Unrequited love and gambling addiction: more similar than you’d think.

I liken having an unrequited love obsession with a gambling habit, linking them through the psychological concept known as partial reinforcement: 630 words.

Some time ago I saw a client who wanted help managing his obsession with a young woman that he’d taken a fancy to, but who hadn’t reciprocated. We did some okay work in the session, but I was improvising quite a lot because I didn’t see much relevance for my clinical training.

Afterwards I spoke to a colleague about the session, and described the client’s predicament as similar to that of a gambling addict: He seemed to be hanging on in the hope of a jackpot, despite realising the odds were against him. My colleague thought this analogy was fitting, because she said both scenarios involve a ‘partial reinforcement schedule’. It was a clever connection to make, and here’s how it works:

Reinforcement

Reinforcement refers to positive consequences that follow an action, and cause that action to be repeated in the future. So if I ask a girl on a date by singing to her in badly pronounced Italian from the streets below her apartment with a rose in my mouth, and she miraculously agrees, then I’m likely to repeat this technique in the future. I’ve learned that performing the action results in a desirable outcome, so I repeat the action with the expectation that I will attain the desired outcome again.

Partial Reinforcement

Partial reinforcement describes a situation in which our actions are followed by positive outcomes only intermittently. Researchers have shown that if an action is not followed by positive outcomes, (not reinforced), human and non-human animals alike will soon give up on that action. This will eventually happen even when the action was previously reinforced: It appears to us that circumstances have changed, and we decide that performing this action will no longer be fruitful. But if our action is followed by positive outcomes every so often, we persist with the action despite it being only somewhat effective. It seems that partial reinforcement keeps our expectations up just enough for us to persist with an action.

Gambling and Partial Reinforcement

The gambling industry knows this psychology well. They want us to bet more, but can’t reinforce our betting every time of course, because they’d lose money. Instead, they allow gamblers to win intermittently, and this keeps them betting. A good example of this are the pokies, (which is what slot machines are known as in Australia; from ‘poker machines’). They are programmed to pay out a certain percentage of the money inserted into them, and they do this intermittently so that the gambler will persist with their betting.

Unrequited Love and Partial Reinforcement

Here’s the fun/sad bit. The love struck individual will try and try to attract their love obsession, and perhaps out of politeness, or because of flattery, or maybe because there’s other benefits in it for them, the love obsession will intermittently reinforce the love struck person’s efforts, despite not being interested. This might be with a simple smile, (oh, they smiled! maybe they  like me), by accepting that lift home at the end of a night out with a group of friends, or just by making polite conversation in the corridor because they couldn’t get away fast enough. In fact it might not matter what the love obsession does, because if a person is infatuated enough they can probably read positive outcomes into anything. Needless to say, in these circumstances the love struck person seldom wins the jackpot, and their losses are measured not only in money spent on overpriced roses, but wasted time, missed opportunities with others who were actually interested in them, in dejection, and in diminished self-esteem. (Then again, I’ve known people to be worn down by persistent suitors they were not initially interested in, so you never know…).

In conclusion, beware of partial reinforcement.

Bracing Ourselves with Worry

I suggest that by worrying we are trying to brace ourselves against the emotional shock that would accompany a calamitous event, only by making a habit of this we are consigning ourselves to a life of stress: 600 words.

For much of my life I was a champion worrier. When I was about 4 or 5 years old my teacher gave me the Mister Men book, Mr Worry, so clearly the writing was on the wall for me from an early age. It was a nice gesture from my teacher, but it would take more repetitions of the basic lesson in this story about needless and excess worry for the message to finally sink in. (I just watched an animated version on YouTube and it actually doesn’t end all that well, which is worrying.)

Why Worry?

Worry can be consider a mental way of bracing ourselves for the emotional shock that would accompany what we perceive to be a calamitous event, and it is thought that worriers are particularly sensitive to such spikes in emotion. To see how this works, let’s represent the event by the bursting of a balloon, and the worrier by a relative of mine who is particularly sensitive to loud noises. I’ve seen him visibly tense up at the prospect of a balloon bursting, and he cannot relax while this is a possibility.

Bracing ourselves in this way is a natural response to the potential for physical shock, and would likely protect us from more serious injury should that shock eventuate. Worry is often an attempt to anticipate negative events, and generate solutions to deal with those events. So in this way it can be thought of as mentally preparing ourselves—bracing ourselves—for the consequences.

