Coping or Curing?

Coping or Curing?

Being mindful requires that we be realistic and honest with ourselves and others. This is important because people who are facing difficulties such as grieving or anxiety tend to construct contingencies (I often think of them as “alternate realities”) by which they seek to eliminate the source of their distress before they move forward with their life, goals, etc. It’s a sort of “if, then” scenario which they seemingly demand or expect be satisfied before they will return to normal existence. We also refer to it as “bargaining” because it’s as though the situation can be changed for the better if only we can promise something enticing enough for fate to change the outcome.

An often heard comment from many of the people I see in therapy goes something like this: “I feel like I’m being told to just get over it and get back to (work, school, the task at hand, etc.).” In this scenario, it appears that people are waiting for their distress to disappear before they reengage in activities that they find difficult due to their distress. Around and around it goes, because which will happen first? Will they return to normal activities, or will the distress disappear? That is a question that they are unable to answer satisfactorily.

They are often angry, sometimes not so much because they are being asked to fulfill their obligations or duties, but because they believe they are being told to “get rid of” their distress first. This is where I am quick to jump in and totally agree with them. They cannot just get rid of their distress, and it would be totally unrealistic to expect such a thing. But, and this is the tricky part, that does not mean that they can’t still function. The right question to ask is: how does a person learn to cope with distress while fulfilling other obligations? Coping with an issue is NOT the same as resolving an issue. Coping can buy time during which someone can work on resolving the source of their distress, and in the mean time still function at a high level. While it is normal and understandable that people engage in bargaining and contingencies before moving on, ultimately the bargains will not be fulfilled and history will not be rewritten. While the love and support of friends and family can be invaluable, you may sometimes find that you need the help of a professional who understands the subtleties between coping and being cured. Make sure you get the kind of assistance that helps you truly move forward.

Mark E. Hankla

How Much Fear? Part 3

How Much Fear? Part 3

Part two of this series of posts describe some of Gavin de Becker's ideas about intuition and making predictions about dangerous behavior. In his book, The Gift of Fear, Mr. de Becker writes that the solution to violence is the acceptance of reality. One aspect of this reality is the understanding that people have reasons for being violent. de Becker describes a system for gaining this understanding. He calls it "the algebra of aggression."

An easy way to remember the elements of the algebra of aggression is the acronym J ACA. J refers to justification. People will act aggressively if they feel justified in using aggressive behavior. There are many ways in which people can justify their behavior, aggressive and otherwise. These can be reasonable such as the use of aggression to escape a life-threatening situation or less reasonable. An example of a less reasonable justification would be rationalizing your use of aggressive behavior just because someone was driving badly.

The first A in J ACA stands for alternatives. People will act aggressively if they feel it's the only or best alternative in meeting their needs. Teaching people nonaggressive alternatives to getting their needs met can be an important part of therapy. The goal is to help people recognize that they are not out of options and their only alternative is aggressive action.

C is for consequences. When the consequences of aggressive behavior are acceptable, people are more likely to behave aggressively. If they stop and think about the consequences of aggressive behavior and recognize that the consequences are serious and ongoing problems for them, the likelihood of aggression decreases.

The second A in J ACA is ability. Does the person have the ability to behave aggressively? While almost everyone has the ability to be aggressive, the degree of aggressive ability may range from verbal complaining and rudeness to the use of a weapon. Good to know.

If your mind and body are telling you that you may be in a dangerous situation with someone, figuring out that person’s justification, alternatives, consequences and ability might help you understand important information and respond to your fear in the best way possible.

Bill Bonacker

Shame and Behavior

Shame and Behavior

Of all of the influences on behavior, shame may be one of the least understood. Shame influences and warps behavior in multiple ways. This includes behaviors such as isolating and avoidance, and often leads to behaviors that make things worse. For example, a person who is consumed by shame may try to avoid people or activities that remind them of what they feel ashamed of. It may also result in deception, or lying about the issue to avoid having to face it.

