by Monica A. Frank, Ph.D.
November 19, 2014
PsychNote: The Paradox of the Mindful Attitude
A paradox is something that may not make sense on the surface but reveals a truth. For example, for people with panic, when they quit trying to get rid of panic, it usually reduces or even
goes away. Or, for a perfectionist, when they don't try as hard at work, they may actually do a better job. It may seem reasonable that if you want to stop panic, you have to try to get rid of
it or avoid the things that might create it. Or, if you want to be a good employee, you must work harder. However, sometimes the truth is the opposite. I often tell my clients that it's as if
a bottomless pit is in front of them and I'm telling them "It's okay. Nothing is really there. You can walk across it." Instead of trusting their senses, they have to proceed against what appears
to be sensible.
That is the nature of the mindful attitude. The mindful attitude is about letting go and just experiencing. The paradox is that it is necessary to let go of the mindful attitude as well.
What does this
mean? It means that trying to create a mindful attitude is counter-productive. Sometimes I hear or read on the internet people priding themselves on how many silent retreats they have been on
or how much mindful meditation in which they engage. To me, this is not the mindful attitude because they are treating mindfulness as a goal to achieve rather than just an experience of "being."
I do recognize that this may be a step in that person's journey and other layers of mindfulness may be revealed to them later. Yet, I believe it is important to point out this paradox to
help beginners understand the true nature of the mindful attitude.
Recognize that as you practice mindfulness you are taking steps towards developing a mindful attitude but the practice may not be mindfulness itself. To understand how to begin mindfulness practice and incorporate it into your life, the Understanding Mindfulness
audios (with transcripts) can be a
good starting point. The mindfulness exercises can be helpful in learning mindfulness, but keep in mind that they are not creating mindfulness but are steps towards the development of
a mindful attitude.
November 17, 2014
New Cognitive Self-talk Audio is Available: THE IRRESPONSIBILITY OF DEPENDENCY
This audio may seem harsh but for those who are overly dependent, it is a necessary truth. Only by recognizing how your dependency creates what you fear will you be able to
change your life. Your fear of being abandoned, of being alone, of being responsible for yourself is more likely to cause you to be rejected, abandoned, and alone. Once you realize that
only you are responsible for changing this pattern, you can create a better life for yourself. No matter what happened to you in the past, you are responsible for your present.
Those who are overly dependent may present in different ways. Some present as helpless with the need to be taken care of while others may present as very controlling. No matter how
the dependency may appear, it has the commonality of creating problems in relationships.
The purpose of this audio is to help you recognize this reality. By listening to it and making the choice to take responsibility for yourself, you can create a better future. Keep in mind
that as with all the cognitive-behavioral tools, this should be used in combination with the other methods such as the cognitive diary
TAP HERE FOR AUDIO
November 16, 2014
PsychNote: The Key to Mindful Breathing for Sleep
Frequently, people find it difficult to fall asleep because their mind won't turn off. Although some people are focused on worries, any kind of thoughts can potentially interfere with sleep.
For instance, if you are excited about something that just occurred or that you are anticipating, you may have trouble quieting your mind. If you are working on a project, you may still be thinking
about it when you go to bed. If you have a problem you are trying to solve, you may be reviewing it in your mind. Whatever the type of thought might be, it can interfere with easily falling asleep.
The Mindful Breathing
exercise can be useful for quieting your mind. First, be sure to thoroughly learn the method before using it for sleep.
You can listen to the audio to learn the method, but for sleep it is best to focus on each breath without listening to the audio. The key to using the mindful breathing method for sleep is to
gently bring your focus back to your breath whenever your mind wanders. At first, you may need to do that many times. Don't get discouraged, but instead, gently refocus to your breath. As your mind quiets, your next awareness is likely to be waking up from a restful sleep.
November 3, 2014
PsychNote: Treatment Resistant Depression isn't Resistant to Cognitive Therapy
About 30% of those treated for Major Depressive Disorder with anti-depressants have been labeled with treatment resistant depression (TRD). Unfortunately, with each additional medication tried, the chances of improvement are diminished. Repeated, unsuccessful trials of different medications causes increased discouragement and hopelessness which may lead to the higher level of suicide in this group.
