The comfort of a good routine

My stepdaughter was on Spring Break this past week so I took off from work to spend time with her.  My sister held her annual Easter Egg hunt the day before Easter.  We went to church with my family on Easter Sunday and had lunch with family afterwards.  We took a two day trip to Baltimore with family on Tuesday and Wednesday.

I always have to prepare myself mentally the week or so before a vacation.  It's not that I don't enjoy the time off from work and spending time with people I love - I do.  It's just that it's very hard for me to deviate from my routine.  My weeks are typically quite structured.  I get up at 5 AM, get ready to go, and arrive to work between 7 and 730.  Even what I eat for breakfast rarely changes: oatmeal with brown sugar and fruit. I get off of work at 4 PM.  I go home, change clothes, and head to the gym.  I spend about 45 minutes at the gym (where I do a strength training routine and either jog on the treadmill or use the elliptical), I come home, change into sweats, and relax.  My husband and I eventually sit down for dinner and spend a little time together before I go to bed around 930.  That's my week, at least Monday through Thursday.  On Fridays, I come home and try to clean up around the house.  Sometimes I meet up with friends for dinner.  Saturdays are free days.  Sundays I go to my parents' and have lunch with my family.

I know, my life isn't very exciting.  Some people might say it's quite boring.  Not me.  I like the calm predictability of structure and routine.  It's familiar.  It's comfortable.

Now I realize I'm probably a little too comfortable with my routine; I have a hard time deviating from it.  I hate when someone calls me at work and asks me to accompany them to some spontaneously planned event that same evening.  I'll usually go, depending on the event, but if it requires me to skip the gym then I end up feeling guilty.  I realize that this is slightly unrealistic.  That's why I typically end up attending whatever event I've been invited too, despite feeling a bit guilty.  Just because I feel a particular way doesn't mean I have to act on those emotions.

And then the vacation inevitably comes to an end.  This is where a little mindfulness is helpful.  It's not unusual to start lamenting that vacation is "almost over" several days before it ends.  Every time this thought comes up it brings with it feelings of disappointment.  These feelings keep you from fully enjoying what's happening now, while you're still on vacation.  I've done pretty well at avoiding this trap.  What I have a more difficult time with is the disappointment that comes when vacation is officially over.  I find myself reliving everything I did and wondering if I made the most of it.  Having looked forward to this vacation for weeks, I find myself thinking about what I have to look forward to now.  Why is there this need to have something to anticipate?  Why not be satisfied with the vacation I've had and get back to my normal routine? I realize this is a common habit; perhaps it's human nature...

Reason vs. Emotion in Decision Making

When it comes to making decisions, Western societies tend to value reason and rational thought.  The assumption is that good decisions are based upon careful consideration of all relevant facts.  Whenever possible, important factors and potential outcomes should be quantified.  The more data-driven the process, the better.

If reason is the foundation of good decision making, emotion is perceived as its enemy.  Emotional decisions are seen as impulsive, reactive, and irrational.  Emotions are thought to interfere with making good decisions by distorting the salience of particular information, thus creating bias in the decision maker.  We are therefore encouraged to set our feelings aside when making decisions, lest they interfere with the process.

Science has started to challenge these assumptions in recent years.  There exists a growing body of evidence suggesting that - far from interfering with the decision making process - emotions are an invaluable source of information. 

According to Seo and Barrett, there are two factors that determine how emotions influence decision making: how people experience their emotions and what they do with them.  The "how" refers to the intensity or strength of a given individual's emotional experiences. "What they do with them" refers to the level of emotional awareness of a given individual and the degree to which his feelings influence his judgment. 

This model acknowledges that emotions have the potential to interfere with one's ability to make good decisions;  they can influence our perceptions and create bias.  As an example: Suppose a person is extremely uncomfortable with risk and uncertainty.  He is presented with an investment opportunity that entails a small level of risk over the short term but a strong likelihood of success over the long term.  He is uncomfortable with uncertainty; whenever he thinks about the risk associated with this opportunity he becomes anxious.  Instead of taking advantage of this opportunity he instead selects a no risk option, even though this selection will earn him less money.  His decision to go with the less favorable (and less rational) option is based entirely on his anxiety. 

