I always wondered how I could constantly be surrounded by imperfect clocks and their irregular second hands. The BBC reports:
You'll be in the middle of something, and flick your eyes up to an analogue clock on the wall to see what the time is. The second hand of the clock seems to hang in space, as if you've just caught the clock in a moment of laziness. After this pause, time seems to restart and the clock ticks on as normal.
I had a request for this article, so I dug it up and I thought I'd post it here. DBT as an Emotion Focused Treatment of BPD
The Guardian reports on the continued psychological impact from the Fukushima disaster in Japan:
Twenty years after the 1986 reactor explosion in Chernobyl, the World Health Organisation said psychological distress was the largest public health problem unleashed by the accident: “Populations in the affected areas exhibit strongly negative attitudes in self-assessments of health and wellbeing and a strong sense of lack of control over their own lives. Associated with these perceptions is an exaggerated sense of the dangers to health of exposure to radiation.”
We live in a world with very short attention spans. It's kind of out of necessity that we move on quickly with so much going on in our lives but there are some things we can't forget about. This is not the place for political statements (and to be honest I don't know where I would fall on the issue of nuclear power anyway) but it's critically important to remember that the psychological impact of a traumatic event often stays hidden for months if not longer.
Jonah Lehrer, one of my favorite neuroscience writers in in the popular press writes:
Children who could better regulate their impulses and attention were four times less likely to have a criminal record, three times less likely to be addicted to drugs and half as likely to become single parents. In many instances, the ability to utilize executive control was more predictive of adult outcomes than either IQ scores or socioeconomic status.
This is an interesting perspective. While he doesn't mention mindfulness by name, it's essentially what he's talking about. Specifically, he's referring to the aspect of mindfulness that helps manage attention. Developing ability to choose where to focus your attention seems to have benefits across the lifespan.
My son has a birthday card he got from his grandparents. It's one of those annoying singing birthday cards that have no audio fidelity at all but makes a 4 year-old crack up. The song is I like to move it. (by a band I've never heard of called "Reel 2 Real".) Whatever the band's name is or the degree of annoyance of the song, it's a catchy tune and an apt title for this post. The NYT reports:
Each volunteer exercised for four months, while continuing to take an antidepressant. At the end of that time, according to the study published recently in The Journal of Clinical Psychiatry, 29.5 percent had achieved remission, “which is a very robust result,” Dr. Trivedi said, equal to or better than the remission rates achieved using drugs as a back-up treatment. “I think that our results indicate that exercise is a very valid treatment option” for people whose depression hasn’t yielded to S.S.R.I.’s, he said.
I like to think of early depression treatment as targeting one or more of the areas affected by Major Depressive Disorder:
There are others things that need to be targeted but the majority of patients in early treatment for depression have a lot of work to do one one or more of those areas and it's extremely relevant to their situation. It's nice to see something so clearly affected by depression, yet so incredibly simple to do, gets continued attention in the press and research literature.
Today we continued our discussion of distress tolerance skills. We reviewed the importance of practice even when not distressed to be ready for the times that we are. We also talked about the ways in which we might not even realize that we are going through a crisis. One of my colleagues, Dr. Martha Golden, likes to start this module with a definition of "crisis" and I think that may be appropriate here as well.
A crisis is defined as:
specific, unexpected, and non-routine events or series of events that [create] high levels of uncertainty and threat or perceived threat
This does not mean that there will be a catastrophe as a result of the event; just that there is a perception that it might. We then moved into discussion of the new skill: accepting reality. We practiced several exercises from Distress Tolerance Handout 2 and each picked an activity to do for homework.
We then discussed the concept of "Half-Smiling" as a way to respond to emotional experiences on a physiological level allowing us to work on counteracting that strong, and often unaddressed, aspect of emotion. As before, we practiced half-smiling.
Both of these activities - observing your breath and half-smiling - are experiential interventions, meaning practicing them and tweaking your practice is essential to making them work. Next week, we'll be discussing more reality acceptance exercises and the concept of radical acceptance.
Dr. Linehan has been an inspiration to many, including me, in trying to figure out how to deal with borderline personality disorder. I count myself among the fortunate few who have had an opportunity to be trained by Dr. Linehan and her "children" during my own training to be a DBT therapist. Does this revelation that she, herself, has struggled with borderline personality disorder change the way I think of her? Yes, but only in the most positive ways: I knew that she talked the talk, but now I know that she walks the walk. When I teach skills to my clients, I often use personal examples as illustrative. I don't have any illusions that my own personal struggles match in intensity their own, but I do think it's helpful to share how the skills I'm teaching have helped me. The stigma associated with chronic mental illness is real and difficult to deal with. Even more for those who already struggle with emotion regulation.
The NYT reports:
“That did it,” said Dr. Linehan, 68, who told her story in public for the first time last week before an audience of friends, family and doctors at the Institute of Living, the Hartford clinic where she was first treated for extreme social withdrawal at age 17. “So many people have begged me to come forward, and I just thought — well, I have to do this. I owe it to them. I cannot die a coward.”
You are no coward, Marsha. Thank you for your courage and your story.
A while back, I bookmarked an interesting article (pdf link) that I've been meaning to write about. As I haven't had a chance to really digest the material and compose a longer entry, I thought I just get it up on the site for wider consumption. The gist of the research highlighted therein is that Tai Chi Chih seems to have a positive impact on geriatric depression. Given the relative reluctance some geriatric patients have to psychotherapy and the complicating factors of drug interactions, anything we can do to help that doesn't involve traditional medication management and/or psychotherapy is welcomed. The question remains what is the mechanism of change for this particular intervention. I suspect that it's a result of the increased ability to focus on an activity and the consequent ability to focus away from unwanted ruminations that helps, but that's just my slightly biased-towards-mindfulness explanation.
After going over the homework, we spent time discussing the importance of judgement in our lives. In light of the work we'll be doing on reducing judgement, it seemed important to make sure that we understood exactly what judgement does for us. Some of the relevant points that people made were:
We, of course, also discussed ways that being judgmental makes being mindful hard.
Tying the non-judgmental stance work we're doing to the next module to be covered in group, Distress Tolerance, homework was to answer two questions:
Next week: beginning Distress Tolerance module.
In today's group, we reviewed making wise mind choices and discussed all the factors involved in making a wise mind choice. As we discussed last week, it's important to consider all the facts of a situation, how you feel about it and what your body tells you about it. There were a couple other key points addressed in the homework review: make sure you address both sides of the question and a wise mind choice does not need to be permanent. That is, you can decide to decide later.
The new material consisted of an overview of the Mindfulness "What" skills:
Homework: choose one of the "what" skills and practice it.