However, Leykin and colleagues (2007) found that those with TRD to medication still respond as well to cognitive therapy as those who have responded to only one or two trials of medication. The researchers suggest that the depression is not treatment resistant, per se, but neurochemically resistant to anti-depressants. In other words, some people may not be able to benefit from medication, however, they can still benefit from other forms of treatment such as cognitive therapy. In addition, these researchers suggest that for some people, the repeated trials of medication may alter the brain chemistry in such a way to lead to a worsening of the depression.
Labeling people as treatment resistant may not only be inaccurate but could potentially be harmful due to the degree of hopelessness that is caused by this label. If someone is not responding to repeated trials of medication, they should be informed of other available treatment options such as cognitive therapy.
Leykin, Y., Amsterdam, J.D., DeRubeis, R.J., Gallop, R., Shelton, R.C. and Hollon, S.D. (2007). Progressive Resistance to a Selective Serotonin Reuptake Inhibitor but Not to Cognitive Therapy in the Treatment of Major Depression. Journal of Consulting and Clinical Psychology, 75, 267–276. DOI: 10.1037/0022-006X.75.2.267
November 2, 2014
This audio relaxation exercise teaches mindful awareness by describing relaxing imagery. This audio describes a walk along a country lane in the woods on a rainy, autumn morning. Just allow yourself to picture the autumn colors and listen to the rain as it drips from the leaves into the stream bordering the lane.
This type of relaxation has several purposes. It teaches you how to be mindfully aware of your full experience. By practicing the methods of
mindfulness, you can develop a greater awareness and appreciation of your daily experiences. In addition, it will help you develop greater relaxation
skills. You can use these methods to reduce the symptoms of stress, manage anxiety, and improve your sleep.
This may be used while sitting or lying down in
a quiet, comfortable place. Just close
your eyes and listen without trying to force
yourself to relax. If your mind wanders,
gently bring yourself back to focus on the
TAP HERE FOR AUDIO
November 1, 2014
Addiction to Emotions and Mindfulness Practice
A complaint some people have about mindfulness is that it dampens their positive emotions as well as negative emotions. Although such experience with mindfulness may
appear to be true, it is actually due to the individual's perspective of emotions. Some people are thrill-seekers and require external emotional rewards. For instance,
gamblers are addicted to the positive emotions involved with gambling and winning: excitement, anticipation, elation (Teper and Inzlicht, 2014). However, they are also very susceptible to the
negative emotions when they lose. Similarly, some people are addicted to the excitement and passion of a new relationship and are more likely to be unfaithful in a longer
Research shows that mindfulness actually increases engagement with positive emotions which means people will fully experience positive emotions. However,
mindfulness may decrease the length of an emotional reaction (Greenberg and Meiran, 2014). Most likely this is due to the length of an emotional experience being dependent
upon re-creating the emotion rather than just experiencing it. Re-creating an emotion is likely to be related to the addictive need for the positive emotion.
Therefore, for those who are addicted to positive emotions, mindfulness will be experienced more negatively as it is a withdrawal from the emotional "high." The benefit, however,
of mindfulness for those who are addicted to emotions is that it decreases the unhealthy behaviors to seek the "high" such as gambling, sex or pornagraphy addiction,
and spending addictions.
Greenberg, J. and Meiran, N. (2014). Is mindfulness meditation associated with “feeling less?” Mindfulness, 5, 471-476. DOI: 10.1007/s12671-013-0201-2
Teper, R. and Inzlicht, M. (2014). Mindful Acceptance Dampens Neuroaffective Reactions to External and
Rewarding Performance Feedback. Emotion, 14, 105-114. DOI: 10.1037/a0034296
October 31, 2014
Mindfulness Practice is Not Focusing, It is Re-Focusing
One of the most common misunderstandings of mindfulness practice, in my experience, is to equate it with being focused. Many initial practitioners will complain, "I couldn't do it! I kept
Such a statement means they don't understand what the practice of mindfulness is. Because if they did, there is no way they "couldn't do it."
If you think of mindfulness practice as learning to re-focus, rather then being focused, distraction becomes your friend. What I mean by this is that the purpose of mindfulness training is
to teach your brain how to be more presently focused. The most common interference with being focused is distraction. Therefore, what you need to learn is how to re-focus when you
Instead of thinking of distraction as meaning "I can't do it," think of distraction as an opportunity to train your brain to re-focus. The more you are distracted and gently re-focus to the present, the better your
brain is trained. Eventually, it becomes easier and easier to re-focus. The result: greater mindfulness!
To learn more, listen to the Understanding Mindfulness
audios (or read the transcripts).
