Mindful Relationships Part 3: The Slippery Slope of Integrity

We all know that living with integrity means matching our behaviors to our values. It means doing the “right” thing. Many times, having integrity is easy. But sometimes, upon closer examination, we may find that there are times when we slip unintentionally.

An example of slipping is when we withhold information from our partners because we don’t want to rock the boat or hurt their feelings. Maybe your partner does something that irritates you and when they ask why you seem upset you simply dismiss the question or offer a false reassurance that you are “fine”. This reaction may not seem like a big deal and if it happens once in a while it is unlikely that it will cause significant problems in your relationship. However, these innocent “white lies” can become a habit that can undermine your ability to fully engage with your partner. Clearly, your intention is good in the moment but the outcome of these repeated transgressions can actually lead to the opposite of what you are trying to accomplish. It also easy to see that one partner can go from a “white lie” that is not meant to hurt their their significant other to a full blown lie because they may not want to admit things to their partner that they know are hurtful or damaging, such as that they spent money that they should not have or talked with an old flame. 

Other examples of types of interactions that can undermine your integrity within your relationship are going along in a situation that you don’t agree with (e.g. riding in the car with your family while your partner is texting and driving) or not being honest about strong feelings you may have (e.g. feeling that you can’t trust your partner or that you are feeling frightened about something in your relationship). As you can see, all of these examples have the potential to erode the quality of your partnership.

So what can you do to maintain your own integrity and strengthen your relationship? Here are some ideas (adapted from Walser and Westrup, 2009):

  1. Spend some time listening for the voice in your head or heart that guides you to make decisions that are in line with your own values. When you hear it, challenge yourself to follow your own advice.

  2. Give yourself a moment to think before you engage or answer a question in order to ponder whether your answer is actually aligned with your true values and feelings. Be mindful and try not to let yourself get away with simply saying what is easy. Keep in mind that you have the opportunity and ability to respond with integrity in every situation. Know that you can be honest and sensitive at the same time if you give yourself a moment to formulate your thoughts.

  3. Take some time to think about times in your relationship when your integrity slipped away (e.g. times when you may have lied or withheld information, times when you didn’t share your true thoughts or feelings). Think about what your own internal voice may have to say about those times now and how you might have wanted to behave differently if given the chance to do things over.

  4. Look for an opportunity to take as step closer to living with more integrity in your relationship. Reflect on whether there might be a feeling or concern you want to share with your partner. Take a chance and tell the truth about something you might have otherwise told a white lie about. See how these changes influence your interactions with your partner.

  5. Talk with your partner about times when either of you might be inclined to share a white lie rather than the truth. For example, if your partner asks how they look in a particular outfit. Talk about what the person asking is looking for (i.e. reassurance or honest feedback) and then move forward in those conversations knowing that you can provide an answer that matches what your partner needs and allows you to be honest. (e.g. you might say that your partner looks good no matter what they are wearing if they are looking for reassurance and you might give honest suggestions if they are looking for fashion advice)

Living and relating with integrity takes attention and mindfulness. Most of us don’t intentionally take actions or engage with those with care about in ways that undermine our values; however, as you can see, small actions repeated over time can have long term consequences that can have a lasting impact on the quality of your interactions. Take some time to notice how you can show up in a different way that is more closely aligned with what is important to you and you are likely to feel more satisfied in your relationship. 

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc.

Altruism: Helping Others to Help Yourself

Have you noticed yourself in a seasonal slump lately as the days grow shorter and colder, and the holidays are lurking just around the corner? You may wish to consider helping others, as it may be a way of helping yourself, too. The act of doing for others has been shown effective in improving your mood and sense of well-being (Buchanan & Bardi, 2010; Aknin, Dunn, Whillans, Grant, & Norton, 2013). You may wonder about whether it is truly selfless and altruistic to offer charity that ultimately ends up benefiting you, too. My question to you, then, is: why should you not also benefit from a situation in which others gain from their interactions with you? This is simply a mutually beneficial arrangement. In nature, animals and other organisms frequently engage in symbiotic relationships (case in point: bees and flowers). 

Have you ever volunteered your time at a local soup kitchen or animal shelter, or perhaps given a monetary donation or tangible gift to a child in need? Not surprisingly, we often feel some degree of happiness and pride in ourselves for having done a charitable deed. This is a normal and welcome consequence of our behavior! When we do something kind or meaningful for someone else, it often reaffirms how we perceive (or wish to perceive) ourselves—as empathic, generous, and caring. We might also consciously, or otherwise, hope for reciprocity of this generosity; we may think, “it would be nice if someone helped me if I were in (such) dire straights.” Of course, doing something kind for others with the hopes or expectations that they will later reciprocate can set you up for significant disappointment and frustration. However, if you believe in the concept of karma or the like, your good energy and vibes may inevitably come back to you later in some form (perhaps in a less direct way). 

Another personal benefit to giving to others is that it affords us the opportunity to put our own misfortunes and problems temporarily aside, or at least to gain greater perspective on them. We all need a break from our “issues” now and again, whether it is through reading a captivating novel, zoning out in front of mindless TV after a long day, or listening to a friend regale you with his/her stories and woes. How often have you, a family member, or a friend lamented about having “the worst day ever” in which “everything is going wrong”? You may feel frustrated, overwhelmed, depressed, or devastated. There are those days, weeks, months, or maybe even years where Murphy’s Law seems to be wreaking havoc on your life. 

However, when you compare your problems side-by-side to someone else’s, does it not change the magnitude of your problems ever so slightly? Is your horrible fight with your significant other, compounded by money troubles and a misbehaving child truly on par with homelessness, chronic hunger, destitution, civil war, or terrorism? Is someone else possibly worse off than you? The point of this is certainly not to invalidate or minimize that your life can be challenging, stressful, and just plain crappy sometimes (people have legitimate trauma, sadness, and tragedy in their lives), or, on the flipside, to propose that we should take pleasure in others’ misfortunes. 

