Referring back to the cup illustration (previous blog), imagine each area of self due to heal/remember wholeness is a cup. With each nurturing practice, we add another drop of water to the cup. Eventually, the cup’s surface tension grows to a point that it can no longer remain bounded by the walls of the cup and an undeniable shift occurs. Try several practices, find what resonates with you, invest in developing a nurturing habit and trust that in time, just like cup illustration, the shift will come.
Centreing is about coming back to your center, the unchanging essence of who you are. There are several centring strategies and I recommend you find one that feels natural and enjoyable. For example, below are a few centring techniques:
“If you don’t like something, change it. If you can’t change it, change your attitude” (Maya Angelou).
Optimism is a significant component of sense of coherence as it relates to a general sense that all things will work out and a reasonably expectation that the future will turn out favourably because of a sense of control over the outcomes that matter most (Antonovsky, 1979; Lee et al., 2019). Not only does optimism reduce our likelihood of suffering from chronic stress, a host chronic health conditions and mental health ailments (Aldao, Nolen-Hoeksema, & Schweizer, 2010), it may also increase our lifespan by 11 to 15% and improve our odds of us living well into our 80’s and beyond (Lee et al., 2019).
In the typical human brain, there is a heavy negative bias, meaning that negative events have a far greater emotional impact on us than positive ones, and that negative events linger longer in our memory than positive ones. This negative bias is significantly higher for those who are struggling with depression (Gollan, Hoxha, Hunnicutt-Ferguson, Norris, Rosebrock, Sankin, & Cacioppo, 2016). While negative bias was helpful in keeping us safe in primitive times, it is not so helpful in our modern everyday lives. Becoming more optimistic requires a conscious effort to be mindful when positive events occur, to bring our attention to the positive feelings that result; taking a moment to breathe it in and relish in them. With practice, we can train our brains to pick up on, even look for, the positive aspects of our day, which counter balances our negative bias.
Optimistic individuals habitually reappraise workplace stimuli in a positive light and identify opportunities within challenges. We can learn to be more optimistic, cultivating a habit, where we mindfully choose to reframe our perspective. By doing so, we choose to view the world from a mindset of abundance rather than from a mindset of fear and scarcity. By practicing mindfulness, we are more likely to notice the positive parts of the day such as breathing in the bright blue sky as we look up from our desk or hearing a bird’s song as we walk from our car to our house. Once we notice the positive, if we take a few moments to attend to it, acknowledge and breath into the way it is making us feel, we are training our brains to focus on the positive rather than fixating on the negative.
Health and human service work is riddled with events that bring up ethical and or moral dissonance. Most people come to these professions because they want to help others. Feeling unable to do what work sets up serious internal conflict in us. We need to either resolve this dissonance or optimistically re-orient ourselves. Otherwise, we will gravitate toward pessimism and hostility. For example, in a recent qualitative study (Dames, 2018) with novice caregivers, Candice reflected on her workplace challenges, “we push people out the door because the hospital is exploding…knowing they will fall and come right back…the guilt for me is a product of an overwhelmed system.” Similarly, Mary stated, “there is just such a general lack of resources. It can feel like sometimes there is just nothing you can do for them.” Mary and Candace’s’ stress is a product of moral injury, leading to a felt lack of control. Even in these situations that seem unchangeable, if we can act, even in a small way, we bolster our sense of self-efficacy, preventing us from spiralling into feelings of hopelessness.
“When one door of happiness closes, another opens; but often we look so long at the closed door that we do not see the one which has been opened for us” (Helen Keller, 1929).
While a tendency toward optimism has more well-being benefits than a tendency toward pessimism, sometimes using pessimism to make a change is more important than accepting a situation as it is and re-orienting ourselves around it. In other words, taking a step back to critically appraise if there is something that can be changed is important; if so, take the steps to change it, if not, accept it and optimistically re-orient yourself. This critical appraisal of events that are causing us discomfort, which may lead to pessimism, enables us to assess the stressor and to determine if we can make a change to remove it. If we apply optimism in every situation, without this objective assessment, it can prevent us from making beneficial changes. To illustrate this point in the research, Troy (2015) showed a significant relationship between stress, context, and whether we tend toward optimism or positive re-orientation (Troy, 2015). If workplace stress is uncontrollable, where you cannot change the thing or event triggering the stress, employing optimism is the most effective skill to use (Troy, Shallcross, & Mauss, 2010). However, if you can control the stressor or change the context to resolve it, then it is more helpful to employ your self-efficacy to change the context, rather than to positively re-orient your emotions about it (Troy et al., 2010).
