Nipping Jealousy in the Bud

Jealousy is wanting something someone else has for oneself. It’s usually accompanied by feelings of dissatisfaction, possible resentment, and yearning for the desired thing/person in some cases. It by definition comes out of a place of insecurity and a sense of feeling lacking or not having enough without the desired object of one’s affection. Jealousy becomes problematic when we don’t recognize it for what it is: i.e. a signpost of something that holds some value to us; a beacon pointing us in the direction of an underlying aspiration. Jealousy becomes an issue when we make it more about others when it is really our own journey.

To transform jealous energy into constructive energy, first hear what it’s telling you. What do you feel lacking in? What would you like to acquire or improve upon?

Ask yourself what you need to help you feel more abundant rather than lacking.

Once you have the goal framework in place, set an intention as to how you might achieve the desired outcome. This might require shifting your mindset. Adopting a problem-solving attitude puts you in the driver’s seat, which is more empowering than passively wishing for something to happen. Envision yourself working toward this goal. Mentally imagine what it will feel like once you have it. And remember patience with the process: everyone has their own path and their own pace; some people will meet their goals faster than others and we cannot always get the exact version of what it is we seek, but with patience, tenacity, and listening, we can be headed in the right direction.

CBT in the Treatment of Chronic Pain

Cognitive Behavioural Therapy (CBT) is one of the leading psychotherapies used to address chronic pain, and there’s good reason why. CBT explores clients’ underlying thought, behavioural, and emotional patterns, the relationship between them, and associated environmental circumstances that might sustain symptoms of distress. It encourages clients to develop new skills to change unhealthy ingrained patterns to in turn change their symptoms. CBT has been extensively researched and is widely used in the treatment of depression, anxiety, stress, anger, addictions, eating disorders, obsessive compulsive disorder, panic disorder, bipolar affective disorder, schizophrenia, and chronic pain, among other concerns.

Pain refers to an unpleasant sensory experience usually accompanied by a strong adverse emotional response. In fact, the same centres of the brain that process physical pain also process emotional pain, so oftentimes when one form [of pain] exists, the other may follow. Chronic pain can contribute to low mood (depressive symptoms), increased worry about health concerns (anxious symptoms), and increased use of the healthcare system, which can be emotionally taxing in itself. It can cause strain on relationships, long-term disability, a loss of one’s life as they knew it, and a loss of one’s identity. CBT is an effective treatment to address all of these concerns, because it emphasizes changing one’s habits within the means available to them, which can be empowering, because even if we can’t change our external or physical realities, we retain the option to shift our mindset.

With increased studies in neurobiology, largely due to advancements in brain imaging technology and accessibility of these technologies, the leading approaches in the field are shifting away from the older thinking that our brains and bodies should be treated separately. A more holistic approach is being adopted, treating the brain and body concurrently to affect changes in clients’ presenting symptoms. You might notice that if we change how our bodies feel physically, we tend to change how we feel emotionally, which often brings changes in our thoughts and behaviours, and vice versa, since they’re all considered interconnected in the CBT model. It also follows that the saying “it’s all in your head” misses the mark, because even if a difficulty is originally psychological in nature, if left untreated, it can impact one’s physiology, disrupting hormones, neurotransmitters, blood pressure, and various other body functions. And our mental and/or physical states can become entrenched; that is, our systems can become acclimatized to staying stuck in a certain ‘mode’ (e.g. feeling depressed or stressed), thereby contributing to symptom chronicity, thus calling for an active, change-oriented approach to therapy.

CBT encourages goal-setting, which can help address the low motivation frequently seen in clients dealing with chronic pain. It involves practices to identify and challenge inaccurate beliefs accompanying the pain, and helps develop cognitive behavioural coping strategies, such as pacing daily activities and shifting negative thoughts. CBT also integrates relaxation practices which teach clients how to decrease emotional reactivity to physical pain by changing how they respond to it (e.g. with calming practices rather than panic), which uncouples the negative association between experiencing physical pain and getting emotionally upset. Relaxation practices are helpful because decreased body tension is less likely to exacerbate the experience of physical pain (think about the powerful impact lamaze can have on childbirth, or relaxing your muscles when getting a needle).

CBT is often combined with mindfulness-based practices, such as Mindfulness-Based Cognitive Therapy (MBCT), which teaches participants to notice pain non-judgmentally, with curiosity and acceptance. This change in perspective often results in less emotional reactivity to pain (mental or physical), thereby cultivating a greater tolerance, which can be a central goal in the treatment of chronic pain. Luckily, in Canada it’s becoming increasingly common for rehab centres to integrate these types of approaches to enhance recovery.

