Stress Management

We’ve all heard that prolonged stress negatively impacts our health, but stress isn’t necessarily a bad thing. Dr. Hans Selye, one of the pioneers of stress management, said that stress can be “the spice of life or the kiss of death.” He labeled negative stress distress and positive stress eustress. If we choose to ride a rollercoaster, or to scale a cliff, or watch a horror movie, we’re choosing to experience stress. Stress is an unavoidable fact of life, and a stress-free life would be an uneventful life – boring. Sexual excitement is a form of stress, and we all enjoy an adrenaline rush from time to time, especially if we chose the stimulus that triggered it.

Our autonomic nervous system, which regulates automatic behaviors, has two branches: sympathetic and parasympathetic. Both are involved what Dr. Selye called the “fight or flight” response. Activation of the sympathetic response gears us up, preparing us to fight or flee, whether or not we’re in danger. Heartbeat and breathing instantly become more rapid,  delivering more oxygenated blood to the brain and the extremities. Blood pressure and blood sugar rise, muscles tense in anticipation of action, and you may experience a jolt of adrenaline. After the event or situation that triggered the sympathetic response is past, the parasympathetic branch kicks in, reversing the fight or flight response and allowing us to “rest and digest.” We’re told not to go swimming right after eating a meal, because our blood flow has been re-directed from our extremities to our gut, increasing the possibility of a muscle cramp.

The fight or flight response evolved to help our ancestors to avoid being eaten and to hunt dangerous prey. If you’re a soldier in a combat zone, or a cop, or a firefighter, you may experience it on a regular basis. But although only a few of us in modern society frequently face physical peril – other than heavy traffic – we respond to perceived existential threats, even if we’re not actually in immediate danger. Combinations of financial, social and environmental stressors (How am I going to pay the rent? Is my wife being unfaithful?) can result in a high level of distress, sometimes manifesting as anxiety.

Anxiety is similar to fear, although the causes might be multiple and may not be immediate physical threats. A person having an anxiety  attack may experience their fight or flight response as paralyzing. Once you’ve had one, your fear of having another one becomes yet another stressor in your life. If you only occasionally have fight or flight reactions, stress may not be a significant factor in your health. But if you have them frequently, your health may be affected. But frequent fight or flight reactions aren’t the only stress-related threat. Chronic overstress – having more on your plate than you can handle – can kill.

Stress management doesn’t mean eliminating stress. It means controlling the amount of stress in your everyday life and, where possible, eliminating stressors. There are both physical and mental aspects to stress management. But first you need to identify the sources of stress in your life, your triggers for stress reactions, and how stress affects you.

If you need to practice stress management, start with an inventory of your stress factors: job security and satisfaction, finances, safety, residential issues, and personal relationships. Think of how you might be able to reduce unwanted stress in each area. It may mean some tough choices. Then list the kinds of situations and events that tend to trigger stress reactions. Being aware of your stress triggers may help you to prepare for them or learn ways to avoid them. Become more aware of how you typically respond to stress triggers and overstress. Do you somaticize (physicalize) it into headaches or bellyaches or backaches? Do you stay angry or depressed? Do you worry excessively? Anxiety has many faces , including free-floating (generalized) anxiety, panic attacks, and phobias – including social phobias. After doing this analysis of the role of stress in your life, you’re ready to look at physical and mental stress management techniques.

Physical stress management techniques include breath control, learning to relax your muscles, meditation, self-hypnosis, yoga, exercise, good nutrition, and adequate sleep. Avoid self-medicating with alcohol or other drugs. If you’ve listed rapid breathing as a stress symptom, you can learn to slow your breathing when you’re under stress. This helps to bring the fight or flight response under your control. There are many techniques for relaxing tense muscles, and relaxing the body tends to simultaneously relax the mind. I used to teach clients a method of focusing on the sensations in each of the muscle groups of the body in turn, tensing and relaxing each muscle group until they became aware that they could relax them at will by focusing on the changing sensations. It’s a form of mindfulness.

