How we integrate or make sense of our experiences have a lot to do with how they affect us. That's just common sense. However, the drive within psychology towards a research and evidence based practice standards has led to a move away from seeking the consensus of practicing professionals in the field on the formation of theory. A theory informed practice has been the standard for many years. Experts construct a theory based on their professional knowledge, including research. The theory is then tested based on the defined concrete references of the theory, called operational definitions. This is a very common approach to theory construction. For example, testing the theory that the planets orbit the sun, one mathematically works out where each planet should be at some set time in the future based on the theory. When they are found there, that provides one study supporting the criterian validity of the theory that the the planets orbit the sun.

The problem is that psychological constructs are notoriously defined differently by different researchers, and there is little consensus on a grand theory that attempts to explain human behavior. Instead there are a number of theories that have been developed that accounts for behavior based on the thoughts that occur before the behaviors. Research has shown that behavior can change when thoughts about that behavior change. This has been replicated many times. Cognitive behavior therapy is the model in the psychology that enjoys the largest following. But this theory does not explain all or even most behavior, nor does in fit with some of the more common beliefs and assumptions about human behavior.

If changing one's thinking were all that was necessary to change behavior, then more people would be successful with New Year's resolutions. Most people will tell you of their dismal success breaking old habits in the New Year. Throughout 2007, one study tracked over 3000 people attempting to achieve a range of resolutions, including losing weight, visiting the gym, quitting smoking, and drinking less. At the start of the study, 52% of participants were confident of success. One year later, only 12% actually achieved their goal.

Another problem with Cognitive Behavior Theory (CBT) is that it assumes that emotions are just an another form of behavior caused by thoughts. In some cases this may be true. In generally healthy people, emotional issues may well respond to changes in thoughts. But it's clear that Post Traumatic Stress Disorder (PTSD) is largely an emotional disorder, where manifestations have incomplete connections to thoughts. CBT is not the treatment of choice. Some form of exposure therapy is widely used to essentially break the pattern of emotionally driven habitual behavior or extinguish the conditioned emotional responses to thoughts, feelings and external stimulation associated with the trauma. If you experience that memory and it's emotions in a safe setting and recognize that your fears were not realized, then the memory is changed with the addition of this new information. This sort of change is incremental. Such learning may need to be repeated several times the intensity of the emotion subsides to acceptable levels.

Other clinicians see a more profound version of PTSD in combat veterans.

Throughout history, warriors have been confronted with moral and ethical challenges and modern unconventional and guerilla wars amplify these challenges. Potentially morally injurious events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally,

Image by Getty Images via @daylife

psychologically, behaviorally, spiritually, and socially (what we label as moral injury). Although there has been some research on the consequences of unnecessary acts of violence in war zones, the lasting impact of morally injurious experience in war remains chiefly unaddressed. To stimulate a critical examination of moral injury, we review the available literature, define terms, and offer a working conceptual framework and a set of intervention strategies designed to repair moral injury. (Litz et al., 2009)

Georgetown University ethics professor Nancy Sherman heard stories of moral trauma when she interviewed veterans of Iraq, Afghanistan, Vietnam and World War II for her 2010 book, The Untold War. "It might be where you felt you should have been able to do more for your buddies, but you couldn't, or because you simply survived," she says.

"Regret," she writes, "doesn't begin to capture what the soldiers I talked with feel. It doesn't capture the despair or depth of the feeling -- the awful weight of self-indictment and the need to make moral repair in order to be allowed back into the community in which he feels he has somehow jeopardized his standing." (Silver, 2011)

This is not a new idea, but rather repackaging of a well documented feature of all trauma, and not just trauma related to combat. Themes of shame and guilt pervade the PTSD literature, often referred to as complicating factors.

Studies suggest that those who interpret a traumatic experience as intensely negative are more at risk for posttraumatic distress and disorder than those who view the event as less traumatic. Specifically, a woman's reaction at the time of her victimization is likely to be an important predictor of her later psychological state. (Briere & Jordan, 2004)

Certainly conceiving of a victim's behavior during a traumatic event as transgressions of deeply held moral beliefs and expectations would qualify as a particularly negative interpretation of the event and thus predict a more difficult recovery. She is also more likely to develop a shame-based view of herself based on the conclusion that she has demonstrated a moral defect reflected in her behavior. In my clinical work, I've seen this phenomena in traumatization caused by crime victimization, particularly rape, in natural disasters, such as hurricaine Katrina and the Northridge earthquake in Oakland, Ca, as well as combat trauma from Iraq, Afghanistan and Vietnam. The complicating factor of shameful beliefs about personal responsibility when others are injured is a prominent feature in people struggling with a difficult recovery.

This new conceptualization of moral injury may come in a useful form, one that is easily understood by the client and destigmatizing in the sense that a "mental health" problem is consistent with cultural norms. In addition, the authors further the theory of PTSD and its notorious resistance to treatment. The shame of a moral injury leads the sufferer to withdraw from social contact even with close confidants, under the assumption that if she doesn't hide their shameful behavior, others will know and find her disgusting and worthy of rejection. This prevents the natural healing process of sharing and reexperiencing the trauma with the support of a loved one. The expression of love and acceptance despite their shameful behavior becomes part of the emotional memory and gradually attenuates the shame as well as the intrusive memories, nightmares and flashbacks. The authors note that self esteem has been found to mediate between belief that the world is just and in the willingness to self forgive Therefore, self-esteem may be an protective factor from moral injury. The authors also note that PTSD as well as moral injury involve healthy feelings. The affliction of a moral injury is in part a believe that the sufferer is not worthy of self-forgiveness. (Litz et al., 2009)

Litz et al., (2009) outlines a model they call a "modified CBT" approach. They describe eight components: 1. A strong working alliance. 2. Educating about the concept of moral injury and preparing a plan for change. 3. a "hot-cognitive" exposure based processing or emotion focused self-disclosure. 4. A thorough examination of the implications of this experience on the sufferers concept of self and other cognitive schemas. 5. An imaginal dialogue with a benevolent moral authority (such as a grandparent or pastor) about the target behavior and implications for the future. 6. Fostering self-forgiveness and reconnection to the community. 7. An assessment of goals and values moving forward.

I've found it particularly effective to treat PTSD complicated by shame in a group setting, where the many components often become a natural process of the group's cohesion and mutual support. When other group members who suffer from post trauma symptoms share their story of how they believed they had personal responsibility that resulted in another's injury, it's much easier for the sufferer to see other's over reactions and offer support and validation. This helps them recognize their own exaggerated self-blame and begin the process of self-forgiveness, a kind of "opposite action" treatment.

References

• Briere, J. (2002). Treating adult survivors of severe childhood abuse and neglect: Further development of an integrative model. In L. Berliner, J. Briere, C. T. Hendrix, T. Reid, & C. Jenny (Eds.), The APSAC handbook on child maltreatment; 2nd Edition., Briere (2002) (pp. 1-26). Newbury Park; CA: Sage Publications.
• Briere, J., & Jordan, C. E. (2004). Violence against women: Outcome complexity and implications. Journal Of Interpersonal Violence, 199(11), 1252-1276.
• Litz, B., Stein, N., Delaney, E., Lebowitz, L., Nash, W., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy Clinical Psychology Review, 29 (8), 695-706 DOI: 10.1016/j.cpr.2009.07.003
• Silver, D. (2011, September 3). Beyond PTSD: Soldiers Have Injured Souls. Truthout. Retrieved from http://www.truth-out.org/beyond-ptsd-soldiers-have-injured-souls/1315066215

I'm going to try to write more short posts rather than work on a big paper for months before I post.

There is a lot of hype about Facebook causing depression citing research. Actually, if you look, you will find the research had nothing to do with Facebook.

It all started with this article writing on this research article where the author rather loosely used the term "Facebook depression". There is of course no such thing as Facebook depression. The author submits her disclaimer here.

All the more reason to read about research in the media with considerable skepticism. Here is a past article I wrote on the topic.

There is reason to be concerned about spending long hours doing anything, including Facebook and the Internet, that could contribute to the development of depression. The causes are much more complex.

Reference 

This is the eighth in a series of articles about emotional intelligence for personal growth.

Emotions give our experiences a sort of color, a dimension of experience very different from other senses, different from even thoughts. Yet many of us find our emotions at times more of an enemy than a friend. Our emotions serve a purpose, one that is not entirely obvious.

Most current theories of emotion share the assumption that emotions serve an adaptive function in human life. Emotions play an important role in how we appraise and prepare to act on current circumstances. There are instances when emotions seem to interfere with what we do. The simplest examples are of anxiety reactions to public speaking, climbing ladders, or spiders. 'Emotion regulation' is a popular way of describing a solution to this problem.

Gross (2002) attributes the roots of the study of emotion regulation to Freud's early psychoanalytic theorizing about the nature of psychological defenses and Lazarus' stress and coping tradition. He describes two forms of emotion regulation. Reappraisal involves changing how we think about a situation in order to decrease its emotional impact. Suppression involves inhibiting ongoing emotion-expressive behavior. The method of reappraisal involves reinterpreting the emotional trigger into something less provocative. Suppression involves catching the reaction after it begins and containing it's consequential behavior.

