the time his son arrived. My bulimic patient made a list of people she found interesting and noticed that none of them had eating disorders--and that two of her friends who also suffered from eating issues hadn't made the list. She also made a list of the qualities that she admired in herself, and identified a number of interesting and enviable traits that weren't related to her eating issues. For myself, I took a closer look at whether or not I was actually more productive when I was feeling anxious. I noticed that while anxiety occasionally propelled me into action, it more often drove me to produce unrealistic to-do lists that raised my stress level and stifled productivity. I also observed that on days when I was more relaxed, I was happily productive.
It's counterintuitive that we want to hold on to being anxious, worried, eating disordered, and depressed, and it can be frustrating for friends, family members, and therapists who want to help us make change. In such cases, exploring beliefs about symptoms helps. Worked for me!
December 04, 2012
The Pleasure Principle
In the upcoming season of excess, what can we do when faced with temptation? When tempted to eat a third piece of pie, drink a fourth glass of wine, or buy a fifth adorable gift for our adorable niece, how can we exercise restraint? If you're wondering how to face the overeating, overdrinking, overspending, and other overs that run rampant in December, here are some ideas:
One way to handle situations that require will power is to have a predetermined rule. As discussed in an earlier post, using a rule means not having to make decisions, thereby avoiding poor choices borne of decision fatigue and ego depletion. For example, if you have a non-negotiable rule that you go to the gym before work every Monday and Wednesday, you don't have to make a decision when your alarm goes off in the morning, you just hop out of bed. If you have a non-negotiable rule that you don't drink coffee after 2pm, there's no will power involved in turning down your colleague's offer to pick you up a latte, because afternoon coffee is simply not something you do.
Rules are rigid, though, and it takes time for them to be integrated to the point that no will power is required. I have a friend who has a novel approach: My friend pretty much never eats dessert. When others are impressed by her will power or accuse her of denying herself pleasure, she replies that rather than denying pleasure, she's giving herself a different kind of pleasure--i.e., the gratification of feeling fit and liking how her body looks. This is a new angle and one that applies equally well to saving money, avoiding sweets, exercising, and other generally positive behaviours.
I like to call this the Pleasure Principle and I've adopted it for my own use in situations involving, for example, spending versus saving money and going to bed at a reasonable hour versus staying up late reading or playing around on social media. I could enjoy new boots or I could enjoy feeling confident about paying my bills at the end of the month. I could enjoy sending one more message or I could enjoy being pleasant and well rested tomorrow. If I decide to save my money or decide to turn off the computer and get in bed, I'm not denying myself the pleasures of new boots or Facebook--rather, I'm benefiting from an alternative pleasure.
How is the pleasure principle different from rules, will power, and doing your future self a favour? Rules imply rigidity, will power implies self-denial, and doing a favour for your future self implies doing something grudgingly, but for a greater or future good. The pleasure principle removes all of the negative implications, leaving you with pure pleasure--it's win/win.
This holiday season, keep the pleasure principle in mind when you're trying to resist the third piece of pie, fourth glass of wine, and fifth perfect gift for your niece. Let me know if it helps!
I like to call this the Pleasure Principle and I've adopted it for my own use in situations involving, for example, spending versus saving money and going to bed at a reasonable hour versus staying up late reading or playing around on social media. I could enjoy new boots or I could enjoy feeling confident about paying my bills at the end of the month. I could enjoy sending one more message or I could enjoy being pleasant and well rested tomorrow. If I decide to save my money or decide to turn off the computer and get in bed, I'm not denying myself the pleasures of new boots or Facebook--rather, I'm benefiting from an alternative pleasure.
How is the pleasure principle different from rules, will power, and doing your future self a favour? Rules imply rigidity, will power implies self-denial, and doing a favour for your future self implies doing something grudgingly, but for a greater or future good. The pleasure principle removes all of the negative implications, leaving you with pure pleasure--it's win/win.
This holiday season, keep the pleasure principle in mind when you're trying to resist the third piece of pie, fourth glass of wine, and fifth perfect gift for your niece. Let me know if it helps!
November 29, 2012
Psychoeducation
Psychoeducation is a core feature of cognitive-behavioural therapy--and any good therapy. The term refers to information that a therapist provides a patient
about the patient's symptoms or disorder, about the therapy model, and about how treatment will proceed, among other things. A lot of psychoeducation occurs in the first few therapy sessions, but psychoeducation also involves explaining new concepts and providing a rationale for in-session exercises or homework assignments over the entire course of therapy.
As a therapist, I sometimes forget the importance of psychoeducation. Particularly when I feel an urgency about helping a given patient, I make the mistake of cutting short the education part to try to jump ahead to a more "active" treatment phase. To avoid this error, I have to remind myself that good psychoeducation is part of the treatment: patients consistently demonstrate great interest in the information provided, express relief to learn that their symptoms are normal, and show greater commitment to therapy following psychoeducation. In fact, often when therapy doesn't seem to be having the intended effect, it's because I went too quickly and failed to psychoeducate sufficiently.
