Coping with Uncertainty

These are challenging times.  Who would have thought that almost overnight, our everyday lives would have so drastically changed?  While not all of the changes have been negative, take the environment, for example, but the stress on our working lives and the economy cannot be denied.  As human beings, we tend to react negatively to the unknown.  Uncertainty is hard to adapt to in an evolutionary sense because it is hard for us to know how best to prepare.  Do I need supplies for two weeks or six months?  Will my job be there when this all over?  Such uncertainty is experienced as a threat and activates primitive emotional systems in our brains that evolved over time to keep us safe.  In a sense, we are operating in the modern world with antiquated hardware. We are no longer scanning for tigers in the savannas (generally speaking) but coping with a rapidly changing modern environment saturated with information designed to activate the fear signaling circuits in our mammalian brains.

So, given that we are living through an event that may as well have designed to create anxiety, how best to cope?  Here are some suggestions for effectively weather uncertainty:

•     Try to maintain some kind of regular schedule.  Eat breakfast, exercise, read, etc. following a predictable routine. Routines make the unpredictable more predictable, and thus safer.  When children experience a disaster, for example, they are comforted by a return to predictable behavior.  You don’t have to pretend you are at the office, but having a loose structure can help.
•     Reach out to social contacts and friends.  Call family members and reconnect with people you haven’t talked to in a while.  Humans are social animals and benefit from interaction with other humans.  We are essentially “wired for social connection.”  This does not mean that you have to become a social butterfly but try to avoid isolation.
•    Limit your exposure to news and commentary about the pandemic.  Like in the aftermath of 9/11, the 24-hour news industry has filled the airways with information of varying quality.  Remember that news producers know full well that engaging their audience through activation of the primitive fear/alert systems in our brains is a sure way to keep us engaged.
•    Engage in moderate cardiovascular exercise.  There is a lot of research that suggests that moderate cardiovascular exercise is related to lower levels of stress and a greater sense of self-efficacy.  You don’t have to train for a marathon, but 15-30 minutes of exercise that elevates your heart rate can be an excellent strategy assuming that your doctor has not limited your activity for health reasons.  Bodyweight routines or walking are good examples and there are many free workouts posted on line. 
•  Take up mindfulness meditation.  Again, there is an emerging body of research linking mindfulness meditation to decreased stress, improved focus, and increased self-efficacy.  Smartphone apps such as Headspace, Calm, and Mindfulness Coach (which is available for free from the Veterans Administration) can walk you through the process of learning to meditate.
• Finally, exercise self-compassion.  Accept that you may be under a great deal of stress and that a wide range of feelings are normal and acceptable

I hope some of these suggestions are helpful.  As always, I am happy to consult with you if you have questions or would like support.  Be safe and well.

You Don't Have to be Sick to Talk to Psychologist

For some reason we have equated talking to a psychologist with a medical visit. We think that there has to be a problem for the doctor to fix to make it worthwhile to visit a psychologist. Where did this idea come from?  Why do we have to be in emotional pain or completely overwhelmed before we decide to talk to someone?  And when did all of this become a medical specialty?

Talking to a psychologist helps

There are lots of studies that document the effectiveness of psychotherapy for all sorts of issues including smoking cessation, anxiety, career burnout, depression, and many more.  I wrote about some of this evidence in my posting Does Therapy Really Work?  Furthermore, we know that talking to a psychologist can head off problems before they get too big to manage. For example businesses utilize psychologists to maximize efficiency and worker satisfaction. Sports teams consult with psychologists in making staffing decisions and helping players maintain peak performance. There are fascinating and useful studies on the prevention of stress and burnout in the workplace. Physicians and nurses have been helped in avoiding what is called "compassion fatigue" brought on by the demands of caring for the sick. 

Achieving our best

Psychologists can help you live more a productive and satisfying life. We don't need to be in pain in order to reach out for these services nor do we need a diagnosis in order to begin living our lives more fully. By talking in a safe and facilitating environment with a well-trained psychologist you can begin to explore all those areas that may be strengths and also some of the neglected corners.  By discovering more about yourself you can allow your natural capacity for adaptation to do its best.  Think of it as a tune up or an attitude check.  That's what top athletes and professionals do.  We can't always be at the top of our game and sometimes the ways in which we cope actually get in the way of our natural resilience.

Just Talking

My job as a therapist is to help you to talk.  It's not that hard really but sometimes knowing how to ask some of the right questions and listen for the blocks can really help you to explore your thoughts and feelings.  If you are interested in going a bit deeper we can try Therapeutic Assessment, a collaborative technique using psychological testing to answer questions you may have about yourself.  I wrote about that here.

So lets just agree that you don't have to wait to have a cold to start working on your immune system.  Give me a call if you are interested in learning about boosting your resilience or knowing more about yourself.