This all sounds great, but if we are sensitive to the possibility of something, anything, going wrong, then we must work extra hard to prevent this. Hence we must keep worrying, constantly bracing ourselves for the moment we have to deal with the next mishap, whatever that may be. Many things in life can go wrong, and these potential negative events—anything from a minor mishap to a great disaster—are like a room full of balloons. There is always uncertainty over when one of these balloons will burst, so the worrier spends their days bracing themselves for this.

The Cost of Worrying

The cost of all this worrying is experienced physically with symptoms of tension and stress, much like you would expect when bracing for a physical shock. And being on edge all the time makes the worrier easy to irritate, like a mouse trap ready to snap. And it’s exhausting being constantly on guard: they say there’s no rest for the wicked, but also none for the worrywart. And how can anyone concentrate when they constantly have things on their mind? And with all that thinking, there’s very little time for action: not much is getting done, which when you think about it, is a bit worrying. Even writing about worry is tiring and repetitive.

Solutions

So what can we do? It’s a good start to recognise what’s happening: that by always preparing ourselves for occasional moments of acute emotional pain, we are guaranteeing ourselves the chronic emotional pain of stress and anxiety. We can ask ourselves whether this is really a worthwhile trade off. And if we decide it is not, then we must first accept that from time to time we won’t be fully prepared for a negative turn of events; but then we can travel through life a lot lighter*. And if this is unconvincing, there are a variety of quite practical ways to reduce our worry. But this post has been long enough, so they’ll have to wait for another day. Don’t worry, I’ll get to it.

(*In another post I make a similar point using a different analogy.)

The Return of Anxiety

After overcoming anxiety, it may nevertheless return unexpectedly. This article explains why, and why you needn’t panic: 790 words.

After the Christmas holidays I returned to work at  my university, taking the train as usual, then walking a short way through Sydney’s Inner West to my office. I used to walk with the majority of students and staff, only I like to walk briskly, and most people take it easy. I felt like a Formula One driver trying to work his way up from last place on the grid; so eventually I chose a different route, cutting through the engineering faculty to avoid the crowds. However, on this first day back I mysteriously reverted to my original route, and only realised what had happened as I was half way along. I chuckled a little, recognising that I had fallen victim to a significant phenomenon relevant to my clinical work, especially related to anxiety.

When we overcome anxiety, we usually learn that what we feared is unlikely to eventuate, or even if it does, it will not be as bad as we thought. An effective way to achieve this insight is to face our fears often enough that our emotional system learns the reality that perhaps our intellect knew all along. For example, the person that fears flying, despite knowing intellectually how safe this mode of transport is, will, by taking enough flights, learn emotionally that there is little to fear about flying. (This method of treating anxiety is called exposure.)

Except some people, after learning not to fear flying, will turn up to the airport one day and be overcome by fear again. Why? Well, we know from extensive research that old learning is not erased: it turns out that what is learned cannot be unlearned, so that our fear of flying, for example, never goes away. But we are able to learn something new that competes with our fear – in this case, that flying is a very safe way to travel. These two nuggets of knowledge compete for influence over our emotions and subsequent actions (whether to fly or not to fly). And a significant factor that can weaken new learning about our anxieties is a change in context compared to when we first learned these facts. This context can be the place, the people involved, or even the time – anything about the circumstances in which we learned to no longer fear something.

So we learn to not fear flying, but after a few months we might then think… “that was then, but this is now: perhaps its no longer safe to fly”. Or, “I felt safe on xyz airline, but this is abc airline – maybe it’s not safe with them”. Or, “I was okay when I flew with my friend, but now I’m alone, so perhaps its not safe after all”. None of these thoughts need be conscious, but there is nevertheless some doubt about feeling safe, so anxiety returns.

This is similar to what happened to me that first day back at work. After a couple of weeks off my brain decided to revert to an old habit-old learning if you will-which caused me to walk an old and less convenient route. When our anxiety returns we are simply walking an old route, but the good news is that the new route is still fresh in our mind, and research has shown that we can return to this route with less effort than it originally took to forge it.

A clever analogy taught to me by a former colleague (Jess), is to think of your existing fear as a wide track through a thick forest. Overcoming this fear requires you to laboriously push your way through virgin forest, making a new track, one that leads to a feeling of safety. At first this is very hard work, but over time you push back the plants and firm the ground, making it easier and easier to travel this route. And all the while the old route, which led to fear and anxiety, is becoming overgrown from lack of use. But it will never quite disappear, so it may be that some days, depending on the circumstances,  you might accidentally travel back down your old trail, ending up in a fearful place. This is perhaps inevitable, but just as certain is that our new track is still available; and we can, after realising what has happened, decide again to choose the route which leads to that sense of confidence we get from facing our fears.

