Dear Readers,
Thank you so much for supporting this blog during the holiday season and purchasing items off of Amazon after clicking on the sidebar links. The proceeds earned will support the broke graduate student who writes this blog.
Thanks again!
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-Tara
Wednesday, December 28, 2011
Sunday, October 16, 2011
Yet Another Reason CBT & ACT are Compatible
Every now & again on this blog, I'm going to really dork-out and get technical. While most of the posts are certainly for the general public, this one is coming from my inner Ph.D.-student.
While folding laundry, I was ironically in my head thinking about the concept of coming into contact with the present moment. This is the thought that indirectly caused me to put my shirts in the sock drawer: CBT instructs people not to ruminate about the past or worry about the future, while ACT provides a substitute behavior (i.e. mindfully coming into contact with the present moment). In other words, roughly speaking, CBT works from the negative and ACT works from the positive in terms of action.
This is yet another reason why I think CT might be useful for some people before an ACT intervention. Allow me to explain. If you were writing a research proposal, for example, first you'd go through all of the problems with the past research and explain why it isn't sufficient. After this, you'd go onto explain exactly what you intend to do instead. Therefore, in order to make some changes on a research level, first you need to understand the problem, then you do something new. Similarly, I think cognitive techniques are useful in explaining what does not work, while ACT is really good at providing what does work.
Of course, this is not to say that out-of-the-office and on-the-spot cognitive disputation isn't ineffective. In fact, I really think it is - especially when one is either first grappling with identifying maladpative cognitions or is having a particularly difficult time. The point is that after one has identified a maladaptive cognition and worked out why it isn't effective, it is helpful to then learn what to do next (i.e. to shift into the present moment). In this way, I think ACT techniques are perfect for where CBT leaves off.
Ok, back to laundry!
While folding laundry, I was ironically in my head thinking about the concept of coming into contact with the present moment. This is the thought that indirectly caused me to put my shirts in the sock drawer: CBT instructs people not to ruminate about the past or worry about the future, while ACT provides a substitute behavior (i.e. mindfully coming into contact with the present moment). In other words, roughly speaking, CBT works from the negative and ACT works from the positive in terms of action.
This is yet another reason why I think CT might be useful for some people before an ACT intervention. Allow me to explain. If you were writing a research proposal, for example, first you'd go through all of the problems with the past research and explain why it isn't sufficient. After this, you'd go onto explain exactly what you intend to do instead. Therefore, in order to make some changes on a research level, first you need to understand the problem, then you do something new. Similarly, I think cognitive techniques are useful in explaining what does not work, while ACT is really good at providing what does work.
Of course, this is not to say that out-of-the-office and on-the-spot cognitive disputation isn't ineffective. In fact, I really think it is - especially when one is either first grappling with identifying maladpative cognitions or is having a particularly difficult time. The point is that after one has identified a maladaptive cognition and worked out why it isn't effective, it is helpful to then learn what to do next (i.e. to shift into the present moment). In this way, I think ACT techniques are perfect for where CBT leaves off.
Ok, back to laundry!
Tuesday, July 19, 2011
Self-Injury as an Inborn Fail-Safe
Where do we get the idea to eat or have sex? Maybe we don't. As Pinker argues, we're not a blank slate. Perhaps the impulse to engage in self-injury when under extreme emotional distress is also inborn.
We are starting to understand the havoc stress wreaks on the body. We are also starting to understand the strong endogenous physiological calming effect self-injury prompts. In this context, I wonder if self-injury acts almost like an inoculation - when given a small amount of manageable physical adversity, the body's soothing and contentment system is able to overcompensate and fortify itself. Maybe the body intuitively knows to default to self-injury under periods of stress because there are dramatic and sudden decrease anxiety due to increases in endogenous calming agents, being that stress is particularly harmful to the body. [There's something about stress triggering autoimmune diseases here that should be looked at. Perhaps it isn't a coincidence that Benadryl can be used both as an antianxiety as well as an antihistamine.]
After all, humans are not the only animals that engage in self-injury (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486411/). My first published study (cited in TIME here) mentions that a certain percentage of people report getting the idea to engage in self-injury from an outside source; however, the other side of that is that some people report never having learned the idea from anyone. Perhaps it is, in fact, an inborn impulse we have that is defaulted to in times of stress because it is protective to the body against stress. This is not to say, of course, that some people don't get the idea to cut from other people. Surely this must be the case. But what about the people who spontaneously start cutting without outside influence? How can that be explained?
I'm beginning to think that the impulse to hurt oneself is a hardwired fail-safe.
We are starting to understand the havoc stress wreaks on the body. We are also starting to understand the strong endogenous physiological calming effect self-injury prompts. In this context, I wonder if self-injury acts almost like an inoculation - when given a small amount of manageable physical adversity, the body's soothing and contentment system is able to overcompensate and fortify itself. Maybe the body intuitively knows to default to self-injury under periods of stress because there are dramatic and sudden decrease anxiety due to increases in endogenous calming agents, being that stress is particularly harmful to the body. [There's something about stress triggering autoimmune diseases here that should be looked at. Perhaps it isn't a coincidence that Benadryl can be used both as an antianxiety as well as an antihistamine.]
After all, humans are not the only animals that engage in self-injury (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486411/). My first published study (cited in TIME here) mentions that a certain percentage of people report getting the idea to engage in self-injury from an outside source; however, the other side of that is that some people report never having learned the idea from anyone. Perhaps it is, in fact, an inborn impulse we have that is defaulted to in times of stress because it is protective to the body against stress. This is not to say, of course, that some people don't get the idea to cut from other people. Surely this must be the case. But what about the people who spontaneously start cutting without outside influence? How can that be explained?
I'm beginning to think that the impulse to hurt oneself is a hardwired fail-safe.
Sunday, April 17, 2011
Is Multiple Personality Disorder Real?
Although it is very rare, early in my career I met two (different) people with Dissociative Identity Disorder (DID; formerly known as Multiple Personality Disorder). The first person I met with DID was a patient at a clinic in Harvard Square, where I was conducting research. Over the course of my two years there, I watched her slowly unravel from displaying one personality to many. By the time I left, she had the voice and demeanor of a seven year old child. Frankly, witnessing this was quite unsettling.
The second person I met with DID was in the psychiatric emergency room at Massachusetts General Hospital, where I was working on another study. I remember the conversations amongst the staff about her case well - some thought she was faking it, while some thought a diagnosis of DID was legitimate.
In short, this is what I think:
People with Borderline Personality Disorder, which is characterized by self-injury, suicide attempts, extreme mood swings, and stormy relationships also has another very important feature that is often less discussed - identity disturbance. Basically, very different personae are displayed depending on the situation. As Kiera Van Gelder describes in The Buddha and The Borderline, a memoir about recovery from this disorder, she would be a hippie one day and a goth the next if it would get her the sexual attention she wanted. In other words, she would drastically change her personality from day to day (in this case, it was for social approval).
The problem is this: A therapist looking at someone who is a goth one day and a hippie the next might conclude that these are just various forms of the self that need to be expressed. (Yikes!)
