Distraction techniques: active, passive, and regulatory

When life gets difficult, it can often become tempting to distract yourself from your own thoughts and feelings. Loved ones may scold us for this, telling us that we should confront our feelings, because distracting ourselves doesn't accomplish anything. However, distraction is an important part of distress tolerance. Imagine Jill, a young woman who, in typical romantic comedy fashion, gets fired and dumped on the same day. Sure, distracting herself isn't going to help her find a new job, but binge-watching her favorite TV series would give Jill time to let her emotions around the problem cool down before she decides to start working on it.

Of course, different kinds of people may require different kinds of distraction. For Jill, a more passive distraction like watching TV is perfect; she may not have the energy to do much else. However, her now-ex Bob is worried about how awkward their break-up is going to make things with their mutual friend group. If he sat down to watch TV, he would still be worrying about it. Bob needs a distraction that he can throw himself into, something that takes so much effort and focus that he can't spend any time worrying. So instead, he decides to pick up his guitar and practice a new song he's been trying to learn. Bob opts for a more active distraction.

The examples above not only show the difference between passive and active distraction, but also how to match what kind of distraction you need to your mood. For a lot of people, depression makes it hard to do things, so a more passive distraction may be preferred. Jill would not have had the energy to practice an instrument while depressed. On the other side, anxiety often manifests as a sort of nervous energy, which can easily be redirected. Of course, this isn't the case for everyone. Some people find anxiety paralyzing, so they may prefer a passive distraction despite being anxious. The important thing here is that the activeness and passivity of your distraction match your energy level.

What some people find to work as a distraction, others might find works better as emotional regulation. Maybe the real reason Jill didn't want to play music is that it wouldn't distract her at all, and would instead remind her of Bob even more! A few days after the break-up, Jill may still be feeling sad and missing him, so she sits down at her piano and plays the saddest song she knows. Here she is not using music to distract her from her feelings. On the contrary, she is leaning into her emotions, and letting them out. The song she plays could be the same exact song that Bob was trying to learn on his guitar; the important thing here is the approach. Jill is choosing an activity that matches her mood. If she was angry about the breakup, she might play an angry song, or go to a kickboxing class. If she was sad, but didn't want to play music, she might write a long letter to Bob, then shred it.

Not only is distraction anecdotally helpful, but research has been done to track symptoms in those who do and don't use the technique. A Swedish study showed that patients admitted to the hospital after a car accident were less likely to develop PTSD if they played Tetris within a few hours of admission. Some of the core symptoms of PTSD involve recurring thoughts, intrusive memories, and flashbacks, and it is thought that distracting a person from ruminating over the event blocks this pattern from forming. Those who distracted in this study had fewer intrusive memories in the week following, and these intrusive memories diminished faster. An earlier Oxford study showed that in a case of simulated trauma, playing Tetris was the best of three options, with taking an online trivia quiz as worse than doing nothing. This indicates that choosing the wrong distraction technique (in this case, a passive one rather than an active one) can actually be hurtful. In this case, it makes sense that a failed distraction could actually train the brain to ruminate even while occupied. A distraction must be sufficiently distracting without being overwhelming.

This is not to say that distraction is always the best technique to use in a given situation. Distraction works best as distress tolerance, and is not a replacement for emotional regulation. As discussed above, the two work differently. Distracting yourself instead of using emotional regulation can lead to unprocessed or buried thoughts and feelings. In the moment, it can be hard to tell whether distracting yourself is helping or not. Different people have different tells (losing track of time, forgetting to do something important like eat lunch, etc) but generally, distraction should make you feel better, not worse. If you feel worse after a period of distraction, it may not be the right technique to be using. So next time you are feeling overwhelmed and need to veg out, go ahead! Just take the time to think about the kind of distraction you need first. 

The two types of Self

When you think of the Self, do you imagine it as something growing and changing, or consistent over a person's life? The definition of the Self is arguably one of the biggest differences between classical and postmodern psychology. Classical theories have their basis in the idea of a True Self, a fundamental unchanging part of a person that stays with them since birth. They may talk of upbringing, life circumstances, and social influence as things that change behavior, but they never change who you are underneath all of that. An artist may always be an artist, even in a world where they had no choice but to sell bread and raise children.

