This blog post originally appeared, in an adapted form, on Mindful.Org
I don’t know about you, but I feel so much better when my environment is neat and organized. After a long day of work, coming home to a neat space is like coming home to myself. It is a refuge, truly, and I feel soothed.
When I wake up in the morning, before the sun comes up, and stumble to my espresso machine, bleary eyed and still ridiculously tired, a neat space seems to beckon me to use my time in the way I so desire. I try to wake up early to practice mindfulness, set an intention for the day, and then either focus to finish patient notes from the day before, or write creatively…although I’d like this to happen more regularly than it does, I am gentle with myself when it doesn’t.
I do know, however, that there are certain ingredients that will immediately create an impasse for all that to manifest. That is waking up to a messy space. Waking up to a messy space becomes a metaphor for the brain fog and overwhelming feelings that begin to ensue. Decluttering is hard, but it is worth it. The effects impact your mind and body. Some of the behavioral work with my patient focuses on paced organization schedules as well as cognitive work regarding the “letting go” of the clutter that many of us create to protect ourselves. This idea is vast, and I will write a post about that in its entirety at a later time.
My patients find that undoubtedly, as the cutter begins to lessen, they feel a clearing in their minds that they never thought was possible. This is a kind of outside-in decluttering. A physical clearing creates vast mind space. I recommend this extraordinary book to help you get started with the outside in process: “The life-changing magic of tidying up”.
Here’s the thing though, just as we need to declutter our physical surroundings, we need to declutter from the inside-out. I like to call this feat “Feng-Shui-ing the Grey Matter”. Literally, we need to spring clean and give our neural circuitry the room to grow. When this happens, we begin to literally feel the lightness of being.
The irony here: When we declutter, both the environment we inhabit and the minds that sometimes seem to inhabit us, we start to fill our lives with meaning and possibility.
The Brain is now known to be a neuroplastic entity (see my recent Mindful.org post for more on that: “How the Brain Changes When You Meditate“). It is no longer static and by “feng shu-ing the grey matter” we can literally change the neurofunctional space that all the crud and chaos seemed to take up.
Personally, I find this comforting and empowering. What I have found, through my own tedious work, as well as the perseverance of my patients, is that this space is a place where we can mindfully allow for positive Qi to flow within us.
Too esoteric? I hear you. What if I concretized the concept a bit so that we can take actionable steps to feeling better, inside-out.
Ok…here goes.
Sometimes it seems like all I can do to calm down, to declutter, to make space, is to Take a Vinyasa (flow with breath and body through a sequence of asanas/postures/yoga poses). Sometimes I go from downward dog to plank to upward dog and back. Sometimes I start from a Warrior II pose then straighten my front leg in sync my breath, which is also now in sync to my hands moving from out to the sides to above my head.
When I am particularly overwhelmed by negative thought clutter, and it seems as though the ruminations won’t end, I Recite a Poem. I literally recite my favorite poem (which I committed to knowing by memory for this VERY purpose), which happens to be Wild Geese, by Mary Oliver. I become so engaged in reciting the poem, mindful of both the rhythm and meaning of the words, that I let go of all other thoughts. My brain can’t BOTH recite a poem and ruminate at once! You don’t have to use a poem…you can use a favorite song, monologue, etc.
One of my favorite ways to instantly declutter is to literally Bust a Move! I bust out one of my favorite dance moves, and even get the added bonus of the endorphins. I grew up with Tapes, not CD’s, so can anyone say THE RUNNING MAN (or the ELECTRIC SLIDE)!
While I don’t purport to live in the past by way of having regrets and overanalyzing situations which are long forgotten, I DO like to Mosey Down (good) Memory Lane. I find it such a treat to close my eyes and picture myself at that concert at the Boston House of Blues, that time my dad took me to my first baseball game… peanuts and all, playing my guitar solo in front of an audience, passing my licensing exam, getting those roses…the list can go on and on. I get to go back to that time and place, to feel the sensations as I surrender to sweet nostalgia.