While chameleoning can be viewed as adaptive in a sense, the person with BPD / identity disturbance seems to be paying little attention to whether or not they actually enjoy a given activity they are engaging in for social approval. Often, people use these different personae as a tool - and a tool only. The who acts as a hippie today has no real affinity for hippie culture in itself. Expression of one's "hippie side" is resoundingly not to be encouraged.
Introducing certain types of therapy that emphasize different parts of the self to people who already have identity disturbance, may cause further polarization. The patient may be reinforced for behaving in certain ways and expressing themselves from various personalities. Hence, the development of DID. Without a question in my mind, this is what happened with the first patient with DID I watched unravel - she initially had a diagnosis of Borderline Personality Disorder (w/ the identity disturbance feature) - and in two years time (after "parts therapy") she had multiple personalities.
People with identity disturbances crave belonging and unity of their behaviors by definition. Slapping a label of DID on someone who is desperately trying to figure out who they are is dangerous. The person knows that a lot effort needs to be put in to establish a sense of self. These uncharted territories of not living for social approval are scary. This unifying label is an excuse to avoid all the anxiety that will come with establishing a sense of self. It is easier to exaggerate the different forms of self that already exist and diverge further.
In the effort to display many personalities, a unifying role of being an interesting patient is maintained.
While the presentation of someone having several personality disorders is certainly real, I highly doubt this is organic. It seems to me that this disorder is related to the same underlying identity disturbance seen in Borderline Personality Disorder. In fact, I'd be willing to bet that a very large number of DID cases are really Borderline cases gone horribly astray due to treatment with talk therapies that have not been supported by research.
I'd also like to add that after having worked with people who have schizophrenia, there is a definite psychotic flavor to DID as well. My gut feeling is that the core underlying feature is the identity disturbance seen in BPD on top of a psychotic tendency to believe what the mind is constructing. It is these two underlying features that combine to the expression of different personalities. In no way do I think there are actually two different personalities encased in one person. In short, I'd reason that DID is simply a specific form psychosis with the core BPD component of identity disturbance.
In treatment, instead of focusing on expression of various external presentations, focus should be on developing a sense of self. Figuring out what the person likes independent from the approval or opinions of others seems vital.
Lastly, unlike depression or anxiety, there is an ego-syntonic feel to multiple personality disorder. In other words, people like having the disorder to some degree and want to continue any associated dysfunctional behavior. Another example of ego-syntonic disorders would be anorexia, where people typically want to continue restricting food intake. In the case of DID, people want to keep their multiple personalities, as they are potentially useful in different circumstances. As such, the expression of different personalities should be particularly discouraged by all staff members at a facility once rapport has been developed and treatment is underway.
The second person I met with DID was in the psychiatric emergency room at Massachusetts General Hospital, where I was working on another study. I remember the conversations amongst the staff about her case well - some thought she was faking it, while some thought a diagnosis of DID was legitimate.
In short, this is what I think:
People with Borderline Personality Disorder, which is characterized by self-injury, suicide attempts, extreme mood swings, and stormy relationships also has another very important feature that is often less discussed - identity disturbance. Basically, very different personae are displayed depending on the situation. As Kiera Van Gelder describes in The Buddha and The Borderline, a memoir about recovery from this disorder, she would be a hippie one day and a goth the next if it would get her the sexual attention she wanted. In other words, she would drastically change her personality from day to day (in this case, it was for social approval).
The problem is this: A therapist looking at someone who is a goth one day and a hippie the next might conclude that these are just various forms of the self that need to be expressed. (Yikes!)
While chameleoning can be viewed as adaptive in a sense, the person with BPD / identity disturbance seems to be paying little attention to whether or not they actually enjoy a given activity they are engaging in for social approval. Often, people use these different personae as a tool - and a tool only. The who acts as a hippie today has no real affinity for hippie culture in itself. Expression of one's "hippie side" is resoundingly not to be encouraged.
Introducing certain types of therapy that emphasize different parts of the self to people who already have identity disturbance, may cause further polarization. The patient may be reinforced for behaving in certain ways and expressing themselves from various personalities. Hence, the development of DID. Without a question in my mind, this is what happened with the first patient with DID I watched unravel - she initially had a diagnosis of Borderline Personality Disorder (w/ the identity disturbance feature) - and in two years time (after "parts therapy") she had multiple personalities.
People with identity disturbances crave belonging and unity of their behaviors by definition. Slapping a label of DID on someone who is desperately trying to figure out who they are is dangerous. The person knows that a lot effort needs to be put in to establish a sense of self. These uncharted territories of not living for social approval are scary. This unifying label is an excuse to avoid all the anxiety that will come with establishing a sense of self. It is easier to exaggerate the different forms of self that already exist and diverge further.
In the effort to display many personalities, a unifying role of being an interesting patient is maintained.
While the presentation of someone having several personality disorders is certainly real, I highly doubt this is organic. It seems to me that this disorder is related to the same underlying identity disturbance seen in Borderline Personality Disorder. In fact, I'd be willing to bet that a very large number of DID cases are really Borderline cases gone horribly astray due to treatment with talk therapies that have not been supported by research.
I'd also like to add that after having worked with people who have schizophrenia, there is a definite psychotic flavor to DID as well. My gut feeling is that the core underlying feature is the identity disturbance seen in BPD on top of a psychotic tendency to believe what the mind is constructing. It is these two underlying features that combine to the expression of different personalities. In no way do I think there are actually two different personalities encased in one person. In short, I'd reason that DID is simply a specific form psychosis with the core BPD component of identity disturbance.
In treatment, instead of focusing on expression of various external presentations, focus should be on developing a sense of self. Figuring out what the person likes independent from the approval or opinions of others seems vital.
Lastly, unlike depression or anxiety, there is an ego-syntonic feel to multiple personality disorder. In other words, people like having the disorder to some degree and want to continue any associated dysfunctional behavior. Another example of ego-syntonic disorders would be anorexia, where people typically want to continue restricting food intake. In the case of DID, people want to keep their multiple personalities, as they are potentially useful in different circumstances. As such, the expression of different personalities should be particularly discouraged by all staff members at a facility once rapport has been developed and treatment is underway.
Sunday, March 13, 2011
Sex - Benefits of Talk Therapy Over Medication
Unlike stereotypical versions of talk therapy where a doctor claims you want to have sex with your mother, a newer treatment called Cognitive Behavioral Therapy (CBT), has been shown by plenty of studies to actually work.
Not only that, it changes your biology. Unlike other talk therapies, this type of treatment involves active learning and homework. As such, it can cause beneficial increases in the size of your brain that controls complex thinking - the cerebral cortex. In fact, CBT has also been shown to be just as effective as medication, just with longer lasting effects.
I would imagine that CBT continues to be beneficial after ending treatment because the time was taken over numerous sessions to rewire the brain. On the other hand, medication may act more by forcing it to function differently for a short period of time. Many drugs also come with a lot of negative side effects.
Unlike a lot of depression medications, CBT just doesn't numb your sexual experience. As Kiera Van Gelder so eloquently describes in her fantastic recovery memoir, The Buddha and The Borderline: "Sometimes when I see his body or smell his scent, I want to consume him with all of my senses. Then, when we meet skin on skin, it's like hitting a thick glass wall. 'It's the medication.' I tell him."
Although it may be advisable for some people to be on medication while in CBT, if you are choosing between talk therapy and drugs, make sure to do your homework. Trying a CBT therapist before medication might be a favorable option for you.