Postmodern theories of psychology look at the ways our behavior changes overtime, and instead see the Self as that which changes. Just as a person can change what they like, they can change who they are. A rambunctious teenager can change and become a stoic adult, and this isn't because they became any more or less in touch with a True Self, but because that Self changed, whether due to social pressure or just maturity.

These different perspectives change the ways clinicians approach their clients. A therapist who believes in the True Self may push a client to become more in touch with lost parts of themselves, while a more postmodern therapist might push a client to grow and change, exploring new hobbies and not remain attached to certain parts of their identity. I want to propose a third idea, which is that this theoretical rift is caused by two different definitions in the word Self.

In a sense, this debate is no different from nature versus nurture. While popular science shifts focus between the two, the truth is somewhere in the middle. Some of who we are is in our genes (brown eyes, wavy hair, a bit of a sweet tooth). The rest (taste in music, friends, hobbies) is influenced by how we are raised. So it can't be radical to suggest that between the True Self and the Changing Self, both as well as neither are true.

The two types of self I want to talk about are those I call the Momentary Self and the Lifetime Self. While there are parts of a person that never change (LS), it is impossible to ignore the ways in which parenting, culture, trauma, and major life events can change a person (MS). Difficulty comes with distinguishing which parts of a person are part of which Self.

Perhaps the most salient example of this in recent history is the debate on where sexuality comes from. While there is a major movement of people who believe that LGBT identities are inherent, there is a significant population that doesn't feel this to be the case. For example, people who have experienced traumas in early childhood may feel that those traumas made them gay or lesbian. The fact that they weren't "born this way" doesn't make their sexuality any less valid. Further, some feel their sexuality is fluid; not only has it changed, but it is likely to change again in the future. While the first population may have sexuality as part of their Lifetime Self, these people may see it as part of their Momentary Self. For a less controversial example, you can note the difference between someone who has been highly social since birth and someone who has taught themselves to be more social. Both may see extroversion as a trait they have, though they came about it in different ways.

It can require a lot of work and introspection to know which parts of yourself are Lifetime and which parts are Momentary. The assumption of identity being one or the other is dated; it may take more work, but sorting through the parts of Self can do a lot to settle things like self esteem and compassion. Trying to change something that's part of your Lifetime Self can be frustrating. Insisting that part of your Momentary Self is stuck like that forever can be stifling. Letting these parts speak for themselves can be freeing.

The Universe Inside Your Head

Let's say you are reading a book about people with magical abilities. As a young child, their abilities manifest spontaneously (accidentally breaking something with their mind, flying instead of falling, etc). Then, they are taken away off somewhere to learn to hone their skills. There may be rules to what magic is and is not possible, how magic is done, and what different students can learn. In this book, the main character has the ability to manipulate electricity. They can use this to control anything that operates with electricity remotely, like by turning lights on and off, or they can just shock people. If it is established in the book that no person has more than one ability, you may be surprised if, later on, the main character starts to manipulate water or read minds. This changes the rules of the story.

In the above paragraph, I painted a picture of a universe, giving you rules about how it worked. If I asked you to write a story within the universe, many of you might take care to make sure the story abides by the rules I have provided. This ability to create a universe in your mind is a skill not everyone has, but it is useful beyond just reading stories and writing fanfiction. This same skill can be used to understand people, and even ourselves, better.

To tie this to another example, let's say you are speaking with someone who you just met. This person is an elementary school teacher. Right away, you know quite a few things about this person (they work with kids, get summers off, probably teach during the day and maybe grade papers and plan lessons after school). In the same way that you did with the book, you can use this information to give more detail to this person's universe. Now maybe the person tells you that they also run a summer camp. If you previously assumed that being a teacher meant they had summers off, now you can update the information you have on this person to include that they have a second job they work over the summer. You now have a slightly more detailed picture of what their universe is like.

Though the example above is a relatively simple one, there are lots of ways to gain information that you can use to add detail to someone's universe. Often times we don't even realize we are doing it; assumptions made based on a person's appearance or social media profile aren't always conscious. There are even small things people say and do that we miss, but could otherwise be useful information in understanding the person better. If someone tells you a movie they saw was "too scary", it may not be a fact about the movie, but about their dislike for horror movies, or fears surrounding the topic of the movie.