Self-efficacy, also an important component of sense of coherence, is the confidence and resulting ability to achieve our goals. Context and self-efficacy determine our ability to manage stressors. Our workplace context is often littered with stimuli, and it is self-efficacy that prevents us from perceiving those stimuli as stressful. When we reframe our situation optimistically AND tap into a sense of self-efficacy, we are more likely to make changes when we can, and if things cannot be changed, to accept and positively re-orient ourselves. The Serenity prayer reflects this sentiment:
God, give us the grace to accept with serenity the things that cannot be changed, the courage to change the things that should be changed, and the wisdom to distinguish one from the other (Sifton, 1998).
Aligning with trauma informed practice principles, choice is a luxury for many. When we come to a challenge with confidence, enthusiasm, and optimism (high sense of coherence), we have a greater ability to view stimuli objectively and are more likely act in ways that are congruent with our values and goals. When we come to a challenge with low sense of coherence, often related to unresolved wounds (trauma) and old belief systems from the past, we are prone to perceive the stimuli as threatening. When threats feel intense, we trigger the nervous system, causing us to react out of fight-flight or freeze, limiting if not completely disabling choice. When this happens, we are far more prone to react subconsciously, doing or saying things that don’t feel congruent to our values and goals.
To cultivate choice, imagine each effort to come to know, attune, strengthen, clear, and align as one more drop into our resourcing cup. The fuller the cup gets, the more our sense of coherence and congruence develops, all of which are investments in the cultivation of more choice in our day-to-day perceptions and resulting actions. We may not feel like the individual drops we add to the cup make a difference, but in time the surface tension builds to a point that it can no longer remain as it is. Eventually, one of those individual drops will cause an undeniable shift, moving us beyond the walls we felt confined by. There are many areas, old stories in which we are developing or evolving beyond, each with its own cup, slowly filling drop by drop. As we intentionally invest ourselves, we add another drop. We can trust that in time, emancipation will come, providing us a new found sense of awareness and freedom. When these overflows occur, perhaps more familiar as an ‘ah ha‘ moment, old belief systems evolve and we awaken to a new way of knowing that deeply and completely changes our perceptions and resulting trajectory.
When we understand this ability and inability to choose, we can offer compassion and forgiveness to ourselves and others. Because we all share in this human experience, we can at some level relate to the sense of powerlessness and shame that comes when we react from fear. In this way, we all experience this form of emotional transference, whereby an experience reveals an old wound from the past and it suddenly feels fresh. Even seemingly small challenges can pull us back to the intensity of the feelings associated with that first core wound, underscoring old and often misguided belief systems, and resulting in spontaneous projections that emerge in a variety of harmful ways. What if we could look beyond the shame of our reactions, self-compassionately and curiously tending to the wound that lies beneath? What if we saw the experience as a gift, providing an opportunity for healing? As we heal the wounds beneath, we promote a greater ability to respond with a different orientation in the future. In these ways, drop by drop, we cultivate choice.
A recent meta-analysis of over 40,000 college students from North America and the United Kingdom found that perfectionism, whether self/socially/or other prescribed is on the rise, especially among our younger generations (Curran & Hill, 2019). Societal pressures are further compounded by professions with idealized standards imbedded in their culture, setting an unsustainably high bar for its members.
Simply described, perfectionism is the dogged pursuit of absolute flawlessness (Frost et al., 1990) and the driving force behind co-worker hostility. Maladaptive perfectionism and particularly socially prescribed perfectionism can create toxically stressful environments for those who do not fit neatly into the status quo (Jahromi et al., 2012). Current healthcare culture often promotes tendencies toward perfectionism; as a result, high levels of anxiety and depression are commonplace (Jahromi et al., 2012).
