Psychologists, Behavioral Health and Primary Care – Oh My!

Ann Becker-Schutte, Ph.D. | Licensed Psychologist:

Can’t wait to participate in this collaboration.

Originally posted on hcldr:

behaviorchangeBlog post by Colin Hung

One of the best things about social media is meeting people with different perspectives. I am constantly amazed at all the points of view that people “see” problems. Each of us has a unique lens through which we see the world – a lens shaped by training and experience.

Dr Ann Becker-Schutte

Dr Ann Becker-Schutte

A few months ago I had the privilege to speak with Dr. Ann Becker-Schutte (a regular contributor to #hcldr, a fellow #TheWalkingGallery member and co-founder of the #InnoPsy tweetchat) and she said something that I found profound:

A lot of what primary care providers struggle with is encouraging patients to adopt new and healthier behaviors. From minor changes like  getting more sleep, losing weight and taking medication as instructed to more complex issues around substance abuse, depression and ADHD – primary care providers see it all. Helping people to make changes and…

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Celebrate the Small Wins

I’ve had bronchitis recently. I don’t know if you have ever gotten to dance with this lovely respiratory ailment, but it completely zaps you. Between the coughing and the fatigue, getting off the couch and back into my normal routine has been a major ask. Before the bronchitis, I had been working on getting more exercise, using a simple tracker to count my steps and active minutes. I was getting better at adding daily activity. I was hitting my targets more consistently.

And then I got sick. And I didn’t move for four days. When I did start to move again, my stamina was shot.

But even with the low stamina, there came a day when I managed to go from getting one blinky light on my my tracker to two. And I was thrilled. Before the bronchitis, a two-light day was a very low activity day, and I would have counted it as a loss. After the bronchitis, two lights was major progress.

I’m not telling you this because I think you really care about my activity levels. I’m telling you because it was a great reminder for me to celebrate the small wins.

It would have been easy to knock myself for that two-light day. I had been getting five lights and more, when I was healthy. Two lights was less than 40% of my total goal. There were plenty of chances to turn that moment into self-blame or self-shaming. But I made a different choice. I knew that even 40% of my total goal was way more than I had been able to achieve when I was really sick. And instead of focusing on the distance between that number and my healthy goal, I focused on the fact that I was improving, that I was headed in the right direction.

Celebrating the small wins is one of the ways that I help myself stay clear, hopeful and focused on the present moment. We don’t always get to have big wins. Those are few and far between. But we can create the chances for small wins every single day. We can shift from a habit of self-blame to a habit of celebration.

That’s my invitation to you today. Do you have a big goal that you have been struggling to reach? Has that struggle left you paralyzed and procrastinating? Then I’m inviting you to carve out one small bit of that big goal. Do that small thing. Then celebrate your win. Want to share it with us! Please do! You can find me here in the comments, on my Facebook page, or on Twitter.

Can We Take the Shame Out of Healthcare?

I’ve been in a bit of a theme recently with the worry posts, and I promise I’ll get back to that. Today’s post is completely off that track. It’s a reaction to things that I am hearing from my own clients and things that I am hearing from patient advocates online. I am hearing a lot about experiences of people feeling shamed and silenced in their healthcare experiences. This feels like a huge problem to me.

Some of our health is about our decisions. We can choose to eat healthy food, exercise regularly, participate in preventive care, manage our own diagnoses if we have them.

But not all of our health is about our decisions.

How many stories have you heard about folks who ate right, exercised, practiced prevention–and got cancer anyway? Or got rheumatoid arthritis anyway? Or experienced sudden coronary artery disease (SCAD) anyway? Because I’ve heard a lot of those stories.

The truth is, we still don’t understand all that much about how our bodies work. Yes, we understand so much more than we did fifty years ago. Or twenty years ago. Or ten years ago. But really, we are just scratching the surface of understanding what is going on in these complex systems we inhabit. We don’t know how much of health is genetic, or environmental, or decision based–not really.

We live in a culture that likes to have answers. We’re surrounded by promises that if we just use this product, or take that fitness class, we will be healthy and happy (oh, and probably thin, because we’re told that’s the only way to be healthy or happy).

Not only do we like answers, we like to have a sense of control. It is really frightening to think that you can make healthy choices, and still face serious illness. That’s not a reality that most people are comfortable with. It’s a little easier to blame serious health challenges on personal decisions. Truly, I’ve worked with folks who were told that their Type I diabetes (diagnosed before age six) was due to their dietary choices.

But not all of our health is about our decisions.

So, for a change this week, can we explore the idea that maybe health is more complicated than a single dimension? And can we look at the possibility that it is nearly impossible to shame someone into making good choices?

