Karuna Counseling’s Newsletter Articles

May 17, 2012

Growing Gratitude

by Micky O’Leary, Ph.D.

Let me begin by acknowledging that Gratitude and I got off to a rocky start. As a child, gratitude often meant being reminded how lucky I was to have a loving family, a roof over my head, an education, etc. I was taught to be polite, to say “thank you” for gifts, whether I liked them or not, to express appreciation for whatever was done for me or given to me.

I remember one Saturday evening in particular. I was about 11 years old and my mother prepared chicken livers for dinner. As we gathered around the table, I expressed my dislike (perhaps, even contempt) for the main dish, to which my father replied that I should be grateful for this nutritious food and be glad that I was not one of the starving children in  (you are free to select an appropriate third world country of the 1950s). After we said Grace, he went on to inform me that I would have plenty of opportunities to learn gratitude for this delicious meal because it would be served every Saturday night from then on.

Fortunately (and for this I was truly grateful), his threat was short-lived and it was only a few weeks before we returned to more appetizing meals like meatloaf. Not surprisingly, I never did develop a liking  for chicken livers, despite my parents’ best efforts. What I do have now, some 50 years later, is a deep and loving appreciation for the childhood meals we shared in our family kitchen, my mother’s commitment to providing us wonderful home-cooked meals, and my parents’ desire that I learn to value what was given to me, even if I didn’t always like it.

Developing gratitude has been a life long journey, with an experience of it that has grown deeper over time. I am often reminded of the Joni Mitchell song “Big Yellow Taxi.” Its refrain is “Don’t it always seem to go that we don’t know what we’ve got til it’s gone….” For many of us, gratitude grows from an awareness of what we’ve lost, or what we stand to lose. For example, how much easier is it to appreciate good health after recovering from a serious accident or illness? Or to value electricity after a lengthy power outage? Or to feel gratitude for our remaining friends and family after one of them dies?

Loss is not always a precursor to gratitude. It is possible to appreciate life’s gifts without it. For instance, think of how children squeal with glee when experiencing a winter snowfall (and the subsequent day off from school). Perhaps you can remember a trip to the beach and seeing the sunset across the water. Or you may be able to recall the excitement and anticipation of a new romance.

However, learning gratitude through loss is an opportunity to deepen our understanding and appreciation of life from a new perspective. Shakti Gawain notes that it is difficult to get in touch with our gratitude when life is hard and we are going through a difficult time. However, with patience and perspective, these “healing crises” can provide meaning and purpose in our life’s journey. For instance, the sudden loss of someone dear to us can show us how “life turns on a dime” and remind us of the fragility and beauty of each moment we have. The unexpected loss of employment can force us to re-evaluate our career goals and options, perhaps leading us to a more rewarding or fulfilling work. Or a reduced level of income may force us to alter our lifestyle, finding a way to live more simply. We can, in the most difficult of times, learn to recognize – and appreciate — our greatest gifts and assets, as well as our “growing edges” – the lessons that we are be challenged to learn. In short, we can take these painful experiences and let them soften and expand our hearts, or harden and contract them.

According to Julie Keene, minister and author, gratitude is closely connected to trust. “In order to be thankful for everyone and everything in my life, I need to trust that the Universe makes sense, that everything my soul has chosen to experience this lifetime has been for my ultimate Highest Good.” Once we are able to appreciate whatever life brings us, it is easier for us to then begin living in a place of contentment and gratitude. Our heart is able to find and dwell in a place of joy.

As I consider what I have written so far, I must admit it looks deceptively simple, a bit like “A Guide to Enlightenment in three short paragraphs.” Finding and living in a place of gratitude is not instantaneous nor without some effort. But be assured, it brings immense rewards.

Benefits of Gratitude as a Practice

There are more than a few reasons to incorporate more gratitude into our lives. Having an “attitude of gratitude” causes us to interact with others from a place of fullness. They are attracted by our energy and feel our appreciation. On the other hand, when our glass is “half empty,” we emit a negativity that tends to repel others and we experience less support.

James Eubanks, an author, columnist and astrologer, notes that it is impossible to feel worry, anger, depression, or any negative emotion in the presence of genuine gratitude:  “The practice of gratitude saves us from our painful human storyline, for it requires us to look deeper into our lives and the people around us. The surface rarely holds depth; rather, it obscures it. Gratitude enriches and deepens the colorful fabric of our lives by allowing us to see more.”

Cultivating gratitude has been linked to better health, sounder sleep, less anxiety and depression, higher long-term satisfaction with life and kinder behavior toward others. In a recent experiment at the University of Kentucky, students who turned in an essay were either praised for it or given harsh criticism. Then each student was allowed to play a computer game with the person who gave them the evaluation. The winner could administer a blast of white noise to the loser. Those who had received criticism about their essay retaliated against their opponent by giving an especially loud blast – much louder than those given by students receiving positive feedback.

However, an interesting exception occurred among students who had been instructed to write their essays about gratitude. Even if their feedback was negative, they didn’t feel compelled to blast their opponents at a higher volume. The researchers viewed the results as an indication that gratitude also reduces aggressive behavior.

 

Suggestions for Practice

Gratitude grows best when it is cultivated. John Kralik, a California attorney and judge, has written about his experience of gratitude in a touching book, A Simple Act of Gratitude: How Learning to Say Thank You Changed My Life. He had reached a point in his life when he felt as if he had lost almost everything that mattered to him. His business was failing, his second marriage was ending, his living conditions were undesirable and he felt distance between himself and his two older children. He was angry and despairing and out of shape. On New Year’s Day he was struck by the thought that his life could be better if he could find a way to focus on the things he had, rather than those he had lost. He made a commitment to himself to write 365 thank you notes over the next year. The resulting story is an endearing and encouraging account of the personal changes he experienced in that process.