The perspective we use to analyze other universes is also important, because it determines what we notice and what we don't. When reading books, we may not think much of things that are normal for us, like a 6-year-old going to school for the first time, but notice things that are not true in our universe, like super powers. The more ways a fictional universe is different from our own, the harder it is to keep track of. Imagine how much easier it might be to follow a book about super heroes, rather than a book about aliens and monsters with magic and futuristic weapons! This is part of why we enjoy spending time with and talking with people who think similarly to us. If a friend's universe is similar to yours, it takes less effort to understand who they are and why they do what they do.

If you meet someone whose universe is too different from yours, you may find them hard to relate to. Part of this is because, by default, we use our own universe to look at other universes. A young child who doesn't know the meaning of divorce might have a hard time understanding the experiences of their friend, who spends half their time with Dad and half their time with Mom, but never together. The child may get frustrated if that friend leaves a book they borrowed at Dad's house, then didn't have it when they spent time together after school at Mom's. It can be so easy to judge other people without thinking about whether what happened makes sense in their universe if it doesn't make sense in yours. The child may assume that the friend didn't want to give the book back or was trying to be mean, rather than realize how easy it is to forget something at one house when you have two. Even adults do this all the time, assuming malice or stupidity when we can't understand another's actions. Taking care to understand another person's universe can help prevent this from happening, sometimes drawing attention to parts of your own universe that you take for granted in the process.

As a therapist, this skill is particularly useful. Creating a vivid picture of a client's universe is essential to helping them understand themselves and their relationships with others. If a client identifies with a particular fictional character, for example, they may be better understood if you take care to learn about the character and the story they're in (either by asking the client, or through direct exposure to the story). A child who enjoys imaginative play can be understood through the assumptions they make in their play (like the assumptions about who does what in a game of house). Even clients with compulsions, fears, and delusions can be better understood through those symptoms. Different therapists will prefer different theories and interventions, which means they will each have different ways of gathering information about their clients, but in the end, the therapist who interprets dreams and the therapist who gives their client hypothetical scenarios are both using the information they gather to create a richer, more detailed picture of what that client's universe is like.

The 5 Stages of Grief, and Why They May Not Be Accurate

In Western culture, we often talk about grief coming in phases. When we first hear about death of a loved one, we may not believe it. Then, once we come to terms with it, we may need to mourn for a very long time before we are able to move on. Many cultures around the world have ceremonies and traditions that deal with mourning, but in the US, people most often talk about the 5 Stages of Grief. This model, also known as the Kubler-Ross Model, goes as follows:

1. Denial (this can't be happening)
2. Anger (why me)
3. Bargaining (maybe if...)
4. Depression 
5. Acceptance

This model, though it does focus on grief, was developed specifically in relation to those who are dying. Rather than being developed about someone grieving a dead friend or family member, it was meant to teach loved ones of a dying person what they go through emotionally upon finding out that they are dying. So, for example, the bargaining phase is not meant to show that a person may think there is a way to get their dead friend back. Instead, it shows that, at a certain point, a dying person may be convinced that there is a way to cure them of whatever is killing them, or hope that their illness may mysteriously disappear.

So what does the process of grief actually look like?

In the 80s, John Schneider developed what he calls the Transformational Stages of Grief. This model looks not only at emotional responses, but cognitive, behavioral, spiritual, and physical responses as well, and thus is designed to nurture growth. Rather than just covering loss of a loved one, it also covers other losses like break ups and divorce, as well as more internal losses like a change in beliefs or a loss of faith. Schneider's model is:

1. Initial awareness of loss (shock, confusion, disbelief)
2. Attempts at limiting awareness by holding on (bargaining, guilt, ruminating, and trying to use coping behaviors that have worked in the past, all in attempt to put off instability. often associated with insomnia, muscle tension, and yearning.)
3. Attempts at limiting awareness by letting go (depression, anxiety, shame, pessimism, forgetting, and hedonism, sometimes involves giving up on formerly held ideals and beliefs)
4. Awareness of the extent of the loss (mourning, deprivation, grief, defenselessness, flooded thoughts, noticing what you are now missing)
5. Gaining perspective on the loss (healing, peace, acceptance, noticing growth and change, awareness of the extent of your and others' responsibility, realizing any positives)
6. Resolving the loss (self-forgiveness, finishing unfinished business, accepting responsibility, saying goodbye)
7. Reformulating the loss in a context of growth (discovering potential, problems as challenges, regaining curiosity, think of a divorced person who has decided to start dating again)
8. Transforming loss into new levels of attachment (awareness of interrelationships, wholeness, empathy, end of searching, reflection)

As a counterpoint to traditional models, there is also what's called The Dutro Model, which doesn't focus on stages at all. This model claims that traditional "stages of grief" models are not supported, and placing time limits on grief is inappropriate. It also holds that pathologizing the suppression of sadness as a response to grief is also incorrect. Instead, the model sees grief as being complex, multidimensional, and individualized, based on a number of variables that are different for each person's individual experience. 

