O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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Happiness and Pleasure Born of Reverie and Reflection

Photo credit: Vicki DeLoach

When I was little and living in lush, sweaty Georgia, my mother would take me and my brother out to the lawn and we’d pick delicate white daisies, carefully connecting stems end to end to make a halo or a crown. Secluded from other cares, for me those afternoons before being called to dinner felt eternal, endless. We didn’t ask to watch TV, the only screen available back then. And if we were lucky, the day would turn dusky and bands of lightning bugs would appear, making their mystical dance around our heads, flying just low enough so we could catch a few in our glass jars. I always released mine after a few seconds, hoping they would remember me as kind and come back again the next evening.

Daisies don’t grow in the grass in California where I live now. Bugs do. They crawl up and down gigantic blades in a determined march to get to the other side of the lawn. When my twins were little, we’d get down on our forearms and elbows and watch their surprisingly fast journey. Then we’d roll onto our backs and look at the clouds, finding comical animals, monsters, and castles. Absorbed in our thoughts, time moved much slower than the clouds and bugs. When my husband called us to dinner, we strolled to the house, calm and happy.

Several years ago, we tore up the grass to save water. I don’t see the bugs up close now, but I see the honeybees and hear their sweet music, along with the birdsong.

Long before Gautama became enlightened while sitting under the Bodhi tree, he experienced a calm, peaceful reverie as a boy while sitting under a rose-apple tree in his father’s field. This Buddha-to-be watched the grass being churned in the fields and noticed the bugs being displaced by the plow, some dying and some surviving. Contemplating the transitoriness of life with calm awareness, he experienced the state Buddhists refer to as jhana—a rapture and pleasure born of seclusion from the usual demands of life. This glimpse was lost in memory for many years, until that day under the Bodhi tree when Gautama realized that life brings suffering, yet it also brings a way out.

Meditation is one of the paths that bring awareness, insight, and calm. These states of meditation where the mind is free from craving, aversion, sloth, agitation, and doubt, are experienced when we can be alone without demands of daily life pressing us toward the ever-present distractions that impinge daily. Watching clouds or bugs with nothing on your mind may bring about that first state of meditation, just as it did for Buddha. Taking time with no purpose, but to sit still, listening and observing, may bring surprise and joy.

 

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How Wisdom Emerges from Body-Scan Meditation

 

 In mindfulness practice we use the Body Scan as a way to develop attention and focus on the body without judgment.Mindfulness Meditation: Using the Body Scan as a Focus

Body-scan meditation focuses deliberate attention on the body without judgment or wanting anything to come from it. This isn’t a traditional relaxation method; people may feel peaceful, but they can also feel antsy, impatient, irritated, and hungry. That’s the point: You can experience these feelings, thoughts, and sensations without needing to take them further. Just notice, and then move on to the next part of the body.

With physical pain, for example, our thoughts might go something like this: “My back hurts, that muscle ache could be a spasm or what if it is bone cancer, maybe I should have an MRI, or maybe I need to go to a chiropractor, but that could mean I have to go three times a week, how will I get off work? My wife is going to be mad at me for spending the money, but then, damn that! If I’m hurting, then I need to get out of pain. She has no business keeping me out of the doctor’s office. I deserve to spend money on me sometimes. Just like when I was a kid, and my mother didn’t take seriously the pain in my arm, and it was broken! I went for weeks before she took me to the doctor… ”

The thoughts go on like that. Before you know it, you’re fuming; your body is more tense than when you began. You feel irritation not only at your wife, but your mother, the medical system, the ACA, and your insurance company. You probably feel sorry for yourself. All that strong emotion gets internalized into your pores, your muscles and sinews, and your heart. Your focus on your body ended ten minutes into the 45-minute practice: all you can think about is getting up and googling “back pain.”

A mindful alternative might go like this: “My back aches, oh, okay. It hurts now, that is how it is right now.” And then you rejoin your yourself, and think, “Noticing my right shoulder…noticing the feelings present there…I bring my attention to my right arm, noticing what is there to be felt…” At the end of the body scan, you open your eyes and realize that you have stayed with the practice for most of the 45 minutes. Your mind wandered, but you didn’t end up becoming angry with your partner, your mother, the medical system, and your poor luck.

