Clinical psychologist Christina O’Connell talks to Leigh Hatcher about developing self efficacy in children.
Written by Ivette Moutzouris
Mindfulness appears to be the new fad at the moment. It has become so popular that it is even being called ‘the mindfulness movement’ and has expanded beyond the therapy room and into everyday life. I thought it would be helpful to explain its origins and some basic core beliefs underpinning Mindfulness because there is so much talk about it and a mixed response about its effectiveness.
So What is it?
Mindfulness is basically the process of being intentionally aware of the moment, with acceptance and with a non-judgemental attitude. The way in which this is achieved is through a set of strategies/meditative exercises and also by understanding and practicing a more mindful lifestyle.
It has been practiced in eastern/buddhist traditions for over 2500 years as a form of meditation and inorder to simplify and create a more meaningful life experience.
In the late 1970’s Jon Kabat-Zinn (known for his work as a Scientist, author and Meditation Teacher) introduced Mindfulness into a Medical clinic which was treating patients with chronic pain symptoms. Jon Kabat-Zinn refined Mindfulness practices and used these strategies to treat his patients and the results were very positive. From this point it was applied to treat other psychological issues such as Anxiety, Depression, Personality Disorders, Addictions and Chronic Pain.
How Do I Practice It?
Mindfulness is Experiential – it involves learning to be more present in the moment by increasing your skill of attention and focus.
An example of this could be sitting and closing your eyes and noticing the sounds around you for at least 10 minutes or more. There are many variations of Mindfulness exercises but the key to Mindfulness is to slow down and notice what is be happening around you and also within you– i.e. to connect more with your world and to find meaning and enjoyment from it. In therapy we also use it to help notice the internal emotions and thoughts and decide whether to accept, reject, defuse or challenge our internal dialogue.
Mindfulness is an Attitude -It is a lot more than just exercises. It involves learning to have a big picture perspective when you approach issues/hardships and life in general. By this I mean learning to not just notice (and even obsess) about the problem but also notice what else is going on in your life. A mindful attitude helps you to see the positives and the simple joys of life that we often neglect or miss when we are preoccupied, worried or constantly busy.
Some people think that Mindfulness is about being positive and/or ignoring issues but it is actually the opposite. It is about accepting and learning to cope with the hard times by slowing down and working through the issues instead of either automatically reacting or avoiding. Mindfulness teaches you to be ‘more reflective’ and ‘less reactive’ and when this occurs we are better able to come up with solutions or accept our situation.
Mindfulness is Educational – this occurs as you slow down and begin to notice how you respond to situations. It also teaches you about other people as you nurture more mindful relationships and learn to listen and understand others better. It encourages us to be less focused on ourselves and to have better connection with others. I recently heard an interview with Tara Bach, who teaches and writes about Mindfulness and she mentioned the difference between Illness and Wellness, i.e. the ‘I’ is in illness and ‘We’ is in Wellness. We are relational and it is often helpful in recovery to connect with other people.
Why is Mindful helpful?
Mindfulness is helpful because as you focus more on the ‘now’ you are less caught up in the past and situations that cannot be changed and also less focused on the future and all the worries about what may or may not happen. Being caught up too much in your past or your future can cause Depression and Anxiety because they are situations that you cannot control. Mindfulness instead teaches you to find meaning in the ‘now’ and even when you are going through a difficult time learning to not avoid it but get through it. It encourages you to look for your strengths and resources and to calm down the automatic emotional reactivity.
When you learn to slow down and observe it not only helps you to alter the emotional intensity of your reactions but also increases your attention, memory, problem solving skills, empathy and compassion. Research has shown that people who practice mindfulness exercises daily for 2 months experience these benefits and brain scans show that other parts of the brain are more active, for example the prefrontal lobe which is responsible for activating positive emotions.
Siegel, Ronald. (2010). The Mindfulness Solution. Everyday Practices for Everyday Problems. New York: The Guildford Press.
