TRAUMA IN THE CONTEXT OF MASS SHOOTINGS

TRAUMA IN THE CONTEXT OF MASS SHOOTINGS

By way of full-disclosure, I’m tearing up as I write this. In the last few years alone, we have seen a rise in mass school shootings; that is, the death of innocent children, adolescents, and their adult mentors/teachers in cold blood.

I too, continue to grapple with the snuffing out of so many lives, and the lack of response to these deaths that somehow don’t seem to create change. Actually, most school shootings aren’t even talked about.

According to a non-profit that tracks gun violence in America, as of April 20th  2018, there have been 17 shootings since the February shooting at the Marjory Stoneman Douglas High School in Parkland, Florida which launched the Never Again movement. You read that number correctly. 

I don’t want to get too political here, but as a mental health practitioner and staunch advocate, I want to go on record saying that gun violence is not a mental health issue. Is mental health sometimes a component in these shootings? Sure. Yet, let’s be clear. The rise of school shootings is not attributable to a national mental health crisis. It is far too easy for someone to get a gun in this country. No matter which side of the gun control debate you are on, it is insulting with those who suffer with mental health to be accountable for this.

Here’s some info taken straight from MentalHealth.gov to keep in mind:

Myth: People with mental health problems are violent and unpredictable.

Fact: The vast majority of people with mental health problems are no more likely to be violent than anyone else. Most people with mental illness are not violent and only 3%–5% of violent acts can be attributed to individuals living with a serious mental illness.

Now that I made that clear, I want to discuss PTSD in the context of these shootings.

Undoubtedly, these shootings will impact the victim’s families, friends and communities forever – some might even develop PTSD, as they are certainly at risk, especially those who survived and witnessed the events.

Of course, what we have seen come out of the Parkland shooting is no less than a post-traumatic growth response (learn more in my PTSD packet); while this doesn’t mean the survivors aren’t deeply suffering, many have been able to utilize this suffering as fuel to advocate for gun control in a way it seems that no other organization or group of individuals has been able to before. Their efforts have affected real change, and I pray the change continues.

What I want to address is the idea of virtual trauma. We, as a nation, are privy to these events either in real time, or moments after. Sometimes, the media coverage is more gruesome and detailed than at others. Regardless, we, as a nation, are at risk for PTSD even if we were not directly affected. Whether we were involved or not, these accounts bring up a real sense of danger and deep concern about our and our loved one’s safety.

According to research in the early 2000’s, approximately 15 to 36 percent of the population that did not experience violence directly, will still develop post-traumatic stress disorder (PTSD) symptoms. 

The impact of trauma has a wide range. Even just hearing about the event can shatter our assumptions about our world. You see, tragedies like these reverberate in the hearts and minds of much of humanity, as it rips through the basic foundation that we lay our trust upon. That is, we don’t expect people to just shoot other human beings in cold blood. So, it seems that trauma’s effect surpasses the psycho-neurobiological impact of experiencing a direct threat to one’s own life.

According to psychologist Janoff-Bullman, what a mass trauma like this does is challenge our assumptions and brings them into question.

These assumptions may include:

  • “the world and people are intrinsically good”
  • “good people experience good things”
  • “the world is safe”
  • “the world is just”

 

Undoubtedly, these assumptions aren’t necessarily true, but can be healthy and adaptive.  For many of us, these very assumptions help us get out of bed in the morning and actually go about our lives and are necessary for meaningful experiences and interpersonal relationships.

The figurative ground we walk on becomes shakier and shakier with each shooting. If you notice that after an event you start feeling more irritable, anxious, like you have lost control, depressed, have trouble sleeping and anything else that is not your baseline and does not seem to be going away, please reach out for help.

This is part 2 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

RECOGNIZING THE COMPLEX TRAUMA OF PROLONGED VIOLENCE

RECOGNIZING THE COMPLEX TRAUMA OF PROLONGED VIOLENCE

Children inside U.S. Customs and Border Protection detention facility at the Rio Grande Valley Centralized Processing Center in Rio Grande City, Texas. CBP/via REUTERS 2018

Complex trauma (C-PTSD) is still, relatively, a new term. It was coined in the 1990’s by trauma expert Judith Herman to connote repeated, prolonged (protracted, chronic) trauma. Another name sometimes used to describe the cluster of symptoms referred to as Complex PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

In reality, C-PTSD is still actually just a proposed disorder: because 92% of individuals with Complex PTSD also meet diagnostic criteria for PTSD. Complex PTSD is not added as a separate diagnostic classification. 

