Embarrassment & Shame

19 May

In our research centre, we have a  birthday tradition that I learned during my time as a postdoctoral fellow with Dr. Marsha Linehan. On our birthdays, we have to answer three important birthday questions: What are we most proud of from the last year? What are we most looking forward to over the next year? What is the most embarrassing thing that has happened over the past year? As you can imagine, this birthday tradition is both fun and, for some, incredibly anxiety provoking. Even before people get to the question about the most embarrassing thing, they often feel embarrassed about talking about what they’re proud of. This is rather interesting, in that pride is often considered the opposite of shame (which is related to embarrassment). The way we think about shame in DBT is that shame evolved to help us remain connected with important people or groups. Back when our survival was critically dependent on our ability to maintain harmony and order in our social relationships, it was dangerous and potentially deadly to transgress against one’s social group. If you violated an important rule or norm of the group or possessed some characteristic that the group found undesirable or threatening, you were in danger of becoming separated from that group. And, it was incredibly hard to survive alone (it still is, but perhaps for different reasons). The value of shame in that kind of environment is that it makes you feel like doing things that might protect you against being rejected by the group. For example, when people feel ashamed, they often feel like hiding averting their eyes, lying or misleading people about what they might’ve done or about certain personal characteristics, and so on. Shame also can prompt behaviours like apologizing and attempting to atone for perceived wrongdoings. Given all of this, why would someone feel embarrassed or even ashamed to talk openly about things they are proud of? While expressing a certain degree of pride may have social benefits, possibly by affirming or elevating your status (see some interesting work by Dr. Jessica Tracey on this topic: http://ubc-emotionlab.ca/), discussing your accomplishments could also elicit envy among others. And, envy could be a dangerous emotion. Envy often comes along with a sense of resentment that others have things that you don’t have. Envy could also have evolved as a mechanism to either protect or attain important resources. Considered in this manner, it could be dangerous to make others envious, as they might attempt to take or undermine what you have. Indeed, one of the tendencies that goes along with envy is called “schadenfreude,” or deriving pleasure from the misfortune of others. Although this is perhaps not the most optimistic note on which to end a blog before the long weekend, I will stop here for now and return to this topic next time. ~ Alexander L. Chapman, Ph.D., R.Psych.

One Step Forward…

12 May

Often, in therapy, it can feel like you’re taking one step forward and one or more steps back. There will be days when you feel like you’re headed in the right direction and others when you feel like you’re back to square one. When progress is slower or less consistent than you’d like, the challenge is not to get stuck in demoralization and hopelessness. Even if you’re not in therapy, this experience of feeling right back where you started is common. I’ve often reflected on the past and wondered why I did or said some of the things I did or said when I was younger. Now that I’m older, I figure I’m wiser, and my brain has finally matured. I’d never do or say those things now, right? Well, sometimes, but not always! I sometimes see myself doing things I know are ineffective, and when this happens, I wonder why. I mean, I certainly know better, don’t I? I think I do, actually. One way to avoid getting stuck in the experience that you’re back at square one is to recognize that you can’t possibly be back at square one. Throughout therapy, you learn new things about yourself, other people, and how to cope and manage stress, emotions, troubling thoughts, and so on. You might develop new insights about your past or about where you would like to head in the future. The things you learn don’t simply vanish; thus, you can’t actually return to where you were before. You are, quite literally, a different person than you were when you started. Biologically, we know this to be the case. Our organs, tissues, and even our brains are constantly in a state of change. Moreover, the things we learn at one point are still in there somewhere. Some of the latest research on exposure therapy (a powerful treatment for anxiety-related problems, such as phobias, trauma, and OCD) suggests that the things you learned in the past don’t go away. The bad news here is that, if you learned to be afraid of certain things (dogs, spiders, heights, etc.), that learning doesn’t go away. You might always have the potential to be afraid of these things again. Through therapy, however, you learn new things, such as the fact that people or things you used to be afraid of are not actually as dangerous as you once thought. The good news is that, just like the old learning (that these things are dangerous), the new things you learn that help you overcome your fears don’t simply vanish (see Craske et al., 2014, for an excellent summary of this, related to the topic of exposure therapy). When you learn new things in therapy, new connections in your brain become stronger. There’s even some preliminary evidence that DBT might lead to important changes in brain regions related to the effective regulation of emotions (Goodman et al., 2014). So, whenever you feel like you’re back to square one, remind yourself that this is impossible. Imagine that you’ve moved forward on the path, and the path keeps disappearing behind you. You can’t go backward, and you can’t stay where you are for long. When you experience a setback, try your best to accept this as  a normal part of the recovery process. Avoid judging yourself, remind yourself that you’ve learned and changed, and do your best to keep moving forward. ~Alexander L. Chapman, Ph.D., R.Psych.

