O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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Standing Behind the Waterfall: Learning to Change Distorted Thinking with Mindfulness

Giving yourself a ledge to stand on as you watch your thoughts will help get perspective.
Getting a Different Perspective

Thoughts are not facts. When we’re upset, our thoughts seem valid—yet it’s exactly when our emotions get stirred up that our thinking can easily become distorted. Conclusions based on distorted thinking can’t be trusted.

When my friend Sharon returned from a business trip, she was feeling disturbed and uncomfortable. As she described her experience, she clarified why: She had been working remotely in Africa and knew few of the other participants in her company’s conference. She wanted to be included, but wasn’t part of the main team; she felt uncharacteristically shy and felt that her participation wasn’t up to her typical style. Sharon was aware of the tremendous talent that surrounded her and wished she’d had more opportunity to interact with her co-workers.

Taking a Different Vantage Point Gives Perspective When Thoughts Are Overwhelming

Sharon observed her feelings and thoughts with great skill, teasing out the mixture of sometimes conflicting emotions she felt, but importantly, she wasn’t condemning herself or anyone else. If her thought had been “I’m so inept, I can’t compare to these other people,” she might have gotten carried away with ruminations about her inadequacies. By asking herself “What is this I am feeling, in this moment?” Sharon gave herself a vantage point—feeling anxious is not the same as being worthless.

Teachers of meditation often use the image of the sky to illustrate how thoughts, like clouds, come in and out of our mind. The sky is always there, even when dark clouds momentarily obscure the sky. In another moment, the sky might be a brilliant blue with white downy clouds moving slowly or swiftly across its surface. We use these images to show that clouds come and go changeably, just like our thoughts, but mind and sky always remain. Sitting in meditation, we witness the changes of thought and feeling but don’t partake in them, just as the sky is unchanged by the clouds.

One of the exercises used in mindfulness-based cognitive therapy is that of standing behind a waterfall. Standing behind the rushing water and watching it without getting swept away by the torrent gives us a ledge to stand on, just as meditation gives us the perspective to look at our thoughts. We don’t have to believe everything we think, and we don’t have to be deluged by ruminations arising from anxiety or depression.

Try this short meditation:   

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Every Ornament Tells a Story: Coping with Holiday Stress

ornament

Two weeks into December, and I had no holiday spirit. I had no desire to decorate or to do what I have done for the last 25 years. I am not a bah-humbug person! I love the holiday season: the tree with its hodge-podge of ornaments hiding in the branches illuminated by colored lights; magic memories from my childhood; reading “The Night Before Christmas”; and the magic come newly alive in my own daughters.

That magic was never just about presents. It lay in the expectation, the surprise, and the stories, like the ones I created about each small ornament, tucked into the branches. The glass moose was grazing on the evergreens, the pink elf was watching over the skiing Santa, and the rat king was just inches away from the prince. Every ornament has a history that began from its entrance into our household, and I remember most every one.

But this year was different. I dreaded getting out the boxes or ornaments and mantle decor. I dreaded the holiday parties. I was not inspired by any of it. And while it may have been unusual for me, I know that the holidays are fraught for many. For example, our feelings might not match up with the ones we’re supposed to have. When our emotions aren’t congruent with our expectations and the mood we perceive around us, they feel inauthentic and out of synch. Instead of being the one time of year when everyone comes together in love and support, the holidays can throw a spotlight on a year’s worth of things left unsaid, hurtful words that should never have been said, and all the ways last year’s New Year hopes didn’t pan out. And of course, there is the nearly ubiquitous overconsumption (food, alcohol, shopping) which can create conflicts, guilt, debt, or other problems.

Expectations, Overconsumption, and Depression

In my psychotherapy practice, I often see people who don’t just dislike but hate the holidays. For some, the season reminds them of childhood Christmases when mom and dad would argue, or maybe dad fell off the roof putting on the lights because he was drunk. For others, their kids have left the nest, and all the seasonal rituals feel empty without them. And some parents make the horrendous mistake of using the holiday to announce to their kids that they’re getting divorced, leaving terrible associations for my clients. Although Christmas music and decorations dominate the month of December, holiday stress bleeds into our culture so that people who don’t celebrate Christmas are affected. Families who celebrate other holidays, or none, can feel mixed emotions around this time of year.

I work with people who are experiencing loss of various kinds during the season: loss of an elderly parent; a marital separation; a job loss. The analogy I sometimes use is that this period of their lives may be like a tree weathering a bad year. Growth rings aren’t always even; drought, disease, or just a northern exposure can affect the ring’s thickness and shape, and so the tree trunk’s straightness. In time, their lives would be like that tree, incorporating the unique patterns formed in the process of living.

Nothing is ever perfectly straight. If it was, Christmas trees would be like the artificial ones in shops decorated with perfectly matched bows and garlands. There are no broken ornaments, but also none made by a child’s hands, or passed down from grandma, or chosen together by a young couple. Finding the joy in the season doesn’t require perfection. The imperfect family, the broken ornament, or the crooked tree all offer opportunities for reflection and stories told around the fire.

This poem by Rabindranath Tagore expresses some of the complexities of the season. In living alongside the joy and sorrow it becomes easier to find meaning in a season that remembers so many stories.

 He it is, the innermost one, who awakens my being with his deep hidden touches.

He it is who puts his enchantment upon these eyes and joyfully plays on the chords of my heart in varied cadence of pleasure and pain.

He it is who weaves the web of this maya in evanescent hues of gold and silver, blue and green, and lets peep out through the folds his feet, at whose touch I forget myself.

Days come and ages pass, and it is ever he who moves my heart in many a name, in many a guise, in many a rapture of joy and of sorrow.

      Gitanjali, with an introduction by W.B. Yeats, Scribner Poetry, 1997.

Gradually, almost imperceptibly, I came out of my funk and realized that I felt like my usual self again. Recognizing that emotions can be mixed during this time of year, allows for acceptance of feeling that doesn’t fit the season’s glitter and glam. As Tagore wrote; days come and ages pass, and enchantment joyfully plays on our hearts in the varied cadence of pleasure and pain.

If you are having difficulties coping with holiday stress, this article from APA has some good suggestions.
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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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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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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)