Mindfulness

What is mindfulness?  It would appear that this would have a simple answer and to some extent it does.  Mindfulness is being aware of what you are doing in the moment.  Sounds easy, right? However, the act of being mindful encompasses much more than that.  Being mindful can be a difficult process to learn.  For example, say you are doing the dishes.  Paying attention to what is going on in the moment while you are doing the dishes, without your mind wandering, can be hard to do.  Focusing on the way the water feels on your hands, the movement of scrubbing the dishes instead of going on autopilot, because this is something that most of us do every day, is challenging. 

What are some ways to be more mindful in your daily activities?  One excellent example is through mindful eating.  This is about being fully present while eating, noticing all five senses during the experience.  It is also about being nonjudgmental about yourself before, during, and after eating.  Eat, don't do anything else.  Notice with food smells like.  Notice how the food looks.  Notice how it feels in your hand or with the utensil.  Notice salivation and taste.  Chew each bite at least 20 times.  Notice any feelings of food in your stomach.  Continue eating the rest of your food paying attention to all of these sensations.  Notice feeling satiated and full.  This can be practiced with something small that you typically eat in handfuls such as popcorn, nuts, chocolate, dried fruit, or chips.  You can practice one mindful meal a week for one month.  Then practice 3 mindful meals a week for another month.  Eventually, it will be useful to practice one mindful meal a day.  Some statements to answer as you're practicing mindful eating are as follows:  "Things I noticed when I was 'Mindfully Eating'; Things that I was surprised by or didn't expect an eating mindfully; 'Mindful Eating' will be useful to me by; Ways that I eat mindfully on a regular basis." (Moonshine, 2008).

In being mindful, it is important to do one thing at a time.  If you are driving, just drive.  If you are at work, focus on the tasks at hand.  If you are taking a break or practicing self-care dedicate yourself to that moment.  Being mindful is focusing on the here and now and being present in the moment.  It is a skill that takes practice, but is well worth the reward.

References

Moonshine, C. (2008).  Acquiring competency in achieving proficiency with dialectical behavior therapy: Volume II, the worksheets.  PESI: Eau Claire, Wisconsin.

Generalized Anxiety Disorder (GAD)

Imagine yourself sitting there feeling anxious without knowing the reason why.  You may feel nauseous, have difficulty concentrating, and feel restless.  There is muscle tension, you are easily fatigued, and you have difficulty sleeping or you have restless sleep.  You find it difficult to control the worry.  Now, imagine that going on for six months or more.  These are some of the prevailing symptoms of generalized anxiety disorder or GAD.

I have known people with GAD who told me that there were times when they have been so anxious before going places that they wanted to turn around and go back home because the anxiety they were feeling at the moment was so intense.  This speaks of the potential debilitating nature of GAD.  It affects all areas of the sufferer’s life.  I realize for those who've never had GAD it can be difficult to understand its effects because you may be thinking “we all get nervous or feel a little anxious sometimes,” right?  The difference with GAD is the intensity of the anxiety is greater and the length of time that it occurs is longer.  

Frequently, it is difficult for those without GAD to understand how the person with GAD feels.  This is unfortunate.  The well intentioned attitude portrayed by well-meaning friends and family of "there's nothing worth being that worried about" often makes the person feel worse because s/he may now believe s/he are disappointing family or friends. 

So what is the solution?  As the therapist, I would refer them to see a psychiatrist for medication evaluation.  I would teach them relaxation techniques to help relieve anxiety such as mindfulness, meditation, and deep, diaphragmatic breathing.  Also, since I'm a certified hypnotherapist, I could use hypnosis as a relaxation technique as well.  Discussing the issues of concern can also be helpful.  Of course, this is only some of the things I could do.

GAD can have a paralyzing effect on the individual.  It is important for the individual with GAD to have supportive friends and family and to seek counseling in order to find ways to gain control over their anxiety.  GAD does not have to rule their life.

My Favorite Psychological Theorist

I realize it might sound strange to some to be talking about my favorite psychological theorist but I think that the work of John Gottman is very interesting.  Over the last three decades John Gottman and  his wife Julie Swartz-Gottman have created, with the help of their “Love Lab” studies, an effective method of treating couples in distress.  This method is centered in the here and now, is emotion focused, and experiential in nature.  What follows is a brief description of the Gottman method of couple therapy.