Learning time management or anger management might be part of your stress management plan. The best single mental stress management I’m aware of – besides meditation, which calms both body and mind – is rational thinking. (I’ve previously published several posts on rational thinking as a learnable skill.) Any stressful situation can be made more stressful by the way we think about it, and the effects of stressors in our lives can be minimized by thinking about them rationally. Failing to achieve something you wanted to achieve doesn’t make you “a Failure.”  Telling yourself that you’ll never get over a loss can be a stress-inducing self-fulfilling prophesy. Thinking that they “can’t stand” something has never helped anyone to cope with distress.

Some stressors can be minimized or overcome, others can be tolerated until circumstances change, by developing coping skills. We can all learn to manage our stress to some degree, if we understand it for what it is and make a conscious effort to control its effect on our lives. Coming up with your own personalized stress management plan and implementing it can help you to become more resilient in times of adversity, and might add years to your life.


Mindfulness and meditation

Mindfulness has become a buzzword, not only in psychotherapy, but in the mass media. Mindfulness is when you “stop and smell the roses.” Some people are making a lot of money marketing mindfulness training, but learning to practice it costs nothing beyond an investment of your time. An age-old Asian aphorism is that the mind is like a drunken monkey bitten by a scorpion. One of the benefits of this time investment is learning to tame your monkey mind.

Fritz Perls said that past and future are fictions: our lives are spent exclusively in the here-and-now. Buddhism teaches that all suffering arises from attachments, and in that regard it correlates to cognitive behavioral therapy. Self-talk is like a constant mental radio broadcast that most people don’t know how to turn off, as much as they might wish to sometimes. In my career I’ve had many clients who lived their lives in thrall to their frequent or constant irrational thoughts. Learning meditation gives you a way to turn off the mental radio at will.

Mindfulness is a kind of meditation that’s always available to us. It doesn’t require silence, or sitting in the lotus position, or chanting, or concentrating on a mandala, or doing yoga breathing – although all of these practices are valid methods  for learning to meditate.  Mindfulness simply means getting out of your head and being fully present in the here-and-now, the only time there is, without letting your mind wander and without making judgments.

Before I specifically get into mindfulness further, I’ll first share my understanding of meditation in general. I learned to meditate in grad school, and found that there are many methods for learning to stay in a meditative state of consciousness, some of which I listed above. I’ve experienced two distinct levels of meditation. I started out with what I call single-pointed meditation, which means learning to focus on a single thing – a candle flame in a darkened room, a mantra (chant), focusing on your breathing to the exclusion of all other thought. Unrelated thoughts will inevitably intrude, but with practice you can learn to ignore them, let them go, and return your focus to the single point. At first it’s a balancing act, like walking a mental tightrope. When you first realize that you’ve achieved a meditative state, you think “I’m meditating!”, but the instant you think that, you’re not – you’re thinking again. With sufficient practice you can lengthen the time you stay in the meditative state, and develop confidence in your ability to meditate whenever you choose to.

Once I’d learned to stay focused on one thing exclusively, without letting my mind wander to other things, I was able to move on to a new level of meditation – pure awareness. I learned that it’s possible to be awake and aware, without being aware of any thing. Learning to suspend object-consciousness and judgement is a liberation. You can tame your monkey mind, turn off the mental radio. The silence is golden. It’s a distinct state of consciousness that teaches you what thinking cannot teach. It calms the body and the mind.

Mindfulness is a kind of single-pointed meditative state. You can be mindful while performing a task, taking a walk, taking a bath, having a conversation, doing Tai Chi, or standing in a crowd. You can be mindful of your self-talk. Mindfulness means staying focused on your here-and-now experience, to the exclusion of extraneous thoughts and without making judgments like good/bad, beautiful/ugly, or right/wrong.

Many times in public I’ve played a mindful game with myself, a game that teaches me things about my ordinary (non-mindful) consciousness and my monkey  mind. Normally when I’m in public, people-watching, I’m constantly categorizing and judging and speculating about all the people I see: whether or not I find them attractive, whether they’re fat or thin, graceful or clumsy, whether  they seem smart or dumb, likeable or unlikeable, etc.  Sometimes when I catch myself making these instant evaluations, I decide to play “the Buddha game.” I mindfully suspend my monkey mind and imagine that everybody I see is a Buddha – perfect, God in disguise. Just as I believe that meditation has changed my ordinary consciousness over time, I believe that playing the Buddha game has helped me to be less judgmental and more compassionate.