I’m included in the group of many clinicians, however, who render it extraordinarily useful as a separate diagnosis. The current PTSD diagnosis often does not fully capture the severe psychological harm that occurs with prolonged, repeated trauma. While some symptoms may overlap, there are additional possible symptoms as well as possible conceptual differences.

Certainly, more precision in diagnosis leads to more precise treatment, and treatment for PTSD often fails with those experiencing C-PTSD. So, regardless of how one’s cluster of symptoms is labeled, it is crucial for a clinical to know the hallmarks of C-PTSD.

 Another trauma expert, Dr. Christine Courtois, wrote that complex trauma is “a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts.” In her well-known article, Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Dr. Courtois continues to summarize the characteristics of complex traumatic events as:

  • Repetitive, prolonged, or cumulative.
  • Most often interpersonal, involving direct harm, exploitation and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults.
  • Often occur at developmentally vulnerable times in the victim’s life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/disempowerment/dependency/age/infirmity, etc.

 

While there are many types of repeated trauma, it is most often experienced by children who are victims of long-term physical and/or sexual abuse. It also can include: experience in a concentration camp, POW situations, long-term domestic violence, prostitution/brothel situations, and organized child exploitation rings. In all of these circumstances, according to Dr. Herman, the trauma victim is generally held in a state of captivity, physically or emotionally, and in a situation in which there is no actual or perceived way to escape.

As I write this, I humbly and painfully think about how the current #BorderCrisis is a #MentalHealthCrisis, and how this will impact these children long-term. At the heart of C-PTSD is the idea of emotional neglect. When it comes to human beings making emotional attachments and proper development – we need more than just a bed to sleep in.

C-PTSD is not a psychological death sentence, so to speak, and there is treatment, but it needs to be recognized in general, and particularly with regards to what is going on at the border. People need to know that these children need help, and like any challenge, the earlier there’s intervention, the better.

People who experience chronic trauma often report symptoms that are additional to those seen in those diagnosed with PTSD. Dr. Herman initially identified this list of additional symptoms, which aren’t all included in the diagnosis of standard PTSD:

  1. Difficulty Regulating Emotions: May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  2. Alterations in Consciousness:Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation).
  3. Alterations in Self-Perception:May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  4. Distorted Perceptions of the Perpetrator:Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  5. Difficulties with Relationships to Others:Examples include isolation, distrust, or a repeated search for a rescuer.
  6. Somatization and/or medical problems: Somatic reactions may relate directly to the type of abuse suffered (or any physical damage endured) and can involve all major body systems.
  7. Alteration in One’s System of Meanings:May include a loss of sustaining faith or a sense of hopelessness and despair.

 

Personal Clinical Note: Patients of mine who have experienced complex trauma, consistently describe feeling a lack of sense of self, very low self-esteem, extreme self-loathing, difficulty in interpersonal relationships, and an inability to discern between any real or potential threats to their minds and/or bodies. Often, and while this can happen in other diagnoses and from enduring a solitary trauma, it is more likely for someone who is chronically traumatized to engage in self-destructive and self-mutilating behaviors.

 Many C-PTSD researchers and clinicians report that using the same treatment paradigm as one would use for PTSD (see below), might not cut it, and might even prove problematic. In response to this, the recommended course of treatment involves the sequencing of healing tasks across several main stages of treatment. These stages include (1) pre-treatment assessment, (2) early stage of safety, education, stabilization, skill-building, and development of the treatment alliance, (3) middle stage of trauma processing and resolution, and (4) late stage of self and relational development and life choice.”

This is part 1 of a 4-part series of excerpts from the latest 2018 edition of Dr. Wolkin’s PTSD Packet

Repost: The Mindful Approach to Those Very Real Butterflies in Your Stomach

Repost: The Mindful Approach to Those Very Real Butterflies in Your Stomach

This blog post originally appeared on Mindful.org

An Early Account

In the 1950’s Dr. Thomas Almy, a prestigious gastroenterologist, snapped a picture of a live colon responding to the proverbial “butterflies in the stomach.”