Instead, it is merely to suggest that reframing a situation and putting into perspective what you think of as “the worst day ever” may be beneficial. When we can take another person’s or group’s perspective, we may develop greater compassion and understanding for their lived experiences. Imagine how grateful someone without shelter and a reliable food source might feel when you have empathy for their situation and offer a helping hand. In that moment, you are stepping outside of yourself, and seeing someone else’s difficulties as more urgent. Of course, exclusively meeting others’ needs at the expense of taking care of your own runs the risk of compassion fatigue, burnout, and even depression. The key is to find an ideal balance between caring for others and yourself!

So, what can you do to help others? What resource(s) do you have that you are willing and able to share? Is it time, money, a well-stocked pantry, an ear to listen, cooking or knitting skills? What organizations really speak to you and your personal values—a food bank, homeless shelter, animal rescue, nursing home, Church or other religious community? Some suggestions for how to help in your community include:

  1. Volunteer to read/provide companionship to the elderly at a senior center or nursing home

  2. Mentor a child (i.e., Big Brother/Big Sister)

  3. Volunteer at a local animal shelter or farm sanctuary

  4. Collect food and/or toys for individuals in need (donate to a local Church or drive)

Giving and helping others need not be time-consuming, cost-prohibitive, or even a formal endeavor. You may already engage in these random acts of kindness. I propose that you consider intentional acts of kindness, such as offering a well-deserved compliment to a coworker, employee, friend, or family member. Acknowledge their efforts and be more mindful of how you subsequently feel after offering them praise. Being thoughtful and considerate of others can go a long way…try holding the door for someone, saying “thank you” and genuinely meaning it when interacting with the store cashier, smiling and saying hello to a passerby, or doing a favor or kind gesture for someone you care about…. Go on, help someone else, and help yourself in the process!

Dr. Jacquie Talesnick is a licensed clinical psychologist at the Rowan Center for Behavioral Medicine who has trained in both cognitive-behavioral and psychodynamic therapeutic approaches. She considers herself to be an integrative therapist, pulling from different methodologies and theories to tailor treatment to each individual with whom she works. She offers psychotherapy services to the adult population in individual and couples modalities. She specializes in working with individuals in the LGBTQ community. Her other specialties include treatment of relationship difficulties, trauma, depression, and anxiety.

REFERENCES

Aknin, L. B., Dunn, E. W., Whillans, A.V., Grant, A. M., & Norton, M. I. (2013). Making a difference matters: Impact unlocks the emotional benefits of prosocial spending. Journal of Economic  Behavior and Organization, 88, 90-95.

Buchanan, K., & Bardi, A. (2010). Acts of kindness and acts of novelty affect life satisfaction. The Journal of Social Psychology, 235-237. 

Mindful Relationships Part 2: Valuing Authenticity

So we hear a lot about the importance of leading an authentic life. What does this really mean? Authenticity is about being genuine and trustworthy in the way that we interact with ourselves and the world around us. Sounds like a great approach in relationships but why do we struggle with this?

The reality is that it is a challenge to show up as your true self. This approach requires that we notice those external and internal factors that push us to compromise our value of authenticity. The pressure to appear as a certain kind of person in our interactions with others can interfere with our ability to keep in touch with our genuine sense of self. 

In relationships, this pressure may show up in our self-talk. We can find ourselves veering into “I’ll be whatever you want me to be” territory in order to keep the other person interested. When the inauthentic self shows up in those moments we may be inadvertently selling something different than who we truly are.

Let’s look at how this played out for Susie:

Susie met Trevor at a party. The two spent the evening with a group of friends laughing and telling stories. Susie was confident, witty and intelligent. The group clearly found her engaging and refreshing. She was being herself and her friends new and old enjoyed her company. At the end of the night, Trevor asked her out thinking that she would be a great person to spend more time with. On their first date, Susie was nervous and began to think about what type of person Trevor might find interesting. She was quiet and withdrawn. She let Trevor do most of the talking. She was agreeable and friendly enough. However, instead of letting herself show up as her authentic self, Susie became focused on figuring out what Trevor might find impressive about her and in turn became less interesting. The date was nice enough but certainly ended without the spark that Trevor had hoped for. 

We can see here that Susie lost the aspects of herself that were most appealing to Trevor because she had lost touch with her sense of self and became too focused on her date. Although this is a small example, it is easy to image all the ways in which each of us dull a bit of our own spark in the interest of appealing to others. 

Now, let’s take a look at Mitch:

Mitch and Anna have been together for several years. They are happily in love and recently got married. Mitch has been working at that same insurance company since college and has been feeling unfulfilled at work. Lately, he has found himself thinking more and more about alternative career paths and he has come to the realization that he may be happier if he returns to school to pursue his teaching credential. He has mentioned his dissatisfaction to Anna in passing and has found her to be rather disengaged from this discussion. Mitch has become increasingly concerned that Anna and their families will see him as less of a provider if he decides to quit his lucrative job and return to school. Instead of allowing his true feelings to be present and share them with his wife, Mitch finds himself trying to focus on other things to make himself happy.’

Here we can see that Mitch is feeling self-conscious about his job choice and instead of exploring his own desires and sharing them with Anna, he is taking the path of least resistance and finding other ways to channel his energy. While this approach may keep the peace in the short run, we can see how the long term implications could cause feelings of dissatisfaction and even resentment later on. Again, this is just one example but it illustrates the tendency each of us can have to want to stick with the status quo rather than tackle a difficult discussion, hence giving up a bit of our true self. 

