Yesterday Ellen walked into my office looking annoyed and confused. “I don’t know what to do. Robin invited me to her wedding and I don’t want to go, but I think I should. It’s a destination wedding, a long weekend in Mexico- four days! It might be fun but I can’t afford it, and I can’t take time off from work either. But I have to go.”

“Why do you have to go?” I asked.
“Because of what happened. Her parents both died in an auto accident last year, and she will feel awful getting married without them.”
“That is tragic. Who is standing up for her?”
“Luckily, Robin has brothers and a sister, aunts, uncles and cousins- a big family, and they will all be there.”

“That’s good. Are you and Robin close friends?”
“No. But I helped her out a lot when her parents died, and I feel like I have to go. I’ve been worrying about this all week, ever since I got the invitation. I went out and charged plane tickets and bought some really nice presents right away. Maybe I can find somebody to share a hotel room so I can save some bucks. I’m really over my head financially. I just can’t afford this…..”

“You feel you have to go, even though you can’t,” I said.
“What should I do? I’m driving myself crazy.”
“Well, explain to me why you think you have to go.”
“I told you, Robin’s parents died in an accident.”
“That’s awful, but why does that mean you have to go to the wedding?”
“To make up for her parents.”
“Oh, can you?”
“Of course not. But Robin expects me to be there. What should I do?”

So there you have it. That’s the problem. Ellen wanted me to tell her what to do, but I thought it was more important for Ellen to figure this out for herself. Perhaps I’ll tell you her decision- but maybe it’s more interesting to ask you what you think about the situation she found herself in.  Difficult decisions like this have to be made by the person involved, not by the therapist. There are many answers; Ellen has to find out what is the best answer for herself. What does she really want to do? Maybe we can figure it out.

We have some clues to help with our detective work:

1. Ellen bought the tickets immediately, even though she couldn’t afford to.
2. She bought wedding presents- more than one, right away too. And she charged everything.
3. After she spent the money, she worried about going. Ellen really didn’t have the money or, equally and maybe more important, the time. She had just started a new job and had no vacation time. Her boss might not like her taking time off right away.
4. She feels like she HAS TO go. She never said she WANTED TO GO. I wondered if she was feeling guilty in her relationship with Robin. Ellen told me once that she feels like she has a charmed life- a loving family, a promising relationship, and a meaningful vocation. Robin’s life, by comparison, is far from charmed. Her parents both died young, her career is not going well. She is getting married, though. And, unlike Ellen, she has no money problems- she came into a lot of money when her parents died.  Clearly, she would rather have her parents and not the money, but a hefty financial back up is some compensation.
5. There are lots of things we all have to do; was going to the wedding a “have to”? It conflicted with Ellen’s job obligations; she was afraid her job might be in jeopardy if she just took time off. It was not easy to get this job, and she really liked it and needed it too.
6. Ellen didn’t seem very excited about Robin’s wedding. Was she envious because she wanted to get married too?
7. Ellen seemed stuck between obligation and generosity. If she really wanted to go, she would deal with the problems involved and get on with it. I know Ellen; she’s that kind of person. She sounded like she felt forced.

Generosity must come from the heart. If your head is telling you that you must, and your heart is saying otherwise, take another look at the situation.  Ellen’s body language was pinched up and uncomfortable- anxious looking. She needed to find a free place inside herself to listen deeply and find out what she really wanted to do.

There are many answers. What would you do? What do you think Ellen decided to do?

Related articles:
Part II: Should You Attend a Friend’s Wedding Even If Your Heart Says “No”?
A Picture of Lasting Love
Love Is Not Enough

You look terrific today. I love what you’re wearing. You have such a nice smile. I like the sound of your voice.

Many people would rather eat a broccoli-flavored Popsicle than be on the receiving end of a compliment. Are you one of them? How did you feel when you read the previous paragraph? Receiving compliments – and also giving them – is hard when self-esteem has been injured. Low self-esteem tells us we’re just plain not good enough. And we imagine that if we can see it, so can everyone else.