Dr. Almy invited a student to take part in an experiment where he used a sigmoidoscope to look inside the student’s rectum and colon. A bystander complicit in the experiment said something about cancer of the colon. Upon hearing this, the student concluded that he must have cancer, at which time his colon started to change color, tense up, and contract rapidly. When the student was reassured that cancer was not his diagnosis, his colon regained its natural color, and relaxed.

This experiment paved the way for a deeper understanding of the visceral processes behind our gut-wrenching experiences. Getting butterflies before a big test or nausea right after a breakup: those feelings are much more than anecdotal. It’s a physiological reality that our emotions and stress physically impact our gut.

The Brain-Gut Axis and Stress

One of the major breakthroughs in understanding how the central nervous system (CNS) and the gut communicate was the discovery of the enteric nervous system (ENS). The ENS, sometimes called the “second brain,” is a complex system of about 100 million nerves found in the lining of the gut. Both of our brains, so to speak, are in constant dialogue and speak in many “languages” as they send signals to and fro via neural and endocrine pathways that collectively have been dubbed the “Brain-Gut Axis” (BGA).

The BGA plays a prominent role in our overall wellness, and there is significant evidence that it’s susceptible to stress. The route to BGA dysregulation has many avenues, all of which make the gut more vulnerable to disease.

Stress-induced changes in the physiological functions of the gut include changes in: gut motility, mucosal permeability, visceral sensitivity, gastric secretion, and the gut microbiota. Changes to gut microbiota is called dysbiosis, which may lead to disease. Many of these stress-induced changes account for the symptoms seen in many gastrointestinal disorders.

Functional Gastrointestinal Disorders (FGIDs): When the Gut Acts Up

In my clinical practice, evidence of the BGA is most visible in the functional gastrointestinal disorders (FGIDs): cases when the gut is acting up and there’s no obvious physical cause, like a tumor or bowel obstruction, for example. This does not mean that an FGID is all in one’s head, however. A more precise conceptualization is that stress influences the actual physiology of the gut. In other words, psychological factors can impact upon physical factors, like the movement and contractions of the GI tract, causing inflammation, pain, and other bowel symptoms. These disorders often significantly reduce quality of life.

FGIDs include the better-known irritable bowel syndrome (IBS) and the lesser-known small intestinal bacterial overgrowth (SIBO). Given their functional nature, they continue to be difficult to treat, and often require GI doctors to use multiple treatment modalities and make referrals to other clinicians, including psychologists.

A Vicious Cycle

To be clear, the brain-gut connection is complex. For one, it is bidirectional; just like a stressed brain sends signals to the gut, a troubled gut sends signals to the brain, putting someone at greater risk for anxiety and other neuropsychiatric difficulties. Parsing which came first, the stress or the gut distress, becomes challenging and most often this bidirectionality between enteric and central nervous systems is a vicious cycle of great discomfort.

Just like a stressed brain sends signals to the gut, a troubled gut sends signals to the brain, putting someone at greater risk for anxiety and other neuropsychiatric difficulties.

On top of that, many of the FGIDs become chronic conditions, which pose a stressful physical and psychological burden. Many of the patients I treat come see me because having a disorder like IBS primes them for stress that maintains the original symptoms. For example, while stress is a clear player in the origin of FGIDs, “gut-focused” thoughts, emotions, and behaviors start to create stress that reinforces the underlying pathophysiology (i.e., slows motility, visceral pain). For example, my patients with FGID have become hyper-vigilant of their heightened visceral pain and then begin to catastrophically appraise their abdominal sensations. Also, their quality of life starts to significantly decrease, many times leading to anxiety and depression.

Many of the patients I treat come see me because having a disorder like IBS primes them for stress that reinforces the original symptoms.

A SIBO Story

I’ve learned about the FGIDs firsthand. I have a deeply personal connection to the BGA, and it serves to enhance my professional passion and expertise on the subject. In the winter of 2013, I experienced a feeling of pressure in my stomach after every meal. I felt visceral pain, and it felt difficult to empty my bowels. My heart felt fiery. I wasn’t just bloated—I looked pregnant. I had a belly the size of six-month gestational equivalence.

I wasn’t just bloated—I looked pregnant. I had a belly the size of six-month gestational equivalence.

I was otherwise healthy, and thankfully so, and the onset of symptoms was anxiety provoking. After a multitude of tests ruled-out anything life threatening, I took a hydrogen breath test that my GI specialist said was indicative of small intestinal bacterial overgrowth (SIBO).