For more posts, check out The Psychology Easel and follow me on Twitter at @TaraDeliberto.
Not only that, it changes your biology. Unlike other talk therapies, this type of treatment involves active learning and homework. As such, it can cause beneficial increases in the size of your brain that controls complex thinking - the cerebral cortex. In fact, CBT has also been shown to be just as effective as medication, just with longer lasting effects.
I would imagine that CBT continues to be beneficial after ending treatment because the time was taken over numerous sessions to rewire the brain. On the other hand, medication may act more by forcing it to function differently for a short period of time. Many drugs also come with a lot of negative side effects.
Unlike a lot of depression medications, CBT just doesn't numb your sexual experience. As Kiera Van Gelder so eloquently describes in her fantastic recovery memoir, The Buddha and The Borderline: "Sometimes when I see his body or smell his scent, I want to consume him with all of my senses. Then, when we meet skin on skin, it's like hitting a thick glass wall. 'It's the medication.' I tell him."
Although it may be advisable for some people to be on medication while in CBT, if you are choosing between talk therapy and drugs, make sure to do your homework. Trying a CBT therapist before medication might be a favorable option for you.
For more posts, check out The Psychology Easel and follow me on Twitter at @TaraDeliberto.
Saturday, March 12, 2011
Thoughts on Secret Fears of the Super Rich
by Tara Deliberto
I came across this article "Secret Fears of the Super Rich," and thought it was pretty interesting. I posted a link to it in an online forum, and one of the readers responded with this Ayn Rand quote: "Only the man who does not need it, is fit to inherit wealth, the man who would make his fortune no matter where he started."
Here are my brief thoughts on this marvelous quote from a psychological perspective:
Being in my line of work, I'm acutely aware of the fact that people need to build their own sense of mastery. Without mastery, feelings of helpless set in and a general lack of motivation is fostered. Translated into clinical terms, people become depressed and anxious. So perhaps if an individual is given everything, their sense of mastery can be diminished because they have not had to take opportunities to succeed on their own.
There are several possible reasons why these opportunities are not taken. For one, when the bar is set so high by a family member who built a fortune, it may be too frightening to even approach success. It is seems safer not to attempt anything at all and live a comfortable life. But is it better for one's own well being to never have tried?
While fear of failure might drive this behavior, the possibility also exists that it is that once wealth is attained or inherited, there may simply be no perceived need to achieve. Perhaps if the same person who inherits wealth and chooses not to engage in tasks to build mastery is put under real pressure, he or she might very successfully build resources. But without ever needing to, attempts are not made to earn one's own living.
In short, I'm conceptualizing two paths, the first would be an anxiety-avoidance path while the second is a contentment/maintenance path.
Whether or not they want to, people who inherit money may benefit from continually engaging in mercenary tasks where failure is possible along with adopting an accepting attitude that they may never achieve at the level of their family members. The idea is that when any amount of success is achieved, their own sense of mastery may increases, motivation can ignite, and life many feel more purposeful.
I think this idea fits nicely w/ Ayn Rand's - one needs to be motivated to achieve for their own sense of self-worth. Sometimes having an inheritance can take away one's own sense of importance while increasing entitlement. While importance and entitlement are often linked, perhaps they are very different constructs. While a person may not view themselves as being meaningfully able to contribute to the world (importance), they may think they deserve everything (entitlement).
I came across this article "Secret Fears of the Super Rich," and thought it was pretty interesting. I posted a link to it in an online forum, and one of the readers responded with this Ayn Rand quote: "Only the man who does not need it, is fit to inherit wealth, the man who would make his fortune no matter where he started."
Here are my brief thoughts on this marvelous quote from a psychological perspective:
Being in my line of work, I'm acutely aware of the fact that people need to build their own sense of mastery. Without mastery, feelings of helpless set in and a general lack of motivation is fostered. Translated into clinical terms, people become depressed and anxious. So perhaps if an individual is given everything, their sense of mastery can be diminished because they have not had to take opportunities to succeed on their own.
There are several possible reasons why these opportunities are not taken. For one, when the bar is set so high by a family member who built a fortune, it may be too frightening to even approach success. It is seems safer not to attempt anything at all and live a comfortable life. But is it better for one's own well being to never have tried?
While fear of failure might drive this behavior, the possibility also exists that it is that once wealth is attained or inherited, there may simply be no perceived need to achieve. Perhaps if the same person who inherits wealth and chooses not to engage in tasks to build mastery is put under real pressure, he or she might very successfully build resources. But without ever needing to, attempts are not made to earn one's own living.
In short, I'm conceptualizing two paths, the first would be an anxiety-avoidance path while the second is a contentment/maintenance path.
Whether or not they want to, people who inherit money may benefit from continually engaging in mercenary tasks where failure is possible along with adopting an accepting attitude that they may never achieve at the level of their family members. The idea is that when any amount of success is achieved, their own sense of mastery may increases, motivation can ignite, and life many feel more purposeful.
I think this idea fits nicely w/ Ayn Rand's - one needs to be motivated to achieve for their own sense of self-worth. Sometimes having an inheritance can take away one's own sense of importance while increasing entitlement. While importance and entitlement are often linked, perhaps they are very different constructs. While a person may not view themselves as being meaningfully able to contribute to the world (importance), they may think they deserve everything (entitlement).
Friday, March 4, 2011
Does A Therapist Judges You?
Today I received a question from a man in Mumbai asking if I went into being a psychologist so I could be in a position to judge people. He expressed the sentiment that everyone must understand that we are in no place to judge others and that he prefers a live at let live philosophy.
Here's my response:
Thanks for the post. Since many people share your opinion, I think this question is particularly important to address.
I can understand that without an introduction to the type of treatment I practice, one may assume therapists just want to judge people. In fact, it is just the opposite! People come into my office with a series of judgments about themselves that we work together to debunk. I've seen people who have made wonderful contributions to society but seem to think that they are completely worthless. My job is simply to neutralize judgments. We help people to stop harshly judging themselves so that they can function better and suffer less.
While many people are not in need of treatment, I'm afraid that many people are seriously troubled and on the fence abut whether or not they should end their own lives. With suicidal people, a live and let live philosophy wouldn't exactly work out. And just because someone is contemplating suicide, does not make them worthless and deserving to die, it just means they are suffering from what can feel like a tortured internal experience. They come to treatment of their own volition because there is a piece of them that wants to get better. Therapists don't force clients into treatment.
There have been many research studies on the type of therapy I do showing that the techniques are in fact useful in helping people build a life worth living. Therapy, when practiced well, is much more than a series of judgments - it is an effective way to retrain people's thoughts and behaviors.
Here's my response:
Thanks for the post. Since many people share your opinion, I think this question is particularly important to address.
I can understand that without an introduction to the type of treatment I practice, one may assume therapists just want to judge people. In fact, it is just the opposite! People come into my office with a series of judgments about themselves that we work together to debunk. I've seen people who have made wonderful contributions to society but seem to think that they are completely worthless. My job is simply to neutralize judgments. We help people to stop harshly judging themselves so that they can function better and suffer less.
