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Simcha

Emotional avoidance: Make it go away!

Emotional avoidance: Make it go away!

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Lately I’ve been thinking about the various ways that people try to avoid their emotions. And it’s understandable. Emotions can feel pretty scary, especially when they get intense. Intense anxiety can elicit a sense of impending doom, the physical symptoms that accompany panic can generate a sense that one is having a heart attack, and individuals overcome with anger can feel like they are going to explode. So it makes sense that we would want to avoid negative emotions. In fact, it’s not uncommon for people to cite getting rid of an emotion like anxiety as their initial goal for therapy.

Problems with wanting to eliminate negative emotions

Although it’s understandable to want to avoid negative emotions, either by numbing ourselves when they arise, or wishing we could eliminate them altogether, there are several reasons why this isn’t actually a good idea.

1. Our emotions are useful signals. A helpful analogy here is to think of physical pain – although many people wish they could avoid or prevent physical pain, pain signals give us useful information that we need to protect ourselves (indeed, people who do not get these pain signals often develop serious injuries; see link). In a similar way, our emotions are there to tell us something. For example, when we feel threatened in some way, anxiety alerts us to the possibility that we may need to protect or prepare ourselves. Without any anxiety, we might take risks that put us in physical danger, or we might shirk our responsibilities altogether.

2. It’s often not possible. When we suppress an emotion, it doesn’t typically go away.

a. The emotion might actually intensify over time (have you ever tried to push away feelings of frustration about something only to blow up about it later on?). In this way, our emotions are not all that different from children asking their parent for something – what do they do if they don’t feel heard? They raise the volume (sometimes very, very loudly!).

a. Or the emotion might come out in a different form, which can be hard for those around you to understand (e.g. if you become passive aggressive) or in ways that might confuse even you (e.g. you might be unsure of why you feel tense, irritable or drained).

3. The ways that some people try to avoid negative emotions, including drugs or self-harm, can lead to more suffering. Sometimes people avoid thinking about negative emotions by throwing themselves into projects or focusing on the world outside of their inner experiences (e.g. with to-do lists, focusing on other people’s problems); this can be a hard one to detect because we might trick ourselves into thinking that we are being productive when we might also be avoiding (the motivation behind our action is the important distinction here).

So, you want me to just…what? Sit with my emotion?

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Although this might seem crazy at first, allowing ourselves to sit with a negative emotion provides us the opportunity to see that our emotional wave (although very uncomfortable) will decline in intensity over time and will not destroy us. Also, by not trying to “do something” to get rid of the emotion at the peak of its intensity, we might avoid doing something impulsively which we might later regret (McKay, Wood, & Brantley, 2007).

Rather than telling ourselves that our emotions do not make sense, that we should not be feeling that way, that our emotions are dangerous, or that we should try to get rid of them, we can try to identify what emotions we are experiencing in that moment (e.g. I feel angry), validate for ourselves that our feelings are understandable in light of the situation or context (e.g. it’s understandable that I’m angry because this situation is unfair), provide ourselves with words of compassion (e.g. I know this is really hard right now, and I know I will get through this), and ask ourselves what it is that we might need - not what we need to get rid of the emotion, but what we need to take care of ourselves (e.g. restorative activities like a nap, working toward boundary setting)…and if we’re really up for challenging ourselves, we can even thank our emotion for drawing our attention to this need and for giving us the opportunity to take care of ourselves in a more compassionate and present way (Neff & Germer, 2018).


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

1. https://ghr.nlm.nih.gov/condition/congenital-insensitivity-to-pain

2. McKay, M., Wood, J.C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance. Oakland, CA: New Harbinger Publications.

3. Neff, K. & Germer, C. (2018). The mindful self-compassion workbook: A proven way to accept yourself, build inner strength, and thrive. New York, NY: The Guilford Press.

Less What, More Why

Less What, More Why

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In sessions, clients often contemplate important decisions, such as whether to quit a job or whether to end a friendship. We sometimes go into problem-solving mode and consider practical factors, like the pros and cons of their different options. But over time, I have found myself focusing less on the ‘what’ and more on the ‘why’. That is, why they would be making that decision. So often, I don’t think that either of the options they are contemplating is inherently right or wrong, good or bad; but the reasoning behind it can vary in how healthy or constructive it is for them.