If I believe I’m a dull and boring person, I will assume that you agree with me. So if you tell me that you think I’m fun and interesting, something feels very wrong. Either you’re being nice to spare my feelings, you don’t know me very well, or you’re just plain lying to me. Any way you slice it, your compliment makes me uncomfortable! (more…)

Many people curb their nervousness with a nice glass of wine or other alcohol beverage. Whether you’re gathering the courage to socialize with people you barely know, fly on an airplane, or even if you’re just feeling worried about the future, alcohol can help loosen inhibitions and dampen self doubt and fears.  While you may feel more relaxed temporarily, using alcohol to tame your anxiety can backfire in the long run.

Immediate Effects

Even though you may be feeling calmer after the first one or two drinks, your body is processing the alcohol and the physiological effects can actually trigger feelings of anxiety. Alcohol can negatively impact blood sugar levels each time that it is consumed. Research has shown that the body responds to alcohol by increasing insulin secretion, causing low blood sugar and also impairs the body’s hormonal response that would normally be able to normalize blood sugar levels. Drinking as little as two ounces of alcohol on an empty stomach can lead to very low blood sugar levels. Low blood sugar levels can cause dizziness, confusion, weakness, nervousness, shaking and numbness, all of which can mimic the symptoms of anxiety, or even trigger an episode of anxiety.

Alcohol consumption can also cause dehydration. Alcohol is a fairly strong diuretic, meaning that the body loses water by producing an increased amount of urine. Symptoms of dehydration include dizziness, muscle weakness, lightheadedness and nausea, again, all of which can mimic symptoms of anxiety, or induce anxious reactions related to the fear of being ill.

Alcohol consumption has a sedative effect on the body. It is a drug that depresses the central nervous system. Immediate effects are a sense of euphoria, decreased inhibitions, and lessened anxiety. However, over time the chronic use of alcohol could result in tolerance, dependency, and damage to many organs of the body including the brain, liver, and heart.

Longer Term Effects

People with anxiety are up to three times more likely to have an alcohol problem or other substance abuse than those without anxiety. It takes increasingly larger amounts of alcohol to achieve the same effects, leading to alcohol dependence. Long-term alcohol use can have multiple negative effects on the body and aggravate existing anxiety.

Recent studies have shown that heavy drinking or long term drinking stresses the body and causes it to have higher levels of the stress hormone, cortisol. Cortisol is necessary in short term stress situations because it helps focus alertness and attention, but cortisol also suppresses bodily functions such as wound repair, bone growth, digestion, and reproduction. Chronically high cortisol levels therefore interfere with these important processes in the body. Alcohol use also depletes the body of vitamin B6 and folic acid, which the body needs to help cope with stress. Long-term exposure to alcohol reduces the levels of the GABA-benzodiazepine receptor in the central nervous system and reduces the brain’s ability to calm the mind and the body and cope with anxiety in the long run.

Serotonin is a chemical in the body which is needed for memory, learning, and especially for feelings of ‘wellbeing”. Drinking alcohol can temporarily boost serotonin levels, therefore making you feel happier, but in the long term, excess alcohol can actually lower serotonin levels, and therefore either causing or exacerbating depression.

In another recent study, researchers found that high anxiety levels in humans are related to a deficiency in an important protein called CREB, which is needed by the amygdala, the area of the brain where emotions are processed. The amygdala is important in calming anxious thoughts. The study results showed that drinking alcohol boosts the CREB levels in the brain and therefore lessens anxiety, which helps to explain why so many anxious people us alcohol to self-medicate. The good news is that there are other, healthier ways to naturally raise CREB levels, such as getting regular exercise and listening to music. Some antidepressants can also help raise CREB levels also.

So, even though using alcohol is an easy, short term fix for anxious feelings, you’re not doing your body or your mind any favors by self-medicating with alcohol. Learning to manage anxiety (and naturally boost your CREB levels) in healthy ways such as through exercise, music, and expressing creativity is possible.  Psychotherapy can also be very helpful. In fact, research shows that psychotherapy is usually the most effective long-term treatment for anxiety disorders. Therapy treats more than just the symptoms of anxiety. It helps you discover the underlying causes of your worries and fears.  In therapy, you’ll learn to relax, perceive and interpret situations in new, less frightening ways, and learn better coping and problem-solving skills. Through therapy, you learn the tools to overcome anxiety and how to use them effectively.

