O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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The Present Moment and Transformation

Mindfulness and transformation.Research reported in the respected journal Science, in an article titled “Just think: The challenges of the disengaged mind” by Timothy D. Wilson et al. (345, 75 [2014]), presented results summarizing 11 studies where participants were first given an electric shock; all participants admitted that the shock was unpleasant, and said they would pay to avoid it. Researchers then asked the subjects to sit in the empty room and entertain themselves with their thoughts without cellphones, iPads, or other distractions. There were only two rules: you can’t get out of your chair, and you can’t fall asleep. Participants did have the option to press a button and receive a shock again.

The mind is its own place, and in it self

Can make a Heav’n of Hell, a Hell of Heav’n.

 John Milton, Paradise Lost

 Very much to the researchers’ surprise, the study found that 70% of the men and 25% of the women chose to shock themselves instead of just sitting there with their thoughts—remember, for no more than 15 minutes.

Researchers ran the test in a lab with college students, but also with older subjects (recruited from churches, farmer’s markets, etc.) in their homes, and they tried to replicate the study with a wider sample of people minus the electric shock. They found that these folks also had difficulty sitting still for 15 minutes alone to entertain themselves with their thoughts. Over half the people admitted to cheating by using their phones. The majority said that hated the experience—it was boring.

What is going on here? Why is it so hard to entertain ourselves with our thoughts that people will actually resort to painfully shocking themselves just for something to do? Why not just stay in the moment and wait it out? Partly, reflecting back and looking ahead are just human nature, something our big brains allow us to do and a big reason for our evolutionary success. Because we can think ahead and formulate goals, or review the past and learn from it, we can accomplish stunning achievements like writing novels, building bridges, and curing diseases (not to mention more ordinary but still essential accomplishments like saving for retirement). But that’s not the whole story.

While being past- or future-minded can have benefits, it’s clear that mindfulness—staying in the present moment—offers essential benefits as well. The present moment is the only one that truly exists. It’s only in the present moment that we can feel peace, fulfillment, and harmony. And it’s only in the present that we’re free to choose. That’s why people meditate and why so many religious traditions include some kind of mindfulness exercise.

But researchers in the study found that even subjects who had experience with meditation and mindfulness found it only slightly easier to sit still without distraction. I’ve found this in my own practice. When I explain mindfulness to my psychotherapy clients, they understand the concept and its value on an intellectual level, and may even experience a sense of pleasurable release during some meditations. Even though my clients have come to me for help in dealing with life’s burdens, and even though they get good results from meditating, it’s still not easy for them to practice mindfulness regularly.

So, what comes up for people when they sit alone with their thoughts? We experience restlessness, discomfort, boredom, and irritation. Sitting in stillness, letting moments come and go and staying with the quiet space, gives room to encounter the self. We come face to face with our anger, our envy, our jealousy and our pride. Those feelings are unpleasant and it is easy to want to be quickly rid of them. Switching the channel in our mind to a diversion such as a show, a game, or a piece of chocolate cake takes us temporarily away from the difficult emotion. We don’t want to feel like a jealous person, for example, because that gives way to other feelings such as guilt—which makes us feel worse. Our self-concept takes a beating when we give it time in the quiet moments.

But if we are to enlarge our Self and be fully alive, we have to face the darker sides. As Goethe writes in “The Holy Longing”:

 And so long as you haven’t experienced this: to die and so to grow,

you are only a troubled guest on the dark earth.

To be at home on earth, learn to sit with yourself in the present moment.

 

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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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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.

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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.

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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)