Negative What-Ifs Do Not Exist

But what if I get sick? What if I have a reaction to the vaccine? What if COVID never ends?

What if the world ends? Well it might…or it might not. Any event or circumstance has the potential of an infinite number of possible outcomes. So why focus solely to the worst, most negative result?And this is the problem with negative what-ifs. We are jumping into future time to put a negative outcome on an event that has not happened. 

To be clear, I’m not talking about using the analytic mind to rationally prepare for a rainy day. The mind can be very useful for planning vacations, picnics, retirement, you name it. I’m talking about cycling in future scenarios, sometimes repetitively.

Where do negative what-ifs come from? One emotion: fear. We feel scared and anxious and so we attach the fear to a future circumstance in an effort to control the outcome. Perhaps if we worry enough, plan enough, turn it over in our minds enough, then maybe, somehow, we can avoid it happening. 

The trouble is, that’s not a strategy that works. In fact, it can be counterproductive. We don’t create our future by jumping ahead into it and fretting. We create our future by how we feel and the actions we take in the present. And that’s before we get to all the things that are out of our control anyway….which when it comes down to it, is quite a lot. 

The more we can be out of fear, the clearer and more certain we become. Think of two soldiers on the battle field: one of terrified and quaking in his boots, the other is confident and certain in himself. Who’s going to fare better? 

Perhaps that gives you more of an idea of how fear can destroy the present and the future.

“Okay,” I hear you say, “That’s all well and good, but how do we get out of fear?” The million dollar question. 

The first step here is identifying when you go to a negative what-if. In psychology we call this catastrophizing. Shut it down. No, obsessing about it doesn’t prepare you for the worst case scenario - if that happens you’ll deal with it. It simply whips your anxiety up into a frenzy, until you feel terrible enough to have to…call a friend in utter distress, have a drink, eat a pint of ice-cream or overindulge in whatever your poison might be. 

Start to say ‘no’ to these thoughts. They are a distortion. 

The second step is to bring yourself back into present time. What is present time? Whatever is happening right now. The sunlight shining through the trees, a raucous crow calling outside the window, the warmth of the couch against your back as you read this post. When we identify the present moment through a mindful approach of noticing we can get out of our heads and into our life. What do you notice through your five senses - what do you smell right now, see or hear right now? 

This is really all about focus. How? Think about it: whatever you put your focus on in life, is what will expand. You practice speaking Spanish every day - pretty soon your Spanish will be more fluent, you go to the gym every day - you’ll be stronger each week that goes by, you focus on your anxiety frequently, the anxiety will grow. So by putting focus into the moment, the moment can grow. And that’s a pretty valuable tool for enjoying life more. 

We have a choice in what we do with our mind. That doesn’t mean that your fear isn’t valid, or doesn’t come from an historical place of trauma - something to absolutely be explored in therapy. It means that you the option to begin regaining control of your mind. And that’s a pretty empowering place to be…

I Don’t Want to Come Out of My Cave!

“It’s warm and cozy, and so comfortable in here.”

As a long winter of discontent comes to a faltering close, and the vaccine rollout looks promising, we are faced with an adaptation. Where once we were challenged to withdraw, do less and constrict, now we are dealing with its reverse: the task of making our lives bigger. Clothing doesn’t fit, workouts have gone by the way side and isolation has increased. All of sudden, life as it was might not so rosy. 

This is bringing up anxiety for a lot of people. Why? Because adapting can be hard. We may like trying new things or going on adventures, but we also like consistency. 

And d’you know what else we like? Doing things on our terms. Most of us aren’t fans of being told what to do. If we can pick our new experiences, then great. But if they are foisted on us, we react with resistance, reluctance and a fair amount of grumbling. 

But emerging from the cave is a very different process than the entering of our hibernation. 

This time there’s more choice. This is a wonderful opportunity for us to examine what we want to bring back into our lives. Do you know how many people have said to me, guiltily, with a sideways glance, “You know, I feel terrible saying this, but I actually really enjoyed the lockdown.” Now, I’m not saying for a second that this hasn’t been a time of tragedy for hundreds of thousands of people dealing with the reality of unemployment, sickness or death. But it’s also been a time of self-reflection, and making more of doing less. Zero commute: check. Meditation: check. Creative activities: check. 

So tell me, why on earth would we go back to life as ‘normal’ if that’s not something that we want, nor enjoy? While there are certain activities we must re-engage in, there’s a lot that we can choose not to include again. 

What’s more, we get to pace this. Of course it’s anxiety-provoking re-entering such an uncertain world. But we have some element of choice in how we construct our lives - when we’ll travel, when we’ll go back to group exercise, when we’ll hold parties and more. We can take this step by step, accustomizing to each new level that we undertake. From that perspective, we can really use this time as an opportunity to create more of what we want in life: we become the creator rather than the passive participant. And that’s an exciting place to be.

Mindful or Mind Full?