I had an experience today that reminded me just how powerful psychoeducation can be: I have a patient who suffers from obsessive compulsive disorder (OCD), an anxiety disorder characterized by intrusive thoughts and by repeated compulsive actions designed to eliminate the anxiety generated by the thoughts. During our session, we were discussing the nature of OCD and I emphasized the fact that intrusive thoughts* (e.g., I could jump in front of this bus; what if I had sex with my best friend's partner; my hands could be contaminated from that weird meat at lunch; I could drop the baby off the balcony) are normal and common, and that most almost everyone--OCD or not--experiences them. My patient was so happy and relieved to hear this that he kissed my cheeks when he left my office--not our usual way of saying goodbye!
My patient's reaction reminded me that psychoeducation is an important part of my job. Here are some examples of information that can make a big difference for patients:
* NB: Everyone has intrusive thoughts, i.e., thoughts that seem to come out of nowhere and are inconsistent with our real feelings and values (e.g., we don't really want to jump in front of a bus or have sex with our best friend's partner). The difference is that someone who doesn't have OCD treats the intrusive cognition as an annoying but passing thought and lets it go, whereas someone with OCD perceives the thought as both realistic and dangerous, and needs to perform a compulsive behaviour to alleviate the anxiety generated by the thought.
As a therapist, I sometimes forget the importance of psychoeducation. Particularly when I feel an urgency about helping a given patient, I make the mistake of cutting short the education part to try to jump ahead to a more "active" treatment phase. To avoid this error, I have to remind myself that good psychoeducation is part of the treatment: patients consistently demonstrate great interest in the information provided, express relief to learn that their symptoms are normal, and show greater commitment to therapy following psychoeducation. In fact, often when therapy doesn't seem to be having the intended effect, it's because I went too quickly and failed to psychoeducate sufficiently.
I had an experience today that reminded me just how powerful psychoeducation can be: I have a patient who suffers from obsessive compulsive disorder (OCD), an anxiety disorder characterized by intrusive thoughts and by repeated compulsive actions designed to eliminate the anxiety generated by the thoughts. During our session, we were discussing the nature of OCD and I emphasized the fact that intrusive thoughts* (e.g., I could jump in front of this bus; what if I had sex with my best friend's partner; my hands could be contaminated from that weird meat at lunch; I could drop the baby off the balcony) are normal and common, and that most almost everyone--OCD or not--experiences them. My patient was so happy and relieved to hear this that he kissed my cheeks when he left my office--not our usual way of saying goodbye!
My patient's reaction reminded me that psychoeducation is an important part of my job. Here are some examples of information that can make a big difference for patients:
- For patients with panic attacks: It's normal to think you're going crazy or to think you're having a heart attack during a panic attack. In fact, both are listed as panic symptoms in the DSM.
- For patients who feel guilty about being depressed: It's normal to feel guilty when you're depressed. In fact, guilt is one of the DSM criteria for diagnosing depression.
- For patients who fear their depression is making them stupid: Poor memory and difficulty concentrating are listed as DSM diagnostic criteria for depression.
- For patients with generalized anxiety: Worry and anxiety are maintained by intolerance of uncertainty.
- For depressed or anxious patients: Depression and anxiety can be maintained by beliefs about depression and anxiety (e.g., anxiety makes me productive; only stupid people are happy).
- For patients with insomnia: Many cases of insomnia can be cured through simple sleep hygiene (e.g., always going to bed at the same time; not eating, drinking, or exercising right before bed; eliminating noise and light in the bedroom).
- For mindfulness meditation clients: Meditating doesn't mean clearing your mind of all thoughts. Practicing mindfulness doesn't mean you'll be Zen all the time.
- And my favourite, for everyone: Thoughts aren't facts. Not everything you think is true.
* NB: Everyone has intrusive thoughts, i.e., thoughts that seem to come out of nowhere and are inconsistent with our real feelings and values (e.g., we don't really want to jump in front of a bus or have sex with our best friend's partner). The difference is that someone who doesn't have OCD treats the intrusive cognition as an annoying but passing thought and lets it go, whereas someone with OCD perceives the thought as both realistic and dangerous, and needs to perform a compulsive behaviour to alleviate the anxiety generated by the thought.