While many people are not in need of treatment, I'm afraid that many people are seriously troubled and on the fence abut whether or not they should end their own lives. With suicidal people, a live and let live philosophy wouldn't exactly work out. And just because someone is contemplating suicide, does not make them worthless and deserving to die, it just means they are suffering from what can feel like a tortured internal experience. They come to treatment of their own volition because there is a piece of them that wants to get better. Therapists don't force clients into treatment.
There have been many research studies on the type of therapy I do showing that the techniques are in fact useful in helping people build a life worth living. Therapy, when practiced well, is much more than a series of judgments - it is an effective way to retrain people's thoughts and behaviors.
Acceptance and Commitment Therapy is Officially Listed as Effective!
Great news! The United States Substance Abuse and Mental Health Services Administration (SAMHSA) has now listed Acceptance and Commitment Therapy (ACT), a therapy I practice that is based on Eastern Mindfulness techniques, as an official treatment that has been shown by research to work!!
This is part of SAMHSA'sNational Registry of Evidence-based Programs and Practices (NREPP). What a wonderful initiative. Bravo.
http://174.140.153.167/ViewIntervention.aspx?id=191&
This is part of SAMHSA'sNational Registry of Evidence-based Programs and Practices (NREPP). What a wonderful initiative. Bravo.
http://174.140.153.167/ViewIntervention.aspx?id=191&
The Relationship between Negative Thoughts & Serotonin
I'm happy to be a member of an online community where some intellectual forum discussions are generated. In this setting, a question was posed to me pertaining to the relationship between negative thinking and serotonin from Scott in Auckland. Since other people may be curious about the same topic, I thought I'd post my response here.
Reply:
I absolutely love this question! The interplay between what we do as psychologists and biology is one of my favorite topics. How we are trained through all of our collective learning experiences to think - and more specifically, appraise, evaluate, and interpret - has a direct effect on our physiology and biology.
For those of you not familiar with Cognitive Behavioral Therapy (CBT) it involves very active Socratic questioning on the therapists part about thoughts the patient currently has. This type of therapy is in stark contrast to old-fashioned Freudian type therapies that mainly just involve combing over events of your past. If a patient comes into my office and says "I'm a loser," my response would be "Oh, yeah? It must stink to think that. But what is the evidence that you're a loser?... Have you ever won anything?... Even if you are a loser now - whatever that means - will you always be a loser?" etc.
After all this questioning, we usually end up laughing together about what I ridiculous statement "I'm a loser" really is and how true it can feel. Through this process, the rift between what our mind thinks and what is actually true is created. After the initial separation between thought and belief is fostered, we go come up with rational responses to these types of negative automatic thoughts like "I'm a loser" and practicing mentally rehearsing the rational responses as homework.
So, that is a brief description of the cognitive piece of cognitive-behavioral therapy. Interestingly, the behavioral piece has been shown to be more effective than the cognitive piece at changing the interpretation of thoughts. Let's take, for example, someone who has social phobia. You can tell them that their phobia of talking to other people is silly all you want, but they still may not believe you. The best thing to do is act.
We start small. I might grab the secretary into the therapy room and ask her to have a 5 minute conversation about something like traveling with the patient. After five minutes, the secretary says it was lovely chatting and leaves. Now, that wasn't so bad was it?
Then as homework assignments, the patient is to engage in social activities, starting with a small anxiety producing task, and working their way up to doing something very scary like public speaking, over the course of weeks. In this way, their own thoughts are directly challenged by the outcome of their behavior. They always think it will be worse than it ends up being. In this way, they engage in little "behavioral experiments" that directly test their maladaptive beliefs.
It is worth noting here that while the behavioral piece has been shown to be more effective, people may not be willing to engage in the behavioral piece without both a strong rationale for it. It is my opinion that going through the cognitive part of the therapy and disputing thoughts that automatically pop up is an extremely useful first step that must be taken with a vast majority of people before jumping into the behavioral piece. In fact, a client of mine expressed this sentiment completely of her own accord to me today.
While we have discussed both the cognitive and the behavioral piece at this point, there is a third very important piece that changes our relationship to our thoughts - Eastern mindfulness practice. Learning to be aware of our thoughts and release the less useful ones is extraordinarily helpful as well. As a side note, I practice letting go of thoughts every day during yoga, which I use as a moving meditation more than exercise. '
I'll talk more later about integrating these components of treatment, but for now, back to your question! There have been many studies showing that CBT is as useful as treating depression as antidepressants; however, CBT has the added effect of continuing to work even after treatment ends. In terms of whether or not it increases serotonin in the synapse, there are huge ongoing clinical trials in the U.S. examining this right now. So far the evidence points that learning to regulate your emotions through these types of treatments does effect serotonin.
Here's a link to clinical trial information.
Reply:
I absolutely love this question! The interplay between what we do as psychologists and biology is one of my favorite topics. How we are trained through all of our collective learning experiences to think - and more specifically, appraise, evaluate, and interpret - has a direct effect on our physiology and biology.
For those of you not familiar with Cognitive Behavioral Therapy (CBT) it involves very active Socratic questioning on the therapists part about thoughts the patient currently has. This type of therapy is in stark contrast to old-fashioned Freudian type therapies that mainly just involve combing over events of your past. If a patient comes into my office and says "I'm a loser," my response would be "Oh, yeah? It must stink to think that. But what is the evidence that you're a loser?... Have you ever won anything?... Even if you are a loser now - whatever that means - will you always be a loser?" etc.
After all this questioning, we usually end up laughing together about what I ridiculous statement "I'm a loser" really is and how true it can feel. Through this process, the rift between what our mind thinks and what is actually true is created. After the initial separation between thought and belief is fostered, we go come up with rational responses to these types of negative automatic thoughts like "I'm a loser" and practicing mentally rehearsing the rational responses as homework.
So, that is a brief description of the cognitive piece of cognitive-behavioral therapy. Interestingly, the behavioral piece has been shown to be more effective than the cognitive piece at changing the interpretation of thoughts. Let's take, for example, someone who has social phobia. You can tell them that their phobia of talking to other people is silly all you want, but they still may not believe you. The best thing to do is act.
We start small. I might grab the secretary into the therapy room and ask her to have a 5 minute conversation about something like traveling with the patient. After five minutes, the secretary says it was lovely chatting and leaves. Now, that wasn't so bad was it?
Then as homework assignments, the patient is to engage in social activities, starting with a small anxiety producing task, and working their way up to doing something very scary like public speaking, over the course of weeks. In this way, their own thoughts are directly challenged by the outcome of their behavior. They always think it will be worse than it ends up being. In this way, they engage in little "behavioral experiments" that directly test their maladaptive beliefs.
It is worth noting here that while the behavioral piece has been shown to be more effective, people may not be willing to engage in the behavioral piece without both a strong rationale for it. It is my opinion that going through the cognitive part of the therapy and disputing thoughts that automatically pop up is an extremely useful first step that must be taken with a vast majority of people before jumping into the behavioral piece. In fact, a client of mine expressed this sentiment completely of her own accord to me today.
