Embrace the Paradox
Wednesday, June 1, 2016
Saturday, March 12, 2016
How Anxiety Reshapes Our Perceptions
A new study of anxiety published in Cell Biology found that anxious people tend to overgeneralize stimuli. That is, they are less able to distinguish between a neutral or "safe" stimulus and an emotionally charged stimulus. Follow-up functional magnetic resonance images (fMRI) of the brains of participants found the main differences between people with anxiety and the non-anxious controls were in the amygdala.
There has been other evidence and discussion pointing to the role of the amygdala in anxiety. It has long been known as the site of fear and aggression in the brain. The amygdala is part of the limbic system, one of the oldest parts of the brain which is seen as more primitive in evolutionary terms than the prefrontal cortex, the seat of our decision-making and other higher-level thinking. Daniel Goleman, known for his theory of emotional intelligence, used the term "amygdala hijack" to describe how a stimulus that is perceived as threatening causes the amygdala to short-circuit the higher brain. I recall hearing that one reason this can happen is that, since it evolved first, the route the amygdala takes to direct other parts of the brain into action is much faster than the route the prefrontal cortex has to take to do the same.
So when the amygdala hijacks things, your higher level thinking is still trying to catch up. Meanwhile, your lower brain may have already taken action. This is that feeling you have in moments of high anxiety of not being able to think clearly, of flailing or super fast movement, and behavior which upon reflection may be rash, unwise, or otherwise counterproductive. Sometimes, it can feel like we are watching someone else doing the action during these moments, as our prefrontal cortex watches on helplessly.
In a nutshell, what is this study telling us about anxiety and what can we do about it? I believe there are a few takeaways here. One is that, if you tend to have anxiety, you may need to bring a bit more skepticism into how you are analyzing your own perceptions. Likely due to multiple factors including behavioral modeling within the childhood environment as well as genetics and epigenetics playing a role, those of us with anxiety tend towards hyper vigilance, assuming the worst, and quickly ratcheting up our emotional arousal. A cognitive behavioral prompt I like to use is, "Don't believe everything you think."
But it goes beyond thinking to our feeling and sensations as well. If you have been practicing meditation for some time, you may have noticed how the body goes through cycles. At times, heart rate, breathing and the like can accelerate for no apparent reason, as if the body has its own weather. And then the brain attaches a story to this physiological phenomenon, which we then believe without question. So learning to use more discernment can be bolstered through mindfulness practices, which promote healthy non-attachment/the observing self, somatic attunement through diaphragmatic breathing, and cognitive delusion.
The deep breathing from the diaphragm also rebalances the oxygen to CO2 balance in our lungs. Particularly when we are anxious, we tend to constrict our breathing to our chests and this shallow breathing can deprive us of oxygen and concentrate CO2. In a lab experiment, administering CO2 in a mask was sufficient to induce a panic attack in participants who had never before experienced them.
Thus, we can counter anxiety on multiple levels: through body-based techniques; our intellectual understanding of the process; increasing our mindfulness and meta-cognition so that we can utilize our observing self to notice when the anxiety cycle is occurring; making room in our behavior so that we are anticipating and making contingency plans.
Finally, there has been a growing body of research on self-compassion as an important component to not only well being but also performance results. As we work through our own anxiety through understanding and prevention, we endeavor to also hold a space for compassionate regard for this aspect of ourselves.
Study article URL: http://wis-wander.weizmann.ac.il/life-sciences/people-anxiety-show-fundamental-differences-perception
There has been other evidence and discussion pointing to the role of the amygdala in anxiety. It has long been known as the site of fear and aggression in the brain. The amygdala is part of the limbic system, one of the oldest parts of the brain which is seen as more primitive in evolutionary terms than the prefrontal cortex, the seat of our decision-making and other higher-level thinking. Daniel Goleman, known for his theory of emotional intelligence, used the term "amygdala hijack" to describe how a stimulus that is perceived as threatening causes the amygdala to short-circuit the higher brain. I recall hearing that one reason this can happen is that, since it evolved first, the route the amygdala takes to direct other parts of the brain into action is much faster than the route the prefrontal cortex has to take to do the same.
