One of active addiction’s cruel realities is that gradually and progressively, alcohol and other drugs work less and less well. The inexorable truth the phenomenon of tolerance teaches all addicts is that the longer they use substances—whether from the street like crack and heroin, prescribed by a doctor like painkillers and benzodiazepines, or bought at a store like alcohol and now, in some states marijuana—the less of the desired effect they will experience. As human biochemistry adapts to the substance and becomes used to it, it takes more of that substance to produce the same mind- and mood-altering effects.

The only options are to continually increase the amount used or to switch to a more efficient route of administration (such as smoking or shooting) that delivers the payload more rapidly to the brain’s reward center. However, even these are but temporary fixes (pun intended). At a certain point in the evolution of an addict, a threshold is crossed where he or she no longer gets “high.” Past that point, alcohol and other drugs are used just to feel “normal,” and to avoid the agony of withdrawal. Using ceases being “fun” and becomes a form of work—a job unto itself.

The drug-induced dynamics of diminishing returns have two levels: micro—declining effects with each successive dose over the course of a given day or using session, and macro—decreasing desired effects that occur over the total length of time one has been using, whether weeks, months, or years. This notwithstanding, those in active addiction invariably continue to chase the sublime intensity of the rush they experienced early in their using careers. Addicts retain vivid Technicolor memories of that revelation of chemically induced ecstasy. It is that perfect moment, resplendent as the memories of one’s first true love. Like petroglyphs etched in rock formations that are clearly visible hundreds of years later, those rhapsodic recollections are engraved deep within the midbrain—beckoning sweetly and seductively.

The progression of active addiction is a deviation-amplifying process, much like pushing a wheelbarrow in a rut. The more the wheelbarrow is pushed in the rut through time and repetition, the more well-established that rut becomes. The more well-established and deeper the rut becomes, the harder it is to get the wheelbarrow out of it. There comes a tipping point where it becomes much harder to get the wheelbarrow out of the rut than to continue to follow it, which only makes the rut deeper still.

The brain adapts to repetitive experiences by forming memory connections or tracks that are unconscious. When such repetitive experiences revolve around using, the memory tracks that are laid become the neurological foundation of the “habits” of addiction. These unconscious learned responses are strong enough that they remain operative, even after years of abstinence. As a result, people are naturally pulled back toward the experiences and behaviors with which they are familiar and comfortable, making it more difficult to stop such behaviors and stay stopped.

However, a predisposition to returning to using alcohol and other drugs or addictive behaviors (gambling, eating, or sex) does not predetermine relapse. For many people relapse is a reality, but it is by no means an inevitability.

Recovery is a deviation-counteracting process that involves consistent course corrections based on conscious awareness of one’s internal and external environment—for which basketball is an excellent analogy. On the court, as in real life, the environment and its circumstances evolve continuously. The action is ongoing but its pace varies, and energy and momentum can shift dramatically.

Different players rotate in and out of the game, some playing more substantial roles than others. Each person’s playing time and the significance of his or her role can change. Coaches and assistant coaches are resources that help to provide direction, guidance, and mentoring. Even the best players require the support of teammates in order to win games. And even the best teams have to call time-out on occasion, when the game gets away from them, and they are anxious or stressed and need to regroup.

In order to be successful, it’s important to be present-centered and not get sidetracked by self-defeating thoughts or distressing emotions. It’s imperative to be able to see the court accurately if one is to respond skillfully. Is the defense playing man-to-man or a zone? Is it ultilizing a full-court press or a half-court trap? Is the defense laying back to prevent the dribble-drive and giving up the outside shot? Or it is playing close and tight, creating opportunities to drive to the hoop? Success in different circumstances requires a different set of responses.

Achieving and sustaining recovery by negotiating the ever-evolving flow of life on its own terms requires a similar assessment of the full range of situations with which we are presented. And, as is the case with basketball (or developing real skills in any area), the way to become proficient is through persistent and dedicated practice. This is the 25th anniversary of September as National Recovery Month. Its message is that people can and do recover.

Copyright 2014 Dan Mager, MSW
Author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain

Years ago on a hot July afternoon, I made a very bad decision.  With a new baby, a new house, and a new book in the works, I was in an abnormally stressed-out state of mind.  So I did what all red-blooded American consumers know is the best way to cure stress:  I went shopping.  Specifically, I bought a motorhome.  This was a horrible decision given that we lived in a city where there was no place to park a vehicle extending 31.5 feet from bumper to bumper; my wife and I were roughly four decades away from prime motorhome travel age; and my 4-miles-per-gallon enviro-slayer wasn’t exactly fuel efficient.  In terms of quality this decision ranked somewhere between Neville Chamberlin’s choice to appease the Nazis and Eve’s decision to nibble on that apple in the Garden of Eden.  And I could have avoided it simply and easily if I had only consulted my Anti-Me first.

Whether purchasing a car, planning a team strategy, or contemplating a career switch we always run the risk of betraying our own self-interest.  Beginning with Herbert Simon’s classic work on “bounded rationality” in the 1940s, and kicked into high gear by Daniel Kahneman and Amos Tversky in the 1970’s, the thriving field of behavioral economics has identified hundreds of irrational quirks of the human decision-maker.  Almost all of them can be traced back to the stubbornly narrow frame of reference held by all goal-driven beings like you and me.

Consulting your Anti-You before deciding is perhaps the simplest way to protect ourselves from these blunders.  Your Anti-You is something like a frenemy who sees the world very differently than you do, so their opinion naturally broadens your frame of reference.  For example, after I sold my money pit on wheels, I received one of two responses from friends and colleagues.  Some people were stunned, wondering why I would have possibly sold something with so much untapped potential for future fun.  These people tend to make decisions the same way I do—they are reward-seekers who make decisions quickly. (Good judgment be damned!) 

On the other hand, people like the COO at my company or my wife usually err on the side of caution, so they responded very differently to news of my RV sale.  Without rubbing my nose in it, their eyes clearly said why in the world did you buy that thing in the first place?  Any one of those people could have pointed out that a mechanically inept, 28-year old urbanite with no depth perception, probably should not purchase a motorhome. But I didn’t think to ask them.  

So how do you find your Anti-You? 

My research reveals approximately eight Decision Styles: Hunter, Inventor, Farmer, Fisher, Investor, Builder, Thinker, or Manager.  Each of those styles also has a natural Anti-Style. For example, I am an “Inventor” and my natural Anti-Style is a “Manager.”  I have short list of “Mangers” that I turn to often—some for personal choices and others for business—before deciding.  It is surprisingly effective and takes no special skills. 

Even though the occasional regret is unavoidable simply because we can’t predict the future, finding your decision style, and then identifying the people in your social network who are your Anti-Style can eliminate the vast majority of otherwise regrettable decisions.  Of course, if all that doesn’t sound like much fun, I know a great place to get a new motorhome.  

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What if I told you that 350 million people worldwide were afflicted with an illness that can significantly compromise their quality of life? What if this disease could leave them tired, drained, achy, irritable, apathetic, restless, hopeless and  even at risk of losing their life?  What if it made people feel like they had no purpose, undermined their goals and diminished their motivation? What if the people suffering were parents, grandparents, spouses, partners, teens or, more and more often, children? The reality is that this epidemic exists in the form of depression.

Depression is not something to be taken lightly. It affects people of all ages in all walks of life. Harry Potter author J.K. Rowling once said, “Depression isn’t just being a bit sad. It’s feeling nothing. It’s not wanting to be alive anymore.” Depression is an illness and should never be treated as something that’s “all in your head.” Yet, those who haven’t experienced it have trouble understanding it. As Rowling went on to say, “I don’t wish it on anyone, but if they would know how it feels, I swear they would think twice before they just shrug it off.”

While the first step to understanding depression is accepting it as a health issue on par with any other physical affliction, it is then essential that we shift the conversation to treatment. Yes, depression is a real illness, but there are ways to heal from it. Do not let the fact that depression is serious ever steer you to believe that it is hopeless. There are countless treatments, and the secret is finding the one that works for you.A new study from Northwestern University has even identified certain genetic fingerprints that could not only be used to diagnose depression in adults but to help distinguish which therapies would be most effective for each person. This is an optimistic finding in a landscape where targeted treatments may be required for each individual.

While finding what works can feel like an uphill battle, especially when you are depressed, it is one with a statistically optimistic outcome. According to the National Institute of Mental Health, more than 80 percent of people who experience depression can be effectively treated. This even includes those with severe depression. Moreover, there have been a solid series of actions people can take that have been scientifically proven to curb symptoms of depression for most people, including exercise and mindfulness meditation. Often, a combination of medication and psychotherapy is the most beneficial. Furthermore, studies have revealed that psychotherapy can be particularly helpful in preventing relapse in people who’ve experienced a depression. Despite these reassuring realities, it is estimated that only about two-thirds of those suffering with depression seek help. October is Depression Awareness Month. If you or a loved one is experiencing symptoms of depression, there is no better time to start taking steps to get help and feel better.

One technique I use with clients struggling with depression is Voice Therapy, an approach developed by my father, psychologist and author Robert Firestone. Voice Therapy introduces people to the concept of the “critical inner voice,” a destructive pattern of thoughts that fuels self-hatred. The critical inner voice is like a sadistic coach who comments on our lives and torments us. It undermines our goals and kicks us when we’re down. People with depression often strongly experience this “voice,” driving feelings of hopelessness, unworthiness or shame, a concept I’ll elaborate on in two upcoming Webinars on depression.

In Voice Therapy, you are first asked to vocalize your negative thoughts in the second-person (as “you” statements , i.e. “You are worthless; you make people feel bad.”) This helps distinguish your voice as an alien enemy as opposed to your real point of view.

The second step involves thinking about where these thoughts come from. Do they sound like anyone or remind you of anything from your past? This helps you develop compassion for yourself. You did not get to feel this way for no reason.

Next, you answer back to this enemy, including responding to this inner critic from a more compassionate and realistic stance, talking of yourself the way you would talk about a friend, using “I” statements (i.e. “I am fun, kind and funny. People enjoy my company.”)

The fourth step is to think about how your voice influences your behavior. For example, do you steer clear of social situations, isolating yourself or keeping quiet around friends?

The fifth and final step is to then acting against your critical inner voice. Stop engaging in the behaviors that buy into or feed its directives, thereby living free of its constraints. This includes both stopping behaviors that are self-sabotaging or even self-destructive and increasing behavior that is in your own self-interest.

Part of fighting depression means identifying behavior patterns that worsen its symptoms. While people come by their condition honestly, they may not recognize the behaviors they engage in that exacerbate and feed their depression. The numb state people enter when in a depression can be created or inflated by the psychological defenses they’ve formed. These defenses are like walls that were built subconsciously to protect people from painful circumstances and conditions throughout their lives, particularly in childhood.

As my father wrote, “Feeling and compassion are a significant part of our human heritage, but when faced with overwhelming primal pain, we develop defenses to minimize our suffering.” In other words, we learn strategies to cut off from our feelings, which may alleviate the immediate pain but will also shut out the many joys of life. This unconscious pattern of trying to not feel an unpleasant feeling, be it anger, hurt, anxiety, grief or sadness, can actually lead to depression. While depression is hardly a pleasant or preferable state, it can mask a sea of emotions that we’ve long tried to subdue.