Mindfulness training is at the core of Dialectical Behavior Therapy (DBT), a highly effective therapy developed by Dr. Marsha Linehan to treat people who meet the diagnostic criteria for Borderline Personality Disorder. While she was devising the core strategies of DBT, Dr. Linehan studied meditation with a Catholic priest in a contemplative order and with a zen master. The people for whom DBT was designed tend to be extremely judgmental (of themselves and others) and emotionally volatile. Dr. Linehan became convinced that practicing mindfulness would help them to find balance in their deeply conflicted lives. Having co-led DBT skills training groups and seeing first-hand the effectiveness of mindfulness training, I believe that it’s beneficial for mentally ill people with other diagnoses, too. But as I’ve said many times, you don’t have to be sick to get better. Mindfulness is a learnable practice that can improve your life, if you invest some time in it.


Improving your memory

I’m convinced that memory is something like a muscle – if you don’t use it, it shrinks. Over the years I’ve heard many people, in treatment and in my personal life, complain about their memory. Some folks make excuses in advance, don’t trust their memory, and consequently don’t rely on it. This can be a self-fulfilling prophesy. There are many factors- some biological – that affect memory. I’ve come to believe that one of these factors is a “reinforcement loop” involving (1) trusting your memory and (2) relying on its accuracy from experience and therefore exercising it more often. If you don’t have a biological or psychological impairment, you mostly remember the things you actively commit to short-term memory. This increases your trust in your memory and increases your reliance, which further increases your trust, etc. Part of having a good memory is cultivating good memory habits.

Another factor is mindfulness, as opposed to “being in your head,” lost in thought. I used the term “actively commit to memory” above. Actively committing something to memory is something like active listening: it requires mindfulness. Mindfulness is being present in the only time there is – this moment. I’ve admitted in a previous post to having obsessive-compulsive traits. There are times when I leave the house preoccupied with thoughts, and then worry because I can’t remember locking the door. But when I lock the door mindfully, it’s as if I have a video recording of the event in my head, and there’s no subsequent anxiety.

This is an example of committing something to short-term memory simply by paying attention, being mindful. But there are also memory aids known as mnemonic devices that can help you commit things to your short- or long-term memory. Acronyms can serve as mnemonic devices. Ever since I heard of Roy G. Biv ( a made-up name) I’ve been able to name the colors of the spectrum: red, orange, yellow, green, blue, indigo and violet. The first letter of each word in the following sentence is a mnemonic device for recalling the planets in the solar system, in order of their distance from the sun: “Molly very easily makes jam, sometimes using no pectin.” A sentence is often easier to memorize than a list of names, and this sentence is the key to remembering: Mercury, Venus, Earth, Mars, Jupitor, Saturn, Uranus, Neptune and Pluto. You can make up your own mnemonic sentences to memorize things. Rhymes can also be mnemonic devices, as with “Thirty days hath September/ April, June and November./ All the rest have thirty-one/ Except the second month alone./ To it we twenty-eight assign/ ‘Til leap year gives it twenty-nine.”

Another mnemonic device – an ancient technique now known as image mnemonics – involves visualizations that serve as “pegs” to hang list items on. I’ll share two variations on that technique that will allow you to reliably store a ten-item shopping list in your short-term memory. The first variation is to memorize ten places in or around your home, in a specific order, such as the order in which you’d encounter them when you come home. Number one might be your driveway, number two the walkway to your front porch, number three the front porch, number four the hall table just past the door, etc. Once you have the places memorized in order, have somebody name random grocery list items – slowly, as you indicate you’re ready. When each item is specified, imagine it -perhaps in some altered or exaggerated form – in the sequential locations. The weirder the image, the better. If the first item is bread, you might imagine a giant loaf blocking the driveway. If the second item is eggs, imagine a row of colored Easter eggs on the walkway. If the third item is chicken, imagine a live chicken clucking on the front porch. Once you have an image for each grocery item pegged on one of the memorized locations, all you have to do to recall the items is to mentally go to the ten locations in order and name what you put there.