On the other hand, when given a proper role emotions can be an essential part of the decision making process.  Research, in fact, suggests that it might be impossible to take emotion out of the equation.  One study included participants with impairment in brain areas associated with perception of emotion.  When presented with several options and given factual information about each, they found it difficult to develop a preference for any one option over another.  As it turns out, preference is, at its core, an emotion.  Without emotional input, one cannot develop preferences; it is quite difficult to make decisions without preferences. 

In summary, emotions can both facilitate and interfere with good decision making.  What do we do with this apparent contradiction?  Fortunately, there is a (relatively) simple solution.  The key is emotional awareness (mindfulness of emotions).  Studies show that the impact of emotional bias on decision making is completely negated when people can recognize their feelings and reflect upon their relevance to the situation at hand. 

Using the earlier example, a person could say, "I'm feeling anxious about taking this risk.  This is probably because I am uncomfortable with uncertainty; taking risks always makes me anxious.  My anxiety is based on habit, not on fact.  I will take the risk because it is the better option."

Here's a link to an article that gives some good tips on using emotion in the decision making process:

http://scholar.harvard.edu/files/jenniferlerner/files/govt_exec_edit_6-151_ks_999wds-_pz_6-28.docx.final_.pdf

Time poverty

When my husband and I first got engaged, I had an opportunity to get a second job.  It was a good opportunity -- the pay was good and we needed the money -- but I didn't really want to work two jobs.  I didn't like the idea of leaving one job at the end of the day and driving straight to another one.  My husband, however, thought I should do it.  "Think of all the extra money!" he said.  He made a compelling argument and I was eventually persuaded to his point of view. 

I was miserable as soon as I started the job.  I always felt rushed, like I never had time to do the things I wanted to do.  I was constantly stressed out and was often irritable.  I ended up quitting after about a month.

Did my second job really consume so much of my time that there was none leftover for me to do the things I felt were important?  I honestly don't know.  What's important is that I felt like I didn't have enough time to do the things that were important to me.  My perception was what mattered.

The mistake I made (i.e., taking a second job I knew I didn't want) is a common one: I bought into the belief that money is more valuable than time.  Ours is a fast-paced society.  We are always in a hurry and there is never enough time in the day to accomplish all the things that need to be done.  Studies in both the U.K. and the U.S. have found that while a typical adult has about five to seven more hours of leisure time compared to thirty years ago, people today  feel like they have less time to engage in meaningful activities than they did back then. 

If we have more free time than ever before, why do we still feel so rushed?

As it turns out, I'm not the first person to ask this question.  And there's actually a name for feeling like there's never enough time: it's called time poverty.  Time poverty is an inevitable outcome of living in a world that never slows down.  Some suggest that it's tied to the competitive nature of Western (and especially American) society.  Culturally, we have embraced the idea that success is measured by material wealth and tangible achievements.  For this reason, we attribute more significance to a prestigious job title than to the nature of our relationships with family and friends.  We want to be successful so we constantly strive to "get ahead."  (The irony is that no matter how far you get ahead it will never be far enough to make you happy.  True happiness doesn't come from getting ahead or even from being successful).  We fill our schedules with activities that reflect the value we place on material gain and personal achievement.  Unfortunately, these are typically not activities we find to be meaningful or personally fulfilling.  Still, they consume the bulk of our time, often at the expense of activities that we do find intrinsically rewarding.

So what can we do about it?  We can't exactly get off the boat while life sails past us at breakneck speed.  Dr. Stephan Rechtschaffen believes he has a solution.  He calls his strategy "timeshifting."  According to Dr. Rechtschaffen, the problem with living in a fast-paced world is that we never switch gears.  There are times, he acknowledges, when we need to move quickly.  At other times, however, we need to slow down and be present.

Sound familiar?  Dr. Rechtschaffen is basically telling us that the way to create balance in our lives is to incorporate periods of mindfulness.  He assures us that we don't have to take time out of our already hectic schedules to integrate mindfulness practice into our day.  All we need to do is pick a mundane task and make a conscious effort to bring our full attention to the activity.

Use of Buddhist Practices in Western Psychology

The Buddhist tradition and the field of Western psychology define the "self" (or ego) in similar ways.  They agree that the self is not something a person is born with; it is therefore not an inherent human trait.  They both see the self as something that develops over time in response to one's interactions with others and with the environment.  They agree that the function of the self is to integrate our subjective experiences in order to provide us with a sense of internal cohesion and personal continuity (personal continuity is the sense that "I" am the same person from one moment to the next).