The adaptations we made to survive emotionally as kids aren’t necessarily the best strategies as adults. The defenses enlisted to protect us early in life can hurt us later on. For example, isolating ourselves in our room may have drowned out the loud arguing of our parents, but it’s most likely not an adaptive tool in our adult lives. Moreover, it probably didn’t abolish the pain or anger we felt inside. When we grow up, no matter how deeply we hide them or attempt to cover them up, painful experiences from our past stay with us. They shape how we see ourselves and the world around us. We carry our feelings about them with us as well as the adaptations we made to try and cope with them. For example, as an adult experiencing depression, a childhood tendency to isolate one’s self can be the absolute worst thing to do. Therefore, part of feeling better means recognizing our defenses and being willing to act against them, no matter how much anxiety it initially sparks. As my father further wrote, “To alter this negative legacy requires a depth of psychological knowledge and compassion as well as the belief and fortitude to pursue this endeavor against all odds.”

No life is free from hardship. The human condition is a painful one, and no more so than for those who suffer from depression. The aim will never realistically be a life free from sorrow or a state of permanent happiness. But what is possible is a life of meaning, which always includes a willingness to feel our feelings. Whether we recognize it or not, in any particular moment, each of us is a vital being, capable of happiness, fury, fear and love. With the many hurdles we ultimately experience in life come moments of overwhelming joy, bittersweet sadness and finally a sense of peace that can only be reached when we are willing to face the depths of feeling that exist in all of us.

Those who know depression should be assured that the pathway to feeling like yourself again, while it can be arduous, is still possible. It’s a brave battle, but one that is worth it, because you are worth it. Think of the joy Rowling’s books have brought millions of children or the smile you’ve brought to your own child’s face. Depression may be an obstacle that can cast a shadow on your life, but it can never overshadow who you are.

 Read more from Dr. Lisa Firestone at PsychAlive.org

Join Dr. Lisa Firestone for free and CE Webinars on depression.

Please note, this blog does not address clinical depression or anxiety, disorders which may create more extreme changes in mood and negatively affect feelings of well-being. Managing a mood disorder is not as simple as managing the usual ups and downs most people experience and may require medical intervention. However, some of the suggestions in this blog would be helpful for those with mild depression and/or anxiety.

Some days we wake up feeling great and don’t know why, other days we wake up in a low mood with or without consciousness of the reason. What most of us didn’t learn in childhood is that ups and downs are not always related to problems or something you did to cause them. It’s okay to let a slump run its course, especially when we need a break from our own striving or when too many real problems pile on at the same time. Attempts to suppress and analyze bad feelings can sometimes make us feel worse.

The need to be proactive arises in times when we just want to feel good and don’t know how to get there. I confess that am just as confused by my high energy, optimistic days as I am by my slumps. We are not always aware of how we feel or why we feel happy or sad, frustrated, lonely, guilty, or just overly sensitive. I often hear clients say “I’m having a bad day” followed by a list of the terrible things (which individually are really not that terrible) that happened, in an effort to try to explain away their low mood. It doesn’t help to pile them up and vent.

The fact is, every day has its good moments and unfortunate glitches, but sometimes we only see the negative and start to collect it throughout a day or week or month. The question of why we feel this way is not as important as how we can change our emotional state when we cannot simply fix a problem of which we are aware. If you want to feel better, there are many things that can help.

Through work with clients and my own life experiences I have learned that I do have some power over my moods beyond the “snap out of it” and “don’t feel that way” approach often heard from well meaning parents and friends. It takes a little time and effort, but with practice, we can get better at identifying, accepting, and yes – managing our own feelings.

The most likely causes of feeling low are physical; not enough sleep, low blood sugar, or the need for exercise. It could also be stress, lack of fun, need for human contact, lack of choices, or worries about other people. It is also important to recognize that when you focus for too long on what you don’t like about someone or something, you are guaranteed to end up with a low mood and find yourself attracting bad feelings like a magnet.

First of all, remember there is probably nothing wrong with you except that you are human and this is what human beings experience. No one is happy and energetic all of the time. It is ok to allow yourself to feel down, but if you want to feel better, these things may help:

1. Unless it is something obvious, stop trying to figure it out.
2. Breathe deeply and drink more water.
3. Open up your posture - Body stance can change your mood according to social psychologist Amy Cuddy as seen on You Tube.
4. Don’t push and drag yourself through the day. Allow your feelings and thoughts to come and go on their own without judging.
5. If you usually race through your day, slow down; drive slower, walk slower, talk slower.
6. If you tend to be immobile when you are down, move more and be sure to continue to open up your posture throughout the day.
7. Use all of your senses to notice good things around you – nature, laughter, love, kindness, music. Comment on those things or write them down.
8. Skip the morning and evening news. Avoid reading or listening to anything negative.
9. Eat healthy at least for today – make it something delicious.
10. Make eye contact with people. Emotional connections with people raise our spirits.
11. Gather your “tools” and use them – pray, read positive things, be around people you like, smile, and allow loving energy to flow from you.
12. When a better mood returns, notice what you are doing that makes you feel good.

With some effort, it is very likely that you will begin to feel better and several outcomes are possible:

• You realize that there was no problem and your mood has lifted.
• There may be a real problem, but it will resolve by itself.
• There is a problem, but it feels smaller and less important.
• There is a problem and I know I need to address it but it’s not essential that I do it today.
• I’m OK as I am.

For those who worry that America is rapidly devolving into a culture of narcissistic malcontents, recent research from Emery University offers both good and bad news.

First, the good. In a June 2014 paper, psychologist Emily Bianchi reports that individuals coming of age during economic hard times are less likely to view themselves as special or entitled as they age, and also score lower on standardized tests for narcissism, than are those raised in more prosperous times. Why? Some research suggests that less-well off youngsters simply feel less entitled or special. As such, writes Bianchi, “the Great Recession may produce a cohort of less self-focused young adults.”

And the bad news? What goes down may go back up. If the economy continues to recover, there is no reason to imagine we won’t see a return of the earlier trend toward narcissism and self-absorption. In fact, one could easily argue that, given changes in the marketplace, the trend could get worse.

Some background. Researchers have long been aware of a link between prosperity and a more individualistic and self-focused personality. In the 1970s, University of Michigan socialist Ronald Inglehart showed that as economic conditions improved in the United States and Europe after World War Two, citizens were more and more likely to focus on individual pursuits and “self-expression.” The shift was striking. People born before the Second World War, who had grown up insecure, tended to give higher priority to economic stability, political order, and other traditional “materialist” values, even if it meant sacrificing some individual liberties. But those born after the war had quite different concerns. Raised in a time of economic growth, these baby boomers had been relatively free to focus on less urgent “post-materialist” objectives: entertainment and leisure, but also education, cultural enrichment, travel, political activism, and other more elevated individual pursuits.

To be sure, this shift to post-materialism led to many positive social and political changes, including greater support for liberal social institutions, such as democracy, freedom of speech, gender equality, workers’ rights, and environmental regulations. But also brought something else. As societies become more postmaterialist, Inglehart found, citizens tend to become steadily more individualistic in outlook, and to be less inclined, for instance, to support traditional, collective values and institutions. Inglehart and his colleagues insisted that any such surge in individualism wouldn’t lead to “asocial egoism.” But one could argue that this hopeful outlook hasn’t always been borne out. The famous self-absorption of the 1970s was, by many accounts, a reflection of the fact that Baby Boomers had enough discretionary income to pursue, “the polishing one’s very self,” as Tom Wolfe put it in his famous essay, “The Me Decade.”

By the 1980s and 1990s, these journalistic appraisals were being confirmed by clinical data suggesting an increase in narcissism. Psychologists and counselors were reporting a growing numbers of people—patients, but more important, members of the general population—with symptoms of clinical narcissism. The inflated self-importance, the tendency toward aggressive self-promotion, the need for constant affirmation, the deep sense of entitlement that easily turns to anger—it was all becoming more common.

Granted, the percentage of people with full-blown narcissistic personality disorder was fairly small. But according to social psychologists Jean Twenge and Keith Campbell, the number of people exhibiting one or more of the identifying traits was growing much more rapidly than with other disorders, such as obsessive-compulsive disorder. By the early 2000s, write Twenge and Campbell, authors of The Narcissism Epidemic, symptoms of narcissism in the general population are growing as rapidly as other public health problems, such as obesity. And why is narcissism on the rise? Standard explanations have focused on cultural and family factors, notably the heavy emphasis, beginning in the 1960s, on building self-esteem in children. But Twenge and Campbell have argued that there is likely an economic element at play here.

One component of the narcissistic personality is the refusal to accept limits. For whatever reason, the narcissist comes of age without having learned to temper his or her own desires, and so goes through life expecting to be fulfilled and gratified by others—and upset when it doesn’t work out. For most of human history, such an expectation of limitless gratification could happen only to the wealthy. For the rest of us, life imposed a more realistic self-conception—Freud’s reality principle in action. But as Twenge and Campbell argue, over the last century, and in the last four decades in particular, soaring levels of personal financial power may have allowed a narcissistic avoidance of reality to take root among a much broader population.

Of particular interest to Twenge and Campbell is the rise of easy credit, which enabled the narcissistic personality to simultaneously avoid the reality of financial limits while using overconsumption to affirm his or her massively inflated sense of self-worth. By the 1980s and 1990s, Twenge and Campbell suggest, the financial revolution and narcissism were feeding off each other. They write: “The availability of easy credit—in other words, the willingness and ability of some people to go into tremendous debt—has allowed people to present an inflated picture of their own success to them- selves and to the world.”

What’s more, some researchers have argued that a growing sense of entitlement and self-centeredness may have contributed to the recklessness of many corporate executives, especially during the run-up to the financial crisis. As Campbell, now head of the psychology department at the University of Georgia, argues, narcissistic business executives fit in all too well to a corporate world that, from the 1980s on, prized fast results and wasn’t overly concerned with long-term consequences. “With a lot of these CEOs, you end up with these high-risk, sometimes high-reward outcomes,” Campbell told me. Unfortunately, these kinds of high-risk personalities are also associated with “poor ethics—they kind of go together.”

What’s more, although the financial meltdown and the end of easy credit appears to have slowed economic-related narcissism, it seems likely to return. In fact, even though economic recovery has been lopsided, with fewer of us enjoying the sort of prosperity we experienced in the 1990s and early 2000s, there are new economic developments that may be just as conducive to self-absorption.

Thanks to the accelerating digital revolution, we’re increasingly surrounded by products and services that provide the narcissistic personality an even cheaper and more efficient way to present an inflated self-image to the world (and to itself). Take the “self-tracking” movement. Ever-cheaper sensors and smarter software mean we can monitor, analyze and posting everything about ourselves, from how many calories we burn to how many steps we take to our mood fluctuations and our home office productivity. In short, we now have an “objective” reflection of ourselves that is, almost by definition, encouraging the tendency toward self-focus.

Or consider the burgeoning practice of photographing and displaying every piece of our lives—reality that can only fuel the narcissistic love of celebrity. “We film everything,” Campbell told me. “People will film themselves at the concert and that becomes the experience itself. Rather than ‘being there,’ it’s ‘showing people that you were there.’ It’s like, ‘God, I’ve got to get a picture of this so I can post it and get all this feedback.’ ”

Where will this pattern of economic development and narcissism take us? The pessimistic view is that any resurgence in prosperity will only rekindle our self-absorption and narcissism and recreate the conditions for yet another financial calamity.

