Tag Archives: values

The lost art of joy – Something to do

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“So, what do you do?”

I don’t like that question. We all ask it as a relatively benign conversation starter, but it still makes me cringe a little. It’s not that I’m not proud of what I do, but so often the moment I tell people that I’m a doctor, they assume that I’m rich or pretentious, or that they suddenly have a segue to some free medical advice.
“Oh, you’re a doctor hey? Pleased to meet you … so, uh, can you have a quick look at this mole on my neck?”

It’s interesting that we treat someone’s occupation as the second most important thing to know about them after their name, and it shows how subliminally important our occupations are to us.

And I think that’s largely to do with the personal and social value of purpose.

It’s starts from childhood doesn’t it? “When I grow up, I want to be …”

“I want to do nothing with my life” said no kindergarten child ever. Our subject choices in through high school, and out decisions after high school, to go to University or join the military, or taking a job in a trade, come down to what we want to do, to what we want to be. We all want to be someone, to do something. We all aspire to a life of meaning through purpose, because deep down, having a life which makes a difference is much more rewarding to us than having a life than means nothing.

Happiness is someone to love like we discussed yesterday, but happiness is also something to do.

It’s well known that long-term unemployment is associated with poorer physical and mental health outcomes including increased stress and isolation, depression and anxiety, heart disease and a myriad of other illnesses.

By contrast, according to research done at Deakin University, engaging in activities that provided a sense of purpose was strongly associated with wellbeing. It could be paid employment although in order to increase wellbeing, the employment had to provide more than just financial security. However, any activity that provided purpose tended to increase wellbeing, such as volunteering or being a part of a club like Rotary.

Knowing what we know about joy, it’s easy to see why engaging in activities which give purpose to life also increases our joy. Like having someone to love, having something to do that provides purpose usually involves committed action to our values, incorporating psychological flexibility, kindness, giving, moving, learning laughing … the list goes on.

There are several keys to ensuring that what we do is truly purposeful, and thus provides the greatest opportunity for joy to flourish

First, “It’s not about you.” This was the first sentence in Rick Warren’s phenomenally successful book, “Forty Days of Purpose”. True purpose in life goes beyond our needs and aims to fulfil the needs of others. This is a reflection of the true interdependency of the human race. We’re social creatures by design. We can survive independently, but we thrive collectively. We’re at our most successful when we’re dependent on each other and we work together. If we focus only on ourselves and our own needs, we fail to connect with others, and we miss out on the benefits of living in community.

Second, your purpose is inseparable from your values. As we’ve talked about several times in the last month, our values are integral to living a life rich in meaning and joy. Values reflect what is most important in the deepest part of ourselves that we can access. Our values provide us with direction. If our true purpose is going to enrich our lives and enhance our joy, then it will always be built on and synchronised with our deepest values. If your purpose and your values don’t align, then you need to reconsider either or both.

There are lots of other interesting and insightful explorations of purpose in the blogosphere but I don’t want to be over-prescriptive about it. Our own individual purpose in life is as unique to use as our fingerprints. So long as we commit the best of ourselves to being part of something bigger than ourselves.

Or as George Bernard Shaw wrote, “This is the true joy in life, the being used for a purpose recognized by yourself as a mighty one; the being thoroughly worn out before you are thrown on the scrap heap; the being a force of Nature instead of a feverish selfish little clod of ailments and grievances complaining that the world will not devote itself to making you happy.”

The lost art of joy – Someone to love

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In 1939, a doctor at Harvard University initiated a research study into long term health and happiness. He recruited 268 physically and mentally healthy young men who were all in their second year of study at Harvard University, including one John F. Kennedy, who went on to become US President. As the story goes, as part of the recruitment process, “the men who were chosen for the study had what the team considered a ‘masculine body build’: significant muscle mass, narrow hips and broad shoulders. The study participants were asked about masturbation and their thoughts on premarital sex. They were also measured for brow ridge, moles, penis function and the hanging length of their scrotum.”

As it turns out, the hanging length of one’s scrotum isn’t a significant factor in one’s long term health and happiness.

What is important is love.

Over the last eight decades, the study has grown to include a number of control groups, wives and children. The longer the trial has gone on, the stronger the conclusions, that “Close relationships, more than money or fame, are what keep people happy throughout their lives, the study revealed. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes.”