Transit

10 May

I’m writing this, or rather speaking it, while waiting for the bus at about 6:45 AM. Several years ago, because of my interest in preserving the environment and saving some money, I pretty much went everywhere by transit. I did this for about five years before giving up and buying a car. It was just too inconvenient and took to long to get to places that were not that far away. It was also challenging to shuttle the kids back-and-forth to their increasing activities, being a one car family. I was fortunate enough to get the exact car I had always wanted, and there’s no doubt that it improved the efficiency, and in some ways, the quality of my daily life. Recently, despite the car, I’ve gone back to using transit a lot more often, and it has been an interesting experience.

People often talk about the main benefit of transit being environmental, but I’m noticing several other interesting benefits.

One key benefit is that taking transit provides many opportunities to practice patience and tolerance. When you take the bus and train a lot, you spent a lot of time waiting. I think I put out a previous blog on waiting, but to reiterate, I think there is great value and practising this skill of waiting for things. In so many areas of life, we all try to be efficient and to avoid waiting whenever we can, but waiting is a normal everyday activity. We wait in line, wait for the bus, wait for our coffee at Starbucks, wait for food, for someone to call or text us back, wait for our children to grow up and mature (and then miss their earlier years!), and so forth. No matter what we do, we’re going to end up waiting for things every day; thus, I think there’s great value in the practice of waiting, and transit offers many opportunities for this. In terms of tolerance, on the bus or train, we often have to tolerate others’ behaviour, smells, sounds, appearance, and so forth. During the winter months, I find myself working to tolerate the fact that everyone around me seems to be coughing up a lung. Sometimes, I can feel the air from such coughing on the back of my neck, and I want to jump out the window. This all probably sounds very unpleasant, but I think it’s great practice at tolerating the small everyday things that bother us.

Finally, I’ve noticed another benefit of transit, and that’s the sense of community that I experience when I’m on the bus or train with other people. This came to the forefront of my mind in the first week of December, at the beginning of the 2016 “Snowmaggedon” event. The bus was chugging up the hill, and we were all in it together, hoping that the folks who were dropped off would make it to their homes, and hoping the bus would make it up the hill. There was a real sense of camaraderie and connection. This is not always the case, but if you practice mindfulness, consider doing this on the bus. Specifically, try to practice mindfulness of the other people around you – mindfulness of the presence of others. Try to use the DBT mindfulness skill of “observing” (Linehan, 2015) to notice your connection with these other people, many of whom you may never talk to, even if you see them every day or every week. Perhaps also use the mindfulness skill of “participating” by actively connecting with those around you (e.g., through greeting, small talk, letting someone enter the train or bus before you, and so forth). Whether you love or hate transit, use it as an opportunity to improve tolerance and practice connecting with others. ~ Alexander L. Chapman, Ph.D., R.Psych.

Embarrassing?

1 May

I was recently on a trip and learned (or rather, re-learned) something interesting about embarrassment. My normal way to keep up with daily exercise is to work out in the morning before breakfast. Because I’m more of an early bird than anyone else in my family, this system works really well: Nobody is awake early enough to ask me to do anything or interrupt my precious exercise routine! When I go away, I try to keep up the same routine, but I often end up in hotels where the room is too small to move around much, or where it would be too cruel for me to jump up and down on the heads of people below me at 5:30am. So, I often go to the fitness room in the hotel. My favourite workout routine is either a specific workout that I get from an app or a combination of that and martial arts practice, weights, and so forth. For a long time, I avoided doing my regular routine in the fitness room, because I was afraid some of my exercises would be embarrassing. All of the other folks in those rooms seem to mainly use the treadmills or stationary bikes. Once or twice, I’ve seen someone doing yoga, but that’s about it. So, I’d just do the treadmill and some weights. The treadmill can be good exercise but is excruciatingly boring. I mean, you’re not going anywhere. It’s like being a hamster in one of those wheel contraptions. And, the TV doesn’t make it any better, because it’s nearly impossible to hear the TV over the sound of the treadmill. Bouncing up and down and trying to read the script on CNN is no fun either. Well, in the past year or so, I decided to just go back to my normal routine (without the yelling or kicking), even in front of others in those small fitness rooms. At first, I felt anxious and a little embarrassed, but I found it helpful to just focus one-mindfully (as we say in DBT) on my exercises and really throw myself into them. My embarrassment went down a bit, or at least I wasn’t as aware of it, until I finished my exercises and wondered whether others thought I was weird. To really conquer the embarrassment, I realized I had to look around and become aware of those around me, rather than intently ignoring everyone. I noticed nobody was giving me strange looks, avoiding me, leaving the room, or calling security. In fact, on a recent trip, an older gentleman came up to me and said, “That’s an interesting exercise routine. Where did you get it from?” I told him about the app I use and the other stuff I do, and went back to it with renewed vigour. The next morning, I saw same fellow again, and he told me he bought the app and is going to give it a try soon. This kind of thing has happened a couple of times now. As a result, I’ve begun to realize that my embarrassment wasn’t really “justified” (another DBT term) at all. On the contrary, I’d become some kind of fitness mentor for those poor souls who would otherwise be chained to the treadmill, sweating it out while trying to make sense of the recent news stories about President Trump. Ok, so this might seem to be a simple life lesson, one that you’d think a psychologist would have learned many years ago, but sometimes, the simplest life lessons are the ones we have to keep learning over and over again. And, there’s nothing simple about embarrassment, shame, and other such emotions. I’ll come back to this soon in another blog. ~ Alexander L. Chapman, Ph.D., R.Psych.