October 25, 2014
The most common cause of insomnia is not being able to quiet the mind. This audio, Insomnia Education
, provides education to learn how to address the thinking that
occurs for many people who experience insomnia. Even if the cause of your insomnia may be physical, learning some of
the methods to quiet the mind and improve sleep can still be helpful.
In addition to this audio, the mindfulness
techniques can be helpful for insomnia. Also, if worry is the main cause of your insomnia,
the Worry Box
audio and Excel At Life's Android app, Worry Box--Anxiety Self-Help
, and learning how to put worries away before you go to bed can be helpful. Be sure to check out the relaxation
October 24, 2014
Yogic Breath Training
is a meditative type of breathing that is often good to use at the beginning of your daily meditative practice. However, it can also be practiced periodically throughout
Although this method is not for immediate anxiety relief, the daily practice of it can help prevent or reduce overall levels of anxiety.
Initially, when you begin this practice you may not be able to do it as slowly as it is described. Start with a count that is comfortable for you and eventually you will be able to
gradually slow down your breath. The transcript for the audio is included so that you can practice this method in the way that works best for you.
October 20, 2014
Older, but Happier
Although as people age and they experience more health problems, more losses, and other significant changes in their lives, research shows that older people are happier. Specifically, fifty appears to be the magic number in which overall well-being improves and anger, stress, and worry decline. Interestingly, sadness doesn't change as much as these other states (Stone, et al., 2010).
Why Are People Happier As They Grow Older? An opinion.
Most young people are focused on external validation which means their self-assessment is based on achievement and outside opinions. In other words, they need to achieve at work and/or school, obtain the approval of others, raise successful children, and acquire objects of status such as homes, cars, and other material items. Such a focus tends to be stressful, competitive, and not completely under their control. They are at the mercy of outside forces such as the economy and the decisions of other people. As a result, they may worry about uncontrollable events that interfere with their goals and they become easily frustrated with others who get in their way.
However, wisdom comes with aging. In particular, older people more frequently have developed a sense of internal validation which is a self-assessment based upon self-esteem, sense of purpose, and other qualities that are based within the individual. Thus, for the most part, they don't try to control external events or other people. They have developed a more mindful attitude towards life which allows them to be more at peace with all experience instead of trying to make life what they believe it “should” be. This attitude of acceptance tends to reduce anger, stress, and worry, although sadness is likely to still be present when relevant such as when losses occur.
Stone, A.A., Schwartz, J.E., Brodericka, J.E. and Deaton, A. (2010). A snapshot of the age distribution of psychological well-being in the United States. Proceedings of the National Academy of Sciences, 107, 9985-9990. doi.10.1073.pnas.1003744107
October 15, 2014
Anxiety Disorders May Not Be As Prevalent As We Thought
Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a survey of the prevalence of mental disorders in the U.S. population. The survey evaluated the presence of a disorder in the previous year. Interesting, this survey showed much lower one-year prevalence* rates for anxiety disorders than previous major studies.
Although the one-year prevalence for the depressive disorders is down slightly from about 9% of the population to 7%, the prevalence for anxiety disorders is substantially lower. Overall, anxiety disorders has dropped from 19% of the population to a little less than 6% with the largest drops in Social Phobia and Specific Phobias.
What does this mean? Is mental illness decreasing in our population? Or, is there a problem with the way these studies have been conducted? If so, which one is accurate?
The previous comparison study conducted from 2001-2003 involved in-person interviews conducted by lay persons with no professional training using a script of questions without follow-up. The current study involved telephone interviews conducted by clinically trained interviewers who could ask follow-up questions to ascertain the diagnosis. Thus, this study could be illuminating problems with the different interview questionnaires used and how the interviews were conducted.
My tendency is to think that the current study may have been a more rigorous study due to the use of clinically-trained professionals and reflects the actual rates of mental illness. Therefore, the prevalence rates haven't changed but the way they are measured influences the outcome. In other words, anxiety disorders are not decreasing but may have been over-estimated in the past.
*Note: One-year prevalence is typically much lower than lifetime prevalence as it is measuring how many people can be diagnosed with the disorder at any particular time versus how many people may have the disorder at some point in their lives. Since many of these disorders aren't present throughout the lifetime but only periodically or for a short time, the rates will differ significantly.