The short and intense forms of love are very strongly associated with happiness. Remember the study we discussed in earlier posts from George MacKerron, who mapped the correlation of happiness to activity and location of the users of his specifically designed mobile phone app? With hundreds of thousands of data points, he was able to show that people were happy when they were exercising, when they were at the theatre, ballet, or a concert; when they were at a museum or an art exhibit; and while doing an artistic activity (like painting etc.). Though at the top of his list, the greatest number of people were at their greatest level of happiness during “sexually intimate moments” (on a date, kissing, or having sex).

Of course, love is more than just a good snog, but it demonstrates that intimate connection with another person you love, and who loves you, is an intense and intoxicating source of joy.

Other research into the relationship between love and joy shows the same thing as the Harvard Study of Adult Development. The “Very Happy People” study showed that there was a 0.7 correlation between social support and happiness, which is higher than the connection between smoking and cancer. People with one or more close friendships are more likely to be happier, and those with few social connections are more likely to be depressed than those who have more social connections. People with strong and healthy relationships are less likely to feel stressed by challenging situations. Supportive marriage is a cause of happiness.

We always need to be careful in interpreting these sorts of conclusions, remembering that correlation does not equal causation – people don’t get depressed because they have no friends. Often times there are underlying factors contributing to both a persons depression and difficulty in forming solid friendships.

What we can safely say is that happiness and love are intimately connected. The deeper the social bond, the more likely there is to be happiness.

It’s also important to remember that it’s not quantity of the social connections that’s important, but the quality of the social connections. A hundred loose associates, or deep but unequal, unreciprocated relationships are not associated with happiness. Joy comes from sincere, committed love that gives as much as it receives.

Do those themes sound familiar? They are the same sort of themes that we have discussed on other blogs in this series, the same sort of things that are common to our personal search for joy – kindness, giving, honesty and acceptance, committed action to a deeper value. When you apply the same things that bring individual joy to a relationship, they also bring joy, but to more than just yourself.

And what else better sums up love, but sharing the best things in life with another person.

If you want to foster happiness, invest in quality connections with other people by sharing those same things that bring individual joy. Be thankful, be kind, be generous and be committed and there will be more than enough joy to go around.

The lost art of joy – Resolve

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When it comes to New Year’s resolutions, we’re pretty abysmal.

Not that making New Year’s resolutions is abysmal, but our ability to actually keep them is particularly poxy. It’s said that about half of us make New Year’s resolutions, but only about eight percent of us actually keep them. Eight percent … that’s a solid F minus.

New Year’s Eve inevitably brings out the mantras, affirmations and aspirations, millions upon millions of people taking to social media to express how they’re making new goals or stepping into their destiny, moving to the next level or claiming their inheritance from the universe … something like that. It’s like someone coded a random phrase generator using the twitter feeds of Tony Robbins and Deepak Chopra and pumped out a random string of meaningless drivel.

Hey, we’ve all been there. This post certainly isn’t about judging the spirit of all these mantras, affirmations and aspirations. People genuinely want to change, to improve, to have a better life … to live a life of joy and meaning.

Wishing to have a life of joy and meaning isn’t enough though. We don’t get a life of joy by just wanting one. How do we go from etherial to tangible?

One day, I would like to visit England. I want to trace my family’s roots. I want to see the world famous landmarks like Buckingham Palace, Big Ben, St Paul’s Cathedral. I want to watch the first day of an Ashes test match at Lords. I would like to attend a lecture at Cambridge. I want to see sites of wonder like Stone Henge. I want to experience the local delicacies like black pudding. I would even love to go to Ireland and drink a pint of Guinness, or to the highlands of Scotland, put on a kilt, and have a haggis.

That’s all well and good, but I’m not going to get there unless I get a passport, buy plane tickets, book hotels, book transport, get some maps, and ensure that I’m in the right place at the right time to be at Lords for the opening session of the Ashes test.

Then I actually have to get on the plane and go, and do all those things I want to do.

We all want joy – no one ever seriously says that they want a life of misery. We all have values that we aspire to fulfil. We need those values. As I’ve written about before, they provide direction to our lives. Values reflect what is most important in the deepest part of ourselves that we can access.

In order to live by those values, and to experience the richness and meaning that our values add to our lives, we have to act on them.

