New Year, same goals

Several times a week, I will coach a parent, teen, or adult patient about how to use the principles of behaviorism to change his or her behavior or the behavior of someone else. This year, I finally have found some success applying it to myself! I have been wanting to get more active for a long time both to improve physical and mental wellness. I often have created goals for myself, even created a worksheet to fill out on my refrigerator with a reward system. However, change would last for a couple weeks at the most. By combining enough behavioral principles, I finally found some movement (literally and figuratively) . I had bought a pedometer months ago hoping tracking steps would motivate me..not so much. What does motivate me, though? Chai lattes! (positive reinforcer). I started by just monitoring how many steps I was getting on average per day. The answer was, quite low. Using the principles of shaping, I decided to set my first week goal to just a little higher than my usual average in order to start with some success. Knowing that some days I have too many patients and meetings to meet my goal, I allowed myself one day to miss my goal. At the end of the week, if I met my goal 6 out of 7 days per week, I get a new Peets card to use.  It has been about 4 weeks and I have been able to increase my weekly goal by 2,000 steps, have felt more energetic, have been sleeping better, and actually lost a little bit of weight. In essence, I finally practiced what I preached. Some of the key points here are first to monitor where you are at. It would have been too much to expect 10,000 steps per day when I sometimes barely made it to 2,000. Next, think of a reward that will actually reinforce you to change your behavior and make sure to implement the reward. Even better, I sometimes will get half of my steps in by walking to Peets to use my reward! It is helpful to give yourself “partial credit” so that if you cannot do the behavior every day you still get some sort of reward (ie. 6 out of 7 days per week). Once you master one step, keep moving toward your final goal (ie. shaping). That is why I am now 2,000 steps higher and plan to increase my goal by 1,000 steps next week.  A final help can be the accountability factor. My partner and I both set steps goals and update each other daily. He also holds the Peets cards so I cannot reward myself if I do not meet my goal and I get the pleasure of asking for my reward at the end of the week!

This article is helpful on discussing how to shape someone else’s behavior: http://www.nytimes.com/2006/06/25/fashion/what-shamu-taught-me-about-a-happy-marriage.html. You can also read a book that was recommended in my dialectical behavioral therapy (DBT) training called Don’t Shoot the Dog: The New Art of Teaching and Training.  So, next time you are hesitant to set a new goal for yourself, just remember, just because you did not have success before does not mean you will not have success in the future. You may have asked for too big of a change right away or may not have picked enough reinforcers for yourself to change the behavior. I still am not sure how I feel about the fact that humans can train ourselves and others just like we can train animals, but I’m not thinking about it too much as I sip on my delicious Chai Latte!

Driven to be mindful

Yesterday I went to an alumni drop-in session for the Compassion Cultivation Training (CCT) course I took last year.  During the session, the moderator asked participants to journal about various ways we have used mindfulness this past year and goals for the next year. Upon reflection, I was glad to see that I have taken several steps toward more fully integrating mindfulness into my life.  I have begun to put my phone away  much more often. Out of sight is not quite out of mind,  but it is much easier to prevent myself from getting distracted with the future or the past and to stay in the present moment. I also have attended a few sitting meditation events locally.  I realized how much I have been craving to start a daily meditation practice and have set the intention to begin doing so in the coming year.  When we shared with the larger group, one of my peers mentioned that she sets an intention every morning about her day.  I loved this idea and already have set my morning alarm to remind me to set a mindful intention.