Another way to begin a practice of gratitude is with what Robert Emmons of the University of California calls “gratitude lite.” It involves keeping a journal listing five things for which you feel grateful. The list is brief – only one sentence per item – and is done only once a week. The research he did with Michael McCullough of the University of Miami showed that after two months, there were significant changes among the journal keepers, compared with a control group. They felt more optimistic and happier. They reported fewer physical problems and spent more time working out.

One suggestion for bringing more gratitude into your life is planning a “gratitude visit.” Psychologist Martin Seligman recommends writing a 300 word letter to someone who changed your life for the better. Be specific about what the person did and how it affected you. Then deliver it in person without telling the person in advance what the visit is about. When you get there, read the whole letter slowly and out loud to the other person. According to Seligman, if you do this, within a month you will feel happier.

Other possibilities include keeping a gratitude calendar which emphasizes different blessings in each month; performing a service or volunteering to help someone; saying “thank you” often and with sincerity.

One especially lovely practice is the “Hugging Meditation” described by Buddhist monk Thich Nhat Hanh:

  1. Hug someone three times, breathing in and out with awareness;
  2. On the first breath in and out, both of you think about how, at sometime, you don’t know when, you will no longer be here;
  3. The second time, focus on how, at sometime, the other person will no longer be here;
  4. The third time, truly take in that you are both here now, together in this precious moment.

Finally, if you should find your gratitude aptitude getting especially challenged, remember what Buddha wrote:

“Let us rise up and be thankful,
for if we didn’t learn a lot today, at least we learned a little,
and if we didn’t learn a little, at least we didn’t get sick,
and if we got sick, at least we didn’t die;
so, let us all be thankful.”

Suggested Reading

Kralik, John.  A Simple Act of Gratitude: How Learning to Say Thank You Changed My Life. New York: Hyperion, 2011.

Hay, Louise L.  Gratitude: A Way of Life. New York: Hay House, 1996.

Ryan, M.J.  Attitudes of Gratitude: How to Give and Receive Joy Every Day of Your Life. San Francisco: Conari Press, 1999.

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April 2, 2012

Acceptance and Commitment Therapy (ACT)

Open window
by Darby Christopher, LMSW
A new wave of well researched and effective therapies has emerged in recent years. Examples include Eye Movement Desensitization Reprocessing (EMDR), Emotional Freedom Technique (EFT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), and others. This article will focus on the process and benefits of ACT, which primarily provides tools that can be applied to everyday life, with or without the help of an ACT therapist.
Overview
The primary goal of Acceptance and Commitment Therapy, according to Dr. Russell Harris, is the attainment of “psychological flexibility.” This refers to an ability to be open to the present moment, a perhaps deceptively simple yet powerful concept. When we are psychologically flexible, we are able to feel and to observe what shows up in our lives, without clinging to it too tightly.
If much our suffering results from how we respond to sadness, a depressed mood, anxiety or anger, then ACT provides the tools necessary to not worsen the situation by reacting to it or fighting with it. The result is greater self acceptance, less time focused on negative possibilities, and more time invested in valued action.
ACT often uses metaphors to convey its ideas, and a metaphor is helpful here. Suppose  that a certain set of circumstances triggers a depressed reaction in me, and let’s say that this depressed reaction is like a branch that is floating down a stream. Any of the ways that I fight with this depression – whether by feeling badly about it, denying it or trying to avoid it by destructive means – are ways that I am damning up the stream that will not allow the branch to flow through. ACT provides the tools that will help keep me from doing this, so that I will be more able to watch the branch come, flow through and float by.
Acceptance and Commitment Therapy falls under the broad category of Cognitive-Behavioral Therapy (CBT). However, it also follows a current trend in CBT to avoid counteracting symptoms, and to instead embrace the stance and practice of mindfulness.
ACT Tools
What are these tools? Acceptance and Commitment Therapy focuses on 6 core processes that work together. Each one requires effort, and will probably not be mastered over the course of a life time. The goal is to get better at them and experience more freedom, rather than perfection. Let’s look at each one individually.
  • Defusion. This refers to an ability to watch and observe our thoughts and emotions, and to create a little distance between our selves and the thought or feeling. This step is not easy because we often tend not to be aware of our thoughts. With defusion, we slow down and observe ourselves having thoughts and feelings. Next, if appropriate and helpful, a step can be taken to see the thought as perhaps a part of me, but not attached to my deepest identity, and therefore capable of change. 
  • Acceptance. This refers to how I relate to the thoughts and feelings that show up in me. Am I mad at them? Do I hate them and wish they would go away? Do I treat them like unwanted guests? Or, conversely, do I welcome even the painful thoughts and feelings that show up in me, knowing they could have some useful information for me? Do I love these parts and treat them with compassion? Loving what shows up in us leads to relaxation and an ability to listen to ourselves.
  • Contact With The Present Moment. To make contact with the present moment is to experience some sense of vitality right now. The requirements for this may shift as our moments shift. When we engage our observing self, we may pay attention to our sense of sight, smell, hearing, sound or touch, we may look inward and pay attention to our inner sensations, and we might do both of these at once. If we are dealing with a painful experience from our past, we will pay attention to our bodies and feeling experience, rather than ruminating over the facts of the past. Staying focused on the feeling sensations in our bodies allows us to be informed by them, as opposed to diverting our attention and missing out on the message they may offer us. Contact with the present moment often involves slowing down to be present with others, nature, and our own selves.
  • Self-As-Context. This refers to an ability to be in touch with the deeper part of me that is doing all of this observing. When we build our “self-as-context” muscle, we are able to know that there is a part of us that endures and stays steady through the day to day and even moment to moment changes in our lives. Why is this important? Knowing ourselves in this way facilitates the goal of psychological flexibility. If I know that I am so much more than my thoughts and feelings, then I won’t get too attached to them. (However I will still know and honor them as important, and give them their proper place in my life.)
  • Values. This refers to an ability to know what is important to me, and to allow myself to be guided and instructed by this knowledge. We are all given a certain amount of time on this earth to live in this life time. How do I want to spend it? What matters to me? What do I wish to leave behind? Getting in touch with my values both gives me a compass and a sense of deeper meaning.
  • Committed Action. Once I know what my values are, what do I want to do to act on them? What possibilities am I willing to try out? How could my life take on more vitality by my action(s)? 
Conclusion
Acceptance and Commitment Therapy provides useful tools to stay open and present to the moment. There are times when using these tools may seem difficult, if not impossible. With practice, however, they can be useful in even the most difficult situations. ACT does not take the place of other types of important work that also help us be more present to our lives, such as grief work, trauma work, and understanding how our past experiences affect us. ACT can stand on its own as a useful and healing therapy, and can be used in powerful ways in conjunction with other types of therapies.
Resources
The Happiness Trap: How To Stop Struggling And Start Living, by Russ Harris, 2008
Act Made Simple, by Russ Harris, 2009 (Note: This book is written primarily for therapists, though anyone may benefit from reading it.)