But there may be a silver lining. As Bianchi’s work suggests, any subsequent downturn could well produce individuals who are less narcissistic and entitled—and, perhaps, a little more inclined to work toward goals that benefit not just themselves, but society generally. For example, surveys find that Millennials, who came of age during the worst recession since the Great Depression, are often more socially engaged than their predecessors, and are more likely volunteer and to incorporate their political values in all aspects of their lives. As the Millennial generation matures and takes on decision-making authority, they might restore some economic stability--and, at least temporarily, rein in a culture all too focused on “me” and “now.”

Paul Roberts is an author and journalist. His latest book, "The Impulse Society: America in the Age of Instant Gratification," explores the complex connections between the marketplace and the self. You can see more of his work here and follow him @pauledroberts

References:

Emily C. Bianchi, “Entering Adulthood in a Recession Tempers Later Narcissism”

Goizueta Business School, Emory University

http://pss.sagepub.com/content/early/2014/05/06/0956797614532818....

Ronald Inglehart and Christian Welzel, Modernization, Cultural Change, and Democracy: The Human Development Sequence (Cambridge, UK: Cambridge University Press, 2005), p. 149.

Tom Wolfe, “The ‘Me’ Decade and the Third Great Awakening” New York Magazine, August 23, 1976

Twenge, Jean, and W. Keith Campbell. The Narcissism Epidemic: Living in the Age of Entitlement. New York: Free Press, 2009.

People go to more meetings than needed. Managers whom I coach or teach tell me that they show up to support their team. Or they check to make sure things are being done right. Or they show up merely to show their face or cover their ass.

After a bit of reflection, these same managers confess to over-attendance: “I should let go more,” they say. “I should move up and move on, and I should trust more.” They decide to experiment, and they let their team meet without them more often.

When they let go, people are stretched to step up. Most people, given the opportunity to get things done without the boss present, will rise to the occasion. Growth becomes inescapable. Some can’t make the leap, and that’s good to discover as soon as possible. Sunshine is the best disinfectant, but meetings make for very effective shadows.

In 1973 Ernest Becker published TheDenial of Death, and then he died. In 1974 Becker was awarded the Pulitzer Prize for the book, posthumously. Nearly 5,000 scholarly books or articles, including more than a dozen just this past month, have cited Denial of Death. The book, Becker’s ninth, was the culmination of his career as a cultural anthropologist and an attempt to answer big questions and explain big mysteries.

Becker’s ideas continue to shape the way many therapists and coaches approach their work. It informs my approach to the leadership development workshops I lead at some of the world’s largest companies. Perhaps Becker also provided an explanation for the over-stuffed calendars of the modern manager.

Glenn Hughes, a scholar of Becker’s work, summarized the thesis of Denial of Death on The Ernest Becker Foundation website:

Human beings are mortal, and we know it. Our sense of vulnerability and mortality gives rise to a basic anxiety, even a terror, about our situation. So we devise all sorts of strategies to escape awareness of our mortality and vulnerability, as well as our anxious awareness of it. This psychological denial of death, Becker claims, is one of the most basic drives in individual behavior, and is reflected throughout human culture. 

Becker argues that religion is one of the primary “immortality projects” that humans have created to distract us from our terror of death.

As workplace meeting attendance climbs, conference rooms become hot commodities. For my work, I’m a frequent visitor to big corporate campuses. Between sessions, I often try to sneak in a call to one of my three kids (and, as Becker would argue, to distract myself from my own mortality). As I’m doing this, inevitably a stranger walks in and asks, “Did you book this room?” After I apologize for squatting in an unreserved space, I trudge on to find a free spot to finish my call. Instead of this corporate hobo life, I should probably stop looking for a conference room and start looking for a church pew – plenty of empty space there.

As meeting attendance has gone up, church attendance has declined. In modern, industrialized nations, religious attendance is on the decline. In Western Europe it has nearly vanished.

Are all those work meetings just the new immortality project to replace going to church?

One of my executive clients asked me in a moment of candor: “If they don’t need me, then what’s my job?” It’s pretty easy to get your head around the notion that people hang on to work that they should let go of just to feel indispensable. 

But maybe the stakes are even higher. Maybe we’re not merely distracting ourselves from the fact that we’re dispensable. Maybe we’re distracting ourselves from the fact that we’re dying. Without as much religious attendance, perhaps we need to meet and multitask more to forget about our mortality.

To be clear, Becker didn’t advocate religion as a distraction. And I doubt he’d endorse the weekly standing team meeting. Becker primarily advocated for awareness and consciousness and courage -- what we would call mindfulness today. If you haven’t read Denial of Death, I recommend it highly. 

But if your calendar is too stuffed with meetings for you to read a 40-year-old philosophy book, take this challenge instead: find 30 minutes in the next week that is currently booked for a meeting that could survive without you. Keep that calendar time empty. Protect it. When the time comes, don’t distract yourself with news or games or media or your needs or the needs of any others. Consume nothing and produce nothing. For those thirty minutes, just be alone, awake and alive.  

Sarah White is the pseudonym of a woman who operates an online service, called “The Naked Therapist.” (Link is NSFW!!!) Via web camera, Sarah provides one-on-one interaction with men around the world, talking with them about their problems and issues. But, distinct from any other therapist or coach I know of, Sarah disrobes during the session, and allows her clients to also disrobe, and even masturbate.

Sarah’s business has gotten a lot of media attention, due to the salacious nature of her services. But, most of the attention has focused overwhelmingly on the skin and the sex, often dismissing and even ridiculing her claim that she is providing a therapeutic service.

Sarah’s comments in these articles intrigued me, as a psychologist. I’m not planning on getting naked with my patients, but her strategy of accepting sexualization in order to help men to express their needs and desires is compelling. Sarah agreed to an interview with me, exploring her business and the philosophy behind it. (We were both clothed during the interview, for those of you who might wonder, though fair disclosure, I wrote some of this while in my pajamas.) Sarah turned out to be far more than the “dumb naked chick” portrayed in the media, but was a thoughtful, poised individual, with a great head on top of her admittedly attractive shoulders.

Sarah’s "Naked Therapy" business started, first, with an idea of offering “naked” coding and programming assistance. At the time, Sarah was working as a waitress, model and doing web design, and realized that people might pay her to discuss web design while naked. Lots of customers turned out to want to talk to her while naked, though they didn’t care about web design. Sarah has been around therapy, in her personal and family life, and she realized that just talking to people, while naked, could be a powerful therapeutic phenomenon.

Since 2010, Sarah has worked with over 1000 men, and feels that her practice has improved as she has gained more confidence and experience in developing insights into her clients. She has increased her fee, now charging $250/hr, compared to the $150 she started at, but her increased rate has not hurt demand. She tried having some other people work for her and replicate the approach, but found that it wasn’t a good match, and continues to provide the service herself.

Sarah has been criticized as being merely a “webcam girl with a clever hook,” so I asked her how what she does is distinct from the naked women readily available for free via webcam, and what distinguishes her service from mere porngraphy:

A webcam girl is there to fully serve and please the visitor within her personal limits in whatever way he deems desirable. I'm a therapist, so my goal is to help my client achieve therapeutic progress. I do not simply "do whatever the client asks" (even within my limits). Rather, I do what I consider most valuable toward achieving that ultimate goal: therapeutic progress for the client.

There is a world of difference between pornography and Naked Therapy. One is a mere sexual indulgence (and is perfectly acceptable) and the other is a therapeutic practice that involves the component of arousal.

Sarah believes that by getting naked online, she can connect with men in ways which shortcut around men’s barriers and their fears of intimacy. What she is doing is tapping into powerful issues of acceptance, which, in men, is intrinsically connected to sexuality.

Naked Therapy has several features that make it an exciting alternative to normal therapy. First, because nakedness is allowed, there is an immediate sense of intimacy, openness, and trust between the therapist and client, which many of my clients have said has made a huge difference in terms of what they're willing to talk about with me vs. a normal therapist. Surprisingly, I have found that many men won't talk to normal therapists about a variety of issues because they're too embarrassed, but they feel comfortable talking to me about them because they find my willingness to undress for them a sign that I trust them and that I won't judge them (which is true).

Distinct from other forms of therapy (excepting perhaps the very limited service of sexual surrogacy), Sarah’s approach actually embraces (virtually at least) a client’s sexual expression. In traditional therapy, a client’s sexual desires should be addressed and discussed, in the abstract. A client’s arousal towards their therapist would never, ever result in actual in-session sexual activity, without potential charges of misconduct. But for Sarah, that’s where the real work actually starts:

Naked Therapy engages sexual arousal as a vital part of thinking. Rather than pushing it aside, or claiming that it is simply an expression of a deeper longing, Naked Therapy says "sexual arousal is important in and of itself" and it utilizes the sexual arousal of the client to arrive at unique, powerful, relevant insights.

Asking a man to share his feelings in an environment in which sexual arousal is forbidden is like teaching him to swim on land. I just firmly believe that sexual arousal is so central to men's cognition that it must be openly embraced and accepted in the therapeutic context if men want to truly get to the bottom of their feelings.”

All of her 1000 clients are men. Originally, Sarah saw some women, but over time, she’s gravitated towards working only with men, and feels that her style and approach is most effective and helpful in dealing with issues of masculinity. Indeed, Sarah has become a defender of men, and argues that masculinity is too often reduced to simplistic, stereotyping concepts which paint men as simple beings controlled by their sexual desires.

Naked Therapy is man-positive. One just hears too many therapists these days - male and female - talking about how men have a hard time expressing their feelings (they even have a word for it - alexithymia), how men don't want to be in therapy, how men are resistant and aggressive and often overly sexual toward female therapists, etc. I'm probably the only...therapist in the world who can say she has an all male patient list and not one of them is there because a judge or a wife made him go. The men I see are also deeply capable of recognizing and expressing their feelings.

I have never found them aggressive or resistant, and in embracing their sexual feelings toward me, rather than shaming them for having them, I have had countless intimate dialogues with men in which they've talked to me about things they've never told anyone in their lives. Talking about these things has allowed them to better understand, come to peace with, and/or put behind experiences.

What kinds of men come to Sarah’s virtual office? She presents four types of men who are willing to pay for her services, talking out their issues while she, and they, take off their clothes:

• Curious/frightened: has "reached a point where he wants to try something new in his life, usually of a sexual nature, but he's confused about how to pursue it, so we work together on understanding his desires, becoming brave and figuring out a way to realize his urges."
• Unconfident/shy: "feels like he can't talk to women, can't sexually perform with them, or doesn't understand how to be a "good man," so we work on helping him gain confidence and we talk a lot about the reasons he feels uncomfortable around women and how he can start to feel stronger and more knowledgeable around them.
• Unmotivated/depressed: "we do a lot of work on optimizing arousal and finding things that can help him feel excited to live and pursue goals."
• Sexually obsessed/frustrated: "has a sexual 'addiction' of some type that he's concerned with, which is most often pornography, so we work on coming to terms with his desire for porn and figuring out a way he can either stop or look at porn in a way that makes him feel powerful and in control.

The latter category hits an interesting issue, as male sexuality is frequently synonymous with the modern issue of porn or sex addiction. So-called sex addicts are overwhelmingly male. Some have argued that Sarah's Naked Therapy is either treating, or even encouraging, porn addiction through her work. Sarah says that she doesn’t use or adopt the sex addict label, but it does come up quite a bit in her work:

I meet with a lot of clients who state openly that they have an "addiction to porn," ...in general I try to steer my clients away from thinking they have an addiction and toward a more thorough analysis of the hole in their life they're trying to fill with that activity, the positive things that activity does or can bring into their lives, a larger understanding of how that activity might fit into a healthy, positive, self-acceptable way of behaving, how it might bring them power, how they might lose the shame, etc.