The other variation is to memorize these ten words that rhyme with the numbers one through ten: bun, shoe, tree, door, hive, sticks, heaven, gate, line (as in clothesline) and pen (as in pigpen). As you’re given the ten items, match each one of them with one of your ten images, in order. You might end up with a whole, raw potato in a bun, a shoe filled with milk, a tree hung with toilet paper, a giant fish standing at the door, a beehive buzzing with flying shrimp, a fried egg on a pile of sticks, a turkey at the gates of heaven, a gate made of cheese, bagels hanging from a clothesline, and a pen filled with bacon.

This mnemonic device works by allowing you to create an association between random items you want to commit to your short-term memory, and a fixed sequence of mental pegs on which to temporarily hang the items. I’ll be writing more about memory in future posts, but in the meantime you can amaze your friends with your ability to memorize lists. Once you understand the principles, you can create your own mnemonic devices, and work at developing good memory habits.

Trains of thought

In my last post I said I’d explore how an initial irrational thought can lead to a train of connected irrational thoughts, expanding from incident-specific to generalized irrational thoughts. Thinking this way doesn’t help you to feel the way you’d like to feel, or to act wisely.

I used to lead a psychoeducational group (as opposed to a process group) called Skills for Recovery at South Carolina’s largest psychiatric hospital. When I taught my module on rational thinking and irrational trains of thought, I’d draw a crude train on the whiteboard as I taught the concepts. I started by drawing a rectangle on “wheels” on the right-hand side of the board, adding a smokestack and a triangular cowcatcher to distinguish it as the locomotive. Then (right-to-left) I’d draw several more rectangles on wheels – boxcars – behind the locomotive. Inside the locomotive rectangle I’d write Activating Event, then I’d write Thought 1, Thought 2, Thought 3, etc. in the boxcars (right-to-left). My standard rap on trains of thought went something like this:

Trains can take you places, hopefully places you want to go. Trains of thought can also take you places. If your thoughts remain rational, your trains of thought  will take you in positive directions. If they’re irrational, they’re likely to take you places you don’t want to go. Take Luke for example. He’s between girlfriends and looking for a new one. He fancies himself a pretty good dancer, and likes to hang out at dance bars and clubs. He’s attracted to Lucy and has seen her out on the dance floor with different men. He works up the courage to approach her at the bar, introduces himself, and asks her if she’d like to dance. She says “No thanks,” gives no qualifiers or explanations, and walks away. Luke isn’t sure how to read her Mona Lisa smile.

Luke’s first thought is rational. “I’m disappointed that she doesn’t want to dance with me.” If he remains rational, he might think “I don’t know why she turned me down. I probably never will, and that’s okay. It may not have anything to do with me, personally. I’ll find someone who wants to dance with me before the evening’s over. And even if I don’t, it’s not the end of the world.” If, instead, Luke has a gut reaction and starts thinking irrationally, his thinking might go in either of two directions: what’s wrong with her, or what’s wrong with me? If he boards the former irrational train, he might conclude that (T1) she’s either a lesbian, or that (T2) she’s stuck-up and thinks she’s too good for him. After another drink, he might start to generalize that (T3) all women are like that, thinking they’re better than us, and that (T4) they’re all stuck-up bitches who don’t know a real man when they see one. Luke’s behavioral response to these angry thoughts is to get hammered.

Luke may instead think of his rejection by Lucy as proof that there’s something wrong with him. He might jump to the conclusion that (T1) she turned him down because she doesn’t find him attractive – which may or may not be the case. He’ll probably never find out, but irrational thinkers with low self-esteem tend not to give themselves the benefit of the doubt on such self-judgments. Luke may think that (T2) he was foolish to ask Lucy to dance in the first place; he should have known she’d turn him down. He may convince himself that (T3) there’s no point in asking any other woman to dance, because she’d just turn him down like Lucy did. Riding that irrational train of thought, he might generalize that (T4) he’s just not attractive to women. From there he might label himself (T5) a pitiful Loser who will never find love, and leaving the club thinking suicidal thoughts.