This month our Paramita, or practice on the path towards happiness, is patience. The practice of patience involves a shift in our perspective. Buddhist teacher Sylvia Boorstein says patience “…remains present as long as the mind remembers that things end…when their conditioning causes end…” Conditioning causes are the elements that are coming together in this particular place and time that are causing us stress. In other words, have patience, this too shall pass.

Stress could, in fact, be celebrated as the only opportunity we have to practice patience. Of course, our habitual tendency is to react against stress rather than greet it with enthusiasm, but that doesn’t mean it’s impossible to do so. Try it sometime.

We sometimes object to the idea of patience, as if it will make us passive patsies and “someone will get away with something” (oh, no!). Holding this attitude, we ignore the depth of harm we do in our impatience, and also misinterpret the actual practice of patience. Patience isn’t standing by while harm is done to us or to someone else. It is not about letting someone take advantage of us or abuse us. Patience is the capacity to calm the mind under stress so we can see our way clearly. In an abusive situation, for example, patience can lead us to make a plan for our safety, and come up with an exit strategy that will actually accomplish our freedom. Impatience can lead to running out of the house without clothes or money or any support at all, and where does that end up? Not in a good place, usually.

What Does Patience Have to Do with Happiness?

Patience is the antidote to anger. If we are irritated or angry or even feel violent impulses, we can actually learn to wait until the feelings pass, which they will. Anger can be difficult to work with, because it so strongly compels us to action. We often feel we will have no relief until we let it all out. In truth, we always do harm when we act out of anger, whether towards another being, a circumstance, or ourselves.

Patience comes from having confidence, born of awareness, practice, and experience that the storm will pass, and that if we ride it out, all will be well again. I recently heard a woman on the radio describing her radical approach to conflict in intimate relationships; instead of “Never go to bed angry” she suggested just going to bed, and seeing if you are still angry in the morning. Given the impermanent nature of all emotions, this approach makes sense. If there is something you can do about it, no need to get upset. If there is nothing you can do about it, there is no need to get upset.

[fat_widget_left] The therapist who changed my life in my mid-twenties used to tell me, “The reward of patience is patience.” I didn’t find that appealing in the least, and I told her so. I may have said, “So what?” or “What’s that got to do with me?” I was impatient and had no interest in slowing down. I could not conceive of any possible benefit to patience. If it was its own reward, that meant nothing to me. Twenty-five years later, I think I may have finally caught on a bit.

When I put some effort into practicing patience in one area, such as in traffic or with a person I might find irritating, then patience is more likely to arise spontaneously, without effort, when I need it most. I was on an airplane recently that had been delayed by weather. We were two hours late taking off, and most of us were going to miss our connections. The man sitting next to me was extremely fretful and frustrated and tense, and I found that I was actually quite relaxed. We chatted a bit, and I tried to cheer him up, but I could see how deeply attached he was to feeling upset. He told me he traveled a lot for business and it was just getting worse and worse. I agreed that air travel has grown pretty unpleasant for most of us, but I noted to myself that, above all, we have the experience we create for ourselves. That day I realized that my efforts to develop patience had paid off—I felt patient without even trying!

What does patience feel like? For me it is relaxing, energizing, with a clear tone, like a bell, and a view that goes on as far as the sky. Patience is the willingness to stop stirring the water of the pond we are trying to look into. Patience sets down the stick and waits for the natural clarity of the settled water to arise. (Of course, as a teacher of mine noted recently, then we can see all the junked tires, tin cans, and skeletons down there on the bottom!)

Patience is trusting our natural minds to know what to do when we stop disrupting and distorting what is actually happening in the here and now, and practice mindfulness.

Now, I eventually ended that plane trip in a miserable heap, having missed too many planes to reach my destination and having a respiratory illness that forced me to make a last-minute decision to just go home. So, patience is not the answer to everything, nor is it guaranteed to stick around all the time. What stands out in my mind is the contrast between myself and that fellow steeped in anxiety on the airplane, and the knowledge that it is possible to feel calm even when our impulses drive us strongly toward distress. The reward of patience is, in fact, patience!