Can we offer compassion, connection and the kind of communication that really works toward change? Because that’s what I want in health care! How about you?

This past weekend was Mother’s Day here in the US (in case you somehow missed the onslaught of ads and social media). And what struck me on Mother’s Day is that we like to think and act as though there is one right way to approach life. On Mother’s Day, the “one right way” is to be grateful and excited. Grateful for your mom. Excited for the chance to be a mom. Except, what if:

  • I'm Blogging for Mental Health.Your mom has passed away, and you are missing her terribly.
  • You don’t have children, and you truly wanted that opportunity.
  • Your relationship with your mom or with your children is strained and difficult.
  • You’re a single parent, so there’s not really anyone to show you appreciation on Mother’s Day.
  • You’re working and don’t get the freedom to be “spoiled.”
  • You had a child who passed away, so you’re a mother with no visible children.

Those are only a few reasons why you might be having emotions that aren’t simply “grateful and excited.” This post isn’t actually about Mother’s Day.

This post is about the fact that there is no one right way to be human. There is no one right way to experience emotion. There is no one right way to cope with stress. There is no one right way to handle grief.

Out of the billions of people sharing this planet today, not a single one is entirely identical (even identical twins grow different over time). Our bodies aren’t identical. Our circumstances aren’t identical.

And yet, we often act as though there is a single correct way to cope with the challenges in life. I have lost track of how many of my clients share experiences of being told that they are “doing it wrong,” when it comes to experiencing their own feelings. I think that this messaging about how we should feel and how we should cope is truly harmful to our mental health. When you are already struggling to cope with life’s tough stuff, it can be overwhelming to be told that you aren’t doing it right. That message of judgement can damage a fragile self-image.

I believe that sometimes, healthy self-care includes feeling sad, or angry, or frustrated. Sometimes (most times) grief doesn’t disappear in a poof of smoke because you pass some imaginary time limit. Sometimes, you really are facing overwhelming things, and you need a few moments (or longer) to sort them out.

So, as we recognize National Mental Health Month this May, my hope for you is that you give yourself permission to experience your own life in your own right way. Please know that I’m not saying that all coping is equal. I’m not. Some choices lead to healthier outcomes than others (for example, you’ll probably benefit more from a walk than a bottle of vodka to manage pain). But when it comes to your feelings and how you feel them, there is no one right way.

Have you had an experience of being outside the “perceived normal” experience? Feel free to share it in the comments. If you need help finding the healthy coping choices for your unique journey, you can always connect with me.

Fear vs. Worry

Bear with me folks. Today’s topic might feel a little nit-picky to you, but I think that it’s an important one to explore. I’d love for you to think a little bit about two emotional experiences that often get mixed up together. I don’t believe that they are the same, and I hope that you (and my clients) can learn to tell the difference between them. The definitions I’m about to use are not dictionary definitions. Instead, they are my own working definitions, drawn from lots of great researchers (Brene Brown, Rick Hanson, and Robert Siegel are just a few). But for the purposes of this post, these are the definitions I’m working with:

Fear: An emotion tied into the “fight-or-flight” sympathetic nervous system, triggered by situations in which we experience emotional or physical danger.

Worry: An emotion tied into the “fight or flight” sympathetic nervous system, triggered by anticipation of things that may cause emotional or physical stress.

Now if you look at those definitions, they look a lot alike, at first glance. In fact, they start off identically. That’s because they set off the same series of responses in our bodies. They use the same neurochemical pathways.

But worry and fear are different. And we don’t treat them that way. Our language acts as though they are the same. Here’s an example: “You have nothing to fear but fear itself.” WRONG! If there is a tornado bearing down on you, or someone pointing a gun at you–you are in danger and you should be afraid.

Fear is your brain and body’s way of letting you know that you are in a dangerous situation. It is supposed to trigger your sympathetic nervous system to help you respond appropriately to danger.

Worry is a fear-mimic, which generates an endless list of possible dangers that you should prepare to be ready to respond to. Worry doesn’t keep you safe. It just drains your energy. It keeps your body in a state of high alert that is toxic. Worry actually makes it hard for you to notice real, appropriate, self-protective fear. If you are reading about tornadoes in other states, you’re not in danger from them. You don’t need to go into fight-or-flight mode. That’s a worry response.

Worry is one of the primary things that stops us from living as though it will be okay.

So I’m going to ask you to join me in an experiment this week. I’m inviting you to notice your responses and try to sort them based on these definitions. Are you responding to a current physical or emotional threat? That’s fear. Are you preparing for the possibility of some future physical or emotional threat? That’s worry. You don’t have to do anything else. Just try out how it feels to notice the differences and call them out.