We have to get on the plane. We have to take effective action.

In the framework of ACT, this sort of effective action is called “Committed Action”. Committed action means connecting with individual styles of effective action, driven and guided by core values. As we talked about yesterday, things in life inevitably change, so committed action also needs to be flexible – being able to adapt to the invariable changes of life but still being driven by your underlying values.

Committed action doesn’t mean perfect execution. We are human beings and we are bound to fail, to drift off course or to run into obstacles. No matter how many times we drift away from our values, when we are committed to our values, we can always reassess where we’re at and get back to them.

The word “resolution” comes from the word “resolve”. If we want a life of joy and meaning, we need to do more than make up some New Year’s aspirations. If we’re going to have New Year’s “resolutions”, we need “resolve”, “settle or find a solution to a problem or contentious matter, decide firmly on a course of action”.

Take the next step. What’s one specific, concrete thing you can do in the next day that’s in line with your values? It doesn’t have to be complex. It can be as simple as hugging your kids every day, or calling a friend to arrange a time to catch up over lunch, or getting up ten minutes earlier to go for a short walk in the morning sunlight. Whatever it is, take that step.

If we resolve ourselves to committed action in line with our values, we will be able to translate our desire for a life of joy and meaning into actually experiencing it.

The lost art of joy – Change

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“The only thing that is constant is change” ~ Heraclitus

2017 is drawing to a close and 2018 is rapidly approaching. It always seems like such a big transition, moving from one year to the next, but when you think about it, December 31st, 2017 and January 1st, 2018 aren’t going to be that much different. Let’s face it, 11:59pm on the 31st of December is really not much different to 12:01am on January the 1st. Rationally, the transition into 2018 holds no more meaning than the transition from November 30 to December 1, or as 3:36am quietly clicks over to 3:37am. Why does the passage of time matter so much more at the stroke of midnight? 11:57pm is probably feeling a bit irked.

Change in all other parts if our lives is a bit like the movement of the clock. Every now and then, we look to see that change has happened but it’s been happening imperceptibly all around us, the state of perpetual flux.

There are always constants – the immutable sunrise and sunset, the lunar rhythm of the full moon, the soft cycle of the seasons. It’s easy to be distracted by their comforting predictability. And yet, ironically, it is these power of these cycles that creates the constant change all around us that we fail to perceive – the winds, the rain, the tides which ever change our natural world, sculpting our land and changing our oceans over eons.

Change is constant, whether it be in our natural world, in our community, or in our body. How we approach this change is a key to living a life of joy and meaning.

It’s natural to dislike change. Our brains are essentially predictive pattern recognition engines. Our brain understands our environment by using the pattern of the world it’s already learnt to make a prediction of what it thinks will happen, and then it compares that prediction to the current inflow of information. If the brain’s prediction and the inflow of information match, the brain doesn’t need to do any more work. When the brain encounters something it didn’t predict, it has to work a lot harder to process the new information and use that information to update its internal model of the world.

I don’t like to shave, because shaving takes time, energy and resources. By not shaving, I’m being much more efficient (though some would say ‘lazy’).

Our brains are like my shaving habits. The brain would much rather not have to process any extra information because that takes time, energy and resources. By not having to process any more new information, our brains are efficient. Unlike my shaving habits, which probably are born of laziness, the brain likes to conserve energy since there’s only so much fuel the body can spare for it, and the more efficient the brains processing is, the less fuel it needs.

So by keeping things fairly constant and avoiding change, the brain can just plod along rather efficiently without all the extra resources needed if it had to process constant change.

But this puts us in a bit of a bind, since change is happening anyway whether our brains want it to or not.

It becomes the immovable force versus the irresistible object. We can dig in and resist the inevitable, or we can adapt to the change.

If we dig in, if we stay static, if we fail to adapt, then it eventually costs us more in terms of energy. It creates a greater cognitive load – maybe not in the short term, but resisting change is like padding against the current … it takes a lot of work, and it’s cognitively taxing. All that energy for no actual gain, well, we’ve talked about that before in other posts.

We can’t change ‘change’, and by trying to change ‘change’, we expend huge amounts of energy to get nowhere. And it changes nothing, except for diminished motivation, volition and resistance. The futile fighting with ‘change’ makes it hard for joy to flourish, not that it stops us trying sometimes.