November 20, 2012
Anecdote: Parallel Therapy Universe
In September, I explained how psychologists are just like other professional that you might consult--with a specific set of skills, knowledge, and training. Today I had an experience that demonstrated the remarkable similarities between two very different types of therapy:
Before work this morning, I had an appointment with an athletic therapist. I told her my problem: "One of my knees hurts when I run." After asking some questions to understand the background and history of the problem, she maneuvered my legs around, testing muscles and ligaments to determine a diagnosis. Then she educated me: "Sometimes when you have surgery on one knee, that leg never fully regains equal strength; over time, the discrepancy between the two legs forces the muscles and ligaments to compensate--pulling in weird directions and resulting in pain." Next, she guided me through a few exercises that will strengthen the weaker leg. Once she was sure I understood how to do them, she prescribed a few for homework and made sure I wrote them down. She took notes during our session and put them in my file.
After my athletic therapy appointment, I went to work and met with my first patient of the day, a socially anxious man in his late twenties. He told me his problem: "I have to give a toast at a friend's wedding this weekend and I'm so anxious about it I can barely breathe." After asking some questions to fully understand the situation, I asked him to write down some of the thoughts and feelings that come up when he imagines giving the toast. His thoughts included "I'll go blank and won't be able to give the toast," "The other guests will laugh at me," and "If that happens, I'll be humiliated and devastated." Then I educated him: "Often people who are anxious both overestimate the likelihood of a feared event and underestimate their ability to cope with it."
Next, I guided him through an exercise that involved rating the probability of each thought: Given his ample preparation and the notes he planned to bring to the wedding, he rated the probability of forgetting his toast at only 15%. Given that most of the guests were friends of his, he rated the probability that they would laugh at him at only 10%. Given that he had experienced embarrassment during public speaking in the past--but allowing that humiliation and devastation were probably exaggerated predictions--he rated the probability of humiliation and devastation if he forgot his toast at 60%. Together we did the math (15% x 10% x 60% = .009% chance of his feared outcome occurring) and explored the impact of calculating the probabilities on his anxiety. Once I was sure that my patient understood how to apply this strategy, I assigned the use of probabilities in other anxiety-provoking situations as homework for next week. I took notes during our session and put them in his file.
There you have it! Regardless of type, it seems that therapy involves explaining the problem, testing and diagnosis, education, introduction of a new skill or exercise, practicing the skill/exercise, and homework.
Before work this morning, I had an appointment with an athletic therapist. I told her my problem: "One of my knees hurts when I run." After asking some questions to understand the background and history of the problem, she maneuvered my legs around, testing muscles and ligaments to determine a diagnosis. Then she educated me: "Sometimes when you have surgery on one knee, that leg never fully regains equal strength; over time, the discrepancy between the two legs forces the muscles and ligaments to compensate--pulling in weird directions and resulting in pain." Next, she guided me through a few exercises that will strengthen the weaker leg. Once she was sure I understood how to do them, she prescribed a few for homework and made sure I wrote them down. She took notes during our session and put them in my file.
After my athletic therapy appointment, I went to work and met with my first patient of the day, a socially anxious man in his late twenties. He told me his problem: "I have to give a toast at a friend's wedding this weekend and I'm so anxious about it I can barely breathe." After asking some questions to fully understand the situation, I asked him to write down some of the thoughts and feelings that come up when he imagines giving the toast. His thoughts included "I'll go blank and won't be able to give the toast," "The other guests will laugh at me," and "If that happens, I'll be humiliated and devastated." Then I educated him: "Often people who are anxious both overestimate the likelihood of a feared event and underestimate their ability to cope with it."
Next, I guided him through an exercise that involved rating the probability of each thought: Given his ample preparation and the notes he planned to bring to the wedding, he rated the probability of forgetting his toast at only 15%. Given that most of the guests were friends of his, he rated the probability that they would laugh at him at only 10%. Given that he had experienced embarrassment during public speaking in the past--but allowing that humiliation and devastation were probably exaggerated predictions--he rated the probability of humiliation and devastation if he forgot his toast at 60%. Together we did the math (15% x 10% x 60% = .009% chance of his feared outcome occurring) and explored the impact of calculating the probabilities on his anxiety. Once I was sure that my patient understood how to apply this strategy, I assigned the use of probabilities in other anxiety-provoking situations as homework for next week. I took notes during our session and put them in his file.
There you have it! Regardless of type, it seems that therapy involves explaining the problem, testing and diagnosis, education, introduction of a new skill or exercise, practicing the skill/exercise, and homework.
November 16, 2012
The Apple of my Eye
Why do people love Apple products so much? Sure, many of us also love our best pair of jeans, our favourite book, or our sharpest chef's knife, but I think it's fair to say that we have beyond-reasonable affection for our MacBooks, iPhones, iPods, and iPads--and that we don't feel the same way about our coffeemakers, alarm clocks, or the PCs we have to use at work.
What's this outsized love about?
