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The Great Deception - Page 3

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Using Brain Science for Behavioral Change

Over the years, I’ve come to recognize that there’s no one-shot, magic-bullet approach to retraining the human brain. Instead, I’ve developed a process that systematically combines what we know about the power of the emotional brain, the particular strengths of the rational mind, the mechanics of mindfulness meditation, and the brain’s impressive flexibility to help clients learn to calm their nervous systems and navigate their lives more effectively. This process includes:

  1. Conscious pursuit of understanding and change. We need to use our conscious minds to understand our lives, develop ideas about what’s healthy and unhealthy, and pursue concrete changes that move us toward health and well-being.
  2. Stress reduction and rejuvenation. We need to develop nervous system inclinations that reduce stress, relax the mind, and rejuvenate the body.
  3. Distress tolerance and self-regulation. We need to develop nervous system inclinations that help us tolerate the inevitable stress that accompanies making difficult changes and self-regulate in emotionally charged situations.
  4. Emotional accessibility. We need to develop nervous system inclinations that produce feelings that connect us to others.

At our treatment center for couples, my colleagues and I begin stress reduction and rejuvenation in the first week of therapy, asking partners to start mindfulness classes in conjunction with therapy. While mindfulness training alone won’t heal broken relationships, we consider it an indispensable part of the relationship improvement process. Years of experience have taught us that there’s only so much that we can do with clients whose default nervous system impulses and inclinations keep them perpetually stressed, edgy, and preoccupied.

While partners engage in their first eight weeks of mindfulness classes, we use therapy sessions to engage them in the conscious pursuit of understanding and change. Specifically, we help them (1) become aware of studies suggesting that people who believe their partners are “the main problem” are usually mistaken, (2) consider evidence suggesting that this mistake is of no small consequence to relationships, (3) become receptive to our opinion that their habits have been as damaging to the relationship as their partner’s habits, (4) listen with an open mind as we paint a clear picture of their problematic habits, (5) understand why it’s in their own best interest to explicitly acknowledge and accept responsibility for their roles in the deterioration of their relationships, and (6) become determined to develop the full set of habits that are characteristic of people who know how to get their partners to treat them well. We also help partners accept mutual responsibility while in the presence of each other. Then we move on to identify the underlying needs, worries, fears, and insecurities that are beneath their previous blaming and defensive postures, and we help them talk about these vulnerable feelings without accusation or blame.

The combination of stress reduction and rejuvenation (facilitated through mindfulness classes) and conscious pursuit of understanding and change (during therapy sessions) is powerful, and couples often make significant strides in the first two months of therapy. But in my experience, that’s rarely enough. Up to this point, the shifts that clients make during sessions are heavily therapist dependent. We help partners self-regulate during sessions. We create the conditions that enable them to connect with vulnerable feelings. The biggest challenge for them is still ahead: learning to rewire their brains to produce automatic inclinations that enable them to do these things on their own. This is hard, gutsy work, but it can produce substantial change, so we help clients walk the arduous path toward self-regulation through exercises in distress tolerance and self-soothing and in emotional accessibility.

Developing Calm in the Storm

Neuroscientist and psychiatrist Daniel Siegel notes that the process of turning toward and soothing upset feelings (rather than focusing exclusively on the external threats) is what good parents do in responding to feelings of distress in their children. Before helping children solve their problems, skillful parents relax, turn toward and welcome their children’s feelings while providing direct physical soothing—often through hugging, holding, and other forms of nurturing contact. Similarly, distress tolerance and self-soothing exercises help clients turn toward their own upset feelings and engage directly in physiological soothing, temporarily postponing thoughts about problems. This process of self-accompaniment elicits a sense of calm in the storm, allowing clients to avoid alarm or panic when things aren’t going well.

We begin by asking clients to notice when small annoyances or disappointments occur in the course of each day. When they notice these frustrations, clients stop what they’re doing and spend one to three minutes resisting the urge to analyze their upsetting circumstances. Instead, they’re encouraged to slow down their breathing and focus attention on their physical sensations.