Living with all our emotions can be difficult. It’s not uncommon for feelings to be transformed into physical sensations that can very possibly develop into an illness. You didn’t cause the illness, but being in prolonged or frequent physical and emotional turmoil puts the autonomic nervous system (ANS) into a constant state of over-arousal, a kind of hyper-drive that leads to difficulty sleeping, tense muscles, fretting, and worry.

In his poem fragment “Eternity,” William Blake wrote about the elusiveness of joy:

He who binds to himself a joy

Does the winged life destroy

He who kisses the joy as it flies

Lives in eternity’s sunrise.

Happiness studies show that no one is happy all the time. In the same way, wisdom is not always with us. We have moments where it all comes together, and then it disperses again. Focusing on the body with awareness is a way to allow wisdom to emerge without trying.

How does wisdom enter in? In the second, alternative, body scan you notice the pain in your back, move on, and finish the practice. You’re more rested because you didn’t get attached to any one thought. Then sometime later in the day, you do a kindness to yourself. You think, “I’m feeling some ache in my back; I’ll listen to my body over the next day and see if I should pursue it further. But for now, I’ll take care to not overdo the wedding, and to come inside and rest.”

That is wisdom. It’s not Socrates, or Jesus, or Buddha; it’s your own wisdom that emerges because of your kindness to yourself, and because you didn’t let yourself go down the rabbit hole of your thoughts.

Below is a thirty-minute Body Scan Mindfulness Meditation. It is one of the first meditations used in Dr. Kabat-Zinn’s Mindfulness-based Stress Reduction class (MBSR) and is also a core meditation used in Mindfulness-based Cognitive Therapy (MBCT). It is best done laying down, with your eyes closed.

Body Scan Mindfulness Meditation

 

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Alternative & Complementary Treatment for Emotional and Physical Health

Self-care and ethics for psychologistsWith changes in health care following the Affordable Care Act, providers will soon emphasize health promotion over disease management. Integrating alternative and complementary approaches to well-being will provide patients with ways to manage their health and provide a foundation for preventing new health problems. Complementary and Alternative Medicine (CAM) has been practiced for the last 25+ years in the United States, but many of these approaches have a much longer history: well over 2,000 years, in the case of yoga. In the last decade, studies examining the effects of yoga have increased substantially—important for yoga’s acceptance as a mainstream treatment.

CAM includes health-care practices that have not generally been considered part of conventional medicine. In 1991 Congress passed legislation to provide the National Institute of Health (NIH) with $2 million in order to study unconventional medicine. Some of the most widely studied alternative approaches to health promotion and maintenance include biofeedback, meditation, dietary supplements, chiropractic treatment, massage therapy, relaxation training, movement therapy, art therapy, and acupuncture, together with spirituality, religion, and prayer. Other approaches, such as hypnosis and bodywork (including Reiki, Hanna Somatic Education, and Feldenkrais), have also been used for several decades.

Biofeedback is One of Many Treatments Shown to be Effective in Treating Medical Problems

Biofeedback can help many medical problems.
Biofeedback Before the Digital Age

I incorporated biofeedback training for the patients I saw during the eight years I worked at Kaiser Hospital in Vallejo, CA. Biofeedback informs a patient of important physical measures such as muscle tension, skin temperature, brain wave activity, and heart rate. The photo shows what was state-of-the-art equipment at the time (circa 1988.)
I treated patients referred by their PCPs, neurologists, and orthopedic physicians for chronic medical problems. These patients were considered ‘high utilizers’ of medical services such as doctor office visits, prescription drugs, and special procedures. Using a treatment model that included cognitive-behavioral therapy, biofeedback, relaxation and meditation training, patients suffering with chronic headache were able to reduce doctor’s office visits by 75%, medications by 56%, emergency room visits by 19%, and special procedures by 6% for up to five years after treatment.

We have come a long way since then. Digital developments since those early years have dramatically changed the way biofeedback services are delivered. But the principle is the same: taking responsibility for your own health.