So, if you find yourself beset by fear once again, remember that this is just a wrong turn. Retrace your steps, and pick up where you left off. You’ll find your sense of confidence will return more easily the second (or third, or fourth…) time around.

Types of Psychological Therapies

A brief summary of mainstream psychological therapies of the modern era.

Therapy styles discussed in this post include the insight therapiesPsychodynamic and Humanistic; and the cognitive-behavioural therapiesCBT, Third-Wave therapies, and a couple of others.

When deciding on a psychological therapy you might like to know roughly what’s in store for you. Although they all involve talking to some degree, what you’ll talk about and what exercises you’ll be asked to engage in will differ. I would say they all have one major thing in common, and that is we don’t know exactly how they work, although each has a theory behind it, and some are more scientific than others.

As to which is better, there is a school of thought that they all do roughly the same thing and it doesn’t matter much, and it does seem that a good working relationship between the therapist and client is still the most important factor behind successful therapy. However, there is evidence out there suggesting some therapies are better for treating certain disorders, so receiving a good assessment by a competent clinician will help in your choice.

Often though, you’ll go to see a clinician after a recommendation or a search on the internet, and they will already have training in certain therapies, so it would be useful at that stage to know what they are offering. Here’s a quick run-down of the major therapy styles available in the Western world at least, in roughly chronological order of their development.

Insight Therapies

Insight therapies aim to help a client by improving their awareness and understanding of relevant aspects of their psychological functioning. With this increased insight the client is able to make positive changes to their life. I’m not formally trained in these therapies, but I know enough to pass on the basics.

Psychodynamic Psychotherapy, including Psychoanalysis (345 words)

The Austrian neurologist Sigmund Freud was a pioneer in developing a formal ‘talking cure’ for mental health problems, beginning in the late nineteenth century with psychoanalysis, and his body of work has been very influential on Western culture more generally. Psychodynamic theories and therapies were once dominant, but began to wane in influence from roughly the 1970’s. They nevertheless remain a significant alternative to the cognitive-behavioural therapies I’ll discuss later.

Psychodynamic psychotherapy presumes the existence of subconscious psychological processes, (including basic drives and motivations), that are thought to significantly influence our behaviour and psychological wellbeing. By identifying damaging processes and bringing these to light, the therapist hopes to release the client from their influence.  These processes develop gradually throughout our lives, particularly in our impressionable childhood years, and are influenced heavily by interactions with our family. Consequently, there is a focus on the past, and on interpersonal relationships.

The therapist will look for subtle, often symbolic cues as to the source of distress and dysfunction, and may interpret dreams, which are a meaningful product of the unconscious mind (according to the theory).The relationship between the therapist and client is particularly important, as it represents a source of data, so-called ‘transference’, when the interpersonal patterns of the past are played out between the client and the therapist in the present.

Hence psychodynamic psychotherapists will generally take on a less active role, letting the client do most of the talking. And they are quite disciplined in their approach to therapy so that they don’t muddy the waters; for example they’ll typically maintain regular appointments at the same place and time, and will disclose relatively little about themselves in session.

The less active role of the therapist, and the rather ambitious goal of uncovering the unconscious mind means this therapy can be slow going, and that requires a substantial investment of time, and probably money. But you can expect to learn more about yourself in the process. It doesn’t have a strong scientific basis, although studies have shown it to be effective for a range of problems.

Humanistic Therapy (215 words)

Carl Rogers, who developed a humanistic ‘client-centred’ approach to therapy from the 1940’s to the 1980’s, is still thought of as one of the most influential of all clinicians. The humanistic approach was never taught to me formally in my clinical training, but his client-centred principles are infused in the way therapy is taught, and hence in the way most therapists work.

The client is presumed to have within them the ability to change for the better, and achieve personal growth. The therapist is led by the client, helping them to gain insight along the way. As in Psychodynamic Therapy, the client tends to do most of the talking; and the direction therapy takes depends on what issues or ideas the client brings to the table (…or chair, more commonly). The therapist uses active listening to reflect back the client’s own ideas in a way that promotes insight, treats the client with ‘unconditional positive regard’ to bolster their own self-regard, and shows empathy and understanding towards the client. Lovely stuff :-).

