Psychological flexibility: What is it and how does it help us?

Like many of you, I have spent much of the last month watching Olympians contort their bodies into some pretty stunning shapes. Seeing such incredible physical limberness on display has also got me thinking about one concept in particular: “psychological flexibility.” Whereas an Olympic gymnast’s flexibility is measured by looking at how their body bends during a floor or vault event, psychological flexibility is “scored” in terms of how far we are able to “stretch” our thoughts and actions during everyday life events. 

Let’s say that during any social event you attend, your mind automatically convinces you that others are going to negatively judge you, no matter what you say or do. Unfortunately, because your mind is unwilling to “bend” towards multiple possibilities (e.g., that others may also judge you positively), it would not receive very high flexibility scores. And instead of winning you a gold medal, this rigid mindset only offers you added worry, anxiety, and apprehension.

The good news is, just like our physical flexibility can be enhanced by routinely stretching our limbs, there are a couple different “exercise” approaches we can use to improve our psychological flexibility as well. While the cognitive approach involves switching up our thinking strategies or shifting our belief systems, the behavioral approach involves switching up our actions or shifting the way we conduct ourselves in a given situation.

For example, let’s say our manager at work provides us with constructive (albeit negative) feedback. Rather than rigidly assume that this feedback means they hate us and are going to fire us, the psychologically flexible method of response would be to fully flesh out the facts and adjust our beliefs to better reflect them. Here, the facts indicate that while yes, we have indeed made an upsetting error at work, we are not being let go. Instead, our manager has actually given us the opportunity to correct our mistakes and learn from this incident. 

Having “stretched” our thoughts in this way, we can then decide what actions are best for us to take. While rigidly assuming that our job is doomed might rigidly cause us to react defensively (e.g., telling our manager “you can’t fire me, I quit”), adopting a more flexible mindset will lead us to develop a more flexible action plan. Perhaps instead of impulsively quitting or arguing back to our manager, we decide to hear their suggestions, apologize for our oversights, and heed their advice in order to prevent this error from happening again in the future.

Behavioral flexibility in this case may also involve “manually” bringing down the physical activation and tension that come with the anxiety we often feel in moments of conflict like this. For example, we could momentarily distract ourselves from this distressing situation by engaging our five senses (e.g., intensely focusing on the sounds, smells, or visual details of our surroundings). Or, we do some square breathing exercises to bring our heart rate down. We could also methodically relax the tense muscles in our body one by one. Regardless of which option we select, all of these actions listed will help reduce the physical symptoms of anxiety and ultimately allow us to manage the situation more adaptively.

Engaging flexibly with our own beliefs, bodies, and behaviors will help us more effectively tackle the challenges that we inevitably encounter in life. When we are better able to change things up and strategically adapt to the demands of the situation, we drastically increase the odds that our own “gold medal” goals will be achieved. 

If you or someone you know would like to become more psychologically flexible and adaptive, our team of CTW clinicians are here to help you get started. Reach out and speak with us today!

Context Is Everything

Many of us are traveling more since COVID.  I recently returned from a trip to Japan to visit my in-laws.  While the trip was nourishing and long overdue, I noticed a significant dip in my mood upon my return.

I gave myself recovery days prior to returning to work, but nevertheless I struggled with upside-down jetlag this week which definitely impacted my sleep, appetite, energy, and mood.  Thankfully, I have experienced this frequently before, and so simplified my week in preparation.

This reminded me of the importance of  context when interpreting our moods. 

There are so many external and internal influences on our moods - travel, illness, hormones, work ramp ups, family demands, nutrition (the list is endless).  But it’s a core skill to assess whether these influences are likely temporary and/or changeable.   For me, I understood that the source of my low mood was  jetlag, and so I was not concerned as I understood jetlag to be a temporary biological phenomenon. This helped me cope; I simplified my week, ate nutritiously, lowered socializing, and was patient with the transition back to my normal circadian rhythm.

The ability to have some meta-awareness about our moods is critical in mood management.  When we notice our lowered mood, we can check the context for our mood shift by asking ourselves a few questions:  1)  Is there something external or internal that is known and influencing my mood?  2) Has anything changed biologically for me this week? 3)  Can I expect this to be temporary?  3) What can I do to anchor or soothe myself today?  4)  Am I willing to ask for support from my friends/family/coworkers?

Here at CTWPS, we are always trying to help our clients expand their self-care repertoire.  Getting curious about the context of our moods is key.