Suicide is a mood-specific behavior; people never try to kill themselves because they’re elated. Some impulsive suicide attempts are triggered by a train of irrational thoughts, culminating in the irrational belief that suicide is the “solution” to the present conflict or problem. This kind of irrational thinking can be fatal. Suicide hotlines have saved innumerable lives by engaging people who are in crisis in compassionate dialogue until the suicidal mood passes.

Trains of irrational thought are perpetuated when we don’t recognize them as such, and ruminate on them. Situational depressions can be drawn out by dwelling on negative thoughts. If you should catch yourself ruminating on negative thoughts, learn to identify and challenge them. Luke might challenge his persistent thoughts that he’s a pitiful Loser in this manner: “Is it a fact or do I just feel that way? If it’s a fact, what’s the proof? Some pretty women have been attracted to me, and I don’t even know if Lucy turned me down because she doesn’t find me attractive. I have friends who believe in me and don’t think I’m a Loser. Loser is just a word, anyway. I’m not a Loser! Like everyone else, sometimes I win and sometimes I lose. Anyway, sitting here staring at the floor and feeling sorry for myself isn’t helping anything. I need to go for a run.”

Negative, irrational thinking and ruminations can be a “rehearsal for failure,” while riding rational trains of thought can be a “rehearsal for success.” People  who become mindful students of their own thinking can eventually become experts on their own thinking and where it typically takes them. They can avoid the traps of irrational thinking and ride trains of thought that take them to chosen destinations. Cognitive and cognitive behavioral therapies resonate with the buddhist teaching that all suffering arises from our attachment to things – in this case to irrational thoughts and expectations. Irrational thoughts often lead to irrational decisions and behaviors, based on false assumptions. Becoming a rational thinker means learning to spot and challenge your irrational thoughts before you act on them. It gets easier with practice.


Rational thinking

My therapeutic orientation was existential and I was trained in a humanistic psychology program, but as I told both clients and colleagues, if I had a Gospel to preach in my clinical practice it was the Gospel of Rational Thinking. It’s a learnable skill and I wish it was a standard part of the public school curriculum; but the corporate state wants the public education system to turn out conditioned consumers, not independent thinkers. Independent thinkers are as hard to herd as cats. I’ve practiced and taught rational thinking for decades. Being able to spot my irrational thoughts before acting on  them has kept me from making innumerable mistakes and spared me a lot of unnecessary pain over the years. (I actually met Dr. Albert Ellis, creator of Rational Emotive Behavior Therapy, at a professional conference. I’ll tell you more about him in a later post.) Rational thinking is an important component of cognitive and cognitive behavioral therapies, whether irrational thoughts are labeled as thinking errors or as irrational self-talk. The wisdom of rational thinking correlates to the teachings of buddhism and to the Serenity Prayer. It’s a learning program that teaches people how to think rationally, without telling you what to think. It’s the opposite of  – and the antidote to – indoctrination.

We all engage in self-talk, our constant mental monologue, judging and labeling and making choices throughout our waking hours. Some self-talk is innocuous, but other self-talk carries a lot of weight and guides our subsequent behavior. Some of it is rational, but some is irrational – for all of us, even psychologists. In my experience most people can’t always tell the difference between their rational and irrational thoughts, and sometimes suffer painful or destructive consequences from their irrational thinking. Rational self-talk helps us to feel the way we want to feel and accomplish what we want to accomplish. Irrational self-talk leads to avoidable negative emotional states (anxiety, depression, anger) and undermines our ability to function at our best.

Many irrational thoughts are characterized by the words “always” and “never,” “should/shouldn’t” and “must.” Some examples: “I should always make a good impression on people.” “Things never go my way.” “I’ll never succeed in life.” “I shouldn’t ever let down my guard around people. They always take advantage of you.” “Life should be fair.” “I must get this promotion!” When people think irrationally, they set themselves up for disappointment, or worse, when things don’t go as they’d hoped.