Humanistic psychology doesn’t really offer specific theories of mental disorders, and so a purely humanistic approach to therapy may not suffice for those in an acute stage of mental illness. It aims rather to promote personal growth, and to help people achieve their potential.

Cognitive & Behavioural Therapies

The psychological therapies in this category focus more on changing what you do, rather than building insight, (although increased knowledge and awareness is important still). Their development began in the 1950’s and has continued until the present day. They can be split into roughly three groups – Behaviour Therapy, Cognitive Therapy, (together, ‘Cognitive Behaviour Therapy’), and finally, the so-called ‘Third-Wave’ therapies.

Cognitive Behaviour Therapy (CBT; 530 words)

The main assumptions of CBT are that our thoughts, feelings and actions are interconnected, and hence changing one will lead to changes in the others, offering opportunities for targeted therapeutic interventions. The relationship between them is often portrayed by diagram below.

 

Whereas in psychodynamic theories the majority of important psychological processes are unavailable to our conscious awareness, CBT assumes that whilst much of our thinking may be automatic and out of awareness, with a little practice we can begin to notice our thoughts, and connect them with related feelings and actions. This allows us to consciously make beneficial changes to these processes. The therapist’s job is to help the client to develop the skills to identify and change the relevant processes, leading to improved psychological health, and providing additional coping skills for the future; when successful, the client becomes their own therapist.

Behavioural techniques were the first to be developed, and came with a fairly rigorous scientific backing (at least by psychological standards). Research has shown that certain habits of behaviour maintain psychological problems. For example, for those suffering from excess anxiety, consistently avoiding what they fear maintains this anxiety in the long run, as they never have the opportunity to disconfirm their expectations of threat. To address this, behavioural techniques for anxiety involve facing our fears (called exposure therapy). There are also behavioural techniques for depression, which aim to reverse corrosive patterns of withdrawal and social isolation. Behavioural techniques are widely used to manage behavioural problems in children, and adults in some cases, by manipulating the pattern of positive and negative consequences following targeted behaviours.

Cognitive techniques came later, and are premised on the idea that the way we feel is a direct result of our thoughts, specifically the way we appraise a situation. And although our perspective on the world is certainly influenced by our upbringing and events of the past, the focus of CBT is on the present, in that we can change how we presently think in order to improve our psychological condition. CT generally involves monitoring thoughts to identify patterns of thinking that are maintaining poor psychological health, and will then employ techniques to test the validity of these usually biased and unrealistically negative thoughts, thereby weakening their hold on our emotional health.

CBT is probably the most well researched psychological therapy, and there is a fair bit of evidence supporting its effectiveness.  It is also quite targeted and can be effective in a relatively short time, (weeks or months, sometimes even just one session for simpler problems like specific phobias eg, spiders). It requires more effort from the client though, who is generally set homework tasks, and we need to repeatedly use skills to get them to a point where they are effective. Treatments like exposure therapy are potentially very effective, but only if you can talk someone into doing them: facing our fears is not, at first, a pleasant experience (although it can be very empowering once accomplished). And the cognitive techniques use our conscious thinking to challenge ingrained ways of seeing the world, which can be quite a big ask for some people, especially those who are not psychologically minded.

Third Wave Therapies (515 words)

These therapy styles came to prominence in the 1990s (give or take), and are generally influenced by Eastern philosophies. Whereas the CT in CBT asks us to change the content of our thoughts, which leads to a change in how we feel and act, these therapies ask us to change the way we relate to our inner psychological world. Many promote acceptance of our thoughts and feelings by learning to view them as merely psychological and physical events that we can choose not to engage with, if it is unhelpful to do so. We learn not so much to change our psychology, as to live with it.

Mindfulness

Mindfulness Based Stress Reduction (MBSR) was one of the earlier therapies to adapt certain meditation techniques into a psychological therapy. This particular therapy is generally conducted in a group format, and is almost entirely based on applications of Mindfulness. Mindfulness practice is quite experiential, as you can’t really understand what it is without doing it. MBSR uses mostly meditation exercises.

All of the other third-wave therapies I mention below include some concept of Mindfulness.