What I treat are men looking to make a change, and I help them understand and achieve that change in whatever way we together come to believe it is best.

I received an email from a man who lives in Saudi Arabia who said "My wife will not have oral or anal sex with me, so I am addicted to pornography that contains these. Can you help me please?" This man is not addicted to pornography. He has a fully understandable desire to take part in certain types of sex, and his wife, because of (I imagine) her religious or family beliefs, will not take part in those types of sex. So then HE is an addict? No, SHE is an addict to traditional values that restrict her from exploring certain sexual activities that are perfectly fine to partake in.

When a man says he is addicted to pornography, what I do first is to talk with him about his life situation, and beneath every "addiction" I generally find a wife who is not interested in sex, a man who is afraid to talk to women, or a man who has been told that sex and/or masturbation are shameful and wrong. But, of course, we are very sexual by nature, so we WILL have sex one way or another, and often that's through watching pornography, which there is absolutely nothing wrong with. What I do is help men come to understand how they can solve whatever is causing them to watch pornography (if they want to stop watching it) or I help them understand how watching pornography can actually be a perfectly acceptable part of a sexual existence.

Naked Therapy helps men achieve better lives.

Despite her grounding and theoretical understanding of some aspects of psychotherapy, Sarah isn’t a licensed therapist, or even a self-described lifecoach. She has a disclaimer on her website that her services are not intended to be therapeutic, but informational only. But, her work seems more than titillation, or mere entertainment. Sarah looked into going to graduate school and pursuing a degree and license in therapy, but was told that to do so, she’d have to stop doing Naked Therapy. She believes strongly that what she does is therapeutic, and helps people, but thinks it is best for people to know up front that she is not offering a licensed service.

I had to choose: stop practicing Naked Therapy and get my license, or keep practicing Naked Therapy unlicensed, and I chose the latter.

Sarah’s not worried about professional licensing boards coming after her for use of the term “therapy/therapist,” but she is cautious to avoid using words such as counselor or psychologist, which could result in sanctions. Unfortunately, as Sarah’s work crosses state lines via teleconferencing, she could find potentially find herself subject to licensing boards in other states. This seems somewhat unlikely, but as many licensed clinicians have learned, professional boards can be mercurial, vindictive and unpredictable at times. Some have recently taken action against coaches and other advice givers who cross state lines,using teleconferencing, though such actions have typically emerged from complaints by clients. Given the sexual nature of Sarah’s work, I can imagine that in such a case, being seen as merely a “webcam girl” could actually be protective, as clinical licensing boards might not feel her services are credible enough to restrict.

Regardless, Sarah knows her limits. She refers clients to licensed and specialty therapists when shee feels they need more than she can offer, such as dealing with clearly organic issues such as schizophrenia and brain injury, or where she feels they may benefit from “more advanced help,” and specialty services such as EMDR.

Sarah believes that she is being ethical and careful, by being up front and honest, about her limitations and abilities, and about the nature of her service. “I am a firm believer in patients knowing what they're getting into…” She clearly distinguishes her approach from therapists who cross ethical boundaries and become sexual with their patients. She argues that such patients aren’t treated properly or ethically, when they enter treatment thinking that rules and expectations such as ethical boundaries around sex, will be enforced.“It's all about acting in accordance with what is laid out in the beginning so that no one feels taken advantage of and treated unfairly.” Though she might not describe herself thus, Sarah is supporting her clients’ rights to determine for themselves what they need, and is enacting a unique form of client-directed therapy.

Kate Franks, PhD., is a researcher and former exotic dancer, who argues that men go to topless clubs for much more than the nude women. In such environments, Franks has suggested that men can behave naturally, not suppress their sexuality, and are seeking acceptance by women in such clubs, even as they indulge their desires to sexualize and leer at women. Sarah appears to have hit on the same phenomenon, and has found a unique way to respond to it.

Sarah’s business reminds me of another entrepreneur and "therapist", who provides “cuddling” for hire, and the current controversy over the "cuddling app." They are all recognizing and responding to an unmet need for people to connect, and be accepted. In the 1970’s, some mental health therapists did practice “naked therapy,” during the heyday of Free Love and the hippie movement. Some of my older colleagues have told me stories of conducting naked group therapy sessions. Modern therapists have suggested to me that in some cases, such as body image disorders, they believe that naked therapy might actually be therapeutic and beneficial. But in today’s American business and liability environment, it is essentially impossible for a licensed clinician to include such activity in their work, regardless of its potential therapeutic benefit.

Entrepreneurs and creative thinkers like Sarah White are recognizing the effects of these limitations that have been imposed on how traditional therapy can work, and are using the power of modern communications technology to circumvent these limits. Men, particularly heterosexual men, traditionally access psychotherapy far less than other groups. The high rate of suicide in men is often attributed to this, at least in part, and if Sarah's work is getting men to engage with help and support, it's hard to argue with.

I’m not professionally inclined to take my clothes off in front of a patient, even on-line, and would certainly discourage any of my own employees or interns from doing so. But, I would certainly accept a referral from Sarah, and I can imagine times when I might refer a man to her. Like Cindy Gallop’s “Make Love Not Porn” initiative, Naked Therapy is trying to change the world and the way we view sex in our lives and society. I’ve got to say, I’m cheering them on. Psychologists, and our industries of mental health and sexuality counseling, need to be taking these people and their ideas and questions more seriously. Believe it or not, they have things to teach us.

Stories of physical abuse rock the NFL. Late to acknowledge the extent of head injuries in the league (1 in 3 will suffer from the effects of head concussions during their lifetimes), professional football has been embarrassed by two star players using their muscle off the field: Ray Rice punched his girlfriend hard in the face and Adrian Peterson produced cuts and bruises on his son.

The NFL stories are high-profile because the players are news makers as athletes, but the sad truth is that violence in the family is widespread in society. One in six women will be a victim of sexual assault. The violence cuts across racial lines: 17.6 % of white women will experience rape or attempted rape, while 18.8% of black women and nearly 25% of mixed race women will. https://www.rainn.org/get-information/statistics/sexual-assault-v...

Children suffer at great rates, too. Three million reports of child abuse are made each year. More than four children a day die from abuse and neglect, making the US one of the worst offenders in the industrial world. http://www.childhelp.org/pages/statistics

There is another NFL statistic that hasn’t received much attention but one that also reveals a deep social problem. Ticket prices reveal the economic gap between the wealthy and the rest of society.

The average face value of a NFL game ticket is $84.43, up $3 from last year. This doesn’t mean that a fan will pay the asking price. Tickets are aggregated and resold on eBay and elsewhere, so that many are forced to buy from one of the sites, not at the stadium. So if you are a Detroit Lions fan, where tickets are amongst the least expensive in the NFL, the face value is $72.82. The resale average is $148.58. If you want to attend a game, you will pay, on average, nearly $150 per ticket. The lowest ticket resale value was $70; the highest ticket went for $800.

Few go to a game without buying something else. There is beer and soda, hot dogs, parking, programs and caps. The estimate is that to take a family of four to a Lions game costs an average of $411.94, up $10 from last year.

So who is going to the games? Certainly not the typical Detroit families, a city with a household median income of $26,000 and where one out of three residents and more than half the children live in poverty.

There is something wrong with America’s most popular spectator sport and it isn’t simply the behavior of the players, on and off the field. The NFL is driven by huge profits and the news stories about the league reveal the deeply troubling underside of American society.

Call it whatever you want: the Mommy wars, Mean Girls growing up, cat (or Tiger!) fighting: American culture seems to delight in watching mothers tear each other down. In researching friendship horror stories for my first book, The Friendship Fix, the tales of the transition to motherhood were particularly hair-curling: women being ostracized by members of parenting message boards; new mothers feeling silenced and belittled by passive-aggressive "Sancti-Mommies"; venomous elementary school cliques not in lunchrooms, but in PTA meetings. Glaringly absent from the discussion, however, is the real damage that these conflicts can do to parents, mentally and physically. From shortening your lifespan to increasing your risk of depression, the breakdown of supportive communities and relationships has real implications. Fortunately, though, there is one often overlooked antidote to this growing trend: returning to an emphasis on quality, nourishing friendships, whether they are online, off-line, or anything in between.

Sometimes, as I chase my own children at the playground or laugh with other parents at preschool dropoff, it's easy to believe that the "war" itself is media-generated. But in the age of the Internet, and with the proliferation of parenting communities online, the media has become part of everyone's neighborhood. And mothering in the age of Facebook and WebMD is a complex prospect indeed. The very balm that provides 3 a.m. advice on just how high a fever needs to be to warrant panic can also be the enemy of a new mother's self-esteem and emotional health. Disposable diapers or cloth? Cry-it-out or cuddle 'till the sun rises? Tiger Mother, or something more resembling a pale-throated sloth? Now it's not just a neighbor or an in-law making you feel bad about your choices, but a mob of anonymous voices in your living room.

"Turn it off!" some might say, or "Focus on your real life." But for many, the Internet IS real life. The friends they have, the advice they trust, the vulnerabilities that keep them awake at night, and the yardsticks -- metaphorical and literal -- that they internalize for their children's development all play out online. As soon as people were able to get a second opinion via their smartphone while still in the doctor's office, or upload a video of their children blowing out birthday candles moments after the fact, there is no longer online versus offline life, but just rather a continuous, enmeshed stream of both.

And tuning in to these parenting conflicts is sometimes all too tempting. Parenting is stressful, and other people's drama can be escapist. We're unsure of our choices and have become accustomed to seeking out information overload. And judging someone else -- whether via an online comment or in our own head -- sometimes makes us feel better about ourselves, especially when we already feel overworked and overwhelmed and judged in our right.

But the uglier these conflicts get, the bigger the health danger. Women (and men!) entering the life-altering transition of becoming parents are arguably more in need of emotional support than during virtually any other time of their lives.

It's an oft-cited research finding that parents report more moment-to-moment stress and less happiness than non-parents. And postpartum depression, which affects 10 to 15 percent of Moms, can be debilitating and have lasting effects on mother, partner and children. By some studies, up to 14 percent of all postpartum women have suicidal ideation. Even those who don't meet full diagnostic criteria can feel more overwhelmed, emotionally unstable and alone than ever before. Don't they get enough screaming from their newborn that they don't need to get it from society as well?

This is not to say that all conflict is bad. Certainly, a forced group hug is not necessary (our shirts are stained enough already). And sometimes the best kind of friend is the one who will give you a strong opinion about a choice you're facing. Embracing diversity and spirited discourse are arguably among the best behaviors we can embrace for our children.

But media coverage of the Mommy Wars is often sensationalized, oversimplified and belittling. Instead of encouraging women to find help in the form of quality relationships, it often implies that connecting with other Moms will leave you worse off than before. The longer we avoid the real issue -- that parenting can be a terrifying endeavor, and that for all our online connectivity, many Americans feel lonelier, more distressed, less satisfied and more disconnected than ever before -- the worse these wars will get.

In the meantime, what's a mother to do?