Buddhism teaches that the self we perceive as a solid and integrated entity is, in reality, just an illusion.  If we focus our attention on our internal experiences, we will eventually see that this "self" is nothing more than a collection of experiences - of thoughts, feelings, attitudes, and sensations - that arise and then pass; there is no permanent substance or structure - no "self" - underlying these experiences.

This is, in fact, quite consistent with many of the mainstream theories underlying Western psychotherapy practice.  Psychodynamic and constructivist theories suggest that, for each person, the sense of self is achieved through the interactions of many different "self representations."  A self-representation is an unconscious collection of related schemas (ideas and beliefs) that produces a particular experience of the self in a given moment.  A person has many self-representations and any of them can be dominant at a given moment in time.  Thus, the "self" one experiences "is actually being constructed anew from moment to moment" (Jack Engler, "Therapeutic Aims in Psychotherapy and Meditation").

In short, when we talk of the "self" in Buddhism or of the "self" in Western psychology, we can be sure we are talking about the same concept.  The differences in how the two traditions deal with the self is not in how they define it; rather, it is in the role each believes the "self" plays in human lives and human functioning.

Whereas Buddhism sees the self as the primary source of all human suffering, Western psychology sees it as necessary for healthy functioning.  Buddhism teaches that suffering can only be alleviated when a person realizes that what he perceives as a cohesive, integrated, and continuous self is only an illusion and that it disappears under close scrutiny. 

In contrast, Western psychotherapists see the lack of a stable, integrated, and cohesive self as a major cause of suffering.  A self without cohesion is fragmented; complete fragmentation results in psychosis.  In less extreme forms, a loosely cohered self caueses a person to experience a deep sense of emptiness accompanied by desperate (but unsuccessful) attempts to fill it.  Western psychotherapy practice seeks to alleviate suffering by strengthing the self, fortifying its boundaries, and integrating its various components.

Which tradition is right?  Do we suffer because we believe in a self that doesn't exist?  Or do we suffer because our self needs to be integrated and strengthened?  And how is it that Western psychotherapy borrows from Buddhist practices that seek to accomplish the exact opposite of what it aims to achieve?

There are some psychotherapists who make this very point and argue that Buddhist practices have no place in psychotherapy.  Others embrace Buddhist teachings and practices wholeheartedly and use them as the foundation for their psychotherapy practice.  Still others believe that Buddhist practices have a place in psychotherapy but caution against using them as substitutes.  Practices like insight and mindfulness meditation are not equivalent to psychotherapy.  In fact, as we've already established, while meditation and psychotherapy both aim to relieve suffering, they do so via fundamentally opposite strategies. 

I think it is interesting to note that Western psychotherapy borrows from Buddhist practices, but not the other way around.  Buddhism borrows nothing from Western psychology.  When Western psychotherapists use specific Buddhist practices as interventions they use these practices outside of their original context.  They do not use them as they are used by Buddhists.  Buddhists engage in various types of meditation with the ultimate goal of achieving enlightenment (which also brings about freedom from suffering).  When a psychotherapist teaches a patient to engage in mindfulness meditation he does not do this in an effort to help this patient see through the illusion of self to become enlightened.  Rather, he hopes that insight (Vipassana) mediation and mindfulness meditation will help the patient to build ego strength.  He hopes to strengthen the patient's "self" by teaching him to observe his thoughts and feelings objectively, to approach his internal experiences with acceptance, or to recognize the role that identifying with maladaptive thoughts plays in generating negative emotional states.  These are all functions that Western psychology traditionally ascribes to the ego.  These are all worthwhile endeavors but they are not goals that are pursued within a traditional Buddhist framework. 

I suppose there is a bit of irony in how the West has chosen to embrace Buddhist ideas.  We adopt Buddhist practices in an effort to achieve goals that are completely at odds with the fundamental tenets of Buddhism.  This is at least the case in terms of using Buddhist practices as psychotherapy interventions.  In reality, to do anything more would require a complete change in worldview for everyone involved. 