Among others, two features of Apple products elicit affection:
1) Anthropomorphism is the attribution of human characteristics or motivations to animals (e.g., My cat knows when I'm sad and comes to purr on my lap), to non-living objects such as cell phones (e.g., My phone thinks I want to say 'spring' when I'm trying to say 'sprint'), or to phenomena like the weather (e.g., This snowstorm is trying to make me miss my bus). Apple products are deliberately anthropomorphic: they have ultra-responsive touch screens, which makes us feel like we're communicating with them; they're silver or white with a sleep light that throbs like a gentle heartbeat (e.g., MacBook), rather than black and machine-like with flashing red or green lights.
2) Not only do they breathe and respond to touch, but many Apple products are tiny, captializing on the cute response. The cute response is an evolutionary concept that refers to a variety of features (small, smooth, rounded) that, across species, make something look cute. Now think of Apple products: like babies and unlike boxy old computers, Apple products, including most of their icons and features, are characterized by a general absence of sharp corners and right angles. Add miniatureness, and we're in love. I mean, who hasn't cooed over an iPod nano or iPad mini?
Why do we anthropomorphize? Anthropomorphism is hypothesized to help humans make sense of our environments and feel greater control. That is, assigning human motivations to our cats, dogs, laptops, and iPods makes it easier for us to understand and interact with them. Further, anthropomorphism has been demonstrated to be more common in people who are socially isolated, where it fills a need for connection. Think of Tom Hanks and Wilson the volleyball in Castaway.
Why do we like things that are tiny and cute? Evolution science suggests that mammals are hardwired to respond quickly and lovingly to anything with big eyes, a high forehead, a small nose, and an undersize chin. These cute features signal extreme youth, harmlessness, and vulnerability; they trigger our caring instincts, which is key for evolution since the infants of most mammal species are pathetically helpless and would quickly die without parental intervention.
Apple products capitalize on anthropomorphism and the cute response, at least partially explaining our boundless affection for inanimate gadgets. These features are no coincidence, but rather a careful design and marketing strategy.
NB: The flip side is that when we anthropomorphize, we make non-human entities responsible for their actions, explaining why we feel confused--if not humiliated and betrayed--when our gadgets don't work (e.g., "I charge it every day! I always keep it in its little case! I didn't do anything, but it's suddenly dead! How could my phone do this to me??").
What's this outsized love about?
Among others, two features of Apple products elicit affection:
1) Anthropomorphism is the attribution of human characteristics or motivations to animals (e.g., My cat knows when I'm sad and comes to purr on my lap), to non-living objects such as cell phones (e.g., My phone thinks I want to say 'spring' when I'm trying to say 'sprint'), or to phenomena like the weather (e.g., This snowstorm is trying to make me miss my bus). Apple products are deliberately anthropomorphic: they have ultra-responsive touch screens, which makes us feel like we're communicating with them; they're silver or white with a sleep light that throbs like a gentle heartbeat (e.g., MacBook), rather than black and machine-like with flashing red or green lights.
2) Not only do they breathe and respond to touch, but many Apple products are tiny, captializing on the cute response. The cute response is an evolutionary concept that refers to a variety of features (small, smooth, rounded) that, across species, make something look cute. Now think of Apple products: like babies and unlike boxy old computers, Apple products, including most of their icons and features, are characterized by a general absence of sharp corners and right angles. Add miniatureness, and we're in love. I mean, who hasn't cooed over an iPod nano or iPad mini?
Why do we anthropomorphize? Anthropomorphism is hypothesized to help humans make sense of our environments and feel greater control. That is, assigning human motivations to our cats, dogs, laptops, and iPods makes it easier for us to understand and interact with them. Further, anthropomorphism has been demonstrated to be more common in people who are socially isolated, where it fills a need for connection. Think of Tom Hanks and Wilson the volleyball in Castaway.
Why do we like things that are tiny and cute? Evolution science suggests that mammals are hardwired to respond quickly and lovingly to anything with big eyes, a high forehead, a small nose, and an undersize chin. These cute features signal extreme youth, harmlessness, and vulnerability; they trigger our caring instincts, which is key for evolution since the infants of most mammal species are pathetically helpless and would quickly die without parental intervention.
Apple products capitalize on anthropomorphism and the cute response, at least partially explaining our boundless affection for inanimate gadgets. These features are no coincidence, but rather a careful design and marketing strategy.
NB: The flip side is that when we anthropomorphize, we make non-human entities responsible for their actions, explaining why we feel confused--if not humiliated and betrayed--when our gadgets don't work (e.g., "I charge it every day! I always keep it in its little case! I didn't do anything, but it's suddenly dead! How could my phone do this to me??").
November 11, 2012
Confirmation Bias
Confirmation bias refers to our tendency to seek and favour information that confirms our pre-existing ideas, and to interpret ambiguous information as supportive of our beliefs. That is, we pay attention to and believe information that confirms what we already think, while ignoring contradictory information. So for example, if I believe that the city where I live has the best restaurants in the world, I'll notice and remember every delicious meal I eat in my city--ignoring any poor customer service or bad food experiences, and forgetting about delicacies consumed in other cities.
