Archive for May 2010
Awareness, pain, and relationships?
Sometimes I am in a relationship and I really really want the other person to “get” it.
What I’ve noticed is that I can get really persistent and even pretty angry when they don’t. Sometimes if feels as if I just can’t stand it if they don’t. I feel helpless. I want them to see what they can’t see and they won’t.
So what does awareness have to do with anything? If I’m aware that another person doesn’t “get” it, isn’t that sort of like being reminded over and over again how helpless I feel?
The irony is, awareness also has to do with getting me to see aspects of the situation that, in my persistence, I may be blind to. And this also means seeing reality for what it is, in its entire-ness, and being able to get my mind around the whole situation.
And then I can start to move out of being stuck and start to look at my options. And in this I gain perspective, and I gain power, and I start to realize that it’s not “just me”. So hence the paradox: I can truly “get” that the person I am in conflict with isn’t “getting” it only when I really “get” it.
Now this may bring about a fair amount of pain and disappointment. Sometimes my persistence has been a way of refusing to accept what is lost, or a way to avoid the pain of the limitations of other people. However, this capacity for awareness and acceptance gives me the opportunity to let go of my persistence that the other person “get” it. And then perhaps I can start to look at my options. Here are some possible options in this situation:
1) Stop persisting.
2) Accept my own emotional pain.
3) Grieve what has been lost.
4) Accept the limitations of other people.
5) Re-consider how much energy I want to invest in this relationship, and consider focusing my energy and attention in another relationship.
6) Figure out how to best be in relationship with people that don’t “get” it.
7) Find people in my life who do “get” it and turn my attention and energy somewhere else.
Look around and see if other people have noticed this person not “getting” it, and see if they have been able to accept it.
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Another perspective: What is mindfulness?
As always, I’m looking for answers to the question “What is mindfulness?” so that my readers can understand. Here is a truly lovely quote about mindfulness that I discovered recently. The author is MJ and you can visit her at www.mydbtlife.com, where she offers a free weekly blog dedicated to the teaching of DBT.
“The basic concept of mindfulness is that in order for us to open up options for ourselves when we are suffering, we need to be fully aware of the circumstances surrounding that suffering. These circumstances may appear to be self-evident. However, there are so many things going on with us when our suffering is at its greatest. Going on inside and outside. Our environment has a lot of factors that are weighing in on our level of suffering.
Believe it or not, when we are not suffering, most of us are only aware of a fraction of all that there is to be aware of within us or around us. When we are suffering our awareness shrinks even more. There are options for every action, effective or ineffective. Options to speak, think, feel, or behave. These options are limited if we are not aware of everything that contributed to what we are experiencing. To bring about a self-awareness that will improve our chances of effective choices, we need to practice being in the moment we are in, for what that moment truly is.”
What is mindfulness?
I have a plan. I want to find out the answer to the question “What is mindfulness?”
There is a type of research called phenomenological research that is done by asking the same question to multiple persons. If the phenomenon in question (we’ll say, “mindfulness”) is asked about over and over again, and if you ask enough people, eventuallly you would start hearing the same or similar things. Themes and common answers show up.
The thing is, the concept and teachings of mindfulness has really become a powerful presence in healthcare. We have mindfulness based cognitive therapy, mindfulness based treatments for depression, acceptance and commitment therapy, dialectical behavior therapy, and functional analytic therapy. We’ve got a lot of well known people writing books and teaching mindfulness. Jon Kabbat Zinn even said recently at a conference that kindergarden teachers and Monet knew about mindfulness, but would never have called it that. I listened to Jon Kabbat-Zinn for a few hours, but if I didn’t know anything about mindfulness I would have had a hard time summing it up at the end of those few hours.
