Way To Go, Godot!

People communicate with each other constantly, and in ways we hardly ever even realize. You heard that right: even a truly prolific writer is unlikely to ever match in written words the sheer volume of information that is constantly transmitted to the people around them, in the form of body language, expressions, small gestures, barely detectable fluctuations in muscle tone, in vocal cadence. Beyond these measurable types of physical communication, there’s another level of communication buried under and between the language itself. It occurs just as automatically as body language and just as pervasively. And, like body language, we usually don’t even realize we’re doing it.

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Let’s look at an example. You’re walking down a busy street, and someone is walking toward you in the opposite direction. But for some strange reason, you can’t figure out which way he’s going to go. Left? Right? He’s looking at you as if you should know. You become confused and enraged. In your mind you are calling him a schmuck. So you tell him to watch where he’s going.

What a strange thing to say. Why would you want him to watch where he’s going? It seems like you only want him to make up his mind about what side of the sidewalk he’s going to walk on and then do it. Actually, the failure in this situation is not really a failure of decision-making, but of communication.

When we’re walking on a crowded street, we’re constantly looking into the spaces that we want to navigate our bodies into and between. At the same time, we are unconsciously noting the spaces that other people are eyeing and making automatic adjustments to accommodate them. When we ask someone to watch where they’re going, we’re effectively asking them to tell us where they’re going so that we can act accordingly. And even though we don’t know exactly what we mean—at least on any conscious level—we tell them in plain language exactly what to do. And they usually do it, too.

There are many more perfectly concrete expressions like this that we use all the time while never understanding or even feeling a need to understand their meaning. We don’t question them because they already make perfect sense to the parts of us that know what they mean. Which means, of course, that the conscious mind that you identify as “me” is not the only part of you that communicates with the other people in your life. Much of the time, it’s ’someone else’.

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This has real implications for our relationships, and for those parts of our livelihood which depend upon communication with others. It is not uncommon for people to unconsciously sabotage themselves by thoughtlessly communicating their fears, insecurities, or hidden motives. The way a poker player displays “tells” indicating the type of hand they are playing, and the way a pedestrian on a crowded street gives signals indicating their next steps, so are all of us constantly telling each other what kind of internal experience we’re having, what we want, and what we’re doing.

The only way to improve the chances that your unconscious communications will be in line with your conscious goals is to work on improving the overall integration of your personality. As daunting as that may sound, it can be accomplished through the use of things like meditation, spiritual practices, and psychotherapy.

Can you think of a situation in which you may have unconsciously interfered with your own plans? Post a comment about your experience.

When you’re considering psychotherapy, you should remember that the most important aspect of the treatment, in terms of predicting whether it will be effective for you, is the relationship itself. A deeply trusting and cooperative relationship with your therapist must be developed in order for all the other things that need to happen to happen. So, first of all, find a therapist you like and feel understood by. That means calling up a few different therapists and speaking with them over the phone, maybe even going in for consultations, until you find someone who you feel like you can relate to.

The next thing to understand is that different therapists will approach the treatment from different angles. I’ve spoken with an awful lot of people who had “tried psychotherapy” and been disappointed by a therapist whose treatment style just didn’t mesh with their own way of thinking. In some respects, the ability to adapt to the needs of the patient is the mark of a really good psychotherapist. But there is also an element of the basic theoretical underpinnings of different types of therapy simply not being a good fit for a certain individual’s personal style. So you may want to look for a psychotherapist whose theoretical orientation is basically appealing to you.

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There are three major theoretical schools in modern psychotherapy: Cognitive Behaviorism; Humanistic, also called Client-Centered; and Psychodynamic. Each of them approaches the patient and the treatment from a different place, and they will each feel very different to you in practice. There’s been a good deal of research to try and determine which of these is the most effective, and it’s pretty much all come back that they are equally effective, so I think you should simply go with whichever one seems most appealing to you (or whichever one your favorite and most respected therapist happens to practice.)

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Cogntive Behavioral Therapy approaches the treatment from the understanding that we are all engaged in a dialogue with ourselves all the time. It happens automatically, and it’s one of the main ways that we generate feelings and behaviors. That applies to positive feelings as well as negative ones, so a Cognitive-Behavioral therapist will attempt to help you identify the automatic negative thoughts that are making you feel and act in suboptimal ways. Once you’re able to recognize the cognitive mistakes that have been lodged in your thought process, this type of therapist will help you to modify these ways of thinking, so that your automatic thoughts are more conducive to the types of emotions and activities that you want.