Karg, R.S., Bose, J., Batts, K.R., Forman-Hoffman, V.L., Liao, D., Hirsch, E., Pemberton, M.R., Colpe, L.J. and Hedden, S.L. Center for Behavioral Health Statistics and Quality (2014). Past Year Mental Disorders among Adults in the United States: Results from the 2008-2012 Mental Health Surveillance Study. http://beta.samhsa.gov/data/sites/default/files/NSDUH-DR-N2MentalDis-2014-1/Web/NSDUH-DR-N2MentalDis-2014.htm
October 10, 2014
Choose Your Own Dream: Don't Pursue What You “Should”
Often, young people feel pressure from parents, teachers, and others to pursue certain goals in life. These goals may not be the passion of the young person, but instead, reflect the expectations of others. In cognitive therapy, we refer to these as “shoulds” which, in this case, is an irrational belief about the necessity of meeting the demands of others. As a result of this pressure, many young people choose educational goals and careers that do not reflect their own dreams, desires, or goals.
Certainly, the people applying pressure probably have good intentions and believe they know what is best for the young person. However, the problem is that success is related to developing intrinsic goals based on the individual's interests and passions (Koestner, 2008). A person who pursues a career or interest because of the expectations of others is less likely to be motivated which leads to being less successful.
What does this mean?
If you are a young person, pursue your dream no matter the demands of others. If you are a parent or teacher, recognize that motivation and success comes from the young person discovering and choosing what is personally meaningful.
Koestner, R. (2008). Reaching One’s Personal Goals: A Motivational Perspective Focused on Autonomy. Canadian Psychology, 49, 60 – 67. DOI: 10.1037/0708-55188.8.131.52
October 8, 2014
Please help translate Excel At Life's apps if English is your second language or you have expertise in other languages. People the world over have requested translations saying that they do not have access to the type of information and help provided by Excel At Life. Help others get the help they need!
Excel At Life is using Crowdin to translate our android apps. Join our project here: Crowdin.com
. You can help as little or as much as you like. A "crowd" project means the more people who help translate, proofread, and vote on the translations will insure a good translation.
The Cognitive Diary app is the basis for many of the other apps so once it is translated much of it can be used for the translations of the other apps.
October 7, 2014
Announcing: Excel At Life's PsychNotes have been indexed!
Now it is easier to find PsychNotes according to topic of interest: Index
October 4, 2014
New Article: What to Expect from Mindfulness-based Cognitive-Behavioral Therapy (MCBT) When You Have Depression and Anxiety
When practicing the techniques described by Excel At Life, people want to know when they should feel better. This is a difficult question to answer because it requires an assessment of each situation which is why it is best to practice these techniques under the guidance of a MCBT therapist. However, in this article I will discuss what to expect and how to assess your practice.
What is Mindfulness-Based Cognitive-Behavioral Therapy (MCBT)?
1) Cognitive Therapy
. First, CBT is a type of treatment that focuses on how you think (cognitive) by examining the accuracy of your thoughts about yourself, others, and the problems you face. Then, when thoughts are found to be an inaccurate appraisal, cognitive therapy helps to change these thoughts by developing a more accurate (or rational) way to think or approach the situation. Once a believable rational has been developed, the idea is to frequently express this new thought to create the new pathway (connections) in the brain.
2) Behavioral Therapy
. CBT uses a variety of techniques to help change a person's behavior. These methods can include goal-setting, communication training, relaxation and biofeedback, behavior modification, and exposure methods as well as many others. The commonality of these methods is they are meant to affect the behavior.
. Although a technique that has often been included under the behavioral methods of CBT, mindfulness has taken a more prominent role due to its influence upon the other methods and its overall impact in the therapy. Mindfulness is an approach that is present-focused and teaches to refocus when engaged in the depressive or anxious thoughts.
4) Mindfulness-Based Cognitive-Behavioral Therapy
. CBT has a history of bringing under its umbrella any techniques that have been shown to be effective. Since cognitive therapy, behavioral therapy, and mindfulness have all been shown to be effective, they have been combined into MCBT. So MCBT isn't a new therapy, nor is it necessarily one specific treatment used for all similar cases, but it is the use of a variety of methods that are chosen based upon each individual's problem. Thus, MCBT may look very different for each client because it is specifically designed for each person and problem.