The relationship between mindful participation and "flow"

Most people are probably familiar with the concept of "flow."  "Flow" falls under the realm of "positive psychology" and was formulated as a psychological theory by Hungarian psychologist Mihaly Csikszentmihalyi. Csikszentmihalyi describes flow as a state of consciousness that occurs when a person's attention is completely absorbed by a given activity.  During a state of flow, all sense of time is suspended.  A person becomes fully immersed in a given experience; he is no longer conscious of himself.  His actions and attention are completely in sync.  In a state of flow, a person is not conscious of external distractions.  Neither does he experience any internal distractions; "mental chatter" does not occur in a state of flow.

According to Csikszentmihalyi, only certain activities can stimulate flow.  To enter a state of flow, a person must engage in an activity that is challenging, but within his ability.  Challenging activities, Csikszentmihalyi asserts, require our attention.  Simple tasks, on the other hand, are frequently performed on auto-pilot.

It seems to me that a lot of people tend to think of flow as something that just "happens" when you find the right kind of challenge.  I am sure this is sometimes the case.  We start doing something; we become so immersed in it that when we next look at the clock we are shocked to find that hours have passed.  So to a certain extent, the experience of flow does seem to depend upon finding the right activity.  It is not, however, a given that once you find the "right" activity, flow will just come naturally.  There is also no guarantee that it will be easy to find the activity that compels you to fully immerse yourself in it.  For these reasons, flow depends upon more than just finding the "right" challenge.

If we leave it to chance, flow is likely to be a state of mind that we achieve spontaneously, but infrequently.  Flow is the type of experience that allows us to fully engage in our lives; as such, it has the potential to enrich our quality of life and to add to our sense of purpose or meaning.  Why leave something like that to chance?

When I teach mindfulness to my patients, I use the model designed by Marsha Linehan, Ph.D., creator of Dialectical Behavior Therapy (DBT).  The DBT manual distinguishes between mindfulness "what" and "how" skills.  The three "what" skills are observing, describing, and participating.  I see the skill of "participation" as the sort of culmination of mindfulness practice, i.e., as something you work towards.  The more you practice observing and describing the world around you (and within you) without judgment, the better able you are to participate mindfully in whatever is happening in the present moment.

The practice of mindfulness is concerned with process, not outcome.  Flow, too, is about process.  Flow is achieved through mindful participation and is its own, intrinsic reward.

I will be the first to admit that I do not experience flow very often.  As a very task oriented person, it is difficult for me to take time to engage in the process of doing something.  Often, I am so focused on needing to get things done that the process of doing brings no satisfaction at all.  Because of this, I cannot jump straight to mindful participation when I practice mindfulness.  Instead, I must practice non-judgmentally observing and describing.  Gradually, this will enable me to maintain contact with the present moment more and more frequently.  The more I engage with the present moment, the better able I am bring mindful presence to my daily activities.  Mindful presence leads to mindful participation; mindful participation leads to flow.

Meaning from Suffering

I believe it is often essential to find meaning in suffering before you can move past it.  When I say this to people, their typical response is, "How am I supposed to do that?"  There is no universal answer to that question.  Still, I believe it is vital for a person who is suffering to find a satisfactory answer before he or she can move beyond his or her pain.

A lot of my patients are people who have experienced some sort of trauma.  Some of these patients are able to "recover" from the symptoms caused by their trauma (or traumas); some patients are not.  Some patients seem to fall into despair.  One thing I've noticed about those who fall into despair is that they often view their suffering as meaningless.  When they look back on the trauma and consider the pain they have endured and how much they have struggled as a result they conclude that they are somehow being punished or that they are irrevocably damaged.  They say to themselves, "All of this pain, all of this suffering, and for what?  For nothing!"

So how can a person grow from his struggles?  How can he look at a terrible experience and see a silver lining?    Again, every person must answer this question for himself.  Still, there are some common "categories of meaning-making."  These "domains" were developed after an extensive review of the research on posttraumatic growth and were ultimately incorporated into something called the Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996).  They are:

1. An increased appreciation for life (especially its simple pleasures) and a change in priorities:   I've heard survivors of potentially terminal illnesses (like cancer) talk about appreciating a sunset for the first time.  Minor irritations and petty squabbles no longer seem important.  Time with family and friends seems more precious and is therefore appreciated more.

2. Closer, more intimate relationships with others:  People might rally around a person who has experienced a trauma, offering love and support; this can lead to closer relationships with these people.  In addition, people who have had similar traumatic experiences (e.g., rape victims, children of alcoholic parents, bereaved parents, etc.) often find particular comfort from one another.  This can lead to a whole new network of mutually supportive relationships based on common past experiences.