Both of these are clear examples of how our internal voices and external pressures can get in the way of expressing our genuine feelings, hopes and desires. It can be hard to get out of our own way and let our true sense of self shine through. However, as we can see, our desire to be pleasing and avoid conflict often leads to the loss of our authenticity.

So what can we do? Here are some ways to think about and practice cultivating a greater sense of authenticity in your relationship (adapted from Walser & Westrup, 2009):

  • Begin by reflecting on areas where you could increase your level of authenticity. It can help to find a quiet time to think about areas in your relationship where you may be struggling to be authentic. Ask yourself the following questions:

    • What may be leading to this struggle? Is it fear or some other emotional response?

    • What might happen if that emotion was not dictating your behavior? What might you do differently?

    • Are there some small ways that you might be able to change your behavior so that you can get closer to being more authentic?

    • Are there particular conversations that you may be avoiding that, although challenging, may create a path toward a more genuine interaction and a greater sense of intimacy?

    • What are your hopes and desires for yourself? How might you share those with your partner?

  • Consider changing some of your actions in the following ways:

    • Practice reflecting on and expressing your own likes and dislikes

    • Challenge yourself to share your thoughts and feelings

    • Remind yourself that when you are being truly authentic there are times when disagreements are sure to happen

    • Look for ways in which being authentic helps to you achieve a greater sense of intimacy

    • Reflect on whether you are being true to your own thoughts and values as you make decisions and interact with your partner

  • Spend some time examining your core values. Click here for some helpful ways to examine what is most important to you.

Taking some time to find your own authentic voice can have a powerful impact on how you show up in your relationship and can lead to a stronger and deeper connection with yourself and your partner. 

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc.

Mindful Relationships Part 1: The Honeymoon Trap

Experiential avoidance is a term, used in Acceptance and Commitment Therapy (ACT), that refers to the mental acts or behaviors that we perform in order to stay away from feelings or thoughts that we don’t like. For example, it you have a feelings that you don’t like, such as sadness, you are likely to try to find a way to get rid of that feeling. Along with this feeling, you are likely to also experience a range of thoughts such as, “I shouldn’t be upset,” or “Just snap out of it.” What people often do next is to try to avoid whatever it is that may be upsetting them. It makes sense, right? If something feels bad then we just stay away from it and then we can feel good and happy all the time.

Any chance you see a problem here? The challenge lies in the fact that “negative” feelings are a part of our experience as humans. No matter what we do, we are going to have to come in contact with the full range of emotions that we are capable of feeling. So why do we do avoid negative or uncomfortable emotions? Because we are told all the time that we should just do what feels good. All you need to do is to turn on the television to see, that as a culture, we value being happy and are given a multitude of ways to buy our way into that feeling. Relationships are no different.

According to Walser and Westrup (2009), the “story” that society gives us for what a good relationship can be explained like this: “A good relationship is a happy relationship. And a happy relationship is one in which you feel happy, your partner feels happy, your family is happy about your happiness, and even the dog is happy!” Walser and Westrup (2009) go on to say that, “Good relationships aren’t about being happy. They’re about vitality and about manifesting life to its fullest within the relationship.” So what does this mean? It means that you and your partner will feel the happy feelings such as joy, pleasure and love as well as pain, sadness, anger, fear, anxiety and more. This means that in order to be in a successful relationship, we need to be willing to work with our partners as we we travel the myriad of human emotions. 

You may ask, What happens if we just stay in the happy, honeymoon phase forever? Well, there are a few problems with that. The first, is that these negative feelings give us valuable information. If you forget that you were sad, angry and hurt when someone in your past did something that upset you, then you may find that you allow people back into your life that may treat you that same way again. A simple example relates to the feeling of anxiety. Without the mechanism that creates anxiety, humans would never have survived because we would have lost that famous “fight or flight” response that has protected our species since the beginning of our existence and has helped us escape basic threats to our well-being such as predators or dangerous situations. 

Another problem is that we cannot experience the good without the bad. A classic example is that with love comes pain. In order to truly love someone, you will feel the pain of losing them at some point. If you have ever met a couple who has been together 50 or more years, you can see that they know this deeply. Hilary Stanton Zunin says it best when she explains that, “The risk of love is loss, and the price of loss is grief. But the pain of grief is only a shadow when compared with the pain of never risking love.” So, we learn that in order to really experience the wonder it is to feel this deep human experience that we call love, we must be willing to also feel the pain of loss. 

In addition, we know that we cannot go back and undo something that has happened. This means that you can’t erase hurt feelings once they have been felt. So, despite your best efforts to forget that you felt sadness when you broke up with your first love or that you were hurt when your partner forgot an anniversary or some fact or event that was important to you, it is impossible to do so. These experiences are part of what make you who you are and they influence the choices that you make. 

Like experiences, our thoughts also cannot be erased. So, once you have the thought that something was hurtful you can’t simply unthink it. If you say to yourself, “She is so inconsiderate.” You aren’t going to forget that. It is actually more helpful to just observe it. You can then either accept it and move on or you can take some time to challenge the thought because you know that it was just a quick reaction that doesn’t really reflect your overall opinion. 

So where does this leave us? The most important thing to take away is that being in a relationship means experiencing the ups and downs. This does not mean that you have to stay in an unhappy partnership. What it does mean is that you don’t have to beat yourself (or your partner) up because you may be struggling. Simply start by thinking about whether this is the person that you want to be with in both the good moments and the hard ones. If so, then it can help to simply be mindful and notice what kind of moments you may be having at different times throughout the day or week. 

As we move forward in this series, we will begin to use the principles of Acceptance and Commitment Therapy (ACT) to begin to explore how focusing on your values, accepting yourself and your partner, being more open and present and committing to what is most important to you, can help to create a more meaningful connection in your relationship. 