Pillow Talk: Women's Sleep and Mental Wellbeing

Ever tell someone they "woke up on the wrong side of the bed"? While this is just a saying (and the side of the bed we find ourselves on in the morning has little to do with our mood!), sleep, in general, greatly impacts our mental health. This is especially true for women. 

Sleep and mental health have a bidirectional relationship: poor sleep affects the mood and can exacerbate mental health disorders, and an existing mental health condition can affect sleep quality. 

Traditionally, sleep troubles were viewed as an outcome of depression. Yet, increasing evidence suggests that poor sleep could also trigger or worsen depression. Sleep problems and depressive symptoms seem to mutually amplify each other, forming a reinforcing loop. For those struggling with anxiety, the hyperarousal, or "racing mind," associated with an anxiety disorder is a key contributor to insomnia. 

During the night, the body enters the rapid eye movement (REM) stage of sleep. Here, the brain is given the opportunity to process emotional information, analyzing thoughts and memories from the day. Without enough sleep, the body misses out on crucial REM time and the synthesizing of important positive emotional content (Suni & Dimitriu, 2023). 

Women are more likely than men to have insomnia disorder and sleep disturbances. In a survey conducted by the National Sleep Foundation, 71% of women said menstrual symptoms like bloating, headaches, and cramps impacted their sleep. In another study, sleep quality and efficiency tended to be poorer during the menstrual and premenstrual phases than other phases of the cycle. This is attributed to the fluctuating levels of steroid hormones (like progesterone) released during the premenstrual and menstrual phases. Progesterone is the hormone that facilitates pregnancy and has a slight sedative effect. Following a woman's luteal phase, progesterone levels drop dramatically during menstruation, hence the reason for sleep difficulties (Baker & Driver, 2004). 

Cognitive-behavioral therapy (CBT) can prove beneficial if you're struggling with sleep disturbances or insomnia. CBT can help you manage your mood and the thinking processes that impact sleep, as well as providing concrete strategies to support your sleep.   

About Those New Beginnings

In the Northeast, we are pretty much programmed to anticipate new beginnings in September.  We may feel a surge of inspiration and energy that catapults us out of the last vestiges of summer.  

Changes in season often reflect in our mood, at least temporarily.  A key aspect of managing our moods is recognizing the transience of mood.  Everything - including our mood - changes. And while external factors, like a seasonal shift, might impact us briefly, we don’t always have to make a larger negative story out of it.  Sometimes our meta-story about our mood is the culprit in worsening it.   For example, a client might say “Every winter I get depressed”, and the result of that belief is that she feels anticipatory anxiety and dread as the winter approaches.  But a further examination of that statement reveals that most winters (not all) she feels a brief but significant drop in her mood that signals her to then anchor herself in her coping skills, and shift herself out of that low mood.   So a reframe of that statement could be “I typically feel a significant mood drop in late November. I am going to try to get ahead of that by being proactive and practicing my repertoire of coping skills to either prevent, or move more quickly out of a depressed mood if it arises.”  

Changes in mood are inevitable.  But our power lies in our willingness to directly influence the meaning we give to those changes.  If you would like support in doing just that, we’d love to help!

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Shining a Light on Perinatal Mood and Anxiety Disorders

As a clinician whose practice focuses on all aspects of maternal mental health, I was motivated to write June’s blog after reading a tragically resounding story that recently made national news. Among other reactions I had, this story reminded me that the information I hold as a specialist in this area is not common knowledge for the majority of women in this country. As such, through this month’s blog I hope to educate, normalize, and destigmatize a disorder that affects so many American mothers and their loved ones. 

Arianna Sutton had a history of postpartum depression after the birth of her first child. But after her second pregnancy, her symptoms returned more quickly and stronger. Nine days after giving birth to twins, Arianna died by suicide. Tragically, Ariana’s story is not uncommon. Moreso, it underscores the importance for awareness of and knowledge about the most common pregnancy related complication: perinatal mood and anxiety disorders (PMADs). 

What are PMADs? 

PMADs include a variety of disorders and symptoms that a woman may experience during both her pregnancy and the year following birth. Postpartum depression is the most commonly known among them, but it is just one experience that fits under the PMAD umbrella. Specifically, additional disorders include anxiety, panic disorder, postpartum bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, and postpartum psychosis. 