One of the most effective ways to Feng Shui the Grey is to simply Say Thank You. You don’t necessarily have to have a god, or the universe, or anyone in particular in mind. Just a general “thank you” to express gratitude for everything you are or aren’t, and everything you have or don’t have. This is by no means easy, and I do NOT mean to placate you or undermine any difficulty you are experiencing. But there is actual literature in the field of “Positive Psychology” that expressing gratitude is a huge part of mental health, which includes stress reduction.
For those of us who want to have at least SOME control in such an uncertain life, we can actually make the CHOICE to declutter our minds, and in doing so we actually change the map of our lives.
Fibromyalgia consists of a complex array of symptoms, which include widespread muscle and joint pain along with overwhelming fatigue. It is often a diagnosis with higher prevalence rates in women and has been described as one of the “most controversial conditions in the history of medicine.” To many medical critics, fibromyalgia is one of several “somatic syndromes” driven by sensationalized media coverage, self-interest, and litigation. For these critics, chronic pain syndromes are believed to reside in the minds of the sufferers.
A variety of social and medical critics view chronic pain as a post-modern illness sharing a lineage with nineteenth-century pseudo-maladies like hysteria. These illnesses, they contend, originate in vulnerable human psyches. Central to these suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic disorder, with the implication that the sufferer’s pain is not medically “real.”
Psychosomatic explanations ultimately reduce chronic pain to mental factors, the consequences of which are significant.
One consequence is that psychosomatic pain is inevitably devalued and the credibility of its sufferers is questioned. Another consequence is that accepted treatments for “physical” pain, like analgesics, may be discouraged even when they may be necessary. Often, being invalidated triggers depression and anxiety, which increases the burden of the disease, adds to the pain, and results in more stigmatization.
A lot is at stake, then, if chronic pain is conceived as psychogenic.
When it comes to fibromyalgia, there is a lot that Western Medicine continues to ignore. There is still no certain cause or recognized treatment that works for everyone. Many things, however, have become, at least anecdotally speaking, crystal clear:
2. The expression and manifestation of Fibromyalgia is diverse and what works for one person might not work for another.
3. Fibromyalgia symptoms can have a significant impact on your life—your work, relationships with family members and friends, and your overall outlook.
4. A combination of treatment modalities is very beneficial.
Many people who suffer with fibromyalgia turn to their diets when making lifestyle choices that will offer relief and improve their overall functioning. The fibromyalgia-diet connection has in part emerged from the idea that people with fibromyalgia have mitochondria dysfunction, and therefore they need to increase levels of certain nutrients in order to produce enough energy.
While research hasn’t indicated specific foods that all fibromyalgia patients should add or avoid, there is a lot of anecdotal evidence that supports eliminating and adding certain nutrients to the diet for relief. For example, caffeine and highly processed foods are often linked to exacerbation of fibromyalgia symptoms. The relief that comes through this kind of mindful eating is buttressed by other healthy lifestyle choices, such as adding an exercise regimen to your day, getting enough sleep, and reaching out to a mental health professional.
Since fibromyalgia is so diverse in its symptom presentation, what works for one person might not work for you. There will most likely be trials and errors as one finds relief, and a multi-disciplinary and holistic approach will likely work best. This might include dietary changes, psychological support, and perhaps medications and/or herbal supplements.
Whatever your journey entails, I know and trust it is worth the hope of a healthier and happier life. You can and will come to thrive, one step at a time!
Not too long ago, most of us thought that the brain we’re born with is static—that after a certain age, the neural circuitry cards we’re dealt are the only ones we can play long-term.
Fast-forward a decade or two, and we’re beginning to see the opposite: the brain is designed to adapt constantly. World-renowned neuroscientist Richie Davidson at the Center for Investigating Healthy Minds at the University of Wisconsin-Madison, along with this colleagues, want us to know three things: 1) you can train your brain to change, 2) that the change is measurable, and 3) new ways of thinking can change it for the better.
It’s hard to comprehend how this is possible. Practicing mindfulness is nothing like taking a pill, or another fix that acts quickly, entering our blood stream, crossing the Blood Brain Barrier if needed in order to produce an immediate sensation, or to dull one.