Dr. Stephanie Davidson is a licensed, clinical health psychologist and co-founder of the Rowan Center for Behavioral Medicine specializing in the use of cognitive-behavioral, humanistic and existential approaches to treat patients with a range of medical and mental health challenges. She has a strong interest in acceptance and commitment therapy and other mindfulness-based interventions to heal the body and mind. Her focus is on collaboration with the goal of assisting patients in adjusting to difficult experiences and achieving a greater sense of well-being, balance and peace in their lives.

REFERENCES

Walser, R. D. & Westrup, D. (2009). The Mindful Couple: how acceptance and mindfulness can lead to the love you want. Oakland, CA: New Harbinger Publications, Inc. 

Hypnosis: How Does It Really Work?

For many, hypnosis conjures images of a man with a vest, swinging a pocket watch, speaking slowly and encouraging sleepiness. Alternatively, hypnosis has been incorporated into many stage shows, with depictions of previous shy audience members, bursting forth into maniacal dance moves while hypnotized. However, the use of clinical hypnosis has been gaining momentum over the past several years. It is now accepted as a valid subject of scientific research and is a useful clinical tool for a variety of medical conditions, including: 

  • Acute and Chronic Pain

  • Phobias

  • Anxiety

  • Depression

  • Eating Disorders

  • Smoking

  • Obesity

There are many theories on hypnosis and how it works. It is often referred to as a procedure involving cognitive processes in which an individual is guided to respond to suggestions for changes in sensations, perceptions, thoughts, feelings, and behaviors. Alternately, hypnosis can also be defined of its effect (Barnier & Nash, 2008). This refers to the fact that not all individuals will respond the same way to a hypnotic suggestion during treatment or even become hypnotized. Therefore, the response to hypnosis can differ from widely from one individual to the next. In short, hypnosis can either be defined by “what it looks like” (hypnosis-as-procedure) or “what it does” (hypnosis-as-response; [Jensen, 2011]).”  

Hypnosis begins with an induction and is followed by one or more suggestions for making positive changes. At times, these suggestions are designed to result in a positive response during the treatment, as well as after the session, becoming “permanent and automatic.”  In the first phase, hypnotic induction, the individual is guided through suggestion to relax, concentrate, and/or to focus his or her attention on one thing. The second phase, hypnotic suggestion, is when the individual is guided to undergo changes in experience. There are different types of suggestions including: 

  • Ideomotor Suggestions – experience a movement

  • Challenge Suggestions –told he or she will not be able to do some particular thing and then is asked to perform the prohibited behavior

  • Cognitive Suggestions – experience changes in sensations, perceptions, thoughts or feelings

Hypnosis is generally used as a clinical tool for making direct suggestions to reduce symptoms or as an addition to other forms of psychological treatment. For example, hypnotic analgesia helps a patient undergoing a painful medical procedure (e.g., surgery, a lumbar puncture, spinal tap) by suggesting that the affected body part (i.e., the back) is numb and insensitive to pain through hypnosis. Hypnosis can alter and eliminate the psychological experience of pain and the brain’s neurophysiological processing of pain. Remember that not everybody responds the same way to a hypnotic suggestion during treatment or even becomes hypnotized. 

There are simple tasks, known as test suggestions, that can help determine how a person may respond to hypnosis. The number of test suggestions that a person responds to (or passes) indicates their level of suggestibility. Each individual will differ in terms of how high or low they fall on suggestibility, which is a marker for how much or how little a person will respond to hypnosis. Below is a simple task called the Chevreul Pendulum Demonstration that can be used to test whether a person is suggestable or not.

Instructions:  

  1. Obtain scissors, string, and ½ inch washers at a hardware store.

  2. Cut a 5-7-inch length of string and tie it to the washer.

  3. You will have an opportunity to experience an imaginative suggestion.

  4. Place your right elbow on your right thigh and hold the string between your right thumb and index finger so the washer is suspended beneath.

  5. Hold your hand as still as possible.

  6. Now imagine that the washer is beginning to move from left to right. The washer is beginning to move from left to right. Continue imagining that the washer is moving from left to right. Continue to imagine this for another minute or so.

  7. Now I want your hand return back to normal.

*NOTE. There will be a range of responses.  Some of you will show no response at all.  Others will find that their washer moves quite a bit. The degree of movement is suggestive of your degree of suggestibility. Remember suggestibility accounts for a portion of how much or how little you respond to hypnosis. However, research strongly indicates that the vast majority of people can benefit from hypnosis interventions.

Common Myths about Clinical Hypnosis (NONE OF THE BULLET POINTS BELOW ARE TRUE)

  • Individuals undergoing hypnosis lose control and can be made to say or do whatever the hypnotist wants.

  • Individuals may not be able to come out of hypnosis.

  • Hypnosis only affects naïve and gullible people.

  • Hypnosis reliably enhances the accuracy of memory.

  • Hypnosis enables people to re-experience a past life.

  • Hypnosis depends primarily on the skill of the hypnotherapist.

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

Barabasz, A. F., & Barabasz, M. (2008). Hypnosis and the brain. In M. R. Nash & A. Barnier (Eds.), The Oxford handbook of hypnosis: Theory, research and practice, 337-363. Oxford, UK: Oxford University Press

Jensen, M. P. (2011). Hypnosis for chronic pain management: Therapist guide. Oxford University Press, USA.

Authenticity: Well-being and Living A Values-Driven Life

There are many views of happiness but messages from our society seem to promote the idea that we “should” be happy all of the time, and instantly so. However, recent evidence suggests that meaning, purpose and authenticity are key to well-being. In this post, we will explore methods of getting in touch with your core values and taking steps to live them out today.