Walk Carefully

19 Apr

Crossing the street can be a dangerous activity. A few weeks ago, I was waiting to cross a busy downtown street, and a couple of fellow pedestrians were standing next to me looking at their phones. When the light changed, they began to walk. This was one of those intersections, however, where the light changes a good 20 seconds in advance of the safe walking signal, to allow cars to make left turns via an advanced green arrow. My fellow pedestrians were about 1/5th into the intersection before they realized their error. It wasn’t a close call this time, but it easily could have been. I’ve seen cars narrowly miss pedestrians in similar circumstances – in fact, in this very intersection. This reminded me of the importance of proceeding with caution, which of course, reminded me of mindfulness and one of the newer skills in DBT (Linehan, 2015). In particular, there is a skill called the STOP skill. STOP stands for Stop, Take a step back, Observe, and Proceed mindfully. The skill is especially helpful in situations in which you normally act on impulse. It’s important to first identify the high risk situation. This requires some awareness that a given situation is potentially risky. For people who have trouble with gambling, such risky situations could include being around friends who like to drink and gamble, driving by a casino, staying in a hotel in a different town where a casino is nearby, drinking, smoking, and so forth. For people who have trouble with alcohol or drugs, risky situations might similarly involve people, places, or things associated with alcohol or drug use. Coming back to crossing the street, we all do this so often that it probably ceases to be a risky situation in our minds. It might be important to know, then, that there were approximately 47 pedestrian deaths per month in British Columbia in 2016 alone (http://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/mvi-pedestrian.pdf). The number of pedestrian accidents involving injury is most assuredly considerably higher. Further, I would suspect the majority of pedestrian accidents occur at intersections when the pedestrian is crossing the street. If you look at the rate of pedestrian deaths per 100,000 population (found at the same website cited above), however, the actual chances of being hit by a vehicle and dying might seem vanishingly small. This, then, is one of those situations involving low risk (low probability of a problem) but high impact (if there is a problem, it’s a major problem). Nevertheless, it’s probably still prudent to take steps (no pun intended) to avoid a low risk/high impact situation. Further, if the statistics were to zero in on those people crossing the road with their eyes glued to their smartphones, jaywalking, crossing before the walking signal has begun, crossing on a dark, rainy evening in black clothing, and so forth, the “risk” level might start to seem a little more worrisome. For my fellow pedestrians, the STOP skill would involve (a) stopping all activities other than vigilantly attending to traffic and traffic signals, (b) taking a step back mentally, and ideally physically, to get some perspective on where they are and what they’re doing, (c) observing the situation, the cars, the signals, whether anyone appears to be trying to run the red light, and so forth, and (d) proceeding mindfully (slowly walking out into the intersection when it’s safe, and carefully crossing the road). These steps are sometimes hard to put into action. I recently sprained my back. I couldn’t sleep for a few days, as laying down led to great pain. I also had a lot of difficulty getting in and out of chairs, but more to the point of this blog, I was walking really slowly. When I came to an intersection and couldn’t walk nearly as quickly as usual, the orange countdown became a trigger for mild panic. That countdown actually goes pretty quickly. Sometimes, you only have 10 seconds to get across a pretty wide intersection. I started to have a lot of empathy for people with physical difficulties and those of advanced age who can’t walk like they used to or need supports (canes, walkers, and so forth). My letter to the city is in the works (in my mind at least), but for now, I’m hoping this blog has made the point that the STOP skill is a very practical strategy for everyday life situations. Walk carefully! ~ Alexander L. Chapman, Ph.D., R.Psych.

