O'Grady Psychology Associates

Psychotherapy, Marriage Counseling, Neuropsychological Assessment

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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.”

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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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Depressed, anxious, or both? Part Two

Depression is a Treatable Illness

According to the National Institute of Mental Health, an estimated 17 million adult Americans suffer from depression during any 1-year period. Depression is an illness that carries with it a high cost in terms of relationship problems, family suffering and lost work productivity. Yet, depression is treatable.

Everyone feels down from time to time, and often these feelings can be attributed to a situational or environmental cause. A rift with a friend, or the loss of a job, can cause feelings of self-doubt that will leave one feeling sad for a time. But when feelings such as helplessness, sadness, or hopelessness last longer than a month, there may be more going on.

In the case of job loss, it is normal to feel depressed and worried about the prospect of finding new work and to ponder what led to being let go, or fired. But if the thoughts turn to rumination about failure, and hopelessness about finding another job, then it may be time to seek treatment.
Depression wrecks motivation through its characteristic anhedonia—Latin for inability to feel pleasure. Often this is a gradual process, creeping up over time in such a way that even the depressed person doesn’t see it coming. One day, it is there. Unshakable, unspeakable. Shame and self-doubt take hold as feelings of worthlessness erode a once-affable person. Family and friends try to help, but often give up after their attempts are met with an attitude of hopelessness.

How Psychotherapy Can Help

In my work with clients who come in for psychotherapy because of depression or anxiety, I take a careful history to see if medical problems may be causing any or all of the symptoms. Biological factors can interact with mood, increasing the severity of depression. Medical disorders such as low thyroid can mimic depression and cause some of the same symptoms such as low energy, sleep disturbance, and difficulty with focus and concentration. Once medical causes are ruled out, we reconstruct the timeline of when they starting feeling depressed or anxious. Sometimes these feelings are rooted in childhood experiences and memories, but not always. We start where the clients are, giving them a wee bit of mastery so they can feel hopeful.
Recapturing a sense of mastery is vitally important in recovery from depression. In psychotherapy, we identify what negative or distorted thinking may be contributing to feelings of helplessness. Research has shown that when someone feels helpless and out of control, they tend to avoid those situations where they are likely to feel overwhelmed. Yet, like the phobic avoidance described in the previous post, the more you avoid life, the more depressed you will become. Psychotherapy helps people to see the choices they make and to slowly incorporate fulfilling activities back into their lives. Unlike a family member making the suggestions that can easily feel like a demand or criticism-the collaborative relationship developed in counseling, allows the depressed person to take ownership for their healing. This in itself gives back a sense of control. Gradually, people can identify options and set realistic goals that enhance their sense of well-being. Whatever triggered the depressed feelings is seen from a different vantage, and automatic negative thinking begins to diminish. Going back to bed becomes less appealing as life feels more enticing.

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Anxious, depressed, or both?

Anxious people fret. Depressed people brood.

Anxious people worry about what may happen, while depressed people ruminate about what has already happened. In each case, life becomes more and more constricted.

Sometimes the two conditions may look similar because both use avoidance as a coping strategy. Think of avoidance as going back to bed and pulling the covers over your head: back to the womb. Safe and secure. Everyone has the urge to go back to bed to avoid facing some task or situation at one time or another, but depressed or anxious people turn to avoidance habitually.

In both cases, the anxious or depressed person may even end up avoiding people, places, and things they used to love. The difference is that the anxious person is avoiding occasions that trigger overwhelming, out-of-control feelings of panic, while the depressed person has lost the ability to feel pleasure in once-loved activities.

Anxiety that Causes Phobias

For instance, Julie was missing out on occasions like social and family gatherings, going to a favorite antique store, or seeing shows she used to enjoy—all because she was afraid to drive on freeways. She would go far out of her way to avoid them. Google Maps allowed her to program her navigation system to skip all freeways and bridges. But just getting from point A to point B on surface streets was too time consuming and life restricting. She didn’t apply for jobs that required driving across a bridge. She stayed home more and more. Eventually, even driving across town was daunting. She was miserable.