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Pain management strategies you can try at home:

  • Notice your beliefs about pain. Are they limiting you?
  • Practice spreading out your daily activities and/or planning to tackle strenuous tasks when you tend to feel better in the day, or leave them for “good days”
  • Anticipate needing extra recovery time after strenuous activities and don’t judge yourself for it.
  • Resist the urge to push beyond your limits. Take a break if you need one. Pushing yourself too hard can be counterproductive, leading to longer recovery times.
  • Getting proper sleep can reduce emotional reactivity (i.e. crankiness).
  • If the pain disturbs your sleep, relaxation training and meditation can offer a restful alternative that’s nearly as restorative as REM sleep.
  • Practice mindfulness: focus on the present moment with non-judgment, curiosity, and acceptance. Connect with a mindfulness-based therapist if you’d like to learn more.

Stop Judging Your Nervous System

We can’t judge ourselves for our responses to trauma. A judgement is a cognitive (thinking) action. It doesn’t matter what we think should be easy to deal with or talk about, or how we think we should have responded. Trauma is registered in the body in the nervous system, so our responses to trauma happen subconsciously. That’s why we need to go at the body’s pace in recovery and learn to speak our body’s language.

#traumaawareness #traumasense

The Importance of Somatic Approaches to Trauma Treatment

There are often a lot of misconceptions about therapy. Many of the therapy sessions we see in Hollywood films depict clients pouring their hearts out to silently nodding, onlooking therapists, usually wearing trendy spectacles. (I don’t wear spectacles. Yet.) While this approach to therapy does exist, it reflects a less frequently employed modality. It lends to the common idea that clients have to purge all details of their past to their therapists, sometimes within their first meeting! This can create an intense sense of pressure on the first meeting. But not all therapists or therapies are alike, and there are times when such cathartic monologues may be harmful; especially when trauma is concerned. That’s why it’s important to work with practitioners who specialize in trauma treatment, specifically somatic, or body-oriented, approaches, if you experience these types of concerns.

To understand the importance of this, one must grasp how the nervous system works. When a person is confronted with something their brains and bodies perceive to be threatening (a stressor), their nervous systems automatically react with the stress response, putting them into a state of fight, flight, or freeze, and when these are ineffective, a submit or feigned death (dissociative) state. These are our natural survival mechanisms. Neurologically, during this process, our frontal cortex (or thinking/executive brain) and hippocampus effectively shut down. The evolutionary psychological explanation for this is simple: when we’re confronted with a potential life-threatening stressor, we don’t need to be eating a ham sandwich, reproducing, or thinking analytically; we simply need to mobilize our survival instincts to ensure our safety. And it’s for this very reason that top-down therapy approaches miss the mark when it comes to trauma treatment, because it’s at this level of functioning that we’re most affected by trauma.

Thinking more about neuroanatomy, the frontal cortex, or “primate brain,” responsible for our executive cognition (thinking), uses verbal language and analytical reasoning; the mid-brain, referred to as the limbic system, or “mammalian brain” speaks the language of emotion; and the brainstem, or “reptilian brain” speaks the language of sensation and impulse (Ogden, 2002). There are psychotherapeutic approaches which address each part of the triune brain (the three subsections previously described), such as: CBT for the “thinking brain;” emotion-focused approaches for the “feeling brain;” and sensory-oriented approaches for the “sensory brain.” When we are traumatized, our brainstems are overwhelmed by the threat; the frontal cortex is compromised and we don’t fully encode or process the experience analytically or emotionally. Our trauma response gets ‘stuck’ in the body and continues to activate primitive parts of the brain, implicating impulses and reactions that don’t get fully ‘metabolized’ in higher-level cortical areas. That’s why we need to start with the body in trauma treatment in a bottom-up approach to address the impact of trauma that was stored somatically before we can facilitate subsequent emotional and thinking processes (which happen later in therapy).

Somatic approaches help clients respect their personal limits, such as, how much they can comfortably tolerate in discussion before becoming flooded or overwhelmed. Such approaches incorporate the most recent advancements in the field of neuroscience and teach clients how to regulate their bodies to achieve greater personal safety…before going into the stories. It’s for these reasons that I stop clients from going into detailed accounts of their trauma histories during our first moments together. While my interruption may seem surprising, to allow them to continue may compromise their nervous system functioning and possibly retraumatize them.