Five Steps to Cultivate Patience:

• Meditate regularly, for 5, 10, or 15 minutes daily.
• Count ten breaths (yes, ten) when feeling stressed.
• Remind yourself that the other person is acting out of pain or ignorance and needs your compassion.
• Remember that this too shall pass.
• Give yourself 24 hours before you act.

What other ways can you find to practice patience?

Vulnerability is an emotion that affects individuals suffering from eating disorders in a multitude of ways. It is the opposite of being in control and a state of mind not particularly comfortable for people suffering from this mental health issue. Feeling vulnerable is an uncomfortable feeling for many of us, but even more so for individuals suffering from an eating disorder. Not feeling in control often acts as a trigger that begins the destructive cycle of disordered eating. A trigger is any input that a person receives; either from their environmental or an internal thought that creates an uncomfortable feeling.

It is important to note, for these individuals their eating disorder is what allows them to cope with emotions. As a whole, individuals suffering from an eating disorder tend to view things in black and white terms; meaning their behaviors and thoughts are either right or wrong/good or bad. This strict thinking pattern leaves little room for ambiguity. Ambiguity is not only part of being vulnerable, but also part of everyday life, so it is important to learn how to navigate through it. (more…)

It seems that most couples struggle with criticism, though some tolerate it better than others. Nevertheless, criticism of, or from, your partner will happen periodically. This post provides an alternative way to manage criticism that may help sidestep defensiveness. Here are some common options when we want to be critical of our partner:

1. Keep our mouths shut, and say nothing. Besides, we all were told that if we didn’t have anything nice to say, then don’t say anything, right? (This one probably fell in to the category of “do as I say, don’t do as I do.”)
2. Provide unvarnished criticism, regardless of the impact it may have on our partner, and ultimately on the relationship. If it leads to defensiveness, an argument, a fight, so be it, just deal with it.
3. Sugarcoat it, water it down, either because you can’t deal with your reaction to your partner’s reaction to your critical remark, or you want to protect your partner from his/her feelings that surely will arise from being criticized. (“You can’t handle the truth!”) Maybe there is an alternative, an option that satisfies both sides of a chronically thorny equation: On the one hand, how to get your point across without selling yourself out, while on the other hand lowering the odds of running in to defensiveness.

Enter the complaint. Sit alongside that of criticism, let us compare the two, see how they differ, and why it matters. A complaint is about the one complaining, and a criticism is about the other, the listener. Or, the complaint is about me, and a criticism is about you. Take a guess as to which one will usually be easier for the listener to hear: the complaint. Why? A complaint is not about the listener, and therefore tends to lower the risk of listener defensiveness.

Not only that, if I’m talking about me (instead of you) I have a much better chance of being understood. The goal of transforming a criticism into a complaint is to increase the odds of the speaker being heard and understood, while simultaneously reducing the odds of the listener being defensive. Ultimately, the goal of the process is to preserve the closeness and intimacy of the relationship.

Consider the following vignette: On long road trips, the majority of the driving is done by the same partner. One of the difficulties for the passenger is that the driver tends to speed—we’re talking about 90 mph to 95 mph versus the limit of 75 mph. They have never had an accident, nor a speeding ticket, but they are constantly bickering about the speed and the danger. The driver doesn’t understand what the “big deal” is, and the passenger doesn’t think the driver cares about the passenger.

The passenger criticizes: “You are the worst driver ever! For you, it’s all about the speed and the thrill! You have no respect for the fact that you might get us both killed!  And one of these days you will get a ticket—it’s only a matter of time! You have no respect for what it’s like being a passenger when you’re the driver! Nobody likes the way you drive!”

In this case, there is a lot of accusation, attack and judgment, while focusing on the driver/listener.

The passenger complains: “When you drive 95 mph, I feel so scared! I’m am so afraid of speed, that I literally sit in sheer terror when I look at the speedometer, and when I see us pass other cars at what feels like warp speed! And when I tell you how I feel about all of this, it seems to me it doesn’t matter to you. Please understand I am not telling you what to do or not do, I am telling you how I feel and why. After this last trip, I am going to have to re-think whether or not I can drive with you on long trips. I may have to fly and meet you there.