From ancient Greek philosophers to modern psychological researchers the question of how to define well-being has been controversial and elusive. The modern definition of hedonic well-being is focused on subjective well-being, the presence of positive mood and the absence of negative mood. In this view people are happiest when experiencing maximum amount of pleasure with the least amount of displeasure. 

The eudaemonic view of well-being places less emphasis on subjectively felt happiness and places authenticity at the center of the definition of well-being. The experience of eudaemonia occurs when people’s daily activities are congruent with their most deeply held values (Waterman, 1993). People who have lives characterized by daily actions that are in line with their core values, they experience a sense of feeling intensely alive and authentic. 

Ryff and Singer (1995, 2000) have described psychological well being which includes actualization across six domains: autonomy, personal growth, self-acceptance, life purpose, mastery and positive relationships. They have presented evidence to suggest that eudaemonic living can influence both emotional and physical health. 

Therefore, an important step to cultivating a life of wellness and vitality is to define your core values and begin enacting them in your daily life. The idea of living a value driven life is foundational to Acceptance and Commitment Therapy, a therapeutic intervention developed by Steven Hayes. This evidence-based therapy is part of the third wave of cognitive therapy that incorporates mindfulness practices and values based behavior change. Below are some activities 

Define you core values:

  1. Write your own eulogy.

    • How would you want the people close to you to describe your relationship?

    • What would you want people to say about your character and personal strengths?

    • What would you want people say you stood for in your life?

    • What would you want people to say about your achievements or the legacy you left behind?

  2. Think of someone you admire or who inspires you.

    • Write down their unique qualities.

    • Choose those qualities that you would like to bring to your own life.

    • Write down the various roles you have in your life (father, son, brother, student, husband, wife, etc).

    • Now, take the qualities that you’ve chosen from above and place them in front of your various roles (e.g. loyal friend).

  3. If you are having difficulty defining your core values, consider the list below:

        Acceptance

        Adventure

        Caring

        Committed

        Courage

        Creativity

        Curiosity

        Efficiency

        Engagment

        Fairness

        Friendliness

        Forgiveness

        Fun/humor

        Genuine

        Gratitude

        Honesty

        Integrity

        Intimacy

        Kindness

        Loving

        Respect

        Responsibility

        Self-care

        Sexuality

        Supportiveness

        Trust

Take steps to live out your core values:

  1. Think about the domains in your life (work, family, school, health, community) and specifically how the core values you’ve identified would look in these domains.

  2. Describe a concrete action you can take today to embody your values.

  3. What long-term actions can you take to bring you closer to living out these values?

  4. What are some barriers you have to living out your core values? Explore the thoughts and feelings that may be keeping you from committing to valued action.

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

REFERENCES

Ryff CD, Singer B. 1998. The contours of positive human health. Psychological Inquiry, 9:1–28

Ryff CD, Singer B. 2000. Interpersonal flourishing:A positive health agenda for the new millennium. Personality and Social Psychology Bulletin, 4:30–44.

Waterman AS. 1993. Two conceptions of happiness: Contrasts of personal expressiveness (eudaimonia) and hedonic enjoyment. Journal of Personality and Social Psychology, 64:678–91

To read more about Acceptance and Commitment Therapy please visit: https://contextualscience.org/about_act

More than Medications: Integrated Treatment for Chronic Pain

There are many people who suffer from what doctor’s describe as chronic pain. The management of this type of ongoing pain can be complex, which is why an integrative approach to treatment is essential to helping patient’s get relief and find a better quality of life.

Pain is considered to be chronic when it lasts longer than 3 months, above and beyond what would be considered a normal healing period. Ongoing pain can cause structural and functional changes to the nervous system. As a result of these changes, the pain can continue to exist even after the injury has healed. 

Chronic pain can manifest as a result of various diseases and illnesses. Certain risk factors may increase the likelihood of experiencing chronic pain such as traumatic injuries, stressful life events, worsening medical or surgical conditions, and family history. Chronic pain is a significant problem for many individuals with other medical conditions as well, including, multiple sclerosis, stroke, brain injury, spinal cord injury and amputations (O’Connor et al. 2008; Sackly et al. 2008). If the pain is left untreated it can lead to many physical and mental health difficulties, lowering an individual’s quality of life and causing great distress and suffering. Often individuals who suffer from chronic pain seek treatment from many healthcare providers. Individuals are typically put on many different medications with unpleasant side-effects to control pain and some have even tried multiple surgeries. Individuals with chronic pain are often left without hope when told that nothing else can be done. 

Chronic pain is often coupled with psychosocial difficulties. Relationships can be affected as those individuals suffering from chronic pain become isolated from their friends and family,  and can exhibit symptoms of depression, insomnia, and frustration with the healthcare system. Because chronic pain is a complicated problem that affects the individual’s mental and physical health, chronic pain management often requires a combined treatment effort. It is recommended that rehabilitation psychology, musculoskeletal medicine and a pain management specialist treat the patient in an integrative manner. Most importantly, individuals with chronic pain can significantly reduce the severity of their pain by being actively involved in their pain control plan.  A rehabilitation or health psychologist can assist individuals to move towards reaching this goal. They can help increase active involvement in pain control plan by working to develop a physical activity routine and mental health exercises. Though the outcomes of psychological treatment have shown to be significantly effective for managing chronic pain, studies show that very few (10-15%) individuals with co-morbid disability and chronic pain report having tried a psychological intervention (Ehde et al., 2006; Hanley et al., 2006; Widerstrom-Noga & Turk, 2003). 