From the crest of the hill, a wide, cerulean expanse curves around the bay, serene as it merges with the horizon. The perfect vista, a seemingly incomprehensible paradox to the city it contains. This is a well-earned reward for Angelenos patient enough to navigate the winding roads of Malibu to reach this little known hike. Up here, the stillness that exists quite separate from the constant murmuration of the city reminds me of the state we can rest in when we do not attach to our thoughts - a state I’d like to be in all the time, but as a human being find elusive. 

Many people come to therapy for the first time not understanding that we don’t have to believe our thoughts. And, in all fairness, how can we comprehend that until we learn it? How many of us were raised in homes that imparted such knowledge?

But in the recognition that thoughts are really nothing more than a string of words entering the mind, comes the implicit fact that we therefore have a choice to believe them or not. Do we want to punish and berate ourselves, or affirm and nurture ourselves? It sounds so simple, doesn’t it? But if we look at how often we get caught in this trap, maybe it’s not so easy after all. 

Now, I’m not for a moment suggesting that very real life struggles don’t exist. Our circumstances can be overwhelming and extremely challenging. But at times, our stuckness, our difficulty changing our mindset undeniably comes from our attachment to old stories and self-defeating negativities. And what we think effects how we feel, and how we feel impacts how we behave. 

So often, we fuse with our thoughts and remain so attached to them, that it quickly becomes our reality. Or, historical patterns, old ghosts that have no place in the present, elicit a cracked record of negative self-belief. These ideas are the building blocks of Cognitive Behavioral Therapy and frequently used in EMDR therapy, where we explore underlying negative beliefs and seek to shift the neurobiology that holds them in place. Both of these can be helpful accompaniments to insight-oriented therapy.

Some beginner ideas to work with at home:

• Start a basic mindfulness practice to cultivate the observing mind - the mind that can witness non-judgmentally thoughts, memories and feelings that come and go.

• If you find yourself ruminating or in a repetitive thought loop, examine the content of your thinking as soon as you are able. Challenge your mind by asking the question, “Is this thought helpful or not?” If it isn’t, you can work on replacing the thought with something kinder.

• Consider how much energy you put towards unproductive thinking. With limited time and energy, we want as much as possible to go in a direction that serves us. 

Oh, and that hike? It feels pretty good when I can get there…and when I can’t, I try and work with what’s right in front of me.

I'm losing my mind over the state of today's world! What can I do?

“New COVID variant accelerates! Ten killed by crazed gunman!” What used to be headline news every other month, we now see on our feed daily. Many people tell me that they’ve reached a point where they can no longer cope with events in today’s world: pandemic, political strife, global warming, mass shootings, in addition to our own personal daily challenges. This is a huge amount to hold in our nervous systems and begs the question, ‘How can we make sure we’re not overwhelmed?’

1. Limit your access to the news and social media. We are not designed to be able to hold the volume of information that modern media gives us, especially in the way that it is delivered, which is constant, overwhelming and sensationalized. Watching the news or keeping up on social media can loop us into an addictive cycle that hijacks our nervous system. I’m not suggesting you don’t keep abreast of current events, but I’d like to invite you to experiment with seriously reducing how much of this you allow into your nervous system. 

2. Look at what is IN your control and what is NOT in your control. We can burn a huge amount of anxiety worrying over and over about issues we can’t control. When we bring the focus back to what we can control, it enables us to have more efficacy in our lives. Which leads us to…

3. Put your focus on in something action-oriented or calming. One of the many things I teach in my practice is where you put your focus is what will expand. Typically when we feel anxious, we zoom in on it, making it larger. So moving attention away from anxiety, and putting it somewhere else is a great step towards cultivating a different internal environment. 

4. Come back into the present moment. Anxiety is future-focused. Tools that bring us back into the moment will help. Basic mindfulness exercises can support this goal. 

5. Connect with a person or pet you love. Unconditional acceptance and love through connection with others helps to soothe us and de-escalate our sympathetic (fight, flight) response.

6. Use anxiety tools to reduce stress, and go to therapy to resolve any ‘old’ anxiety that is stuck in your nervous system. There are ways of working with our thoughts, feelings and nervous system to reduce suffering. Situations change and crises pass, so it’s important to learn ways to tolerate intensity, knowing it ebbs and flows. Meditation helps us clear the slate of the mind and reset.

Some anxiety is normal and healthy, but when it begins to get out of hand, it’s time to take action to bring it into check. 

What is Developmental Trauma?

Many people who arrive in my practice tell me that they do not have a trauma history, yet consistently experience issues such as fear of intimacy, multiple failed relationships, self-esteem struggles or repeated challenges in the workplace. Although an increasingly bright spotlight has been shining on the topic of trauma in the last several years, there persists a misunderstanding of the spectrum of trauma and its effects. Trauma can mean the classically-billed single incident type, such as an assault, a car accident or a mass shooting, But it can also refer to repeated events over time, that may seem less impactful, yet can have an equally devastating effect on our functioning. Growing up in poverty, unsure if basic needs will be met, or growing up as any kind of minority in which ongoing microagressions are present, would both be examples of this. In the psychology world we refer to single incident trauma as Big T, and repeated trauma as little t. Beyond this, there exists another kind of trauma, that can be insidious and covert: developmental trauma. 