In this instance, the main focus is the passenger, feeling states, and possible decisions about future travel the passenger might make based on experience. There is no attack, judgmental attitude or accusation.

Re-read each one again. The main difference between them is that the critical one is all about the driver, and the complaint is all about the passenger. Bottom line, which way would you rather hear the speaker? No doubt, some of you who are less conflict averse will prefer the direct criticism, or at least might not be derailed by it. Others may want to hone their skill of complaining.

And by the way, complaining is NOT the same as whining! Complaints require that you talk about yourself, not your partner. Complaints are NOT “I” statements. Complaints are descriptive statements about your experience which, indeed, may contain the word “you,” such as, “… when you drive 95 mph I feel scared!” The purpose of the complaint is to detail your experience, make it real for the listener. While generally not responding favorably to demands, listeners do tend to respond more favorably to hearing the speaker’s experiences and behavioral changes the speaker makes in response to their experiences.

Why? Because when I become aware of the impact of my behavior on you, I can then access empathy or compassion for you. That often results in behavior change because ultimately I do not want you to feel bad. On the other hand, while being criticized, which is often experienced as an attack, it will be very difficult, if not impossible, to simultaneously feel empathic. Attack triggers the fight or flight response, not the compassion response.

Is it possible to be critical without attacking? Certainly, but it takes couples working out a system they can both agree on, practice, become comfortable with, and trust. In the meantime, try developing the art of the complaint. Remember—it requires you to talk about yourself, take responsibility for yourself, while not attempting to change your partner.

Here’s some interesting new insight into the human mind: first perceptions are even harder to overcome than most people had realized. According to research conducted on an international scale, our first impression of a person, place or idea becomes our brain’s default perception. If we later learn information that contradicts that perception, our brain categorizes it as an exception, rather than using the information to alter the rule. Specifically, we associate the exception with the context of that new information; all other contexts get the ‘default’ association. Say, for example, your first impression of a new coworker is negative, but you end up having a pleasant conversation when you run into him or her at the gym and change your mind. In the context of the gym, you’ll see the person more positively, but anywhere else (be it work, or even a new environment such as a restaurant), you’ll still be guided by your first impression.

This insight is especially interesting for therapists and counselors who help clients overcome phobias, said lead author Bertram Gawronski. “If someone with phobic reactions to spiders is seeking help from a psychologist, the therapy will be much more successful if it occurs in multiple different contexts rather than just in the psychologist’s office.” A similar pattern may be relevant for people struggling with profound anxiety and even PTSD. Learning healthy coping strategies in the therapist’s office can be helpful, but the idea of concept-based perception may explain why people sometimes feel less confident in their ability to apply those strategies in their daily life. (more…)

When a loved one hurts you through excessive criticism, put downs or abuse of any kind, you experience emotional and often simultaneous physical pain. But can emotional abuse be considered traumatic? Dr. Francine Shapiro defines two types of trauma—“big T” trauma and “little t” trauma. “Big T” trauma refers to what we commonly think of as trauma like war or natural disaster, “little t” trauma refers to incidents such as getting teased as a child or getting rejected by your first love. Most people experience “little t” trauma some time in their lives. People who live with and love someone emotionally abusive experience “little t trauma” on a daily basis. The experience of put downs, criticisms or whatever form emotional abuse takes, not only wears down self-esteem but also impacts the nervous system. Memories of the abuse can elicit negative feelings, tense physical sensations along with negative thoughts about yourself long after the abuse has occurred.

Human beings are born with a fight, flight, or freeze response. This is nature’s way of protecting us from danger. However, our minds can’t differentiate between the danger of let’s say the sound of a grizzly bear from the sound of the voice of someone who yells at you on a regular basis. In essence, prolonged exposure to emotional abuse can create similar symptoms to posttraumatic stress disorder experienced by a combat veteran. These symptoms include anxiety, depression, social withdrawal, and avoidance of situations or people that are reminiscent of the abuser, difficulty sleeping, flashbacks of abusive memories, difficulty focusing on the present or trouble concentrating. There can also be stress-related physical symptoms like migraines, digestive problems, fibromyalgia, or fatigue.