Harris, Russ. (2012). The Reality Slap. Finding Peace and Fulfillment When Life Hurts. CA: New Harbinger Publications.
Williams, M., Teasdale, J., Segal, Z., Kabat-Zinn,J. (2007). The Mindful Way through Depression. New York: The Guildford Press.
Recently I found out that an ex-client from my old workplace had completed suicide, which really rattled me as a person and a psychologist. I immediately thought of the pain and despair they must have had to feel that it was impossible to continue living, pictured the grieving family and friends and then reflected on my past interactions with them. A week after I heard this awful news, I happened to have a supervision session which quickly turned somewhat into a therapy session. My supervisor gave me a space to grieve and reminded me to do what I often tell my grieving clients – try to find meaning in loss. This supervision/therapy session was exactly what I needed at that time to process my grief.
I was surprised when I heard the statistic from a recent episode of ABC documentary series called ‘You Can’t Ask That Question’ on suicide attempt survivors – 8 people died from suicide each day in Australia. This concerning statistic is double the number of Australians who died from road accidents! Most of the suicide attempt survivors interviewed in the program reported that they did not actually want to die instead they wanted a break from the painful feelings they had been experiencing.
What is grieving? Grieving is a healthy human reaction to a loss experienced, which typically involves acceptance of loss and learning to manage daily life without the person who died. Everyone grieves differently (even in the same family) because everyone has a different relationship with the person who died, carries varying past experiences of loss, and expresses their grief differently; for example, one person may prefer to share their feelings and thoughts while another may find it hard to show their emotions or verbalise their grief. Remember, there are no set rules on how to grief or what emotions one should be feeling.
When someone dies suddenly, it is not uncommon to feel overwhelming arrays of emotions and thoughts. Below is a list of feelings and thoughts that may be experienced:
- Anger towards the person for taking their own life and leaving pain behind; or towards someone else who might have been perceived to cause or contribute to the suicide; or towards your God (if you have faith). It is also not uncommon to try and find someone to blame from the suicide.
- Defensiveness as a protection against other people who may ask intrusive questions or say something upsetting.
- Depression and anxiety from the intense grief.
- Despair over prospect of life without the person who died.
- Fear of how life will be like without the person who died.
- Guilt over something that they believe they could have done differently to prevent suicide.
- Numbness or feeling ‘nothing’ – for some people if may take a while before pain shows up.
- Physical reactions – sometimes grief manifests in physical symptoms such as headaches, upset stomach, sleeping difficulty, change in appetite and/or poor immune system.
- Intense longing to have the person return to life and experience their presence either physically (to see, touch, hold or smell) or emotionally.
- Questioning “what if?’’ – It is not uncommon to question if suicide could have been prevented or if something could have been done differently.
- Questioning “why?” – This is a common question that people who were left behind ask themselves and sometimes this question may never be answered completely. The reasons for suicide are often complicated and only the person who died could answer this question.
- Rejection – sometimes people may feel that their love and care were rejected by the person who committed suicide; or sometimes people may feel rejected by others when they seemingly don’t offer appropriate support.
- Relief – some people could not help but feel relief especially when the person who died had been experiencing distress and pain for a long time. This is a natural response from a long period of tension and stress and does not mean wishing the suicide to happen.
- Sadness is the most frequent response reported after death of a loved one.
- Searching for the person who died for instance by visiting places where the person used to go in case they will be there. It is also not uncommon for the grieving person to think that they have caught a glimpse of the person who died, to dream about that person or to call their name.
- Sense of acceptance. It is possible to both accept the person’s death as a choice they made to end their pain and feel sadness over what has happened.
- Shame maybe from regret that more could have been done to prevent death or maybe from stigma associated with suicide.
- Shock and disbelief can manifest in different ways, such as losing ability to breathe normally or to complete daily tasks, or to feel detached from reality.
- Stigma. Despite the concerning rate of suicide in Australia, suicide is still considered a taboo subject to discuss. People bereaved by suicide have reported feeling judged by others when death was by suicide.