Dialectical Behaviour Therapy (DBT)

This therapy was developed in response to the specific needs of a particular clinical group, but is now used more widely. It combines pretty pragmatic behavioural techniques with Mindfulness and other skills-based practices. DBT therapists are often more forthcoming in style, may disclose more about themselves, and will sometimes be available to consult with their clients out of session (often to coach people through crises).  Some therapists use DBT techniques to supplement their main therapy modality, but this won’t be the full DBT experience.

Acceptance and Commitment Therapy (ACT)

As the name suggests, ACT promotes acceptance of our psychological experience, and asks the client to commit to living life according to what they most value. In ACT, the therapist will help the client to see that the way they have struggled to manage their symptoms so far has not helped, and may even be making things worse. They then make use of a range of analogies and other techniques, such as Mindfulness, to help the client accept their negative thoughts and feelings, and re-focus on living a meaningful life, taking some of their symptoms along for the ride! Although symptom reduction is not the aim of ACT, the paradox of acceptance is that by not trying to reduce symptoms we no longer fuel them, and they may subside as a result.

Metacognitive Therapy (MCT)

This therapy focusses not on managing symptoms directly, but on managing what we think about our symptoms, and how we respond to those symptoms. It has elements in common with ACT, although acceptance itself is not a central theme. Many of the techniques are designed to change the processes of thinking without necessarily changing the content of thinking. It nevertheless aims to challenge unhelpful thoughts about our own symptoms, such as worrying about how we worry too much, which only adds to the worry (and don’t I know it!). It also uses analogies, visualisation techniques, attention training, and a more specific concept of Mindfulness (without the meditation practice).

A Couple of Others (130 words)

Schema Therapy

Still quite new, Schema Therapy combines the focus on thinking from Cognitive Therapy, with the past focus and longer term approach of Psychodynamic Therapy. The CT part of CBT focusses (at least initially) on individual thoughts identified by the client, but recognises that these thoughts come from ‘core beliefs’ that we hold about the world. Schemas are collections of core beliefs on related topics, and so represent maps or blueprints of our life. Schema Therapy aims to improve our psychological health by re-programming these schemas, re-drawing the maps in our mind in a sense. It can be quite experiential, dealing with significant memories and themes from a client’s life.

Interpersonal Psychotherapy (IPT)

This cognitive-behavioural therapy is an evidence-based treatment for depression, and focusses on the interpersonal aspects of this disorder.

The Complex Symptoms of Trauma

A brief look at common responses to trauma, addressing some of the complexity in these responses, and the relationship between associated disorders: 640 words.

The symptoms of Post Traumatic Stress Disorder (PTSD) are a common response to a traumatic event. They include vividly re-experiencing the event and associated anxious arousal, but also growing avoidance of anything related to the trauma, and an increasingly negative view of the world. For the majority of people such symptoms will subside over time, particularly if they are well supported in the period after the trauma. But for a significant minority the symptoms will persist.

Not all responses to trauma fit this picture however. The situation is often complicated when we are exposed to more than one traumatic event, when we experience trauma as a child, or when our trauma has an interpersonal element, as in abuse. Feedback loops that develop after trauma can set in motion processes associated with other disorders, such as anxiety and depression. And many people will become addicted to alcohol or other drugs in an unhelpful attempt to manage these complex and self-reinforcing symptoms, and addictions cause a whole set of problems by themselves.

It may be helpful to think of each person’s trauma response as a point floating somewhere in the Venn Diagram below, often falling within the PTSD oval, but just as often encompassing greater complexity. And so to make sense of these complexities it is useful to consider other diagnoses and their relationship with PTSD.

A person’s response to trauma may fall somewhere within this Venn diagram. PTSD symptoms are common, but so is a mixture of symptoms from related mental health disorders, as are addiction and relationship problems (not represented here).
Anxiety

Anxiety symptoms are often prominent after trauma. We commonly react to anxiety by avoiding the things that make us anxious, but avoidance undermines our confidence and leads to further anxiety and avoidance in a vicious cycle. The traumatised person may avoid doing things and going places that remind them of the trauma, and may avoid even talking or thinking about the trauma. As their cycle of avoidance widens, they may begin to experience difficulty just leaving the house, or carrying out everyday tasks. I’ve worked with highly trained and very competent members of the military who were reduced to staying at home all day, reluctantly going out only with their partner, or who found it difficult to answer the phone and check their emails in case it meant doing something they felt unable to handle. In this way anxiety becomes its own problem as it spreads and leads to conditions like agoraphobia (roughly defined as a fear of public places), social anxiety, severe worry and stress.

