Tag Archives: CBT

Mindfulness Reloaded

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The beach can be a buffet for the senses

Last week, I was on vacation in Florida. We spent a day at the beach during which I found myself mindfully aware- really awake- to sensations that were previously mundane. I watched my young son playing in the sand and wondered what this was like for him, given that he was experiencing this beach day as a true beginner. I tapped into my “beginner’s mind” and opened my awareness to all sensations equally: the sand between my toes, the breeze on my face, the warmth from the sun, that distinctly oceany smell. When I noticed my mind clinging to any particular sensation, I took note and then expanded outward.

Yes, I think it is easier to be mindful of sensations that are inherently pleasurable and evoke positive emotions. But my overall pleasant experience of the beach was no less interesting. I watched as my mind worked harder than usual to cram all the goodness in, almost bingeing on the details of the experience. Simultaneously, I saw my mind never letting go of the idea and images of what we were not experiencing back in Switzerland (which my mind deemed “bad”): cold, cloudy, wet days of winter. I was aware that my mind was both enjoying the feast while preparing for the famine. There was a hurried and almost gluttonous pace to my practice that day.

Now that I am back in Switzerland (where it is indeed cold, cloudy and wet), my mind often boomerangs back to the memories from that beautiful day. I notice a range of emotions- longing predominant among them. Yet when my awareness widens beyond the images of the beach, I notice the less exotic but pleasurable sensations of contentment, warmth, ease, the breath. I recognize that this is a “famine” that I can manage.

I have heard happiness described as “the lack of sadness.” This definition suggests that the contrast between states is responsible for generating the emotion, or perhaps recognition of the emotion. However, being mindful showcases the possibility of many emotions existing together and that the recognition of difficulty sometimes makes ease feel sweeter. Practicing mindfulness illustrates that the mind is a wonderful, curious and incessantly complex lens through which we experience our circumstances.

As I go forward with my mindfulness practice in 2015, I intend to bring this lesson with me: that experiences can be wonderful and mundane and thrilling and uncomfortable all at the same time. And that the feast and the famine only exist as such because that is how my mind labels them in a given moment. Each experience is colored by the context of our thinking and that is absolutely ok.

Mental Healthcare in Switzerland: Options for Finding a Psychologist

Finding the right support in a foreign country can be challenging
Finding support in a foreign country can be challenging

Given this recent study from Oxford University which shows that mental health conditions can influence life expectancy in the same way that heavy smoking does, I am reminded of the importance of access to effective mental health services. It can be challenging enough to find a psychologist or psychiatrist or even a knowledgable general practitioner in your country of origin. When abroad, that challenge is increased by the daunting prospect of making appointments in another language and consulting your health insurance to see what kind of coverage is provided for psychological care.

Given Switzerland’s unique geographic location, currently lucrative economic position and excellent reputation for providing high caliber post-secondary education, it is a country highly frequented by increasingly mobile individuals from around the world. It is a small country with 25% of its workforce comprised of foreigners, which makes this land-locked alpine nation a truly international mileu.

Despite its picturesque setting, expatriate life here can be difficult. Those who move here often do so at great personal cost- leaving behind social support networks, established careers, and affordable childcare. Given the stress of the transition, these individuals are at higher risk of developing adjustment reactions or other mental health issues, including but not limited to major depression (often with postpartum onset) and anxiety disorders. Moreover, coverage of mental healthcare is expensive here, requiring the purchase of a “complementary” insurance plan that most families do not buy. For non-native residents, finding affordable mental healthcare providers with legitimate qualifications and that fluently speak their language is an almost impossible task.

However, the organization in Switzerland that regulates psychologists (basic training) and psychotherapists (specialty training to provide psychotherapy) provides a search engine to help you find someone that matches your language needs and location. It can be found here.

Although this regulatory body is necessary, there are also a number of therapists and counselors from other countries who provide psychological services. Usually the services they provide are lower cost as they will not reimbursed by the complementary insurance plans. In selecting one of these providers, proceed with caution. Ask about their training and credentials. Ask them why they have not obtained FSP certification.

In some cases, like my own, the training provided in North American universities to licensed psychologists/psychotherapists is not easily translated into Swiss standards given that the American and Canadian training structure is more targeted and applied versus the Swiss graduate training structure. As of yet, there is no treaty between North America and Switzerland/Europe to facilitate easy recognition of the academic credentials of psychologists.

However, the need for native-English speaking psychologists is plainly there, particularly in the French-speaking part of Switzerland and in Zurich where an international workforce thrives. If you are searching for support to address a mental health issue, the “fit” between therapist and client is critical. Research indicates that people who participate in therapy overwhelmingly benefit from it, especially when there is this good fit between the therapist and the client. Part of this good fit is feeling understood and connected to the provider and the odds of this are increased when the provider fluently speaks a language in which you feel comfortable expressing your thoughts and emotions.

Finding psychotherapy when living in Switzerland is difficult but not impossible. Given what is at stake, it is worth the effort needed to find an effective and reputable mental healthcare provider.

(Image courtesy of Kittikun Atsawintarangkul / FreeDigitalPhotos.net)

New Pathways

Even when a path already exists, you can make a new one.
Even when a path already exists, you can make a new one.