But just as we learn to play the piano through practice, the same goes for cultivating well-being and happiness. Davidson told Mindful last August that the brain keeps changing over its entire lifespan. And he thinks that’s very good news:
We can intentionally shape the direction of plasticity changes in our brain. By focusing on wholesome thoughts, for example, and directing our intentions in those ways, we can potentially influence the plasticity of our brains and shape them in ways that can be beneficial. That leads us to the inevitable conclusion that qualities like warm-heartedness and well-being should best be regarded as skills.
Davidson adds that research on neuroplasticity gives neuroscientists a framework for tracking meditation research. And CIHM is beginning to see that “even short amounts of practice,” like 30 minutes of meditation per day, “can induce measurable changes in the brain” that can be tracked on a brain scanner.
Based on recent research, I’ve chosen to share four ways your brain may change when you practice mindfulness:
• Anterior Cingulate Cortex: Increased grey matter changes were noted in the anterior cingulate cortex (ACC), which is a structure located behind the brain’s frontal lobe. It has been associated with such functions as self-regulatory processes, including the ability to monitor attention conflicts, and allow for more cognitive flexibility.
• Prefrontal Cortex: Increased grey matter density was also found in areas of the prefrontal lobe, which are primarily responsible for executive functioning such as planning, problem solving, and emotion regulation.
• Hippocampus: Increased cortical thickness in the hippocampus has also been noted. The hippocampus is the part of the limbic system that governs learning and memory, and is extraordinarily susceptible to stress and stress-related disorders like depression or PTSD.
Decreased Amygdala Size:
Studies have shown that the amygdala, known as our brain’s “fight or flight” center and the seat of our fearful and anxious emotions, decreases in brain cell volume after mindfulness practice.
Diminished or enhanced functionality in certain networks/connections:
Not only does the amygdala shrink post mindfulness practice, but the functional connections between the amygdala and the pre-frontal cortex are weakened. This allows for less reactivity, and also paves the way for connections between areas associated with higher order brain functions to be strengthened (i.e. attention, concentration, etc.).
Reduced activity in the Brain’s “Me” Center:
Mindfulness practice has been implicated in the decreased activation and the stilling of our Default Mode Network (DMN), which is also sometimes referred to as our wandering “Monkey Minds.” The DMN is active when our minds are directionless as it goes from thought to thought, a response that is sometimes likened to rumination and not always adaptive with regards to overall happiness.
The impact that mindfulness exerts on our brain is borne from routine: a slow, steady, and consistent reckoning of our realities, and the ability to take a step back, become more aware, more accepting, less judgmental, and less reactive. Just as playing the piano over and over again over time strengthens and supports brain networks involved with playing music, mindfulness over time can make the brain, and thus, us, more efficient regulators, with a penchant for pausing to respond to our worlds instead of mindlessly reacting.
At the end of each new intake evaluation I always ask my patients to delineate one to three concrete goals for their work in therapy. Many of them don’t even have to give it any thought, and immediately and confidently say: “I want to lose this sense of my fear, and make these symptoms of anxiety go away”.
Yet, from what I have learned through my training, mentors, and my own therapy, and what I tell my patients when they embark on a journey to rid themselves of anxiety and fear…
Not only is it impossible to rid yourself of these feelings, it is detrimental. The point of therapy isn’t to “fix” you, or to make your feelings go away, but rather to help you learn the skills to enable yourself to bring those feelings into balance, to an adaptive level, where they belong.
Fear, you see, is evolutionary. The fact that our fight or flight mechanisms arouse us to impending dangers or threats is a gift. Anxiety, which is similar to fear, but engages more of the thinking part of our brain, is also just as adaptive. If we never got anxious, we’d never go to the doctor, study for an exam, make sure we have a retirement plan in place, or pay our electric bills. In fact, anxiety is linked to conscientiousness, and conscientiousness is linked to longevity.
Yes, the inability to feel anxious can shorten your life! So, by that logic, anxiety is life-promoting!
Here is the thing to remember though. It is about working to keep the anxiety and fear at adaptable levels, and to live not in spite of these feelings, but because of them!