Let me give you a couple of examples to illustrate what I mean:

1. Imagine that you want to stay home and cancel plans to go out with friends over the week end. Again, there is nothing inherently right or wrong about this decision. But the reasoning is important.

a. You might be doing this because you have had a busy week and you find alone-time nourishing, especially when you spend it resting and engaging in hobbies that you enjoy.

b. However, you might also be making this decision because social situations make you nervous and you’d rather not put yourself through that. Indeed, anxiety often elicits the urge to avoid. People struggling with social anxiety often find themselves avoiding social situations which make them anxious (American Psychiatric Association, 2013). Importantly, avoiding something that makes us nervous can lead us to feel relieved in the short-term, but may actually serve to reinforce our fear over time (see Barlow & Craske, 2007).

In this example, the same behavior can be performed in the service of self-care in the former instance, and as an act of avoidance in the latter.

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2. Imagine that you often find yourself doing more than your fair share in a relationship. Over time, you might find yourself feeling hurt or resentful. You may be tempted to dial back how much effort you’re putting in for a while. There is no clear good or bad choice here, and this is where I would suggest that you pause and ask yourself why; what would be your goal in reducing your efforts?

a. You might be driven by a desire to make things more equitable in order to avoid feeling resentful toward your partner in the future. Indeed, some research suggests that relationship partners are more satisfied when they view the relationship as equitable (Stafford & Canary, 2006).

b. However, you might also be doing this to test your partner, that is, hoping that they’ll notice the change in your behavior, detect your underlying dissatisfaction, and adjust their behavior accordingly (e.g. by expressing more appreciation or doing their fair share). This can be risky for multiple reasons, including that your partner may not recognize the message you are trying to send and/or that they might not appreciate being tested in this way.

As you can see, the same behavior can aim to prevent resentment in one case, or to test the relationship in another case.

The practice of pausing and asking ourselves why may help us to get in touch with our underlying motivations, so that we can make more informed decisions. In so doing, it brings us one step closer to purposeful and thoughtful responding - rather than simply reacting.


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References and Resources

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Barlow, D.H. & Craske, M.G. (2007). Treatments that work: Mastery of your anxiety and panic (4th ed.). New York, NY: Oxford University Press.

McKay, M., Wood, J.C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance. Oakland, CA: New Harbinger Publications.

Stafford, L. & Canary, D.J. (2006). Equity and interdependence as predictors of relational maintenance strategies. The Journal of Family Communication, 6, 227-254.

The Ins and Outs of Introverts

The Ins and Outs of Introverts

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One thing that I’ve noticed more and more in my sessions recently is that individuals who consider themselves to be more introverted have often been told that we were too shy or have had people try to bring them out of their shells at some point in their lives. Messages about the advantages of extraversion abound in North America. As kids, we are taught to be social, talkative, outgoing, assertive, and communicative. Extraverts might be more comfortable when it comes to public speaking, job interviews, or group work. And extraverts might even get more attention, at least according to American proverbs like “the squeaky wheel gets the grease”.

Introverts, on the other hand, might get overlooked or feel overwhelmed by the high energy stimulation of sleepovers, school dances, family reunions, or work functions. And in an Instagram world where we are constantly sharing what we are doing and thinking with others, introverts might be left feeling like there is something wrong with them if they would rather keep to themselves.

Introversion has been shown to be associated with multiple strengths (e.g. Feist, 1999; Lee, 2017), many of which are described in the New York Times bestselling book entitled Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain (2012), whose TED talk can be seen here. Here are a few things to keep in mind if you’re friends with, in a relationship with, working with, or raising, an introvert:

First, try not to mistake introversion for social anxiety: According to the Diagnostic and Statistical Manual of Mental Disorders – 5th edition, individuals with Social Anxiety Disorder often worry that others will judge them negatively or that they will humiliate themselves; people with this disorder might avoid social situations because they anticipate social rejection. These symptoms elicit considerable distress and/or negatively impact their ability to function in areas like relationships, work or school. In contrast, introverts may simply prefer to spend time alone or with one or two close friends because that is how they recharge or because they genuinely enjoy solitary activities like reading. So, before you try to bring introverts out of their shells or nudge them to be ‘more social’, consider their reason for spending time alone or for limiting their time spent in groups.