However, this is a rather simplistic description of a complex process. The very act of suppressing the target emotion evokes more emotions. An emotional response that invites suppression might evoke embarrassment at the intensity of the reaction, fear about the consequences of inadvertent expression, and shame about not having learned from similar experiences in the past. Cognitive reappraisal is strategy that can be useful to head off a response, but is possibly even more useful as a method to review the experience after the emotion has been contained. It seems to me that there are few examples I can think of that don't involve both strategies more or less working together.

Gross & Levenson (1993, 1997) notes that expressive suppression can lead to decreased emotion expression, but interestingly, the body seems to feel the emotion even more intensely as reflected in increased sympathetic activation. Emotional suppression reduced memory for details emotional events, while reappraisal had no effects on memory.

Reappraisal may be related to relabeling and sublimination. Relabeling involves a cognitive reassignment of meaning that changes the qualitative emotional response, perhaps even it's valence. Sublimination is the directing of emotionally based response tendencies (motivation) into constructive problem solving responses that address the situation that elicited the emotion. Relabeling may play an important role in sublimination by redirecting energy into a more productive direction, presumably making it even more directable. Relabeling a suppressed emotion and subliiminating the motivation into a constructive response allows greater adaptive potential, memory, and interpersonal functioning.

Gross (2002) argues that suppression--as a response-focused strategy-- acts comparatively late in the regulation process. Thus, the emotion is already underway and thus the energy implied in the sympathic activation is no longer available to be redirected. The decreasing in expressive behavior has some side effects in terms of cognitive (impaired memory) and physiological costs (increased sympathetic activation). Suppression does not diminish negative emotions. In contrast, reappraisal theoretically takes effect before the emotion response tendencies have been triggered leading to fewer behavioral and experiential signs of emotion without increasing physiological responses or impairing memory. However, it's hard to imagine that a person could have perceived the emotional trigger and selected an alternative interpretation without experiencing the emotion. Emotional processes is known to be much quicker than the more methodical and step by step rational process (Kahneman, 2003). I think it's reasonable to assume some suppression is required to enable the time to reappraise, then the emotion is redirected into it's alternative conceptual context. Since reappraisal is known to decrease emotional activation, one must assume that the energy is redirected somewhere in a way that prevents most sympathetic activation. Redirecting the energy into motivation towards a constructive solution (sublimination) seems a likely explanation. Sublimination may well be regular part of the reappraisal process.

Gross and John (2003) found that the habitual use of both strategies is uncorrelated. That might be explained by a conscious or pre-conscious choice. Suppressing an emotion might be a decision distinct from brief suppression followed by reappraisal and sublimination. Perhaps suppression is used because an obvious reappraisal strategy is unavailable or the person has an underdeveloped reappraisal skill. One has to wonder what happens to the energy. Invitably, the emotional activation will be expressed cognitively. Strong activation requires an explanation. If there is none, then feelings of helplessness and anxiety can spiral into being overwhelmed quickly. Few people will have the ability to supress the emotion with denial, but anger and blame towards some external source might head off a spiraling cycle of anxiety and helplessness. One would expect that such unspoken expression of emotions to be incomplete, even unsatisfying, and create an expectation of more negative outcomes. This would appear to be a largely maladaptive strategy.

Gross and Thompson (2007) describe emotion regulation as one of four types of affect regulation. "Coping" is solely focused on decreasing negative affect across greater periods of time and multiple instances. They define mood as a global more persistent set of affect than an emotion and it's regulation as a means to manage the experience and action tendencies it may evoke. Emotion refers to one single meaningful event. It's regulation is focused on managing the experience and behavior tendency (motivation) it evokes evokes.

They describe five families of emotion regulation.

Situation selection involves planning to minimize any possible distracting or destructive emotions, by taking actions that make the desired outcome more likely. This is an important method used by parents during the life of a young child. A parent might recall a previous fantasy play at home with a toy doctor's bag to explain and distract the child during a visit to the doctor.

Situation modification involves quick actions that change the situation to one in which the outcome is more favorable. Very little planning is involved, though the skill might be developed by practicing and role playing. Supportive and empathetic responses to children's expression of emotion lead to more effective coping. Angry, denigrating, or dismissive responses undermine emotion regulation. An example might include bringing a book or activity to use during a waiting room period.

Attentional deployment involves directing one's attention within a given situation such as distraction, concentration, leaving, refocusing. This is probably how people suppress thoughts. Trying not to think about something is usually an exercise in futility. Replacing the thought with something incompatible is pretty effective. At least some cognitive restructuring is an example of attentional deployment. For example, you can refocus on past successes in solving problems when stuck with a current one. A glass is half-full, rather than half-empty.

Cognitive change involves altering the emotional significance of the appraisal by changing the meaning or changing one's capacity to manage the emotion. Cultural differences in socialization may play heavily on this skill, it's flexibility and effectiveness. Deciding that someone's inattentiveness caused them to bump into you, rather than a deliberate attempt to disrupt what you were doing would be an example of alternating the emotional significance of the event.

Response modification is the method that is used after the situation is perceived and a response is initiating. This method involves influencing the physiological, experiential, or behavior responding as directly as possible. Drugs, exercise, relaxation, alcohol, cigarettes, medication, and food have been used this way. You can also modify how the thoughts and emotions are expressed. An important consideration is the situational context impacts the meaning of how the emotion is expressed and the consequences of the expression. For example, appropriate expression is different at home than it is at the work place or even in the grocery store.

Most techniques of emotion regulation seem to assume that emotion is a distraction or a nuisance that needs to be managed or suppressed. Someone who has frequented this blog would be aware that the function of emotion is a common topic. Emotions have a purpose, otherwise we wouldn't have them. They have served humanity for a long time, apparently quite effectively. What's new is that we are actively second guessing their influence on our thinking.

Ayn Rand asserts unequivocally:

Your only choice is whether you define your philosophy by a conscious, rational, disciplined process of thought and scrupulously logical deliberation - or let your subconscious accumulate a junk heap of unwarranted conclusions, false generalizations, undefined contradictions, undigested slogans, unidentified wishes, doubts and fears, thrown together by chance, but integrated by your subconscious into a kind of mongrel philosophy and fused into a single, solid weight: self-doubt, like a bail and chain in the place where your mind's wings should have grown...

I think everyone would agree that emotions can distort our decisions if we are not aware of their impact. However, I challenge the assumption that we can reason logically. Certainly, we can structure our reasoning to be as logical as possible, but a self aware person will note that the logical conclusion is often in conflict with the personal preference.

Barrett, et al., (2001) describes a study that supports affect-as-information and emotional intelligence perspective.

According to that perspective, specific emotional states have more adaptive value than global affective states, in part, because ... emotions are typically associated with a causal object, whereas global affective states are not. Identification of the source of an emotional state has important consequences. ...emotion differentiation is correlated with emotion regulation.

.... Emotional intelligence is broadly defined as the ability to perceive emotions in self and other, to reflectively regulate emotions, and to access and generate emotional experiences to inform adaptation.... Those individuals with the ability to distinguish among negative emotional states and subsequently regulate their emotions may prove more ''emotionally intelligent'' than those who have less differentiated emotion representations. [Italics are mine.]

With practice, we can learn to influence but perhaps not totally control which emotions we have and how we experience and express them. We can act early in the emotion generation process or we can aim at modifying emotional response tendencies once they have already been triggered.

The purpose of emotion is to "inform adaptation". Emotions have evolved in the context of social relationships and serve as another avenue of exchange of information between and about people and relationships. Emotions reach beyond the logic of the situation to assess the risk in a social encounter and to communicate the nature of the relationship with the other person.

Rottenberg, J., & Gross, J. J. (2003) notes that its very difficult to operationally define 'excessive sadness', or any other emotional excess or disturbance because of the need to integrate a considerable amount of contextual information into research formulations. Excessive sadness about loss of a loved one is not the same as the sadness that comes from being overlooked for recognition. Defining excessive emotion seems a futile endeavor. It would be more fruitful to ask what is it about this episode of sadness appear excessive. Sobbing at work is hardly the same as doing so in the privacy of home. But observing sobbing at work, you still can't describe the sadness as excessive without inquiring as to what the sadness was about.

From Dare To Dream blog:

Our motivations are largely emotionally driven. Negative emotions push us to face and act on those things that make us most uncomfortable. Positive emotions allow us to enjoy success and give us energy to meet new challenges. But negative emotions inspire us to make changes.

Misery is perhaps the most creative force in our lives. Seldom do we make major changes in our lives without considerable emotional pain. Each negative emotion comes complete with an intuitive guide to action. Anger pushes us to stand up for ourselves and speak up when we've been treated with disrespect. Fear makes us hyper-vigilant to potential danger and readies us to duck or run away if needed. Sadness makes us review over and over again what we've lost. That ruminative search is for the knowledge to compensate for our loss [as well as reassess its meaning and purpose. Ultimately, such learning leads us with the wisdom to understand our lives from a new perspective and make our actions more adaptive.] Guilt reminds us of our responsibility in the errors we make and motivates us to work to understand our mistakes and learn how to avoid repeating them.

