Recovering from Perfectionism

perfectionism

I had a mentor once, whose mentor who had instructed him, “It’s important to make five mistakes a day.” While for many, this might seem to be an easy assignment, accomplished quickly through wrong turns while driving, incorrect references in speech, maybe forgetting to throw the laundry in the dryer, perhaps an errant email spelling, for those who struggle with perfectionism, the task might seem unimaginable. The thought of making a mistake, let alone five of them, can elicit discomfort, anxiety, even dread.

Perfectionists hold themselves to rigid standards in action, performance, and speech.  If they don’t perform up to these standards, they will often rehash and review, berating themselves for erring or not performing up to par. The perfectionist has a judgmental, unforgiving inner critic. That perfectionists hold such impossible standards often inhibits any behavior, with individuals frozen in fear that they’ll mess up. It’s not surprising that perfectionists often procrastinate. Perfectionists might also impose their rigid standards on others in their lives, including coworkers, partners, children, and friends, disappointed and angry when these individuals don’t measure up.

Perfectionism is correlated with several mental health conditions, including anxiety, depression, and eating disorders. Moreover, those who have perfectionistic tendencies often struggle with balance, acceptance, self-care, and self-compassion – all elements in a healthy emotional life. It’s not surprising that perfectionism is correlated with poor physical health.

Still, perfectionists are typically reluctant to lower their standards, afraid that if they dial back their expectations, their achievements will take a hit. But seeking perfection can interfere with learning, creativity, risk-taking, and flexibility, variables that can actually promote achievement.  As Winston Churchill said, “Perfection is the enemy of progress.”

What does recovering from perfectionism look like? It’s setting a high bar and learning from our mistakes. It’s settling for “good enough” and living a life in balance.  It’s making those five mistakes a day, sometimes less, sometimes more. It’s starting when the end (or outcome) is uncertain. It’s saying, “I’m okay,” “I’m good enough,” and “I deserve” as many times as necessary until we believe these words. It’s finding compassion for ourselves and others, toward the goal of peaceful living. And finally, it’s simply being human and embracing our messy, flawed, and evolving selves.

Are You Suffering from Meta-Depression?

meta-depression

Do you struggle, or have you been diagnosed, with depression? The DSM-5 criteria for a major depressive episode include:

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels
    sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and
    adolescents, can be irritable mood.)
    2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
    (as indicated by either subjective account or observation.)
    3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight
    in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to
    make expected weight gain.)
    4. Insomnia or hypersomnia nearly every day.
    5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective
    feelings of restlessness or being slowed down).
    6. Fatigue or loss of energy nearly every day.
    7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day
    (not merely self-reproach or guilt about being sick).
    8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective
    account or as observed by others).
    9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan,
    or a suicide attempt or a specific plan for committing suicide.

One criterion that isn’t included in this symptom set but is sometimes observed in practice is what we might call “meta-depression” – feeling depressed about one’s depression.  Sample thoughts might include, “I’ve been feeling depressed for so long, I can’t take it!”, “I’m so sad that I have to go through this,” or “Why is this happening again?” Accompanying feelings might include hopelessness or despair. The experience is clear. Part of why you are depressed is because you are depressed, creating a loop of suffering.

Depression is not a choice. Multiple factors, including genetics and biology, trauma, and life circumstances, can all interact to cause a depressive episode. Many of these factors exist outside your personal control, though choosing treatment is a volitional decision that incorporates other choices, such as  behavioral activation, identifying and challenging thoughts, processing trauma, addressing co-occurring conditions, and potentially going on medication.

Another aspect that you can control is how you experience your depression. Do you fight against it, trying to ward it off, denying it exists? Are you angry at it, or the universe for sending it to you, a sign of meta-depression? Or, do you accept that you are depressed and try to do what you can to get the help you need? We know from Dialectical Behavior Therapy (DBT) and from Acceptance and Commitment Therapy (ACT) that acceptance plays a powerful part in the recovery from various symptoms and disorders. Instead of fighting against challenging thoughts and feelings, accepting them can defuse them and often leads to their passing more quickly.  DBT’s concept of radical acceptance, accepting life as it is, removes the struggle from many of our experiences. As we know, depression is draining enough, and using our energy to deny or refuse to accept it is energy that could be used toward recovery. The next time you find yourself depressed that you’re depressed (or experiencing meta-depression), see if you can toss aside the “meta” – depression is challenging enough to address; you don’t need this additional battle to fight.