Counting Our Blessings

13 Apr

The recent, tragic events in Syria have certainly put my day to day problems and hassles into perspective. I feel incredibly lucky to be living in a relatively safe and prosperous country, in an area where the chance that the horrors people experience in other parts of the world will occur here are vanishingly small. It’s not always easy to attain or maintain this perspective when we become mired in the stresses and hassles of daily life. A couple of the skills we teach clients in DBT relate to this issue: counting blessings and comparisons.

Counting blessings may sound like your grandmother’s advice or admonishments at the dinner table when you refused to eat that gristly steak as a child (What about the starving children?!). As a skill, counting blessings is usually most helpful when you feel envious of other people. Envy is a very interesting emotion that arises when another person or group has something important to you (e.g., money, power, fame, relationships) that you don’t have. Envy kind of feels a bit like jealousy but is often more tinged with resentment and even anger toward those who have what you feel you want or need. As a result, counting blessings can be a helpful way to remind yourself of what you actually do have. If you can feel grateful for what you have, the fact that others have more can feel more tolerable.

Comparisons is a skill in the distress tolerance section of the DBT skills (Linehan, 2015) and is used to help us tolerate difficult situations. You can use this skill in lots of ways: (a) compare your situation to that of people who are less fortunate, (b) compare your current situation to a time when your circumstances were worse, (c) compare your situation to a hypothetically worse situation, and so forth. The idea is not to dismiss or invalidate your feelings about your current situation. Your distress is perfectly understandable and shouldn’t be minimized. That said, considering others who may be in more pain or anguish can give us some perspective on our suffering. If I’m frustrated because I have a lot of work stress and feel overwhelmed with things to do and challenges to face, it does help a bit to sit back and reflect on the fact that I’m not living in a war-torn country. Things could be much, much worse. If you use the skill of comparisons in this way, watch out for the following thought, “Well, that means I don’t deserve or shouldn’t feel this upset.” Don’t invalidate your feelings. Use the skill to gain perspective, and then see if your situation feels slightly more bearable. ~ Alexander L. Chapman, Ph.D., R.Psych.

Getting Around: Use Your Brain

28 Mar

On a recent trip, I began to think a lot about the merits of the old-fashioned map. To get from Point A to Point B, we initially thought it would be a good idea to print out directions from Google maps or MapQuest. We were driving along merrily, confident that our directions would lead us to the hotel from the airport, when they led us right into the parking lot of a big box store. We asked a customer how to get back onto the right road, and, apparently through clear memory and perhaps practice, she immediately gave us excellent directions. We got back onto the right road and proceeded to continue to use our MapQuest directions, successfully arriving at the hotel. The next time we had to make a tricky drive, the directions (or rather more likely, our interpretation of the directions) led us in the complete opposite direction, and it took us quite some time to get back to where we needed to go. Having had a similar experience during a trip about a month ago while mindlessly following directions from Siri, I was ready to return to good old-fashioned methods: maps and street signs. I’m sure I’m not alone in discovering that, when I rely on verbal directions to get from place to place, my brain basically turns off. I stop creating a vision or mental map of where I’m going, because I’m relying so much on rules and directions. It’s a lot like sitting in the backseat of a car while someone else drives and navigates. Even though you have travelled the route several times, if you need to do it yourself, you probably won’t be able to do it without a map or directions. This is probably because, when someone else is navigating, you don’t have to use your brain to visualize or figure out where you’re going. I was initially thinking about this problem from the perspective of rules. Rules can be incredibly helpful in daily life, but when we blindly rely on or overuse rules, they can prevent us from thinking or learning from our experience. In fact, I was planning on making this blog all about the dangers of over-relying on rules. Coincidentally, however, when I returned from my trip, some new and interesting research conducted by researchers in London was getting a lot of press. These researchers did an innovative study to examine the effects on our brains of navigating with and without GPS-style assistance. I won’t reiterate their findings here, as the article is freely available through an open access journal (http://www.nature.com/articles/ncomms14652). The bottom line, unsurprisingly, is that the hippocampus is involved in having a mental map or vision of where you are going, and when you have to make a navigational decisions, the prefrontal cortex is involved. Researchers have argued that systems such as GPS largely remove the need to exercise these brain regions. And, from what we know about neural plasticity, our brains are a lot like muscles: Keeping them fit and in good shape involves exercise (both mental and physical). So, consider turning off the GPS and picking up a map. Challenge yourself to try out different routes from place to place. Put yourself in a position where you have to make challenging decisions about where to go, using your own brain rather than following rules or directions. ~ Alexander L. Chapman, Ph.D., R.Psych.