June 28, 2011

Book review: The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life, by Susan M. Orsillo, Ph.D., and Lizabeth Roemer, Ph.D.

Filed under: 2011 Articles,Anxiety,Lisa's Articles,Mind-body-spirit Integration — karunacounseling @ 2:37 pm
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Mindful Way Through Anxiety
A book review by Lisa Anyan Smith

We live in a stressful world.  Anxiety is a part of the human condition.

Many people complain of feelings of anxiousness, ranging from occasional mild worrying to full-blown anxiety disorders such as Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Social Phobia, or a specific Phobia.

Although anxiety is a normal human emotion, we find feelings of anxiety unpleasant and typically try to avoid experiencing them.  Attempts to avoid  anxious feelings may include overeating, drinking alcohol, watching TV, taking prescription medications, or staying away from situations or people that may trigger anxiety. In their new book, “The Mindful Way Through Anxiety: Break Free from Chronic Worry and Reclaim Your Life,” Orsillo and Roemer propose that avoiding anxiety or attempting to control it does not ease pain and suffering.  Rather, avoidance brings its own costs.  The authors suggest that to break free from anxiety, instead of avoiding anxious feelings, we practice coping strategies that allow us to turn toward and pay close attention to anxiety.  Turning toward something that we would usually avoid and taking a fresh look at habitual responses are crucial components of mindfulness.

Before exploring how mindfulness can help us break free from the grip of anxiety, let’s look at an example of what anxiety is.

Jody recently moved to New York City from Alabama to start a new job.  Heading into a corporate meeting, she notices that most of her coworkers are already seated and chatting with one another.  She takes a chair between two groups already engaged in conversation and begins shuffling through her papers.  She feels her anxiety rising.  Some of the thoughts that go through her mind include, “I don’t fit in here,” “My clothes are all wrong,” and “They must think I’m an idiot.”  She feels her face flushing, palms sweating, and pulse quickening.  Thinking of the friends she left behind at her former job, she feels a wave of sadness and regret.  She despairs as she thinks about the years ahead of her, just knowing that she will always feel alone.  For the duration of the meeting, she keeps her eyes downcast, contributing nothing to the discussion.

As this story illustrates, components of anxiety include thoughts, emotions, physical sensations, and behaviors.  Evolutionarily, humans are hardwired to feel fear.  Fear is actually a helpful warning that alerts us to potentially dangerous situations.  When we perceive a threat, the fight-or-flight response kicks in to ready us to combat or escape from harm.  The physical symptoms we experience when this response occurs (increased heart rate, rapid breathing, adrenaline rush, etc.) are merely side effects of the body getting ready to fight or flee.

Compared to fear, anxiety is a more subtle but chronic state.  Whereas fear is an automatic response to a threat we perceive as immediate, anxiety includes thinking about or imagining some possible threat we may come up against in the future.

Orsillo and Roemer’s research indicates that our struggle with fear and anxiety does not come from any actual harm caused by the physical sensations of these emotions.  Rather, it arises from our reactions to these emotions and the thoughts, sensations, and images that accompany them.  Criticizing ourselves for feeling fear or anxiety is what hurts us, not the fear and anxiety themselves.  This is where the turning inward is helpful.  Mindfulness can help us replace self-criticism with compassion.

Simply put, mindfulness is a specific way of paying attention.  It involves “purposefully expanding your attention to take in both what you are experiencing inside – your thoughts, feelings, and physical sensations – and what is happening around you.” (p. 81)  The key concepts of mindfulness include 1) Noticing – becoming fully aware of the thoughts, feelings, physical sensations, and images that you experience, as well as the details of your environment; 2) Curiosity – approaching experiences with openness; and 3) Self-Compassion – acknowledging that the reactions we have are part of being human, accepting what cannot be controlled, and treating yourself with kindness and care.

The authors provide a series of exercises progressing from a 5 minute breath exercise through a number of informal and formal techniques to practice mindfulness.  Readers are also encouraged to download audio recordings from the book’s website to listen to while practicing or to record their own scripts.