The answer is surprisingly simple, though not necessarily easy: focus on improving one's friendships. Quality social support is one of the strongest predictors of life satisfaction and mental health well into old age. The ability to choose friends and communities wisely, to nourish and draw support from those relationships, and to handle conflict without being drawn into toxicity -- online or offline -- is not a frivolous luxury. It all too often feels quaint in the age of the Internet, or impossible in the crossfire of the supposed Mommy Wars. But it's a set of skills that can be a lifesaver, and it's perhaps the most important gift a mother can give herself. (Yes, even better than that $2,000 stroller.)

Andrea Bonior, Ph.D., is a licensed clinical psychologist and media commentator. She is the author of The Friendship Fix and Baggage Check, the longtime mental health advice column in the Washington Post Express.

Photo credit: Lisa Sjoland (Flickr Creative Commons)

I previously posted about “Are you a people-pleaser?” This question is related to the Four Tendencies framework, which I develop in Better Than Before, my book on habit change. (To hear when it goes on sale, sign up here.)

A key piece of self-knowledge — which is crucial to habit change — is “What is your ‘Tendency?” That is: How do you respond to expectations?

-outer expectations (meet a deadline, perform a “request” from a sweetheart, follow traffic regulations)

-inner expectations (write a novel in your free time, keep a New Year’s resolution, start flossing)

Your response to expectations may sound slightly obscure, but it turns out to be very, very important.

In a nutshell:

Upholders respond readily to outer and inner expectations (I’m an Upholder, 100%)

Questioners question all expectations; they’ll meet an expectation if they think it makes sense, so they make everything an inner expectation

Obligers meet outer expectations, but struggle to meet expectations they impose on themselves

Rebels resist all expectations, outer and inner alike

I gave a talk at LinkedIn about the Four Tendencies, so if you’d like to see me discuss each category in a video, you can watch: for Upholders, watch here; Questioners, here; Obligers, here, and Rebels, here.

I’m always trying to deepen my understanding of how the Tendencies play out. So over the past week, I’ve been posing some questions. One day, I focused on Rebels.

Today’s questions relate to the Questioner Tendency.

I have a lot of exposure to this Tendency, because my husband is a Questioner.

Being married to a Questioner is helpful to me, because as an Upholder, my instinct is to meet an expectation without questioning it too closely. My husband always questions an expectation before he’ll do it, and I’ve learned to question more myself. This Tendency saves him a lot of work. Sometimes I admire it, sometimes it drives me crazy.

Last night, I pointed to two small drawings hanging on the wall, and said, “Can you please switch these two?”

He said, “Why can’t you?” He didn’t mean it in a bad way, but just — why can’t you do it?

I gave him a look. As an Upholder, I must confess, this response annoys me. I don’t ask him to do much, and when I do ask him to do something, I have my reasons, and I don’t feel like I should have to justify at length every single request. But that’s what a Questioner wants! Explanations, justifications.

I’m making a list of the questions that Questioners pose, before they meet an expectation. Forming a habit is a form of expectation (whether self-imposed or other-imposed), so to form a habit successfully, Questioners need to have their questions answered. They often ask:

–Why should I listen to you? (This question isn’t meant in a snarky way, but literally.) What’s your expertise? A friend told me, “When my son broke his arm, I interviewed four doctors. My husband thought I was crazy, but I can’t listen to a doctor unless I have complete trust.”

–Why should I have to do this, instead of someone else? My husband and household habits. Questioners are great at delegating, unless they think that no one else can do something.

–Where can I get more information? Questioners love information and research. In fact, they sometimes complain of “analysis paralysis”; they want more and more information.

–How can I tweak this habit to suit my individual needs?

–Isn’t there a better way to structure this habit? Questioners like to find better ways to do things.

–What problems has everyone else overlooked, that I can identify? Questioners are good at spotting error.

Questioners, what other questions do you find yourself asking? Questioner-observers, what do you get asked? Does this list ring true?

Do you find questioning helpful, or does it become tiresome at some points?

What am I missing?

Also ...

Allow me self-promotingly to suggest The Happiness Project. I can’t resist mentioning: #1 New York Times bestseller, and a bestseller for more than two years. That's right, TWO.

Order your copy.

Check out the gallery of foreign covers. It's so interesting to see what different countries put on the cover.

Watch the one-minute book video.

Tags: character, Four Tendencies, habit, habit change, questioner

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Consider These Questions Posed To You Upholders, Questioners, Rebels, And Obligers.

What Andre Agassi Can Teach Us About Habits, Happiness–And Ourselves.

Can You Add To This List Of Famous Upholders, Questioners, Rebels, And Obligers?

    Many people think about pain psychology as being a way to help them cope with pain. In this sense, the thinking is that psychological factors – depression, anxiety, fear– happen in response to pain. While this is true, the important part of the equation is often overlooked: that psychological factors can predict how well pain treatments actually work! That’s right: your thoughts and emotions are so powerful that they can determine how much pain you have, how well opioid medication works, how well surgery works, and even how well physical therapy works.

For people with chronic pain, one of the most important factors to evaluate and treat is pain catastrophizing. Pain catastrophizing is a pattern of responding to actual or anticipated pain with distressing thoughts that involve ruminating on pain, having a hard time focusing on anything but the pain, feeling helplessness about the pain. While pain catastrophizing is related to depression and anxiety, it is a distinct and powerful predictor for outcomes related to pain. People who catastrophize have more severe pain, require more opioid medication, and have reduced response to multidisciplinary pain care. Several studies have examined how catastrophizing impacts response to surgery. People who catastrophize are much more likely to develop post-surgical chronic pain. This tells us very clearly that psychology isn’t just about learning to cope better with pain. Instead, your psychology powerfully interacts with other factors and contributes to the development of chronic pain, and in part determines how much pain a person has and how well pain treatments work.

Brain imaging (fMRI) studies show that catastrophizing is associated with attention to pain, anticipation of pain, and negative emotions related to pain—all of which serve to amplify pain at the neural level. Catastrophizing lights up the same areas of the brain associated with pain processing and thereby amplifying the pain experience and suffering. It is important to learn information and skills that dampen pain processing in the brain—otherwise you may unwittingly make your pain worse!

While you did not choose to have chronic pain, it is important to understand that you are participating with your pain with your thoughts, emotions and choices. A pain psychologist will help you learn behaviors and ways of thinking that dampen pain processing in your brain, thereby supporting good pain control and improving your response to a wide variety of medical and physical pain treatments.

At Stanford University we have developed and researched focused, single-session treatment for pain catastrophizing (in the Systems Neuroscience and Pain Lab: www.snapl.stanford.edu). This research was published in April 2014 in the Journal of Pain Research (Darnall BD, et al). Our results suggest that in as few as 2 hours you can learn how to stop catastrophizing and develop your own personalized plan to gain control-- in doing so you will ensure your brain is fit to have the best response possible to all of the treatments your doctors are trying. Stay tuned for more on this topic!

September 24, 2014

I’ll admit it.  I’m a little afraid of the Apple Watch.  I’m afraid that if I put that shiny smartjewel on my wrist, it will someday glow red, telling everyone that my time is up, it’s time for Carousel.  Children of the 70s will remember the hit movie Logan’s Run.  Under a post-apocalyptic dome in the 23^rd Century, population control is achieved by limiting everyone to a 30-year life span.  As citizens approached their “last day”, the life-clock crystal on their palm changed colors and finally turned red.  They were called to Carousel, for a quasi-spiritual “renewal”, during which they floated into the air and were vaporized, but revelers in bleacher-pews shout their approval for what they think is their ascension to some Cloud above.  It looked a bit like an Apple press announcement.  “Just one more thing,” indeed.

I do live under the Apple dome; I’ve exalted its devices since teenage days spent programming in my public junior high school computer lab.  Since that time, technology has become a religion.  Cyberism has its objects of worship, communion rituals, and promise of transcendence, and its dome seems increasingly irresistible, inescapable, and irrefutable.  Don’t Steve Jobs and Tim Cook seem like prophets and preachers to enthusiastic worshippers?  Hardware and software have become manna from heaven, data and code our new scripture.  Everything will be perfect in our friction-free silicon future.  The body and mind seem to become more powerful with our Borg-like blessings.  Wearable technology, smartphones, microchips in everything from cups to cars – it all can feel like living on the tip of a pyramid of gadgets, their possibilities elevating us skyward.  Alternately, it can feel like you wear the equivalent of the carbon footprint of several African villages on your wrist.  This is all supposed to make you feel healthy, lighter, less burdened and more hopeful.  “One more thing” is heady – but at what price this consumer delirium?  Is Google Glass a lens or a blindfold, or some strange small mirror of our misshaped desire?  Does the Apple Watch track guilt at our use of the Earth’s resources, or will we have to invent some other device or social network to magnify our conscience about our consumer appetites and human values?

While most wearable devices get unworn after a brief trial, perhaps the Apple Watch, the “Strapple”, will fare better.  It has the potential for renewing its novelty and becoming an eye-catching, mind-pulling distraction.  Imagine new artwork by, say, Banksy, Fairey or Hockney beamed directly to your watchface on a daily basis.  You could subscribe to Deepak Chopra’s messages, alerting you to the hum of the universe with a buzz of your wrist.  The Buddha could ping you, nudging you gently towards nirvana with reminders for mindfulness and compassion.  The Muslim call to prayers could emanate from your arm, the Sermon on the Mount could be your personal siren.

But will you feel like you are wearing the Watch, or that the Watch is wearing you?  Will we begin to develop form of somatoparaphrenia, and begin to feel like our wrists and arms are not really parts of us anymore?  Interactive, wearable devices cross our boundaries in subtle ways, and may impinge on our identity and integrity in ways we can’t foresee.  Will your wrist feel yours, or a part of Apple’s expanding territory?  Is this the next stage of an imperial occupation by the technological superpowers?

Devices and apps already impinge on our consciousnesses; the Watch makes further inroads.  For example, it is supposed to be an integrated “health tracker”.  I’m sure there are those who benefit from micromanaging their bodies, downloading their steps, sleep cycles, vital signs and calories into a spreadsheet, the first incarnation of their verisimilar digital avatar.  But outsourcing our awareness this way seems problematic.  First, it exacerbates our obsessional, addictive mind, of questionable benefit to our mental health.  Instead of improving our intuitive sense of our bodies and minds, we become dependent on a cyber-superego, which views us as objects to be manipulated and controlled, and a little less as whole, living beings.  We might take personal responsibility for ourselves with this technological lever, but then ignore the societal components of our health.  It can seem like a diversion from the choices that could have a bigger impact on us, from what gets to our grocery store shelves to improving public transportation and civic engagement.  We might live longer, but have less of life.  It’s not the bargain I’d like to make.

Perhaps someone will create an app (called “Morbid”?) which will not only track your stats, but also give you real time updates of how much time - and how many paces - you have left to shuffle this mortal coil.  Your Watch should come preinstalled with Chicago’s famous song.  Does anybody really know what time it is?  Does anybody really care?  We’ve all got time enough to die.

Near-centenarian Detroit activist Grace Lee Boggs (now ill and entering the last days of her life), active in civil rights, labor and other movements for the last seventy years, famously asks “What time is it on the clock of the world?” 

I don’t think the Apple Watch will tell me. 

We’re here, I think, to live, and to help life.  How technology helps us or keeps us from that task is a question we must take to heart, the same heart that beats out our transcendent, human rhythm.

© 2014 Ravi Chandra, M.D. All rights reserved.  Subscribe by RSS above.  Sign up for a quarterly e-newsletter to be the first to find out about my upcoming book on the psychology of social networks through a Buddhist lens, Facebuddha:  Transcendence in the Age of Social Networks, at www.RaviChandraMD.com.  Facebook page: SanghaFrancisco-The Pacific Heart. Twitter @going2peace. Thanks for your shares on Facebook, etc.!  