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Also, consider what you appreciate about them, just the way they are: Notice things about the introverts in your life for which you are especially grateful – maybe they are really good listeners, good at keeping secrets, empathetic, down to earth, and funny once you get to know them. Consider sharing this with them; it may be especially appreciated if they grew up surrounded by messages that they were too quiet or shy.

And finally, take it as a compliment: Because they would often rather be alone or with one or two people, them choosing you as one of the people who they enjoy spending time with might mean that you are special to them and that there is something about you in particular that they really cherish!


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Cain, S. (2012). Quiet: The power of introverts in a world that can't stop talking. New York: Crown Pub.

Feist, G.J. (1999). The influence of personality on artistic and scientific creativity. In R.J. Sternberg (Ed.), Handbook of creativity (pp. 273–296). New York: Cambridge University Press. 

Lee, S.S. (2017) Has medical education killed “silence”? Medical Teacher, 39, 444-445, DOI: 10.1080/0142159X.2016.1248919

Michael Phelps: Breaking records, smashing stereotypes

Michael Phelps: Breaking records, smashing stereotypes

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Have you ever heard someone suggest that ‘Depressed people are lazy, and they just need to toughen up’? Not only can such statements be extremely hurtful, but evidence flies in the face of such thinking.

Case in point: Olympic athlete Michael Phelps’s battle with depressive symptoms and suicidality. One thing that makes his story so compelling is that he is a record-breaking gold medalist whose training undoubtedly requires tremendous focus and dedication, and who most people would certainly not consider to be ‘weak’ or ‘lazy’.

In recent years, he has opened up about his experiences (1, 2). Let’s take a look at what he has shared, and how this might relate to mental health more broadly:

1. He cited social support as an important factor which helped him realize that suicide was not a good solution.  My clinical experience has shown me that people with depression often tend to isolate themselves. Low mood seems to say ‘just stay in bed, cocoon yourself under the warm covers, things will seem quieter and safer there, and you won’t have to struggle to expend energy interacting with people or doing activities.’  Sometimes people feel like they would be burdening others with their problems, or that others won’t understand what they are going through. But the reality is that isolating ourselves from the people who truly care about us can contribute to further worsening our mood, resulting in a vicious cycle where low mood makes us want to isolate ourselves, which in turn can contribute to further lowering of our mood. And ironically, sometimes the periods when our mood is lowest and our inclination to confide or socialize is plummeting can actually be among the most important times to do the opposite and reach out.

2. He reported having been critical or disappointed with himself when he did not beat a certain world record. This suggests that he may have had a focus on outcome goals, where the motivation is tied to the result (e.g. winning a competition), as opposed to process goals where the focus is on the steps involved (e.g. hard work, love of learning) (3). This may have left him feeling like a failure when he did not achieve his desired outcome. Indeed, some research has found that process goals can have certain advantages, including more enjoyment (4). I’ve often heard clients say things like ‘I’ll be happy when I achieve x goal / when I hit x milestone / when x is over’, but as clinical sports psychologist Kristen Keim noted, it is important to take pleasure in the process and in the moment (5).

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3. He reported that his sense of self-worth declined after he retired from swimming. Sports psychologist Dr. Goldman noted that equating identity with sport can lead some athletes to lose their sense of self (5). It can be very risky to put all of your eggs in one basket by linking your sense of self-worth to any one area of life (be it academic performance, romantic relationships, or physical appearance) because of the negative ramifications for mood and/or self-esteem when we don’t perform as well as we would have liked in that area, or when our involvement in that area diminishes. As such, some therapies encourage clients to develop and value multiple domains of life (6).