I had never heard of it before, so I began to just refer to myself as a “digestive mess.” It definitely felt like a mess, as SIBO had nonchalantly decided to go camping in my gut, like a pesky parasite sucking the life out of every ounce of normal flora to be found. Camping: as in pitching tents, starting fires, and sleeping in the dark hollows of my alimentary organs (i.e., my gastrointestinal tract).

This was my up close and personal reckoning with just how much stress was taking over my mind—and body. SIBO was a wake-up call to inspect my habitual patterns of thinking and behaving that were adding to my stress levels over time.

This was my up close and personal reckoning with just how much stress was taking over my mind—and body. SIBO was a wake-up call to inspect my habitual patterns of thinking and behaving that were adding to my stress levels over time. These patterns weren’t “bad” per se, they were just not serving my wellness. It is hard to pinpoint any one stressor, or any one pattern that contributed to SIBO. In retrospect, it was probably an accumulation of stress that I carried with me during a grueling postdoc. Postdoc was an extraordinary experience that afforded me first-class training. Yet, I pushed myself without taking the time to rest. I can still recall one of my supervisors saying that “postdocs” never get sick, or if they do, they sweat through it, and suck it up. All I could think then if I needed a break was “I am such a failure.” I think I carried this line of thinking with me as I embarked on the first phase of my career post-training. I kept going without rest, and if I needed a break I’d once again hear the stress-inducing voice in my head reminding me of what I thought was my inadequacy.

It is hard to pinpoint any one stressor, or any one pattern that contributed to SIBO. In retrospect, it was probably an accumulation of stress that I carried with me during a grueling postdoc. Postdoc was an extraordinary experience that afforded me first-class training. Yet, I pushed myself without taking the time to rest. I can still recall one of my supervisors saying that “postdocs” never get sick, or if they do, they sweat through it, and suck it up. All I could think then if I needed a break was “I am such a failure.”

SIBO was a wake-up call, albeit a very uncomfortable one. So uncomfortable that I began to resent my body, avoiding social engagements, and hyper-focusing on my symptoms. The heaviness I physiologically felt in my core became a psychological burden, and I became depressed, until I finally realized that by calling myself a “digestive mess” I was colluding in the maintenance of my pain.

4 Ways to Treat FGIDs Using the Mind

Since multiple components, including physiological, affective, cognitive, and behavioral factors are associated with FGIDs, an integrative approach to treatment is prudent. The research indicates that psychological interventions have been successfully applied. More specifically, a large number of randomized controlled trials suggest that cognitive behavioral therapy (CBT), biofeedback, relaxation techniques, and mindfulness meditation are effective psychological interventions for FGIDs.

1) Cognitive Behavioral Therapy

Cognitive Behavioral Therapy is based on the idea that sometimes people engage in habitual thinking patterns that are founded on a skewed perception of their experiences or unhelpful, “distorted” thinking. It’s an inquiry-based approach that asks people to take notice of their mood changes and the habitual patterns of behavior they engage in.

CBT is the most studied psychological intervention vis-à-vis FGIDs, and most studies were conducted with IBS populations. Many people with IBS engage in unhelpful thinking styles related to their actual symptoms, which then impact upon their moods and behaviors. For example, imagine a scenario during which someone with IBS is certain that eating out in public means they will absolutely have diarrhea. The thought creates anxiety, which might actually lead to autonomic arousal that could potentially trigger diarrhea. Eating out is now linked to having diarrhea and so eating out is likely avoided. CBT treatment would first be geared toward helping someone identify this pattern of thinking, feeling, and behaving. Then it would be utilized to help someone learn to challenge this unhelpful thinking and develop healthy active coping skills.

One study conducted over twenty years ago focused on the impact of CBT on IBS by randomizing 34 patients to eight weeks of cognitive therapy, a self-help support group, or a waitlist control. The results indicated that post-treatment the cognitive therapy group showed a significant reduction in gastrointestinal symptoms, as well as significant improvement on measures of depression and anxiety when compared to both the support group and waitlist control paradigms. These results were maintained at a three-month follow up.

A recent study, published in January 2017, looked at the effects of a 12-week course of face-to-face CBT on 18 subjects with IBS. Results indicated a decrease in self-rated visceral sensitivity, as well as associated psychiatric symptoms. The authors of the study attributed the results to increased ability to cope with IBS symptoms.