In my office, we’ll likely get to the trauma histories and move past them, if a client is ready; but we always go at the nervous system’s pace.

A Commentary on ‘The Lifelong Effects of Early Childhood Adversity and Toxic Stress’

[Article cited: “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” by Shonkoff and Garner, (2012)].

This is an excellent article that comprehensively outlines the connection between early childhood stress with disease and disorder in adulthood. Although highly scientific and medically focused, the implications this article point to (i.e. correlations between early life adversity and subsequent susceptibility to mental health concerns and chronic disease) needn’t be pathologized; rather, I see these biological changes merely as our body’s way of promoting a prolonged stress response to adapt to and survive difficult experiences. Certainly this can lead to increased disease, disorder, and/or morbidity later in life, but if we develop self-awareness of our weaknesses (i.e. an over-developed stress response), we can develop skills and strategies to overcome them. Thank goodness for neuroplasticity, neurofeedback, yoga, meditation, and psychotherapy which help to restructure our brains, rebalance hormonal and biochemical processes, and promote psychological resilience. (For example, mindfulness meditation has been shown to reduce grey (brain) matter in the amygdala (a neurological structure responsible for processing fear), thereby counterbalancing the implications of toxic childhood stress discussed here.

For further reading on the mind-body connection and study on correlations between trauma and disease, I recommend Dr. Gabor Mate’s (2003) book, “When the Body Says No.” (Note that I don’t receive any endorsements for this recommendation, it’s just a really informative book by an insightful author.)

My Take on Mindfulness-Based Cognitive Therapy Vs. Neurofeedback

As all of you know, Heartfulness Psychotherapy is offering a Mindfulness-Based Cognitive Therapy (MBCT) group this spring and has also recently been involved in offering neurofeedback treatment. As such, I was asked by some very clever clients the difference between the two treatments and the associated benefits to be gained from MBCT versus neurofeedback, which I thought was a really interesting question. So let’s get into it.

Research has shown that MBCT has been beneficial for treating numerous concerns, such as:

  • Stress
  • Anxiety
  • Anger
  • Depression
  • Postpartum Depression
  • Bipolar Disorder
  • Chronic Pain
  • Addictions
  • Trauma
  • Eating Disorders
  • Fibromyalgia and Chronic Fatigue
  • Sleep Difficulties
  • Compulsive Behaviours
  • Attention Regulation (and associated disorders)
  • Acquired Brain Injury (ABI & TBI)
  • Sexual Difficulties
  • Relationship functioning
  • High blood pressure
  • Stress factors in heart disease
  • Increased self-awareness
  • Genetic resilience from illnesses, including cancer
  • Increased control of thoughts & emotions
  • Affective (read emotional) dysregulation, thus having beneficial implications for concerns such as borderline personality disorder

MBCT is a particular type of mindfulness-based approach. It’s a manualized 8-week course that teaches techniques to manage difficult thoughts, feelings, emotions, stress, and pain to promote health and relaxation using guided meditation exercises. It’s not a therapy or support group per se, but rather an experientially focused group that encourages participants to try exercises and share their experience in group.

Mindfulness is a practice. This is good news and bad news for some. It means that it offers life-long skills to manage life’s challenges, which is empowering! It means if you practice these tools, you’ll have access to long-term resilience and skillfulness for the rest of your life, and once you know the practice, it effectively becomes free (you can practice it on your own), or with minimal follow-up/ “booster sessions” required. It also means that it’s most effective if it becomes part of a lifestyle (i.e. if it’s done on a regular basis), which some people aren’t willing to do consistently.

Neurofeedback uses EEG (electroencephalography) to get a baseline reading of the brain’s electromagnetic frequency waves such as delta, theta, alpha, beta, and gamma which may be over or under active in various brain regions, consequently affecting a range of functions. Based on the baseline reading of one’s neural activity, and based on their subjective reports about the symptoms or complaints they’re experiencing, a recommended treatment protocol is generated by the system. While neurofeedback systems may differ slightly, the overall premise behind their effectiveness is that they provide stimulation [in the form of auditory, visual, or tactile rewards (less commonly used)] to help the brain “train” or learn how to function at the healthier brainwave frequency for that particular brain region, as determined by the particular system. Every system is different. The technology I worked with compared each individual’s brain reading to a vast normative database, which has pros and cons in itself (e.g. some systems employ technology that only trains the brain in comparison to itself, since some people prefer not to have their brainwave frequencies modeled based on a normative sample, while others don’t mind).

