O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

By Leave a Comment

Procrastination: Scratching Items off the Mental To-Do List

When tasks overwhelm
Getting Unstuck: Finding Flow Again

A lot of our stress comes from holding our undone tasks in mind; the more we have, the more they weigh upon us. Sometimes it’s not our actions but the actions we’re not taking that cause us stress. If we can generate ways to off-load the things on our to-do list from working memory, we are freed to focus on one thing at a time, relieving a sense of burden and at the same time allowing us to be more productive.

Full Engagement & Wholeheartedness

This idea of doing one thing at a time with full engagement of attention has been seen as crucial to a sense of well-being by many observers. In David Whyte’s book Crossing the Unknown Sea, he describes an exchange with Brother David Steindl-Rast, who says: “You know that the antidote to exhaustion is not necessarily rest? . . . The antidote to exhaustion is wholeheartedness.” (p. 132, emphasis original)

Finding Flow in Difficult or Unpleasant Tasks

This idea of full engagement as a part of well-being was observed by psychologist Mihaly Csikszentmihalyi, who researched the concept of “flow.” Tapping into this idea, he observed that when people are engaged in an activity that is moderately challenging( neither too easy nor too hard), allows some creative problem-solving, and absorbs the mind, they report that they can be lost in a task with little sense of time passing. On emerging, they feel a sense of satisfaction: pleasure in achievement, but also pleasure in the intrinsic reward of being fully engaged in something interesting.

It’s important, then, not just to focus on the product of your work—the outcomes, the problems solved, the things you get to cross off your list—but also the process. If in addition to achieving good work you are also using your skills and challenging yourself to improve, that, in and of itself, is gratifying.

A recent study, reported on in a New York Times piece, explored how people make decisions—and turned up some surprising findings. Researchers asked subjects to carry a bucket down an alley; they could pick a bucket close by, or an identical one closer to the alley’s end. Believing that people are inclined to save physical effort, the researchers expected that people would pick the bucket farther away, which would require less carrying. Instead, most people chose the bucket near them at the alley’s start.

Working Memory- The Mental Scratch Pad

They tried this experiment in eight different ways with the same result. Why? Researchers believe that people engage in “procrastination”—taking on tasks ahead of time because it feels so good to get it off our minds, even if it’s more work. We can also call this “offloading working memory.” Working memory refers to holding information in mind for a short span of time, just long enough to complete a brief task, as opposed to short-term or long-term memory, which stores information for later use.

Working memory is a mental scratch pad: once an item is completed, it’s crossed off and thrown away. You may remember from Psych 101 the magic formula 7 +/- 2. On average, humans can hold seven bits of data in mind at one time—plus maybe two on a good day, or maybe just five if you’re tired or stressed. There is a limit to what you can hold in your head at one time. That’s why phone numbers are seven digits.

If we try to hold too much information in our heads at once, it feels stressful, so we’ve developed strategies to offload tasks from your working memory. If you can confidently say, “I know I can get to that later; I don’t have to think about that now,” then you’re freed to focus on just the one thing in front of you. This is the reason behind to-do lists.

The Myth of Multitasking

The idea of doing one thing at a time is something we come back to again and again. It is impossible to do constantly but is something to aim for because of the greater feelings of satisfaction it produces. Multitasking is a myth: when you divide your attention between tasks you are less productive and less accurate.

It’s understandable that people want to offload from working memory, but answering trivial emails (tweets, phone calls), sharpening pencils, and so on, may seem like accomplishing things, but they pull focus from the important tasks. We have to select which of these to respond to and which will get done later.

Of course, a lot of what makes us human—and so successful—is our ability to plan and think ahead: we inhibit automatic, impulsive responses in favor of thoughtful, controlled responses. The kids in the famous impulse-control study who were more successful at inhibiting had higher GPAs, SATs, and higher-paying jobs in comparison to the kids who couldn’t stop themselves from going for the marshmallow. At the same time, we know that scholastic achievement does not necessarily make people happy and that restraining all impulses can make for a life without spontaneity and joy. Finding the balance is a crucial component for happiness.

What is it that makes us feel happy? Maybe it’s the wrong question. It is not happiness we should be seeking; we need to engage in meaningful work. As Eleanor Roosevelt wrote, “Happiness is not a goal, it is a by-product.”

By Leave a Comment

Chronic Pain: Talking About Pain

Synapse process over neuron connection background – 3D rendering

Treating pain is difficult for several reasons. Narcotic painkillers bring with them addiction and other problems, but the medical system isn’t set up to handle behavioral interventions that can help pain management, as I wrote a couple of years ago in a post on “A Behavioral Approach to Treating Chronic Pain and Medical Problems.”