While we have discussed both the cognitive and the behavioral piece at this point, there is a third very important piece that changes our relationship to our thoughts - Eastern mindfulness practice. Learning to be aware of our thoughts and release the less useful ones is extraordinarily helpful as well. As a side note, I practice letting go of thoughts every day during yoga, which I use as a moving meditation more than exercise. '
I'll talk more later about integrating these components of treatment, but for now, back to your question! There have been many studies showing that CBT is as useful as treating depression as antidepressants; however, CBT has the added effect of continuing to work even after treatment ends. In terms of whether or not it increases serotonin in the synapse, there are huge ongoing clinical trials in the U.S. examining this right now. So far the evidence points that learning to regulate your emotions through these types of treatments does effect serotonin.
Here's a link to clinical trial information.
Thursday, March 3, 2011
Do We Have The Ability to Change?
Similar to the last entry, here I repost my responses to questions posed to me in a forum thread from Eline, whose blog you can find at (http://businessbabyandblog.blogspot.com/).
Eline's Question:
My knowledge of phychology is at best very basic, but I do find it a fascinating subject, and I'm also interested in coaching, and I'd love to know what you think about a question that I have asked myself lately... On the one hand, the hypothesis is that there is high hereditability for almost everything (including personality), and that anything non genetic comes from non shared environment, and thus that personality traits are stable over time. On the other hand, I believe in free will, and that it's possible to change your values, beliefs, thoughts and actions. Taking it further, if you believe in free will, to what extent could we use the plasticity of the brain to shape and transform our personality ourselves? I'm thinking, with so many self-help books on the market, what proportion of identity is really up to us?
My Reply:
You ask a very interesting question! Speaking very broadly - from a combination of fancy statistics and studying identical twins who were adopted into different families, we have estimates that genetics and environment contribute about equally to various personality traits, behaviors, and disorders. Let's first discuss these factors before getting into free will.
From an evolutionary perspective, this makes sense. It is favorable to survival to have some traits passed on from one generation to the next. On the other hand, there needs to be some room for adaptability.
In some people personality traits are really stable across time; however, stability cannot be confused with heritability. In other words, just because something is stable, doesn't mean that it is inherited or genetic. For example, someone could have experienced something extremely traumatic early on in their childhood and would remain fearful and avoidant their entire lives. In this case, the environment would be the main contributor to a fearful and avoidant personality. While this is true, a complex interplay of genetic and environmental factors after the trauma may also maintain a fearful personality.
As someone who studies the treatment of "personality disorders," which are considered to be such stable disorders that they are part of one's personality, I can tell you that personality disorders are not stable over time. A very difficult disorder to treat called Borderline Personality Disorder - which involves suicidal tendencies, behaviors like cutting, chronic feelings of emptiness etc - has been shown to be effectively treated with a talk-therapy called Dialectical Behavior Therapy (DBT). This suggests, that even very difficult and stable traits can be changed with a psychological treatment. Because it is obviously not gene therapy, therapeutic change can be viewed as the environment (along with the individual) shaping behavior.
As I mentioned on this thread where this blog post originated, the mind and body are shaped by the environment. Talk-therapies and experiences can actually re-wire the brain. So even if we're born with a genetic predisposition to something, we can mold it, within certain limitations that are hard to estimate, with experience. There is, however, very likely an element of choice in whether to proceed with and effective treatment.
Although this is likely the case, free will is a really difficult topic to discuss with confidence. We are often very influenced by factors completely outside of our awareness. We also make up reasons for why we do things, when we really have no idea why on earth we do. Many cleverly designed studies have shown this.
With that being said, my own ideas on free will are this: when we become aware of our thoughts and actions, perhaps through the practice of meditation, we have an increased ability to choose. As we hone this ability, over time, we become less like a pinball careening towards different springs that just send us hurling in random directions. We can shape the way in which are brains are rewired by choosing to practice a craft, studying a topic, or participating in an effective treatment like CBT or DBT where psychological management skills are learned.
Eline's Repsonse:
How interesting! Thanks for such a complete answer! I just completed an introductory course in psychology and am having a hard time putting the pices together. What you say really makes sense..
Now I'm thinking about meditating again, I did it for a while, but never really made it a routine or a priority.. :)
My Response:
Eline, my pleasure! If you have any more questions, this thread is here :)
I absolutely love meditation - I research, practice, and teach it. I just wrote an article about meditation here:
http://www.tidytemple.com.au/AnnouncementRetrieve.aspx?ID=45454
If you have the time to check it out, let me know what you think!
Eline's Response:
Great article! I used to share the same misconceptions you address, and I'm sure there are many like me.. I also like the idea of starting with 2 minutes, I started directly at 15 and found it really long, maybe that's why I stopped
My Response:
Thanks for the positive feedback, Eline! It is much appreciated.
Eline's Question:
My knowledge of phychology is at best very basic, but I do find it a fascinating subject, and I'm also interested in coaching, and I'd love to know what you think about a question that I have asked myself lately... On the one hand, the hypothesis is that there is high hereditability for almost everything (including personality), and that anything non genetic comes from non shared environment, and thus that personality traits are stable over time. On the other hand, I believe in free will, and that it's possible to change your values, beliefs, thoughts and actions. Taking it further, if you believe in free will, to what extent could we use the plasticity of the brain to shape and transform our personality ourselves? I'm thinking, with so many self-help books on the market, what proportion of identity is really up to us?
My Reply:
You ask a very interesting question! Speaking very broadly - from a combination of fancy statistics and studying identical twins who were adopted into different families, we have estimates that genetics and environment contribute about equally to various personality traits, behaviors, and disorders. Let's first discuss these factors before getting into free will.
From an evolutionary perspective, this makes sense. It is favorable to survival to have some traits passed on from one generation to the next. On the other hand, there needs to be some room for adaptability.
In some people personality traits are really stable across time; however, stability cannot be confused with heritability. In other words, just because something is stable, doesn't mean that it is inherited or genetic. For example, someone could have experienced something extremely traumatic early on in their childhood and would remain fearful and avoidant their entire lives. In this case, the environment would be the main contributor to a fearful and avoidant personality. While this is true, a complex interplay of genetic and environmental factors after the trauma may also maintain a fearful personality.
As someone who studies the treatment of "personality disorders," which are considered to be such stable disorders that they are part of one's personality, I can tell you that personality disorders are not stable over time. A very difficult disorder to treat called Borderline Personality Disorder - which involves suicidal tendencies, behaviors like cutting, chronic feelings of emptiness etc - has been shown to be effectively treated with a talk-therapy called Dialectical Behavior Therapy (DBT). This suggests, that even very difficult and stable traits can be changed with a psychological treatment. Because it is obviously not gene therapy, therapeutic change can be viewed as the environment (along with the individual) shaping behavior.
As I mentioned on this thread where this blog post originated, the mind and body are shaped by the environment. Talk-therapies and experiences can actually re-wire the brain. So even if we're born with a genetic predisposition to something, we can mold it, within certain limitations that are hard to estimate, with experience. There is, however, very likely an element of choice in whether to proceed with and effective treatment.
Although this is likely the case, free will is a really difficult topic to discuss with confidence. We are often very influenced by factors completely outside of our awareness. We also make up reasons for why we do things, when we really have no idea why on earth we do. Many cleverly designed studies have shown this.
With that being said, my own ideas on free will are this: when we become aware of our thoughts and actions, perhaps through the practice of meditation, we have an increased ability to choose. As we hone this ability, over time, we become less like a pinball careening towards different springs that just send us hurling in random directions. We can shape the way in which are brains are rewired by choosing to practice a craft, studying a topic, or participating in an effective treatment like CBT or DBT where psychological management skills are learned.