2) Relaxation Techniques

In 1975, Herbert Benson, a physician at Harvard, introduced the concept of the relaxation response. It is the physiological opposite to the fight or flight response. In this way, stress management can be achieved by dampening the effects of the sympathetic nervous system’s “fight or flight” arousal mechanisms by activating our parasympathetic nervous system through relaxation techniques.

Research has suggested that practices like meditation, yoga, and prayer, which elicit the relaxation response, alleviate stress and anxiety’s physiological counterparts, which as we now know, can impact gut motility and induce dysbiosis.

A pilot study from Harvard University affiliates Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital and Beth Israel Deaconess Medical Center was designed to investigate whether meditation, a relaxation-response-based intervention could reduce negative symptoms and improve quality of life in patients with IBS and irritable bowel disease (IBD). Forty-eight patients with either IBS or irritable bowel disease (IBD) took a 9-week session that included meditation training, and the results showed reduced pain, improved symptoms, stress reduction, and the change in expression of genes that contribute to inflammation. 

3) Biofeedback

Biofeedback uses computerized technology to help someone learn to control or manage the body’s response to stress. Sensitive instruments are used to measure physiological processes, like heart rate variability and/or muscle contractions, for example, with the purpose of “feeding back” the information to someone so they can learn to control them.

In terms of FGIDs, biofeedback’s effectiveness has mostly been investigated in those experiencing functional constipation. In this case, biofeedback is used to help someone tune in to a propensity for paradoxically contracting the pelvic floor muscles during bowel movement (often referred to as pelvic floor dyssynergia (PFD), and then to train someone to relax these muscles instead.

One study compared the effects of five weekly biofeedback sessions with those of laxatives plus counseling in patients with severe PFD. The researchers studied overall satisfaction with treatment, symptoms of constipation, and pelvic floor physiology. At six months, improvement was reported in 80% of patients in the biofeedback group vs. 22 % in the other group. Results were sustained at 12 and 24 months post-treatment. More specifically, biofeedback produced a greater reduction in straining, a greater reduction in the sensation of incomplete evacuation, a greater reduction in abdominal pain, and reduced use of suppositories. Since the study clearly indicates the benefits of five biofeedback sessions vs. continuous laxative use, it’s become the gold standard for treatment for this type of functional constipation.

4) Mindfulness Meditation

John Kabat-Zinn, the pioneer of mindfulness meditation’s use in Western psychological interventions, proposes that mindfulness is a state of greater awareness cultivated by paying attention on purpose, in the present moment, and without judgment. This definition reflects mindfulness’ positive impact upon sensory, cognitive, and emotional processing through cultivating purposeful, present-moment focus on experiences without the added judgment and evaluation often projected onto them. Since FGIDs are often maintained by the stress burden induced by the narrative that is created about the symptoms—a narrative that is rooted in judgment—mindfulness meditation has recently been studied and added to a growing list of possible psychological interventions for FGIDs.

One particular study in the Journal of Behavioral Medicine, looked at the impact of mindfulness training based on the MBSR program developed by Kabat-Zinn, on the quality of life of 39 women with IBS. As compared to a control group, the women who received the training experienced a significant attenuation of symptoms and an increase in quality of life.

More specifically, the mindfulness training cultivated a less reactive mindset toward potentially distressing thoughts, emotions, and sensory experiences. As the women were able to just witness their visceral sensations without catastrophically appraising them, anxiety was reduced, pain was attenuated, and they even started to think they had the potential to successfully cope with their symptoms.

Mindfulness for My SIBO Case

I personally looked toward mindfulness meditation to help me sit through a lot of the discomfort from SIBO. I repeatedly practiced sitting with the sensory experience of my symptoms without the added judgment. The anger toward my body for betraying me was slowly replaced with a compassion for what it was enduring.

The anger toward my body for betraying me was slowly replaced with a compassion for what it was enduring.

Overall, what I learned through my healing process, in a nutshell, is that given just how clear it is that emotional and psychosocial factors can trigger symptoms in the gut, I needed to make some lifestyle changes. So I did, and I still do. When we have engaged with certain unhealthy thoughts, feelings, and behaviors for a long time, the path toward wellness takes extra patience, perseverance, time, and trust. Nothing about the path is easy. Sometimes, it’s even disheartening. Always, it’s worth the chance to thrive.