In our earliest years, we require caregivers who are consistently loving, safe and accessible to us. In this kind of environment, our brain is able to develop in a healthy way, and we can reach developmental milestones that reinforce that the world and its people are generally predictable, and safe. If we are fortunate enough to have caregivers that attune to us and effectively meet our needs, we are able to navigate developmental stages that build a sense of trust, autonomy, adequacy, ability to maintain intimacy and healthy self-belief.

Often, caregivers are not able to provide young children with the kind of environment that fosters this, due to the shortcomings in their own environment growing up or their own adverse life events. Emotional invalidation occurs when caregivers minimize a child’s needs, ‘It’s no big deal, you don’t need to cry!’, shut down a child’s needs, ‘Stop crying!’ or withdraw affection in an effort to manipulate or control (conditional love.) Children can be led to believe that they only have value if they perform or look a certain way, ‘It’s straight As or the highway, buddy!’ Intrusive parenting, in which the child is not allowed their own opinion, or indulgent parenting, in which limits are not upheld, can both cause problems in self-concept. The birth of a sibling with a high level of need, inconsistency of caregivers, childhood hospitalizations and other early losses can also impact development. 

In graduate school, we were posed the question, ‘How does a fish know it’s wet?’ The answer, of course, is that it doesn’t - it is swimming around in the pond unaware, unless it leaves the water and gets a different perspective. So it is with developmental trauma: emotional neglect or abuse is not always intentional on the part of the caregiver, leading us to believe that the environment we grew up in is ‘normal’. But current symptoms often tell a different story. When we are not able to feel successful in relationships, work and life, it can frequently be a sign of an environment in which something was ‘off’, despite the best intentions of our family. 

In my practice, I specialize in repairing just this kind of challenge. Through relational consistency, neurobiological repair and insight, I support clients in overcoming developmental trauma, so that life is not just about surviving…but thriving.

Botox: Does Looking Younger Come with a Psychological Price Tag?

A cursory look around Los Angeles would suggest that Botox is as routine as its less invasive counterparts the blowout and the manicure. Perhaps not a surprise in a city that eulogizes youth and beauty. But while there's no doubt of the popularity of flocking to the needle, the jury is still out on the psychological effects of this injectable medicine. 

In a recent study out of the University of Southern California, it was found that due to frozen facial muscles, botoxed participants were unable to mimic the facial expressions of those they interacted with. Unconsciously imitating another's expressions sends a signal from the listeners’ face to their brain, enabling them to interpret the other's intended meaning. When this ability is impaired, the capacity to perceive others' emotions is impacted. In the study, women with Botox had increased difficulty interpreting both positive and negative emotional expressions, compared to their non-Botoxed peers. Although extended relational studies have yet to be done, with a little imagination we can foresee the potential downfalls of being in a relationship with someone who is not able to consistently decode our emotional expression. 

Perhaps the greatest implication of an inexpressive face is its impact on child development. The dual trend of increased Botox and higher child-bearing age could also affect babies' social and emotional development. Mimicking the facial expressions of the primary caregiver is crucial for two reasons: firstly, baby learns about emotions and social interactions through imitating the primary caregiver; secondly, baby develops his sense of self from feedback from the caregiver. We know from clinical experiments that when a baby can't get a positive emotional response from his caregiver, he quickly moves to a place of distress and nervous system dysregulation. Over time, repeated experiences of this kind negatively impact brain chemistry. And what of tone of voice and content as part of communication? Yes, these can somewhat compensate for lack of facial expression, but up to 80% of our communication is non-verbal. It is too early to say what the long term effect of Botox in the infant-caregiver relationship is, but we do know what happens when people lack communication skills and have a poorly developed sense of self. To view a short video of the Dr Edward Tronik’s Still Face Experiments, which show the impact of lack of facial expression and interaction on baby.  

http://www.youtube.com/watch?v=apzXGEbZht0

With mounting evidence on how Botox impacts relational quality, we are left to wonder if it has any redeeming psychological features. Enter Dr Eric Finzi who for almost two decades has been studying Botox's effects on mood. In his recent book, The Face of Emotion, he shares his research on the use of Botox, particularly his findings that Botox’s inhibiting of depressed patients' frowns improves mood. These are dramatic findings that suggest that facial expressions, rather neurotransmitters in the brain could be the driving force behind our emotions. The idea of inhibiting negative facial expressions as an antidepressant is radically different to any other intervention currently available.

The observed effects of Botox seem to make a case for and against. How about you? Does Botox affect your mood and relationships?