My work as a therapist is devoted to help heal those who have suffered from abuse. I believe the only way to facilitate deep and lasting healing is to treat the trauma associated with the abusive incidents. I do so with a technique called Eye Movement Desensitization and Reprocessing. EMDR has been well researched as an effective treatment approach to eradicate symptoms related to trauma. This technique can alleviate anxiety, depression, and other related disturbances resulting from emotionally abusive experiences. EMDR helps the individual eradicate any disturbance related to an abusive incident; the memory of the incident remains but the disturbing emotions and sensations associated with the memory are eliminated. Then, the person can move on in their life free from the “ghosts” of the past. EMDR can relieve symptoms fairly quickly.

Here’s a case example. “Jane” came to therapy lacking self-confidence in meeting men. When I took a look at her thorough history, it turned out she was mercilessly bullied by peers when she was a child. Jane agreed to EMDR treatment and after a few sessions, reported no leftover negative emotions or disturbances when she thought about the bullying. She reported feeling more confident and outgoing in the company of men. Even the way she carried herself changed; she held her head high with much better posture having an air of confidence.

You don’t have to suffer from trauma related to emotional abuse. You can free yourself of painful memories and move on with your life in a positive direction with the help of an EMDR trained therapist.

We are in the midst of January. One way to combat the cabin fever of winter and the shorter daylight hours for those across the northern hemisphere is to turn to creative processes.

In 2010, during one of the worst blizzards in New York history, many people bundled up and went outdoors with their cell phones or digital cameras to capture the beauty of the pristine snow against the textured backdrop of the urban environment. Some captured the absurdity of humans struggling against Mother Nature in their fight to dig out and return to ‘normal’ as soon as possible.

Contrast often gets our attention. It can be very dramatic. Drama can cause a variety of experiences such as: awe, giddiness, fear, and sometimes shock.

Coping with an experience generally falls into three categories:

1. engaging in the experience
2. avoiding it
3. overcompensating for it

After the blizzard, some people gave into the experience and engaged with the snow. Some people avoided it by staying away from the region or staying indoors. Others got caught up in the ‘expectation’ that the Department of Sanitation would handle what Mother Nature was delivering. When those in charge fell short, the situation heated up, not enough to melt the snow but in finding someone to blame.

The ‘unexpected’ can cause a range of feelings in humans, from joy to fear. The ways in which people cope are specific to them, to their early life experiences, their stage in life, and their future concerns. Most people had an experience flowing somewhere in-between. In some people the unexpected contrast of the heavy snow sparked their creativity. Others felt shutdown. In extreme cases their basic survival was threatened because support vehicles could not get down snow-packed side streets. Mother Nature is not fair in how she delivers her impact. She just does. Just as a bobcat in the wild does not discern which animal to take down for its next meal, Mother Nature spares some and hits others hard without reason.

In art, the contrast between the dark pigment of charcoal against light or absence of pigment on paper can create drama that is compelling to the eye. The self-portraits of Kathe Kollwitz and Egon Schiele are good examples of this. In Kathe Kollwitz’s work, drama is created by the contrast of not only the pigment but of the pressure applied to the paper, and the use of contrasting line to define and imply action or the lack of it. In Schiele’s numerous self-portraits, intensity is created by the placement of thick, dark, lines which define and the almost absence of pigment in other areas. Schiele’s self-portraits express his willingness to expose himself literally and figuratively on paper and canvas. If you Google an ‘image’ search for Kollwitz or Schiele and self-portraits, you will find very expressive examples of contrast in: texture, line, form shape and subject matter. You may find the experience exhilarating. You may find some of the artwork off-putting. The art may trigger feelings like the snow did for many New Yorkers.

In art, as in life, all drama or complete void cannot be tolerated for too long. The experience would be overwhelming. Many people have had an experience of contrast that shakes their lives and shapes them forever, for example: the profound loss of someone or something, a traumatic experience, relationship issues, a sense that something is holding them back from living fully, or an expectation that life has let them down. Uncontrollable anxiety that flares up and takes over, or depression that has an emotional base so deep that it limits the simple pleasures in life are indicators that life is being coped with rather than lived. Most of life is lived in the flow somewhere in-between contrasting poles of drama and void, in the blended parts of life where life is fluid, where creativity and hope are accessible.