You might also like some of my other PACIFIC HEART articles on technology:

We Need a Surgeons General Warning for Social Media!

Spike Jonze's HER:  Existential and Emotional Questions

10 Reasons Facebook is Not the Happiest Place on Earth

I Have Met the Internet and It Is Not Us

Do you love to snack? If so, you’re in good company. Consumer research tells us that snacking accounts for more than half of all eating occasions. That means, for some people, snacks may substitute for at least one regular meal.

Emotional snacking—turning to food when you’re bored, lonely, angry or stressed—is common. Are you a sneaky snacker? Always popping something into your mouth when no one’s looking and then feeling guilty? If snacks were monitored or forbidden in your home while you were growing up, you may always feel some guilt if you eat between meals. Hey, get over it! Why not snack openly and enjoy it? If you snack only when you’re hungry, snack mindfully on well-chosen foods, eat snack-size portions, and eat these snacks well ahead of mealtime, there’s no reason to feel bad about it.

If you think snacking is unhealthy, that might be because of the foods you associate with snacking. Products designed specifically to be snack foods—chips, dips, pretzels, crackers, cookies and all those individually packaged cakes and pastries—are traditionally high in fat, sugar, and/or salt, and low in essential nutrients. More and more packaged snack foods are made with less salt, less sugar, and healthier fats, and that’s a start toward healthier snacking but it’s not the whole story.

If you snack often throughout the day, and these snacks are contributing excess calories to your diet, and thereby unwanted weight gain, it’s time to find a new snacking strategy. Here’s why: If you feed yourself six, eight, ten times a day, your body comes to expect food at those times of day and you feel hungry more often, even if you really don’t need the food. If you keep feeding that type of hunger, your snack habit will most certainly lead to weight gain, even if you’re eating more nutritious foods.

But snacking can actually be a good strategy for weight control if you snack on wholesome foods in healthier ways and use snacks only to alleviate, say, a mid-afternoon slump, keep your blood sugar even, or prevent you from becoming so hungry that you overeat at your next meal. Think of snacks as mini-meals, and balance them the same way you would a full meal, by making sure there’s a variety of foods on your plate that provide a little of each of the major nutrients: some protein, some carbs and some fat. This may be as simple as a small piece of cheese, a sliced apple and a few roasted almonds, or any food that combines these same nutritional elements into one snack, such as yogurt mixed with fresh or frozen fruit and topped with nuts or whole-grain cereal.

Other ideas: a whole-grain bagel topped with reduced-fat ricotta cheese and sliced strawberries; toated whole-grain waffle topped with sliced peaches and vanilla-maple yogurt; cheese toast made with whole grain bread, topped with shredded cheese and broiler in the toaster oven or melted in a microwave oven. Non-dairy or vegetarian ideas include a nori seaweed wrap filled with seasoned rice and bits of leftover cooked vegetables or beans, seasoned with kimchi or sirachi and soy sauce, or a small “salad” made with cubes of tofu, watermelon and chopped fresh mint. And, of course, no matter what combo you come up with, reasonable serving sizes are key to healthy snacking. That way you’re not filling up on too much of any one type of food and you’re getting a variety of nutrients at the same time.

The best tip for successful snacking is careful planning. Rather than grabbing random foods, be prepared for snack attacks by having plenty of healthful, ready-to-eat snack foods on hand at home and at work, including a variety of clean and cut-up fruits and vegetables. If you make snacking a conscious activity, as you should also do with regular meals, you’ll pay more attention to the types of snack foods you’re eating, you’ll eat your snacks more slowly, and eat only as much as you need to satisfy between-meal hunger.

Again, snack only if you're hungry or trying to prevent yourself from getting too hungry before your next meal. If you are reaching for a snack in response to an emotional upset, find something else to do (like, go for walk). Here are some other guidelines for healthy, guilt-free snacking:

• All snacks must fall in the main food groups, with minimal processing: meat, tofu and other proteins; fruits and vegetables; whole grains; dairy.

• Keep all junk food out of your house and out of your workplace. If you can’t see it, you won’t be tempted to eat it!

• Schedule snacktime into your daily routine to avoid random eating.

• Be creative. Just because snacks can be good for you, they don’t have to be boring. Try new foods and new combinations of familiar foods, and serve yourself healthy snacks in fun serving containers.

When I first met Larry, a 20-year-old college student, he had just been released from an intensive care unit. His teeth were wired, his ribs bandaged, his eyes blackened. He had been speeding in a flashy sports car beneath an elevated rail line in West Philadelphia while under the influence of alcohol. He hit a center post head-on and felt the steering wheel crushing into his ribs. 

Before the police arrived, while covered with blood and attempting to regain consciousness, he helplessly watched the local inhabitants remove his car radio and four wheels.  After recovering from the impact, but while still in the intensive care unit, the police stopped by and left him a summons to appear for drunk driving.  The court suspended Larry’s driver’s license and mandated that he seek counseling.

When asked about his social life, Larry said after several drinks he became a jovial, fun-loving person.  Yet, he felt lonely and depressed most of the time.  He had been undergoing psychotherapy from time-to-time with an off-campus clinical psychologist.  The night of the incident, following a therapeutic session, he felt particularly unsettled and visited a disco bar.  After several hours, he became verbally abusive to other patrons at the bar and was asked to leave.  He remembers getting into his car and heading back to his dorm.

Larry had little use for psychotherapy, which he believed was in business just to make money.  Larry was bitter at the criminal justice system, which he also claimed was in business only to make money.  Larry defended the police, however, who he thought had tried to do the “right” thing. 

I asked how did Larry know what was “right,” and had he ever questioned what was “right?”  Larry gave me a look of disgust and replied that a voice inside told him right from wrong.  I asked if he had ever done anything that wasn’t right?  Larry’s blackened eyes lit up and he smiled through his wired teeth, “You have to have fun, you know.”

At the following session I asked Larry if he’d had any fun during the week.  Larry said he visited his mother, had four or five mixed drinks, and without license drove back to college.  A police car had come up alongside, and, Larry said laughingly, he had waved to the officers, and they waved back.

Larry missed his next two scheduled appointments.  His probation officer finally caught up with him and told Larry to complete his court mandated therapy sessions or go to jail.  Larry returned to therapy with a big smile, “Well, at least I tried.”

I asked what in the recent past was he most angry about.  He leaned back and looked up.  “My step-dad is a real s.o.b."                

“And your dad, were you ever angry with him?”  Yes, Larry said, for having gotten killed in Iraq and not coming home to take care of Larry's mother.  I asked if there were any men who Larry looked-up to?  Larry said he liked war heroes in the movies, particularly the carefree ones who “lived it up.” I asked if his dad had “lived it up?”  Larry looked down and said he did not know, but just hoped his dad had died for something.

I pointed out that Larry’s dad was very much alive, insofar as being an embedded voice in Larry’s head and advising him to do the “right” thing.  Larry’s inner-most feelings, however, defied this embedded voice by wishing to be carefree and “live it up.”  These two unconscious forces were locked into an ongoing conflict which led to Larry’s mood and behavioral swings.

One way to step aside this perpetual conflict was to strengthen his own voice and decide for himself the right thing to do in his best self-interest.  Doing so, would not belittle Larry’s respect for his father, but would enhance Larry’s becoming his own man.  Larry could also respect his inner-most feelings, which, although irrational, were an innate part of us all.  By hitting the center post head-on, he had nearly killed himself as a way to tune out this unremitting internal conflict. 

After a long pause, Larry told me that he was thinking back as he walked to his car after leaving the disco bar and remembering a faint voice that said, “Take him out!”  I suggested that this may have been Larry’s irrational feelings that would rather not be, than to go on living, imprisoned by his righteous embedded voice.  

At our next session, Larry reported that he had begun to think for himself.  I asked Larry how he knew this.  Larry replied that he knew it because he was thinking of his own best self-interest.  Yet, Larry said, he also felt a little guilty about being selfish and not listening to others. 

I suggested that it was alright to listen to others, both internally and externally, as long as one’s own voice remains loud, purposeful, and clear.  Only by respecting his inner-most feelings, however, could Larry be his own man and not have to adopt the values and norms of others.  Allowing others to decide what is right and wrong, can lead to being a mere pawn, with no inner core and without a raison d’etre.    

Yesterday I had a car crash, which I was lucky to survive. I was driving in the middle lane of a motorway (or highway), when a truck pulled out from the inside lane, without seeing us, and hit the side of our car, putting it into a spin, then hitting us again. While the car was spinning round, I thought my wife and I were definitely going to die, or be seriously injured – it was a busy stretch of the motorway, and it seemed inevitable that other cars would hit us. We span around for a few seconds, and I could see cars coming towards us. Then suddenly I had some control of the car again. I pushed the steering wheel to the left, into the hard shoulder and the crash barrier. I looked over at my wife and then looked down at my own body and was absolutely amazed that neither of us had been hurt. ‘It’s okay! We haven’t been injured!’ I shouted to her.

Today I feel in a heightened state of appreciation. I'm normally a positive and appreciative person in any case, but today I feel especially fortunate to be healthy and alive. There seems to be an enhanced freshness and ‘is-ness’ to everything I see.

As a result, I’ve returned to thinking about appreciation, and how it can transform our lives. Positive psychologists have found that a sense of gratitude has a more powerful impact on well-being than any other characteristic. Tests of different personality traits linked to happiness (such as openness, agreeableness or extraversion) have repeatedly found that gratitude is more strongly associated with happiness than any other trait.

It seems obvious that appreciation should bring happiness, in the same way that it seems obvious that being pessimistic should create unhappiness. But it’s worth thinking for a moment about the reasons why appreciation has such a positive effect. 

A number of different reasons have been suggested by positive psychologists. One is that gratitude increases our enjoyment of things. When we feel grateful for things, we relish them more. If you feel grateful for your spouse or family, for example, you will enjoy their company more. If a friend treats you to a meal, you feel grateful and so enjoy it more than if you had just bought it yourself.

Another suggestion is that gratitude enhances social relationships. Grateful people tend to have good relationships. Their positivity and responsiveness makes them likeable, so they attract friends easily. They tend to be altruistic, and their appreciative attitude promotes trust, so that other people form bonds with them easily.

In addition, gratitude supports “adaptive coping.” When bad things happen in their lives, grateful people adjust better. They find it easier to make sense of negative events and tend to let go of negative memories, rather than dwelling on them. As a result, it’s not surprising that research has found that, following traumatic experiences, gratitude-oriented people experience fewer post-traumatic symptoms.

I would like to add three ideas of my own to this summary. Firstly, appreciation brings a decrease in desire. It means that we become more satisfied with our present situation. There is no sense of lack, and no desire to add anything to ourselves or our lives. We become liberated from the craving for more possessions, wealth, love or success, and from the restless striving to gain these. Craving gives rise to unpleasant emotional states such as envy and bitterness. Envy comes from comparing ourselves to others, and feeling that they are better off than us, that we lack something that they have. Bitterness can come from comparing our present situation to our past, feeling that we were better off then, or that a particular event or person is responsible for our discontent. But if we become satisfied with what we have, and with our present situation, we become free of envy and bitterness.