We all have automatic thoughts and core beliefs about ourselves, others, and the world. Some of our problematic thoughts and beliefs aren't quite accurate and, reinforced by confirmation bias, they can be quite resistant to change. Consider one of my patients--an undergraduate student who was depressed after a longterm relationship ended. She was very lonely after the break-up, and frequently had the thought that everyone in the world but her was in a relationship. This recurring thought meant that every time she attended a social event, she was hyper-aware of couples and failed to notice people who had arrived alone or with friends. In our sessions, my patient repeatedly compared herself to her two best friends, both of whom were in relationships, ignoring that her sister and her roommate were both single.
As her depression deepened, my patient's recurrent thought was reinforced by confirmation bias and consolidated into a biased belief: if she was the only single person in her peer group, she must be unlovable. The belief that she was unlovable was in turn reinforced by confirmation bias: when her friends organized a huge surprise birthday celebration, she reported they were just looking for an excuse to party. When her lab partner asked her out, she assumed it was only because he wanted to copy her notes. Her confirmation bias prevented her from taking in any information that contradicted her belief that she was unlovable, maintaining both the belief and the depression.
How does confirmation bias manifest in clinical psychology practice?
As her depression deepened, my patient's recurrent thought was reinforced by confirmation bias and consolidated into a biased belief: if she was the only single person in her peer group, she must be unlovable. The belief that she was unlovable was in turn reinforced by confirmation bias: when her friends organized a huge surprise birthday celebration, she reported they were just looking for an excuse to party. When her lab partner asked her out, she assumed it was only because he wanted to copy her notes. Her confirmation bias prevented her from taking in any information that contradicted her belief that she was unlovable, maintaining both the belief and the depression.
You don't have to be clinically depressed to experience the effects of confirmation bias. Think about the last time you woke up in a bad mood. You probably paid a lot of attention to the guy whose massive backpack took up an extra seat on the subway, or to the fact that the elevator at work was out of service again. You probably failed to notice the gorgeous weather, or the delicious lunch your loving partner packed you. Why? Because these things didn't fit in with your preconceived idea that day that the world was a lousy place.
How can we challenge confirmation bias?
The trick is to realize when we're in the grip of confirmation bias, to identify the bias, and to be willing to test it. Example: I have a patient who has a high-powered job and young kids, but her life is more difficult than it needs to be because she believes that fundamentally, other people are incompetent. Not only does this belief create interpersonal conflict, but it means that she can never delegate responsibility for any task or chore to her colleagues, her husband, or her kids because they're liable to do it wrong.
After a bit of psychoeducation about CBT, and some work on cognitive distortions, she agreed to test her belief. Armed with the scientific hypothesis "Others are incompetent," she set out to complete the following assignment: for one week, record evidence that supported or contradicted her belief. Evidence that supported the belief included "My husband put my daughter's diaper on backwards" and "The construction on my street that was supposed to be completed two months ago still isn't done." Contradictory evidence included "The tech support guy at work fixed my printer," "The airline actually served me the gluten-free meal I ordered," and "My son did his homework while I was away."
The trick is to realize when we're in the grip of confirmation bias, to identify the bias, and to be willing to test it. Example: I have a patient who has a high-powered job and young kids, but her life is more difficult than it needs to be because she believes that fundamentally, other people are incompetent. Not only does this belief create interpersonal conflict, but it means that she can never delegate responsibility for any task or chore to her colleagues, her husband, or her kids because they're liable to do it wrong.
After a bit of psychoeducation about CBT, and some work on cognitive distortions, she agreed to test her belief. Armed with the scientific hypothesis "Others are incompetent," she set out to complete the following assignment: for one week, record evidence that supported or contradicted her belief. Evidence that supported the belief included "My husband put my daughter's diaper on backwards" and "The construction on my street that was supposed to be completed two months ago still isn't done." Contradictory evidence included "The tech support guy at work fixed my printer," "The airline actually served me the gluten-free meal I ordered," and "My son did his homework while I was away."
Faced with clear evidence that others are not always incompetent, my patient was forced to reconsider her belief. She modified "Others are incompetent" to "Other people can be incompetent sometimes, but often get it right." My patient's new faith in her husband, children, and colleagues smoothed relationships and allowed her to delegate tasks, leaving her a bit of time to relax.
Challenging confirmation bias is tricky and requires an open mind. If there's a thought or belief that's making you depressed or anxious ("I never do anything right"), creating relationship problems ("No one could ever really love me"), or generating stress ("Asking for help implies weakness"), try looking around for information you might be ignoring, and for possible reinterpretations of the information you've been using to justify your belief!