Often times, a grieving person can expect a flood of support when people first hear about the loss, though the support may wind down when the news is no longer as new. It is important to keep in mind that grief can go on for a long time. Sometimes, particularly when grief involves trauma, people can experience post-traumatic stress along with their grief. Think of the couple going through a particularly contentious divorce, or someone who witnessed a friend being killed. This can result in a complicated grief reaction, which can take much longer to process than grief on its own. 

Ultimately, each person's experience of grief is going to be different, depending on the type of grief they are going through and the circumstances around the loss. Stage models are useful for those in the middle of the grieving process, as well as friends and loved ones of the grieving person. The grieving person may find comfort in knowing what may happen next and understanding that this too shall pass, while their friends and family may feel that knowing what's going on and what to expect can better help them be supportive. Complicated emotions around grief can be sudden and painful, or they can sneak up on you when you don't expect it. Understanding what you are going through and knowing that you are not alone in your experiences can often be one of the most helpful things in getting through that dark tunnel and out the other side.

Communication and the Desired Response

A friend once told me a story of how an interaction with her mother changed her perspective on communication. She said that she had been going through a break up at the time, and was venting to her mother, when her mother responded with "Do you want my advice, or my sympathy?"

Often times, when we have something important to talk about, we consider how we expect the other person to respond, and talk to people who will respond the kind of way we want. We may choose to speak to someone who we know can keep a secret, or who gives good advice, or who will say nothing at all, only listen. Sometimes we may turn to someone who won't want to talk about it at all, and will instead distract us from our problems. This can be great if you have a number of close friends who reliably respond in different ways, and you are able to predict this and make use of it. However, not everyone is in this situation, and so instead, we end up with interactions where people are not getting their desired responses.

Take an interaction between example-humans Alice and Bob. Alice's goal in the conversation may be to be heard, whereas Bob may want to feel validated for what he says. If Alice is talking, Bob may point out something or make a clever remark. Instead of validating Bob, Alice feels like she hasn't been heard, and is quiet in response. Now Bob has not been validated either, and they are both sad.

Sometimes, a person's desired response can be inferred. This is like how generally, if someone tells a joke, their desired response is for you to laugh, or at least acknowledge that the joke was funny. However, this isn't always easy to tell. Some of us may know the best thing for our best friend in a time of stress, but we don't always know what's right for someone else, even if we are close. Often times we will assume that what works for us will work for them, but then there is a risk of emotional damage. Trying to talk about a situation that someone wants to avoid thinking about may exacerbate the problem or cause tension between two people. Usually, it is better to ask a person what they need -- like how my friend's mother asked her.

Going more deeply, some people may tend to have common desired responses, in general interactions. Think of the person constantly telling bad jokes, excited to hear people groan and laugh, or someone who loves giving advice and recommendations. The first of these two may love the validation they get from humor, whereas the second may want to feel helpful, and be appreciated for it. This goes far deeper than a single situational interaction; these people want these kinds of responses in everyday conversations. This may even tie to how we want others to see us (clever or kind) or how we most enjoy interacting with others (playing with ideas or working with people, receiving attention or giving it). A person's desired response may not always be the response that feels right, or the response that we want to give -- and that's perfectly okay. But it does give us insight into what drives them, what is important to them, and who they are as a person.

How social media can affect your sense of self

When we check social media like Facebook and Instagram too often, we can be inundated with the good parts of peoples' lives. Facebook in particular has an algorithm that results in a news feed that prioritizes things to celebrate, like an engagement, a baby, or a new job. Then, when we scroll down an individual person's page, we see their highlights: how their diet has been, or fun things they do with their friends. What we don't often see, though, is the days they are home alone, in their pajamas, watching Netflix all day. This is especially the case with any friends who we only see online, whether due to distance or time; we only see the parts of their lives that they consider to be worth documenting. And when this happens, we often end up comparing the best parts of their lives to the worst parts of our own.