Appreciation can also give us a wider sense of perspective, which makes our own concerns and difficulties seem less significant. When you compare yourself to other people in the world who are living in dreadful circumstances (or other people in history who lived in dreadful circumstances) then your own “problems” seem to diminish.

And finally, appreciation is strongly related to present-ness. Appreciative people tend to live in the here and now, rather than giving their attention to the future and the past. They spend less time in states of abstraction and absorption, and more time in awareness. The relationship between appreciation and present-ness works both ways: the more appreciative we are the more present we are; and the more present we are, the more appreciative we become. Being present – living in the here and now – is also a powerful source of well-being. 

Grateful people are happy people. Ungrateful people are unhappy people. And people can be made happier by practicing gratitude or appreciation. Cultivating appreciation can therefore be seen as a form of therapy – Appreciation Therapy, or Gratitude Therapy, as it might be called – which could be used to alleviate depression, or to improve general life-satisfaction.

In the meantime, I’m going to enjoy my own heightened sense of appreciation. Often appreciation fades away, but I also think that an ‘attitude of gratitude’ can become ingrained, so that we feel a constant sense of appreciation. I think this attitude has become automatic to me to some degree, and hopefully my experience of surviving the car crash will deepen and expand it. 

Steve Taylor, Ph.D. is a senior lecturer in psychology at Leeds Metropolitan University, UK. He is the author of Back to Sanity. www.stevenmtaylor.com

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How many people do you think are sex trafficked in the U.S. every year: 200,000? 300,000?

If your blood’s boiling about what sounds these days like an epidemic, here’s good news: According to the U.S. Justice Department, the actual number of people trafficked into the country for all reasons (mostly for labor rather than sex) is about 17,500 people year. In a rare show of bureaucratic consensus, the U.S. State Department’s estimate is between 14,000-17,000.

“But,” you say, “surely that’s too low? What about the numbers I hear from all these anti-trafficking organizations?”

Good question. And here’s the answer: if you define trafficking broadly enough, it does look like there are a million or more victims. The numbers also sound enormous if you’re vague about whether the trafficking involves the U.S. or semi-functional countries like Moldova, Haiti, and Bangladesh.

Some non-profit organizations define sex trafficking to include all prostitutes. Others include all porn actresses. Still others include anyone giving hand jobs in a massage parlor. Forced marriage of teen girls and older men is ugly—and virtually unknown in the U.S.. But some anti-sex trafficking activists count these young people as well. No wonder these activists or “researchers” get such enormous, scary, numbers.

Most manipulative of all, activists keep warning of the number of people “at risk” for being sex trafficked—millions of women and children. “At risk” because they’re poor, or unloved, or drug-addicted, or have trouble with English.

Using that logic, 45 million Americans are “at risk” of dying in plane crashes every month, and twenty million Californians are “at risk” of dying in car crashes every week. No one’s in a panic about that, of course, because such definitions of “at risk” are meaningless.

The results of this muddled thinking are great for fund-raising but bad for public policy. Our anxiety increases at a far greater rate than the supposed problem we’re being told to fear.

Which brings us to the SAVE Act, passed overwhelmingly this year by a proud Congress. It supposedly criminalizes the advertising of trafficking. But because of the way that activists define “trafficking,” it actually criminalizes the advertising of all commercial sex work (neatly undermining that pesky First Amendment at the same time).

This extends to websites like MyBackPage.com and Redbook.com, which not only advertised sex work and related services, but also served to create and focus a vibrant community. Websites like these are places for sex workers to get emotional support and medical information, and to alert each other to dangerous clients and helpful public resources.

And so the SAVE Act attempts to protect us from a very small amount of sex trafficking by undermining the health and safety of a fairly large number of sex workers. It would be hard to design a worse system if you tried.

Let’s review the differences between sex work and sex trafficking.

Sex Trafficking: Always involves coercion. Generally involves being removed from one’s home. The person is always being controlled while not working, often hidden from the public. A person can’t voluntarily leave this situation.

Sex Work: Mostly done by choice (while many have only limited life choices, that still doesn’t make it coercion). Typically stay in or near one’s home, and usually still connected with loved ones such as children, parents, or spouse. The person generally has a near-normal private life when not working. Most such persons can voluntarily leave if they choose to do something else.

These are completely different phenomena—except in the minds of many anti-trafficking activists, who can’t seem to imagine treating sex workers as actual human beings making adult choices about their lives.

The SAVE Act takes resources earmarked for ending trafficking—a horrendous crime of coercion by truly evil people—and instead uses them to undermine sex work—a dramatically different “crime” that primarily involves willing adults, most of whom are ordinary people. As are their customers.

It’s simply immoral to take money and time that could be used to fight evil and spend it instead to fight a moral crusade that most people don’t care much about-- unless activists spread the myth that prostitutes and escorts are victims of sex trafficking who must be rescued.

The SAVE Act also undermines the fight against trafficking in these other ways:

* By eliminating U.S.-based websites, it pushes sex workers to use offshore-based websites (just as Americans moved to offshore gambling websites when domestic sites were criminalized in the U.S.). Historically, these offshore sites have been much less cooperative with American law-enforcement than domestic sites in pursuing and catching real traffickers.

* It creates a heavy incentive for content platforms and third-party hosts to obtain identifying information from every person using their internet service. Given sex workers’ reasonable fears of police action, hacking, blackmail, and public exposure, compromised privacy is the last thing any sex worker wants.

* It undermines everyone’s rights of free expression, creating a new class of speech outside the First Amendment’s protection. Legal, protected expression is eliminated along with newly-criminalized expression when websites are shut down. This is never good, particularly for people whose lifestyle or political ideas attract criticism.

The people the SAVE Act is supposed to help—sex workers “at risk” for trafficking—oppose it almost unanimously. They know it will make them less safe, less able to vet customers, less able to maintain a community where they help and support each other. When a law designed to help a group is opposed by that group, you know it’s a bad law—almost certainly passed by cynical (or ignorant) politicians trying to score points with a gullible public.

The SAVE Act makes no one safe, and benefits no one—except those determined to inflate the number of those supposedly trafficked year by year until we have the (media-driven) “epidemic” they claim to be committed to preventing. As each website is shut down, expect activists to proudly note the number of “at risk” people it has “saved.”

So get ready for the alleged trafficking epidemic the SAVE Act is supposed to eliminate. In our perverse world, the larger the alleged epidemic gets, the more it will be used as “evidence” that activist efforts are somehow very necessary—and effective.

Rather than fill this blog with my own thoughts about the issues that revolve around food and weight issues, this time I’m filling it with the thoughts of men and women who have shared their stories with me over the years. There’s nothing more inspiring than the words of those who’ve fought the good fight, some of whom have been successful at shedding pounds, and some who may still be struggling to get to a better weight, but all of whom have been willing to share their hopes, insights, and solutions so that others may benefit.

“All in all, I’m quite comfortable in my own skin, and if I didn’t live in a city where the standards for “healthy weight” are so much higher, I probably wouldn’t give a thought to the 10 or 15 extra pounds I carry around these days. I am who I am, the same person I’ve always been. My clothes are just a little tighter now!”

“I’m older now, I still have stress in my life, and I still respond by eating. But I know now that dieting isn’t a real solution because my overeating has never really been about food. I need to figure out how to cope with stress without resorting to overeating. My next step is to find a good support group.”

“I know my weight problem has nothing to do with food. I’m using food to fill a void that’s been there for a long, long time. I just never let myself think about it before. Psychotherapy has helped me open up, find my feelings, and talk about my history of abuse for the first time in my life.”

“What’s most important is that my daughters see me as someone who accepts herself. I want them to know their mom is okay with who she is so they will follow my example in that respect. I feel great, I’m healthy, I walk for thirty minutes every day, and even though I wear a size 18, I consider myself pretty stylish.” 

“I’m 27 years old, I like myself, but I want to like my body, too, so I’m trying to lose weight. I’ve gone on three diets in my life and each time I lost 20 or 30 pounds, then gave up for one reason or another and gained the weight back. Twice I joined weight loss programs and once I followed a high protein diet. Now I want to start fresh; I want to find a new job and get out more and work on my social life. I don’t want to bring all this old fat with me to a new job. Until I figure out a better way, I’ll just keep counting calories. For now, it’s a good workable plan because I’m not overeating and I know it’s just a temporary way of eating to lose some weight, not a permanent solution.”

“The lesson I learned is that anything can happen, and when it does, I have to be prepared to pick myself up, stay out of the kitchen, and [literally] just keep running.”

“When I joined a medically supervised program at a local hospital, I didn’t just join a weight loss program. I joined a program designed to improve my overall health and well-being. I’m writing this story seven months after I started the program, and I feel almost like a completely different person—or at least a new and improved version of the person I was a year ago. Right now I’m accountable to a lot of people—to the other members of my weekly counseling group and the dietitian we report to, and to my family, friends, and co-workers who have watched me get back in shape. Initially, those accountabilities helped propel my drop in weight. Now I have to learn to be accountable to myself and respect myself enough to stay in shape and maintain a healthy relationship with food on my own, for the rest of my life. That’s the part that will take some time.”

“Before I knew it, my children grew up and left home, and I lost my husband at an early age. More and more, I found myself sitting on the couch at night, watching television and eating snacks. As time went by, I would start doing this earlier and earlier in the day. I laughed at myself but I knew I couldn’t go on this way. I gained almost 30 pounds in eight months. What worked for me was to get busy and rejoin the human race. I was very nervous, but with the help of friend, I found an office job. That meant I needed new clothes and I had to face the fact that I had to lose weight. But once I started working and having more face-to-face contact with people, it wasn’t hard to lose. I knew all I had to do was give up the tv snacks, go back to eating healthier foods, and get moving. So I ate lunch in the office and spent the rest of my lunch hour walking. I didn’t stop watching tv but I stopped snacking at night. In less time than it took to put on the weight, I took it off. That was six years ago and I haven’t had a weight problem since.” 

“I finally admitted I was losing control of everything. I couldn’t control my food and my life was equally out of control. I knew there was a huge psychological hole in me that wasn’t getting filled no matter how much I binged. It was very scary. The change that came over me from working a 12-Step program was nothing short of miraculous. It was a bridge back to life for me, and now I live life on life’s terms, not my own, and it’s OK. My food habits aren’t perfect, but I eat normally. I’m generally more flexible, and I don’t beat myself up for my mistakes. I am so much more at peace with myself.”

“Does it ever end? I believe it does. I put out my last cigarette thirteen years ago, and I haven’t touched one since. I know if I could overcome that addiction, I can overcome my addiction to food. I just have to keep struggling to work with my feelings, not against them, and find other outlets to replace food. It’ll happen. It’s just a matter of time and I’m not about to give up now!”

Hedge funds have been cloaked in mystery from the start, starting with the name. “To hedge” means to protect or limit, but in fact the funds have been among the more risky and obscure investment vehicles Wall Street has to offer.

“Hedging” investments was designed originally to protect against loss by counter-investing in alternatives that would rise in value if the original investment declined. Originally, the funds attracted smart and sophisticated managers, as it required considerable savvy to match up such investment pairings. But those managers soon decided that hedging investments was a drag on profits. So the funds discarded their original efforts to hedge their bets, keeping the privacy, exclusivity and mystique of being exceptionally clever.

Capitalizing on their success, they charged a lot: 2% annually of assets, typically, and 20% of profits. Regulators – aware of the increased risk — discouraged ordinary investors from participating, but that seems only to have increased the allure of hedge funds in the eyes of the public and some portfolio managers eager to get into what was, for a time, a very profitable game.