Emotions are made to be understood by experiencing them, by sitting with them for a time so as to make some sense of them. By trace emotions to their origins you can come to understand what they might mean for you today. That will enable you to make a reasoned decision about what should be done. As hard as it is to sit with a profoundly negative emotion, you will find that emotion an amazingly creative force for change.

Emotion regulation is learned in infancy when the child attunes with his mother. When attuned,

the infant is learning a number of very useful things: (1) that expressing her feelings can bring about positive outcomes--which generates positive feelings about the self and others; (2) that she can have impact on others -- which generates a dawning sense of agency or self-initiative; and (3) gradually, that particular affects elicit particular reactions-- which helps her begin to differentiate and eventually name her feelings. (Fonagy el., 2002 as referenced in Wallin, 2007).

The essence of mothering is providing a holding environment where empathy and devotion offer a supportive relationship for her child's growth. The quality of maternal attention, or attunement, was a key factor in determining how infants thrived. The "good-enough mother" is a mother who is able to adequately attune to her infant's needs and abilities despite the complex and always changing processes of growth and adaptation. In the natural process of infant care, misattunement and reattunement occurs regularly. Within the attachment relationship, the secure mother, at an intuitive, nonconscious level, is continuously regulating the infant's shifting arousal levels. Attachment can be defined as the dyadic regulation of emotion. And thus, emotional expression serves to stimulate a dyadic exchange within the attachment relationship that results in corrective and informative regulation. By being exposed to the primary caregiver's fluxuating attunement, the infant learns an expanding adaptive ability to evaluate on a moment-to-moment basis stressful changes in the external environment. Over time, this exchange with his mother allows infant to form coherent responses to future stressors and prepares him for future relationships. (Dales & Jerry, 2008)

Research in psychotherapy provides us with validation with the common sense notions of what makes a good approach to relationships: acceptance, permissiveness, warmth, respect, nonjudgmentalism, honesty, genuineness, and empathy or empathic understanding. Maintaining long term relationship require similar attunement and repair reminiscent of a mother and her infant.

Other research in psychotherapy has found complex positive emtions are experienced in the aftermath of the processing of intensely painful emotion and are highly correlated with positive outcome. Such "positive emotions may not only appear as a result of successful processing of negative emotions but be an integral, and perhaps overlooked part of modulating and deepening this processing." Presumably, such deepening and repair of attunment would enhance and deepen the relationship. Perhaps this is what is often observed when "kissing and making up" after a conflict.

For adults, as well as children, the amplification and regulation of these positive states by a caring other are critically important to the self's ongoing development, the discovery of new capacities, and the healing of old wounds. (Russell & Fosha, 2008).

Moreover, the regulation of otherwise overwhelming emotional intensity is vital in promoting the required depth of emotional processing. Finally emotion regulation involves not only the restraint of emotion, but at times its maintenance and enhancement (i.e., down- vs. up-regulation) (Greenberg and Pascual-Leone 2006, pp 616-617).

Clearly emotion is much more complex than a problem to eliminate or at least contain. Humans by their very nature are in capable of the cultural ideal of rational thought. Emotional expression is the core of our expression in relationships and evokes a response from the other that helps refine possible responses. Effective communication cannot occur without the emotional referents that define and structure mutual expectations and possible responses. Our awareness of this process is critical to learning effective relationship communication, boundaries, and building a support network. The key to learning how to express ourselves is understanding our emotions and using them to formulate a reasonable response based on an intuitive melding of emotion and rational thought, what Marsha Linehan (1993) elloquently calls "wise mind."

References

Dales, S., & Jerry, P. (2008). Attachment, Affect Regulation and Mutual Synchrony in Adult Psychotherapy. American Journal Of Psychotherapy, 62(3), 283-312.
Egloff, B., Schmukle, S. C., Burns, L. R., & Schwerdtfeger, A. (2006). Spontaneous Emotion Regulation During Evaluated Speaking Tasks: Associations with Negative Affect, Anxiety Expression, Memory, and Physiological Responding. Emotion, Egloff et al (2006), 6(3), 356-366
Barrett, L. F., Gross, J., Christensen, T. C., & Benvenuto, M. (2001). Knowing what you're feeling and knowing what to do about it: Mapping the relation between emotion differentiation and emotion regulation. Cognition And Emotion, 15(6), 713-724. doi:10.1080/0269993014300023
Greenberg, L. S., & Pascual-Leone, A. (2006). Emotion in Psychotherapy: A Practice-Friendly Research Review. Journal Of Clinical Psychology, Greenberg and Pascual-Leone (2006), 62(5), 611-630.
GROSS, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences Psychophysiology, 39 DOI: 10.1017.S0048577201393198
Gross & Levenson (1993, 1997) cited in Gross, J. (Ed.). (2007) Gross, J. J., & Thompson, R. A. (2007). Emotion Regulation: Conceptual Foundations. In Gross (2007).
Gross, J. (Ed.). (2007). Handbook of Emotion Regulation (2009 paperback ed.). New York: The Guilford Press.
Kahneman, D. (2003). A Perspective on Judgment and Choice - Mapping Bounded Rationality. American Psychologist, 58(9), 697-720. doi:10.1037/0003-066X.58.9.697
Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Linehan 1993. New York: The Guildford Press.
Rand, A. (n.d.). Philosophy, Emotion and Reason from the Objectivist Philosophy of Ayn Rand. Retrieved November 11, 2008, from http://www.skysite.org/philo.html#link
Rottenberg, J., & Gross, J. J. (2003). When Emotion Goes Wrong: Realizing the Promise of Affective Science. Clinical Psychology: Science And Practice, 10(2), 227-232.
Russell, E., & Fosha, D. (2008). Transformational Affects and Core State in AEDP: The Emergence and Consolidation of Joy, Hope, Gratitude, and Confidence in (the Solid Goodness of) the Self. Journal of Psychotherapy Integration, 18(2), 167-190. doi:10.1037/1053-0479.18.2.167
Wallin, D. J. (2007). Attachment in Psychotherapy. New York: The Guildford Press.

Related articles

• Emotional Intelligence for Personal Growth - Part I (blog.davemsw.com)
• Mindfulness - Emotional Intelligence for Personal Growth Part II (blog.davemsw.com)
• Self-Awareness - Emotional Intelligence For Personal Growth Part III (blog.davemsw.com)
• Self-Knowledge - Emotional Intelligence For Personal Growth Part IV (blog.davemsw.com)
• The Essence of Human Experience: What is Normal? Emotional Intelligence for Personal Growth, Part V (blog.davemsw.com)
• The Two Darts of Suffering: Pain is Inevitable, Suffering is Voluntary Emotional Intelligence for Personal Growth, Part VI (blog.davemsw.com)

• Gazing in the Looking Glass without Self-punishment - Emotional Intelligence for Personal Growth Part VII

• One of the best methods of emotion regulation: Teach your kids young to reframe (westallen.typepad.com)

• IDENTIFYING Emotions (Part 1) (acoarecovery.wordpress.com)
• Distract yourself or think it over? Two ways to deal with negative emotions (scienceblog.com)
• Cognitive Appraisal Theory - Understanding our emotions in a crisis or disaster (fsomle.com)
• Social and Emotional Learning and Bullying Prevention (education.com)
• The Channels of Emotion: Not (Just) in the Face! (psych-your-mind.blogspot.com)
• Emotion hot spots in our brain - modern phrenology (mindblog.dericbownds.net)
• The dark side of emotion in decision making. (mindblog.dericbownds.net)

by Ronald Ruden, MD, PhD

When the Past Is Always Present: Emotional Traumatization, Causes, and Cures introduces a new treatment for trauma. Ronald A. Ruden is an internal medicine physician practicing in Manhattan. Since beginning his practice in 1983, he has dedicated part of the proceeds to follow research interests. His first efforts resulted in the book, The Craving Brain, a neurobiological discussion of addictive behaviors. In 2003 he redirected his interest in understanding traumatization. That has led to three publications in Traumatology, edited by Charles Figley, and to this book.

The book begins with an easy to understand review of the neurobiological and neuropsychological literature as it relates to trauma. His intent is to provide a primer that a lay person could understand. He still provides adequate citations for those who have deeper interests.

Ruden believes that the means to treat Post Traumatic Stress Disorder (PTSD) is to use the senses. This idea, which is at the core of the theory of psychosensory therapy, forms what the author considers the "third pillar" of trauma treatment. The first and second pillars refer to psychotherapy and psychopharmacology. The theory of psychosensory therapy postulates that sensory input, for example, touch "creates extrasensory activity that alters brain function and the way we respond to stimuli". In other words, new sensory input can change memories and their power over us.