4. He noted that he had not reflected on his accomplishments along the way. Perhaps it is surprising that someone who has won so many gold medals during his career would not have already reflected on his successes. But many of us can relate to being focused on getting things done; it can feel like we are running on a treadmill that is going so fast that we struggle to keep up and to catch our breath, making it a real challenge to focus on the present moment and to practice mindfulness. See my colleague Natsumi’s blogpost to learn more about mindful awareness and how you can begin to incorporate it (7).

5. He was initially reluctant to get help, and anxious about the idea of change. Some people think – if you’re not doing well, you should jump at the chance to feel better, right? In reality, things often aren’t that simple. In many ways, we are creatures of habit, and we often find comfort in familiarity, even if that familiarity isn’t ideal. The idea of some unknown change can feel risky or scary, and people may wonder if they are capable of change, if that change will be sustainable, or if they will be fundamentally different people when their depressive symptoms have improved. These are all valid questions; make sure to raise them with your therapist if they are of concern to you.

6. Having benefitted from treatment, he went on to raise awareness and develop a foundation aimed at promoting stress management for youth. Although not everyone will have their own foundation, some people are eventually able to make meaning or see the silver lining in their experience, for instance, by noting that their own struggles have improved their ability to empathize with others and to demonstrate self-compassion.

Bottom line: Struggling with depression does not make someone weak or lazy. And the wide variety of people coming forward about their own experiences demonstrates that very accomplished, hard-working and motivated individuals can struggle with mental health problems. Michael Phelps’s experience illustrates this point well, as well as the importance of factors like social support, motivation, self-worth, and mindfulness in mental health.


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

  1. http://www.cnn.com/2018/01/19/health/michael-phelps-depression/index.html
  2. https://www.cnn.com/2017/07/03/sport/olympics-michael-phelps-swimming-mental-health/index.html
  3. Qu, Y.., Pomerantz, E. M., & Deng, C. (2016). Mothers’ goals for adolescents in the United States and China: Content and transmission, J Res Adolesc., 26, 126-141.
  4. Wilson, K. & Brookfield, D. (2009). Effect of goal setting on motivation and adherence in a six-week exercise program. International Journal of Sport and Exercise Psychology, 6, 89-100.
  5. https://www.theatlantic.com/health/archive/2016/08/post-olympic-depression/496244/
  6. Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York, NY: The Guilford Press. 
  7. https://connectepsychology.com/blog/2016/1/11/3-simple-mindfulness-practices-for-coping-with-difficult-experiences-and-emotions-in-day-to-day-life

It’s fall already?! 5 ways to cope with end-of-summer blues

It’s fall already?! 5 ways to cope with end-of-summer blues

       Fall is often a time where we get a high volume of referrals at the Connecte Montreal Psychology Group – and that’s not entirely surprising - the warm weather is fading and the reality of back-to-school/work (whether for ourselves or our kids) is setting in. All of this can contribute to feelings of heightened sadness (as we ‘mourn’ the end of summer) or anxiety (as we picture the next few months like a mountain of upcoming work projects and dread the inevitable shift to colder weather). Some research even shows an association between vitamin D (which we get in part from the sun) and mood (Anglin, Samaan, Walter, & McDonald, 2013). It might seem like an objectively undesirable situation that we just can’t do much about. As it turns out, we have a lot more control than we may realize. In this blogpost, I’ll suggest some specific things that you can do to make this transition to fall more bearable, and hopefully even enjoyable.

#1. Take things one step at a time. It sounds cliché, but it’s true! Take the example of a student who, on her first day of school, looks at her syllabus and sees every chapter she will have to read, every assignment she will have to write, and every exam she will have to take for the remainder of the school year… of course she would feel overwhelmed and/or anxious! And she’s right, at some point she will have to undertake all of those challenging tasks. But viewing the school year that way is akin to looking at all of the food she will eat in a semester piled up on her kitchen floor – that would be enough to make even the biggest foodie lose her appetite. Instead, we want to take things one step at a time. For example, instead of thinking of everything you have to do in the upcoming semester, try instead to focus on what you have to do that week, that day, or even that morning. This change in perspective can make things more manageable. Indeed, much research has shown that the way we think about things can have a tremendous impact on our mood (Greenberger & Padesky, 2015).