According to Postpartum Support International, approximately 15 to 20% of women (or approximately one in seven) will experience symptoms consistent with PMADs. Additionally, women with a history of clinical depression or anxiety are at a significantly greater risk for developing PMADs, and those who have experienced PMADs during pregnancy are more likely to experience recurring symptoms in subsequent pregnancies. But important to also note is that a woman can be diagnosed with PMADs even if she did not experience symptoms during previous pregnancies. 

Although it captures most of the PMAD-related headlines, postpartum psychosis is a rare experience that occurs in 0.1% of women with onset two to four weeks postpartum (Postpartum Support International). Symptoms include, elated high mood, overactivity, racing thoughts, confusion, mania, suicidal or homicidal thoughts/actions, hallucinations and delusions. Though postpartum psychosis is a medical emergency that often requires hospitalization and medication, with early intervention, symptoms can typically resolve within weeks (Postpartum Support International).

In contrast, the so-called “baby blues” is a very common postpartum experience that occurs within two weeks of birth and whose symptoms include weepiness, fatigue, anxiety, and difficulty sleeping. Though the baby blues are typically resolved with simple self-care practices, if symptoms persist beyond three weeks postpartum, a diagnosis of PMADs may be considered.

Additional PMADs symptoms to be aware of include

• Feeling sad or depressed

• Irritability or increased anger

• Difficulty bonding with your baby 

• Feeling high or elated above and beyond what is typical 

• Reduced need/desire for sleep 

• Anxiety of feeling panicky

• Upsetting thoughts that you can’t get out of your mind

• Feeling as if you are “out of control” or  “going crazy”

• Feeling like you should never have become a parent

• Worries that you might hurt your baby or yourself

Treating PMADs

As many women feel shame, struggle to ask for help, minimize their symptoms, are fearful that they will lose their babies, or have limited support and awareness of PMADs, they often suffer their symptoms in silence. Fortunately for those affected, with proper intervention, PMADs are in fact highly treatable and have a favorable prognosis, often with a combination of medication management and psychotherapy.

Cognitive-behavioral therapy (CBT) is a highly effective form of psychotherapy treatment for PMADs, as it empowers sufferers to work in the “here and now” - as opposed to focusing on family of origin dynamics that are likely not helpful to the crisis at hand - to experience symptom relief.   CBT works with the interplay of a patient’s mood, thoughts, and actions, to provide a patient with alternative perspectives and experiences of her situation, healthy practices that can support her mood, as well as providing immediate coping strategies to the patient.  

At CTWPS, the specialized training our practitioners have into the specific challenges of women with PMADs makes us uniquely qualified to work with affected individuals. We strive to not only provide our patients with effective symptom reduction strategies, but also to normalize, educate, decrease shame, and improve their quality of life. If you, or someone you know, may be experiencing a PMAD, we at CTWPS are here to help and provide support. Reach out today!

References

https://www.today.com/parents/family/mom-dies-suicide-twins-rcna88579

https://www.postpartum.net/learn-more/

Our Boys

My son, a freshman at a large university in the midwest, called me early this week to share the tragic news that a friend of his had died by suicide while on campus.  I write this post still struggling with grief for my son’s friend, his family, my son, their community, and for the many young men struggling with their mental health in seeming isolation. My son was profoundly shocked by his friend’s suicide, and saw no warning signs, no signs of distress, no drug or alcohol use, or any form of self-harm by his friend. He is unable to wrap his mind fully around this, nor am I, even as a psychologist and therapist.  What I often believe about suicide is that the suicidal person is in a profoundly altered state.  But of course, I can’t really know that to be true.

While we all have heard the statistics on the mental health crisis facing young people, it is important to acknowledge that young men sadly are more apt to commit suicide than young women, perhaps partially because they typically  use more aggressive means to do so. Per the CDC, men die by suicide nearly 4 times more than women. While the mental health of young men and women is deeply concerning, young women may be better at expressing their high risk ideation and seeking help as compared to young men. 

I mourn the seeming mental isolation of my son’s friend, but also the many young men in the world who may not be able to find a way to share their suffering with others.  I write this not to provide a psychoeducation on suicidality, but to encourage us all to reach out and connect more to the people that matter in our lives.  To talk more, to open up all sorts of conversations - especially with our boys and young men.  The conversations don’t have to be serious, psychological, or profound, I think it’s ok to start with the silly, the mundane, the playful.  

But however it is that we connect, are we willing to connect some more?