When a phobia such as Julie’s is pervasive, it prevents experiencing the fullness of life. Because her anxiety was interfering with her happiness, Julie was motivated to tackle her fear of driving. She came to therapy with a willingness to stick with it, even though she knew her anxiety would increase (at least temporarily). We outlined a plan that would allow her to gradually try driving on the freeway—getting on an easy entrance close to her home, and then taking the very next exit. We worked on relaxation and self-soothing so that she would be able to calm herself when she noticed the beginnings of panic. We discussed ways she could cope when she felt anxious.

Exposure Therapy Helps Master Fears

We also explored how she was holding herself back from pleasurable activities. She listed the things she would like to do if able to drive further from home, such as visiting a certain antique shop and crossing the Bay Bridge to see a show in San Francisco. Making this list helped her stay motivated when she wanted to give up.

Psychologists call what we did exposure therapy. We slowly introduce the feared situation in a way that is tolerable. This allows for mastery and gradually increases confidence. Avoidance is the opposite of mastery. It is not easy to face fears. It takes persistence and sustained motivation.

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The Buckeye: Intimations of Spring

In psychotherapy we go through the dark winter of our soul to find the spring and our wholeness.
The first California Buckeye of spring.

Spring is still a ways away where I live in northern California. The air is fresh; the sunlight brightens the green hills surrounding our mountain. The evenings are becoming just noticeably longer. The opposite coast, from Boston to Maine, saw 30 inches of snow in just a few days. Sensational news stories tell of people stuck in their homes with snow blocking doorways and covering cars.

It might be hard to believe in spring back east, but during my hike in the foothills this evening, the California buckeye trees—always the first to show their green leaves—were magnificently preening against the backdrop of a the late western sun. The Valley oaks will leaf out in a month or so, but until then, the buckeye takes center stage.

In the Greek myth, Persephone is the daughter of Demeter, goddess of the harvest. The beautiful young Persephone is abducted by Hades and taken to his kingdom in the underworld, where he makes her queen. Her mother grieves for her so intensely that nothing grows, introducing the first winter to the world. When Persephone emerges at last, Demeter relents and releases her stranglehold on the earth, letting the tender shoots and tendrils which had been underground unfurl toward the warm sun. The cycle repeats each year.

As for us, by mid-February the urge to shed accumulated winter layers of clothes, pounds, and clutter settle into the collective psyche. Days lengthen and we move outside, toward the grill, or to a patch of weeds. Weeding is therapeutic. Digging the damp dirt, just deep enough to feel the fragile weed roots and gently shaking off the dirt clumps while careful not to disturb those humble tillers, the earthworms, reminds us of the inevitability of change. And that while frost covers the earth, life continues to work underground, below the surface of what is seen. Like Persephone, we emerge from winter to notice the results of underground happenings.

Psychotherapy Provides a Safe Place to Grow into Wholeness and Fullness

When people enter psychotherapy, they are encumbered with layers of accumulated mud. It takes many forms—secrets, sadness, and shame—but alongside the difficulties that motivate people to seek counseling, there is a drive to be whole. It’s manifested in the desire to take care of yourself by reaching out beyond your circle of family and friends to move forward in life, to find a neutral, safe place to explore where you’ve been and who you’ve come to be.

Taking the step to make a call, to schedule an appointment, and to find a way to pay for therapy is a beginning. When new clients arrive in my waiting room, it is with mixed emotions—fear and dread certainly, but also excitement because they have taken the initiative to shake off the dirt and move toward the growth that will surely bring healing. The first appointment brings relief co-mingled with excitement about the prospect of change.

These hints, these intimations that spring is near—just around the corner of the calendar—reconnect us with the ancient knowledge that it is only by going into the dark places within that we can emerge into the fullness of our individual uniqueness. Along with cultivating our gardens, we can cultivate ourselves.