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Humanistic or Client-Centered Psychotherapy approaches the treatment from the understanding that every person has an inherent tendency to grow and to improve—to self-actualize. And that all we need to activate our tendency to begin growing into better versions of ourselves is just a basic level of nurturance and empathy. So, a Client-Centered psychotherapist will gradually help you to experience the therapeutic relationship as a place where you will never be rejected, no matter what happens. They will allow you to explore your own emotions and come to your own realizations at your own speed, by providing you with the basic ingredient of simple, unconditional positive regard.

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Psychodynamic Psychotherapy approaches the treatment from the understanding that we are all thrown into this world cold and naked, surrounded by omnipotent giants whom we are absolutely dependent upon for survival. From there, we simply do whatever we have to do to adapt to that situation—and we generally do a very good job of adapting. The difficulty comes when the situation changes. Despite finding new situations and new people, we generally tend to feel and behave as though we were still in the same situation with the same people. So, a Psychodynamic psychotherapist will spend some time helping you to understand the ways you adapted to your early life, and how those early experiences are affecting your current circumstances. Then they will help you to reconfigure your approach to the world so that it is more flexible, and more congruent with your current situation.

Those are the three major types of psychotherapists that you’ll encounter in the wild. Of course, there are a wide variety of offshoot sects and in-betweener “eclectics” with whom your mileage may vary. The important thing is that you can personally like and respect the therapist, and feel liked and respected by them. It is also important that you enter into the therapeutic relationship with a good understanding of how your therapist will approach the treatment and why. In many cases they will offer you an explanation of how they work as a part of the early stage of therapy, but if they don’t you should definitely ask.

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This is because psychotherapy is a collaboration. There is no magic pill for the therapist to feed you to make you perfectly happy and well-adjusted, and there is nothing the the therapist can really do “to you” to make it happen either. It’s going to take some work on your part. A good therapist will be able to help you to feel motivated to do that work to some extent, and to help you figure out exactly what types of things you need to do, but do not expect to enter into psychotherapy as a passive recipient of treatment. That’s why it is so important for you to know what is going on in the therapy, to understand your therapist’s theory of change: so that you have some idea of what you’re expected to do if you’re going to change yourself and your life for the better.

In my work with sufferers of chronic pain, I’ve taught hundreds of people to practice mindfulness meditation. I do this not only because mindfulness meditation is in itself an effective treatment for chronic pain, but also because it helps the practitioner to manage their thoughts and emotions more effectively. It can help you to boost your creativity and can even improve your hypnotic ability.

Mindfulness meditation is probably the simplest form of meditation. It is deceptively simple; a lot of people have difficulty understanding how doing so little can have such deep and powerful effects on well-being. In studies with headache patients practicing mindfulness meditation every day for just 20 minutes a day, the most notable psychological effect of the practice was a pervasive sense of improved control. This is a common experience for people who take up the practice of mindfulness meditation:

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1. Mindfulness meditators experience an improved sense of control over their own physical sensations. For sufferers of chronic headaches or other types of chronic pain, this comes on as a noticeably higher pain tolerance. Other people who practice this type of meditation often find that their ability to comfortably exercise also improves, and that they begin to feel generally more comfortable in their own bodies.
2. Frequent mindfulness meditators also begin to notice an improved sense of control over their thoughts—a growing ability to think with more intention and to pare down the types of racing thoughts that anxiety brings about. If you find yourself worrying all the time, being easily distracted, or feeling overloaded with information, this effect will be particularly useful to you.
3. Similarly, frequent meditators typically experience an improved sense of control over their emotions. If you often feel moody or irritable, or become frustrated more easily than you wish, mindfulness meditation is a fantastic way to develop a more balanced and enjoyable emotional life.

The way that mindfulness meditation does all of this is by activating and exercising the frontal cortex of your brain, which is the command center of the entire brain. That means it is responsible for regulating almost all of your conscious activity. Anytime you’re feeling particularly focused, are engaged in problem-solving activity, or are working very hard to moderate your emotional expressions, the frontal cortex is at work. So by exercising this critical area of the brain, mindfulness meditation strengthens your ability to do all of these things. If you do it for long enough, the increased activity and bloodflow in the frontal cortex actually begins to physically alter the structure of your brain. After years of regular meditation practice, the cortical tissue actual grows thicker and more robust, like a muscle that has been regularly worked out.