So when the amygdala hijacks things, your higher level thinking is still trying to catch up. Meanwhile, your lower brain may have already taken action. This is that feeling you have in moments of high anxiety of not being able to think clearly, of flailing or super fast movement, and behavior which upon reflection may be rash, unwise, or otherwise counterproductive. Sometimes, it can feel like we are watching someone else doing the action during these moments, as our prefrontal cortex watches on helplessly.
In a nutshell, what is this study telling us about anxiety and what can we do about it? I believe there are a few takeaways here. One is that, if you tend to have anxiety, you may need to bring a bit more skepticism into how you are analyzing your own perceptions. Likely due to multiple factors including behavioral modeling within the childhood environment as well as genetics and epigenetics playing a role, those of us with anxiety tend towards hyper vigilance, assuming the worst, and quickly ratcheting up our emotional arousal. A cognitive behavioral prompt I like to use is, "Don't believe everything you think."
But it goes beyond thinking to our feeling and sensations as well. If you have been practicing meditation for some time, you may have noticed how the body goes through cycles. At times, heart rate, breathing and the like can accelerate for no apparent reason, as if the body has its own weather. And then the brain attaches a story to this physiological phenomenon, which we then believe without question. So learning to use more discernment can be bolstered through mindfulness practices, which promote healthy non-attachment/the observing self, somatic attunement through diaphragmatic breathing, and cognitive delusion.
The deep breathing from the diaphragm also rebalances the oxygen to CO2 balance in our lungs. Particularly when we are anxious, we tend to constrict our breathing to our chests and this shallow breathing can deprive us of oxygen and concentrate CO2. In a lab experiment, administering CO2 in a mask was sufficient to induce a panic attack in participants who had never before experienced them.
Thus, we can counter anxiety on multiple levels: through body-based techniques; our intellectual understanding of the process; increasing our mindfulness and meta-cognition so that we can utilize our observing self to notice when the anxiety cycle is occurring; making room in our behavior so that we are anticipating and making contingency plans.
Finally, there has been a growing body of research on self-compassion as an important component to not only well being but also performance results. As we work through our own anxiety through understanding and prevention, we endeavor to also hold a space for compassionate regard for this aspect of ourselves.
Study article URL: http://wis-wander.weizmann.ac.il/life-sciences/people-anxiety-show-fundamental-differences-perception
Saturday, March 5, 2016
Remote Therapy - Can It Really Work?
When I was still working towards my licensure as a clinical psychologist, I began to see ads for online therapy on Facebook. Just having these imposed on my thread invoked a righteous anger in me. There's no way that could possibly be effective, I told myself.
Then when I got licensed and was beginning to build my private practice, I decided to see what it was all about firsthand. I was heartened by the fact that these platforms required that counselors be licensed clinicians, and that the vetting process included proof of malpractice insurance and a background check. I figured it would be a convenient way to supplement my in-person practice, and that to stay on the side of disregard would be to miss out on an exploration of this brave new world.
The actual process of connecting with prospective clients varied across platforms. Of the two message-based companies, one seemed to use an M Turk type system to distribute sign-ups among competing counselors, who were then given an opportunity to write an introductory message. I must have written dozens of messages, none of which got a response. When I saw that I was getting referrals in the middle of the night, I realized that no human was involved in this process. I left this experiment shortly thereafter, as it seemed quite dehumanizing and with poor results in terms of engaging in a therapeutic experience with clients.
The second message-based platform was an almost polar opposite experience. They used human beings! Facilitating counselors began the process with the client and helped match them with their primary counselor. An incredible amount of clinical support was on hand to help new counselors understand and master the ins and outs of working with clients. Very quickly, I found myself working with a growing caseload of individuals seeking support and interventions around common challenges such as anxiety, relationship issues, and emotional distress. I have found it to be a rewarding addition to my practice, and have developed meaningful therapeutic relationships with visible results in terms of my clients' progression, both in their own estimation and my own. It has restored my hope in the viability of remote therapy.
By engaging in this process, I have become a believer. We know that studies demonstrate the effectiveness of remote therapy. And yet, intuitively, we can resist that this could really be true. It just seems like there is too much room for it to be impersonal, inauthentic, and non-rigorous.
But here's what I've found. Remote therapy seems to be particularly well adapted for millennials and tech savvy folks. We have all been engaging in Internet and mobile phone-based social exchange for years now, so it would make sense that this mode of correspondence feels comfortable and accessible to many people.