Mindfulness to me is one of the gifts that DBT has given me to be creative, to engage people, and to approach a concept in a clear way with one specific path. I would say lots of different things if asked the question, “What is mindfulness?” I believe the difficulty in teaching mindfulness is that it can be overly simplified if not well taught (So what about breathing? I don’t get it) or overly complexified if not made experiential (so the teachings are too much in-your-head). Mostly what I try to do is give my clients a simple explanation, a simple exercise, and get a bit of feedback. But the brief point and the experience can be different all depending on what the mindfulness exercise and experience is that day.
So I am on a quest to find what people are saying when asked the question “What is mindfulness?” and to start posting it on my blog. I want to quell the curiousity of my readers. I want to give information that is based on what is being taught in the community for behavioral healthcare problems. And perhaps even find out what clients are saying who have had DBT and really felt like they “got” what mindfulness is all about. So stay tuned…
Treatment for panic disorder
Panic disorder has a lot to do with being afraid of panicking. A comprehensive treatment will address fear of fear, which generally involves approaching verses avoiding fear. This is known as exposure. The basic concept of exposure is that a person stays in the presence of a threatening stimulus long enough for his or her fear to go down, at least a little bit.
When a person has a panic attack it is not uncommon for the person to fear the panic itself. This has the paradoxical effect of making the panic worse. For instance, it is normal for a person’s heart to race when exercising. A person who has panic attacks may start to become hypersensitive to feeling his or her heart racing. This may result in the person’s avoidance of going up or down stairs. While the intention is to avoid panic, this can be problematic as more situations become associated with the panic. Eventually the panic is more in control of the person than the person is in control of the panic.
Most of the time, the situations, events, or circumstances the person is afraid of are not harmful. Treatment generally consists of educating people on panic and non-useful ways of thinking, It involves helping people regulate anxiety through breathing exercises, controlling their body with progressive muscle relaxation, and facing feared situations over and over again until the fear goes down. Part of emotion regulation training encourages persons to identify the function of the fear (Does it truly help them avoid harmful situations? Or is the fear getting them to avoid living the life they want?). Too much fear may be fear worth trying to change. The DBT opposite-action-to-emotion skill is to approach, which is exactly on target with evidence-based treatments for treating fears and phobias.
Are self-defeating thoughts actually useful?
Thoughts can play a key role in a person’s emotional life. The way we appraise, judge, interpret, or address an emotional event can determine whether emotional arousal goes up, stays the same, or goes down.
One way of addressing thoughts in psychotherapy is by looking at the accuracy of self-defeating thought and challenging oneself to come up with more realistic appraisals of a situation. For instance, if one setback leads a person to remember all past failures and to predict all future failures, that person may be asked to evaluate the reality of this possibility. The person may also be asked to attend to times in which setbacks did not lot lead to failure. This is very characteristic of cognitive-behavioral therapy, or CBT. Remembering times when things have gone well is one way in which people can regulate their own mood.
Just like thoughts influence emotions, emotions influence thoughts. A predominantly unpleasant mood may lead to a person’s tendency to predict his or her own failings. People often cling to non-useful, self-defeating, and highly judgmental thinking in the hopes that emotional pain might somehow be solved. Asking a highly distressed person to assess reality may result in more examples of failures. He or she may continue to persist in a self-defeating fashion, engaging others in arguments about self-hatred, self-worth, deserving or not deserving. The overall problem with these types of conversations is that they generally don’t get people to feel better and they don’t solve problems. In addition, these conversations can really kill relationships.
Another way of addressing thoughts in psychotherapy is with mindfulness. The focus is not on getting the thought itself to change (despite the fact that the thought might be a self-hating thought). Instead, the focus is being able to identify thoughts and to notice how they get in a person’s way. Being mindful of a thought might include asking “What is the usefulness of this thought right now?” If the thought is not useful, it may be of benefit to focus attention elsewhere.
Sometimes it is difficult to notice when these thoughts arise. Our brains may automatically generate defeating, harsh, rigid, and automatic thoughts when distressed. Mindfulness also includes “catching” oneself in automatic thinking patterns by starting to notice such thoughts.