Another reason brought out by Joanna Bourke in her July 13, 2014, New York Times Sunday Review column “How to Talk About Pain,” is simply how difficult it can be to put pain into words that other people can hear. Partly, Bourke writes, this is due to the introduction of effective anesthetics and analgesics, which paradoxically turned describing into complaining:

In earlier periods, doctors regarded pain stories as crucial in enabling them to make an accurate diagnosis. But within a century, clinical attitudes had radically changed. Elaborate pain narratives became shameful, indicative of malingering, “bad patients.”

How are patients encouraged to describe pain today? Often, it’s by picking a number on a scale—sometimes according to a series of increasingly distressed-looking cartoon faces. This might be enough for emergency use, but there’s more to the experience of a chronic pain patient beyond “6. Hurts even more.”

A study published in Proceedings (Baylor University. Medical Center) underscores these findings: “Acute and chronic pain not properly assessed can result in inadequate pain management outcomes and can negatively affect the physical, emotional, and psychosocial well-being of patients. Pain assessment is the cornerstone to optimal pain management.”

For Bourke, assessing pain means listening to the patient:

Pain will always be with us, and by listening closely to the stories patients tell us about their pain, we can gain hints about the nature of their suffering and the best way we can provide succor. This is why the clinical sciences need disciplines like history and the medical humanities. By learning how people in the past coped with painful ailments, we can find new ways of living with and through pain.

Fanny Burney (1752-1840), the English novelist and diarist, wrote a searing account of her breast-cancer operation—sans anesthetic—in 1811. Reading it with a sense of history should give any clinician a better sense of the nature of suffering.

I began a scream that lasted unintermittingly during the whole time of the incision – & I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, & the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp & forked poniards, that were tearing the edges of the wound – but when again I felt the instrument – describing a curve – cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose & tire the hand of the operator, who was forced to change from the right to the left – then, indeed, I thought I must have expired. (The Oxford Book of Letters, 1995, p. 203)

Modern medicine has impoverished the language we use to describe our suffering.

By 1 Comment

Post-traumatic Stress Disorder and Post-traumatic Stress Injury

 Responding to first responders and PTSD

Responding to First Responders:  PTSD and PTSI in First Responders

Psychologists sometimes treat first responders to an emergency. We may see police officers, firefighters, hospital staff, paramedics, and clergy who have suffered psychological trauma after responding to a natural disaster or critical incident. First responders may come to us to help them with post-traumatic stress disorder (PTSD), substance abuse, chronic pain, depression, and anxiety. Treatment for first responders and their families is further complicated by their access to firearms, which increases the risk of suicide.

The symptoms of PTSD, include hyper-vigilance, insomnia, flashbacks, and nightmares. Another “post-traumatic stress injury,” or PTSI. A traumatic injury implies that the reaction to a critical incident must not necessarily lead to a psychiatric disorder or become a chronic condition. Diagnosing a “disorder” may lead first responders to believe that their reactions are wrong and that they won’t get better. By using the word “injury,” we empower people to feel they have some control over how they recover from the event. In the words of Matthew J. Friedman, executive director of the Department of Veterans Affairs National Center for PTSD: “The concept of injury usually implies a discrete time period. At some point, the bleeding will stop. Sometimes the wound heals quickly, sometimes not. A disorder can stretch on for decades.”

An emergency can present first responders with a critical incident—that is, a sudden, unexpected, unusual event that includes the loss or threat of loss of life. First responders who perceive a threat or trauma can react in significant psychological and physiological ways. It’s important for the treating therapist to understand the meaning clients attribute to a critical incident, which affects how it is processed. Police officers at a violent scene might be excited, afraid, or just wonder about what’s for dinner that night.

Stress, left alone, is neither harmful nor toxic. Whether the stress becomes damaging is the result of a complex interaction between the outside world and our physiological capacity to manage it. – John J. Medina, Ph.D.

Our body’s reaction to stress is partly a matter of what stress we encounter, partly its duration, and partly what the responder brings to the event. Other life events can also play a role in reactions to critical incidents. At least 60% of adults in the United States have experienced at least one traumatic event in their life, such as child maltreatment, interpersonal violence, natural disaster or serious accident. Exposure to traumatic events is a risk factor for depression, substance abuse, and PTSD. When a parent or other significant adult has traumatized a child, scars are left that can re-emerge in adulthood. Depression is the most common effect of trauma. However, most who have experienced a critical incident don’t experience long-term consequences; in fact, only about 7% develop PTSD/PTSI, although the percentage is much higher in the military, at 20-30%.