If you examine most self-help books you can see the influence of CBT running through them. Similarly, many specific therapies for certain types of problems are often just a set of methods chosen from CBT to address a certain problem. For example, when I have had discussions with DBT (Dialectical Behavioral Therapy) practitioners, I haven't been able to determine the difference between that therapy and MCBT except that DBT spells out certain specific techniques to use for treating trauma. Also, EMDR (eye movement desensitization and reprocessing) uses the CBT methods while adding in the eye movement component but has not been shown to be any more effective than CBT alone (Seidler and Wagner, 2006). I'm not saying that these methods aren't effective. I'm just saying that I would tend to categorize them under the umbrella of MCBT. Some people may swear by the differences they have experienced from these various therapies but I suspect it may be due to individual preference or a difference in the therapists seen by the individual (see my article: Does CBT Lack Compassion? It Depends Upon the Therapist
Read complete article
Some people may be curious as to why this website is
dedicated to the "pursuit of excellence" when I am
constantly warning about the dangers of
perfectionism. To address this question we must
differentiate between the pursuit of excellence and
the need to be perfect. These concepts are not only
different but can be considered antagonistic to one
another. In fact these concepts are so opposed to
one another that excellence can best be attained by
giving up the demands of perfection.
What is Perfectionism?
is the individual's belief that he or she must be
perfect to be acceptable. Perfectionism is black and
white with no gray area. Anything other than perfect
is failure. Perfectionism is an attitude, not
necessarily a behavior. In other words, two people
can engage in the same behavior such as trying to
win an Olympic gold medal but one can be pursuing
excellence and the other is demanding perfection.
The difference lies in the thought process about the
goal or behavior, not in the goal or behavior
Listening to the weather forecast one frigid day, I
realized how much we are influenced by the
catastrophic thinking of the media. The weatherman
reported, "The weather has brought more misery
to the St. Louis area." Certainly, the weather was
causing problems that day. An ice storm caused car
doors and locks to be frozen so that people had a
great deal of trouble getting into their cars.
However, I thought, unless someone was in the middle
of nowhere with no cell phone and they were unable
to open their car door because of the ice, this was
not "misery." Instead, I would call it an
"inconvenience." Most of us walked out to our cars
to find that we couldn't open the door, went back
inside a warm house or office, and found some
solution to our problem.
For many years when my husband and I were first
together I would ask him "When are things going to
get better?" We were dealing with the usual
stressors that couples face: not enough time, not
enough money, and the inevitable random events such
as family conflict, deaths of loved ones, illnesses
and injuries. In addition, for most of our early
years together I was in school and struggling with
the balancing of demands of advanced education,
part-time work, and a family.
But I had the belief that we were working towards
this perfect life that one day would emerge shining
a rainbow of happiness forever over us. My husband,
inclined more toward the practical, just answered my
question of "When are things going to get better?,"
with "Another six months." That answer typically
pacified me for awhile because I thought I could
handle any amount of stress for six months.
However, a point would occur when I once again I
asked my husband "When are things going to get
better?" Once again, he would answer "Another six
months." This scenario occurred fairly routinely
for many years.
However, fortunately during this time I had
experiences that began to teach me about my
expectations of life. In particular, when I was
completing my internship at the Veterans
Administration Medical Center I had the opportunity
to work on the spinal cord injury unit. That
experience forever changed my thinking. In
particular, I was struck by the differences in
attitude among the patients.
don't have any willpower."
"I can't do it."
Do these statements sound familiar? Too often, our
self-statements about weight management interfere
with our efforts and lead to failure. By changing
how we think about developing a healthy weight we
are able to change the behaviors that can lead to
Not long ago I conducted a little experiment with my
cardio-kickboxing class. After an intense class I
told them to get the heaviest weights they could
curl 8-10 times. I spent a minute telling them to
focus on feeling tired, that they had just worked
out hard and they couldn't do anymore. Then, they
were to curl the weights to exhaustion. Once they
finished, I spent another minute telling them to
focus on having energy, feeling good, feeling
refreshed, and knowing they could do more. Once
again, they lifted the weights to exhaustion. The
results were that out of nine people, only one did
fewer lifts the second time! And typically, when
someone lifts weights to exhaustion they should not
be able to lift as much the second time when it is
only a minute later. Although this was not a
controlled scientific experiment, it was a
demonstration to my class to show how powerful our
thinking can be. What this exercise showed was how
positive thinking overcame the natural exhaustion of
the body and created a self-fulfilling prophecy of
lifting more weight because the participants
believed that they could.