#2. Shift your basis of comparison. If you love warm weather and find yourself feeling down after comparing the current 12-degree weather to the sunny 22-degree days that we enjoyed just a few short weeks ago, try to then compare the current weather to the much colder temperatures that we have endured (‘well at least it’s not anywhere near as cold as it was in February!’) or that people in other countries are currently exposed to. Maybe there are some things you could do without from the summer months – like the sticky humidity or those pesky mosquitos! Shifting our baseline can have a big impact on how we perceive our current situation.

#3. Consider whether there is anything you actually LIKE about the change in seasons.

a. Maybe you think it’s super interesting that we in Montreal get to have four seasons, whereas temperatures in some other places stay pretty constant over the course of the year; this gives us the opportunity to see our city through an entirely new lens – doesn’t your neighborhood look totally different when the streets are basked in sun versus colorful fall leaves or a blanket of fresh white snow? That variety can keep things novel and exciting should we choose to look at things this way.

b. Make a list of all the fun things you can do in the upcoming season(s) that you didn’t get to do in the previous one. Maybe you finally get to go skiing again once the weather gets cold enough - especially if one of your values is being healthy/active or being in nature. Or maybe you just love watching your kids roll around in the colorful fall leaves. Maybe you have been meaning to take up photography and the changing city views are leaving you inspired. Instead of looking back longingly at the lovely summer we just had or dreading the upcoming winter, why not plan fun things that you can look forward to doing in the coming month or two? Maybe you can rent a cozy log cabin with your family or friends, or maybe you can look forward to the winter holidays.

c. If you’re having a hard time thinking of something you actually like about the colder months, one of my favorite ways to do this is to follow the lead of children! Those little people know how to have a good time – and they can be a great source of inspiration – snow fights, rolling down a mountain, etc. 

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#4. Instead of trying to deny or disconnect from the inevitable fact that the season is changing, practice heightening your awareness by being mindful about these changes; try to be fully conscious and aware of the present moment, without being judgmental of your experience (click here for a review of the positive effects that mindfulness can have on mental health). Consider the difference between walking out of your house and grumbling to yourself about how the weather is getting colder versus taking a minute to notice how the crisp fresh air feels on your cheeks, how the crunchy leaves feel when you step on them as you walk down the street, etc. For more information about mindfulness, check out my colleague Dr. Natsumi Sawada’s blogpost.

#5. Increase self-care. Self-care can mean different things to different people; examples include taking time to prepare a healthy meal for yourself, reading a book by your favorite author, going to bed early, going for a run, or carving out time to catch up with a good friend. You might even talk to that good friend about how you notice a dip in your mood around this time of year; he or she might feel similarly, and it might help you to feel that you two are in it together. Self-care can contribute to improved mood, and pre-emptively engaging in more self-care activities can be especially helpful if you have noticed that your mood has tended to dip around this time of year in the past. Check out my colleague Dr. Jodie Richardson’s 3-part blogpost for more information about self-care.

Importantly, these same tips (e.g. shifting your baseline, increasing self-care) can be applied to many other life situations that might have you feeling down. Although the end-of-summer period can be rough for many of us, my hope is that these tips help to make that transition a bit easier!


Simcha Samuel is a clinical psychologist in Westmount, Montreal, Quebec, at Connecte Montreal Psychology Group. The team at Connecte loves writing about ways to boost our mental health and bring psychology into our everyday lives. For more helpful tips, check out Connecte’s blogspodcast, follow @connectepsychology on Instagram or like us on Facebook.


References

Anglin, R. E. S., Samaan, Z., Walter, S. D., McDonald, S. D. (2013). Vitamin D deficiency and depression in adults: Systematic review and meta-analysis. The British Journal of Psychiatry, 202, 100–107.

Greenberger, D. & Padesky, C. A. (2015). Mind over mood, second edition: Change how you feel by changing the way you think. New York, NY: The Guilford Press.

Keng, S.-L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clin Psychol Rev, 31, 1041–1056.