NB: Sneaky confirmation bias occurs on sites like Facebook that use algorithms to feed us information. Example: If in following the US election, you clicked on and "liked" all your Obama-supporting friends' statuses and ignored all your Romney-supporting friends' posts, your Facebook news feed narrowed, showing you more news from your Democrat friends and fewer posts from your Republican friends. Through the Obama supporters' posted statuses and articles, you learned more about why the Democrats were the better party, and received little information that challenged this perspective--maintaining and strengthening your bias.
November 02, 2012
Do Me a Favour
Mental health tip: Do your future self a favour.
In a prior post, I discussed how you can motivate yourself to keep your resolutions and to do things you don't feel like doing by connecting behaviour with values. Another way to motivate yourself to take care of annoying errands and tedious tasks is to view them as favours for your future self. For example, you might not feel like taking the clean sheets out of the dryer and making the bed right now, but when your tired future self retires to your bedroom at midnight, he or she will probably be pretty pleased that you did him or her that favour this afternoon. Another example: if you shlepped around shopping all afternoon, you probably don't really feel like making one more stop at the drugstore to buy shampoo. You might feel more motivated, though, when you consider the thanks you'll get from your tomorrow-morning self, who won't have to shampoo with body wash.
It can help to imagine the pleasure of your future self as he or she receives your favour, in the same way you might picture the face of a loved one opening a perfect gift. I used this trick today: It's Friday and I'm headed out of town for the weekend; my refrigerator is nearly empty, but I was strongly resistant to the idea of going out in the cold rain to get groceries. To motivate myself, I pictured the comfort and relief of my tired late-Sunday-night self, whom I know will be pleased to find provisions for Monday morning breakfast. Building on this kindness to my future self, I even convinced myself to wash all of the dishes before leaving (rather than leaving the skillet "to soak").
You can't always do favours for your future self, and different people will have different priorities. I have one friend who consistently practices what she calls Operation Integration: when she arrives home, she always puts her coat, keys, and bag where they belong, and unpacks any other items--rather than abandoning them in the entry way or only putting half her things away. She doesn't always feel like taking the time reintegrate her belongings, but her ten-minutes-later self is glad the apartment is tidy, and her next-morning self is glad she knows where to find her keys!
What favours do you do your future self?
NB: You can also do your future self a favour by not doing certain things. For example, you might be finishing a lovely meal out and really feel like having coffee with dessert--but it's 10pm. It could help to consider not having coffee as a favour to your midnight self, who would like a decent night's sleep.
In a prior post, I discussed how you can motivate yourself to keep your resolutions and to do things you don't feel like doing by connecting behaviour with values. Another way to motivate yourself to take care of annoying errands and tedious tasks is to view them as favours for your future self. For example, you might not feel like taking the clean sheets out of the dryer and making the bed right now, but when your tired future self retires to your bedroom at midnight, he or she will probably be pretty pleased that you did him or her that favour this afternoon. Another example: if you shlepped around shopping all afternoon, you probably don't really feel like making one more stop at the drugstore to buy shampoo. You might feel more motivated, though, when you consider the thanks you'll get from your tomorrow-morning self, who won't have to shampoo with body wash.
It can help to imagine the pleasure of your future self as he or she receives your favour, in the same way you might picture the face of a loved one opening a perfect gift. I used this trick today: It's Friday and I'm headed out of town for the weekend; my refrigerator is nearly empty, but I was strongly resistant to the idea of going out in the cold rain to get groceries. To motivate myself, I pictured the comfort and relief of my tired late-Sunday-night self, whom I know will be pleased to find provisions for Monday morning breakfast. Building on this kindness to my future self, I even convinced myself to wash all of the dishes before leaving (rather than leaving the skillet "to soak").
You can't always do favours for your future self, and different people will have different priorities. I have one friend who consistently practices what she calls Operation Integration: when she arrives home, she always puts her coat, keys, and bag where they belong, and unpacks any other items--rather than abandoning them in the entry way or only putting half her things away. She doesn't always feel like taking the time reintegrate her belongings, but her ten-minutes-later self is glad the apartment is tidy, and her next-morning self is glad she knows where to find her keys!
What favours do you do your future self?
NB: You can also do your future self a favour by not doing certain things. For example, you might be finishing a lovely meal out and really feel like having coffee with dessert--but it's 10pm. It could help to consider not having coffee as a favour to your midnight self, who would like a decent night's sleep.
October 19, 2012
Ingratiation Investigation
I recently went to a friend's housewarming party. I knew she was thrilled with her new apartment and I exclaimed over the painting and decor as I came in and looked around. Her response: "Yeah thanks, it's great but the lighting is bad in the living room and I still need to paint the bathroom." Later that night, a friend and I were talking to an acquaintance who was excited to hear that my friend was planning to complete his first marathon this year. Instead of accepting congratulations on his upcoming achievement, my friend deflected it by pointing at me and saying "Yeah but she's run a ton of marathons." To which I responded: "Yeah but anyone could do it if they trained; I'm not a natural runner or anything." Still later that night, I overheard a friend dismissively refer to his innovative and successful start-up as "my non-profit thing."