I’ve already mentioned that this technique is deceptively simple. All you have to do is to pay attention to something. Anything, really—a very good place to begin is with your breath. Just paying attention to your breath.

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1. Begin by finding a comfortable position where your body can feel reasonably relaxed. If you know any relaxation exercises like diaphragmatic breathing or progressive muscle relaxation, you may find it easier at first if you first get yourself nice and relaxed before beginning.
2. Now begin to pay full attention to your breathing. You don’t have to change anything about it, just pay attention to it. Notice all of the physical sensations associated with it. For example, you might notice the sensation of the air going in and then out through your nose or mouth. You’ll probably be able to detect some differences in the way the air feels going in, versus the way it feels going out. On the way in, you’ll probably notice that the air is a bit cooler. There may even be a little bit of a tingling sensation associated with it. On the way out, the air will probably have a warmer, softer quality to it. Notice any changes that you might be able to feel in your face as you breathe in and out, in and around your sinuses, through your cheeks and eyes. Notice the way the muscles naturally push and pull in your chest, and any sensations in your lungs. Just try to completely attend to any and every aspect of your breathing that you can notice.
3. Inevitably something will distract you from this simple task at some point. Some people find it difficult to block out noises or commotion happening around them. This is perfectly okay. As soon as you realize that you are being distracted, simply take note that this has occurred and calmly return to your breathing. If you feel irritated or frustrated, that’s okay too. Just allow yourself to focus as fully as possible on your breathing and nothing else. Many people also find that their minds wander; one minute you will be attending to your breath and the next you will find you have been thinking about something else—worries, responsibilities, plans, ideas. This is also okay. When you notice that you have been distracted, simply return to your breathing, again paying attention to the simple, natural motion and all of the sensations which it brings about.
4. Keep trying! Don’t get frustrated! When you get distracted, you should know that absolutely nothing has been lost. The whole point of this exercise is to train your brain to be able to focus more effectively, and it is a slow and easy process. Some days you will find it easier to focus, and other days it will be harder. Even on the days that it is completely difficult, however, the positive effects of the meditation that we have discussed here will still be taking place—perhaps even moreso! The struggle itself is the activity. So there, when you lose your concentration, you can even feel good about it, because by the time you realize that you have been distracted, you will already have realized, and then you can return to being mindful.

This is something that you can do in whatever amount of time you have available to you. Personally, I like to practice meditation on my morning bus commute—the time costs me nothing and the extra distractions give me something to work on! But literally any time that you have available to you will do. Ideally, you’ll spend at least 10-20 minutes at a time practicing mindfulness at least once or twice each day.

As your skill increases, you may find that you’re motivated to spend even more time meditating. It won’t be long at all before you will be able to comfortably sit for an hour or more, doing nothing but being mindful of your breath or whatever else you have chosen to be mindful of.

And that brings us to the final point of this lesson, which is that in time you will find that nearly anything you do can be done mindfully. When you begin practice, it will be beneficial to stay in one spot, and pay attention to a simple, natural, effortless process like breathing. But when you have become relatively proficient in this practice, you can begin to branch out into other more complicated forms of mindfulness meditation.

You can, for example, walk mindfully, by simply taking your time and paying attention to each muscle movement, to each exertion of pressure against the bottom of your foot, to the sensation of the breeze passing against your face, and to the faint sound of your clothing rustling against your body. You can eat mindfully by chewing slowly and deliberately, paying attention to each little explosion of flavor and texture on your tongue, by attending to the movements of your jaw as you tear or grind or perforate your food, by being mindful of the sensations of the food traveling down your esophagus toward your stomach.

If you try this technique for a little while and decide you’d like to get a little heavier into it or have some extra guidance, I recommend Jon Kabat-Zinn’s excellent audio program Guided Mindfulness Meditation. In the meantime, I’m here to help, so please post your comments here about your experiences. Let me know if you would like clarification on anything I’ve talked about here, tell me what parts of the experience you found particularly easy or difficult, and feel free to ask any questions about how to improve your practice for maximum effectiveness and enjoyableness!

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On some level, most people recognize that psychological factors affect physical health. People basically seem to know, for example, that a stressful career or a ‘Type A’ personality might give them a heart attack, or that an abrasive colleague can give them a headache.