An example of a psychologically-focused treatment strategy is chronic pain acceptance, which is based on the principals of Acceptance and Commitment Therapy (ACT). This approach focuses on both thinking (willingness to experience pain) and doing (engagement in life), and it is related to positive adjustment, lower pain interference and decreased depression. More specifically, patients are taught to allow some pain some of the time,  how to be willing to experience pain and still engage with life. They are also taught non-judgmental awareness of pain and how to act with intention. Using Acceptance and Commitment Therapy (ACT) in treating chronic pain emphasizes the importance of flexibility in responding to pain. This is different from commonly-studied coping strategies that focus on using distraction techniques to redirect attention away from the pain, reframing thoughts and eliminating pain. 

Other evidence-based treatment also includes Cognitive Behavioral Therapy (CBT) for Pain and Hypnosis. Hypnosis treatment for acute and chronic pain has been shown to be very effective. Though studies on hypnosis for pain have focused primarily on acute pain, more recent studies are examining its effect for chronic pain management when coupled with CBT. Those who are interested in this combined treatment should discuss this with a health or rehabilitation psychologist.

Remember, it is very important to receive treatment in an integrative manner. Therefore, if you seek treatment from a psychologist make sure they take every step to ensure that care is coordinated with your other providers, including your primary care doctor, pain specialist and/or musculoskeletal medicine physician. Providers should also strive to offer an interdisciplinary holistic/integrated approach to any treatment that they provide for individuals with chronic pain. 

When should an individual with chronic pain consider seeking treatment from a psychologist?

  • Symptoms of depression are present: Individuals who are depressed are less likely to engage in self-management

  • Increased levels of anxiety or worry related to daily activities or fear of pain

  • Increased levels of pain interference with activities, including sleep, relationships, and physical activity

  • If catastrophizing or very negative thinking about pain management exists

  • Low self-efficacy for pain management

Here is a list of evidence-based psychological treatments offered for individuals with pain: 

  • Cognitive Behavioral Therapy (CBT) for chronic pain

  • Hypnosis for acute and chronic pain

  • Acceptance and Commitment Therapy (ACT) for Chronic Pain

  • Mindfulness-Based Intervention for pain

Resources :

Dr. Narineh Hartoonian is a Clinical Health and Rehabilitation psychologist at the Rowan Center for Behavioral Medicine. She has several years of interdisciplinary clinical and research experience in health and rehabilitation psychology and has served the needs of many individuals with chronic medical conditions and disability. Dr. Hartoonian received her Bachelor and Master of Science in Physiology from the University of California, Los Angeles (UCLA) and her Doctorate in Clinical Psychology from Loma Linda University (LLU). She has taught various graduate and undergraduate courses in the physiological sciences, health and psychobiology.

REFERENCES

O’Connor, A. B., Schwid, S. R., Herrmann, D. N., Markman, J. D., & Dworkin, R. H. (2008). Pain associated with multiple sclerosis: systematic review and proposed classification. PAIN®, 137(1), 96-111..

Sackley, C., Brittle, N., Patel, S., Ellins, J., Scott, M., Wright, C., & Dewey, M. E. (2008). The prevalence of joint contractures, pressure sores, painful shoulder, other pain, falls, and depression in the year after a severely disabling stroke. Stroke, 39(12), 3329-3334.

Ehde, D. M., Osborne, T. L., Hanley, M. A., Jensen, M. P., & Kraft, G. H. (2006). The scope and nature of pain in persons with multiple sclerosis. Multiple Sclerosis, 12(5), 629-638.

Hanley, M. A., Jensen, M. P., Ehde, D. M., Robinson, L. R., Cardenas, D. D., Turner, J. A., & Smith, D. G. (2006). Clinically significant change in pain intensity ratings in persons with spinal cord injury or amputation. The Clinical journal of pain, 22(1), 25-31.

Widerström-Noga, E. G., & Turk, D. C. (2003). Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics. Spinal Cord, 41(11), 600-609.

Lions, Tigers and Bears……Oh My Stomach Hurts! The relationship between stress and digestion

Many people speak of the “fight or flight” response that occurs in the body when something stressful happens. Stress can be caused by upcoming exams, playing in game 7 of the world series (or watching the game as a diligent fan), running late for work, arguing with another person, paying the bills, running from a bear in the woods, having a big surgery, getting injured, or even just constantly being on the go and never taking the time to sit down and take a few deep breaths. There are many things that cause the body to kick in to high alert. The “fight or flight” response is a protective mechanism that our bodies do without thinking about it. This response is what kept our ancestors alive when they roamed the earth in need of food, shelter and safety a million years ago. 

Take a moment to think about any of the stressful situations mentioned above. During any of these situations do you think it would be helpful for the body to all of a sudden say “Hmmmm…I think this is a good time for me to poop.” Absolutely not! The last thing you would want to do when you are being chased by a lion is to have to think about where, how and when you will stop to use the restroom. This is another protective mechanism your body has inherited over time.

When we are in a “fight or flight” response, our bodies: 

  • Stimulate the sympathetic nervous system
    • Pupils dilate so we can see better
    • Heart rate and blood pressure rise so our muscles get the oxygen they need to work harder
    • Hormone levels shift to increase the feeling of adrenaline and decrease the body’s awareness of being tired, scared and/or in pain
    • Muscle is broken down to help provide energy for the response
  • Override the parasympathetic nervous system (rest and digest response)
    • Digestion is stopped so more blood can go to our muscles and so we don’t have to worry about going to the restroom
    • The ability to slow heart rate is turned off
    • The ability to save up energy is stopped
  • Other side-effects of the shift in our nervous system activity include:
    • Immunity is suppressed due to elevated hormone levels
    • The body’s inflammatory response is triggered
    • The body’s ability to prevent cell damage and detoxify harmful chemicals decreases due to the body’s inflammatory response
    • Fat digestion is impaired
    • Glucose and cholesterol are release in the blood
    • Fat and fluid are retained
    • Energy levels decrease (energy is used up by the “fight or flight” response resulting in less overall energy. Hence you want to take a nap after a long day at work.)
    • Mood fluctuations occur due to energy and hormone shifts