 

Permission for the New Year

new year

For many, the New Year is filled with cocktails and celebrations, hope and possibility, and family and friends. For others, the holiday might be difficult, potentially fraught with anxiety and regret. Part of the challenge that some of us experience might result from the expectations we typically attach to the new year – expectations of fun, reflection, and growth.

If New Year’s Eve – or the new year as a whole – is difficult for you, it’s time to examine and challenge some of these expectations. December 31st and January 1st are just two calendar days and need not have any other connotations. On this new year:

  1. You have permission to choose not to celebrate. You can treat the new year just like every other day, and you don’t have to defend this choice.
  2. You have permission to celebrate New Year’s Eve in your own unique way, even if others judge or don’t understand your choice.
  3. You have the permission to stay home, avoiding crowds, festivities, and fun.
  4. You have permission to cuddle up with a book or a movie and call it a day.
  5. You have permission to fall asleep before midnight.
  6. You have permission to celebrate without alcohol.
  7. You have permission to eat more than you intended.
  8. You have permission to be sad, anxious, jealous, or angry, and to acknowledge and honor any other feelings that come your way.
  9. You have permission to refuse to set any New Year’s resolutions.
  10. You have permission to avoid reflecting on the year that was, promising for something better yet to come.
  11. You have permission to avoid falling prey to any seductive New Year’s diets you encounter. Diets do not work.
  12. You have permission not to knock yourself down while setting resolutions.
  13. You have permission to wake up on the 1st and act like it’s any other ordinary day.
  14. You have permission to take care of yourself.
  15. You have permission to say “No, I don’t want to.”
  16. You have permission to ask for more.
  17. You have permission to change your mind.
  18. You have permission to be your authentic self, today and every day.
  19. You have permission to grow at your own pace.
  20. You have permission to create your own set of permissions.

Contact us at Gatewell for better understanding and/or execution of any of the items on this list.

Beginner’s Mind

beginner's mind

Be willing to be a beginner every single morning.  – Meister Eckhart

Dialectical Behavior Therapy (DBT) refers to the concept of “Beginner’s Mind,” a Zen Buddhist practice of keeping your childlike openness and readiness to experience.

Think about how often you zoom through your days mindlessly and robotically. Imagine if everything you did, you did instead as if you were doing it for the first time. Picture yourself during your daily commute or taking your morning coffee. This is a novel experience each and every time. What do you see, hear, or taste? What if every day, you approached these experiences as if they were your first, rather than monotonously going through the motions? What would you focus on? Would you be more present? Can you imagine the effect? Do you feel a sense of wonder or excitement bringing a child to your favorite restaurant, theme park, or activity? That’s because you’re picturing the experience through the child’s eyes – beginner’s mind!

Shunryu Suzuki writes: “In the beginner’s mind there are many possibilities, but in the expert’s there are few.”  When we become “experts” on places or situations, people or things, we shut down to possibility, to incorporating novel information, points of view, or opportunities. But if we remain open and curious, so many possibilities await us.

Yes, this is a cup of coffee, just like the one you had yesterday. But is it really the same? If you brewed it yourself, did the liquid drip at the exact same rate? Were you watching? Is it the same color or density? How do the flavors blend in this uniquely brewed and flavored cup? There’s a wonderment that exists when we make each situation, no matter how many times we’ve lived it, something novel. And, the more we pay attention to detail, focusing on what is immediately present, the less we drift off into past or future, typical triggers for anxiety and depression.

Can you try Beginner’s Mind today?

Coping with a New Medical Diagnosis

medical

Receiving a medical diagnosis can stir up all sorts of emotions, including sadness, fear, and hopelessness. Whether the diagnosis came out of the blue or after a significant period of symptoms and diagnostics, attaching a label to the experience – particularly one that has chronic implications – can be traumatic and, typically, life-changing.

To help you cope with a new medical diagnosis, we’ve compiled a list of tips that can reduce some of the distress around the diagnosis and help you to feel more supported and empowered.

  1. Seek out information – BUT, look to professionals as sources. This is not the time to consult with Dr. Google, as the information you find online might be incorrect, might not apply to you, and won’t be interpreted through a professional lens.  Ask your doctor(s) all the questions you can think of regarding your condition, your prognosis, and your treatment plan. It’s helpful to make a list of questions you have before each appointment and to take notes during the appointment. It can also be helpful to bring along a trusted friend or relative to your appointments. Sometimes, when we hear emotional information, our ability to think clearly and encode memories gets fuzzy.