"...the human brain can change it's own structure and function with thought and experience, turning on its own genes to change its circuitry, reorganize itself and change its operation, is the most important alteration in our understanding of the brain in 400 years." (Norman Doidge, MD pXVII in Ruden, 2011)

This process of brain modification is called neuro-platisticity. Evidence of this concept has begun a revolution in thinking about the brain. No longer can one assume that brain damage creates an impermeable barrier to recovery. The point is we can change how well our brain functions if we work at it. If we neglect our brain, it will deteriorate before it's time. Yoga, mindfulness, meditation, and exercise enhance resilience. Resilience is associated with high self-esteem, good emotion regulation skills, optimism, healthy relationships, and an active problem solving response. When you believing you can meet your needs, you feel self-contained, like your world can be managed, you can respond to challenges and can readily find help if you need it. Vulnerability is increased by putting aside your needs to care for others, low self-esteem, difficulty in regulating the intensity and duration of emotions, obsessive-compulsive traits, introversion or being very shy, being anxiety prone, substance abuse, poverty and low education.

"In early life, when the limbic system has not completely formed (the hippocampus is not yet functional), highly emotional moments that occur become stored in a separate memory system called procedural [or implicit] memory.... The cognitive component of the event is not stored...." (Ruden, 2011, p24)

When a child experiences trauma, the emotional memory is stored in a part of the brain not easily accessed by our thoughts, our conscious mind. But the memory is there ready to be triggered some event that reminds you of the traumatic memory. You may not even understand why you feel the intense emotions which will add to your confusion and anguish. Chronic release of stress chemicals by repeated triggered panic, changes the landscape of the brain producing self-defeating behavior and thinking, stress related disease, and vulnerability to further traumatization. Retraumatization may be related to repetition compulsion, a homeostatic driven need to heal. If you seek mastery over a situation without new skills to ensure success, the memory is triggered without the healing sense of safe haven, increasing the compulsion to seek mastery. Subconsciously, you may reenact the trauma by repeatedly exposing yourself to a similar trauma.

The second idea presented in this book is that traumatization is encoded into the implicit memory only under special circumstances. Traumatic memories are formed by an emotion-producing event with significant meaning to the individual, the brain must be appropriately primed to acute stress, and the event must be perceived as inescapable. (Ruden, 2011, p47) Encoding is completed at high norepinepherine and dopamine levels, while the prefrontal cortex is shut down. (Ruden, 2011, p59) Ruden insists the trauma must be perceived as inescapable for encoding as a traumatic memory. Feeling trapped, unable to escape takes the prefrontal cortex is taken off line, and we are unable to plan or think. (Ruden, 2011, p47-49) In my clinical experience, feeling trapped, responsible, and in some part to blame for the outcome also appears to play an important role in the development of PTSD.

"The third idea is that traumatization occurs because we cannot find a haven during the event. This is the cornerstone of havening, the particular form of psychosensory therapy described in the book. Using evolutionary biological principles and recently published neuroscientific studies, this book outlines in detail how havening touch de-links the emotional experience from a trauma, essentially making it just an ordinary memory. Once done, the event no longer causes distress." (Yaffe & Ruden Medical Associates)

Ruden's proposed treatment provides another method to unlearn these emotional reactions and retrieve a sense of mastery and safety after a traumatizing experience. Ruden's approach and other sensory-based techniques, are exposure based, a method that has extensive research support. Ruden's claims that animal research supports the notion that bilateral stimulation enhances healing is at best weakly supported by the studies cited.

Rasolkhani-Kalhorn & Harper (2006) appears to be Ruden's primary reference. The authors of this article acknowledge the limitations of the research support for their theory. They use anecdotal research evidence from animal studies to suggest that Eye-movement Desensitization and Reprocessing therapy (EMDR) and other psychosensory therapies, work by stimulating part of the brain to decouple the emotion from the memory. Those studies use fMRI, a scanning technique that can detect brain activity, and other methods. The idea is where there is brain activity when a person is doing something, identifies what parts of the brain are involved. However, every scan shows a lot of activity that is not understood and only some that is thought to be related. The method doesn't prove causation, only a relationship of co-occurance in time or correlation. There is no direct evidence that this correlation in animal brains will translate to human brains. There are real structural differences between humans and animals. So the research results at best only suggest that bilateral stimulation might be related to decoupling emotion from memories.

Ruden's theory is a bit different. When a traumatic event is recalled or reenacted while the survivor is in safe haven, the trauma-induced linkages are disrupted and the emotional response is subsides or is eliminated. According to Behavior Theory, a well research and widely accepted model, a conditioned emotional response is said to "extinguish" when it is repeatedly stimulated when the person feels safe. But Ruden's theory goes much further. He believes that as little as one exposure to to Havening can decouple the memory. Once the traumatic memory is brought into working memory, if it's dislodged before activation, the triggering stimulus is disconnected from the response. The treatment is to create an escape from the memory of trauma. His method of dislodging the memory from working memory involves mental distraction and caressing arms, shoulders, face and tapping rythmically and bilaterally on each shoulder.

However, there is many confounding factors at work in both EMDR and Havening. Besides the exposure process, a proven technique, is built into both methods. Touch effects provides comfort, sensuality, relaxation. Massage therapy has been shown to enhance attentiveness, alleviates depressive symptoms, reduces pain, improves immune function. Cortisol secretion, a hormone that is part of the bodies stress reaction, is diminished. Dopamine and serotonin, pleasure related brain chemicals, are increased. Norepinephrine, a stress chemical is decreased. These are all related to an enhance sense of calm while exposed to the traumatic memory.

Anestis (2009a, 2009b) reviews the literature on EMDR and finds no evidence that it works any better than exposure. From my clinical experience, I've seen many times a one time telling of the story of trauma, another exposure method, resulted in a dramatic decrease in symptoms.

I too have experienced an immediate response from a single administration of totally different treatment technique while in training for hypnotherapy. At age 10, I was in a house struck by lightning. No one was injured, but there were several things that happened that heightened the traumatic impact of the event. I watched one leg of the lightning arc strike a tree outside the window. I knew a loud crash was imminent. I jumped none-the-less at the uncharacteristic "crack" rather than the usual "rumble" of thunder. At about the same moment, the radio behind my head shorted out with a loud pop and started smoking!

Years later, another therapist-in-training and I were paired to attempt a hypnotic regression. I helped direct the therapist trainee by bringing my therapist self of that day, back to comfort my 10 year old self in that memory. From that day until today, despite having lots of experience with lightning since, I have what I consider an unhealthy lack of fear. I have to consciously remind myself to avoid unsafe actions in a storm!

Ruden provides what I think is another explanation for why psychosensory therapies may work for some in as little as a single exposure.

"...the extrasensory response to sensory input [is what] effects change in psychosensory therapy. In the psychsensory therapy havening, touch produces change. It is not the simple act of touch and the brain's concommital response that is therapeutic; it is the meaning the brain ascribes to the touch that appears to be crucial." (Ruden, 2011)

In other words, Ruden sees Havening as a particularly effective way to stimulate his clients to experience comfort and meaning.

A person with a healthy attachment is best suited to respond to supportive comfort from another and will quickly find the meaning implied and benefit immediately. Like most treatment techniques, the overall health of the client is a critical aspect of the outcome. Healthy people get better faster and with less effort. The more resilient factors noted above, that a person has, one would presume they would either not develop PTSD, or be most likely to respond immediately to treatment. Unfortunately, Ruden does not report differences in clients responses based on client characteristics. So his report that a single treatment sometimes works sounds sensational, but is not anything other than an expected outcome from an exposure based method.

Despite the disappointment I experienced with the discovery that Havening offers really nothing new, I enjoyed the book. It's a worthwhile read for it's easy to follow and understand review of the literature. He is a good writer.

References:

Anestis, M. (2009a, June 18). Eye movement desensitization and reprocessing (EMDR): What is it and does it work? Psychotherapy Brown Bag. Retrieved December 31, 2010, from here.
Anestis, M. (2009b, October 23). EMDR: Do bi-lateral eye movements actually add anything to treatment? Psychotherapy Brown Bag. Retrieved December 31, 2010, from here.
Rasolkhani-Kalhorn, T., & Harper, M. (2006). EMDR and Low Frequency Stimulation of the Brain Traumatology, 12 (1), 9-24 DOI: 10.1177/153476560601200102
Ruden, R. (2011). When the Past is Always Present Psychosocial Stress Series. Routledge ISBN: 978-0-415-87564-6
Yaffe & Ruden Medical Associates. (n.d.). Dr. Ruden's Books. Yaffe & Ruden Medical Associates.. Retrieved January 20, 2011, from here.

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This is the sixth in a series of articles about emotional intelligence for personal growth. In keeping with the idea that emotional intelligence is one of the foundational concepts of mental health, I dedicate this installment to May, Mental Health Month.

It is often said that life is suffering. Some of that suffering is unavoidable. Life has a way of throwing us adversity. The pain of physical distress and illness as well as the psychological pain of loss is unavoidable. This is the first "Dart" and might be called pain. Pain serves an adaptive function in human life and allows us to appraise our experience and prepare to act in ways to maintain favorable conditions or to change unfavorable conditions (Egloff et al., 2006). Positive emotions encourage us to maintain that which evoked our pleasure. Negative emotions motivate us to avoid or solve the problem that triggered the pain.