Pain is inevitable, suffering is optional

I've been reading Rick Hanson's book Buddha's Brain, a fascinating and very readable presentation of the neuroscience behind mindfulness practices. Recently these practices, including relaxation and mindfulness meditation, have received support as viable treatments and, unlike medications, there are very few side effects.  I have been finding myself recommending mindfulness meditation to clients suffering from anxiety, depression and impulse control disorders.  It is a nice way to develop resilience and self-efficacy while enhancing health through decreased tension.  There is even a smartphone app called Mindfulness Meditation that can walk you through several basic meditation routines.  While not a panacea, mindfulness practice can be very helpful.

One quotation that I have found especially helpful in re-framing problems that we all struggle with is: "Pain is inevitable, suffering is optional." What I like about this quote is that it highlights the role the sufferer has in the creation of his or her misery.  Pain cannot be avoided.  It is an essential though unpleasant aspect of being alive.  We can, however, choose to accept this reality instead of engaging in the grandiose fantasy that pain can be avoided or negated.  We often find that the pain, once regarded as intolerable, is actually manageable once we let go of the delusion that it can be avoided.

So much of what my patients come to treatment for relief from is the by-product of frantically trying to avoid discomfort.  Alcohol, drugs, sex or compulsive shopping all promise relief from, or at least avoidance of pain but in the end they only create suffering.

Using mindfulness techniques can help us "sit with" and tolerate all of our feelings, painful or otherwise, and to function with resilience.  Our culture of immediate gratification and pursuit of the latest and greatest makes this hard but we can choose to exercise mindfulness just like any other muscle.  When we do, we live more intentional and satisfying lives.

Tolerating Discomfort

"If some longing goes unmet, don't be astonished. We call that Life." - Anna Freud

This is essentially the argument for affect tolerance, the ability to tolerate all of our feelings and continue to function; being able to feel all our feelings without compulsively needing to anesthetize ourselves from them. There are always discomforts, disappointments and even tragedies in life. Our ability to bounce back from these experiences is resiliency. We can learn from our feelings, particularly the uncomfortable ones, so long as we are open to having them. If we choose to close ourselves off from these feelings we do so with the cost of impoverishing our genuine experience. 

So many of my patients come to me initially seeking relief from "anxiety" or "depression" by which they mean a subjective experience, a feeling, that is uncomfortable or unbearable. Our culture tells us that there is no need to tolerate an uncomfortable feeling. There are medications or new consumer products that can take these feelings away, banish them to the unknown.

But in doing so we flee the here and now for imagined comfort of somewhere else.  We trade our lived experience, the only true reality, for some imagined talisman that will end our suffering.

Michael Balint, a Hungarian psychoanalyst, argues that advertising, art, the longed for relationship, all depend upon our yearning for what he calls the transformational relationship. If we could possess that thing or relationship our lives would be transformed and made better. 

The hard sell in psychotherapy is that rather than taking uncomfortable feelings away, we work to increase the capacity to tolerate the full range of feelings, including the "bad" ones. So question is not "how can we take that feeling away?" but rather, "how much of that feeling can be tolerated?"

As you can imagine, not everybody wants to take that on. Why not just make the thing that causes discomfort go away? The point is that once a greater capacity to experience feelings without being overwhelmed is reached, greater emotional flexibility and resilience is attained, and that is the proper goal of growth oriented psychotherapy. 

Resilience from a psychoanalytic perspective

In 1932, addressing a gathering of medical students, Sigmund Freud made the famous and often quoted statement "where Id is, there ego shall be" (New Introductory Lectures). For a long time, before I read Freud more closely, I took this to mean that over time the ego could be trained to better dominate the unwieldy Id and that he was really talking about domination of the impulses.

As a review, the ego is that part of the mind with which we are most familiar. It is the seat of our conscious thoughts, sense of the here and now and the experience of the ourselves at any given moment.  The Id is the source of energy in the mind; all the instincts and drives as well as the parts of ourselves that we find uncomfortable or unacceptable. (As a side note, Freud's language was much more familiar and less scientific than the Latinized "ego" and "Id" suggest. Freud's translator, James Strachey, wanted the theory to sound more scientific and so dressed up the English translation using Latin terminology). 

At any rate, my initial understanding of this famous phrase could not have been more wrong. Freud was not suggesting that we increase our censorship and banish more of our experience to the Id, he meant the opposite; that as the ego grows stronger, more of the Id can be tolerated in our everyday lives. This enables us to benefit from all the energy of the Id and function more flexibly. 

Anger is a good example of this process. Many of us are uncomfortable feeling anger and even less comfortable expressing it directly. We are led to believe, through growing up, that it is impolite to express anger so we squelch it at every opportunity. The problem is, there is a lot of energy to be had in anger and anger can be an important signal that our needs are not being met. If we divert anger out of our awareness and into the Id, we loose this resource and impoverish our ego. 

This is not to say that we should be yelling at people all the time or making unreasonable demands. Rather, we should learn to tolerate anger (and all of out feelings) without resorting to defenses that negate reality and squelch anger. 

If the Ego can be strengthened so as to tolerate all our feelings, comfortable as well as ugly, then we expand the Ego and allow it occupy territory once claimed by the Id. We function more flexibly, get overwhelmed less easily, and experience life more fully.  That is resilience from an analytic perspective.