Most of us will have experience with perfectionism, some may slip in and out of it in milder and more adaptive forms, while others will spend every waking hour driven by a compulsion to attain a standard that is unreasonably high. In the more adaptive form, striving for perfection can benefit us as it motivates us to complete work and produce the best product (Harari, Swider, Steed, & Breidenthal, 2018). When in its more adaptive form, we keep our high standards to ourselves as opposed to socially prescribing our ideals onto others. We are more likely to be self-motivated, goal oriented, more willing to adapt to obstacles that may delay achievements, and to find satisfaction from our accomplishments (Ellis, 2002). The downside of perfectionism, evident in its maladaptive forms, is the natural inclination to hold others to the same idealistic standards, which can cause unreasonably high expectations (Melrose, 2011). If we cannot meet these idealistic standards, detrimental mental health effects often result (Melrose, 2011). These health effects often correlate with fears of criticism and failure and when left unaddressed can lead to moral injury, emotional exhaustion, and eventual burnout (Chang, 2012; Gould, Udry, Tuffey, & Loehr, 1996; Sevlever & Rice, 2010).
Two perfect doors. There are two dimensions of perfectionism, ‘excellence-seeking,’ whereby we are driven to achieve high standards and ‘failure-avoiding,’ where we are driven to avoid shortcomings. Both versions are ultimately driven by the same core factors such as black and white thinking, a compulsive need to attain lofty standards, and self-worth evaluations contingent on one’s achievement of their idealized standard (Harari, Swider, Steed, & Breidenthal, 2018; Hewitt & Flett, 1993).
Perfectionism spilling into the workplace. When mired in perfectionism, we are likely to dissociate from emotions, often ignoring and internalizing fears of worthlessness, shame, and failure (Petersson, Perseius, & Johnsson, 2014; Shafran, Cooper, & Fairburn, 2002). Over time, this habitually defensive way of being will cause an overall lower tolerance for exposure to stress (Ellis, 2002; Petersson et al., 2014). These maladaptive forms of perfectionism lead to self-destructive behaviours, which extend into prescribing the same unrealistic expectations onto others (a phenomenon called socially prescribed perfectionism). Socially prescribed perfectionism uses shaming tactics to pressure others to live up to unrealistically high standards and when culturally reinforced, it has toxic effects on workplace morale, resulting in a chronic workplace stressor.
Perfectionism and sense of coherence (SOC) inversely link (Rennemark & Hagberg, 1997); those who have a low sense of coherence score have higher perfectionism scores; therefore, improving sense of coherence buffers us from extreme forms of perfectionism (Rennemark & Hagberg, 1997).
When we fall into states of fight-flight or freeze, we cannot objectively work through difficult thoughts and resulting emotions, often leaving them unresolved, fuelling the same old cyclical event-response behaviour. However, the theory behind exposure therapy is that by re-imagining the event at another time, when we feel safe and supported in our environment, we get another chance to work through and update the old (and often no longer true) thoughts. To feel and then release the associated emotions.
Several therapies that have shown promise in the research as tools that help us go back to the stressful event so we can re-experience from a more confident and empowered orientation (with a higher sense of coherence). As a result, we can feel the emotions that need to be felt and with practice, upgrade old belief systems that fuelled the stressor in the first place. Doing this re-exposure work after the stress response passes, is a great way to prevent future or reduce the intensity of future triggers. Others will want a more formal therapeutic environment to facilitate the feelings of safety necessary to stay present and connected (avoiding triggers that promote dissociation).
Two popular therapeutic tools that support re-exposure are EMDR and CBT.
EMDR involves eye movement desensitization and reprocessing, which as the title suggests can involve a variety of techniques to direct the eyes back and forth while re-imagining a triggering event. Cognitive Behaviour Therapy (CBT) brings awareness to the relationship between thoughts (conscious, automatic, core beliefs beneath) and behaviours. This technique works toward behaviour change through self-monitoring, scheduling, and exposure-response prevention.
In an extensive meta-analysis of studies over the past decade, researchers (Khan et al., 2018), found EMDR and CBT to be equally effective at reducing depression but EMDR was superior in its ability to reduce anxiety and PTSD symptoms.
Ultimately, re-exposure practices, whether or not part of formal therapy, are an excellent tool to work with past traumas projecting into the present day, reducing their intensity until they are no longer a perceived threat. We can practice with this tool on our own or with another, reducing our future risk of falling into fight-flight-freeze when a similar situation arises.