- Suicidal thoughts.
Can unresolved grief be problematic? The new Diagnostic and Statistical Manual for Mental Disorder (5th Ed., DSM-5) listed Prolonged grief disorder as a syndrome when a bereaved person experiences persistent yearning of the deceased for at least six months after the death. Criteria for prolonged grief disorder include preoccupation with the circumstances of death, difficulty of positive reminiscing about the person who died, and a desire to be together with that person. Prolonged grief disorder has been associated with 6 to 11 times greater risk of suicidality.
Regardless of how one chooses to grief, it is important for the grieving person to continue looking after themselves. It may be by doing things that they enjoy, spending time with other people or being alone by themselves. Looking after self is about identifying what is needed and getting those needs met. Many people also find talking about their grief helpful – it may be to a friend/s or family member/s, a professional who does not know them, and/or to a support group or other people who have been affected by similar experiences. Some people prefer to express their thoughts and feelings on paper instead of talking to others. Other things that can help include spending time outside, making opportunities to remember the person who died, and/or developing a personal ‘emotional first aid kit’ that can be used when feelings associated with grief get too much. Grief can feel crushing and relentless, but processing grief over time will give space for growth to occur and hope to return.
Below are telephone numbers for crisis help and support:
Mental Health Telephone Access Line 1800 011 511
Suicide Call Back Service 1300 659 467
Kids Helpline 1800 55 1800
MensLine Australia 1300 78 99 78
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Public Health England. (2015). Help is at hand: Support after someone may have died from suicide. doi: http://supportaftersuicide.org.uk/support-guides/help-is-at-hand/
Whether minor or severe, chronic pain affects 29 percent of Australians and about 15 to 20 percent of Americans each year. In Australia, the total cost of chronic pain is estimated to be around $34.3 billion including lost productivity, attribution to other illnesses such as depression, heart disease, and cost of the health system.
According to the International Association for the Study of Pain, pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage (Merskey & Bogduk, 1994). The Australian definition for chronic pain is defined as pain that extends beyond the expected healing time of an injury or can accompany chronic illnesses such as arthritis or lupus” (Pfizer Health Report, 2011; Stollznow Research for Pfizer Australia, 2010).
All pain experiences are normal experiences to what your brain thinks is a threat. The amount of pain you experience is not commensurate with the amount of tissue damage. Acute pain is thought to be an important and adaptive signal. It tells us a message or warning that something is damage in our body. Sometimes pain can misinform us. It reminds us that we are in danger and we needs to avoid that.
Pain receptors are called nociceptors, and are scattered all over our body. It transduces noxious stimuli into nociceptive impulses. Electrical impulses are being transmitted to the spinal cord via afferent nerves and then along sensory tracts to the brain. The neural signal will modulate the pain by amplifying it. Consequently, we will experience the pain through this process. During this process psychological and social factors are involved, and as a result it may aggregate the pain.
When we receive our pain signals, some chemicals are produced to calm down the system to inhibit the pain reaction while the other chemicals excite the system to stimulate the pain response. The pain experience is related to ascending, and descending messages and this process happens in the spinal cord itself (Wales, 2012a). If there are more inhibitory chemicals, the person may feel more pain, and if there are less of the inhibitory chemicals, the pain may be less. Messages ascend to the brain through the spinal cord to inform a threat in tissue damage and is called neuropathic pain.
Pain centralized in the nervous system can become very sensitive, and after a while, it adapts to it. In the end, even low-key events are perceived as painful. Fibers with messages descending from the brain involve the sympathetic and parasympathetic nervous systems. Those nerve fibers that associate with the sympathetic and parasympathetic systems make a contribution to the pain experience. The role of the sympathetic system is to protect us during dangerous time by the stress hormone adrenalin and the good hormone endorphin into our body. If it lasts too long, the chemical cortisol will damage our body and brain and will make us feel sick. Chronic pain can lead to depression, mood changes, anger, anxiety insomnia, and it will make the patients feel stressed all the time.