What most people aren’t fully aware of is the profound interconnection between the mind and the body. The past twenty or thirty years have seen an explosion of research on the ways that the mind and the body relate to each other. The further the research goes, in fact, the less it looks like there is a mind apart from the body, or a body apart from the mind. Everything that happens to your body has an effect on your thoughts and feelings, and every emotional or intellectual event has effects on your body.

The upshot of this is that you can improve your physical well-being through purely psychological means—just by talking to someone, or by thinking a certain way. There are purely psychological ways to:

Prolong your life

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Psychotherapy doesn’t just improve your emotional health and well-being, it actually tends to improve your physical health as well. A particularly dramatic example of this is the effect of psychotherapy on the terminally ill.

At least six good studies so far have examined the potential benefits of psychotherapy for terminal cancer patients by randomly assigning some of these patients to participate in individual or group psychotherapy. We’re not talking about any specific, cancer-focused therapy or mind-body voodoo, just good old regular psychotherapy. So these patients, who had been told they were definitely going to die talked about their feelings, and their backgrounds, and what they were going through and how it related to their past experiences, and so on.

And you know what? These patients ended up living twice as long as their counterparts in the control group. The control group received the exact same medical care, administered by the same staff, in the same setting. But they only lived an average of about 9 months, versus a full year and a half for the psychotherapy group. Imagine if you could double your lifespan just by talking to someone.

Reduce your symptoms

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While those kind of results definitely seem pretty fantastic, I can assure you that psychotherapy can be extremely effective for a wide range of physical illness. A great example is irritable bowel syndrome, or IBS. Psychotherapy is not only an effective treatment for IBS, it is now the preferred treatment for IBS. Psychotherapy is better at calming down an irritable bowel than any medication or combination of medications that have yet been tested.

My own patients at the Diamond Clinic suffer from chronic headache pain. Naturally, they tend to have a lot of resistance to the idea of going to psychotherapy, oftentimes because their medical doctors have been telling them the pain is “all in their head” when in fact they feel actual physical pain right there inside of their actual bodies. “I’m not crazy,” they object, “I just have headaches.” And they do. But the fact remains that the patients who seek out and regularly attend psychotherapy tend to improve more than the patients that don’t.

Prevent and control pain

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Some of the more targeted psychotherapeutic techniques can have particularly amazing results. Clinical hypnosis, for example, involves nothing more than talking to someone in order to help them achieve a state of extremely focused relaxation. And yet, people who cannot tolerate anesthetic drugs can often achieve the same effect through hypnosis.

When I say the same effect, I actually mean a better effect. Patients who undergo surgery using hypnosis instead of anesthetic drugs not only experience no pain, they actually usually enjoy the experience very much. There are also a number of side benefits: these patients tend to bleed less during the surgery, resulting in faster surgery times and lower cost; they tend to require much less pain medication after the surgery; they tend to experience far less physical and emotional discomfort overall; they also tend to heal up much faster, and much nicer.

Convince your body to cooperate

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When I talk about improved quality of healing, I’m especially thinking about all the great research that’s been done on spinal surgery. Spinal surgery is one of the most delicate and difficult surgeries to perform, because the tissue itself is so complex, unique, and fragile. But you can be an absolute artist of a spinal surgeon, and perform the surgery completely flawlessly, and close everything up so that it looks beautiful and perfect. And in a couple months, the corrected area might very well just heal up into a gnarled mess of scar tissue. Or, it could still look great.

It turns out there are measurable psychological factors involved in this healing process. By administering a quick psychological test before the surgery, we can actually predict how well your surgery is going to heal. By using psychological techniques to modify the factors that interfere with proper healing, we can actually improve the healing of surgical wounds.

Make right what once went wrong

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I saw a man with an alcohol burn over 90% of his face. He arrived at the ER with his whole face a big red swollen mess. He was fortunate enough to find himself at a hospital where someone trained in clinical hypnosis was on staff. This doctor placed the man into a nice hypnotic trance, and suggested that his pain and swelling would both begin to reduce and simply go away.

Within a half hour, this guy was voluntarily turning down pain medications. He simply wasn’t in pain. Not only that, but the inflammation response in his skin actually turned off. His face stopped swelling and began returning to its normal size. The damaged layers of skin then began to reattach to the rest of his face, and the affected cells slowly began to be cleared out.