What's going on here? Why are we all downplaying our pride and our achievements? Are we actually not proud? Do we not want others to be impressed?
My guess is that we're all just trying to ingratiate ourselves. In social psychology terms, ingratiation means using deliberate communication strategies in an effort to become more attractive or likeable to others. There are a few different strategies, including other-enhancement (complimenting others), conformity (agreeing with or making yourself seem similar to others), self-promotion (emphasizing your own attributes), and self-deprecation (observing something negative about yourself or belittling or undervaluing yourself or your achievements to avoid seeming arrogant and to help others identify with you).
Social norms dictate that bragging is obnoxious. Rather, we are supposed to be modest, and people who aren't modest violate our expectations. At the party described above, my friends and I were all engaging in social ingratiation via a combination of conformity and self-deprecation. By emphasizing the apartment's imperfections, deflecting congratulations and insisting that anyone can run a marathon, and dismissing business success, we were a) being careful not to brag, and b) making ourselves more similar to our listeners, who may not have run a marathon or launched a start-up, and who may also have home improvements they'd like to make.
Is it really necessary to downplay or outright dismiss achievements? Would I view my friends unfavourably if they confessed to being thrilled with a new apartment or to taking pride in a successful business venture? What are the advantages and disadvantages of this kind of ingratiation?
Advantages: Conformity allows you to avoid threatening or alienating others, something braggarts often do. Self-deprecation can be funny and can defuse awkward social situations (e.g., telling a story about your own gaffe to take the heat off someone else). Overall, using conformity and self-deprecation appropriately demonstrates good social intelligence.
Disadvantages: Too much self-deprecation will turn you into a person who can't take a compliment, which can be annoying. Further, if you deflect every compliment and deny every achievement or success by turning it into a self-deprecating story, people might eventually start questioning your self-esteem, your skills, and your honesty.
Moral of the story: Ingratiate often, don't brag, and use conformity and self-deprecation wisely.
What's going on here? Why are we all downplaying our pride and our achievements? Are we actually not proud? Do we not want others to be impressed?
My guess is that we're all just trying to ingratiate ourselves. In social psychology terms, ingratiation means using deliberate communication strategies in an effort to become more attractive or likeable to others. There are a few different strategies, including other-enhancement (complimenting others), conformity (agreeing with or making yourself seem similar to others), self-promotion (emphasizing your own attributes), and self-deprecation (observing something negative about yourself or belittling or undervaluing yourself or your achievements to avoid seeming arrogant and to help others identify with you).
Social norms dictate that bragging is obnoxious. Rather, we are supposed to be modest, and people who aren't modest violate our expectations. At the party described above, my friends and I were all engaging in social ingratiation via a combination of conformity and self-deprecation. By emphasizing the apartment's imperfections, deflecting congratulations and insisting that anyone can run a marathon, and dismissing business success, we were a) being careful not to brag, and b) making ourselves more similar to our listeners, who may not have run a marathon or launched a start-up, and who may also have home improvements they'd like to make.
Is it really necessary to downplay or outright dismiss achievements? Would I view my friends unfavourably if they confessed to being thrilled with a new apartment or to taking pride in a successful business venture? What are the advantages and disadvantages of this kind of ingratiation?
Advantages: Conformity allows you to avoid threatening or alienating others, something braggarts often do. Self-deprecation can be funny and can defuse awkward social situations (e.g., telling a story about your own gaffe to take the heat off someone else). Overall, using conformity and self-deprecation appropriately demonstrates good social intelligence.
Disadvantages: Too much self-deprecation will turn you into a person who can't take a compliment, which can be annoying. Further, if you deflect every compliment and deny every achievement or success by turning it into a self-deprecating story, people might eventually start questioning your self-esteem, your skills, and your honesty.
Moral of the story: Ingratiate often, don't brag, and use conformity and self-deprecation wisely.
October 02, 2012
Capacity for Composure
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).
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).
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!
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.
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.
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
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Giving up
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Letting go
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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 21, 2012
When Panic Attacks
We use the term "panic" all the time, saying we panicked at our job interview, or had a panic attack when our child wandered into the street, but what do psychologists mean when they talk about panic attacks or panic disorder?
Panic isn't the nervousness you feel the morning of your presentation at work, the stress you feel when you're running late for an appointment, or the anxiety you feel when your partner is mad at you. A panic attack is a sudden surge of overwhelming anxiety and fear, accompanied by a flood of physiological symptoms; it develops abruptly and usually lasts no more than fifteen minutes. It may be triggered by something specific (e.g., public speaking, enclosed spaces, a stressful thought), or may come out of the blue.