Starting the day with fibromyalgia pain made Vera angry

Fibromyalgia made it hard for 46 year old Vera to get her legs out of bed in the morning. As she moved toward the bathroom and began her toilette, the pangs of pain moved to her hands, head and neck. It brought tears to her eyes. It made her angry to think that Kurt hadn’t even thought of organizing things around the house to make life a little easier for her. Vera remembered the arguments about accompanying her on doctor appointments and got even angrier. But she never said anything to him. She turned her mind to the support group she would attend later that day, although it wasn’t successful in easing her physical discomfort.

Vera found it easier to focus on the fibromyalgia pain than her scary emotions

As she ate breakfast, flashbacks of her early family file flooded Vera’s vision. She relived the tension she used to feel coming home from school wondering if her parents would fight out loud or give each other the cold shoulder. Her mother would take out her frustration on Vera the oldest and quietest of her kids. Her muscles tightened up as she recalled the fear of uncertainty and not knowing how to speak about her worries. It was the same thing now. She didn’t know how to talk about the anxiety of not being able to take care of herself. Vera had no words for the anger at her father for not making her mother happy, and at Kurt for being equally insensitive and uncaring. What she did have was body pain that ranged from dull aches to excruciating pain for which no specific organic cause had been found. Fibromyalgia was the diagnosis. It came with fatigue, slowing down of actions and restricting her life. It was making Vera dependent on pain medication and on a husband who let her down, repeating the cycle of her childhood. (more…)

If you’ve done any channel surfing at all in the last year or so, you might have come across a couple of documentary shows (Hoarders on A&E; Hoarding, Buried Alive on TLC) featuring people who are living with massive amounts of clutter and/or trash in their homes. The piles of “stuff” often reach to the ceilings, and there is barely space to stand, much less walk across a room. The programs show professional organizers and psychotherapists working with people to clean out their homes. If you’ve seen either of these shows, then you know what I mean when I say it’s something you don’t forget easily. Although the people being featured on the shows are treated with respect and compassion, the images are shocking and disturbing. How does this happen? Why do people do this? Can they be helped?

Contrary to what you might think, people experiencing compulsive hoarding are not just being lazy or careless. They are experiencing an anxiety related condition; although, there is disagreement in the medical/psychiatric community as to whether hoarding is its own issue, or that compulsive hoarding is a subtype of obsessive compulsive disorder (OCD). Although many people experiencing OCD also exhibit hoarding behavior, not all people experiencing OCD also hoard, and many people who hoard have no other symptoms of OCD.

People who compulsively hoard do experience excessive extreme anxiety, doubting, checking, and reassurance seeking before discarding items, which does suggest a close relationship to OCD. However, recent research suggests that compulsive hoarding may also be associated with a range of other psychiatric conditions, in addition to OCD. Compulsive hoarding behavior has been reported in disorders including schizophrenia, social phobia, eating disorders, depression, and dementia. In studies of the brain, researchers compared neurochemical activity and patterns of blood flow in the brain of people who compulsively hoard and people who experience OCD who did not hoard. They found that the neurochemical activity and blood flow patterns in people who hoard were different than those in people with OCD, suggesting that compulsive hoarding is a separate symptom/condition from OCD.

Many, if not most, people have a certain amount of clutter in at least one part of their homes. Where is the line between average messiness and compulsive hoarding? Hoarding behavior includes:

• Acquiring and keeping, indefinitely, a large number of possessions which appear to be useless or of limited value
• Living in spaces so intensely cluttered as to preclude activities for which those spaces were designed
• Significant distress or impairment in functioning caused by the hoarding (e.g., health problems, inability to keep a job, difficult relationships or lack of relationships with other people)
• Reluctance or inability to return borrowed items; impulsiveness and compulsion to acquire more “things” sometimes leading to stealing or shoplifting

Why/how does a person cross the line from messiness to hoarding? There are several proposed explanations for the causes of hoarding behavior. Investigators have suggested that errant cognitive processing leads to hoarding. These include information processing deficits, meaning that people who hoard have substantial problems focusing and sustaining attention, difficulty categorizing and prioritizing their possessions, and difficulty in making decisions about their possessions.