I personally struggle with the balance of adaptive and less adaptive anxiety all the time. Here’s just a little example:
A few weeks ago, I woke up at 4am. I couldn’t sleep – at first, I didn’t really feel much of anything. I just lay in bed, not knowing what to do, so I just looked up at the ceiling. I finally got up and walked around, shut the light, opened the light, shut the light, got some water, went back into bed, got out of bed, and at that point I was starting to cycle through some very destructive and fear-induced thought processes. I was starting to feel mentally and physiologically stressed, but then…
here was my moment…
I put my sneakers on and I could feel some sort of new adrenaline rush inside me, not a toxic one, but one that lifted me up (there’s a fine line between these adrenaline rushes, different mindset, but same ‘ol physiology). Whether I was excited or stressed, my fight or flight was elicited. I think the interpretation of what it means is the difference between the biophysiological and psychosocial consequences of the rush.
This rush catapulted me to the gym, finally feeling energized enough to exercise. I nearly skipped all the way there, and when I arrived the sight of sweaty people elated me – so many people alive and moving and motivated to heal and live longer by bringing their heart rate up, or combating obesity, or high blood sugar, or just general malaise, or a depressed stupor. I was inspired by this tableau, which touted the need for social milieus to act out the yearnings of the mind and body to thrive. We were all acting on our fears together.
Fear and anxiety are the human struggle, and the struggle is real. My therapist encourages me, and I in turn encourage my own patients, to embark on living a healthier life, the life they desire, by embracing their fear, without letting it cripple them. And fear, can most definitely cripple.
Many people have said, “Use fear as fuel”, and while the catchphrase might be cliché, it couldn’t be truer. There is nothing to rid ourselves of, only everything to embrace…
What has your experience been? Are you up for embracing your fear and working WITH it?
Let’s embrace all of ourselves; especially those BrainCurves :).
New E-motion picture teaches us to embrace all of our emotions
I recently had the opportunity to see Disney Pixar’s latest animated feature, ‘Inside Out’. I didn’t need much prompting, given that it IS a movie about feelings, and well, as a psychologist, it was an easy sell! It did not disappoint.
Here’s a quick synopsis of the film’s premise before I share my experience of it! An 11-year old girl named Riley, moves cross-country with her family. A move is a huge transition, especially at such an impressionable age, and she experiences a gamut of emotions as she leaves her home, friends, and hockey league behind. Enter the main characters, Riley’s feelings: Joy, Sadness, Anger, Fear, and Disgust who provide a glimpse into the workings of Riley’s mind as she navigates this life-changing experience.
From the moment it started, I couldn’t contain my excitement. The nerd in me was blown away at the extraordinary way in which many of the movie’s messages “measured up” from a neuro-scientific perspective. For example, the way a day full of short-term/working memories is then consolidated during sleep.
While the film gave up some scientific integrity for the sake of storytelling (i.e., conveying parts of Riley’s personality as destructible islands) its poetic license didn’t drive too far away from the reality that we are, essentially, made up of personality traits that wax and wane in prominence during different points in our life and under different circumstances.
Beyond the intricate science of it all, what ‘Inside Out’ did do so well was to provide the empowering message about how to understand, connect to, and accept our feelings and memories in a way that is conducive to thriving…to kicking butt at life!
Here are 5 ways I feel it did this:
ALL of our emotions exist for a purpose
Emotions are neither inherently good nor bad, and to think of them in such dichotomous terms is to do oneself a disservice. Emotions just are. In fact, every emotion tells us something about our inner experience that might be informing our outer experience.
In fact, Rumi, the Sufi poet, waxed poetic in his ‘The Guest House’ (see below) a long time ago about how we should treat every emotion as a visitor, without looking to get rid of any of them, rather to understand their message and purpose.
What Rumi alluded to in his writing, was also recently confirmed by research that indicates that well-being is actually predicated on having a wider range of emotions! Yes, that’s correct, the more you can feel, in all of feeling’s iterations, the better off you are.
To have emotion is to have a compass
The importance of every emotion is a good segue to this next idea, which again, the movie illustrates with beautiful clarity. Having emotions are much healthier, productive, and adaptive then not feeling at all. In the movie, Joy tried to have Sadness stay as far away from Riley as possible.
Although she felt other emotions, including anger, the inability to feel sadness, coupled with her mother’s request for Riley to stay happy, ultimately lead to a cold and numb existence. This state only generated poor judgment and unhealthy choices. It wasn’t until she allowed herself (SPOILER ALERT: rather, until Depression got back to HEADquarters) to feel sadness that Riley was able to see more clearly and reach out for support.