 

Repost: April Showers Bring Poetry Pitter Patters: My Favorite Poems and Why They Resonate

Repost: April Showers Bring Poetry Pitter Patters: My Favorite Poems and Why They Resonate

This blog post originally appeared on The Huffington Post

It’s April, and while that means more rain showers, it also means it’s time to recognize a literary style “in which special intensity is given to the expression of feelings and ideas by the use of distinctive style and rhythm”. Or, simply put, poetry!

In honor of National Poetry Month, I would like to present these 4 poems that not only resonate deeply with me, but have also helped to inform my work with my clients.

One of the beauties of poetry, I think, is that there is no single meaning to any one poem. The poet pens a narrative in verse that can be interpreted in all ways; I would even go so far as to say that a reader of poetry projects upon a poem what he/she needs in that given moment. The interpretation is never static, and likely the reader will experience something different with each reading or recitation. So, if it stirs something within you right now – and moves you to greater awareness of self, others, and the world – then honor those things!

Vulnerable alert: These works have seen me through difficult times. As my post-doc and a romantic relationship were both simultaneously coming to an end in 2010, the feeling of loss led me to these poems. I recited them every time I needed a reminder that not only was it was okay to feel every iteration of my feelings, but that those feelings were also healthy, and important – serving as a springboard for new endeavors and a greater openness to identifying, and then saying yes to, those things I desired that were beyond my comfort zone.

Reciting the poems, as I power-walked around the Charles River, comforted me, and also allowed me to notice and feel the pain of confronting the changes in my life. The more I recited, the more I let myself feel, and the more facile it became to just put one foot in front of another, trusting that those small steps would lead me to my somewhere new. The words reverberated over and over until I found my way towards healing.

There is much to be learned from a poetic journey inward. I hope that one, or more, of these poems bring you some of the peace that they have brought me.

 

1. The Journey

by Mary Oliver

One day you finally knew

what you had to do, and began,

though the voices around you

kept shouting

their bad advice—

though the whole house

began to tremble

and you felt the old tug

at your ankles.

“Mend my life!”

each voice cried.

But you didn’t stop.

You knew what you had to do,

though the wind pried

with its stiff fingers

at the very foundations,

though their melancholy

was terrible.

It was already late

enough, and a wild night,

and the road full of fallen

branches and stones.

But little by little,

as you left their voices behind,

the stars began to burn

through the sheets of clouds,

and there was a new voice

which you slowly

recognized as your own,

that kept you company

as you strode deeper and deeper

into the world,

determined to do

the only thing you could do—

determined to save

the only life you could save.

Why it resonates:

The Journey resonates with me because it speaks to the idea of individuation and separation.

It is hard for most of us to leave our family of origin, mentally speaking. It’s a challenge to go out into the world, without the protection and grounded-ness that our primary attachment figures provided (if we were lucky enough) when we were younger. It is also just as hard, because despite wanting to “become ourselves” as individual entities, we often stay enmeshed in the maladaptive patterns of our ancestry. Their traumas, and subsequent triggers, sometimes become ours, and though we want to shed those layers from our own psyches, it is what we know – the familiarity is resoundingly comforting.

My clients and I have learned that we sometimes make unconscious agreements with ourselves to hold on to the pain, until we realize we can’t breathe from the bearing of it, and we need to let go of it in order to save ourselves.

2. Autobiography in Five Chapters

by Portia Nelson

I

I walk down the street.

There is a deep hole in the sidewalk

I fall in.

I am lost…

I am hopeless.

It isn’t my fault.

It takes forever to find a way out.

II

I walk down the same street.

There is a deep hole in the sidewalk.

I pretend I don’t see it.

I fall in again.

I can’t believe I’m in the same place.

But it isn’t my fault.

It still takes a long time to get out.

III

I walk down the same street.

There is a deep hole in the sidewalk.

I see it is there.

I still fall in…it’s a habit

My eyes are open; I know where I am;

It is my fault.

I get out immediately.

IV

I walk down the same street.

There is a deep hole in the sidewalk.

I walk around it.

V

I walk down another street.

Why it resonates:

Both personally and professionally I know so well that change is hard. Actually, that’s the understatement of the day! When we have engaged with certain unhealthy thoughts, feelings, and behaviors for a long time, the path towards wellness takes extra patience, perseverance, time, and trust. This poem resonates for me because it reflects a sequence of change that is authentic.