Depression

Negative thinking and mood states are now formally part of a PTSD diagnosis, and the effects of trauma are so debilitating that people may understandably respond with the feelings of hopelessness and helplessness closely associated with depression. When you feel nothing can be done to help, you may give up and withdraw from life, and if you think nobody understands you, or that you are a burden on others, you may isolate yourself socially. Severe and chronic depression works against people seeking help and engaging in treatment, so when depression is bad enough clinicians may opt to treat this before addressing trauma symptoms, even if they think the trauma symptoms came first.

Borderline Personality Disorder (BPD)

This diagnosis represents long standing problems with strong and chaotic negative emotions, interpersonal insecurity, confusion with one’s own identity, and frequent self-harming behaviours, including suicide attempts. There are many variations of symptoms that can earn this label, so BPD can be experienced quite differently by different people. It may well develop from early experiences of repeated abuse, including sexual abuse, hence the relationship with trauma. The methods used to treat PTSD can be quite different from those appropriate for someone with BPD symptoms, so differentiating between them is important.

Conclusion

Perhaps it is to now state the obvious that determining how someone has been impacted by trauma is critical for planning their recovery, so I recommend an assessment by a qualified clinician as a good first step.

Finance Analogies: Mental Accounting and the Positive Events Diary

I make a case for paying extra attention to the positive events in our lives, and offer one way of doing this: 460 words.

As a former accounting and finance professional I like to find some common ground between my two careers. Here’s my fourth attempt…

In life we can expect some events to add value, and some to reduce value. For example, when we receive a compliment this adds value, and when someone insults us this diminishes value, if we take it seriously anyway. As an accountant, I would record transactions that increased and decreased the value of an organisation, namely income (credits), and expenses (debits). Of course, many expenses are necessary, as we can’t expect to achieve anything without incurring cost. But on the whole we hope to make a net profit (more income than expenses).

Sometimes, though, our mental version of accounting goes a bit haywire. We start recording only the negatives, and fail to notice the positives. This is very common in depression, when we become biased towards noticing failure and setbacks. The reality for the depressed person may well be okay, but their disorder stops them from seeing this.

In accounting we record financial transactions in a ledger. If we are keeping a kind of depressive ledger, recording just the expenses in our life, then we will soon start to question whether it’s worth doing anything at all; we become hopeless. To counter this, we can start to keep a second set of books, in which we will record only mental ‘income’.

Clinicians call this a positive events diary. At the end of the day we can take a simple note of the good things that have happened during that day, whether little or big, and by doing this we begin to build a more accurate picture of our lives. It’s an unashamedly biased exercise, because depression is biased too. Think of it as affirmative action for your positive thoughts.

Each time you do something that your depression would have prevented you from doing, record this as a positive event. It’s an achievement for many depressed people just to get out of bed in the morning. All the usual good things can go in there, and don’t take things for granted. If you make someone laugh, enjoy your morning coffee, or get a question right at college, or in a work meeting, all these are positives and deserve to be recorded. Social media can be used in this way. If we take Facebook as an example, spend less time examining others’ highly curated lives, and record your own ‘best of’; you don’t even need to share these publicly, but going to the trouble of recording these events will remind you of them, and you can look back over them in the low times.

However you do it, keeping a positive events’ diary is a relatively simple way of balancing your mental books. And although you don’t need to be an accountant to do it, you might find consulting with a therapist will help you keep track of all those mental credits.

Finance Analogies: Don’t Over-insure Yourself

A finance metaphor illustrating the cost of trying to eliminate all risk from our lives, and presenting an alternative to this: 480 words.

Here’s another go at finding commonality between my former career in finance and my work as a psychologist.

When we purchase insurance we incur a small cost upfront to eliminate the risk of greater losses later on. That all sounds lovely, only insurance companies earn a profit margin on these transactions, ensuring that in the long run they will earn more in insurance premiums than they will pay out to cover people’s losses. In fact, over a lifetime a large majority of us will claim less in insurance than we will pay out in premiums. So why take out insurance at all? Well, one reason would be if there is a plausible risk of a major loss that you could not expect to cover, such as your house burning down. But aside from these situations, the benefits from insurance are mostly psychological – specifically, we gain peace of mind.