As a visual person, I use a lot of metaphors in my work. A personal favorite relates to the development of new habits, and particularly, new thought habits. Over time, we build up a certain way of thinking about a situation or ourselves or a difficulty until it becomes more or less automatic. This thinking habit becomes a well-worn, frequently-trod path through the landscape of our mind.

For instance, when faced with the prospect of making a presentation at work, some of us have developed the habit of thinking about the worst thing that could happen. Or, when receiving a stinging comment from the mother-in-law, some of us may descend automatically into self-criticism (or revenge fantasies). There are hundreds of mostly automatic thoughts zinging through our mind on a given day. It can be interesting to take a step back and slow down to see if it is possible to make a new path.

Making a new path does not mean that you can never use the old path. It just means that you are opening up options for yourself, consciously cultivating a different type of thinking (that perhaps is more rational and compassionate) that can ultimately impact how you respond to a situation. It will take time and patience to create that new path, just as it did to create that old one. But the beauty is that as a result of this new response flexibility there is greater awareness of choice and of freedom from (as Jon Kabat-Zinn puts it) “the tyranny of thinking mind”.

Change takes time but our mind is an amazingly flexible vessel for our thoughts and motivations. What kinds of new pathways would you like to create for yourself?

Slowing Down

The Grand Canyon did not form overnight
Slow but concerted effort can create incredible change- in a landscape or in human behavior

The other day, I was late for work. I missed the metro and here in Switzerland, when you miss your first mode of transportation, you can be sure that you will also miss your connection. So, there was nothing to do but wait for the next metro and catch the next train to Lausanne.

Knowing that you will be late is an uncomfortable feeling. For me, there is a simultaneous rush of anxiety and irritation and helplessness that sets my heart pounding and shortens my breath. It is safe to say that I find this experience extremely aversive and do what I can to avoid it. But then I remembered something that I say so often in my practice: When you feel the impulse to avoid, try approaching instead.

And so, I relaxed my body, brought my focus to the breath and then watched the anxious thoughts flooding through my mind. By slowing down and intentionally investigating my internal experience, I found that I could step back a bit, remind myself that even though my thoughts felt like facts, they likely were not. I could bring in a different “voice” to counter these anxious thoughts: If I came to work 15 minutes late, I would still have enough time to prepare for my first client and even if I didn’t have enough time, I have enough experience to be able to manage just fine.

Once the wave of “lateness distress” peaked, I decided to see if I could enjoy this small gift of time I had unintentionally received. I channeled my first mindfulness teacher, Dr. Andy Moore at the University of Wisconsin, who once told us that “If you’re late, you’re late. There is no amount of thinking or worrying that will get you there any faster.” It was so nice to be able to stroll to my connecting train, observing the rush of the morning commute. I listened to the street musicians in the terminal. I stood in a sunny spot on the platform. Honestly, I enjoyed myself!

And three days later, I remember those pleasant moments more than I remember the stress. Even though I do not intend to try and be late in the future, I do feel more empowered to manage this experience when it inevitably happens again. Research indicates that it does not take major changes to routine or behavior to form new habits, it just takes brief but repeated moments of intentionally trying something different. This post is headed by a photograph of the Grand Canyon because I think it is a nice metaphor for what can be created as a result of slow but sustained effort. Turning toward difficulty with kindness and self-compassion can become more routine and automatic with the help of gentle intention practiced over time.

For me, slowing down is a habit I hope to cultivate- even in the face of difficulty and unease. And how about for you? What ways of thinking or behaving would you like to deepen in your life?

Acting “as if”

Sometimes it works better to put the cart before the horse
Sometimes it works better to put the cart before the horse

We’ve all heard the phrase “fake it ’till you make it” and this concept has come up frequently in my clinical practice this week. When you find yourself struggling to implement a new skill or persist with a new behavior or routine, this idea of acting “as if” can be particularly useful.

It is important to recognize what one is feeling or how one may be pulled to behave but mindfully implementing this idea can do so much good. For instance, on those days when I am tired and daydream about only getting out of bed to refresh my coffee, I find that it is useful to act as if I am energized. And going through these motions (rather uncomfortably at first) can help to augment my momentum until the behavior feels more natural.

Oftentimes, our behavior can impact our thought patterns in powerful ways. When our minds observe our bodies acting in certain ways, we take that as evidence regarding how we are feeling. And because our minds do not like it when our behavior and our thoughts and feelings do not line up, they shuffle things around a bit so that it all makes sense. If I am singing in the shower to my favorite song, my mind says “Hey- she must be feeling ok. Let’s get pumped up for this day!”

It sounds a bit tricky but I invite you to give it a try. Even in subtle ways, our bodily activity can jumpstart our thinking in very productive ways. A simple way to play with this concept is by wearing a gentle half-smile throughout otherwise mundane activities. Research indicates that because of the bi-directional relationship between behavior and emotion, simply changing our facial posture can trigger a cascade of seratonin and dopamine that results in feeling more positively.

So try putting the cart before the horse and acting “as if” when approaching a difficulty. We sometimes have more direct control over our behavior than our emotions. Therefore, this concept is a useful way to practice self-validation, by recognizing your emotional needs, while gaining a sense of mastery by responding effectively to those needs.

(Image courtesy of vectorolie / FreeDigitalPhotos.net)