The DSM defines a panic attack as a discrete period of intense fear, in which at least four of the following symptoms develop abruptly and reach a peak within ten minutes:
Physiological symptoms: palpitations, pounding heart, or increased heart rate; sweating; trembling or shaking; shortness of breath or a feeling of smothering; a feeling of choking; chest pain or discomfort; nausea; feeling dizzy, lightheaded, or faint; chills or hot flushes; and numbness or tingling, often in the extremities. Psychological symptoms: fear of dying, losing control, or going crazy; and derealization or depersonalization, i.e., feeling unreal, disembodied, or detached from your surroundings.
What does a panic attack feel like?
It feels like terror in your belly, an elephant sitting on your chest, and going crazy. Your heart feels like it's pounding out of your chest, the room seems to be closing in, and you can't breathe. Many people experiencing panic are convinced they're having a heart attack--in fact, over 40% of individuals who show up the emergency room with chest pain are actually suffering from a panic attack. On top of the discomfort of the physiological symptoms of panic, the feeling of derealization can make panic lonely and confusing because what's happening in your mind doesn't match what's happening in the external world; it's hard to understand why other people seem to be calmly and happily going about their business when, for you, the world seems to be ending.
A panic attack is not a DSM diagnosis, but panic disorder is. Panic disorder is diagnosed when recurrent panic attacks result in persistent concern about further attacks, worry about the consequences or implications of the attacks, or significant change in behaviour for fear of future attacks (e.g., refusing to give presentations at work, declining social invitations). At worst, individuals with panic disorder develop agoraphobia--the fear of being out in public, or in a place where they could panic--and begin to avoid crowded public spaces, or avoid leaving the home at all.
A panic attack can happen in the context of panic disorder, depression, or another psychological problem, or can simply be an isolated incident during a stressful period or situation. During a panic attack, it's not important to try to figure out what happened or what's wrong; instead, just focus on breathing slowly and trying to calm down. It can help to realize that you're having a panic attack and to remember that thinking you're going crazy and thinking you're having a heart attack are symptoms of panic. If you experience recurrent panic attacks, it may be time to see your doctor or consult a psychologist. Panic is eminently treatable and responds well to cognitive-behavioural therapy (CBT), among other treatments.
Panic isn't the nervousness you feel the morning of your presentation at work, the stress you feel when you're running late for an appointment, or the anxiety you feel when your partner is mad at you. A panic attack is a sudden surge of overwhelming anxiety and fear, accompanied by a flood of physiological symptoms; it develops abruptly and usually lasts no more than fifteen minutes. It may be triggered by something specific (e.g., public speaking, enclosed spaces, a stressful thought), or may come out of the blue.
The DSM defines a panic attack as a discrete period of intense fear, in which at least four of the following symptoms develop abruptly and reach a peak within ten minutes:
Physiological symptoms: palpitations, pounding heart, or increased heart rate; sweating; trembling or shaking; shortness of breath or a feeling of smothering; a feeling of choking; chest pain or discomfort; nausea; feeling dizzy, lightheaded, or faint; chills or hot flushes; and numbness or tingling, often in the extremities. Psychological symptoms: fear of dying, losing control, or going crazy; and derealization or depersonalization, i.e., feeling unreal, disembodied, or detached from your surroundings.
What does a panic attack feel like?
It feels like terror in your belly, an elephant sitting on your chest, and going crazy. Your heart feels like it's pounding out of your chest, the room seems to be closing in, and you can't breathe. Many people experiencing panic are convinced they're having a heart attack--in fact, over 40% of individuals who show up the emergency room with chest pain are actually suffering from a panic attack. On top of the discomfort of the physiological symptoms of panic, the feeling of derealization can make panic lonely and confusing because what's happening in your mind doesn't match what's happening in the external world; it's hard to understand why other people seem to be calmly and happily going about their business when, for you, the world seems to be ending.
A panic attack is not a DSM diagnosis, but panic disorder is. Panic disorder is diagnosed when recurrent panic attacks result in persistent concern about further attacks, worry about the consequences or implications of the attacks, or significant change in behaviour for fear of future attacks (e.g., refusing to give presentations at work, declining social invitations). At worst, individuals with panic disorder develop agoraphobia--the fear of being out in public, or in a place where they could panic--and begin to avoid crowded public spaces, or avoid leaving the home at all.
A panic attack can happen in the context of panic disorder, depression, or another psychological problem, or can simply be an isolated incident during a stressful period or situation. During a panic attack, it's not important to try to figure out what happened or what's wrong; instead, just focus on breathing slowly and trying to calm down. It can help to realize that you're having a panic attack and to remember that thinking you're going crazy and thinking you're having a heart attack are symptoms of panic. If you experience recurrent panic attacks, it may be time to see your doctor or consult a psychologist. Panic is eminently treatable and responds well to cognitive-behavioural therapy (CBT), among other treatments.
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?
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