In the early 1960s by Ronald Melzack and Patrick Wall, they proposed a Gate Control Theory. They suggested that pain signals encounter what are called nerve gates in the spinal cord that open or close dependent on a number of factors and may be involved instructions coming down from the brain. When the gates are open, pain messages can get through, and pain can be intense. When the gates are close, pain messages are being prevented from reaching the brain and may not even be experienced at all. It is believed that something must be happening to modulate the experience of pain.
Depressed mood and stress can affect the intensity of the pain the person feels. Dr Irene Tracey at Oxford University demonstrated that subjects even thinking of the pain can add an increase activation in their pain-circuits. She also found out that distraction can also cause some reduction in tension as it obviously disrupts the continuation of the cognitive thinking process that has been focusing on the pain sensation.
On the other hand, people experiencing trauma may have their pain experience shut down at that point in trauma, and the body may also release the beta-endorphins, our internal pain killers, to shut down the pain. However, it is only for short-term. Chronic stress on the other hand does not produce analgesia. Instead, it produces hyperalgesia or increased sensitivity to pain. It is believed that it is triggered by high levels of glucocorticoids that involve some structural rewiring of the central nervous system.
Treatment of chronic pain can be managed by pharmacotherapy such as the opioid drug family. It resembles our own bodies’ pain relievers, the endogenous opiates. Sometimes physiotherapy may require helping patients strength their muscles or ligaments to prevent them from further injury in the future.
There are some treatments and techniques that could help manage the pain. If you are suffering from chronic pain, most of the time you are causing pain with your thoughts and emotions. If this is the case, you could benefit from have a psychologically validating intervention. This could help you work out with some accuracy how your thoughts, feelings, and movements all impact on the nervous system affect your chronic pain. Cognitive behavior therapy treatment is quite effective in helping patients with chronic pain challenge their maladaptive cognitions including catastrophising, all-or-none thinking, and maximizing/minimizing, etc. Somatic quieting is preferable for patients to relax rather than tensing their body muscles thus reducing stress and alleviating pain. Graded or gradual physical activity is involved in the CBT to help patients slowly build up their muscles strengths.
Magnet therapy is believed to relieve Headaches, arthritis, menstrual cramps, carpal tunnel syndrome, and sports injuries (Whitaker & Adderly, 1998). Hypnotherapy is a viable alternative to psychopharmacological interventions for controlling acute, chronic, and postoperative pain, as well as pain from nonsurgical procedures (Patterson, 2010).
Butler, D., & Moseley, L. (Second Ed) (2014). Explain pain. Neuro Orthopaedic Institute. Noigroup Publications.
GoodTherapy.org (2013). Chronic pain. GoodTherapy.org. Retrieved on 2 April, 2017, from: http://www.goodtherapy.org/learn-about-therapy/issues/chronic-pain.
Medtronic (2013). Improving life by easing chronic pain. Medtronic, Inc. Retrieved on 2 April, 2017 from: http://www.medtronicneuro.com.au/chronic_pain_causes.html.
Patterson, D.R. (2010). Clinical hypnosis for pain control. Washington: American Psychological Association.
Pfizer Health Report (2011). Australians living with chronic pain. Pfizer Health Report, 46, p 4.
Satterfield, J.M. (2015). Lecture 19 Mastering chronic pain. In Jason.M.Satterfield. Cognitive behavioural therapy: Techniques for retraining your brain. The Great Courses. Chantilly, VA.
Stollznow Research for Pfizer Australia (2010). Chronic pain. Stollznow Research for Pfizer Australia. Australia: Pfizer Australia Pty Ltd.
Wales, C. (2012a). The nervous system. Chronic Pain Australia. Retrieved on 22 May, 2013, from: http://www.chronicpainaustralia.org.au/index.php?option=com_content&view=article&id=31&Itemid=233.
Whitaker, J., & Adderly, B. (1998). The pain relief break through: The power of magnets. Boston: Little, brown and Company.