First let me add some interesting facts… Gottman defines a well–functioning couple as those partners that remain relatively stable and happy over time.  The couple is able to maintain control during negative conflict, create shared meaning in the relationship, and increase positive influence.  They were able to have a 5:1 positive to negative interaction ratio, which Gottman found was important to maintaining an effective, stable relationship.  A dysfunctional couple is partners that either stayed in unhappy relationships together or broke up.  The couple is unable to maintain control during negative conflict, create shared meaning within the relationship, or to increase positive influence.  This type of couple had a lower positive to negative interaction ratio of .8:1 (Gottman, 1999, p. 35).

Gottman's work is based on the Sound Marital House Theory (Gottman, 1999, p. 105).  There are seven levels to this theory arranged in hierarchical order.  1.  Create love maps.  Love maps are a road map of one's partner's inner world.  These maps are built by asking the partner open ended questions.  2.  Make the admiration and fondness system by articulating respect and love in everyday small moments.  3.  Turn toward instead of against or away from their spouse’s requests for affective connection.  4.  Permit positive sentiment override, meaning not taking negative or neutral partner events personally.  5.  Take a multi–pronged approach toward managing disagreements by using a gentle method in stating complaints, receiving influence, compromise, physical soothing, and by creating communication with continuous problems that explores each individual’s life dreams within conflict.   6.  Honor each other's life dreams.  7.  Construct a shared meaning system by creating informal and formal rituals of connection, building shared values and goals, common views of symbols and supporting each other's life roles.  The Sound Marital House Theory provides an overall structure for Gottman's assessments, therapy, and key interventions and techniques.

There are five goals the Gottman method.  I will briefly go over the five goals however I will not discuss the different steps involved with each goal.  For further information, I would recommend reading the chapter on the Gottman method of couple therapy in S. Gurman's Clinical Handbook of Couple Therapy (4^th ed., 2008).  The first goal in the Gottman method is to down-regulate negative affect during conflict.  Although conflict is inevitable, it is important to be able to achieve repair after the fight which means being able to process the fight by talking about it without getting back into the fight.  This also means being able to reduce what Gottman calls the four horsemen of the apocalypse, his greatest predictors of divorce.  This involves increasing the partners’ knowledge of the occurrence of the horsemen and teaching them how to use the appropriate antidotes.  The four horsemen are as follows: criticism, defensiveness, contempt, and stonewalling.  The antidotes for these are: complaining, accepting responsibility for at least part of the problem, respect within the relationship, and self-soothing.

Goal two in the Gottman method is to up-regulate positive affect during conflict.  This occurs by having couples turn toward each other when bids for affection are made couples can also build friendship in their relationship by increasing the activation of the positive affect system in non-conflict periods.  This could potentially lead to an increase in positive affect during conflict.  Goal three of the Gottman method is to build positive affect during non-conflict.  This can be partially accomplished by teaching clients to savor positive affect.  Goal four of the Gottman method is to bridge meta-emotion mismatches.  Meta-emotion is the way people feel about having emotions.  There are two broad types.  Those people who are emotion dismissing have poorly developed dictionaries of different emotions and did not care or know what they were feeling not having needs as a strength.  Those people who are emotion coaching see emotions as a guide on how to proceed through life.  They validate others emotions.  A meta-emotion mismatch predicts the pattern of turning away from bids such as the "pursuer-distancer" pattern.  Goal five is to create and nurture a shared meaning system.  This is something that all couples unintentionally or intentionally build, so it is important for the counselor to assist them in creating a positive shared meaning system.

This provides a brief example of Gottman’s goals in therapy.  He has published numerous books filled with assessments, references to the many tools he uses in his therapy sessions, and he offers seminars on how to use his methods in therapy.  He continues to do research as well. 

References

Gottman, J. M. (1999). The marriage clinic: A scientifically based marital therapy. New York: W. W. Norton & Co.

Gottman, J. M., & Gottman, J. S. (2008). Gottman method couple therapy. In S. Gurman (Ed.).   Clinical handbook of couple therapy (4^th ed.). New York: Guilford Press.