Most people do not think about how the stress in their lives is affecting their digestion, but many studies have found links between chronic stress and gastrointestinal symptoms. When the gastrointestinal tract and digestion are stopped, less stomach acid and digestive enzymes are released. This makes it difficult to break food down and absorb nutrients. Instead, the body learns to break down muscle and over time actually replaces it with fat and extra fluid. Also, as the body is constantly breaking muscle down and releasing glucose in to the blood for energy, the pancreas is forced to work in overdrive to secrete insulin to help the body’s cells use the glucose. Some scientists think that high levels of insulin may contribute to craving sugary foods when we are stressed. Who hasn’t thought about eating a whole pack of cookies or whole carton of ice cream when they are stressed?!  

What all of this means is that our bodies are not designed to be on high alert at all times. And when we are, our bodies do not know how to use the food that we eat. As you run to catch the bus, energy bar in hand, or eat lunch while checking email on your phone, or worry about the day, or think about negative emotions tied to a relationship, you are telling your body “Emergency! Do not digest!” The digestive system is turned off, which negatively affects the nutritional value of food. It can also lead to digestive symptoms, such as heartburn, bloating, belching, feeling like food is just sitting in your stomach, and stomach pain. So here is yet another reason to take the time to be mindful and de-stress everyday. It is important for your mind and body, including digestion and nutrition.

Jonae Perez is currently a clinical dietitian at Professional Child Development Associates providing nutrition counseling for children with special health care needs. She completed her Master of Public Health and nutrition training at the University of Washington, Seattle. She has a background in exercise science and is passionate about adult and pediatric wellness.

Feelings Part 3: Expressing and Communicating Feelings

In parts 1 and 2 of this blog series, we explored what feelings really are and the negative consequences of suppressing feelings. We also discussed some techniques to get in touch with and identify long suppressed feelings. In this blog, we will discuss how to express feelings and effectively and respectfully communicate them to others.

Feelings can be likened to charges of energy that need some sort of release from the body. Physical and psychological wellbeing is improved if you are willing to acknowledge and express your feelings relatively close to the time they occur. Release of feelings can come from talking to someone, writing your feelings out, or physically discharging your feelings

Talking with a supportive and trusted friend, partner or counselor is one of the best ways to express your feelings. It is important that you feel safe enough to let your feelings out rather than just talk about them. Expressing your feelings through talking works best when the person you are sharing with merely listens rather than jumping in with advice, opinions, or suggestions. 

Another way to express emotions is through writing them down. It is sometimes helpful to keep a feelings journal where you can enter your strong feelings. Tracking your strong feelings over time can be helpful in identifying patterns or themes in your life. Whether you choose to save what you’ve written or not, writing feelings down can serve as an effective outlet of expression.

Often people report greater difficulty expressing perceived negative emotions such as sadness and anger. When working with these emotions it is helpful to consider some specific techniques designed to assist with discharging these emotions. 

Sadness

People often report that they feel like they are on the verge of tears or have a lump in their throat but are unable to cry. Crying can be a very cathartic release of grief and sadness that helps people stabilize following a loss or disappointment. If you are having trouble letting out sadness, consider listening to evocative music that has personal significance to you. Watching an emotional movie or reading poetry and literature can bring unexpressed sadness to the surface. 

Anger

Often people chronically suppress anger because of fear of hurting others. As discussed in my previous blog, this can lead to psychological and physical illnesses. At times it can be helpful to engage in physical motions associated with aggression in order to bring anger to the surface. Examples of this include hitting a pillow, hitting a punching bag, throwing eggs against a wall or into a bathtub, yelling into a pillow, hitting a tennis racket against the bed or working out vigorously. A word of caution here though, these techniques are to be used sparingly and only when you are having a difficult time bringing anger to the surface. Evidence suggests that ventilating anger too frequently can lead to increased feelings of anger. 

Communicating Your Feelings

In the section above we were focused on expressing or discharging feelings. Now we turn towards communicating our feelings toward specific people, i.e. letting them know that your feelings are related to something they said or did. Communicating long-held feelings to the person you have them about can be the final step towards being able to release the feelings and move on. There are some important things to consider when communicating your feelings. First, you need to make sure that the person you are going to disclose your feelings to is willing to listen. If your feelings are miscounted or you leave the conversation feeling misunderstood, your sadness, fear or anger toward the person may increase. It is important that you clearly ask for the person to set aside some time to listen to you. You also need to be prepared to ask for the person to wait until you are finished if they interrupt you. 

You should avoid blaming or belittling the person. People are much more likely to listen if they are talked to in a respectful and non-blaming way. Using first person statements helps the listener to remain non defensive. By taking responsibility for your feelings, you avoid such statements as, “You made me so mad when you didn’t pick up the phone.”  A better way to express this is, “I feel angry when you don’t answer my phone calls.” 

A second rule of thumb is to remain focused on the person’s behavior rather than making a personal attack. It is important that you take the time prior to the discussion to clearly identify what the other person said or did that angered or frightened you. By focusing on specific behaviors, there is hope that something can change to remedy the conflict.

The third rule of thumb is to avoid judgments. If you begin judging others, there is less likelihood that they will be willing to hear you out and negative feelings and interactions are likely to continue or even escalate. 