John C. Maxwell wrote, “Change is inevitable, growth is optional”. You can certainly keep swimming upstream if you want to, or you can accept that change can not be changed and adapt in productive ways You can channel the energy that would have otherwise gone into resisting change and put it into something that aligns with your values and helps to enhance your life of meaning, in turn helping you to grow your joy, not unwittingly sabotage it.

If you don’t want to get stuck at 11:57pm and you want to move forward into the new year, accept the inevitability of change, and take that first step of committed action in the direction of your values.

The lost art of joy – Full

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Christmas time is a time of indulgence! And by the end of Christmas day, we’re usually full of something … stuffed full of food, or perhaps a skin full of Christmas ‘spirits’. There are some opinionated family members who are full of … ah … lets just say they’re metaphorically constipated.

While it’s nice to be full of good food and good wine, and not so nice to be full of oneself, the goal of this blog series is for everyone to be full of good cheer.

Which reminds me of a story … this story has been around a while so there are a few variations out there, but this is the one I remember.

A professor once cleared off his desk and placed on top of it a few items. One of the items was a large glass jar.

He proceeded to fill up the jar with golf balls until he could fit no more. He looked at the classroom and asked his students if they agree that the jar is full. Every student agreed that the jar was full.

The professor then picked up a box of small pebbles and poured them into the jar with the golf balls. The pebbles filled all of the openings in between the golf balls. He asked the students if the jar was full? Yes, they said, of course the jar is full.

Then the professor picked up a bag of sand and poured it into the jar. The sand filled in all of the empty space left between the golf balls and pebbles. He asked the class again if the jar was full. The students couldn’t argue, the jar was very full.

Finally, the professor pulled out two beers from under his desk and poured both of them into the jar filling the empty space between the sand. The students began to laugh. This demonstration had gone a lot further than any of them were expecting.

The professor waited until the laughter stopped. “I want you to recognize that this jar represents your life,” he started. “The golf balls represent the important things. Your family, children, health, friends and passions.”

“The pebbles represent the other things in life that matter, such as your job, house and car. The sand, that’s everything else, the small stuff.”

“If you put the sand in first, there is no room for the pebbles or golf balls.”

“The same goes for life. If you spend all of your time and energy on the small stuff, you will never have room for the things that are most important. Pay attention to the important things in your life. Take care of the golf balls first, the things that really matter. The rest is just sand. You are dismissed.”

“But, what about the beer?” asked one student.

The professor smiled.

“There’s always room for a couple of beers.”

It’s an important lesson, and a very good illustration. You can have a full life, but it’s easy to become full of the stuff that doesn’t matter. When we focus on what’s important and get the balance right, when we put our values in first, we can still have a full life, but full of the things that matter to us the most.

There will always be time to clean the house or watch Netflix or take yourself shopping, but if you want to experience a Christmas, and indeed, a life of full of joy, put your values first. Enjoy time with your family. Play games with your kids. Look after those who are struggling, donate to a charity, plant trees … committed action in accordance with your values is the way to a rich and meaningful life of true joy.

And of course, there’s always time for a couple of beers 🙂

The lost art of joy – Adaptability

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A few years ago, I performed in a Christmas musical.

Thankfully, I got the part of the narrator – lots of lines to learn but no singing, because I sing like a cat with laryngitis. I was also hoping to get away without any dancing, because I dance like a dyspraxic hippo, but the director was adamant – all the cast had to participate in the closing number.

Rehearsals for the dance were somewhat embarrassing. There was me – middle-aged, sedentary, overweight and unfit – surrounded by a bunch of skinny, limber teenagers and twenty-somethings. The dance instructor would take us through the warm up and while I would be struggling to get my feet more than shoulders width apart or my fingers much past my knees, the teenage whippets would be doing the splits all the way to the ground, or bending forward with their palms on the floor. Even those who weren’t very good dancers made up for it by the fact that their body had to strength and flexibility to adapt to the moves they had to learn. My body was tight and unforgiving, and I had to work really hard to do what the flexible people did very simply.