Maladaptive beliefs about, and extreme emotional attachment to, possessions may also contribute to a person’s hoarding behavior. People who hoard have an exaggerated sense of responsibility for their possessions, and desire complete control over them. They experience intense emotional distress (anxiety, grief, or guilt) about the ideas of discarding or losing an object, leading to avoidance, and escape in the form of saving and acquiring.

There are also studies showing that difference in brain activity and /or brain injury can lead to hoarding behavior. Scientists have identified the areas of the brain involved in hoarding. One study showed reduced glucose metabolism in certain areas of the brains of compulsive hoarders. Some people with traumatic brain injury, stroke, and neurodegenerative diseases have also developed hoarding behavior.

In the past, clinicians have used the same treatment methods for compulsive hoarding that they used for OCD, with poor results. While medication, cognitive behavioral therapy for OCD, exposure and response prevention therapy have all been effective treatments for OCD, they have been shown to be of little benefit for compulsive hoarding. People with hoarding behavior have high instances of poor insight, refusal of treatment, lack of cooperation, and inability to recognize hoarding as a problem, all contributing to difficulty in effective treatment.

There is hope for people who hoard, though. In a recent study, researchers designed a new cognitive-behavioral treatment especially for treating compulsive hoarding. In this treatment, motivational interviewing (getting people excited about the seriousness of the hazards of hoarding and the benefits of clearing out their homes), skills training for organizing and problem solving, and modification of beliefs about possessions are emphasized. Also, treatment includes frequent off-site sessions in which therapists helped people to sort, discard, and learn to resist acquiring more items. People typically respond more positively when the therapists are at the home with them, assisting them with sorting and discarding.

The sight of such intense messiness and disarray is certainly disturbing to see, but knowing that hoarding is a symptom of a person who is possibly experiencing severe emotional distress, hopefully, helps to engender compassion and patience in friends and family members. Information about help for hoarding can be found online at www.ocfoundation.org/hoarding/.

As humans, we are social animals. One consequence of this is the potential to be uncomfortable or anxious around other people. Some people are born with this tendency and labeled “shy”: these children tend to be more inhibited and fearful around people they don’t know well. If shy children are adequately encouraged and supported when they are young, they often outgrow their shyness.

Adolescence is another difficult time in life for self-consciousness and discomfort with oneself. How well one fits into their peer group is of tantamount importance and affects adolescents’ growing sense of self. If all goes well, the adolescent grows into a self-confident and mature adult.

Early adulthood is the most typical time in life that people develop anxiety. Being an adult presents new stresses that people may lack adequate coping skills to deal with. Severe anxiety states may develop, along with the fear of other people noticing that anxiety. Sometimes this develops into social anxiety, which is characterized by fears of feeling embarrassed or humiliated around other people. Underlying this is the fear of being seen as weak, defective, or somehow not okay in the eyes of other people.  Underlying this fear is shame.

Shame is a feeling of being flawed or unacceptable in some way. Sometimes this feeling is very vague, with people not knowing where their discomfort is coming from. Author John Bradshaw elaborates: “Guilt is the experience that you made a mistake, while shame is the experience that you are a mistake.”

Early in life, shaming experiences happen in one’s family, in school, and among peers. Shame has the adaptive function of guiding us to conform to the ethics, morals, and rules of our environment. However, negative shameful experiences cause us to feel hopeless and inadequate, and sometimes lead to depression. Generally, there are certain areas in which an individual feels lacking or flawed: personal attractiveness, intelligence, competence, and lovability are common themes.

It is almost impossible to get through childhood and adolescence without experiencing at least a few shaming experiences. It is helpful to be aware of one’s areas of shame because shame very much influences how we interact with the world. Avoidance of meeting people is a typical response of someone with social anxiety. Dependence on alcohol and drugs may also be used to numb the anxiety. For others, criticizing or ridiculing others in order to make oneself feel less inferior is another strategy. Clearly, these strategies can have very negative consequences in one’s life.

If you think that shame may influence some of your difficulties, working to transform the underlying beliefs that live inside you may be a good idea. You can continue to read about shame in books like John Bradshaw’s, talk to supportive friends, or see a counselor or therapist.