Much of our suffering after the initial pain is voluntary. How we react to things, how we talk or think about our experiences often complicates and prolongs the pain. This is the second "Dart". Second darts often trigger more second darts through feelings and thoughts about one's first reaction. For example, you feel guilty about your anger about the first dart. Or perhaps you feel sad about having been hurt again. (Hanson & Mendius, 2009).

The concepts of the two darts of suffering come from the "Pall Canon", one of the earliest teachings of Buddha.

There is a further distinction implied in the metaphor of the Two Darts: that reaction and response are distinctly different modes of behavior, the former a pattern rooted in clinging [to reality as it is] and the latter a spontaneous meeting of phenomena free from impatience and judgment. The first dart refers to the ability to be present with what is arising, unfolding, and passing away in present experience. The second dart is characterized not just by fight or flight, but by the entire self-constructing mechanism of the mind.... Whenever there is clinging, there is a story about "me" that arises from one's reaction to what is occurring in that moment. (Thera, 1983)

Pain signals an abrupt change in our environment, one we at least initially do not like. The pain, in a way, represents the reality we cling to being ripped from our grasp. We then perceive a sense of loss, that slows and focuses our thoughts, prolongs the experience and allows us to mourn and make sense of what's happened to us. What we learn from our losses builds our skills of coping with loss. As we age, the frequency of loss accelerates. Our children grow up and move away, grandchildren grow and no longer need the attention of the grandparents. Our friends and older family members die off ever more frequently. If we fail to master the painful process of grief, it will threaten our mental health with a mind numbing depression, increase the stress on our internal organs, shorten our lives and perhaps threaten our very existence (Goleman, 1995).

How we react to our experiences, how we think and feel about them, largely determines how we extract understanding and meaning from them and how they are recorded in memory. All of the thoughts and memories are recorded in bits and pieces that amount to little more than a skeleton of the actual event. Each time we re-experience this memory, it's recreated from the remaining memory traces, and our more recent experiences fill in the detail. The experience of old distress in the presence of new information, permanently changes the memory, adding the new information. However, without our intervention, the overall structure of the memory and it's accompanied emotions will see little change.

This process of recreation allows us an opportunity to change memory permanently. Our experience over time and the support of those around use who are wiser in this regard, can teach us about this experience us, allowing us to modify the experience and direct how the memory is changed (Hanson & Mendius, 2009).

We have many ways we manage our emotions. Two have been widely investigated: expressive suppression and cognitive reappraisal (see Gross, 2002, for an overview). Expressive suppression is a reactive emotion regulation strategy: It aims at inhibiting ongoing emotion-expressive behavior. Cognitive reappraisal, in contrast, is a planned strategy: It aims at changing how we think about a situation such that the resulting emotional response is modified, e.g., by construing the event as a challenge rather than as a threat (Lazarus & Alfert, 1964). In a typical loss situation, we have both strategies available to us. It's probably best if we suppress some rather dramatic expressions of our pain, lest we scare those around us, damage our relationships or our belongings and distract us to the challenge before us. Shock immediately and sadness subsequently manage our reactions. The shock we feel immediately gives us time when we "know" what has happened to us, yet we are not feeling the emotional effects yet. Presumably, we have a bit more judgment to prepare for a prolonged period of impaired judgment. When we are sad, the perception of time and our reaction times slow. Our grief dominates our experience so much that it is difficult to think of anything else. We find ourselves repeatedly re-appraising about our loss, its consequences, and its implications.

This process is a necessary part of grief. We must feel the distress, experience the emotional arousal as a bodily felt experience, accept and tolerate it as a necessary part of integration and resolution. We must also understand that experience as information, explore, reflect on, and make sense of it, and access other internal and external emotional resources to help transform it to something less distressing. This processing of our experience creates a new perspective reflecting acceptance, making sense of difficult and painful events and creates wisdom in the form of future flexibility and mindful adaptability.

An individual's capacity for emotional processing is not an inherent skill. We learn this skill in the process of early attachment experiences. The more secure the attachment, the more effective our ability to tolerate, understand, integrate, and transform an emotional experience into a new perspective that enables us to better cope with the future. Even if we've not had a healthy attachment in childhood, we are able to acquire that skill as an adult in healthy adult relationships, such as a transformative relationship with a counselor (Greenberg and Pascual-Leone, 2006, pp 614-615).

After we have dealt with the initial pain and begun the process of grief, we will experience other less adaptive emotions. These secondary emotions are at best distracting, at worst maladaptive and may need to be regulated. For example, feeling hopeless can be secondary when there is an suppressed feeling of anger. Maladaptive emotions obstruct and the process of grief and can leave the person feeling stuck, often hopeless, helpless, and in despair. These emotions are inevitably a part of grief adding detail and texture to the assessment of our loss and the envisioning of our future. But they also add to the stress and can prolong the experience without appropriate regulation.

Regulation of emotion essentially involves gaining some psychological distance from overwhelming feelings such as despair and hopelessness, in the short term, and developing self-soothing capacities to calm and comfort core anxieties and humiliation, in the longer term. When one feels a maladaptive emotion such as core shame or a feeling of shaky vulnerability and self-doubt, one benefits from regulation in order to prevent becoming overwhelmed by those emotions, thereby creating the opportunity to make sense of them. Forms of meditative practice, mindfulness and self-acceptance are often very helpful in gaining a working distance from overwhelming core emotions.

Mindfulness treatments have been shown to be effective in treating generalized anxiety disorders and panic, and chronic pain and in preventing relapse. Mindfulness allows for flexibility in affective meaning processes and the interruption of automatic, habitual processes. In short, acknowledging, allowing, and tolerating emotion are important aspects of helping to regulate it. Soothing of emotion can be provided reflexively within one's self or with the help of another person. Among other processes, self-soothing involves diaphragmatic breathing, relaxation, development of self-empathy and compassion, and self-talk. Soothing also occurs interpersonally in the form of another's empathic attunement to one's affect and through acceptance and validation by another person. Internal security develops through the feeling that one exists in the mind and heart of the other, and the security of being able to soothe the self develops by internalization of the soothing functions of the protective other (Greenberg and Pascual-Leone 2006, pp 616-617).

And from David Wallin:

...suffering is largely a psychological construction that is largely unconsciously self-generated. Embedding in our experience, we are victims to our own self-constructions. Mindfulness lifts us out of embeddedness and gives us the perspective to see our self-constructions as separate from our selves and our environment. Mindfulness is:

• Non-conceptual. Awareness without absorption in our thought processes.
• Present-centered. Always in the present moment. Thoughts about our experience are one step removed from the present moment.
• Non-judgmental. Awareness cannot occur freely if we want it to be different than it is.
• Intentional. Attention is directed, returning attention to the present moment gives mindful awareness continuity over time.
• Participant observation. Mindfulness is not detached witnessing, but rather experiencing the mind and body more intimately without immersion.
• Nonverbal. The experience cannot be captures in words, because awareness occurs before words can arise.
• Exploratory. Mindful awareness allows investigating subtler levels of perception.
• Liberating. Every moment of mindful awareness provides freedom from conditioned suffering. (Germer et al., 2005)

Mindfulness fosters integration of the social-emotional right brain and the interpreting left brain. Feelings can be informed by thought and thought by feelings. By repeatedly becoming aware of awareness, we shift the locus of subjectivity from representations of the self to awareness itself. Self becomes a continuous flow of aware experiences. Our reified images of self serve only to constrain the limits of potentials for understanding and growth.... Mindfulness allows us to make sense of our awareness of feelings and thoughts and offers a calm spacious meta-awareness [...as well as a perception of] centerness that makes us less vulnerable to confusing our internal experience with who we are (Wallin, D. J., 2007, p 165).

Pain is inevitable. Suffering is largely voluntary. Suffering can and must be used judiciously to improve future coping. We can minimize our suffering by emotion regulation strategies, but we must do so with care. Too little review of what happened limits our learning, too much distorts our judgment.

We are truly not the victims of our experience. While we cannot control external events, we have considerable control over our reactions, both emotional and behavioral, and significant influence on future events. That future influence is, in part, the result of our deliberate review of the source of our pain, using our suffering as part of the information reviewed, while managing the excessive emotional reactions to prevent distortion of our perceptions and conclusions. This is the essence of judgment: balancing our emotions with thoughts.

To be continued....