The world is in constant motion. Every day brings new challenges as the swirling currents of our social and physical environments push and pull us in different directions. Our inner world swirls just as much, as our feelings and emotions ebb and flow, churn and whirl. The collision of the swirling oceans of our outer world and the turbulent air of our inner worlds can create rain, storms or even hurricanes of psychosocial distress. Even without the bad weather, the constantly changing social and emotional forces creates never-ending demands on our ability to cope, and the exigencies can be exhausting.

Just like those people who were physically more flexible were able to better cope with the demands of the dance number, those people who are emotionally more flexible are able to better cope with the demands of our inner and outer worlds.

Psychological flexibility is being able to adjust our short term feelings in service of our long term values. In the research, psychological flexibility actually refers to a number of dynamic processes that unfold over time, such as how a person adapts to fluctuating situational demands, reconfigures mental resources, shifts perspective, and balances competing desires, needs, and life domains.

In other words, psychologically flexibility involves travelling in the direction of your deepest values, but being in touch with the present moment so that adjustments can be made to keep you on track.

Being psychologically flexible is like turning south for a little while to compensate for the northerly breeze so you can keep sailing in the direction of your long term values.

In day to day life, being psychologically flexible means not holding too tightly to our feelings, emotions or thoughts which can change rapidly and which aren’t always reliably in service of our deeper values.

So how can we become more psychologically flexible so that we can enhance the joy that psychological flexibility encourages?

It starts with knowing what your values are, and moving towards them.

We also need to work on acceptance, allowing our feelings and emotions, as strong and as distressing as they are at times, to ebb and flow as they do without rigidly fighting against them or trying to suppress them.

In order to build our capacity to cope with changing situational demands, we also need to “stretch” our mental “muscles” like I needed to stretch my physical muscles to be able to dance better. To become more mentally limber,
1. Learn something new every day, even if it’s something small
2. Do something differently, even if it’s a small change, but don’t always stick to the same routine
3. Do different things, things that you may not have done before. Again, doesn’t have to be much, but try a different coffee order, or a new meal at a restaurant. Listen to some new music.
4. Challenge yourself. Just a little bit every day. It’s ok to be a little bit mentally uncomfortable. Stretching is good for you!

As you continue to grow more psychological flexible, you will open yourself to new and greater experiences of joy.

The lost art of joy – Regret

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I took my son to see the latest Star Wars movie, “The Last Jedi” this afternoon. Don’t worry, no spoilers here. I don’t want to ruin the enjoyment for anyone.

What I can say is that one of the strong themes of the movie was regret. In this movie, Luke Skywalker, the hero of the original Star Wars trilogy, was in self-imposed exile, hiding physically and ‘spiritually’ (from the power of the force), because of the choices he made.

Everyone has regrets, the ‘what could have been’ … the one who got away, the job you could have had, the fight you wish you hadn’t, the investment you didn’t make or possibly the one you did. Like death and taxes, whether big or small, we all collect some regrets as we walk along life’s path.

Regret isn’t necessarily bad, it can be an opportunity to move forward into joy if it’s handled the right way. If regret is eventually going to lead to joy, then it has to spur us on to make adaptive changes. It’s learning from our mistakes. We might realise how we have been too busy to spend our time according to what’s valuable for us, or not given enough, or not looked after ourself enough, and we resolve to eat better, work less, or give more to others. There are so many different examples of how joy can come from acting mindfully and adaptively on our feelings of regret.

But sometimes regret becomes overwhelming, where instead of riding the wave of regret to power us forward, it dumps over the top of us and we are swamped by it’s deluge. They can sometimes merge into an overall feeling of being wrong or bad, it may cause paralysis because you mourn what you could have or should have done, and can’t seem to make a better decision going forward.

If any good, if any joy, is going to come from those experiences we may be regretting, then we have to grab our surfboard. Remember:
1. It’s ok to fail. Failure is inevitable. Without it, there can be no success. What’s done is done.
2. Make lemonade. Learning from what happened takes the lemons that you’re stuck with and makes them into something better.
3. Keep looking forward. Once you stop looking to the past mistakes, you can start focussing on future opportunities
4. Be mindful. Engage in the present moment to enhance your current joy.
5. Be values driven. You’re much less likely to regret decisions that you make if they are based on your values. But if things don’t go according to plan, you can always go back to step 1.

It’s that committed action to our values that ultimately enhances our joy, now and in the future.

The lost art of joy – Values

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“Wait … what are you doing?”