Eline's Repsonse:
How interesting! Thanks for such a complete answer! I just completed an introductory course in psychology and am having a hard time putting the pices together. What you say really makes sense..
Now I'm thinking about meditating again, I did it for a while, but never really made it a routine or a priority.. :)
My Response:
Eline, my pleasure! If you have any more questions, this thread is here :)
I absolutely love meditation - I research, practice, and teach it. I just wrote an article about meditation here:
http://www.tidytemple.com.au/AnnouncementRetrieve.aspx?ID=45454
If you have the time to check it out, let me know what you think!
Eline's Response:
Great article! I used to share the same misconceptions you address, and I'm sure there are many like me.. I also like the idea of starting with 2 minutes, I started directly at 15 and found it really long, maybe that's why I stopped
My Response:
Thanks for the positive feedback, Eline! It is much appreciated.
The First and Ultimate Primary Emotion - Fear
A member of an online community to which I belong posed this very interesting question to me on a psychology thread: Could fear be the origin of the entire spectrum of human emotion?
My answer:
Very thought provoking question. Fear is certainly what we consider a primary human emotion (among other emotions, e.g. happiness, anger, and sadness). Thinking about fear as the first emotion to appear in living things evolutionarily though is interesting.
[When we talk about origins, there are two types: a single person's individual origins and evolutionary origins. Being that each person comes into the world with a complex nervous system, it doesn't make sense to think of fear as being each individual's ultimate primary emotion. Considering this question in an evolutionary sense is far more interesting.]
In an evolutionary sense, fear is - of course - vital. Fear as a threat detection and deflection system certainly seems to rank #1 in terms of importance.
In fact, earlier in the thread in which this blog post originated, I discussed Kandel's Nobel Peace Prize winning work on the "memory" of slugs. The response that sea slugs can "remember" to recoil after being pinched in the gill is certainly very interesting. While this borders on what may seem like a classical conditioning response, there could be the beginnings of fear like responses here. [In terms of fear and how it relates to memory, it may be interesting to note here that fear evokes a release of calcium in the brain that leads to highly ingrained encoding of information.]
Although Freud might have said that sex drive is more primary, I'm not so sure. Perhaps fear responses were actually first to develop evolutionarily and reproduction urges (which aren't really emotions anyhow) came about later. But sex, and it's relation to love, seem way more advanced than fear. As far as a sea slugs is concerned - it is a hermaphrodite so a drive to (at least) seek out sex probably isn't that developed.
Along with sex, maybe other positive emotions simply aren't as necessary from an evolutionary standpoint. In fact, maybe emotions from being comforted and soothed developed after fear as a way to reduce and control it. Paul Gilbert Ph.D. talks about the importance of the physiological Soothing and Contentment System - but soothing from what? My guess is anxiety / fear - which was on the scene first.
Along with positive feelings of being soothed, exhilaration or happiness might also be linked to fear. Just think about the last time you were on a rollercoaster. Since the feeling of fear seems more important than exhilaration, it may be the case that feeling exhilaration developed out of the fear system.
[Hm - just had a thought about bipolar disorder and the sadness and happiness responses being a result of a dysregulation of anxiety systems, one that leads to prolonged depression and the other that leads to constant exhilaration. Anyhow - back to the original question.]
After talking about some positive feelings and the link to anxiety, let's consider anger. We know that someone's "threat detection system" is activated when they're angry. In other words, they may feel anxiety, and anger is the motivator to act. Therefore, the argument could be made that anxiety is first and anger has developed secondarily in the more advanced fight or flight system. We now have two options in response to anxiety: fight (anger) or flee.
Ok, now let's shift from talking about fear arising first on the evolution scene, to fear underlying our everyday experiences now.
For fun, let's consider the link between fear and depression as a psychiatric disorder. When first reading this question, my mind immediately jumped to the link between these two things. Prolonged fear / stress releases enormous amounts of cortisol, which impairs the functioning of the brain (for the scientifically curious - along the Hypothalamic Pituitary Adrenal axis) and leads to depression. Therefore, prolonged fear / stress is experienced first, and we think this is one route to depression.
Now, I realize depression is a psychiatric disorder linked to sadness, but it is not sadness itself. Therefore, saying fear always prompts sadness would not be a logical inference per se. On the other hand, these symptoms may be intimately linked whereas fear sometimes comes first. For instance, one may experiencing horror at the loss of a loved one first, and then deep sorrow. Typically people don't go straight to sad. There is usually shock (perhaps an anxiety response) and then sadness kind of sinks in either seconds, minutes, hours, or days later.
Flipping back into evolutionary terms, it seems that sadness is quite an advanced emotion compared to fear. While I can imagine an insect having a developed reactionary response with the rudimentary beginnings of a fear system, I can't necessarily picture a sorrow system.
In short, I think the case can be made that fear (as it stems from stimulus / threat detection) may be the ultimate primary emotion.
My answer:
Very thought provoking question. Fear is certainly what we consider a primary human emotion (among other emotions, e.g. happiness, anger, and sadness). Thinking about fear as the first emotion to appear in living things evolutionarily though is interesting.
[When we talk about origins, there are two types: a single person's individual origins and evolutionary origins. Being that each person comes into the world with a complex nervous system, it doesn't make sense to think of fear as being each individual's ultimate primary emotion. Considering this question in an evolutionary sense is far more interesting.]
In an evolutionary sense, fear is - of course - vital. Fear as a threat detection and deflection system certainly seems to rank #1 in terms of importance.
In fact, earlier in the thread in which this blog post originated, I discussed Kandel's Nobel Peace Prize winning work on the "memory" of slugs. The response that sea slugs can "remember" to recoil after being pinched in the gill is certainly very interesting. While this borders on what may seem like a classical conditioning response, there could be the beginnings of fear like responses here. [In terms of fear and how it relates to memory, it may be interesting to note here that fear evokes a release of calcium in the brain that leads to highly ingrained encoding of information.]
Although Freud might have said that sex drive is more primary, I'm not so sure. Perhaps fear responses were actually first to develop evolutionarily and reproduction urges (which aren't really emotions anyhow) came about later. But sex, and it's relation to love, seem way more advanced than fear. As far as a sea slugs is concerned - it is a hermaphrodite so a drive to (at least) seek out sex probably isn't that developed.
Along with sex, maybe other positive emotions simply aren't as necessary from an evolutionary standpoint. In fact, maybe emotions from being comforted and soothed developed after fear as a way to reduce and control it. Paul Gilbert Ph.D. talks about the importance of the physiological Soothing and Contentment System - but soothing from what? My guess is anxiety / fear - which was on the scene first.
Along with positive feelings of being soothed, exhilaration or happiness might also be linked to fear. Just think about the last time you were on a rollercoaster. Since the feeling of fear seems more important than exhilaration, it may be the case that feeling exhilaration developed out of the fear system.
[Hm - just had a thought about bipolar disorder and the sadness and happiness responses being a result of a dysregulation of anxiety systems, one that leads to prolonged depression and the other that leads to constant exhilaration. Anyhow - back to the original question.]