Interestingly, as I sat and listened to how others have been integrating mindfulness, I came to the realization that I actually have been utilizing mindfulness and compassion regularly while driving since taking the class. During my CCT class, we spoke quite a bit about the usefulness of using mindfulness while driving. For example, my teacher noted that once she realized that getting upset and stressed while stuck in a traffic jam did not get her to the destination faster and only led to suffering in herself. I realize that I now start to notice when I am getting upset about running late and much more often remind myself that I will get to the destination at the same time and I do have control over my emotional state when I arrive. This is when I will take a few deep breaths to lower my heart rate. We also spoke about how angry we would get at drivers who would cut us off or drive unsafely. We discussed how we could choose to get angry and irritated with these drivers or we could practice compassion toward others. We could realize that sometimes we are that driver and we often have very justifiable (or we justify to ourselves) reasons for our actions. Instead of reacting with a negative response, we can instead react with curiosity. I realize that I often will make a neutral comment in response to these drivers. “That car is driving fast” in a neutral tone affects me much less than thinking “what a jerk!” Instead of arriving to my destinations angry and frazzled, I have been able to drive much more calmly, and I imagine, also safely. I wanted to share this realization with others to help give you some examples of how to integrate mindfulness into your daily lives and also to keep myself accountable to continue working on these skills. Mindfulness is like a muscle. It improves the more we practice. That is while I encourage you all to be driven to drive more mindfully!

Dialectics – No (ifs, ands, or) buts

Dialectical thinking is one of the most influential concepts that I have learned from Dialectical Behavioral Therapy (DBT). I not only teach this to my patients regularly, but I also have shared it with my friends and family and practice it myself. This is an extremely useful life skill.  You can learn more about DBT, a therapy originally developed by Marsha Linehan to help chronically suicidal patients with Borderline Personality Disorder at the following website: https://behavioraltech.org/resources/faqs/what-is-dbt/.

From my understanding, dialectics is the concept that two things that seem opposite and contradictory can both be true. For example, my parents can be very strict and they can still love me. I can do badly on an exam and still be very smart and hard-working. For most individuals, especially at times of distress, we tend to think non-dialectically and this can create problems for ourselves. The beauty about dialectics is that there are some simple tools we can use to change our mindset. For example, I try to eliminate the word “but” from my language. When I talk with parents about communicating better with their children, I remind them that when they are supporting their child, avoid the word “but.” A parent might say, “Honey, I’m so sorry you are disappointed about not making the volleyball team, BUT you were feeling stressed out anyways and now you have more time to do your schoolwork.” Your distressed child likely just heard “You need to focus on your schoolwork” and did not hear any support from you. A lot of times, the word “but” magically eliminates others’ recollection of the statement that preceded it. Instead, try to replace “but” statements with “and” statements. If I’m telling my friend, “I care a lot about you AND I’m worried about you because…”, they are much more likely to hear support and to feel validated then if I use the word “but.”

In addition to eliminating “but” from my language, I also have tried to eliminate other non-dialectical words. These are strong words that are often judgments and lead to strong emotions: Hate, dumb, jerk, etc. Even more interestingly, by changing the way I speak, I also change the way I think.  “But” and other non-dialectical words and thoughts have begun to diminish in my mind before the words reach my mouth. By thinking more dialectically, negative emotions often can be less intense. Dialectics allows us to look at all the facts instead of thinking more rigidly, or having black and white thinking. Black and white thinking involves seeing things as either one extreme or the other: good or bad, smart or stupid, love or hate. When we thinking dialectically, we look at all the other options in the middle.  Maybe our friends are lovable and sometimes mean; maybe our parents try really hard to do their best and sometimes make mistakes.

When we think more dialectically, this often leads to less intense negative emotions and also affects our behaviors. For example, if my friend says something non-supportive, instead of thinking “He’s a jerk” and ignoring him, I may think “Wow, those words were hurtful. He is normally supportive and today he was not. I wonder why?” Of course, I am still upset. However, being dialectical allows me to be more curious and to investigate further instead of reacting immediately. I may be more likely to calmly tell my friend how he upset me and to be better equipped to hear his side of the story. Instead of assuming this person is suddenly not a good friend, dialectics helps me realize that I am probably missing useful information here.