Trauma response doesn’t come out of nowhere. Most people diagnosed with PTSD have had at least two traumatic events in their life. In a study by John Briere (2012) that attempts to predict PTSD, he found that psychological neglect in childhood accounts for the largest percentage of variance, rather than the threat of physical injury. In treating clients with PTSI, it is important to explore the particular incident to which your client’s reaction is tied.

Betrayal for first responders takes four forms: administrative, organizational, personal, and community. An example of betrayal is keeping the first responders locked in a debriefing room, away from press and victims while investigations proceeded—with no provisions made for food or water. This constitutes an institutional failure, or as psychologists would say an empathic failure, and compounds the trauma. In the aftermath of catastrophic events, sometimes the most obvious way to support a traumatized worker is to take care of their physical needs.

Another kind of institutional betrayal was failing to protect a first responder from the press—for example, allowing private observations to be publically recorded. Such inattentiveness and lapse of judgment serve to make the primary trauma much more complex by re-opening wounds from childhood that, when coupled with intense life-threatening trauma, can lead to PTSD or PTSI.

In treating trauma, it is important to:

1. Acknowledge it and move toward forgiveness
2. See the connection between the current critical incident and personal history
3. Help the responder understand why it is so powerful
4. Get peer validation for the first responder’s experience

“What separates people who develop PTSD from people who are merely temporarily distressed is that the people with PTSD start organizing their lives around the trauma.” Bessel A. Van Der Kolk

Treatment elements include cognitive restructuring, development of cohesive narrative, affect regulation and relapse prevention. The real work is ongoing support, through individual and group meetings. Couples and family therapy is also a major component of treatment. Peer support and 12-step programs designed to help first responders are important adjuncts to therapy.

Kamena, M., Kirshman, E., and Fay, Joel(2013). Counseling cops: What clinicians need to know. New York: Guilford Press.

By Leave a Comment

Seeing How Childhood Patterns Affect Marriage

 

Couples Therapy and Family of Origin
Learning about Relationships by Watching Parents

When Mark and Judy came to see me for couples therapy, Judy felt frustrated by her husband’s constant angry mood. They rarely talked anymore, and she felt that any time she brought up a stress, the conversation quickly became a quid pro quo—who had the hardest day? Mark felt low-level irritability and frustration about his life as a parent, provider, and worker. He didn’t feel in control over his life, but rather, at its mercy. ”When do you relax? What do you do?” I asked. He answered, “I veg.”

“How do you veg?” I asked.

“I turn my back on my wife and small kids and look at my laptop, surfing the web, reading this or that,” he replied. Turning his back was Mark’s signal to his family not to bother him, his way of carving some space for himself in his small house. But did it work?

“It works for moments, maybe; they leave me alone, at least.”

But in turning away, Mark was missing the opportunity to turn toward anything enriching. The web gives ample opportunity to veg, plenty of material to inspire reverie, but the end result is not Whitman’s loafing that invites the soul. It is diffuse and at the end of the evening, empty. A one-click purchase was often the only way my client felt like he actually got something for himself.

 Spillover Stress: How it Damages a Relationship

And the next day would be just like the one before, full of stress and angry feelings. The psychological term “spillover” describes how stress can bleed into other aspects of life, especially in relationships. When someone is stressed because of the demands of daily life, they will carry that stress home, like a heavy briefcase they can’t put down. If someone is disconnected from himself or herself because the demands of life feel so heavy, they lose connection to their inner self, the soul.

Using Reverie and Daydreams as an Alternative to Surfing the Web

Returning to my client, I invited him to consider the benefits of reverie. To daydream, to muse with no clear focus, to allow the mind to wander with its spirals and twists—that can be a wonderful thing. “Loaf and invite the soul,” wrote Walt Whitman in Leaves of Grass. We need moments in the day with no one—not even ourselves—looking over our shoulders and monitoring our productivity. We need time where we can let ourselves slip into that pleasant, non-productive time with nothing to do but allowing thoughts, feelings, and images to freely enter and leave our minds.

So why not put the briefcase down, take the weight and the ache away? In Mark’s case, as we explored his feelings more deeply, he revealed guilt: Guilt about taking time for himself. Guilt about not being 100 percent there for his wife and kids. In therapy, we explored some reasons for this.

