Someone just shared a great website for a place called the The Garrison Institute’s Initiative on Contemplation and Education with me (thank you Jess), that relates to the theme of this blog. It seems like a educational program for teachers to cultivate resilience factors in order to prevent burnout, facilitate more creative teaching and provide community support for teachers. I think its a wonderful idea.
Its pretty relevant too. Last year, I attended an event sponsored through the Ziegler Center at Yale that focused on policies related to children's mental health and pre-school education. One of the most fascinating things I saw was a study relating pre-school teacher stress to the diagnosis of ADHD in children. From the preliminary data, it seemed as though there was an inverse correlation between a teacher's level of support and the diagnosis of ADHD given to the children in that class at any point in the future. Crazy right! One of the people I was with explained it like this, "if a teacher is distracted and is unable to pay attention to his/her students, it can induce a neurological change in vulnerable children that ultimately leads to ADHD symptomatology." In other words, when children are taught by unsupported teachers, their brains don't grow well.
This resilience program above might be a really good thing. If the data above holds up, calm, supported teachers could lead to happier, healthier and more resilient children!
Friday, August 20, 2010
Value added
Its been an interesting few weeks with a lot of good patient interactions. Its also been really insightful about how hard it is for people to feel naturally good about themselves. One of my recent interactions really highlighted that a lot. I saw a young lady who had a hard childhood. There was no physical trauma, but there was a constant barrage of emotional abuse coming from both parents simultaneously. Its not hard to imagine how being treated like that really undermined her sense of self-worth, her outlook and her passions. During our times together, she talks about things she's done wrong with her family, mistakes she's made at work... being her own worst critic. As I sit with her, watching her get consumed by her doubts, I think about how there are parts of her, good parts, that maybe she's too afraid to look at.
This sense that "I am good," more than anything else, is one of the hardest resilience factors to obtain, and possibly most important we can cultivate. My opinion, right or wrong, is that in our society we are constantly taught that being ourselves is wrong, making it near impossible for us to hold onto a solid sense of why we're not just ok, but great. Its pervasive, starts early on and is reinforced by our interactions with our friends, family and society. In line with this blog, though, I'm not going to dwell on all the ways we've been messed up. Instead, I want to talk about things we can do to remember and/or learn that we're "good".
Starting Points:
How many times have we found ourselves in situations where we worry if we've done something wrong? Sometimes, an interaction with a co-worker, a family member, or a friend just seemed off and, try as we might, there's no way to figure out why things turned out the way they did. In these moments of ambiguity, people generally turn to one of about 4 coping skills in order to try to fix that feelings of anxiety:
1) Think even harder about why things didn't work out right (and talk it out with others) (Intellectualization)
2) Repress the worry and ignore it/Try to think about something else/Try to convince yourself that there's nothing wrong (Repression)
3) Take out the feeling (generally anger) on someone or something else (Displacement)
4) Explain away the other person's behavior using our own thoughts (Rationalization)
Rarely do we say, "that's ok, I'm ok," accept the feelings we have, and move forward with that understanding.
A Way Forward:
First, you don't need to work so hard.
I think its important to realize how much time and energy we're using to "figure out why things just didn't work." If you pay attention to this, you'd be surprised about how much of the day you use the coping skills I mentioned above to try to deal with this profound source of worry. This is a skill called perspective taking. If you've cultivated some self awareness, it can be a powerful tool for putting the breaks on self critique.
Second, make a list of things you like about yourself
Easy, right? In the times I've asked my patients to do this, more often than not, they end up circling back to their fears, doubts and insecurities. A list like this sometimes includes things that you've done, or things that other people tell you about yourself. Try to avoid that. Focus on things that are unique to you, things that you notice about yourself and you like. They can be physical, emotional, intellectual and spiritual. This tool engages your hippocampus and your internal reward systems. If you can think about things that have made you proud of or happy with yourself you lay down powerful pathways that can interrupt and override the negative thoughts that can fill your waking life.
Third, talk to yourself
Sound crazy? There is some good evidence that some kinds of psychotherapy actually work by people hearing themselves re-frame and re-organize the way they think about themselves. When we pump ourselves up by practicing saying nice things about ourselves, we can do it even in situations where we feel lost or inadequate. I used this skill early in medical school right before I went in to see my patients. I worked myself into a little bit of a football-esque/pump yourself up frenzy to put myself in the right mindset. This is a skill called "suppression" where, through actively moving your thoughts from "I can't" to "I can" you postpone some of your negative thoughts so you can accomplish a task without self-distraction.