Portia beings by speaking to the deeply painful reckoning with bumps in the road. Then, she begins to recognize patterns that might be holding her back, but does so with a gentle nudge and compassion for herself. She continues by putting just one step in front of the other, supporting herself through each step, not blind to the challenges, but not beating herself up either for the slow progress, which includes literally falling into the same old maladaptive patterns.

She recognizes that patterns are like habits, accumulations of ways of being and showing up in a world that used to work for us, and that most likely previously protected us from our pain. Ultimately, she finds a new path. This doesn’t mean her journey is over. In fact, in some ways, it has just begun.

3. The Guest House

by Rumi

This being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,

some momentary awareness comes

As an unexpected visitor.

Welcome and entertain them all!

Even if they’re a crowd of sorrows,

who violently sweep your house

empty of its furniture,

still treat each guest honorably.

He may be clearing you out

for some new delight.

The dark thought, the shame, the malice,

meet them at the door laughing,

and invite them in.

Be grateful for whoever comes,

because each has been sent

as a guide from beyond.

Why it resonates:

Rumi, the Sufi poet, waxed poetic in his ‘The Guest House’ a long time ago about how we should treat every emotion as a visitor, without looking to get rid of any of them, but rather to understand their message and purpose.

Emotions are neither inherently good nor bad, and to think of them in such dichotomous terms is to do oneself a disservice. Emotions just are. In fact, every emotion tells us something about our inner experience that might be informing our outer experience.

What Rumi alluded to in his writing was also recently confirmed by research (https://www.scientificamerican.com/article/negative-emotions-key-well-being/) – which indicated that well-being is actually predicated on having a wider range of emotions, including the negative ones! Yes, that’s correct, the more you can feel, in all of feeling’s iterations, the better off you are.

While relaxation is a beneficial byproduct of mindfulness practice, its salutary effects are associated with the ability to help us expose ourselves to our emotions, to truly feel them, with compassion and as little judgment as possible. That’s why techniques like mindfulness have gained anecdotal significance, and their effectiveness is being confirmed through rigorous research.

4. Wild Geese

by Mary Oliver

You do not have to be good.

You do not have to walk on your knees

For a hundred miles through the desert, repenting.

You only have to let the soft animal of your body

love what it loves.

Tell me about your despair, yours, and I will tell you mine.

Meanwhile the world goes on.

Meanwhile the sun and the clear pebbles of the rain

are moving across the landscapes,

over the prairies and the deep trees,

the mountains and the rivers.

Meanwhile the wild geese, high in the clean blue air,

are heading home again.

Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting —

over and over announcing your place

in the family of things.

Why it resonates:

We are socialized from a young age to think that being “good” means that we will be rewarded. What does “good” really mean though? The need to “be good” for the sake of approval, or the idea that one needs to repent to be redeemed, is immediately refuted here. How do we differentiate our own moral compass, and being a “good” person versus a “bad” person, from how other people interpret “good” and “bad”? When we try to base our actions on other people’s definitions, it can often lead to stifling expectations and guilt, which leads to deep suffering.

This poem, perhaps, then, speaks to a freedom that defies the need to be “good” as a way out of punishment or scorn by others. In this poem, Mary Oliver invites us to shed the shackles we so often place upon ourselves for the sake of pleasing others. She makes room for us to let go of that, to fully embrace our essence, without judging it, without labeling it good or bad or right or wrong.

There is a chance for catharsis here, as we let ourselves connect to the “soft animals of our body”. Beyond the layers of somatic tension, clenching, and a protective posturing, is softness. The soft part of ourselves doesn’t need to hide. We shouldn’t deny what we love or whom we love or how we love.

To me, the most poignant part of this poem is the invitation to shed those limiting layers, and to look at the bigger and grander picture; that is, all of us, every living creature, are immortally bound by our smallness and bigness all at once. Perhaps, this collective truth is the most healing of them all.

You may have noticed that two of the poems I shared are from Mary Oliver’s oeuvre. I tried to be more diverse in my choices, but Mary has become a role model and mentor (read-she doesn’t know who I am!) for me in my own journey as a poet. A few years ago I attended one of Mary Oliver’s rare readings and signings at the 92nd Street Y and scored this!