References

Egloff B, Schmukle SC, Burns LR, & Schwerdtfeger A (2006). Spontaneous emotion regulation during evaluated speaking tasks: associations with negative affect, anxiety expression, memory, and physiological responding. Emotion (Washington, D.C.), 6 (3), 356-66 PMID: 16938078
Germer et al., (2005) cited in Wallin, D. J. (2007). Attachment in Psychotherapy. New York: The Guildford Press, p159
Goleman, D. (1995). Emotional Intelligence. Goleman 1995. New York: Bantam Books.
Greenberg LS, & Pascual-Leone A (2006). Emotion in psychotherapy: a practice-friendly research review. Journal of clinical psychology, 62 (5), 611-30 PMID: 16523500.
Gross JJ (2002). Emotion regulation: affective, cognitive, and social consequences. Psychophysiology, 39 (3), 281-91 PMID: 12212647
Hanson, R., & Mendius, R. (2009). Buddha's Brain - The Practical Neuroscience of Happiness, Love, and Wisdom. Oakland, CA: New Harbinger Publications, Inc.
Lazarus & Alfert, 1964 cited in Egloff, B., Schmukle, S. C., Burns, L. R., & Schwerdtfeger, A. (2006). Spontaneous Emotion Regulation During Evaluated Speaking Tasks: Associations with Negative Affect, Anxiety Expression, Memory, and Physiological Responding. Emotion, Egloff et al (2006), 6(3), 356-366
Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Linehan 1993. New York: The Guildford Press.
Thera, N., (1983) cited in Stone, M. (2006, September 22). The Two Darts: meeting pain with mindfulness practice. ReVision. Retrieved April 11, 2010, from http://www.accessmylibrary.com/article-1G1-164947526/two-darts-meeting-pain.html
Wallin, D. J. (2007). Attachment in Psychotherapy. New York: The Guildford Press.

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This is the fifth in a series of articles on Emotional Intelligence for Personal Growth.

Probably all of us have asked our self from time to time if our thoughts, feelings, or behavior at any single moment is "normal". Actually, there are different answers for each one of these.

Normal behavior is, like it or not, defined by our legal, community (family, neighborhood, social group) and religious institutions. The law is enforced by our local police, and sanctioned by our courts. Religious values might be said to be collectively defined by our church going population and it's leadership. If we are observed behaving outside of legal boundaries, we may find ourselves in a court room facing a judge. If we stretch our community or religious values, we might be ostracized, and separated from the kind of support we have been reliant on through our life.

Our internal life, our thoughts and feelings, that which goes on within ourselves may be our last real privacy. And that is indeed fortunate. Our internal creativity is uncomfortably broad. We are capable of thinking and feeling most anything from time to time. Under provocation, we are capable of thinking about things we would never do. Angry enough, we may think of assault, even murder. Seeing a pretty woman, a married man might think about cheating on his wife, but never act on that thought. Shocked about a death in the family, our first thoughts may be directed at the inconvenience of disrupting out usual routine and our feelings might be closer to annoyed. Our thoughts and our feelings often contradict each other. In a real sense, we live a dual existence.

Duality

Our body speaks to us through our feelings. Messages are typically fast, automatic, effortless, associative, not available to reflection, and often emotionally charged. Messages are also governed by habit and are therefore difficult to control or modify without time and significant effort. Curiously, since the messages do not require conscious awareness, they do not cause or suffer much interference when combined with other tasks.

Our thoughts, however, are relatively slower, serial, effortful, more likely to be consciously monitored and deliberately controlled. Compared to feelings, thoughts are relatively flexible and thus change readily and can be directed by conscious or habitual rules. Because thoughts are effortful, they tend to disrupt each other. Thus monitoring mental operations for quality interferes with monitoring overt behavior. People who are occupied by a demanding mental activity are more likely to respond to another task by blurting out whatever comes to mind.

Intuitive judgments combine the function of feelings and thoughts. The perceptual system and intuitive about perceptions generate impressions of the attributes of objects. These impressions are neither voluntary nor verbally explicit. Judgments are always intentional and explicit even when they are not overtly expressed. Thus, thinking is involved in all judgments and can be reflected upon, whether they originate in impressions or in deliberate reasoning. Monitoring of intuitive judgments is normally quite lax and allows many to be expressed, including some that are erroneous (Kahneman, 2003).

We perceive reality by these two interactive, parallel processing systems.

"The rational system , a relative newcomer on the evolutionary scene, is a deliberative, verbally mediated, primarily conscious analytical system that functions by a person's understanding of conventionally established rules of logic and evidence. The experiential system, which is considered to be shared by all higher order organisms (although more complex in humans), has a much longer evolutionary history, operates in an automatic, holistic, associationistic manner, is intimately associated with the experience of affect, represents events in the form of concrete exemplars and schemas inductively derived from emotionally significant past experiences, and is able to generalize and to construct relatively complex models for organizing experience and directing behavior by the use of prototypes, metaphors, scripts, and narratives. Although the experimental system is generally adaptive in natural situations, it is often maladaptive in unnatural situations that cannot be solved on the basis of generalizations from past experience but require logical analysis and an understanding of abstract relations.

[B]ehavior is guided by the joint operation of the two systems, with their relative influence being determined by the nature of the situation and the degree of emotional involvement. Certain situations (e.g., solving mathematical problems) are readily identified as requiring analytical processing, whereas others (e.g., interpersonal behaviors) are more likely to be responded to in an automatic, experientially determined manner. Holding such situational features constant, the greater the emotional involvement, the greater the shift in the balance of influence from the rational to the experiential system (Denes-Raj & Epstein, 1994). "

One might ask, why are there two systems? Many of us have at times wished that our emotions could quiet themselves or even go away. Our culture has a bias towards logic and is suspicious of our emotional side. To quote Ayn Rand:

"A philosophic system is an integrated view of existence. As a human being, you have no choice about the fact that you need a philosophy. Your only choice is whether you define your philosophy by a conscious, rational, disciplined process of thought and scrupulously logical deliberation - or let your subconscious accumulate a junk heap of unwarranted conclusions, false generalizations, undefined contradictions, undigested slogans, unidentified wishes, doubts and fears, thrown together by chance, but integrated by your subconscious into a kind of mongrel philosophy and fused into a single, solid weight: self-doubt, like a bail and chain in the place where your mind's wings should have grown..."

Not matter how much we wish we could be logical and rational, there is a burgeoning literature that says otherwise. Our decisions are evident in our brain activity long before we are consciously aware (For example, see Libet et al., 1983 and Dennett, 2003). We have a dual system of decision making because it works. Think about it. How often to we make decisions where we have all the information we need to be absolutely sure that our logical deduction is correct? I would venture to say that being sure is limited to only our most simple and concrete decisions. Most every other decision involves weighing facts, impressions, intuitions, and feelings and making as best a decision as possible.

Phineas Gage is perhaps the most famous neurology patient of all time. After a gruesome injury in which he was impaled through his skull by a metal rod and then miraculously recovered, poor Phineas retained all the logic he ever had, but was completely unable to make a decision. He was also left without any awareness or expression of emotion (Demasio, 1994). The very act of making a decision is an emotional process. We choose our decisions among competing alternatives based not only the evidence, but what feels best to us, our "gut level" reaction.

The story behind this dual system is most evident in normal social development.

The Attachment Relationship

John Bowlby (1969/1982) is credited as the founder of Attachment Theory, based on his observations that the quality of a child's social development was largely determined by the quality of the child's relationship with her caregiver. Mary Ainsworth and Mary Main began the research that would ultimately follow children over their first 20 years of development demonstrating Bowlby's concepts to be true and elaborating that theory to account for how, as a child and adult, how freely and effectively she can think, feel, remember, and act (Ainsworth et al., 1978, Main et al., 1985 & Fonagy et al., 2002). Fonagy went on to find that a parents style of attachment before birth predicts their one year old child's attachment style. The parent's ability to mentalize strongly predicted their child's subsequent security. Perhaps most importantly, the the strength of the adult's ability to mentalize enables her to strengthen their attachment style.

"Attachment is not an end in it's self; rather it exists in order to produce a representational system that has evolved, we may presume, to aid human survival. The quality of our attachment enables us to understand, interpret, and predict the behavior of others as well as our own behavior. It is the cornerstone of social intelligence (Wallin, 2007)."

It is through attachment experiences as a child that she develops rudimentary affect regulation. In the loving care of her caregiver, the child senses that connection to others can be a source of relief, comfort, and pleasure. The child ultimately learns that she -- in expressing its full range of bodily and emotional experiences and needs -- is good, loved, accepted, and competent.

One of the more interesting parts of the process is the role of imitation, mirroring and empathy. There is growing evidence that the same brain areas involved in the execution and observation of motor actions also become active when people listen to sentences that describe the performance of human actions using hands, mouths, or legs, or when people imagine performing an action without actual movement. It would appear that the processes of motor control, mirroring, and mental simulation (or imagination) rely on shared neural circuits (van Gog et al., 2009). While a mother interacts with her child, they interact in a largely non-verbal body-based union. This process of attunement builds within her child a largely emotional communication system that becomes the foundation of intimacy in all future relationships.