After talking about some positive feelings and the link to anxiety, let's consider anger. We know that someone's "threat detection system" is activated when they're angry. In other words, they may feel anxiety, and anger is the motivator to act. Therefore, the argument could be made that anxiety is first and anger has developed secondarily in the more advanced fight or flight system. We now have two options in response to anxiety: fight (anger) or flee.
Ok, now let's shift from talking about fear arising first on the evolution scene, to fear underlying our everyday experiences now.
For fun, let's consider the link between fear and depression as a psychiatric disorder. When first reading this question, my mind immediately jumped to the link between these two things. Prolonged fear / stress releases enormous amounts of cortisol, which impairs the functioning of the brain (for the scientifically curious - along the Hypothalamic Pituitary Adrenal axis) and leads to depression. Therefore, prolonged fear / stress is experienced first, and we think this is one route to depression.
Now, I realize depression is a psychiatric disorder linked to sadness, but it is not sadness itself. Therefore, saying fear always prompts sadness would not be a logical inference per se. On the other hand, these symptoms may be intimately linked whereas fear sometimes comes first. For instance, one may experiencing horror at the loss of a loved one first, and then deep sorrow. Typically people don't go straight to sad. There is usually shock (perhaps an anxiety response) and then sadness kind of sinks in either seconds, minutes, hours, or days later.
Flipping back into evolutionary terms, it seems that sadness is quite an advanced emotion compared to fear. While I can imagine an insect having a developed reactionary response with the rudimentary beginnings of a fear system, I can't necessarily picture a sorrow system.
In short, I think the case can be made that fear (as it stems from stimulus / threat detection) may be the ultimate primary emotion.
Monday, February 21, 2011
Amelia's Website
Here is a link to my very talented colleague's website. She has some really great studies on emotion regulation available on it. A link to her website can also be found in the a section on right-hand column of this blog entitled "Other Psychology Blogs & Websites."
Saturday, February 5, 2011
Why Do People Cut Themselves?
by Tara Deliberto
Celebrities like Megan Fox, Angelina Jolie, and Demi Lavato have all purposely cut themselves. But why?
Well, it isn't all that clear. And the answer "they do it just for attention" doesn't make too much sense.
Sure, getting attention could be part of the answer, but it's not that simple. If you've never cut yourself, consider this: of all the things you could possibly do for attention, is carving your skin with a razor really at the top of the list? Probably not.
After researching self-injury for several years, one thing seems certain - cutting immediately halts emotional pain. It might seem backwards that physical pain stops psychological pain. But we need to take a closer look.
Starting Generally
I would actually say a major contributing factor to self-injury is actually our tendency to make things too simple. Allow me to explain. Although judging what is right and wrong is super complicated - hence the whole legal system - we are quick to slap labels on people like "good" or "bad." But life is more nuanced than that! Of course labeling helps us communicate, but a lot of very important information gets lost when we stamp something as "good" or "bad."
More Specifically
Now getting more directly to the point of this post, the very same language we use to describe our world and communicate ideas to others, is used to communicate to ourselves. We think in words. We label ourselves as good or bad. We tell ourselves we are good or bad.
And what people are telling themselves right before they cut is nearly unbearable to hear. I'd imagine their mind is shouting things at them like "You're a worthless bitch. How could anyone love you? You disgust me."
The thing is, I don't think I've ever met a totally worthless, unlovable, and disgusting human being, whatever that is. It is usually very clear from a third party perspective that the self-talk of a person who cuts, is incredibly harsh and one-sided. Despite this, people go on labeling themselves anyhow.
Not only do people who cut tell themselves abusive things, they believe them too. This is a very important distinction. Once people learn to determine the difference between having a thought and believing it in therapy, we usually see symptoms improving a lot. It is one thing to think "Wow, I am a bad person," acknowledging it as just a thought, and moving on. It is another thing to think "Wow, I am a bad person" and believe it.
With a new understanding of abusive self-talk in the mind, let's shift to discussing the body.
The Body
Let's just say you're strolling along, thinking about how beautiful the sky is, when you walk into a telephone pole. The second after your toe smashes into the pole, are you still thinking about that beautiful sky? Probably not. You're just thinking about how much your damn toe hurts.
Now, what if you were thinking about how you're such a selfish slut? What if you believed it? Would you rather be in the emotional anguish that comes along with berating yourself or would it be easier to have your toe hurt?
Yeah, that's what I thought. You'd rather stub your toe, wouldn't you?
Right after the body sustains an injury, it is kind of hard to be caught up in your thoughts. The physical pain provides a mental break from really horrible self-talk. The pain becomes a vacation.
[It is worth mentioning that even if the emotional pain isn't necessarily tied to what some people might call irrational thought (but is from an actual loss or event), it still be halted by self-injury. Usually though, I'd bet there is some degree of extreme thought causing the pain to be increasingly intense.]
Now back to talking about cutting for attention. Sure, people could also be cutting for attention, but the picture is clearly a lot more complicated. On either side of the spectrum, you may have people who solely for attention, and on the other, people who cut and have never told anyone. Most likely, people cut for several reasons. Now, let's take this discussion a bit further from here.
While it seems that verbal thoughts like "You're a worthless cow" repeating over and over might be an important factor, there are many more pieces of the puzzle.
The Physiology of Self-Injury
There are some non-human primates, especially neglected ones, who tear out bits of fur when they're distressed. They actually harm themselves.
[Side note: The thought of a neglected monkey pulling out tufts of fur can be pretty upsetting, cant it? Unfortunately, while it is easy for some of us to have sympathy for monkeys who hurt themselves, it is more difficult to take a non-judgmental stance towards humans who cut.]
While these neglected monkeys harm themselves like humans, they don't have language capacities like us. Therefore, it's not very likely that abusive self-talk leads to self-harm in non-human primates. Percentage wise, the non-human primate self-injury may be maintained much more by the emotional, rather than a linguistic or symbolic system.
While language is a new development on the evolutionary scene, emotions are not. Emotions have been around for a while, without the complication of human language. As any loving pet owner like myself could tell you, animals have emotions.
What happens on a physiological level after someone cuts is not currently understood; however, my guess is that there is a release of endorphins, which make you feel good. We also know that heart-rate dramatically drops after cutting in people who often self-injure.
In short, on a mental/language level as well as an emotional level, there is likely some serious relief occurring right after cutting.
Wrapping Up
The way I see it at this particular point in time, is that very upsetting abusive self-talk is immediately halted, there a shift of attention to the cut, and endorphins are released, which serves to calm the body further.
Of course, the reasons people cut are diverse and they change over time. This may not be true for everyone. For instance, people may also cut to feel something if they're feeling nothing or numb. An additional reason people report cutting is to punish themselves. Perhaps sometime soon I'll write about these functions as well; however, it seems to me that the main function of cutting is to help reduce negative feelings in the moment.
Thankfully though, wonderful treatments like Dialectical Behavior Therapy (DBT) have been invented to help with cutting. If you or someone you love engages in self-injury, there are wonderful resources available. Go online and find a DBT therapist near you or join a DBT Skills Group near you.
Blog Info
For more posts on self-injury, check out The Psychology Easel's Self-Injury Section.
Feel free to follow me on Twitter at @TaraDeliberto and subscribe to this blog in the right sidebar.
Do You Self Harm?