Based on the preliminary research I’m familiar with, neurofeedback has received empirical (i.e. research) support most commonly for stress-related concerns such as:

  • Stress
  • Anxiety
  • Sleep Difficulties
  • ADD and ADHD
  • Depression
  • Trauma
  • Acquired Brain Injury (ABI, TBI, & concussive disorder)
  • Enhancing Cognitive Performance
  • Autism Spectrum Disorders & Asperger’s Syndrome
  • Chronic Pain
  • Eating Disorders
  • Learning Difficulties
  • It has been used with some benefits in Alzheimer’s Disease

 

MBCT Vs. Neurofeedback (My Pros and Cons List)

Neurofeedback is purported to have lasting effects that are produced within 3-10 treatments with a variable amount of follow-up required (on a case by case basis). It is often extremely costly but beneficial results can be seen relatively quickly, although the experienced benefits differ between individuals.

MBCT also has lasting impact but requires maintenance for best results. While the 8-week course can cost generally $600 -$975, it tends to be considerably more economical than neurofeedback and/or individual psychotherapy. However, neurofeedback might appeal to those looking for a ‘quick fix,’ which tends to be attractive in our fast-paced society.

Neurofeedback reflects new technology and all the benefits and limitations that come along with it, while MBCT has its origins in ancient Eastern traditions, thus carrying a sense of tried and true organic wisdom.

Mindfulness empowers individuals to cultivate internal skills and control whereas neurofeedback requires that patients be dependent on the skillfulness of the practitioner and the particularities of the technology being employed, thereby relinquishing personal agency.

Neurofeedback is intended to result in lasting neurological change. The number of brain regions “trained” or targeted during a 10-session treatment protocol largely depend on the particular system being employed. I trained on a system using four regions (i.e. during my treatment, I consistently worked on improving four brain regions). The neural regions selected were determined partly by the clinician and partly by the treatment protocol generated by the technology. Therefore, while there is greater ability to individualize which brain regions (and which associated symptoms) will be addressed by neurofeedback, there are often a limited number of options. Of course one could choose to pay for subsequent treatments and train additional regions.

Mindfulness meditation (and MBCT) affect significant beneficial brain changes too, (see Psychology Today’s listing and Harvard’s recent study) they’re just less individually customizable. Such practices affect the brain’s electromagnetic frequencies as well; again, they’re just less individually customizable than in neurofeedback treatment.

MBCT has few (if any) contraindications and to my knowledge has not been known to cause harm to anyone. Neurofeedback on the other hand is contraindicated for various conditions (e.g. epilepsy), and can be harmful if the clinician implementing it is not properly trained.

Since MBCT is manualized, it should theoretically be offered in a consistent manner irrespective of the group facilitator. Neurofeedback, however, may vary depending on the technology employed and operating clinician.

Both approaches require prolonged sitting (20-40 minutes). Both approaches can make people feel slightly sleepy afterward. MBCT requires approximately 1.5 – 2 hours a week commitment for an 8-week period, while neurofeedback generally requires a one hour assessment, a 30-minute report reading, and 2-3 20-minute subsequent training sessions a week for a minimum of 10 sessions, thus neurofeedback is more time intensive. And it involves hair gel that may hamper your plans if you have a date scheduled after your appointment. Just saying.

MBCT is offered amongst groups, while neurofeedback is offered individually, thus providing a greater sense of privacy during treatments. While some may shy away from groups, I’ve received a surprising amount of feedback suggesting that the group atmosphere helped individuals learn from one another, normalize their own experiences, and feel part of a supportive community. (Note that speaking in group is only voluntary). Nevertheless, it remains up to personal preference.

Conclusion

I prefer MBCT over neurofeedback because I like the self-empowerment, life-long skill acquisition aspect of it rather than feeling dependent on yet another service provider. It helps me feel greater alignment with my spirituality, (note: this component is NOT taught or required in MBCT groups but may be an pleasant and optional byproduct). It also supports my yoga practice since it incorporates some gentle yoga postures. Overall, both approaches are great non-medical alternatives, and both treatments are known to be helpful for a variety of concerns, so it all depends on the treatment outcome you’re looking for. Ideally, we should be so lucky to use both treatments!

Please note that this is my professional opinion on these practices based on my experience with them; feel free to offer your feedback if you feel I’ve missed something; I’m happy to start a dialogue. Happy brain health everyone!

Neurofeedback