If you take just one useful tip from this post, try to notice when you use the word “but” and try to work on replacing it with “and.” Just by doing this, you may already notice some positive changes in your thinking, your emotions, and your relationships. If you feel like this is too much to ask, maybe think: “I’m really busy AND this is really important so I will just do my best to start to make changes.”

Self-Compassion; Learn it, live it

(Please note, I include various links and resources in my blogs. This is purely to provide education and resources to patients and families. I do not get any financial benefits from these resources.)

I thought this topic would be appropriate for my first blog post given that I cannot stop talking about it – with friends, with family, with clients. Earlier this year, I had the privilege (and made the effort) of taking a Compassion Cultivation Training course through Stanford (http://ccare.stanford.edu/education/about-compassion-cultivation-training-cct/). Happily in a profession in which I am utilizing compassion toward others every day for most of the day, I was concerned that there was potential for compassion burnout. While I entered the class hoping to learn how to stay compassionate throughout my future years as a child psychiatrist, what struck me most was the concept of self-compassion (http://self-compassion.org/). Self-compassion, as described by Dr. Kristin Neff, involves three components: mindfulness, common humanity, and self-kindness. First, we must first be aware of our pain and suffering in order to address it compassionately.  That sounds simple but is not so easy. Many of us, including myself at times, distract ourselves from this suffering sometimes because we worry that we would not be able to do what we need to do or to be happy if we acknowledge and/or address it. Interestingly, this is not the case. Even just acknowledging our suffering can cause some relief. In class, we practiced writing a self-compassionate letter (http://self-compassion.org/exercise-3-exploring-self-compassion-writing/) and even just this exercise of writing down and acknowledging my suffering caused significant immediate relief for me. Next, common humanity is acknowledging that many others are suffering in the same way. This element is tricky because it can lead to invalidation (ie. Other people are going through this, so why am I making such a big deal). However, I like to think of it as the fact that all people have imperfections and are vulnerable and that is part of being human. Acknowledging this fact makes it much easier to do the final part – self-kindness. This final part is what I get most excited to teach my clients. Living in the Bay Area, I am surrounded by over-achievers – myself, my friends, my colleagues, my patients, their parents, etc.  A lot of us have gained success using various tools. One tool some, including myself, have used, is bullying yourself. By telling ourselves we should do better and be better, we may imagine that we are pushing ourselves forward and helping ourselves achieve difficult accomplishments. In fact, while at times this may lead to the desired behaviors, it takes a large toll on our wellness. Self-kindness involves talking to yourself like your mentor or friend would talk to you — in a warm, encouraging manner. I think of it as holding my hold hand and gently guiding myself forward. This actually works! If you imagine that you did poorly on an exam and came home and your parents said, “Well, of course you did badly. You are stupid and useless. You will amount to nothing.” Does this encourage or discourage you? What if, instead, they said, “I’m sorry you didn’t get the grade you wanted. You studied really hard and stayed up late to review everything. I know you can do better and I bet you will next time. Maybe let’s look at your schedule and see how we can make more time so you won’t have to cram the night before and can get a good night’s sleep.” Sounds a little more encouraging? I find that my teenage clients are often harder on themselves than their parents are. I have been working on self-kindness myself and it does make a big difference. It encourages me and helps me move forward and I am a happier person ever since I have begun practicing it. Remember, this is a practice. If we forget to do it or slip up, in the spirit of self-compassion, tell yourself, “It’s ok, you can and will do better next time.” At the very least, treat yourself just as kindly as you would treat a friend. Whatever your motivation may be for self compassion (happiness, success, physical wellness, focus, decreased anxiety, closer relationships), use this motivation to keep working on it. If you are feeling skeptical about self-compassion, which is totally fine and expected, at least take a look at this article about myths related to self-compassion:  https://greatergood.berkeley.edu/article/item/the_five_myths_of_self_compassion. If you are interested in learning more, you can also read Kristin Neff’s book: Self Compassion: The Proven Power of Being Kind to Yourself.