By implementing the above strategies for expressing and communicating your feelings, you are cultivating a value of respecting yourself and those with whom you are in a relationship with. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Feelings Part 2: Identifying Feelings

As mentioned in my previous post on feeling, many people go through much of their lives ignoring or suppressing their feelings. This can be for a multitude of reasons including fear of falling apart through experiencing strong emotions and messages from childhood that labeled certain feelings as bad or unacceptable. Because suppressing feelings becomes so automatic for many, many report that they don’t even know what they are feeling. By learning to recognize the characteristics of suppressed feelings and tuning into your body, you can become much more adept at identifying what you are feeling. 

Even though feelings are suppressed, they typically don’t just go away. They often manifest in a number of bodily and psychological symptoms.

Free-floating anxiety: Anxiety is a very normal and common reaction to any multitude of situations. However, if you are feeling anxious and uneasy for no identifiable reason, it may be due to unexpressed feelings. If this is a state you are familiar with, try to observe if this free-floating anxiety arises the next time you hold in your anger toward someone. 

Depression: Depression can arise when we hold in grief or feelings of sadness over a loss. Indeed, a grief reaction that is not fully expressed can evolve into a depressive episode. Getting in touch with our grief, crying and fully mourning often allows us to feel better and begin the healing process. If you have not experienced a recent loss, your depression may be anger directed towards yourself. This is particularly true if your find yourself attacking and criticizing yourself. 

Psychosomatic symptoms: Frequent headaches, gastrointestinal symptoms, high blood pressure and asthma often occur as a result of chronically withheld feelings. Holding in feelings over the course of many years is a form of stress that takes a toll on bodily systems. Often people find that when they learn to identify and express strong feelings, their physical symptoms abate.

Muscle Tension: Tense muscles are a particularly effective cue that feelings are being chronically withheld. We tend to hold tension in different body groups depending on what feeling we are suppressing. Anger tends to lead to the tightening of the neck and shoulders, while grief and sadness often results in tightening muscles in the chest and around the eyes. Fear typically reveals itself through the tightening in the stomach and diaphragm. While these are typical patterns of muscle tightening, these are not absolute. That’s why it is important to get to know your own particular physical experience of various feelings.

Tune Into Your Body

Thinking about your worries and concerns keeps your primarily in your head. It is necessary to shift focus from your mind to your body. The following steps have been adapted from Eugene Gendlin’s work on experiential focusing can be quite helpful in getting in touch with your physical experience of feelings.

  1. Physically relax. Spend five to ten minutes using a relaxation technique such as progressive muscle relaxation or meditation to slow down the mind and relax the muscles of the body.

  2. Ask yourself, “What am I feeling right now?”

  3. Tune into the place in your body where you usually experience emotional sensations such as anger, fear and sadness. Often observing the area of your hear or gut will reveal some sensations, but this may be different for you. Try to identify your particular place where feelings arise in your body.

  4. Observe what you sense when you tune into your body. Don’t try to analyze, figure out, or judge what arises. Just allow your self to wait and observe any feelings that are surfacing.

  5. Many find that they get stuck in steps 3 and 4 and are inundated with racing thoughts. If this occurs for you, simply begin at step 1 as this may mean that you need some more time to relax. You might try a few minutes of slow deep breathing.

  6. Once you have come into contact with a sense of what you are feeling, ask yourself:

    • Where in my body is the feeling?

    • What is the shape and size of this feeling?

    • If the feeling had color what would it be?

Hopefully, this exercise will help you begin to get in greater contact with your physical experience of various feelings. If you are still having a hard time identifying what you are feeling, you might find the feeling list below helpful. 

Positive Feelings                Negative Feelings

Affectionate        Great                                                            Afraid            Hostile

Alive                   Happy                                                             Angry            Humiliated

Amused             Hopeful                                                         Anxious        Hurt    

Accepted        Joyful                                                               Apprehensive        Ignored        

Beautiful        Lovable                                                            Ashamed        Impatient

Brave            Loved                                                                  Awkward        Inadequate

Calm            Loving                                                                  Bitter            Incompetent

Capable        Loyal                                                                  Bored            Indecisive

Caring            Passionate                                                      Confused        Inferior

Cheerful        Peaceful                                                           Contemptuous        Inhibited

Cherished        Playful                                                           Defeated        Insecure    

Comfortable        Pleased                                                   Dejected        Irritated

Competent        Proud                                                        Dependent        Isolated

Concerned        Quiet                                                          Depressed        Jealous

Confident        Relaxed                                                       Despairing        Lonely

Content        Relieved                                                         Desperate        Melancholy

Courageous        Respected                                            Devastated        Miserable

Curious        Safe                                                                 Disappointed        Misunderstood

Delighted        Satisfied                                                    Discouraged        Muddled    

Desirable        Secure                                                        Disgusted        Needy

Eager            Self-reliant                                                   Distrustful        Outraged

Energized        Sexy                                                           Embarrassed        Overwhelmed

Excited        Silly                                                                 Exacerbated        Panicky

Forgiving        Special                                                       Fearful            Tired

Friendly        Strong                                                          Foolish            Touchy

Fulfilled        Supportive                                                 Frantic            Trapped

Generous        Sympathetic                                          Frustrated        Troubled

Glad            Tender                                                          Furious        Unappreciated

Good                                                                                  Guilty            Unattractive

Grateful                                                                             Hateful            Uncertain

                                                                                            Helpless        Uncomfortable

                                                                                            Hopeless        Uneasy

                                                                                            Horrified        Unfulfilled

In my next post, I will be providing some suggestions for expressing and communicating your feelings, so they no longer have to remain suppressed. 

Dr. Angela Williams is a licensed clinical psychologist, specializing in cognitive-behavioral and humanistic/existential approaches to therapy. She has extensive training in Brief Crisis Intervention as well as mindfulness based therapeutic approaches. Her therapeutic style blends strength-based acceptance with practical skill development. Incorporating mindfulness-based interventions, she helps her clients move through difficult experiences and be more present in their lives.

Call Now Button