"[T]hrough a kind of "social biofeedback," the child comes to associate the initially involuntary expressions of her emotions with the responses of the caregiver. That is, the infant comes to "know" that her affects are responsible for evoking the caregiver's affect-mirroring responses. Thus, in the most desirable scenario, the infant is learning a number of very useful things: (1) that expressing her feelings can bring about positive outcomes--which generates positive feelings about the self and others; (2) that she can have impact on others--which generates a dawning sense of agency or self-initiative; and (3) gradually, that particular affects elicit particular reactions-- which helps her begin to differentiate and eventually name her feelings (Fonagy et al., 2002) A relationship of secure attachment can thus be seen as a school in which we learn to effectively regulate affects not only in early childhood but throughout our lives (Wallin, 2007)"

Through the secure attachment experience, the child learns to reflect on her feelings and thoughts. Her sense of security, flexibility, and internal freedom becomes very much enhanced. Secure attachment embodies a quality of attunement and contingent responsiveness between mother and infant that is close but imperfect. By the very process of attunement, distraction and reconnection, the child learns that her own internal states are sharable and, at the same time, distinct from those of her caregiver, she recognizes herself and her caregiver as a separate persons, rather than objects. From the loss and regaining of attuned connection emerges from the discovery that the other, and the relationship itself, can survive anger and conflict, and learn to balance the needs for self-definition and relatedness. The parent must reflect on emotion, her's and her child's, so as to make sense and inform her responses. She effectively regulates her own emotions while modeling how the child can regulate hers. Raw feelings become namable and integrated in interaction with her. The child creates representations of her emotion, then the parent names those emotions through her body, feelings and finally words.

Much learning is acquired in non-verbal form while the child acquires language skills. Some learning may be stored unconsciously, for example, when thought, felt, or spoken, this information could threaten vital relationships, especially formative and traumatic experiences. The center of verbal memory, the Broca's area of brain doesn't come on-line until 18-36 months, remains a secondary process until after a child enters school and continues to mature well into adolescence. Traumatic experiences cause overwhelming emotions, which effectively shuts down Broca's area, limiting verbal learning. So much emotional learning happens after childhood during highly emotional experiences.

Explicit memory, the verbal memory of Broca's area of the brain, can be consciously retrieved and reflected upon. This memory can be readily turned into words, it is symbolic, and it's content is information and images. Implicit memory is present from birth and includes reflexes that are not learned as well as emotional learning acquired in childhood or traumatic learning at any age. It is largely nonverbal, nonsymbolic, unconscious in the sense that it can't be reflected upon. The content includes emotional reactions, patterns of behavior, and skills related to knowing how to do things without thinking. These memories cannot be recalled, but they can be recognized, for example, like deja vois. From implicit memory comes our personal style, implicit relational knowing (gut-level knowledge) and some relational expectations. Perhaps most significant to this article, implicit memory includes the internal working model of attachment. Our attachment style is often enacted without awareness, especially in non-verbal communication.

Ultimately, through our early intimate relationships, we make sense of ourselves and others in terms of a "coherent autobiographical and biographical narrative", a personal story (Wallin, 2007).

Adult Experience - Duality Integrated

We have a built in need to be around people. Our social nature has been built in for thousands of generations with genetic and biochemical support. We feel pleasure just being around people with whom we feel safe. Our social group also influences our behaviors and values. We are reminded by our knowledge of social expectations within the
Continue reading The Essence of Human Experience: What is Normal? Emotional Intelligence for Personal Growth, Part V.

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This is the fourth in a series of articles on emotional intelligence for personal growth.

Self-knowledge is something we all strive towards. But how many of us have done a complete review of our emotions and how they influence our thoughts and behavior? Most people find that pretty hard to do, especially since they struggle to put their feelings into words. We talk about "will power" as the ultimate motivation. It might surprise you to find out that motivation is really emotion.
Emotion in it's simplest form is motivation, "...each emotion offers a distinctive readiness to act; each points us in a direction that has worked well to handle the recurrent challenges of human life." (Goleman, 1995, p4) Entering a state of mindfulness or flow a person reaches "perhaps the ultimate in harnessing the emotions in the service of performance and learning. In flow, the emotions are not just contained and channeled, but positive; energized; and aligned with the task at hand." (Goleman, 1995, p90)
The skill of reading another's feelings is built on self-awareness and flow. People who have good empathy skills are better adjusted emotionally, more popular, more outgoing, and more sensitive. Childhood neglect dulls empathy. Abuse makes people hypervigilent to emotional cues. Empathy predicts intervention to prevent injury to another, certainly an important action in primitive communities.
Expressions of emotions have been found to be a cross-cultural repertoire of non-verbal emotion communication and serve essential functions in cooperative society. "...emotional communication functions to bond social groups. ...language evolved as a more efficient form of grooming and facilitates group cohesion. ...the use of clear signals to communicate intentions and motivations aids the regulation of group processes." (Waller et al 2008)
Human attributes, as important motivation, self-awareness, empathy, non-verbal communication, get little attention in education in our society. The very complexity of our current circumstances makes it our mutual interest to ensure that our community has learned as much as possible about how to understand emotions.
Psychologists have been studying cognitive bias for many years. The various biases demonstrated in these psychological experiments suggest that people will frequently fail to make rational judgments in systematic, directional ways that are predictable. How many of us understand how bias works in our lives?
Many people persistently avoid and suppress negative emotions because of how painful they are. The trouble is, the more they avoid negative emotion, the more negative experiences they have. Those who have experienced emotional excess at it's worst have been traumatized as a result. Revisiting memories of the events seems to stir up the pain all over again for no good reason.
But there is a heavy cost for avoiding emotion. The very act of making a decision and acting on it with any level of motivation depends on emotion. The kind of snap judgments we make in social situations require a finely tuned awareness of our emotional reactions. Even in decisions that allow more time for reasoning, seldom do we have sufficient factual information to make it completely rational. Instead, we have to weigh the information we have with emotional memories of similar situations and intuitions about the current situation to make our best judgment.
People who have learned to numb their emotions have impaired judgment. Their social judgments, their problem-solving and decision making are plagued by systematic error. Many report finding themselves in repeating past mistakes. Many lament that they repeatedly find themselves unsatisfactory relationships, sometimes with abusive and/or chemically dependent partners. They may not recall an error in judgment such as an event they over-looked that might have warned them of the ultimate outcome.
Understanding our emotions is critical to self-knowledge.This is often the part of ourselves we know the least about. However, our ability to read and make use of emotions has been honed over thousands of generations. Even our chimpanzee friends have a similar ability, though no where near as well developed as ours. This conceptual skill is called the "theory of mind." The term theory of mind was introduced into the scientific literature by primatologists who observed a chimpanzee's ability to understand the intentions of an actor in film clips, which enabled her to predict the actor's next move. Theory of mind is the ability to be aware of others' mental states as different from our own. We then use that knowledge to identify others' intentions, motives, beliefs, desires, and feelings in order to interpret their behavior. This is a skill we all have and use all the time. It is critical to communication, building and maintaining relationships, and for most us, our ability to make a living.
A mother, attuned to her child, responded emotionally, physically, and supportively to the child's expressed distress. The mother's theory of her child's mind allows her to anticipate the child's needs and provide for them. Her facilitative movements and empathetic facial expressions communicate her emotional and physical attunement to her child in a way that helps the child convert a felt, physical, sensory experience into a contained mental, conscious awareness of his internal experience, the warm supportive presense of his mother. That awareness enables the child to regulate his affect and distress. It enables the child to develop a sense of self different and separate from his concept of his mother. Mother, then ultimately others, come to be seen as a source of relief, comfort and pleasure. Self-expression comes to be seen as good, loved, accepted, and competent. From this basic begining, the child develops a rudimentary sense of self (Wallin, 2007).
Consciously practiced mindful self-awareness provides an opportunity for the development of a theory of mind for ourselves. Our ability to interpret others behavior utilizes a finely tuned ability to perceive not only a person's behavior, but their unspoken intent. Understanding our own behavior is not so easy. In a real sense, others can see us and interpret our intentions much better than we can. We would rather believe that we know our own minds, that we have a clear idea why we do what we do. Research says that that is often not true. There are all sorts of influences to decision of which we are unaware. Our ability to predict expected punishment is enhanced by our bodily arousal (Dolan, 2002). It would appear that a cool and reasoned state of mind is not as good at predicting punishment. Yet we make some judgments and prepare ourselves for response without any awareness (Kahneman, 2003). Well-learned goals can be activated by environmental stimuli and attendant behavioral plans can run their course without conscious awareness. People can be unknowingly enticed to either trounce an incompetent competitor or protect his self-esteem by words that that encourage acheivement or friendship (Westen, 1998).
Interpreting another's behavior is enhanced by our ability to face and observe that person. We cannot observe ourselves directly. Instead, we rely on our ability to remember our thoughts, feelings and behaviors and make inferences after the fact. There are many unconscious barriers to the accuracy of our memory of our behavior and it's context. We are naturally biased to see ourselves in the right and be suspicious of others. We must learn to correct for our natural biases in order to create a useful theory of our own mind.
There are several skills we can learn and enhance to better understand ourselves and others. Many of these skills are learned in our most cherished relationships, starting with our mothers. We need to be aware of the nature of mental states, that understanding ourselves and others is often difficult and incomplete; people can change their mental state to minimize pain, or disquise themselves. Our interpretations of others are influenced by our own internal states. Feelings often do not follow logic or reason. Mental states evolve from day to day and experience to experience. Parents are highly influential teachers of their children. Their teachings are influenced by that which they learned from their parents. What we learn as children often must be revised based on our adult experiences. Our very presence in a relationship influences the others mental states and in turn our own, often beyond our awareness (Wallin, 2007).
Self-knowledge is often difficult and painful to acquire. Our learning is most robust from a major mistake that we can acknowledge and examine unflinchingly. Healthy self-esteem enhances the accuracy of our self-examination, poor self-esteem distorts it as either positively or negatively based on our willingness to accept the truth. Prediction of our behavior and others is improved with mindful practice and experience over significant time periods.
Continued here.