Shane trembled as she waited her turn to stand behind the podium and deliver her speech.  She had agreed months ago to make a presentation before her colleagues at the real estate convention, even though she was terrified of public speaking.  As the previous speaker was concluding his remarks, Shane felt her stomach churn.  Her neck felt tight and sore, she felt the blood rushing to her face as she blushed, and she began sweating profusely.  “Why, oh why did I ever agree to this?” she thought.  She recalled the incident in high school when she had forgotten her lines in the school play, and now she relived those old feelings of embarrassment.  “It will be just like in high school!”  “These people will think I’m so stupid.”  “No one will ever refer any business to me again, ever!”

Orsillo and Roemer would say that Shane is experiencing “muddy” emotions.  This occurs when we bring in memories of past events – and conjecture about future possibilities – into the current moment.  If Shane were to take a moment to be mindful of the immediate challenge, she would realize that she is muddying her current anxiety by worrying about “what if” rather than focusing on “what is.”

The authors write in a style that is easy to follow and offer many vignettes to provide examples.  They also address the questions that many readers may be asking:

But isn’t mindfulness a Buddhist principle?  Is it a new age fad? What if I have different spiritual beliefs?  

The term mindfulness indeed originated with Buddhism, but the idea has recently been included in research and therapeutic settings.  In fact, mindfulness practice has been shown to decrease anxiety, insomnia, stress, risk of coronary heart disease, substance use, chronic pain, and fibromyalgia, and increase attention, sexual functioning, quality of life, and immune system functioning.  The book does not focus on the religious aspect of mindfulness.

How can I find the time to practice mindfulness?

While research suggests that more practice is associated with greater benefit, the authors offer a variety of techniques including exercises that only take 5 minutes a day.  They also point out activities that you can do mindfully, such as eating, walking, washing dishes, folding laundry, petting your dog, cooking, listening to music, or hugging a friend.

How can mindfulness help with anxiety? 

By this time you may be thinking, “Gee, thanks, but no thanks.  I’m already acutely aware of my anxiety.  Why on earth would I want to focus on it more?”  Yes, it is seemingly counterintuitive, but mindfulness can actually help us notice what we are experiencing and make choices about how we want to respond, rather than automatically reacting in ways that hold us back from fully engaging in our lives.  Let’s look at one more example that illustrates the value of mindfulness:

Sam was on a third date with Chris.  He had been single for a long time and knew that he wanted to develop an intimate relationship.  He was quite fond of Chris, and was getting signals that the feeling was mutual.  As the talk turned more personal, he felt his pulse quicken, his chest tighten, and his mouth get dry.  He felt the urge to change the subject so he wouldn’t risk feeling vulnerable and getting hurt.  He watched Chris for cues, and thought he saw a frown of displeasure when Sam talked about a low point in his life.   What Sam really wanted to do was excuse himself, pretend to go to the bathroom, and run like hell out the back door of the restaurant.  However, he really wanted to build a connection with Chris, so he chose to remain in the situation.

Often the things that really matter to us, like loving people, forming emotional connections, taking on challenging tasks, or caring for those in pain and suffering, bring with them emotional pain.  In these cases, living a fulfilling life means that we notice the pain and allow it, rather than trying to make it go away.  Mindfulness can help us to embrace our entire range of emotional experiences, making it easier to make these choices and enrich our lives.

 

Additional Reading:
Boyce, Barry (Ed.). The Mindfulness Revolution. Shambhala Publications,  Inc., 2011.
Germer, Christopher. The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. Guilford Press,  2009.
Matheny, Kenneth B. & Riordan, Richard J. Stress and Strategies for Lifestyle Management. Georgia State University Press, 1992.
Nhat Hanh, Thich. Peace is Every Step: The Path of Mindfulness in Everyday Life. Bantam Books, 1992.
Siegel, Ronald. The Mindfulness Solution: Everyday Practice for Everyday Problems. Guilford Press, 2010.

August 12, 2010

Procrastination

Filed under: 2007 and earlier,Anxiety,Melissa's Articles — karunacounseling @ 1:03 am
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by Melissa Kulick, Ph.D.

If the topic of this article has caught your attention, I’d go ahead and read it now if I were you.  For most people who identify themselves as procrastinators, deciding to come back to it later  is a likely set-up for never getting around to it.

Despite the fact that procrastination is so widely practiced, I find it can also be incredibly misunderstood. Procrastination is often written off as laziness, but it is not that simple. True procrastination involves avoidance and is the result of any of a number of underlying factors or causes, which will be discussed below. If you are looking only for a quick how not to guide for overcoming procrastination, a number of practical tips can be found at the end of the article. I do not advise, however, skipping to this section. Experience has shown that if you don’t identify and address the underlying causes of your procrastination, you will probably procrastinate in applying these strategies, as well.

What Procrastination is Not

Before jumping into a detailed discussion of what procrastination is, it will be helpful to distinguish it from what it is not. There are legitimate reasons for putting an action or activity off and it becomes our responsibility to be honest with ourselves as we assess our motivations. Among the reasons we might delay action for reasons other than procrastination are:

1) When you lack the skill or knowledge to complete a task. You could, however, then procrastinate seeking the required knowledge or informing an appropriate other person of your situation.

2) When you have a legitimate illness or physical problem.

3) Ignorance – When you genuinely lack the awareness of the task or awareness that you have permission to work on it.

4) Situations where there are problems matching personal priorities with those of others. Again, this is where communication is required, and you could procrastinate in delaying this action.

5) Taking of a legitimate break following an appropriate period of activity.

6) Delays based on self-knowledge of your most and least productive work times during your day.

What Procrastination Is

When we talk about procrastination, we are referring to unhealthy putting off or avoidance of tasks, especially those that would be positive or helpful for us to accomplish. To understand (and ultimately overcome) our procrastination, we need to begin to explore what may be the motivation(s) – both conscious and unconscious – behind our choice to procrastinate. (Yes, we are making a choice, whether we experience it as intentional and deliberate or not.)