Recently I presented a Hot Topic on Emotion Coaching. This is a model that aims to help children regulate their emotions. Research links emotional competence with improved relationships, communication and behaviour so it’s a very useful tool to have as a parent. Below I have outlined the 5 main steps of Emotion Coaching with a short explanation under each one. It’s definitely not a comprehensive outline; rather a taster for anybody wanting to know more. My main source is John Gottman, Ph.D., who is the author of Raising an Emotionally Intelligent Child.
Gottman’s 5 Key Steps to Emotion-Coaching
Being Aware of the Child’s Emotions
Often we’re only tuning in to the high intensity emotions. This can be stressful if both your child and yourself are getting worked up or feel overwhelmed. Remember that there are also moderate intensity emotions and this is what Emotion Coaching is best suited to. Start by trying to increase your awareness of what/how your child is feeling at different points in the day. You will also do well to ask yourself about your own feelings in a range of circumstances. Take the time to talk about and share feelings with your child in an age appropriate way. The more you do this the more natural it will become for you both. If the child is very young, use tangible expressions of feelings e.g. with characters in their play or with feeling faces, drawings etc..
Recognising the Emotion as an Opportunity for Intimacy and Teaching
When it becomes obvious that a child is feeling a particular emotion we are likely to have some kind of reaction. Perhaps we don’t want them to feel that way because it will be uncomfortable for them. Perhaps we want to distract them from it or suppress it because either we don’t have time to sit with them or we can feel that it’s affecting us. Often we fear emotions escalating or think that what we say or do could make it worse. If this is the case, we’re seeing our child’s emotion as something to manage, deal with or discipline. How would that make you feel if someone felt they had to be the boss of your feelings? The key point here is that ignoring emotions or trying to fix them doesn’t make them go away. They just come back bigger the next time.
Acknowledging how they feel is to say “it’s OK to have feelings” and “you matter to me, lets work it out together”. No need to see high emotions as a danger or crisis; it’s an opportunity for intimacy and teaching.
Listening Empathetically & Validating the Child’s Feelings
To listen empathetically is to use both non-verbal and verbal behavior. We have to look like we’re listening with our body and facial expressions and we have to show that we’re listening by what we say. To empathise is to step into the other person’s shoes and imagine what it might feel like at their age to experience that. We might reflect back what we are observing and hearing e.g. “You seem a bit sad”. We then need to validate that it’s OK to feel sad e.g. “I would feel sad if that happened to me” or “I think anybody who lost their favourite toy would feel sad…”
In other words, we don’t want to be dismissive of their emotions. We want to connect with them at that moment and help them to feel understood and that it’s OK.
Helping the Child to Verbally Label the Emotions being experienced
When children are young, sometimes they don’t know what they’re feeling or that there’s even a word for it. This might be the first time they’ve ever felt that way. Your helping them to name that emotion is teaching them about feelings. This can be a worthwhile practice even prior to your child talking as language development starts much earlier than when they say their first words. Feelings are categorized into 5 main groups (as you may have noticed in the movie Inside Out): Joy, Sadness, Worry, Anger and Disgust. We can also coach our children through role modeling: if you are having a feeling in a certain situation then take the opportunity to put words to it out loud. e.g.“I’m feeling very frustrated because the traffic is just not moving”.
Helping Children to Problem Solve (& setting limits where appropriate)
Often children get emotional over an incident that happened or a problem they feel stuck in. This is when we can explore options regarding what to do about it. Problem solving has a step by step method that I won’t go into here but is useful to know. You may find that you already do it quite naturally. It’s important to acknowledge at this 5th step that not all feelings can be ‘solved’. Some just have to be accepted and sometimes they’ll feel uncomfortable. The good thing about feelings is that mostly they are transitory and temporary. This can be a comfort to anybody and a way to even soothe ourselves. As the wise saying goes: “This too will pass”.
Coming soon for more on this subject: go to Online Hot Topics on The Resilience Centre webpage.