But hedge funds are under no requirement to disclose their trades. Moreover, they often made it hard to cash out. All of that was fine, so long as values went up, but recently they have fallen on hard times, failing to match their past performances. Managers of pension funds have gotten wary, and recently Calpers, the California retirement fund for public employees, decided to divest all hedge fund investments.

That seems like a sensible move, especially as pension funds need to rely on steady income to pay out benefits for retirees. They can’t just wait around for hedge funds to rebound.

Moreover the secrecy clouding hedge funds were increasingly problematic for trustees accountable for investment decisions. One trustee for the Kentucky state pension fund noted recently: “The auditor wasn’t allowed to see the contracts, and the contract review committee for the Legislature was not allowed to look at them, either.” Another retirement system in Tennessee was invested in more than 120 hedge funds, “whose identities, securities holdings, trading costs and custodians are unknown.” Substantial duplication of underlying managers was also found. How did they know what kind of “hedging” – in the original sense of the term — went into the fund at all? Indeed, how did they know that investments in hedge funds were not amplifying risk?

Calpers’ decision to divest came as a shock to the system. No doubt other pension funds will follow suit – and a few investors. But the reaction of Wall Street commentators has been fascinating.

The Times followed up its account by noting that Calpers’ investments in hedge funds was miniscule, and other investors were not likely to follow its example. But in an unusual tone of mockery it commented: “So hedge fund titans, California may just not be that into you, but there are plenty of other starry-eyed, deep-pocketed investors to woo.” Businessweek noted that “the industry’s best period is likely behind it.” But then it gave this parting kick: “No matter how many $100 million Picasso paintings they purchase, hedge fund moguls are not magicians.” And The Wall Street Journal dryly provided evidence that across the board, hedge funds are underperforming the market.

Who knew the extent of the hatred and contempt lurking just below the surface? But whether is springs from resentment over the success of the funds, envy for their performance, or retaliation for their arrogance, the schadenfreude is palpable.

Today, 9/25/14, is National Psychotherapy Day. PT Blogger, Dr. Ryan Howes, has spearheaded a campaign to fight the stigma associated with psychotherapy so that people might become more open to receiving the quality help that is available. The stigma surrounding psychotherapy is challenging to overcome. But I am grateful to have a chance to do my part.

Over the years, I have noticed that the mere mention of the word "psychotherapy" strikes fear in the hearts of many. It is equivalent to Harry Potter's Lord Voldemort—it is the profession whose name shall not be spoken!

I am reminded of this idea whenever I attend a dinner party with new people. Inevitably, the dreaded question is asked of me: "So what do you do for a living?" I gulp. I look for an escape route. I wish I were a teacher, or a television editor, or a software engineer, or even an IRS agent. Because I know how intimidated people feel about psychotherapists—and I’m a psychoanalyst, so that makes it even worse. Many people have fantasies that therapists have x-ray vision and can see the deepest, darkest secrets of their minds. They expect harsh judgment and a kind of detached superiority from us. They wonder if we are always psychoanalyzing everyone in the room.

The stigma surrounding psychotherapy is easy to understand. Intuitively, we know that therapy is a vulnerable process. For those seeking help, it involves admitting a weakness or a need and putting themselves in the hands of a stranger before that stranger has earned their trust. When we feel vulnerable like that, we try to protect ourselves. We become suspicious of therapists and the process of therapy itself. We worry that we are going to be harmed in some way—that the power we give a therapist will be misused. We believe that therapists are just in it for the money; they don’t really care; they just like listening to themselves talk. Sometimes such fears are grounded, as not all therapists are ethical and competent in what they do. But these are the exceptions to the rule. By and large—as many who have experienced therapy will tell you and as the research supports—therapy helps.

In my own experience in therapy—as a patient and as a psychotherapist—I have had to confront my own prejudices about the forces that are at play in psychotherapy. I have discovered that psychotherapy is not dark magic, as even I had once feared. In fact, it is not magic at all. It can feel magical because it is not obvious at first how listening and talking can change things. Such a discovery can only be found through experience. But for many people who have had the courage to risk giving therapy a try, it becomes clear that listening and talking do help. Not through magic but through the disciplined, hard work of two people who come together in a relationship that is devoted to understanding the psychological dynamics at play in order to open up a blocked pathway for change.

So let's go back to the aforementioned dinner party. When asked what I do for a living, I try to smile and come across as casually as possible. "I'm a shrink," I say. It's the least intimidating way I know how to describe it. They usually laugh. A good sign. They usually give me a chance. Another good sign. And then after awhile, as they get to know me, they get a chance to see that I'm just an ordinary human being with a desire to help out other ordinary human beings. A particularly good listener, yes, but just an ordinary human being without a single magical power.

I hope that social experiences like these are corrective for people, giving them a chance to challenge their stereotypes and have a positive experience with a real, live, decent psychotherapist. But even more, I hope for this kind of response in my work with my patients. I recognize that my profession sometimes has a questionable reputation, and I am trying to do my part to help restore its good name. And the best way to restore its good name is to do good work by helping people find their way to a more healthy, satisfying and meaningful life.

Copyright 2014 Jennifer Kunst, Ph.D.

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National Psychotherapy Day is September 25, 2014!  Check out resources here: http://www.nationalpsychotherapyday.com/

To see more of Jennifer’s approach to psychotherapy, check out her newly released book: Wisdom from the Couch: Knowing and Growing Yourself from the Inside Out.

Do something for me, will you? Grab a piece of paper and note every feeling you can recall over the past hour. Every nagging worry about your life, every pulse of pleasure at a new text, every blush of nostalgia or enthusiasm at thoughts of the past or the future.

If you're able to recall the last hour in detail, I'd wager that this list is fairly long. Our lives are full of emotional moments. Some of these emotions are entirely appropriate to the situation and we can enjoy them - such as sharing a laugh with a friend. Others are inappropriate to either the situation or your goals and need to be managed - such as dampening your job worry in order to respond enthusiastically to a child's anecdote.

For some time, psychologists have been studying how people regulate their emotions and which techniques lead to the best success. This work often involves asking people to come into the lab, where we evoke emotion by exposing them to emotional pictures or film clips or stressful tasks like speech-giving. We then ask them to manage or regulate their emotions using one specific approach, and then we examine whether people who are successful at doing so score higher on measures of well-being (happiness, satisfaction with life) and lower on measures of psychological ill-health (depression, anxiety) than people who are unsuccessful in changing their emotions.

This work is important and has revealed very interesting patterns (you can read about some of this work in my previous post about emotions in the wake of disaster), but there is increasing evidence that this approach may be overly simplistic. In particular, we need to begin to consider the contexts in which people are changing their emotions - what type of emotions are they regulating? what are their expectations of success? how do they respond when they're not successful? what are the techniques they tend to use in their daily lives?

This increasing evidence that contextual factors are important led me and fellow psychologist Phil Opitz to invite several researchers active in this area to the annual meeting of the Society for Psychophysiological Research to share some of their latest results.

Without further ado, here is that hot-off-the-presses research, organized by the factors examined:

Expectations (of Pain) Matter 

In the first of the four talks, Leonie Koban of the Cognitive and Affective Neuroscience Lab at University of Colorado Boulder presented some work she had conducted with Tor Wager on social and learning influences on pain. Participants were exposed to painful heat stimulation on their forearm that varied from low to medium to high intensity. Whether these stimulations were low/medium or medium/high in heat was predicted by a cue on a screen and participants had to learn how much pain to expect based on these cues. In addition, they were also presented with the pain ratings of several other people. Interestingly, only some participants explicitly learnt which of these cues predicted low and which predicted high upcoming heat. They then rated for themselves how painful each of these touches were. Leonie also measured the degree to which these people's skin sweat when experiencing the pain, which provides a more objective measure of how much pain they registered at the touch.

Intriguingly, Leonie found that both people's pain reports and their body's response to the pain (skin sweating) was predicted by how much pain people expected to feel, based on the social information they saw in the beginning. Therefore, the context in which you are responding to a painful event may govern how you experience an event. Expectations matter.

Intensity of Emotion Matters

Next, Phil Opitz presented data that we collected together with Heather Urry of the Emotion, Brain, and Behavior Laboratory at Tufts University. He shared information collated from four different studies in which participants were shown emotional pictures and trained in one particular emotion regulation strategy and told to change their emotions using only that one strategy. The strategy they were told to use was cognitive reappraisal, or rethinking the meaning or interpretation of an emotional event in order to alter its emotional impact (for example, telling yourself that it doesn't matter that you've been laid off a job you didn't enjoy because this is an opportunity to chase your dreams instead). 

At the end of each of these four studies, we asked participants to describe what they actually did to manage their emotions. We coded these descriptions as to the type and number of strategies people employed. For instance, someone who said, "I too some deep breaths and thought about what I was planning to do that night instead of thinking about the picture" would be coded as having used two strategies - one involving their physical response and one involving distraction. 

Phil presented evidence suggesting that participants in the studies that used more intense images (such as accidents, injuries) more frequently reported using multiple strategies, and using multiple strategies was associated with poorer success changing their emotions. In contrast, participants in the studies that used less intense images (such as sad people, poverty) less frequently reported using multiple strategies, but using more strategies was associated with better success.

We interpret these results as evidence that the intensity of emotion is important in understanding the relationships between strategy use and emotion regulation success. 

Success versus Failure Matters

Rather than focusing solely on emotion regulation success, Lara Vujovic of Tufts University asked the important question: What happens when people try to regulate their emotions and fail? She devised a picture task where participants were given the opportunity to end the emotional situation - they could press a button to make the distressing picture go away. She likened this to leaving an emotional stituation when things get too tense - such as ending an upsetting telephone call. However, some of the time, the picture *didn't* disappear when the participant pressed a button - their attempt to change the situation failed. Critically, when participants' attempts to end the situation failed, they were more likely to report distracting themselves instead - an effect that wasn't observed when the picture disappeared as intended. Lara interprets this finding in light of theories that when people try and fail to change their emotions, they may compensate by switching to a different strategy.

Controllability of Stress (Controllable vs. Uncontrollable) Matters 

Finally, Allison Troy of Franklin & Marshall College took an innovative approach to studying contextual influences on emotion regulation by first examining how well people used cognitive reappraisal in the laboratory, and then following them into their daily lives to see if there was a relationship between lab ability and dealing with real-life stressors. She did this by having her participants complete daily diaries about the types of stressful events they encountered and how they emotionally reacted to them. 

Intriguingly, she found that this relationship varied based on whether the stressful event was controllable or uncontrollable - for events that participants had little control over, better reappraisal ability predicted lower emotional reactivity. However, for events that participants DID have control over, better reappraisal ability predicted *worse* reactivity. Why might this be? Allison proposes that when you can't do anything about the stressful event, it is healthy to rethink the nature of the situation in a more optimistic light. This confirms traditional thinking about reappraisal ability. However, it may be that when something bad happens and there IS a way to better the situation, it is healthier to act differently rather than think differently. Reframing your thinking may get in the way of making changes that would have a better impact on your emotion.

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Collectively, these new research investigations provide compelling support for the idea that if we are to truly understand the complicated relationships among emotions, their regulation, and psychological health, we need to consider the role of context.

As affective scientist and fellow PT blogger Amelia Aldao puts it in her review for Perspectives on Psychological Science, the future of emotion regulation research may well be "considering context".