Taking Responsibility for Your Health is Key to Lasting Change

Teaching a client to control muscle tension so they can reduce musculoskeletal pain, or showing a migraine sufferer how to increase hand temperature through relaxation and biofeedback, involves learning to be aware of stress and the body’s automatic reaction to it. Of course there are some that would rather take a pill to relax, but that doesn’t change the psychophysiological baseline. Taking a pill or a drink will give temporary relief, but will not lead to lasting changes in how the body handles stress, thereby preventing headaches or pain altogether—not treating them once they occur. Implementing positive health behaviors require discipline and consistency. When physicians have 20-minute appointments –once or twice a year—there is not sufficient time to instruct and follow-up on a patient’s exercise or yoga practice. For people who are dealing with significant life stress, medical problems or depression, making life style changes can feel insurmountable. One yoga class will not help an achy back, nor will a meditation class help control anxiety if the home practice component is ignored. Psychotherapy aimed at helping integrate and continue healthy changes can help.

Wearable sensors such as Nike+ FuelBand or the Fitbit One monitor everything from heart rate, steps taken, sleep quality, energy used, and skin temperature. As a recent New York Times article reported, there is even an app to detect signs of depression in diabetes patients through smartphones.

Taking responsibility for health by using both ancient practices and newly emerging technologies and treatments will improve lives and ultimately reduce medical costs. But the most profound outcome is engagement with a life lived fully.

References:

“The Integration of Complementary and Alternative Medicine (CAM) Into
the Practice of Psychology: A Vision for the Future,” in Professional Psychology: Research and Practice, 2012, Vol. 43, No. 6, 576–585.

Changes in medical utilization after biofeedback treatment for headache: Long-term follow-up. O’Grady, Susan J. Dissertation Abstracts International, Vol 49(1-B), Jul 1988, 241.

National Institutes of Health (NIH). (2011). NIH—The NIH almanac (NCCAM). http://www.nih.gov/about/almanac/ organization/NCCAM.htm

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How Lifestyle Changes Can Be Therapeutic—And What To Do When They’re Just Too Hard

The October 2011 issue of American Psychologist featured an article on how mental health professionals significantly underestimate how unhealthy or missing lifestyle factors—for instance, nutrition and diet, or service to others— contribute to many emotional health problems. It also discussed how immensely helpful improving these factors was in treating many mental and physical health problems. Researchers have termed these improvements TLCs, or therapeutic lifestyle changes.

The eight lifestyle factors include exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement, and service to others. Plentiful research supports the importance of these eight TLCs—as does plain common sense. And each lifestyle factor contributes to the others. Exercise and diet affect mood, and recreation (inscribed in the word itself: re-creation) will help instill a sense of well-being. In a virtuous cycle, when people feel physically comfortable with their bodies, when they feel vital and energetic, they will have the energy to engage in activities such as service to others and feel inspired to spend time in nature and contribute by giving to others.

Many folks today are facing challenges in obtaining the most basic and fundamental needs, such as food and shelter and financial and physical safety. These must be met before additional needs can be addressed. Yet by addressing lifestyle factors with the means at your disposal, it may be possible to shore up your resilience, your ability to withstand hard times. Certainly, it is difficult to think about exercise in times of financial stress, but it could be possible to carve out time to participate in a softball league or to make time to walk in nature, or the public park. Cutting out the cable channels can make for creative ways to spend that time. Some of the poorest people are the most active in service to others, because of what giving gives back to them.

It seems obvious that TLCs have to potential to help people lead better lives. When we’re healthy and we know something is good for us, we usually do it. But how do we implement these when depression or anxiety are present? In that case, those TLCs begin to feel like burdensome “shoulds”—and most everyone has resisted doing something just because we should, even if not depressed.

Depression & Anxiety Make Implementing Healthy Behavior Difficult

Depression and anxiety make change feel impossible to achieve. A well-meaning partner will say, “Just get up an hour earlier and go for a walk.” But to a depressed person, that’s a monumental effort. Getting up and exercising when you are feeling fatigued and lethargic is no simple thing. Sleep, as well as energy, is affected by depression; bouts of insomnia, for example, can lead to too much daytime sleeping, making sufferers look lazy to their families. ”Just get up and go,” the non-depressed person might say; “don’t lie around all day.” And while this may be absolutely the right thing to do, the depressed person has no “get up and go.”