But another way to achieve peace of mind in these circumstances is to take a long term view of risk. If we can accept that over a lifetime there is only a very small chance of ever claiming enough on our insurance to justify it, then we could do away with insurance on all but those big ticket items like a house. Sure, we will have a few occasions when we do have to replace an item that we didn’t insure, but the money we save will most probably more than offset this. But many of us struggle to take this long term view. Our emotions are built to focus on more immediate concerns, and if I’m concerned about my new refrigerator breaking down unexpectedly then I’ll buy that extended insurance to allay my concerns. Consequently many of us over-insure our lives.

But this tendency to over-insure doesn’t only apply to financial transactions. We do the same thing if we always carry an umbrella as insurance against it raining, or when we put in unpaid overtime to prepare for almost every possible question at the next work meeting, or when we take a swath of vitamins each day just in case we pick up a particularly virulent flu virus. The cost of carrying that umbrella may be small, but add that up over a lifetime and then compare it to the odd occasion when we’ll get wet, and it’s likely that we could benefit in the long run from leaving the brolly at home.

My examples may seem trivial, but the risk-averse people amongst us insure almost every aspect of their lives, and in doing so, weigh themselves down with the burden of all that insurance. If that is you, then try and take a long term view of the risks in your life, learning to accept the smaller risks that you can deal with should they eventuate, (and you can cope with a lot more than you think). Allow yourself a wry smile when you get caught in the odd rainstorm, but remember that you travel lighter nowadays.

How to Use Mindfulness

How to use Mindfulness for improved psychological wellbeing: 850 words.

The psychological practice of Mindfulness (derived from Eastern meditation practices) is de rigueur at the moment, being promoted as a standalone practice for psychological wellbeing, and forming part of a number of evidence based psychological therapies. A straightforward definition of Mindfulness is to pay attention to the present moment, and to do so non-judgementally. And although anything can be done in a Mindful fashion, there are a number of formal Mindfulness exercises designed to promote this skill, such as paying attention to our natural breathing.

When running therapy groups I noticed that my clients thought of Mindfulness mainly as a relaxation exercise, but Mindfulness can help in more ways than this. What follows is a summary of ways that we can use Mindfulness to promote mental wellbeing. I will start with the simplest uses, and progress to trickier, but potentially very rewarding applications.

Relaxation

An exercise like Mindful Breathing can focus our mind on the rise and fall of our breathing, these natural rhythms serving to calm an agitated mind. And some people will combine Mindful attention with relaxation exercises, such as controlled breathing and progressive muscle relaxation, which are designed to calm us physiologically as well as psychologically.

Distraction

Our attention is a limited mental resource, and when our mind is focussed on a certain aspect of the present moment, it is not thinking about other, possibly less pleasant things. Hence Mindfulness as a form of distraction can help to dampen distressing emotions, and reduce worry and ruminative thinking.

Insight

Much of our mental and physical activity occurs automatically and outside of awareness. Anybody who has regularly driven along the same route has probably experienced getting to their destination without noticing a single part of the journey, perhaps lost deep in thought the whole way. But the car wasn’t driving itself, (although that technology is on its way!), so many parts of your brain must have been working diligently in the background. In a similar way, many of the negative mental processes implicated in mental health disorders occur automatically and outside of awareness.

Exercises like Mindful Breathing, Eating, and Walking, train us to become aware of activities that are frequently automatic, and to examine them with curiosity, rather than jumping to an instinctive judgement.  We can then apply this same skill to other automatic events, particularly the unhelpful thinking patterns, corrosive emotions, and reactive behaviours that contribute towards mental health problems. As a former management accountant we used to adhere to the maxim ‘what isn’t measured can’t be managed’, and in psychology we could say that ‘what isn’t noticed can’t be changed’. So the greater insight we can achieve with Mindfulness allows us to begin that change process. Be aware though that noticing unpleasant thoughts and emotions for the first time can be confronting, so it’s helpful to have a therapist or other trusted person available for support.

Confronting Unpleasant Emotions

Negative emotions fulfil important functions, and must play a role in our lives. But we tend to avoid what we don’t like, and very few of us like our negative emotions. Taking the edge off an unpleasant feeling is okay, but there is plenty of evidence that excessive avoidance of unpleasant emotions is ineffective in the long run, leading to greater negative emotion overall. Hence we are better off learning how to confront and understand our negative emotions, so that we might respond to them in a more considered way. Being Mindful of both the mental and physical components of our emotions, paying attention to them with curiosity rather than judgement, can teach us that these are just sensations like any others. With dedicated practice we can learn to weather the storm, ‘sitting’ with our emotions long enough to decide how best to respond to them.