Within two weeks, you couldn’t even tell that this guy had ever been burned. There was one tiny red patch above his eye; that was all that was left. Ordinarily, this type of injury would have resulted in severe and prolonged pain, extensive scarring, and risk of infection that would lead to extremely painful cleaning procedures.

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As crazy as it all sounds—and it does sounds crazy—just having someone talk to you in the right way at the right time can do all of these incredible things. Psychological interventions can alter the course of a disease, regulate digestive and immune functioning, alleviate existing pain, prevent new pain, control bleeding, improve healing times, and turn off the types of inflammation responses that happen when you’re burned or have an allergic reaction. In many situations, seeking help from a psychologist could be the best health decision you could make.

For thousands of years, life was simple. You spent most of the day dawdling around with your family. You dozed, made arts and crafts, tended fires, gathered nuts and berries. The only time this lifestyle got hectic was when it was time to track and kill an animal, or when it was time for you to run away from an animal that had it in mind to track and kill you. Simple, acute stressors that you could fully recover from within an hour. There were other sources of stress, of course: fighting for dominance within your group, and fighting against other groups. These probably occurred relatively infrequently, and probably usually didn’t last that long.

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When we are presented with something stressful, our physiology responds fairly dramatically. Stress hormones like cortisol are pumped into the bloodstream, inducing a variety of physical changes: increase in heart rate, increase in blood pressure, increased blood flow to the major muscle groups, decreased blood flow to the extremities, down-regulation of immune functioning, decreased digestive activity.

These all happen to be very good things when immediate survival is threatened. The changes in blood flow work to ensure that your major fighting and running muscles have an adequate supply of oxygen and glucose to either fight to the death or run away. The decreases in immune and digestive functioning ensure that no precious energy is wasted on functions that, while necessary in the long run, have no bearing on survival in a fight-or-flight situation.

The problem is that our modern lifestyles expose us to a new and different type of stress, while our bodies continue to use the age-old adaptations to manage it. The stressors most of us encounter these days tend to be somewhat less severe, and much more frequent. They also lack the clear boundaries of their ancient predecessors. We no longer worry about the kill; now we worry about the bills. We worry about the number of crimes committed in our neighborhood, we worry about problems communicating at home, we worry about our self-esteem. The problem has shifted from an acute biological one to a chronic psychological one.

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The physiological effects of the stress, however, remain the same. This is why your doctor will tell you that your stressful lifestyle can give you a heart attack. Prolonged increase of heart rate and blood pressure increase the risk that your heart and blood vessels will fail to withstand the pressure, resulting in heart attack and stroke.

There are subtler effects as well. Most people realize that the immune system plays a role in the eradication of pathogenic invaders, but many do not understand that it is also involved in the body’s natural housecleaning processes. Cells that are dead, dying, or poisoned must be cleared out in order to avoid resource waste, to reduce the risk of infection, and to prevent mutations. If the immune system is not functioning optimally, your risk for all of these outcomes is proportionately increased.

The same goes for digestive processes. If your guts are being mostly shut down most of the time, you’re likely to suffer various forms of malnourishment. This further reduces your defense against stress by reducing your energy levels, and further reduces your defenses against disease by inhibiting immune functioning some more. It’s generally a bad state to be in.

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Life, of course, is going to continue to be chronically stressful, and so we will all continue to be placed at risk for the medical events and degenerative diseases that chronic stress facilitates. However, there are a ways to reduce the effects of that stress. They all involve the invocation of your body’s natural relaxation response.

Just the way your body has a fully integral stress response, it also has a relaxation response. The relaxation response reverses the effects of stress by clearing out the stress hormones from your blood, reducing your blood pressure and heart rate, and returning your digestive and immune functioning to normal. In short, the relaxation response returns your functioning to its normal, healthy, resting state.

The relaxation response can be invoked through any type of active relaxation activity, such as relaxation exercises, mindfulness meditation, or self-hypnosis. Passive relaxation such as listening to music or watching TV—while enjoyable—do not seem to activate the body’s relaxation response, and so do not have the same positive health impact as active relaxation.

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In upcoming articles, I’ll talk about specific methods for activating your body’s relaxation response, as well as ways to use those same techniques to improve your mind-body relationship in ways that can have a direct impact on your physical health.