Also, I have found that once a good sense of rapport has been established, clients often feel more comfortable revealing their innermost thoughts and communicating honestly. Perhaps it's that balance of protective layers and easeful intimacy that contact via messaging can establish. Conversely, sometimes clients impose pressure on themselves in-person to make a good impression, and therefore are less fully divulging.
Remote therapy has helped me understand stories of people falling in love via online chat - how individuals can feel so close to someone that they have never met or even spoken to. Within this format, it can feel like a pure meeting of the minds. I also liken it to confessional, where the priest being behind a screen helps make the truth come out more easily. For in this format, we are also "behind a screen."
In addition, as the therapist, I have found the asynchronous format allows me to take in what the client has conveyed and allow it percolate for a while before responding. It often comes to me after some time being worked out on a more unconscious level, what intervention might be most useful to include in my reply (which can be text, audio, or video).
This process can happen in real time, of course, and within the intense one-on-one rapport of an in-person session, I find my ability to tune into my client's needs in-the-moment is heightened, because my focus is so singular. The in-person exchange, when it's really in the zone, can be likened to a sort of shared, generative trance in which both parties have shifted out of everyday banter into something more expansive and connected. Certainly, there is room for all of these formats in effective therapy.
Then when I got licensed and was beginning to build my private practice, I decided to see what it was all about firsthand. I was heartened by the fact that these platforms required that counselors be licensed clinicians, and that the vetting process included proof of malpractice insurance and a background check. I figured it would be a convenient way to supplement my in-person practice, and that to stay on the side of disregard would be to miss out on an exploration of this brave new world.
The actual process of connecting with prospective clients varied across platforms. Of the two message-based companies, one seemed to use an M Turk type system to distribute sign-ups among competing counselors, who were then given an opportunity to write an introductory message. I must have written dozens of messages, none of which got a response. When I saw that I was getting referrals in the middle of the night, I realized that no human was involved in this process. I left this experiment shortly thereafter, as it seemed quite dehumanizing and with poor results in terms of engaging in a therapeutic experience with clients.
The second message-based platform was an almost polar opposite experience. They used human beings! Facilitating counselors began the process with the client and helped match them with their primary counselor. An incredible amount of clinical support was on hand to help new counselors understand and master the ins and outs of working with clients. Very quickly, I found myself working with a growing caseload of individuals seeking support and interventions around common challenges such as anxiety, relationship issues, and emotional distress. I have found it to be a rewarding addition to my practice, and have developed meaningful therapeutic relationships with visible results in terms of my clients' progression, both in their own estimation and my own. It has restored my hope in the viability of remote therapy.
By engaging in this process, I have become a believer. We know that studies demonstrate the effectiveness of remote therapy. And yet, intuitively, we can resist that this could really be true. It just seems like there is too much room for it to be impersonal, inauthentic, and non-rigorous.
But here's what I've found. Remote therapy seems to be particularly well adapted for millennials and tech savvy folks. We have all been engaging in Internet and mobile phone-based social exchange for years now, so it would make sense that this mode of correspondence feels comfortable and accessible to many people.
Also, I have found that once a good sense of rapport has been established, clients often feel more comfortable revealing their innermost thoughts and communicating honestly. Perhaps it's that balance of protective layers and easeful intimacy that contact via messaging can establish. Conversely, sometimes clients impose pressure on themselves in-person to make a good impression, and therefore are less fully divulging.
Remote therapy has helped me understand stories of people falling in love via online chat - how individuals can feel so close to someone that they have never met or even spoken to. Within this format, it can feel like a pure meeting of the minds. I also liken it to confessional, where the priest being behind a screen helps make the truth come out more easily. For in this format, we are also "behind a screen."
In addition, as the therapist, I have found the asynchronous format allows me to take in what the client has conveyed and allow it percolate for a while before responding. It often comes to me after some time being worked out on a more unconscious level, what intervention might be most useful to include in my reply (which can be text, audio, or video).
This process can happen in real time, of course, and within the intense one-on-one rapport of an in-person session, I find my ability to tune into my client's needs in-the-moment is heightened, because my focus is so singular. The in-person exchange, when it's really in the zone, can be likened to a sort of shared, generative trance in which both parties have shifted out of everyday banter into something more expansive and connected. Certainly, there is room for all of these formats in effective therapy.
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