If you engage in self-injury, an excellent resource is S.A.F.E. Alternatives, an absolutely wonderful organization devoted to the treatment of self-injury (you can visit their website at http://www.selfinjury.com/).
Also, a very helpful book on directly treating self-injury is Bodily Harm. Select this book in the icon above to purchase.
The best treatment for cutting is Dialectical Behavior Therapy (DBT). Find a DBT therapist near you.
Celebrities like Megan Fox, Angelina Jolie, and Demi Lavato have all purposely cut themselves. But why?
Well, it isn't all that clear. And the answer "they do it just for attention" doesn't make too much sense.
Sure, getting attention could be part of the answer, but it's not that simple. If you've never cut yourself, consider this: of all the things you could possibly do for attention, is carving your skin with a razor really at the top of the list? Probably not.
After researching self-injury for several years, one thing seems certain - cutting immediately halts emotional pain. It might seem backwards that physical pain stops psychological pain. But we need to take a closer look.
Starting Generally
I would actually say a major contributing factor to self-injury is actually our tendency to make things too simple. Allow me to explain. Although judging what is right and wrong is super complicated - hence the whole legal system - we are quick to slap labels on people like "good" or "bad." But life is more nuanced than that! Of course labeling helps us communicate, but a lot of very important information gets lost when we stamp something as "good" or "bad."
More Specifically
Now getting more directly to the point of this post, the very same language we use to describe our world and communicate ideas to others, is used to communicate to ourselves. We think in words. We label ourselves as good or bad. We tell ourselves we are good or bad.
And what people are telling themselves right before they cut is nearly unbearable to hear. I'd imagine their mind is shouting things at them like "You're a worthless bitch. How could anyone love you? You disgust me."
The thing is, I don't think I've ever met a totally worthless, unlovable, and disgusting human being, whatever that is. It is usually very clear from a third party perspective that the self-talk of a person who cuts, is incredibly harsh and one-sided. Despite this, people go on labeling themselves anyhow.
Not only do people who cut tell themselves abusive things, they believe them too. This is a very important distinction. Once people learn to determine the difference between having a thought and believing it in therapy, we usually see symptoms improving a lot. It is one thing to think "Wow, I am a bad person," acknowledging it as just a thought, and moving on. It is another thing to think "Wow, I am a bad person" and believe it.
With a new understanding of abusive self-talk in the mind, let's shift to discussing the body.
The Body
Let's just say you're strolling along, thinking about how beautiful the sky is, when you walk into a telephone pole. The second after your toe smashes into the pole, are you still thinking about that beautiful sky? Probably not. You're just thinking about how much your damn toe hurts.
Now, what if you were thinking about how you're such a selfish slut? What if you believed it? Would you rather be in the emotional anguish that comes along with berating yourself or would it be easier to have your toe hurt?
Yeah, that's what I thought. You'd rather stub your toe, wouldn't you?
Right after the body sustains an injury, it is kind of hard to be caught up in your thoughts. The physical pain provides a mental break from really horrible self-talk. The pain becomes a vacation.
[It is worth mentioning that even if the emotional pain isn't necessarily tied to what some people might call irrational thought (but is from an actual loss or event), it still be halted by self-injury. Usually though, I'd bet there is some degree of extreme thought causing the pain to be increasingly intense.]
Now back to talking about cutting for attention. Sure, people could also be cutting for attention, but the picture is clearly a lot more complicated. On either side of the spectrum, you may have people who solely for attention, and on the other, people who cut and have never told anyone. Most likely, people cut for several reasons. Now, let's take this discussion a bit further from here.
While it seems that verbal thoughts like "You're a worthless cow" repeating over and over might be an important factor, there are many more pieces of the puzzle.
The Physiology of Self-Injury
There are some non-human primates, especially neglected ones, who tear out bits of fur when they're distressed. They actually harm themselves.
[Side note: The thought of a neglected monkey pulling out tufts of fur can be pretty upsetting, cant it? Unfortunately, while it is easy for some of us to have sympathy for monkeys who hurt themselves, it is more difficult to take a non-judgmental stance towards humans who cut.]
While these neglected monkeys harm themselves like humans, they don't have language capacities like us. Therefore, it's not very likely that abusive self-talk leads to self-harm in non-human primates. Percentage wise, the non-human primate self-injury may be maintained much more by the emotional, rather than a linguistic or symbolic system.
While language is a new development on the evolutionary scene, emotions are not. Emotions have been around for a while, without the complication of human language. As any loving pet owner like myself could tell you, animals have emotions.
What happens on a physiological level after someone cuts is not currently understood; however, my guess is that there is a release of endorphins, which make you feel good. We also know that heart-rate dramatically drops after cutting in people who often self-injure.
In short, on a mental/language level as well as an emotional level, there is likely some serious relief occurring right after cutting.
Wrapping Up
The way I see it at this particular point in time, is that very upsetting abusive self-talk is immediately halted, there a shift of attention to the cut, and endorphins are released, which serves to calm the body further.
Of course, the reasons people cut are diverse and they change over time. This may not be true for everyone. For instance, people may also cut to feel something if they're feeling nothing or numb. An additional reason people report cutting is to punish themselves. Perhaps sometime soon I'll write about these functions as well; however, it seems to me that the main function of cutting is to help reduce negative feelings in the moment.
Thankfully though, wonderful treatments like Dialectical Behavior Therapy (DBT) have been invented to help with cutting. If you or someone you love engages in self-injury, there are wonderful resources available. Go online and find a DBT therapist near you or join a DBT Skills Group near you.
Blog Info
For more posts on self-injury, check out The Psychology Easel's Self-Injury Section.
Feel free to follow me on Twitter at @TaraDeliberto and subscribe to this blog in the right sidebar.
Do You Self Harm?
If you engage in self-injury, an excellent resource is S.A.F.E. Alternatives, an absolutely wonderful organization devoted to the treatment of self-injury (you can visit their website at http://www.selfinjury.com/).
Also, a very helpful book on directly treating self-injury is Bodily Harm. Select this book in the icon above to purchase.
The best treatment for cutting is Dialectical Behavior Therapy (DBT). Find a DBT therapist near you.
Tuesday, February 1, 2011
The Next Evolutionary Step for Humans
by Tara Deliberto
Recently a friend asked me what I thought the next evolutionary step for humans would be. My answer: the ability to be mindful. Most of us go through life without being present in the moment. The ability to have awareness of our own thoughts opens the door for greater control. Afterall, medititation increases the very part of the brain that is newest on the evolutionary scene - the neo cortex.
Recently a friend asked me what I thought the next evolutionary step for humans would be. My answer: the ability to be mindful. Most of us go through life without being present in the moment. The ability to have awareness of our own thoughts opens the door for greater control. Afterall, medititation increases the very part of the brain that is newest on the evolutionary scene - the neo cortex.
Friday, January 7, 2011
A Remaining Thought on Control
by Tara Deliberto
Today my meditation and yoga teacher described that the point of the practice this: to use the mind to release the mind. I think that pretty much sums it up.
Yoga (and life) is learning to find the balance between effort and ease.
Today my meditation and yoga teacher described that the point of the practice this: to use the mind to release the mind. I think that pretty much sums it up.
Yoga (and life) is learning to find the balance between effort and ease.
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