Our realities AND memories are filtered through our emotional lens
Just like our present reality is seen through the framework of our past experience, the memories we look back upon are colored by our present-moment experience. In Riley’s case, she recalled a championship hockey game several times during the movie. At one point she remembers missing the winning shot and feeling sad about it. At another point, she literally remembers the same moment, but this time, she recalls smiling as she is championed by her teammates who pick her up onto their shoulders to let her know how valuable she is to the team. Same memory, the only difference being that it was recalled through a sad lens, and then through a lens of joy.
This is a very powerful idea. What we really “need” to remember is that our memories are a part of our personal narrative, but that in many ways, we construct the narrative we believe. We can CHANGE our story at any time. We can’t delete certain paragraphs that ooze with negative facts and daunting realities. We can’t cut out chapters that we rather have not had. They will always be there, and that’s ok. Research suggests that the actual experiences we have are less impactful than the story we tell ourselves about them.
Having the language to talk about emotions is empowering
Probably the most remarkable part of the movie is its existence as an E-motion picture ;). As long as more than a modicum of scientific integrity exists, whether or not science was upheld to the nth degree doesn’t really matter. What’s important is that an illustration of the concept of emotion can now be reflected in the dialogue we have with our children.
I am a big believer that this kind of dialogue can’t be started early enough! If children learn earlier on to embrace the way they feel, that it’s not just ok, but crucial to feel all of their emotions, we can hope to see more adjusted adolescents and adults. Really, though, animation aside, this movie’s target audience is feasibly all of humanity. Why? Because to have the language to talk about our emotions, all of its iterations, is to be empowered with an ability to learn from them, to respond to them with the utmost of compassion and less judgment.
Feeling our emotions is a universal human experience
Pixar knew what it was doing when it used 5 scientifically validated universal emotions, a la Dr. Paul Eckman’s work (the 6th universal emotion is surprise). Through his research he showed that certain emotions are felt and expressed through universal facial expressions across cultures around the world. And so, the movie reminds us of our intrinsic humanity, how similar we all actually are despite our differences.
This is a very powerful idea, especially in the wake of discriminations based on skin color and/or gender/sexual identity. At the end of the day, no matter who you are, you experience the capacity for the same gamut of emotions. Therefore, if we can realize that we are all just fighting our own hard battles, we might show up in this world with more compassion and less judgment.
The Guest House
By Rumi
This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
As an unexpected visitor.
Welcome and entertain them all!
Even if they’re a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still treat each guest honorably.
He may be clearing you out
for some new delight.
The dark thought, the shame, the malice,
meet them at the door laughing,
and invite them in.
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.
Click here to download a special ‘Inside Out: Guided viewing with BrainCurves’ question sheet to help start the conversation with your children, loved ones, or even yourself, about how you connect with your emotions and memories in your daily life.
PTSD’s overall impact depends on the severity of the disorder, associated co-morbidity (i.e., substance abuse, mTBI, chronic pain), the duration of the disorder, and of course the individual sufferer’s predisposing neural, genetic, and psychological framework. This all needs to be taken into account when a therapist determines which psychotherapeutic approach is warranted.
Early assessment by the right source will help cultivate a comprehensive and individually tailored treatment plan. Informed treatment is the key to healing, and the treatment of trauma is as delicate as the subject matter itself. Pushing “too hard” or not using treatments well validated in the scientific literature will only decrease chances for improved functioning and increased quality of life.
The course of treatment with someone suffering with PTSD is a long term one, as the capacity of the traumatized “self” is limited. When working with people who are traumatized it should be universally understood that the basic tenants of empathy, creating trust and positive rapport, strengthening positive transference, and making the therapy a “safe space” are probably never more relevant.
That being said, there are a number of different therapeutic techniques implicated in treatment for PTSD. Three common treatment protocols include: Cognitive Behavioral Therapy (CBT) including Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Psychopharmacologic Treatment.