There’s a deep part of our consciousness that acts as our inner emergency brake. You know, when you’re about to call your boss a jerk, or drunk text someone, or post something narky on social media, there’s that little voice inside your head that says, “Uh, do you really think that’s a good idea?”

Thankful most of us don’t end up drunk-texting our boss and would never let ourselves get in a position to do so. Still, it’s a good idea every now and then to reevaluate our general day-to-day decisions, our routines and patterns, to say to ourselves, “Wait … what are you doing?”

Yesterday we talked about the Serenity Prayer – “grace to accept with serenity the things that cannot be changed, Courage to change the things which should be changed, and the Wisdom to distinguish the one from the other”. We talked about acceptance – accepting the things we can not change because fighting with things we can’t change wastes our energy and gets us nowhere. We can also waste a lot of energy and not get to where we want to go by using all our energy going to the wrong place – either we drift on autopilot, doing what we’ve always done because, you know, it’s what we’ve always done, or we can deliberately set sail in the wrong direction, thinking that we’re doing the right thing.

One way that we can build our joy is to live rich and meaningful lives in service of our values. In knowing our values, we can know ourselves, and engage in life in its fullness. ’Values’ can mean different things to different people, but in the Acceptance and Commitment framework, values refer to “Leading principles that can guide us and motivate us as we move through life”, “Our heart’s deepest desires: how we want to be, what we want to stand for and how we want to relate to the world around us.”

Values help define us, and living by our values is an ongoing process that never really reaches an end. Living according to your values is like sailing due west. No matter how far you travel, there is always further west you can go. While travelling west, there will be stops along the way, stopovers along our direction of travel like islands or reefs. These are like our goals in life.

The difference between goals and values is important. You could set yourself a whole list of different goals, and achieve every one of them, but not necessarily find meaning or fulfilment if they all go against the underlying values that you have. So goals are empty and unfulfilling if they aren’t undergirded by your deeper values.

How can you understand your values? There are a couple of ways. Ask yourself: “What do I find myself really passionate about? What things irk me? If I could do anything I wanted, and money was no object, what would I do?” Is there a recurrent theme running through your answers?

There are other ways to discover what your values are. Some people have suggested writing your own eulogy (the speech someone gives about you at your funeral). It sounds a bit morbid, and it’s only a figurative exercise, but it tends to sharply clarify what you want your life to be like. What do you want your legacy to be? Think about the things that you want to be known for at the end of your life, and see if there’s a word that best describes those desires.

Understanding our values can help us to navigate the seasonal madness without becoming overwhelmed. When you understand what’s truly important to you, it’s much easier to focus on what’s really important and say no to the things that aren’t. For example, Your boss invites you to exclusive Christmas drinks are her house, with some of the regional executives. It’s on at the same time as the Christmas Carols concert your sister is performing in. If your core values are career success, then the choice is easy. If you know your values are family first, then the choice is easy. You can make the choice that will bring you the most joy, and enrich your life.

So before the malaise of merriment takes hold, say to yourself, “Wait … what are you doing?” Ensure that what you’re doing is aligned with your deepest values to maximise your joy this Christmas season, and beyond.

But I’m normally a rational person …

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She shifted uncomfortably in her seat, her uneasy hands fidgeting together, her eyes flitting around as she tried to focus on the wall across from her, unable to find a target for her empty gaze.

“But … I’m normally a rational person,” she said, finally putting words to the thought that had been evading her for half a minute.

She was a woman in her mid thirties, with a comfortable job, a family and a mortgage in the suburbs.  We were halfway through a standard GP consult, and we had already discussed and resolved something trivial before she finally plucked up the courage to change tack and reveal the hidden agenda she’d hoped to discuss all along.

“I’m anxious all the time.  I try so hard, but I can’t seem to stop thinking about all the things that could go wrong.”

I empathised.  I’ve been there too – I’ve lived through times when my anxiety disorder was so debilitating that I wouldn’t call someone on the phone for fear of dialling the wrong number.  Or when I was so depressed that I couldn’t see anything positive for the future, when nearly every thought I had was saturated with moribund darkness.

I was anxious as a teenager, but I was depressed as an adult.  I’d been through medical school and I had attained by GP fellowship when my depression took hold.  During the four years or so that I spent with the black dog, I was constantly haunted by the same narrative that now haunted my patient … “I’m a rational person, why am I thinking like this?”