One can easily see how such behavior can cause further issues, effectively digging a deeper hole for the person who already feels ashamed. We see it often in therapy, both as a personal issue and as a source of frustration or anger when interacting with others who are affected by shame. For instance, I often hear parents expressing anger at their children who “lie” or “fib” as though the child is doing so just to be deviant or defiant of them, and they take it personally. But many times when the child is questioned about the behavior, it becomes evident that the deception is due to a desire to not disappoint the parent, which is the opposite of how the parent perceives it. An example might be when a child “lies” about not having homework or says it is already done even when it is not. It might be that the child just doesn’t want to do the work and is trying to get out of it. But it also possible that the child is ashamed that she or he didn’t get the work done already, or doesn’t understand it, or is afraid they won’t do it well enough. Either way the behavior is an issue that needs to be addressed. However, to address the behavior effectively it is important to understand the etiology of the behavior.

People feeling shame tend to avoid others, hiding their activities, avoid eye contact, and are quieter than usual. People feeling proud or happy tend to share their experiences or triumphs, feel more confident around others, and tend to look directly at others while maintaining eye contact. These are markers or indicators that you can use to monitor your own, or other’s, level of shame and vulnerability. If you notice your behavior is indicative of feeling shame, it may be time to discuss your feelings with a trusted friend or with a professional to help you relieve the distress, and help you improve your confidence and self-esteem. Shame can be dealt with so it does not negatively affect behavior.

Mark E. Hankla

How Much Fear? Part 2

How Much Fear? Part 2

In the previous post, we talked about the physical and psychological parts of our fear response. Published in 1997, The Gift of Fear by Gavin de Becker gave us some additional ways of looking at fear. In addition to recommending this book to many clients, our organization also provides a copy to anyone who comes to work here. The subtitle of the book, survival signals that protect us from violence, points to its main emphasis - how do we identify what is truly dangerous and avoid harm?

Mr. de Becker talks about using our intuition to identify danger and to guide us towards safety. He helps us to gain a greater understanding of intuition by listing "the messengers of intuition." These are: nagging feelings; persistent thoughts; humor; wonder; anxiety; curiosity; hunches; gut feelings; doubt; hesitation; suspicion; apprehension; and fear. If you take some time to think about your experiences with these thoughts and feelings, you may be able to remember what they told you or what you should have learned from their presence.

de Becker’s book contains real life examples of dangerous situations that illustrate the points that he is making. He also describes ways of making predictions about dangerous behavior and situations.

After reading his book, I found myself thinking about dangerousness and fear differently. Instead of something to be avoided, fear has become another piece of information. Information that is essential in making important decisions.

Bill Bonacker

How Much Fear?

How Much Fear?

We all know that there are many things to be afraid of. Bad economic conditions, health concerns and, sometimes, other people. We also know that when we are afraid, our bodies and minds experience changes. In his extensive work as a military psychologist, Dave Grossman has written about the effects of fear. He has described five levels or "conditions" and the effects of each of them.

In condition white, we experience our normal resting heart rate and feel calm and relaxed. As we become more alarmed, our heart rate rises from a normal rate of 60 to 80 beats per minute (bpm) through condition yellow (around 100 bpm) to condition red (from 115 to 145 bpm). Dr. Grossman says that in this range, we are at our best for performing complex physical activities and have optimal reaction time for responding to danger. This is not a comfortable state.

If we become even more distressed, our heart rate increases and our bodies experience additional changes. Breathing speeds up. We become less effective. Our ability to make complicated decisions decreases we experience changes in vision and hearing and most of our bodies resources are dedicated to simple physical activities important to survival. This is the state commonly known as "fight or flight." Dr. Grossman labels this as condition gray. Above 175 bpm, we enter Dr. Grossman's condition black. Our thinking may become irrational; we may experience a temporary shut down or freeze. We may still be able to run or fight but doing anything more complicated is unlikely.

Obviously, these reactions have been essential to our survival for centuries. The problem is that although most of us don't run into situations that are so dangerous that conditions red and above are helpful, our bodies go there anyway. Stress and panic reactions can be triggered by reminders of past danger or intense worries about loss or harm. Learning to calm ourselves when no immediate physical danger is present becomes an important skill. In order to function but our best we need to use our physical and mental resources most effectively and stay below condition red most of the time. There are a number of ways to do this ranging from breathing exercises to changing the way we think about the things that happen to us. In future posts, I'll go into more depth about managing our fear reactions. For now, remember to breathe.