Have you had worry try to masquerade as fear? Has it stopped you from living the life you want? We can challenge worry–it just takes practice.

Live As Though It Will Be Okay

The title of this post isn’t really to my credit. It is something that one of my clients brought to session, a paraphrase of something one of their friends said. But it really struck a chord with me. Let’s look at it again:

Live as though it will be okay.–Unknown

I think the reason this struck me so forcibly is that it seems as though many of us spend a great deal of our time doing precisely the opposite of what is suggested. We live as though the next disaster is bearing down on us like a freight train (or, if you live in the Midwest, like a tornado). Does this fit for you? Let’s look at a few quick questions:

  • Do you avoid doing things that you would enjoy because something might go wrong?
  • Have you ever missed an opportunity because you were so focused on how you might mess it up?
  • Do you find yourself just waiting for the next disaster?
  • Have there been moments when you were so focused on managing a crisis that hasn’t happened yet that you missed out on some of your own life?

If you answered yes to any of those questions, then you might be living as though it won’t be okay. And there are lots of reasons that we get to that space. Maybe you’ve been through a series of really difficult experiences. Maybe you’re living with a lot of pain, or medical challenge.

If that feels true for you, you aren’t necessarily doing anything wrong. You’re responding in a way that makes some degree of sense, given the circumstances.

But let me ask you a question. If you think about the hardest thing you have been through, was there any amount of worry or preparation ahead of time that could have changed that event? For most of us, the answer is no. The hardest things that I’ve been through were things that I couldn’t plan for, couldn’t prevent, and couldn’t fix. I just had to live through them.

This is my bias: If my energy, effort and time aren’t going to prevent the hard things in life, I choose to invest them in my hope for the future. [tbpquotable]I choose to live as though it will be okay.[/tbpquotable]

There isn’t anything magic about this. I am going to have difficult times again. My heart will break again. But I’m not going to give up today’s joy to try to dodge tomorrow’s sorrow.

And I’m inviting you to come along with me. What would be different in your life today if you chose to live as thought it will be okay? What would you do? What would you try? Wanna find out? I do!

Please share your experiments in the comments. And, as always, if you need help with this project, you know where to find me.

Do One Thing Different

Have you ever played with a Chinese finger trap? You know, the braided cylinder that you stick two fingers into?

What is your natural impulse when you realize that your fingers are caught in the trap?

You pull them out, of course (at least, the first time you do this). Except that in a Chinese finger trap, pulling the fingers away from one another only makes the cylinder tighter and tighter.

Now, most of us over the age of six or seven know that the trick with a Chinese finger trap is that you have do something different than your first impulse. In fact, you have to go entirely against that impulse and take the paradoxical step of pushing your trapped fingers even closer together. Only then will the trap release.

You have to do something different than you expected.

This is actually a fantastic analogy for many of the difficulties that my clients (and maybe you) face on a regular basis. Here’s how it goes:

You have a problem, and either your impulse, or social messages, or people in your circle say that to solve Problem A, you need to take Action Y. But for you, Action Y turns out to be like trying to pull your fingers out of the Chinese finger trap. It doesn’t work. It might even make Problem A a little worse.

Now, if life were simple, like a Chinese finger trap, maybe more people would decide, “Hey, even though everyone says Action Y should fix Problem A, that’s not what is happening for me. I am going to try a different action.”

But for most folks, the dialogue inside their heads sounds more like this, “I’m trying Action Y and I’m still having Problem A. But everyone says that Action Y will fix Problem A. I must be doing something wrong. Maybe I should try Action Y again, but slightly differently. Or maybe I haven’t put in enough effort. I will try Action Y again, and do it harder this time. Maybe I don’t have enough willpower. I’ll try Action Y again, and I’ll really stick with it this time.”

Does that sound familiar? Can you think of a Problem A in your life (healthy actions, good boundaries, self-care, etc)? Have you tried the same sort of solution over and over, only to be stuck with Problem A in the end? Do you beat yourself up about how you must be really screwing up if Action Y isn’t working for you? Maybe the problem isn’t you. Maybe the problem is the action.

If that sounds familiar, I’m going to invite you to try an experiment with me. Sometime in the next few days, try something different. Maybe even try something paradoxical, like pushing to free yourself from the finger trap. But don’t let your action be any version of Action Y. Make it something entirely new.

I think that things will change. Maybe only a little bit, and probably pretty slowly. But they will change.

If you have a story about getting out of one of life’s “finger traps,” please share in the comments. If you need help coming up with some possible alternative actions, just let me know!

 

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