The fact I had fellowship level medical training intensified my mental self-flagellation, “I know all about depression.  I understand CBT.  I know I’m ruminating on catastrophic thoughts.  So why can’t I stop them?  If only I could think more positively, I’d be so much better.”

I found myself in a self-defeating spiral, often called the struggle switch, where I thought I knew how to climb out of my psychological mire, but all I achieved in trying to climb out was to sink further in, making me feel more defeated, even more of a failure.  It was a very difficult time which I thought would never end.

Eventually it lifted, like a heavy fog thinning in the morning sunlight, but it certainly wasn’t the result of anything clever I did.  So why did my rational brain keep filling my mind with irrational thoughts?

The answer lay in a paradigm shift away from the long held beliefs that we were taught at medical school and in our general practice training.  We’ve been lead to believe for so many years that our thoughts were the key driver of our behaviour, but it turns out that it’s actually the other way around, our behaviour is but one of a number of key driver of our thoughts.

The foundation of CBT is the notion that challenging maladaptive thoughts helps to empower behavioural change.  Except that research suggests that cognitive therapy specifically targeting problem thoughts offers no extra improvement over behavioural therapy alone.

Herbert and Forman confirm this when they point out that, “proponents of behavioral activation point to the results of component control studies of CT, in which behavioral activation or exposure alone is compared to behavioral activation (or exposure) plus cognitive restructuring. The majority of these studies have failed to demonstrate incremental effects of cognitive restructuring strategies.” [1]

This fact has been further confirmed by a number of meta-analyses [2] and by a large randomised controlled trial comparing behavioural therapy and cognitive therapy side by side with medication for depression [3].

So therapies aimed at fixing thinking works equally as well as therapies aimed only at promoting therapeutic action.  However, when thinking therapies are added to behaviour therapies, they add no extra benefit over and above the behaviour therapies alone [2].  This suggests that action is the driver of the therapeutic effects of psychological therapy.  If thinking were the driving force of psychological change, the addition of cognitive therapy to behaviour therapy should have an incremental effect.

That cognitive therapy works equally well as behavioural therapy may be related to their fundamental similarities. Dobson et al explains, “Behavioural Activation is implemented in a manner that is intended to both teach coping skills and to reduce future risk. The same is true for Cognitive Therapy, which adds an emphasis on cognitive change, but otherwise takes a similar skills-training approach.” [3]  In other words, cognitive behavioural therapy is just behavioural therapy with bling.

Herbert and Forman summarise it nicely, “The ideas that thoughts and beliefs lead directly to feelings and behavior, and that to change one’s maladaptive behavior and subjective sense of well-being one must first change one’s cognitions, are central themes of Western folk psychology.  We encourage friends to ‘look on the bright side’ of difficult situations in order to improve their distress. We seek to cultivate ‘positive attitudes’ in our children in the belief that this will lead to better academic or athletic performance. Traditional cognitively-oriented models of CBT (e.g., CT, stress inoculation training, and rational emotive behavior therapy) build on these culturally sanctioned ideas by describing causal effects of cognitions on affect and behavior, and by interventions targeting distorted, dysfunctional, or otherwise maladaptive cognitions.” [1]

I understand this is going to ruffle some feathers, and not everyone is going to be keen to dispense with CBT just yet, but I hope this gets us thinking about thinking at the very least.

For me, coming to an understanding that my thoughts were just the dashboard and not the engine helped me to pay less attention to them and to focus my healing energies on what was really important, taking values based action rather than just fighting with my stream of thoughts.

And it’s helped me to empathise differently with my patients and reassure them that you can still be a rational person even if your thoughts don’t always seem to follow suit.

References
[1]       Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[2]       Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[3]       Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.


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Seven Elements of Good Mental Health: 1. Temet Nosce – The Prospering Soul

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Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

1. Temet nosce – “Know thyself”

Generally speaking, there are two ways that a person can live their lives, as a boat or as a buoy – those who set out to find life or to let life find them.

Some people are quite content to be buoys – to stay in the same place and let the social currents and tides bring different elements to them. They’re more passive in their approach, content to just accept that life will just come and go as it will.