Control

A great paradox of Mindfulness is that by learning to simply observe internal and external events, (including our thoughts and emotions), instead of trying to control them, we are in fact better able to control how we respond to them, and hence influence how they impact upon us. This is because many of our reactions to events are automatic, born from habit or reflex, and our attempts to control particularly internal events, like emotions, are ineffective in the long run. The restraint of a seasoned Mindfulness practitioner allows them to respond to events in a more controlled manner, consistent with their best interests in the longer term.

A Way to Live

If we integrate Minfulness into our lives then we begin to live in the moment. And the reality is that the present moment is all we have. Sure, there are memories of the past, and we will have new experiences in the future, but even these things can only be thought about in the present moment.

An old supervisor of mine used to call thinking about the past or future ‘time travel’. It is important to learn from the past and plan for the future, but if we spend too much time travelling then we miss out on the present anyway, so what was the point of all that thinking?

The Essence of Narcissism

A short article describing the central problem with a narcissistic personality: 390 words.

If you can imagine that within you is a pool representing your self-esteem. Keeping this pool adequately full will maintain enough self-confidence to function in your life. If your pool is empty you will be racked with insecurity, and not even know who you really are.

Your pool is topped up every so often through accomplishments, but it may also be drained by events which reflect badly on you. Generally though, the level of your pool is pretty stable.

Now imagine if your pool had a leaky bottom, steadily draining self-esteem all the while. To keep hydrated you’d have to constantly keep taking in more liquid, but realistically we can’t expect one success after another. This is the predicament facing the narcissist.

Without constant additions to their pool of self-esteem the narcissist would shrivel. They must employ all methods at their disposal to keep the self-esteem flowing in, like a desperate addict looking to score. Putting others down in order to feel comparatively good about themselves is an option, no doubt one reason why narcissism has such a bad reputation. Maintaining a façade of confidence and accomplishment is another. Being in a position of power would be a handy way to regularly feel important, and perhaps a narcissist must ultimately achieve this to live sustainably. Experiences damaging a narcissist’s self-esteem are felt particularly hard, and perceived as an attack, so they will commonly respond with aggression. Perhaps unsurprisingly with such a constant self-focus, the narcissist often fails to empathise with others.

As a clinician I encounter narcissistic individuals at their low point, and so it is this I know best. The client usually still lacks insight into their condition, believing a hostile world to be the cause of their distress, when in fact the world may not have treated them particularly harshly; they just have a leaky bottom (so to speak). The client often still clings to their narcissistic façade portraying achievement and confidence, despite the clear discrepancy with the observable reality. But occasionally they will find a way to lower this façade, revealing the vulnerable human underneath, and this can be a very satisfying moment for a clinician. Narcissism has a bad reputation for a reason – it is frequently unpleasant for all concerned. But we mustn’t forget there is a human like us beneath this syndrome.

An Unstable Sense of Self

A short analogy on the experience of having an unstable sense of self: 340 words.

Most people take for granted a stable sense of the self. We know roughly our main character traits, our strengths and weaknesses, and the ways in which we relate to other people. We also can expect that these attributes will remain largely stable over time, and are not highly dependent on outside events or influences.

But not everybody feels this way. For some, their sense of self, and indeed their value as human beings is very much dependent on the outside world, particularly other people. In order to feel valuable and secure they require unambiguous and constant confirmations that others adore or admire them. Without these they begin to crumble. It is as though they must always be in the sun to keep warm, unable to generate body heat from within. And if a comparison to cold blooded reptiles seems unkind, it nevertheless represents the harsh way in which society judges such people. We interpret their psychological sunbathing as being needy, selfish or arrogant, and find their unpredictability and emotionality troublesome at best, destructive at worst. Related diagnoses such as Borderline and Narcissistic personality disorders carry a stigma, although for some the recognition of their experience as a ‘thing’ can be a relief.

Of course the majority of people who are psychologically ‘warm blooded’ still benefit from a little time in the sun – occasional compliments, hearing “I love you” from our family, a promotion at work – but cannot easily understand what life would be like if our whole identity depended on a constant supply of these events. We’d be always searching for that patch of sunlight in which to bask, and forever vigilant and defensive over threats to our self. There’d be no respite, and so it is not surprising that such experiences can lead people to make suicide attempts.

Overcoming an unstable sense of the self should be considered a long term project, and just realising what is going on is a good start. Then find a qualified clinician to help you or your loved one to take the next steps.