Why We Procrastinate

The motivations involved are fears and/or negative self-statements related to our self-worth. These fears and self-statements mainly stem from a number of commonly held, though irrational, beliefs. Albert Ellis, a pioneer in the field of rational emotive psychotherapy, proposed a lengthy list of such irrational beliefs. Among those that may impact procrastination are:

1) That it is a dire necessity for us to be loved or approved by virtually everyone we know.

2) That we should be totally competent, adequate, and achieving in every respect if we are to be considered worthwhile.

3) That it is awful and catastrophic when things are not the way we’d like them to be.

4) That it is easier to avoid than to face certain difficulties and responsibilities.

5) That our past behavior determines our present behavior.

6) That there is one right and perfect answer to our problems or situations and that to not find this right answer is catastrophic.

These can be incredibly powerful, foundational, beliefs. If you found yourself nodding in agreement as you read any of these, keep them in mind as we go on to discuss the various fears that may underlie our procrastination

I referred earlier to procrastination as a choice. In many ways, when we choose to procrastinate, we are making a decision based on a cost-benefit analysis; we are determining that what we see as the potential cost of taking action outweighs the expected benefit.

Among the possible reasons for procrastination, fear is a strong motivator of action (or inaction), and can come in a number of forms. It is the combination of fear and issues related to self-worth that fuel most, if not all, of our procrastination.

1) Fear of Failure – Holding a belief that our performance determines our worth (especially if we doubt our ability) can create a resistance to risking taking action (and thereby risking our perceived worth.)

A variation of this fear is Perfectionism. In this case, the only perceived measure of success is perfection, and this can apply both to the finished product as well as to an expectation that the effort involved be smooth and even effortless. Anything less than flawless and/or easy is seen as failure – and you become a failure, particularly in your own eyes

2) Protecting an Image of Competence – There are two forms this can take:

Novice Phobia – The fear of putting yourself in a new or novel situation and in the position of being a learner, and therefore not perfect or immediately competent. If I can’t do it right or perfect the first time, I won’t even try it. The anticipated cost, again, is a loss of perceived (by self and/or others) worth.

Fantasy of Competence – Avoiding facing a challenge directly by failing to prepare adequately for it, putting out a full effort, or giving yourself an adequate amount of time to complete it. This strategy, called self-handicapping, allows us to continue believing that we would have done a fantastic job if only we’d tried harder or had more time.

3) Fear of Success – Fearing unwanted anticipated consequences of success: that significant others in your life will be envious or threatened and reject you; that you will continue to be expected, by yourself or others, to maintain or achieve success; or that you or others will want even more from you. The cost of action, of course, is the negative consequences for you.

Another way that the fear of success can lead to procrastination is as a direct expression of a lack of self-worth. We avoid taking action that would be helpful to us because we do not believe we deserve to have, be, or achieve whatever the action would allow us to. This is a form of self-sabotage.  We undermine ourselves. This is also expressed as not seeing ourselves as worth the effort that may be involved in certain activities, regardless of the size of the task (e.g., brushing our teeth.).

4) Rebellion – One other motivation for procrastination stems from a desire to resist authority. Procrastinating in this case allows you a sense of power and control. The perceived cost is that working means submitting to someone else and giving up power.

Overcoming Procrastination

To overcome procrastination you need to address the motivation for your procrastination and honestly confront the question of whether you have a genuine desire to change your patterns. You need to ask yourself if you are motivated by the Pleasure Priority and, if so, if that is how you want to live. If your real priority in life is to have a good time, and you’re genuinely okay with that, then you need to stop kidding yourself and give up unrealistic fantasies of achievement; that’s not what fuels you. If you’re starting from this place but are wanting to work toward more of a balance between having a good time and being successful, a place to start is to recognize the need to learn how to delay gratification and work toward a later payoff.

To allow yourself to let go of the fear of failure and the paralyzing effect of perfectionism, it is very important to make the distinction between what we do and who we are. Our actions do not determine our worth. It is also important to remind ourselves that >we can not control others perceptions, opinions, thoughts, feelings, or actions.

A novice phobia can be addressed by remembering that we are all novices at everything at some point. When we allow our actions to be controlled by this fear, we are trying to protect an unnecessary false pride. If we do away with this pretense, we won’t have to spend all that energy maintaining a front that only limits us in the long run, by depriving us of the chance to learn and grow.

If you find yourself protecting a fantasy of competence, put your abilities on the line – repeatedly. You can then assess your true capabilities. You may have to give up unrealistic expectations or fantasies, but these weren’;t going to be fulfilled, anyway, if you continued to avoid and procrastinate. This will allow you a realistic sense of your strengths and weaknesses (we all have them), which will then enable you to set realistic, accomplishable goals for yourself.

If you find yourself procrastinating as a way to express resistance or as an act of rebellion, know that this is an indirect, passive-aggressive, way of expressing or achieving control. Set a goal for yourself of learning to deal with interpersonal difficulties in a direct manner and of seeing where your choice lies in situations. You likely have valid experiences and emotions that deserve to be acknowledged and expressed.

If you realize you are battling a fear of success, know that you are fully entitled to success and fulfillment. It may be helpful to explore the messages you hold inside you that tell you otherwise, as they can be indicators of tender spots within you that could benefit from some compassionate attention. Also remember that you can’t control others thoughts, feelings, etc. If, upon honest examination, this fear appears to be reasonable in a particular situation, ask yourself what steps you might be able to take to address the issue directly and/or whether this is a symptom of unhealthiness in a relationship.