Then there are those who don’t want to stay in the one place, but want to chart their own course, discover what life is for themselves. Whose to say what’s best for each individual person? We all have our own choices to make.

For those people who are boats, who want to set their course and discover life, it helps a lot in the journey to know where you’re going.

This may seem obvious enough. In fact, it seems too obvious – we often think we know where we’re going when in reality, we haven’t a clue where we really want to go or how to get there.

For starters, it helps to know where you want to go. Some of us are gifted with an amazing confidence, self-assurance and motivation, and have the ten year plan all mapped out, but those people are the minority. It’s fine if we don’t know where exactly we want to go, but what would help every since person is to at least know the direction you wish to sail in, which are our values.

The word ‘values’ can mean different things to different people, but in the Acceptance and Commitment framework, values refer to “Leading principles that can guide us and motivate us as we move through life”, “Our heart’s deepest desires: how we want to be, what we want to stand for and how we want to relate to the world around us.” [1] Values help define us, and living by our values is an ongoing process that never really reaches an end. Living according to your values is like sailing due west. No matter how far you travel, there is always further west you can go. While travelling west, there will be stops a long the way, stop-overs along our direction of travel like islands or reefs. These are like our goals in life.

The difference between goals and values is important. You could set yourself a whole list of different goals, and achieve every one of them, but not necessarily find meaning or fulfilment in their accomplishment if they’re all against the underlying values that you have. So goals are empty and unfulfilling if they aren’t undergirded by your deeper values.

How can you understand your values? There are a couple of ways. Ask yourself: “What do I find myself really passionate about? What things irk me? If I could do anything I wanted, and money was no object, what would I do?” Is there a recurrent theme running through your answers? I have always found myself irritated by mass-marketing, and more recently by disingenuous social media memes and unscientific health messages. The theme – ‘truth’. I know, it sounds a bit trite, like some second-rate comic book hero, but I’ve mulled over this a lot, and for me, ‘truth’ is one of my deepest values.

There are other ways to discover what your values are. Some people have suggested writing your own eulogy (the speech someone gives about you at your funeral). It sounds a bit morbid, and it’s only a figurative exercise, but it tends to sharply clarify what you want your life to be like. What do you want your legacy to be? Think about the things that you want to be known for at the end of your life, and see if there is a word that best describes those desires.

If that’s a bit too confronting, there are some on-line tools that can also give you an idea. There is only so much a long list of questions can discover about you, but results of the survey can provide a starting point for further thought. There is a couple of free resources that may be helpful (though you will have to register):
* https://www.authentichappiness.sas.upenn.edu – and click on the drop-down menu in the “Questionnaires” section, and select “Brief strengths test”
* http://www.viacharacter.org/Survey/Account/Register

One final note on the buoys and the boats – whether you’re a buoy or a boat, you’re still going to encounter large waves, strong currents, and wild storms, as well as peaceful weather. As a buoy, those adverse conditions will simply find you where you are. You can’t escape from them. You’re also going to experience those same large waves, strong currents and wild storms as a boat. The difference is that buoys have no choice but to ride out the adverse conditions. Boats, on the other hand, can use the power of the difficult circumstances to power them to their destinations if they can harness them correctly. Boats can’t outrun bad weather all the time. Adversity is inevitable. Happiness, contentment, enlightenment, or whatever you’re seeking, isn’t found in avoiding or controlling our adverse circumstances, but about learning how to follow our values in the midst of the calm weather or the wild.

As Christians, one of our primary values is our love for God and our desire to follow Jesus. Scripture teaches that each of us has our own unique path to follow. Ephesians 2:10, “For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.” ‘Workmanship’ in the Greek is ‘poiema’ from which we get our English word ‘poem’. We are not a meaningless jumble of letters that makes no sense. We are a beautifully crafted blend of rhythm, harmony and meaning. You are a sonnet from the mouth of God. I believe that our individual purpose stems from our common purpose and values, like leaves are dependant on the branches, trunk and roots of the tree. I heard a brilliant summary of the purpose of the Christian life, which was simply “To know Christ, and to make Christ known.” I believe that it’s from this common value, shared by all Christians, that our direction in life stems from.

In knowing our values, we can know ourselves, and engage in life in it’s fullness.

References

[1]        Harris R. The happiness trap : how to stop struggling and start living. Boston: Trumpeter, 2008.