CBT:
Different clinicians use different techniques, but meta-analytic findings indicate that CBT elicits the most robust results. A particularly effective type of CBT is called Prolonged Exposure. Exposure is used to enhance emotional processing of traumatic events and helps someone face traumatic memories and situations associated with them. A goal in therapy is for the person suffering with PTSD to learn to distinguish memories and associated situations from the actual event itself. Most importantly, the one is encouraged to gradually learn to safely experience reminders, as well as tolerate any resulting stress, which will hopefully decrease in time.
Imaginal exposure to the trauma entails having someone describe a traumatic experience at an increasing level of detail. A key factor in exposure is an understanding that confronting situations or memories of trauma triggers increases the urge to escape and avoid (which is a primary characteristic of PTSD in general). When this occurs, the therapist acknowledges the one’s feelings and reminds the person suffering with PTSD that avoidance reduces anxiety in the short-term, but will maintain fear and also prevent the learning that the feared situations or memories can eventually be perceived as less dangerous in the long-term.
A more general CBT approach might include the therapist helping the someone to explore schemas and self-talk, which mediate trauma-related fears, challenge negative biases, and generate appraisals that correct for the biases (cognitive restructuring), which helps build confidence.
EMDR:
A well known, effective, but still slightly controversial treatment for PTSD is known as EMDR. According to the theory behind the treatment, when a traumatic or distressing experience occurs, it may overwhelm usual cognitive and neurological coping mechanisms. The memory and associated stimuli of the event are inadequately processed, and are dysfunctionally stored in an isolated memory network.
The goal of EMDR therapy is to help process these distressing memories, reducing their lingering influence and allow someone to develop more adaptive coping mechanisms. EMDR integrates elements of many different therapies, including cognitive therapy, imaginal exposure, interpersonal, psychodynamic, and somatic therapies, to name a few. EMDR is distinguishable from these other therapies by its use of bilateral stimulation during each session (i.e., eye movements, tones, tapping, etc). Briefly, in EMDR a qualified therapist guides someone in vividly but safely recalling distressing past experiences (“desensitization”) and gaining new understanding (“reprocessing”) of the events, the sensations, feelings, thoughts and self-images associated with them. The “eye movement” aspect of EMDR involves the client moving his/her eyes in a back-and-forth (“saccadic”) manner while recalling the event(s).
Psychopharmacologic Treatment
In general, one of the greatest challenges in the field of PTSD is that there has been relatively little study of medications. The Selective Serotonin Reuptake Inhibitors (SSRI’s) are, according to the research, most effective with the lowest side effect profile. Yet, only two, Zoloft (Sertraline), and Paxil (Paroxetine), have been FDA-approved for actually treating PTSD. New studies are exploring the possibility of Ketamine treatment. Ketamine works on the glutamate pathway in the brain, pathways involved in memory and mood regulation, which might explain some preliminary results of positive outcome. Research is ongoing, and Ketamine is a long way from being used in clinical practice specifically for PTSD. Consulting with a trained psychiatrist or psychopharmacologist is most prudent.
Again, no matter the treatment of choice, the goals of the therapist should be maintained throughout. These include emphasizing a sense of self-esteem and personal empowerment, helping someone make sense of confusing and disturbing experiences, working collaboratively with someone at his/her individual own pace, keeping a sense of hope alive when the one is unable to do so, and gently guiding the patient to increased self-awareness.
What is YOUR experience with these treatment techniques? As always, your comments are heeded with care.
My patients find that undoubtedly, as the cutter begins to lessen, they feel a clearing in their minds that they never thought was possible. This is a kind of outside-in decluttering. A physical clearing creates vast mind space. I recommend this extraordinary book to help you get started with the outside in process: “The life-changing magic of tidying up”.
Wild Geese, by Mary Oliver. I become so engaged in reciting the poem, mindful of both the rhythm and meaning of the words, that I let go of all other thoughts. My brain can’t BOTH recite a poem and ruminate at once! You don’t have to use a poem…you can use a favorite song, monologue, etc.
Fear, you see, is evolutionary. The fact that our fight or flight mechanisms arouse us to impending dangers or threats is a gift. Anxiety, which is similar to fear, but engages more of the thinking part of our brain, is also just as adaptive. If we never got anxious, we’d never go to the doctor, study for an exam, make sure we have a retirement plan in place, or pay our electric bills. In fact, anxiety is linked to conscientiousness, and conscientiousness is linked to longevity.