Fouth, imagine an ideal you
A lot of self help books recommend something like this. What they often fail to mention is why it works. We have within us memories of the ways people have treated us and their relationships with us. These memories are powerful enough to shape the way we interact with others. Parents who mistreat their children were often mistreated themselves, and people who find themselves in positions with co-workers or bosses that make them miserably often find that they had similar relationships to their parents, siblings and friends when they were younger. Its not fate that they revisit these conflicts throughout their lives, but its the kind of role they know how to play that often influences with whom they chose to affiliate. By imagining a different you, an ideal you, one composed of the things you like about yourself, you change some of the ways you unconsciously create yourself. If you know of a positive (work, friend, romantic, familial) relationship that you want to emulate, visualize yourself in that relationship. By doing this, you have just used powerful neurobiological tools for reshaping your life.
Finally, cultivate compassion for yourself.
Its almost always easier to forgive others than to forgive yourself. We say "forgive and forget" so often and flex all sorts of emotional muscles to forgive the people that have legitimately wronged us, but when it comes to a mistake we've made, sometimes it seems as though there's nothing we can do to give ourselves a break. When I talk about this with my patients, they all say pretty much the same thing: "there's something so wrong with me, and the only way I can fix it is to beat myself up." This is hard. In ancient Greece, there were words for platonic love (philos), romantic love (eros), and compassionate love for the world (agape), but no good equivalent for self love. If in your self talk, or in your imagination, you can see yourself being compassionate and loving towards yourself, it might go a long way.
Of course there's more, there always is, but more to come next week.
This sense that "I am good," more than anything else, is one of the hardest resilience factors to obtain, and possibly most important we can cultivate. My opinion, right or wrong, is that in our society we are constantly taught that being ourselves is wrong, making it near impossible for us to hold onto a solid sense of why we're not just ok, but great. Its pervasive, starts early on and is reinforced by our interactions with our friends, family and society. In line with this blog, though, I'm not going to dwell on all the ways we've been messed up. Instead, I want to talk about things we can do to remember and/or learn that we're "good".
Starting Points:
How many times have we found ourselves in situations where we worry if we've done something wrong? Sometimes, an interaction with a co-worker, a family member, or a friend just seemed off and, try as we might, there's no way to figure out why things turned out the way they did. In these moments of ambiguity, people generally turn to one of about 4 coping skills in order to try to fix that feelings of anxiety:
1) Think even harder about why things didn't work out right (and talk it out with others) (Intellectualization)
2) Repress the worry and ignore it/Try to think about something else/Try to convince yourself that there's nothing wrong (Repression)
3) Take out the feeling (generally anger) on someone or something else (Displacement)
4) Explain away the other person's behavior using our own thoughts (Rationalization)
Rarely do we say, "that's ok, I'm ok," accept the feelings we have, and move forward with that understanding.
A Way Forward:
First, you don't need to work so hard.
I think its important to realize how much time and energy we're using to "figure out why things just didn't work." If you pay attention to this, you'd be surprised about how much of the day you use the coping skills I mentioned above to try to deal with this profound source of worry. This is a skill called perspective taking. If you've cultivated some self awareness, it can be a powerful tool for putting the breaks on self critique.
Second, make a list of things you like about yourself
Easy, right? In the times I've asked my patients to do this, more often than not, they end up circling back to their fears, doubts and insecurities. A list like this sometimes includes things that you've done, or things that other people tell you about yourself. Try to avoid that. Focus on things that are unique to you, things that you notice about yourself and you like. They can be physical, emotional, intellectual and spiritual. This tool engages your hippocampus and your internal reward systems. If you can think about things that have made you proud of or happy with yourself you lay down powerful pathways that can interrupt and override the negative thoughts that can fill your waking life.
Third, talk to yourself
Sound crazy? There is some good evidence that some kinds of psychotherapy actually work by people hearing themselves re-frame and re-organize the way they think about themselves. When we pump ourselves up by practicing saying nice things about ourselves, we can do it even in situations where we feel lost or inadequate. I used this skill early in medical school right before I went in to see my patients. I worked myself into a little bit of a football-esque/pump yourself up frenzy to put myself in the right mindset. This is a skill called "suppression" where, through actively moving your thoughts from "I can't" to "I can" you postpone some of your negative thoughts so you can accomplish a task without self-distraction.