In the case of self-sabotage, at the risk of sounding trite, awareness really is the first step. Acknowledge that this is forming the motivation for your choices and actions, and work on believing that you <u>are</u> worth the effort and do deserve to have, succeed, achieve, take care of yourself, etc. Practice. Don;t let a novice phobia get in your way here, either. It will be natural for resistance to come up as you begin to try on this new way of relating to yourself. That;s okay. There;s an approach used in the 12-Step recovery programs that you can borrow, which is to fake it til you make it. I prefer a slightly different wording, however. Ask yourself what you would do if you actually believed you deserved success or happiness, and then let yourself do it.

Behavior can be a powerful tool in identity formation. Not only do our beliefs about who we are or are not impact our choices regarding the actions we will and will not take, but our actions can create a picture of ourselves that can aid us in our future efforts. This is one way in which acting as if can be very helpful. If you start, for example, doing the dishes after each meal or beginning to read an assignment the day it is given (regardless of any internal pull to put it off), and you see yourself doing this repeatedly, your internal image of yourself begins to shift from someone who lets dishes pile up in the sink or someone who leaves assignments until the last minute to someone who does their dishes right away; or someone who gets a jump on their assignments. These internal ideas of who we are, while they do not define us, can definitely affect the choices we make.

Low self-worth and procrastination form what can be a debilitating vicious cycle where we start out feeling bad about ourselves and so are unmotivated to engage in positive action on our own behalf and we procrastinate and this only reinforces and increases our negative thoughts and feelings about ourselves, leaving us even less likely to act productively the next time. Break this cycle any way you can.

Self-compassion is going to be an important element as you work to change the habit of procrastination. Remember that procrastination as a style of approaching life tasks is an ingrained pattern that took a long time to develop, has been practiced repeatedly, and has been reinforced by (often lots of) internal messages. You should realistically expect that it could take some time to throw off such a well-rehearsed way of being. Many people find it helpful to address some of the obstacles they face in overcoming procrastination, especially their negative or restrictive internal messages and fears, over time and with a trained therapist.

Some Practical Suggestions

Sometimes we procrastinate starting a task because we feel overwhelmed by the seeming enormity of what we must accomplish. When this happens, the most effective approach is to break down the task into more manageable pieces, and this can be done by either dividing the task into individual steps and taking each step one at a time, or by breaking down the time spent working into small segments, contracting with yourself to work for even just minutes at a time. You can then consider renewing the contract once you’ve done that much.

Other things you can do include: creating structure by establishing a set time for a routine – by doing this you are building a new habit; modifying your environment to make it more conducive for working, or moving yourself to more favorable location; go ahead and do it when you think of it; make the most of momentum when you have it – keep going, even if it involves switching tasks; set up reminders for yourself if necessary; create a contract for yourself that includes both a work plan and a reward for yourself.

The most important thing is to start; start taking more responsibility for yourself (and seeing yourself as response-able) and start being more compassionate with yourself. Be both honest and gentle with you; you are a work in progress. And you are worth the effort.

August 3, 2010

Managing Anxiety and Depression Using Diet, Nutritional Supplements and SAM-e

by Darby Christopher, LMSW

Please note: This article should not be taken as advice for how to treat any particular condition. Individuals should always consult with their doctor before making any lifestyle or dietary changes, as some natural substances are harmful to specific medical conditions. Never stop taking any prescription medication without the advice and care of your doctor.

 

Introduction

The decision of whether or not to take prescription medication for anxiety or depression is a personal choice an individual makes based on many factors. This choice is made in conjunction with a doctor and often with the help of a therapist. For many individuals, prescription medication is not only a good fit, but the best fit for their particular constellation of life experiences, genetics and environment.

This article is written for individuals who, with the help and consultation of their doctor and therapist, would like to try to use diet and dietary supplements to manage their issues with anxiety and depression without, or in conjunction with, prescription medication. It is also intended to provide information for individuals to explore more fully on their own and with their doctor and therapist.

There are many factors that can affect a person’s mood and energy level, such as diet, proper rest, psychotherapy, exercise, spiritual practices, environment and relationships. This article will focus on diet and biochemistry, while acknowledging that each of these areas are interconnected and equally important.

Why Nutrition Matters

Our bodies need well functioning neurotransmitters, such as serotonin and dopamine, to experience enjoyment, relaxation, focus and motivation. From a holistic perspective, many factors aside from nutrition can affect how well our bodies are able to produce these chemicals. Yet, inadequate nutrition will result in a diminished ability to produce the chemicals we need to feel good. (Inadequate nutrition may result from a tainted food supply, lack of affordable healthy food, absorption problems in the body, and misinformation or inattention to diet.)

What our Bodies Need Nutritionally to Make Feel Good Chemicals

According to Dr. Charles Gant, author of End Your Addiction Now: The Proven Nutritional Supplement Program That Can Set You Free, there are four primary groups of neurotransmitters that are responsible for feelings of well being, relaxation and focus. They include endorphins and enkaphalins, serotonin, GABA, and dopamine and norepinephrine. (Serotonin also contributes to an ability to sleep well.) What our bodies need is to ingest the nutrients necessary to manufacture these items. So, what are these nutrients?

Let’s start with serotonin. Specific cells in our bodies manufacture serotonin using the amino acid tryptophan, working in conjunction with vitamin b6, vitamin c, folic acid and magnesium. Some foods that contain tryptophan include cheese, soy products, seafood, meat, poultry, whole grains, eggs, beans, peanuts and sunflower seeds. Some foods that contain vitamin b6 include tuna, bananas and a variety of green vegetables.

GABA, a neurotransmitter that promotes relaxation, is produced from the amino acid glutamine, working with vitamin b6, vitamin c and magnesium, among others. Foods that contain glutamine include chicken, fish, eggs, beef, beets, dairy, beans and cabbage. A wide variety of fruits and vegetables contain vitamin c, and magnesium is found in specific beans, seeds, fish and green vegetables.