At times we all wish the world was fair. But it isn’t, and thinking that it “should be” doesn’t help anyone. You might not always succeed at things you really want to succeed at, but that doesn’t make you a “failure” or a “loser.” If we tell ourselves that we’ll “never” get over a loss, we’re programming ourselves to suffer endlessly. If we expect to “always” perform optimally in interpersonal situations, we’re not allowing for the fact that we’re all flawed human beings. To err is human, and to expect perfection, or to always succeed at everything we do, is to court disappointment. Great expectations can lead to great disappointment, and moderate expectations to moderate disappointment. But if you engage in an enterprise because you feel it’s the right thing to do, with no specific expectations pinned to the outcome, you can’t be disappointed.

Here are some categories of typical irrational thoughts: Catastrophizing is imagining that worst-case scenarios are likely outcomes. Minimization is wearing blinders that don’t let you see your own strengths, or the positive potentials in a situation. Grandiosity is feeling superior, having an exaggerated sense of self-importance or ability. Personalization is when someone thinks “It’s all about me.” Thinking you’re the center of the universe. Magical thinking is characterized by acting ritualistically, as if a ritual behavior will bring about a desired outcome. Leaps in logic have to do with jumping to conclusions not based on evidence. Mindreading means attributing motives for a person’s behavior without evidence. “I know why he did that!” All-or-nothing thinking is the inability to see any shades of gray between poles of black and white. Paranoia is characterized by unjustified suspiciousness and feelings of persecution.

I’ll be writing more about mindfulness over time but, suffice it to say for now, one kind of mindfulness is paying close attention to your self-talk and where it takes you, emotionally and behaviorally. With practice, you can learn to immediately distinguish your irrational thoughts from your rational thoughts. In cognitive therapy, when you identify an irrational thought, you learn to frame a challenge to that thought. An example: “I may have lost out on that promotion, but that doesn’t mean I’m a loser.”

I used to teach clients a method called a “4-Step Check” to help them learn to spot and counter their irrational thoughts. After an upsetting event, you analyze it in writing. (1) Event. Describe what happened. (2) How I felt. This might include multiple emotions. (3) What I did.  What would a videocam have recorded? (4) What was/were my irrational thought(s). With enough practice writing 4-Step Checks, spotting irrational thoughts eventually becomes automatic, and you don’t have to do them on paper anymore.

Here’s an example of a 4-Step Check by Charles, an alcoholic in early recovery: (1) Jim, my new AA sponsor, promised to pick me up at 7:30 sharp for an 8:00 meeting across town that he knew was important for me. When he hadn’t shown up by 7:45, I hailed a cab. (2) I felt desperate and alone in the world. I got angrier every minute Jim was late. (3) I kept looking at my watch, sometimes several times a minute.  I paced back and forth on the sidewalk, cursing. I kicked a dog. (4) I should never have asked Jim to be my sponsor. He’s doesn’t really care what happens to me. He’s a selfish, unreliable bastard! You just can’t rely on anyone. I should just go to a bar instead of paying for a taxi to get to the meeting.

As it turned out, Jim showed up late to the meeting and afterwards apologized sincerely, explaining why his tardiness had been unavoidable. So Jim did his 4-Step and was able to spot his irrational thoughts and how they were related to his emotions of the moment. You may have noticed that Charles’ initial irrational thoughts were specifically related to Jim’s failure to show up when he said he would. But then he starts to generalize, telling himself that people aren’t reliable and that working on recovery is useless – a rationalization for relapse. This is an example of how an irrational thought can lead to a progressively irrational train of thoughts, going from specific to generalized irrational thinking. None of these thoughts can help Charles to feel the way he’d like to feel or to help him achieve his goals.

Any irrational self-talk statement can be challenged by asking, “How do I know that to be true? What is my proof?” In my decades as a therapist I urged many clients to “become a student of your own thinking.” Every day holds new opportunities to learn about yourself, if you pay attention. In time you start to see the patterns of your own irrational self-talk, and you internalize the 4-Step Check. Spotting irrational thoughts becomes a learned reflex and voila!, you’re a rational thinker. In my next post I’ll get into “trains of thought” that take people to places they don’t need to go.