Buy more of Mary Oliver’s poetry here

~

Sometimes the only way out of a trying situation or time in our life, is to journey inward, and a great place to start is by peering into a poet’s own journey. I hope that one, or more, of these poems bring you some of the peace that they have brought me.

Repost: 3 Ways Mindfulness Can Improve Your Relationships

Repost: 3 Ways Mindfulness Can Improve Your Relationships

This blog post originally appeared on About Meditation.

Do you ever struggle to connect or communicate with your partner? I mean, who doesn’t?

But what a lot of people don’t know is that brain science shows that practicing mindfulness can help you in this area of life.

You see, mindfulness is much more than meditation. It’s more like a fundamental approach to life.

Mindfulness Improves Relationships

It starts with choosing to become more aware of how we show up in life and making conscious choices about what our presence looks and feels like in each moment.

All of this can inform the way we are as individuals in our relationships.

How is that?

Because mindfulness can help you cultivate healthier relationships through stress reduction, enhanced emotion-regulation abilities, and honed communication skills (Among other ways I am sure)!

1. Stress reduction

We’ve all experienced that moment when we are so stressed that the little things start to bother us. Stress increases our irritability levels, and then inconsequential things start to elicit reactivity.

I know you know what I’m talking about…

Mindfulness meditation can help reduce stress, and consequently, make each individual in a relationship less likely to argue about the little things that—oftentimes unnecessarily—blow up into big things.

Here’s one quick mindfulness exercise to help you in moments like that. Try this stress-busting breathing with your partner.

2. Enhanced Emotion Regulation

It’s becoming clearer to researchers that practicing mindfulness meditation can help us regulate our emotions, and lash out less at one another!

How does that work?

Studies show that practicing mindfulness meditation decreases the grey-matter volume of the amygdala—the fear center of the brain—and increases the grey-matter volume of our pre-frontal cortex.

That’s the part of the brain responsible for forethought, and what we call “higher order” functions.

But it doesn’t stop there. Mindfulness meditation is also associated with increased connection between the amygdala and pre-frontal cortex. This leads to greater integration of our emotions and intellect.

How This Can Help Your Relationship

But you might be wondering, how does this help us? Here’s an example.

When our partner says something we don’t like, it’s plausible that instead of thinking it through, we feel threatened. That activates the amygdala that readies us to attack back.

In truth, much of the time when our partner “acts out” it’s from a place of their own insecurity, and their own deep-rooted pain.

So instead of impulsively trying to attack back from one’s own “wounded place,” try responding with compassion for all of the pain both of you are experiencing by truly listening and then responding from a place that is less fear-based.

Slowly, but steadily, we can work together with our partner to decrease our amygdala volume!

3. Honed Communication Skills

Now, imagine that instead of immediately reacting based on fear, we take a moment to pause and reflect on why we feel threatened and then proceed to respond with more kindness.

We can then start to imagine that our significant other also has their own insecurities and hot-button issues. It’s hard, but imagine if each individual in a partnership practiced taking a few breaths before lashing out and attacking in return and instead responded with a calmer and less defensive demeanor.

We’d actually give one another the space to be heard, and the opportunity to communicate without our armor. WOW.

But how do we do this?

Each partner works on becoming more attuned to their own emotional landscape by starting to understand what triggers them most, and why.

For example, someone might immediately be on the attack if her significant other calls to say that they will be late to dinner. It’s important to understand why that call felt so threatening that it resulted in anger and lashing out.

Perhaps, and this is just an example, it taps into someone’s deeper fear of being abandoned by their partner. If possible, cultivate compassion for oneself for experiencing such deep pain, and even needing to be on the defensive.

This takes time, and it’s a process…one that is often worked upon in therapy.

A Mindful Listening Exercise

Then, maybe try THIS:

Mindful listening is a core element of healthy communication.

Really taking the time to listen to how the other feels, without immediately and sometimes impulsively reacting, creates the space for both parties to feel heard and then to show up in kind with a more mindful ear.

I recommend you set a timer for five minutes. Then one partner begins to speak about whatever they would like (this isn’t the time to attack the other, this is just about practicing uninterrupted listening), which can include how they feel about the relationship or about anything at all.

Non-verbal responses are permitted from the listening part, but no verbal response of any kind.

Then, when the timer goes off switch roles so that the speaker now becomes the listener. Each time you practice the exercise, switch off who starts being the initial listener and vice versa.