Tyrosine is an important amino acid that contributes to the production of dopamine. Food sources of tyrosine include fish, chicken, pork, whole grains, dairy, beans, nuts and seeds.

The reader may have already noticed that the common admonition to eat a wide variety of fruits, vegetables, whole grains and proteins applies to managing anxiety and depression. As the intention of this article is to provide a broad overview, the above examples are illustrative. The reader is encouraged to research and explore more of the specific proteins, vitamins and minerals that manufacture the various neurotransmitters and which foods support their production.

The Benefit of Whole Foods

Because many of the nutrients that our bodies need to manufacture neurotransmitters now come for sale in a bottle at our neighborhood stores, a word about eating whole foods is in order. In their book Paradox & Healing, Dr. Michael Greenwood and Dr. Peter Nunn discuss the Chinese Traditional Medicine (CTM) concept of “Qi,” or, energy, that is a part of whole foods. They contend, “ …it is the “whole” herb or food which has the Qi and its strengthening properties, not any isolated extract which is called for. In other words, the difference between taking vitamin C in capsules and eating fruit which contains the vitamin is profound.” Recent research into the benefits of phytonutrients found in whole fruits and vegetables corroborates the concept of Qi.

Likewise, in his book Food Rules, Michael Pollan says that, “Foods are more than the sum of their nutrient parts, and those nutrients work together in ways that are still only dimly understood.”  Pollan is a reporter who set out to investigate all of the competing dietary claims in the media. He discovered a very simple truth, which is that the Western diet, with all of its processed foods that he calls “edible foodlike substances,” makes people sick, and traditional diets, no matter what whole, natural foods they consist of, promote wellness. Pollan sums up his discovery of what we should eat in what he calls seven simple words: “Eat food. Not too much. Mostly plants.”

Supplements

Having made a case for the benefit of whole foods, our attention will now turn to the possible benefits of nutritional supplements that come in bottles. Just as in some cases prescription medicine is indicated, there are cases also where nutritional supplements, under a doctor’s supervision, are beneficial. These situations might include cases of nutritional deficiency, attempting to overcome an addiction, as advocated by Dr. Gant, or as a personal preference to combat the effects of anxiety and depression.

Many studies have shown and proven the efficacy of treating various conditions with nutritional supplements. Conversely, concern for supplement use may include the body subsequently under producing the item being supplemented, or other imbalances. (Always consult a doctor when considering nutritional supplements, as they can be harmful or even fatal in excess amounts or when combined with certain conditions.)

Of the many supplements on the market today, a few examples will suffice here. If increased serotonin is desired, a product called 5 HTP may be indicated. The amino acid tryptophan turns into 5HTP in the body along the way to making serotonin. GABA can be purchased directly, as can the amino acid tyrosine, which the body uses to make norepenephrine and dopamine. Fish oil aids in overall brain health, and multivitamins enable the chemicals in our body to do their work.

Inositol is another nutrient for sale that contributes to brain health and helps the body metabolize nutrients. Dr. Fred Penzel reports success in his studies with inositol and trichotillomania (hair pulling), to cite one example.

Herbs, such as St. John’s Wort and hormones, such as estrogen, testosterone and thyroid, are also sometimes indicated in the treatment of depression. As with any supplement, careful attention must be paid to combining herbs and hormones with other treatments, and should take place only under a doctor’s supervision.

SAM-e and Methylation

A popular and increasingly well known product on the market today is SAM-e, which is a naturally occurring substance in the body whose function is to act as a catalyst promoting the chemical reactions that allow the body to produce desired substances. These chemical reactions are known as methylation pathways. SAM-e’s benefit is in taking the raw materials available in the body and producing the desired result, including the regulation of neurotransmitters. Many studies have shown the benefit of SAM-e to alleviate depression.

Conclusion

Individuals who are seeking ways to address their anxiety and depression without or in conjunction with prescription medication may find that a well balanced regime of exercise, meditation, proper rest, social support, work with a therapist, and attention to diet may give them the help and relief they are looking for. For the diet portion of this plan, whole foods are essential. Supplements can be added under a doctor’s care and may be beneficial, but do not take the place of whole foods. Informed consultation with a doctor or therapist may help determine an individual’s best course of action, and some trial and error may be expected along the way to discovering what combination of elements will work best.

Bibliography and Recommended Reading:

Food Rules, by Michael Pollan

End Your Addiction Now: The Proven Nutritional Supplement Program That Can Set You Free, by Dr. Charles Gant and Dr. Greg Lewis

Paradox and Healing: Medicine, Mythology & Transformation, by Dr. Michael Greenwood & Dr. Peter Nunn

Web site, The World’s Healthiest Foods, http://www.whfoods.com/

Web site, The Podell Medical Practice: Merging Traditional Medical Practice and Alternative Therapies, http://www.drpodell.org

December 5, 2007

Holiday Bill of Rights – Part 2

The holidays can be fun, but they also can be a source of great stress — and no wonder. The holidays are often depicted as a magical time when people reconcile and dreams come true.

How Can You Deal With Continuing Family Problems During The Holidays?

Being realistic is the first step. If you have bad feelings about someone, try and avoid him or her and not make an issue of it but don’t pretend that all is well. This will enable you to feel true to yourself and less stressed out.

Do Financial Pressures Stress People Out to the Point of Ruining the Holiday Spirit?

Knowing your spending limit is also a way to relieve holiday stress. People believe that they have to go out and buy gifts because it’s the holidays, even if they can’t afford to do so. Not only is it stressful to feel that you have to buy everyone an expensive gift, but you’ll be stressed for the rest of the year trying to pay off your bills. You can show love and caring by getting something that you know is meaningful and personal for

that person that doesn’t have to cost a lot.