3. A greater sense of personal strength: After surviving a trauma, a person might conclude, "If I can survive that, I can survive anything!"  You can't really know how strong you are until you are faced with a situation that forces you to tap into your inner strength.  You might find that you are stronger in a crisis than you thought you would be.

4. Recognition of new possibilities or paths for one's life: Sometimes an event changes a person's life so completely that he is forced to change paths.  In his quest to renegotiate his goals for the future, a person might find himself considering possibilities that had never before come to mind.

5. Spiritual development: Perhaps you've heard the saying, "There are no atheists in foxholes."  People often look to a higher power when confronted with a life or death situation.  Sometimes, when faced with his own mortality, a person begins to seriously consider some of life's existential questions.  This in and of itself can be a profoundly spiritual process.  

Just some things to consider...

States of mind

I thought I'd share a story today, but first let me explain something that will be relevant to my tale.  Marsha Linehan, Ph.D., renowned for developing Dialectical Behavioral Therapy, describes three states of mind - the reasonable mind, the emotional mind, and the wise mind (which consists of equal parts emotion and reason).

Obviously the goal is to spend as much time as possible using your wise mind.  For me, I spend more time in my wise mind than ever before in my life; alas, no one can dwell there all the time.  This story is about a recent incident that took me FAR from my wise mind...

We'd just spent a long and stressful day at court.  (My husband and I have been back and forth to court several times over the past few months, as he is embroiled in a battle with his ex-wife over custody of their five year old daughter).  Court always makes me anxious and I always seem to be irritable when the day is over.

There have been a few other highly stressful things going on at home too.  There is one issue about which I have been extremely stressed and frustrated for the past two or three months.  It's something my husband recognizes is a problem and he and I have spoken about it many times.  I have explained to him how stressed and overwhelmed the issue is making me feel and he has pledged to do everything he can to remedy the situation.

We got home from court and were sitting down to a late dinner.  Somehow, we started talking about the aforementioned problem.  The discussion got heated and at some point I just lost it.  I think I caught my voice of reason napping.  The second I started yelling at my husband - REALLY yelling -- my voice of reason jolted awake.

"Um, Melody," she said.  "You should probably stop.  This isn't a good idea.  And you're not being very nice."  I know, I know.  It seems like my voice of reason is a little on the weak side, huh?  But she's really not.  She gets a lot of exercise on a regular basis so she's actually quite strong.  It just happens that she's also been doing a lot more work than usual lately (due primarily to the stressors I mentioned earlier) and she's worn out.  That's probably why she was asleep in the first place!

Needless to say, the emotional part of me was in no mood to listen to my voice of reason.  All the while I'm yelling there's a heated debate going on in the back of my mind.  My voice of reason cautions me to stop yelling before I say something I'll regret later.  My emotional voice has her own thoughts about this.  "I've tried it your way," she tells my reasonable voice.  "I let you do most of the talking most of the time.  I only put my two cents in when it's helpful to you.  Obviously, he [my husband] isn't understanding how important this issue is to us.  Your way isn't working.  It's my turn to try."

My reasonable voice - being reasonable - listened to my emotional voice and considered what she'd said.  She decided that emotional voice had a point.  Reasonable voice had been talking to my husband for weeks about the issue we were now arguing about.  Unfortunately, very little seemed to have changed as a result of her efforts.  Her strategy just wasn't working.  Maybe emotional voice would have better luck.

I think that's why I lost it - not because my emotional mind hijacked the rest of me but because getting emotional actually seemed like a reasonable option, at least at the time.  Plus, I've been under a lot of stress lately.  My reasonable mind has had to work a lot harder than usual to keep things in balance.  It's overwhelmed.  I'm overwhelmed.

The next day, my husband and I sat down to talk about (and to try to resolve) the argument.  I'd already apologized the night before - I've never been one to stay angry very long and I also believe in saying sorry when you make a mistake.  "You were acting like a crazy person!" my husband said to me.  Not what I like to  hear, especially as a mental health professional.  I can't beat myself up though; we're all human.  Like everyone else, I am a work in progress. 

Another mindfulness handout - mindfulness of thoughts

I made a bunch of these handouts a while back.  I posted a few a long time ago and wanted to post another.

More Mindfulness Handouts