 Going Deeper Within the Context of Couples Therapy

Through his boyhood and teenage years, Mark was what therapists call a “parentified child.” His mother suffered from a degenerative disease. His father worked to support the family on a meager budget, despite working two jobs. Mark had to care for his mother, feed her, and stay home while the other kids were out playing.

He got the message that taking anything for himself when his poor mother had nothing—no mobility, no joy, and no friends—was selfish. He carried this guilt into adulthood without realizing that now, as a parent himself, he was recreating his childhood pattern and taking care of everyone but himself.

While at first glance Mark and his wife Judy’s marriage looked like that of a typically bickering couple, it wasn’t that simple. Just teach them some communication skills, give some homework, and let them go on their merry way? NO. Unless the two understood Mark’s guilt and the reasons behind it, no real, lasting change could be made in their marriage. They would fall back into old patterns six months or less after completing couples therapy.

In Mark’s case, Judy listened quietly at first then interjected, “But I do give you space—I tell you go see your friends one evening after work, go the gym…” Mark had heard her say this countless times since their daughters were born. The conversation was an old one and never changed. When people have the same fight over and over, they become bitter and hopeless. Thoughts of divorce enter along with feelings of self-pity. “Another partner would not treat me this way,” each might think.

 Stepping Out of Gridlock Takes Patience and Time

To step out of a gridlocked conflict such as this one takes patience and time. Couples counseling creates a space for partners to explore some of the not-so-obvious dynamics of their relationship with empathy, putting grudges aside long enough to really see your spouse in a different light. It provides an opportunity to see patterns on many levels: communication with your partner, your relationship to your parents, and how those layers interact with each other to create difficulties in loving.

By 2 Comments

How to Survive a Rip Current of the Mind When Practicing Mindfulness Meditation

Mindfulness Meditation

Ruminations and Worry Make Meditation and CBT Difficult

Recently during a visit to Hawaii, I read a pamphlet on ocean safety that described how to survive a rip current. They can travel 1-8 feet per second, meaning that in an astonishing 8 seconds, you could be carried sixty-four feet out to sea!  The instinct is to fight the rip, which only makes it worse because fighting something that powerful is exhausting.  After exhaustion comes panic, and in gulping for air, swimmers choke on seawater.

In mindfulness training, we talk about letting thoughts pass away like waves in the ocean. But what if your mind gets caught in a rip current? When the waves are so turbulent that they produce the conditions ripe for a rip?

Surviving a rip current depends on doing something that is contrary to instinct. The key is not to fight the current but to understand it and go with the flow—while at the same time, swimming across the strong current, parallel to the shore. Find a spot where waves are breaking on the shore, and let yourself be carried back to the beach by the same ocean that took you away. If you are unable to swim diagonally to the shore until the waves carry you back, then relax and let the current carry you out: it will eventually lose strength and, if you have conserved your energy, you can swim back.

The same instructions can be applied to mindfulness-based cognitive therapy. Many people come to mindfulness meditation, or Mindfulness-based cognitive therapy (MBCT) or stress reduction (MBST) depressed, anxious, or dealing with panic disorders. Asking them to sit still and silently focus on their breathing is an enormous task.  We talk about letting thoughts pass away like waves in the ocean, but what if your mind gets caught in a rip current? Often, the thought stream is too strong for the breath to anchor them, and MBCT clients get carried out to sea by their ruminations and worries.

When the mind gets carried away in a panicky current, it feels as if there is no escape. At those moments, the urge is to give up, even to quit the practice. So, when feelings threaten to overwhelm you during meditation, turn to wisdom learned from the sea.

Remember that a rip current doesn’t pull swimmers underwater; it carries them away from shore in a narrow channel of water. When your mind begins to ruminate, think of the thoughts as a channel, not the whole ocean. That channel can be overcome by allowing yourself to relax and accept the strong pull. Fighting it will wear you out. Notice where the shore is, pay attention to the flow of the water as it moves to the shoreline, and think of your body as the shore, grounding you. You are solid and firm. Ruminative thinking, like the rip current, will lose its strength eventually, and you can return your focus to your breathing. Each time you resist your instinct to fight the overwhelming thoughts and just accept them, you will be training yourself to be a stronger and smarter swimmer.

How to Survive a Rip Current

Remain calm, do not panic. Should you find yourself caught in a current that’s taking you away from where you entered the water, remember that panicking will only tire you.

  1. Go with the flow. Do not attempt to fight the current. You will almost always lose the battle. Swim across or perpendicular to the current’s direction.
  2. Wait until the current releases you. It will.
  3. Swim parallel to shore and then make your way in.

From KORC (Kauai Ocean Rescue Council)