Kristin Neff, a seminal researcher on Self-Compassion, developed a short and affirming exercise called the self-compassion break (2019) and it is a favourite of mine. For this adapted exercise, you begin by closing your eyes and recalling a person or event that is triggering a stress response. Focus on the situation, engaging your heart and mind so that you experience the stress of that moment. From this space, you will talk to yourself just like you would talk to a dear friend. You will begin by mindfully reminding yourself that:
1. “This right now is a moment of stress” (or hurt, pain, suffering, whatever sounds most natural for you).
2. “You aren’t alone, these feelings (pain, suffering) is a normal (natural) part of life.” “Other’s struggle in this way too.”
3. Think of a phrase that you most need to hear right now, something that expresses empathy and kindness. For this, you can speak in the I, or continue to speak to yourself as you would a dear friend, whichever enables you to receive it best. For example, you might say:
“you deserve compassion in this moment”
“I fully love and accept you as you are right now”
“May you forgive yourself for not knowing then what you know now. Making mistakes and learning and growing as we go is part of life.”
“May you have the courage to be imperfect.”
“Even though I feel…. I deeply and completely love and accept myself.”
This self-compassionate exercise reminds us that difficult emotions are a part of life, that we are not alone, and that we are deserving of unconditonally positive regard.
Neff, K. (2019). The Self-Compassion Break. Retrieved from https://self-compassion.org/category/exercises/
… like a diamond, pressed down time and time again, until all that is left is a powerful gem, shining for all the world to see. May you take this journey, fully and deeply realizing that the path that led you to today, the suffering you continue to feel, is no longer a threat to you my friend, it is a vehicle to awaken to a new, more authentic, and more empowered way.
May this journey help you cultivate a community of individuals that will remind you of who you are when you forget, that provide you with a mirror that fills you up with a felt sense of unconditional positive regard, so that you can freely express your magnificent self.
May you cultivate a love so deep inside you so you can find rest in an inner home, that safe place where you are so filled with unconditional positive regard from others and for yourself that it spills into the world around you. This is the journey through suffering, awakening to a new way…
Between unresolved trauma and biological imbalances, dropping into the inner space to self-soothe can be too painful, making it difficult, and for some even impossible, without an intervention. We all have unique needs. Some people may resolve much of their anxiety and depression by removing the the emotional charge of past trauma, using cortisol lowering tools, and engaging in mindfulness, while others will need something more to drop in, to self-sooth. There is no shame in reaching out for external support to work with our biology, promoting greater contentment, optimism, and objectivity (all components of sense of coherence). In fact, many will find that when they find an intervention such as a particular therapy, a supplement or medication that works for them, they wonder how they have survived so long without it. Canadian data is limited but according to the National Health and Nutrition Examination Survey (Pratt, Brody, & Gu, 2017), 17% of Americans between the ages of 40-59 years and 19% of people over 60 use anti-depressants to treat symptoms stemming from anxiety and depression. Females are more likely to take antidepressants than males. To be clear, medications, including herbs and the supplements that provide the building blocks that enable us to produce important chemicals such as dopamine and serotonin, are not the focus of this curriculum, but they are additional and often necessary tools to manage biology and emotions, enabling a greater ability to self-soothe. For these reasons, medications and external therapies are worth mentioning.
Besides traditional pharmaceuticals and therapies, plant-based remedies are emerging in the research, many of which are showing promising results. For instance, we can support our brains ability to make serotonin (associated with happiness and contentment) and dopamine (associated with a sense of reward/pleasure) by focussing on specific foods and supplements that bolster the key amino acids necessary to support their production. We also now have access to a host of botanicals, adrenergics, and nootropics, which can reduce the production and management of stress hormones.
Though not yet mainstream (or approved by Health Canada), an emerging example of how people are using natural remedies is the use of Cannabidiol (CBD), a non-psychoactive component of hemp and marijuana, working for many to reduce the symptoms associated with anxiety and depression (Corroon, James, Mischley, & Sexton, 2017; Soares & Campos, 2017; Zuardi, Rodrigues, Silva, Bernardo, Jaime, Hallak, Guimarães, & José, 2017). An example of a supplement that can work with our biology to bolster serotonin is 5-HTP (Kious, Sabic, Sung, Kondo, & Renshaw, 2017). Among those that can bolster Dopamine are L-Dopa and Tyrosine (Lampariello, Cortelazzo, Guerranti, Sticozzi, & Valacchi, 2012).
Ultimately, if we are committed to thriving, we must be open to our unique needs, removing barriers in whatever way we can; doing so, is another way to practice self-compassion.