Likewise, someone with social anxiety has trouble engaging in activities that will bring social connection. Avoiding people becomes the norm, thereby limiting potential rewards that come with socializing. For the depressed or anxious, not doing what they know they should be doing leads to self-incrimination and shame, worsening both conditions.

How Psychotherapy Can Help

Psychotherapy can help. During the first appointment, psychologists take a history that includes past and current relationships, educational and employment history, and family background. We also ask about current and past medical problems, medications, and use of substances. It is imperative to take this history to understand how the various life factors are impacting the current or “presenting” problem, as we call it.

Of course, while psychotherapy can begin the dialogue, the difficult part for many is implementing TLCs. What gets in the way of exercise, eating well, and taking time for you? If relationships are difficult, how are you contributing to that? Are you engaging in retail therapy or overindulging in drugs, alcohol, or other substances? An important component to any therapy is to look at what is working and what is not—and then taking responsibility for making changes in your life. Good therapy is not just about saying “Uh huh, you poor thing.”

Including the eight lifestyle behaviors in your life will undoubtedly help you feel better, use fewer psychiatric medications, and live life more fully, but if getting there from where you now feel like climbing Mt. Everest, then consider finding a good psychologist to help you.

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How Mindfulness Can Reduce Stress

Mindfulness-Based Stress Reduction

DSC_0231 2 In 1979, Dr. Jon Kabat-Zinn founded the Stress Reduction Clinic at the University of Massachusetts Medical School—the oldest academic medical center-based stress reduction program in the west. In response to inquiries about the clinic’s eight-week course, Dr. Kabat-Zinn wrote Full Catastrophe Living (1990), a the seminal book on mindfulness practice that has spawned numerous offspring, including mindfulness-based cognitive therapy (MBCT), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT.) Mindfulness practices have made their way into schools, prisons, business, hospitals, and health clubs. Psychologists and researchers have explored combining cognitive therapy and mindfulness to help depression, anxiety, and medical problems. Given the ubiquitousness of the practice, it is important to understand what it is, and what it is not.

I have always considered the title of Dr. Kabat-Zinn’s book unfortunate. The title suggests that life is catastrophic, but the book is really about living well with the ordinary stresses of life. In his introduction, Dr. Kabat-Zinn tells the reader why he choose the title:

I keep coming back to one line from the movie of Nikos Kazantzakis’ novel Zorba the Greek. Zorba’s young companion turns to him and inquires, “Zorba, have you ever been married?” to which Zorba replies, “Am I not a man? Of course I’ve been married. Wife, house, kids, everything…. the full catastrophe!”

But despite Zorba’s responsibilities and multiple roles, he lived his life with gusto, very much in the moment. “’Just now I’m thinking of the chicken and the pilaff sprinkled with cinnamon,’” he tells the narrator. “’Everything in good time. In front of us now is the pilaff; let our minds become pilaff. Tomorrow the lignite will be in front of us; our minds must become lignite! No half-measures, you know.” Whether considering the pleasurable dinner or the difficult work, Zorba gave his mind to what was in front of him, never just being a spectator of his life.

We all have stress. As Michael Baime, director of the Penn Program for Mindfulness at the University of Pennsylvania Health System, put it recently:

“Stress doesn’t go away, ever. That’s why we call it stress management rather than stress elimination…in practicing mindfulness you create a world where you experience depth, meaning and connectedness. You see joy and sadness more fully and settle more deeply into an authentic way of being.”

Learning to Live With Stress

There are no avoiding daily hassles, relationship conflict, money worries, and health concerns. Yet by living side by side with our stress, we come to know ourselves more deeply. In mindfulness practice we learn to sit with uncomfortable feelings in a non-judgmental way and thereby develop the ability to tolerate the difficulties of life with more equanimity. The practice of observing our thoughts without getting wrapped up in them gives us the ability to bring insight to thoughts, feelings, and perceptions. By bringing our focus back to our breathing each time we notice our minds wandering, we learn to stop ruminating and obsessing, which will eventually help in reducing symptoms of anxiety and depression.