Social media is developed in such a way to be about building ourselves up. As we share our accomplishments and daily lives with the world, we get responses (likes, comments, reactions). Something as simple as discovering a new restaurant and having friends comment on how delicious the food looks can be a boost of self esteem, even if the same information shared in person wouldn't quite have that strong of a result. Along with insight into our lives, we share insight into our minds: interesting articles, funny pictures, and our thoughts about the world. We may intend to use these to share things we think are important to share (whether for humor or insight or both), but the result is also that it paints a picture of who we are. One particular friend may share lots of politically-charged articles, and that makes your picture of who they are very different from someone else, who shares recipes and DIYs, even if the rest of their content is exactly the same.

Having such insight into who someone is through social media creates an interesting effect; you may know a lot about the person, but that doesn't necessarily mean you are close. For example, you may have read your coworker's posts about all the things their kid says, and even watched videos of their home life, but never quite feel comfortable with them enough to get lunch with them. You may have a friend who you have only met in person once, and have shared incredibly personal things with on chat, but then when you meet them a second time after all these conversations, it feels like there's nothing to talk about. Of course, this isn't true for everybody. For some, it would be easy to find things to talk about with that friend, and no trouble at all to ask that coworker to get lunch together. But usually, the way friendships are formed in person is very different from how they are formed online. The coworker, for example, may know very little about you (despite following and friending each other!), despite how much you know about them.

Part of what's missing here is the humanness that comes with everyday interaction. When in school, you may see your friends everyday, and freely rant about teachers, homework, parents, and other kids at school. You share not only successes, but failures, and places where you need to grow. Online, we portray ourselves as robots, gods, and forces without boundaries. A profile can often read more like a marketing campaign than a human being. It is as if we are trying to disassociate from our own humanness. Recognizing our humanity, and the humanity of others, is important in making the world better, and for so many reasons. Going back to mental health and identity, though, it normalizes suffering. It creates a world where it is okay to lose sometimes, and where someone can feel sad without that sadness becoming a part of who they are. There are ways to do this in online communities. I know people who have created secret Facebook groups for close friends to share painful day-to-day moments, so they can receive support, or who have joined forums so they can hear from people with similar life experiences. But it takes initiative, as well as courage, just as it does in real life.

Why therapy?

"Perhaps love is the process of my leading you gently back to yourself."

~ Antoine de Saint-Exupery

It seems only fitting to start this blog with an explanation for its title. This quote has always rung true with me, but it is only recently that I have realized its connection to my work. The self is the source of much mystery and turmoil, as we often find through media, philosophy, and literature. It is often difficult to balance a full understanding of ourselves with deep and meaningful relationships with others. This can cause problems when we turn to friends and family for advice or support. The people we know may be invested in our lives enough to have preferences, like a parent who wants their kid to go to college close to home. Even if they are unaware of it, they may have ideas of who we are, which sway the kinds of advice they give us. Or maybe they are so stuck in their own lives, including their personal beliefs and what has or has not worked for them, that it becomes hard to grasp the idea that someone else may experience things differently. In a world where everyone has an opinion, it is often hard to find someone truly unbiased.

When somebody asks me about the difference between therapy and friendship, this sense of investment and opinion is the first thing I bring up. Therapists often use the metaphor of the copilot; a good therapist will neither drive your car nor tell you where to go, but simply show you the way. While this metaphor is a good one, it feels detached. Many theorists will tell you that the key to good therapy is not in the technique, but in the therapeutic relationship. The process of doing so is called many different things by different theoretical models (joining, establishing rapport, or alliance), and will also look very different from client to client, but the idea is the same: a therapist and client must establish a connection before any deeper work can be done. This connection is based in trust and openness, as well as a consensus on goals. If a client and therapist disagree on goals, it is like a copilot pointing in one direction, while the pilot wants to go in the other. Chances are, neither person will get there.

Thinking of the journey a client takes in therapy, it always ends in the self. They come in usually with goals they have settled on, intending on making their lives better. The therapist then must use tools that suit the client to meet those goals. In the same way that we do not ask butterflies to swim or turtles to fly, a therapist cannot ask a client to fit into a box so that their techniques may work. The therapy must suit the client. This is how a good therapist will lead you, gently, back to yourself.