We’ve found that the key to reconditioning automatic reactions involves frequent reconditioning exercises that are practiced in close proximity to each other. The brain will acquire a new habit more quickly if a person practices the new habit once a day for 14 days than if a person practices it one time per week for 14 weeks. I learned this concept decades ago from Albert, the white lab rat I worked with in my college experimental psychology class. Albert learned new behaviors, like running to a specific area of his cage, with fewer conditioning trials when he was rewarded for desired behavior once per hour than when he was rewarded for it once per week. This is why we ask partners to practice with every upset feeling—no matter how small—that they experience on a daily basis. We emphasize that most of the work involves simply remembering to do the exercises and being willing to interrupt whatever they’re doing for a couple of minutes. If practiced faithfully, these small moments will change their brains within weeks. We want clients to understand that each day that goes by without practicing distress tolerance and self-soothing decreases the likelihood that their brains will begin to produce calming instincts and inclinations automatically.

Clients begin by practicing with mild upset feelings. Once they’ve worked with mild upset feelings every day for at least a week, they move on to more intense feelings. For this level of practice, we want the upset feelings to be stronger, but not so difficult that clients get hijacked by them and are unable to practice. One method involves having clients listen to complaints that their partners have prerecorded, as I had Steve do with Debra’s complaints in the days of tape recorders. (Now we have the added convenience of making recordings on our smartphones.) Some clients don’t need to listen to recordings to activate upset feelings. They can feel upset just by setting aside times to regularly remember recent upsetting events. To many people this sounds crazy. “Why would I want to deliberately make myself upset?” they balk. The answer is so they can practice calming themselves frequently enough to wire their brains with an instinct to remain calm during upsetting situations.

Although the point of triggering is to learn how to calm oneself and eventually not get triggered in the first place, it’s undeniably painful work. When clients lose their nerve I empathize with them, readily acknowledging that there have been weeks, months, and even whole phases in my life when I just haven’t had the energy or motivation to engage in practices that would’ve been good for me. Sometimes life is like that; you just can’t sustain the courage or motivation to press on, and it’s wise to cut yourself some slack. I support clients who need to back off, but I don’t want them to delude themselves. Even as they’re backing off, I encourage them to consider that at some point, they’ll probably need to find the motivation to engage in difficult practices such as these if they want their habitual reactions to change.

Intense upset feelings during actual arguments are the most difficult for clients to practice with; however, clients who have practiced diligently with mild and moderate feelings can usually soothe intense feelings as well. First, we familiarize them with the process of working with intense feelings in advance, when they’re calm and can fully take in each element of practice. Then during conjoint sessions, we ask them to discuss hot issues, the ones that trigger strong feelings. Ahead of time, clients agree that when they’re triggered, they’ll take session breaks for the purpose of practicing distress tolerance and self-soothing, and I give them the set of instructions in the box on the next page to help them through each of the steps.

Once partners have gone through the steps described in the box to the right, they resume the session and continue discussing the troubling issue. Sometimes another break is needed, and often there isn’t time for issues to get resolved by the end of sessions. To feel okay about this lack of resolution, clients must care more about acquiring the ability to self-soothe and tolerate distress than they do about resolving issues quickly. They must believe that ultimately, the ability to react less intensely and operate with less desperation will lead to easier resolution of differences—and this benefit will extend over time throughout their relationship. They must be willing to exchange the value of quick resolution for the long-term benefits that will come from investing time in reconditioning their brains for calmer reactions in upsetting situations.

After they’ve had success on their own during session breaks, we ask clients to begin practicing at home by taking breaks during real-time arguments. When people have difficulty engaging in distress tolerance and self-soothing exercises at home during arguments, it’s usually because they’re not fully committed to getting better at them. Deep down, they may not believe that calming themselves will matter much. They may feel that they’ve been calm during arguments in the past and it hasn’t made any difference; their partners were still unresponsive. I agree with such clients, acknowledging that staying calm by itself won’t be enough—they may also need to stand up for themselves. To heighten motivation for these clients, we spend quite a bit of time discussing studies showing that the ability to calm oneself in the face of conflict is highly correlated with getting satisfying responses from one’s partner. We then ask clients to complete logs in which they record each upsetting incident, how much time they spent trying to shut down mental chatter and focus on physical self-soothing, and how much calmer they felt after practicing. The good news is that for clients who practice diligently with the full range of mild, moderate, and intense feelings, changes take place in their nervous systems within a period of weeks.

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