Fouth, imagine an ideal you
A lot of self help books recommend something like this. What they often fail to mention is why it works. We have within us memories of the ways people have treated us and their relationships with us. These memories are powerful enough to shape the way we interact with others. Parents who mistreat their children were often mistreated themselves, and people who find themselves in positions with co-workers or bosses that make them miserably often find that they had similar relationships to their parents, siblings and friends when they were younger. Its not fate that they revisit these conflicts throughout their lives, but its the kind of role they know how to play that often influences with whom they chose to affiliate. By imagining a different you, an ideal you, one composed of the things you like about yourself, you change some of the ways you unconsciously create yourself. If you know of a positive (work, friend, romantic, familial) relationship that you want to emulate, visualize yourself in that relationship. By doing this, you have just used powerful neurobiological tools for reshaping your life.
Finally, cultivate compassion for yourself.
Its almost always easier to forgive others than to forgive yourself. We say "forgive and forget" so often and flex all sorts of emotional muscles to forgive the people that have legitimately wronged us, but when it comes to a mistake we've made, sometimes it seems as though there's nothing we can do to give ourselves a break. When I talk about this with my patients, they all say pretty much the same thing: "there's something so wrong with me, and the only way I can fix it is to beat myself up." This is hard. In ancient Greece, there were words for platonic love (philos), romantic love (eros), and compassionate love for the world (agape), but no good equivalent for self love. If in your self talk, or in your imagination, you can see yourself being compassionate and loving towards yourself, it might go a long way.
Of course there's more, there always is, but more to come next week.
Tuesday, August 3, 2010
Enough theory already!!!!
Again, a lot of this is based in the science of the brain, so getting a full understanding of just what's happening and why is, frankly, beyond all of us. What we can say is that there are a few "tricks" that humanity has discovered along the course of human history that seem to confer ... well(,) being. In this post, I'm going to present the most ancient, the most universal and the most powerful of all the techniques: Breath Work.
If you look through the core texts of the world religions, spiritualities, martial arts, meditations and magical pursuits, you find that breath is central to how we understand ourselves. In the Jewish tradition, references to the Divinity's creative and destructive power originates in breath - ruach (wind/breath/spirit/soul): In Roman and then Christian culture, Pneumos, breath means both breath and spirit. I can't help but see the phonetic similarity between this word and numinous (of, or pertaining to feeling the divine), but apparently, the words are not connected linguistically. In all honesty, I could go on for a while... Deepak Chopra does a really good job of talking about this.
One more thing to consider before I go into what to do. Biologically/physiologically, breathing is a pretty unique thing. It is the only life sustaining process that, naturally, has both a conscious level of control and a automatic level of control. If I ask you to stop your heart, increase your body temperature or make your belly gurgle in a specific way just by willing it so, I would bet that no one could. With your breath, you can consciously will yourself to breath deeply or shallow, stop altogether (for a little bit), breath quickly or slowly (though you might get light-headed and pass out if you do) or breath in a specific pattern (playing an instrument). You can also go about your daily life and not have to think about breathing at all! Pretty cool?!
So, the technique that I use with my patients is designed to 1) provide awareness of the body, 2) provide a locus of control within the mind, 3) gives a person insight into the way their mental state affects their bodily state (psycho-physiology) and 4) gives them a tool they can use to generate a state of calm within themselves.
Technique Number One: Breath Work
After explaining what I did above, I tell my patient to put his or her feet on the ground and sit back into their chair, feeling their legs against the seat and their back against the cushion. I encourage them to close their eyes (though this is not necessary) and then ask them to breathe normally.
I breathe with them...
"breathe in through your nose,
feel the rims of your nostrils get a little cold as you breathe in,
feel your belly expand out and your chest wall tighten as you let the air in,
feel the cold air in your nose and chest,
your diaphragm sinking into your belly.
Then breathe out through your mouth,
feel your lips cool as you breathe over them
feel your chest relax, your belly get smaller
feel your diaphragm contracting
Your shoulders dropping"
I go through this with them a few times, breathing and feeling with them. Sometimes, people complain that they fall asleep or that they think too much. Meditation, of which breath work serves as the foundation, encourages nudging the mind into a state of conscious presence. That's too much for anybody to do as they're starting to learn this stuff, especially if they feel as though they "can't stop thinking."
Here's what I say, preemptively:
"If you think of something, remember something that you need to do or have a day dream while breathing, that's great! You don't have to pay attention to it now. You'll have tons of time later. Just try to feel your breath on your nose, feel it in your chest and in your belly, feel how you straighten out your back as you breathe in and hunch more as you breathe out. You don't have to change anything. Just breathe. You can change things later."
I also tell them that its hard to just breathe. I have a hard time feeling my breath and I tell my patients, "if I get one good one where I can really feel it, that's a success for me."
This is the foundation of anything else I'm going to talk about. If you can get 10 breaths in a few times a day, while at work, or with your kids, as you're going to bed or waking up in the morning, before you eat or in your car... you can be well on your way!
More to come!
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