Bill Bonacker

Self Injury

Self-Injury



Self-injury refers to the deliberate, direct destruction of body tissue that results in tissue damage, such as cutting, burning, scratching, or hitting oneself. The person’s intention is not to kill oneself. So why is it then that people self-injure? One theory is that self-injury serves as a form of coping and as a preferable alternative to suicide. Self-injury may be used for emotion regulation when used as a distraction from emotional pain by causing physical pain, to feel alive or real, to relieve tension, to feel numb or at peace, or to feel euphoric feelings. Another theory is that self-injury serves as a form of communication of pain, anger and other emotions, or need for help.

Treatment for those who self-injure includes addressing the function of the behavior and learning alternative coping skills. One treatment that specifically focuses on stopping self-injury and that research has shown to be effective is Dialectical Behavior Therapy. Until alternative healthy coping strategies have been learned and underlying issues addressed, substitution behaviors can be used when having the urge to harm oneself. They are done by matching an activity to the feeling the person is having when wanting to self-injure. For example, doing something physical, when angry, or doing something that creates a strong physical sensation, when wanting to feel something.

Warning signs for family and friends include social withdrawal, injuries, scars, secrecy, excuses for wounds, defensiveness, wearing long sleeves or pants in warm weather, and finding objects used for self-injury in odd places. As for what to do and what not to do if suspecting self-injury. Don’t ignore it, blame yourself, get angry, demand answers, or demand that they stop. Do pay attention, express concern, listen, encourage the expression of emotions, and let your loved-one know that you are there for them and want to help them find the help they need.

Jaci Pekarek

Trust

Relationships and Trust
“I can’t trust anymore”

A very common issue discussed in therapy is a feeling that “trust” is forever broken and therefore its impossible to have fruitful and rewarding relationships. After betrayal and deceit, most people would understand at least a temporary pulling back of trusting feelings and the need for more verification and reassurance in interpersonal relationships. But for some people, trusting is such an internal battle and causes such distress they have difficulty maintaining relationships. An enduring lack of trust erodes the basis of a relationship, and can lead to behaviors (e.g., controlling, jealousy, accusations, stalking) that can end relationships outright.

Psychologist Dr. William R. Stone once defined trust as “the ability to predict how someone is going to act.” In healthy situations, confidence in predicting another’s behavior is most often correlated to the length of time that person has been known and her or his behavior observed. There are real criteria and guidelines we can use to gauge the reasonableness of the trust we put in others. But “predicting how someone is going to act” is an imperfect science and there is always some risk involved. Unfortunately people regularly hurt one another, and betrayal of trust is often identified as the most damaging part of the hurtful act.

There is more to feelings of trust and distrust than how one person feels about another. Some people direct their feelings of distrust toward the individual or individuals who they feel betrayed them. Some react by becoming suspicious of practically everyone and develop a very dark and malevolent world view. Still others direct their feelings of distrust inward as they doubt their ability to discriminate between trustworthy and deceitful people, effectively blaming themselves. Perhaps not surprisingly, some people report all of the above as their reasons for not trusting, which usually is accompanied with very high levels of emotional distress.

So what can a person do if they if they feel they cannot trust? First of all, think of feelings of distrust as anxiety toward allowing yourself to be vulnerable. Emotions are internal messengers and the discomfort of anxiety is like a dashboard warning light. Would you stop driving altogether if a warning light came on? Probably not. A responsible driver would take steps to find out why the light was on and attend to the problem, which would result in the light switching back off. Then you could resume driving normally.

Deciding not to trust at all may reduce the anxiety (at least temporarily), but it would prevent good relationships from forming. So like the driver, acknowledging the internal warning and attending to your needs is the place to start. And where is it written that you are supposed to trust without question, or that different levels of trust are not appropriate? Listen to the anxiety, take into account why it is there, and make an informed decision about how much trust you are willing to give someone. Coping with anxiety does not mean dismissing it or its message, so healthy coping does not mean that you have to put yourself at risk. Talk to trusted friends to get others’ perspectives on trusting in similar situations. High anxiety may indicate you have trauma experiences that you need professional help to resolve. Talking out your deepest fears can help you gain a healthier perspective, and who knows, maybe you can start to trust again!

Mark E. Hankla