How Do Time Pressures Affect People Around the Holidays?

People shouldn’t have to put their lives on pause or totally rearrange their schedules either because of the holidays. Learn to prioritize the invitations you accept and don’t feel that you have to go to every holiday gathering.

How Does a Person Deal With the Holidays When He or She Has Just Experienced A Recent Tragedy, Death or Romantic Break-up?

If you’re feeling really out of sorts because of any chronic or current stressors, like a death or recent romantic break-up, you may want to avoid some of the festivities because they are so out of sync with how you’re feeling. Try to tell those around you what you really need, since they may not know how to help you, and ask for their understanding if you decline an activity.

How Do You Cope With Kids Who Want Everything For The Holidays and Have No Sense of What Things Cost?

Parents need to tell their children to be realistic. It is OK to say to your child that a certain toy is too expensive. And even Santa Claus has limited funds and has to choose what to give because he has a very long list. You can also tell your children that Mom and Dad and Santa Claus will try to choose the most suitable present for the child. Children have to learn that their wish is not someone’s command and to curb their desires for instant gratification.

What Are Some Good Coping Strategies?

Take stock of your expectations and make sure they’re realistic. Don’t expect more of this time of year than of any other. Take a break from holiday music and television specials if you find that they’re turning you into "Scrooge."

Most people dread the holidays because their inner experience is so different from what is being hyped. You should trust your own instincts and don’t try to be what you’re not. Keep up your normal routine and know

that this day will pass too.

If, however, you are unable to shake what you think are "holiday blues" your feelings may not be about the holidays, but about other things in your life. If you need help in sorting out or dealing with this issue, a psychologist is a person with the training to help you do so. Call one of Karuna’s therapists.

Thanks to Dorothy Cantor, Psy.D., a private practitioner in Westfield, N.J., and a former president of the American Psychological Association.

(c) Copyright 2004 American Psychological Association

Documents from apahelpcenter.org may be reprinted in their entirety with credit given to the American Psychological Association. Any exceptions to this, including requests to excerpt or paraphrase documents from apahelpcenter.org, must be presented in writing to helping@apa.org and will be considered on a case-by-case basis. Permission for exceptions will be given on a one-time-only basis and must be sought for each additional use of the document.

February 10, 2005

Preventing The Recurrence of Depression and Anxiety

Filed under: 2007 and earlier,Anxiety,Depression,Former Karuna therapist — karunacounseling @ 4:41 pm
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by Andrea Schrage, MA, LAPC, CMT

The chronic, recurrent nature of depression and anxiety presents an enormous challenge to sufferers and treatment providers. Combining the use of mindfulness and cognitive behavioral therapy allows for individuals to learn skills that will work more holistically to include mind and body in their growth. Participants can learn to play an active role in preventing the return of depression and anxiety as they watch other areas of their life positively impacted during the process. Through learning these techniques, one will notice a change in how they are able to participate more fully in their life in a conscious and often more peaceful way.

Conscious Choices is a 4-session class designed to teach its members how to combine these two modalities and to give them skills to help them prevent the spiral into reactive moods.

  • Learning to meditate for those who think they can’t.
  • Learning to identify the ongoing flow of critical voices in our heads.
  • Learning to sit with painful emotions and body pains.
  • Learning how to see anxiety and depression coming and make choices to prevent them.
  • Learning to recognize joy and happiness in everyday life.

Effects of this class may include:

  • Increased relaxation.
  • Reduced fear and anxiety.
  • Discontinuation or lessening of depression cycles.
  • Increased happiness and appreciation of life.
  • Feelings of empowerment.
  • Ability to make clearer choices about life.
  • Increased connection with others and self.

by Andrea Schrage, MA, LAPC, CMT

November 1, 2004

Handling the Holidays..in a New Way

By Molly Keeton, Ph.D.& Andrea Schrage, MA, LAPC,CMT

The time is coming..food, festivities, and family. This can be a combination for fun or it can be a recipe for the blues. The following is a few ideas for shifting the holiday “shoulds”.

We tend to follow the same traditions every year because, in theory, it gives us some comfort and connection. This year take some time before hand to evaluate which traditions are truly enjoyable for you. This includes who you spend the holidays with, what traditions you participate in, how much time you spend with others and how much time you spend alone. What would your ideal holiday look like? Be creative. Does it include friends, volunteering, staying at home with relatives? If you do spend time with family, how much time is enough time before you find your self needing some space? Forcing yourself into too much togetherness can create resentment that may go outward or turn inward Either way you are not helping yourself or those around you.

When making plans to change holiday traditions, be prepared for responses that you are likely to receive. Does your family use guilt or coercion to keep things at status quo? Anticipating the tactics that might be utilized can help you to plan in advance how to respond without getting caught up in old patterns. It might be helpful to discuss this with your therapist and to use role-play to get feedback on your approach. Talking to your family about your plans in advance is
preferable to discussing it during the holidays when the emotions are high.

It is important to remember that we are adults now and get to make our holidays what we want them to be. Keep in mind that when interacting with our families, it is easy to revert back to childlike ways of coping. Though these patterns kept us safe when we were younger, they currently keep us engaged in the dysfunctional system. Chances are you are in a space in your life in which you don’t solely rely on your parents for food, shelter, support, and love. Therefore you have more opportunity to make your own choices without threat of losing your foundation.

Making changes can cause temporary stress even though the long-term gains are helpful. To soothe your discomfort, try some of the following: take a hot bath, call a friend, treat yourself to a massage, write in your journal, allow yourself a day off from your to-do list, wrap yourself in a warm blanket, or make yourself a nourishing meal.

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