References

Choi-Kain LW, & Gunderson JG (2008). Mentalization: ontogeny, assessment, and application in the treatment of borderline personality disorder. The American journal of psychiatry, 165 (9), 1127-35 PMID: 18676591

Dolan, R. (2002). Emotion, Cognition, and Behavior Science, 298 (5596), 1191-1194 DOI: 10.1126/science.1076358

Goleman, D. (1995). Emotional Intelligence. Goleman 1995. New York: Bantam Books.

Kahneman, D. (2003). A perspective on judgment and choice: Mapping bounded rationality. American Psychologist, 58 (9), 697-720 DOI: 10.1037/0003-066X.58.9.697

Waller, B., Cray, J., & Burrows, A. (2008). Selection for universal facial emotion. Emotion, 8 (3), 435-439 DOI: 10.1037/1528-3542.8.3.435

Wallin, D. J. (2007). Attachment in Psychotherapy. New York: The Guildford Press.

Westen, D. (1998). The scientific legacy of Sigmund Freud: Toward a psychodynamically informed psychological science. Psychological Bulletin, 124 (3), 333-371 DOI: 10.1037//0033-2909.124.3.333

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I caught this article at Psychcentral.com, Positive Thoughts Make Things Worse for Poor Self-Esteem . It struck me as a counter-intuitive finding for a research study. I've been helping clients build self-esteem for over 30 years and while positive thoughts is not a short road to better self-esteem, it certainly does work over the long run. I'd estimate that at least six months is required to make significant progress with self-esteem from solely refocusing on the positive, and some people require much more time. Several things jumped at me as I read the article. First of all, Dr. Grohol quoted an article from the The Economist of all places. Both articles stated the research was published in this month's Psychology Research and authored by Wood et al (2009). A review of the past three months of that journal produced no article.

So I went to the old reliable, I googled the lead author, Joanne Wood. I came up with several mentions of her at academic institutions and emailed the author for a reprint. I also found another review of the same article by Ed Yong writer for the Science Blog Not Exactly Rocket Science dated May 15th.

The next day, the article arrived in my email with a short note from the author saying it hadn't been published yet! Apparently, there have been some pre-publication prints floating about likely for publicity purposes. This is one of my pet peeves. Articles submitted to peer reviewed journals are intended to inform the academic community and allow scholarly review and comment. The object of repeated review is to ensure the research is sound and is appropriately interpreted. When it appears first in lay publications, the writers who are not scientists often inadvertently distort the interpretation of the research, as I've noted before. That really didn't happen this time. Both the Psychcentral.com and The Economist got the research mostly right. But Ed Yong did a much better job of explaining the fine points.

This time, it's the researchers that make a subtle but major error in an assumption involving an interpretation of a key measurement. Its subtle because it's endemic in our culture. It seems like everyone assumes that negative feelings are harmful. In this case, Wood et al (2009) found that their subjects who had low self-esteem, immediately reported a lower mood and self-esteem after telling themselves sixteen times they are a "lovable person." Interestingly, persons with high self-esteem report only slight, non-significant improvement in self-esteem.

I decided to do an anecdotal demonstration of the "intervention" for my own understanding. After saying to my self 16 times "I am a loveable person", I felt annoyed, a little silly, embarrassed, and was reminded of quite a few traits which make me not always so lovable. But I can't imagine how this would have any long term effect on my self-esteem either way.

An even bigger problem is one that I talked about before and called it Dust Bowl Empiricism. Researchers are so enamored with their professional activities, they demonstrate their preference for inductive research. Wood et al. reviewed all the relevant research on their topic quite satisfactorily, but then failed to do a sufficient review of related theory. In previous post, I quoted Michael Schermer, a columnist with Scientific American, who eloquently asserted that the really valuable research, the kind of research that can fairly readily be used to educate the public, "higher-order works of science that synthesize and coalesce primary sources into a unifying whole toward the purpose of testing a general theory or answering a grand question." To be fair, few researchers venture into grand theory, perhaps because of the dearth of recent reviews, and perhaps because of the few notable exceptions have been eviscerated by their colleagues for their efforts. Sigmund Freud comes to mind. I have sometimes wondered if psychology's love-hate relationship with Freud resulted in an over-emphasis on induction and de-emphasis of deduction and construct validity.

Wood et al. appears to be testing a specific intervention using Cognitive Behavior Therapy (CBT). CBT purports to change feelings by changing thoughts.

While I prefer more psychodynamic conceptualizations, lets approach this issue of negative feelings from cognitive-behavioral point of view for purposes of demonstrating how relevent theory would aide in the interpretation of research. There is conceivable explanation of low self-esteem and associated negative emotion in the concept of "conditioned emotional response" or CER. A person may learn they are not valuable or important by, for example, an invalidating experience. That invalidating experience is remembered in at least two ways, by the facts of the event and by the associated emotions. According to current understanding of neurophysiology, memories of facts and emotions are kept in different part of the brain, presumably by different methods of storage with different processes of recall. The hippocampus and medial temporal lobe are involved in verbalized memories. Emotional memories involve the amygdala.

Sufficient invalidating experiences may lead to low self-esteem. Whenever a sufferer of low self-esteem remembers an invalidating experience or experiences a new one, she is likely to remember the event and feel the emotion associated with the experience.

In the Wood et al. experiment, the lowered mood and self-esteem are experienced after a validating experience. The subject feels the emotions associated with the original invalidating experience of invalidation perhaps because the positive self-talk controdicts the perception of the subject. Wood et al. makes that point. However, what she misses is that the subject is under going extinction of the conditioned emotional response. The subject is experiencing the emotion without the triggering invalidating experience. According to the theory of Classical Conditioning, repeated exposures to the emotion without the associated invalidation will eventually weaken the conditioning. Perhaps this process is complicated by the fact that the alternative experience, validation, is a close opposite to the conditioning stimulus, triggering a strong emotional response.

In my experience, this triggering of a strong negative emotional response associated with past destructive learning without the presence of the negative stimulus actually quickens the de-conditioning. What this experience amounts to is an abreaction, an emotional re-experiencing of the past event in a supportive and nurturing environment.

One point of the research is well taken. A person with an abysmal self-esteem reading a self-help book will find herself ruminating about how wrong it is that she could be so lovable. Such a person, supported only by herself, is not receiving the necessary nurturing due to her low self-esteem. She is likely re-conditioning the CER with more invalidating self-talk.

The reviews of this article did a fair job of presenting the study. However, there is risk in presenting research to a lay audience. The well written review by Yong had unintended consequences. The comments below the article contained some anquished and angry responses:

"As a person with very low self-esteem who has been encouraged to think positively and love myself throughout my life, I can only thank Joanne Wood for publishing this study. Packaged one-size-fits-all programs promoting the personal pep talk only serve to make those people already in touch with their mediocre side more acutely aware of their non-value within society."

...and...

"And when I feel unloved by one person even i feel like no one at all loves me or values me. How can I value myself when i feel like that. and after going thru a marriage where my ex always devalued me and everything i did if he did not approve of it. being abusive, verbally, mentally, emotionally, and physically... and even tho i have come a long way past this experience, it haunts me and i feel lower then dirt. no positive self talk makes me feel better, only makes me feel worse, cuz i figure if i don't actually believe what i am saying or thinking how can it possibly be true?"

Unfortunately, some people with very low self-esteem have been reinforced in their belief that positive thinking can't help. Self-help is best read by the worried well. People with long standing issues with low self-esteem need psychotherapy. Both the authors, Wood et al., and reviewer, Yong, stated this clearly, the other two articles did not. Even so, this knowledge proved harmful to a few. I certainly do not fault the authors for this problem. Yong especially did a great job. One can't ensure everyone reads the entire article or even correctly understands it.

I believe we as professionals who write about mental health have a duty to be as clear and thorough as possible in an attempt to avoid confusion and inadvertant harm. But knowledge is powerful. Sometimes, knowledge mishandled can lead to worsening of symptoms that hopefully brings those in need to help.

Reference: Wood, J., Perunovic, W. Elaine, & Lee, J. (2009). Positive Self-Statements: Power for Some, Peril for Others Psychological Science DOI: 10.1111/j.1467-9280.2009.02370.x

Update 7/15/09: Joanne V. Wood, PhD responds to all the media hype about her research.