2. Take care of yourself. While self-care is an important task for everyone, it’s crucual for those who have a medical diagnosis. Get on a sleep schedule and eat regular meals. Make sure you’re taking your medications as prescribed. If you have medical clearance to exercise, engaging in physical activity can help lower stress and improve your mental state. Listening to some of your favorite music, cuddling up with a good book, spending time with your pet, or taking a day trip to a beach or lake can help round out your self-care practices.

3. Don’t forget who you are and what makes you tick. A medical diagnosis has the potential to swoop in and takes over your daily life. Attending medical appointments, changing your routine, and worrying about symptoms and outcomes can become all-encompassing. But, if you continue to focus on your relationships, your hobbies, and other features that make you you, the illness can be just one of many parts of your identity.

4. Seek out social support. Reach out to family and friends on a regular basis. Ask for help. Perhaps you can find a support group or community of those who have a similar diagnosis. Remember, it takes a village.

5. Get professional help. A medical illness can take a significant toll on your emotional well-being. Those who struggle with medical conditions commonly suffer from anxiety,  depression, and symptoms of trauma. It’s as important to treat the mental symptoms as it is the physical ones.

Tips for Managing Anxiety and Maintaining Sobriety During Holiday Family Functions

holidays

Guest blog by Jennifer Scott

Some people feel dread when it comes to celebrating the end-of-year holidays. Their dread often centers on having to spend the holidays with difficult family members, who somehow always manage to bring negativity to holiday events, creating the opposite of joy and cheer.

What happens when family gatherings also tend to make you stressed out and anxious? How do you keep tensions low and focus on the fun without being struck by an anxiety attack? Recalling past family gatherings, you may lack confidence that you can actually enjoy the festive season without suffering from anxiety.

This can be possible, if you implement the following tips.

Process Your Negative Emotions

It’s important not to suppress the dread or other negative emotions you are feeling about mingling with family again. But instead of just riding the wave of negative emotions, do your best to actually process these so that you eventually come to appreciate the silver lining of family functions. Write in your journal, write a fictional piece about your family, express your family hang-ups through art, meditate, or talk to a friend about your family, and try to make it your goal to see the bright side of things. Make it your intention not to allow difficult family relationships to bring you down when it’s finally time to sit across the table from grumpy Uncle Pat or have your cheek pinched by annoying Aunt Jenna.

Bring Your Pet Along

Bringing your pet along to a family holiday gathering can alleviate tensions. If it’s okay with the hosts, being able to bring your pet can help you “survive,” as your pet affectionately keeps you company. He or she can be your oasis of love and calm just in case family bickering breaks out, causing tensions to elevate.

Bring An “Orphan” Friend

Similarly, you can invite a friend along to the party who couldn’t or didn’t want to join his or her own family for the holidays. Such “orphan” friends can be lifesaving because they automatically force the family to be on better behavior throughout the family holiday event and they can inject some welcome positivity to the whole affair, making you laugh when you’d otherwise be feeling stressed or anxious. Plus, they can provide a fresh perspective on the event and the conversation that transpire. Being able to hear an outside opinion of your family members can shed some valuable light as to how to react to the same family members during similar events in the future.

Practice What You’ll Say

If you suffer from anxiety but also are in addiction recovery trying to permanently ditch alcohol, it’s valuable to practice what you’re going to say to relatives who may not understand why you’re not drinking or who try to get you to drink. A simple, straightforward statement that you won’t be drinking is the best approach to keep your relatives from making you feel uncomfortable. Practice what you’ll say with your therapist or a close friend before the event.

Remember, recovery is made possible when you declare your intention to the world that you won’t be drinking ever again. Studies have shown that cognitive-behavioral therapy is especially helpful in achieving and maintaining recovery, even when surrounded by those who imbibe.

A Takeaway

By implementing the above tips, you can do a lot to overcome the stress and anxiety-fueling tensions that sometimes arise during holiday family functions. Counting on support to get you through, and engaging in emotional processing and intention setting, are some ways you can move past the negatives and focus on the positives of such events. If you are a recovering addict, firm up your resolve to set boundaries and use the event as an opportunity to present your confident, sober self to your family members.

 

For professional help coping with anxiety or alcohol/drug concerns, contact us at Gatewell.

Panic Attack Coping Statements

panic attack

Panic Attacks Defined

You’re on a plane. . . or in your car. . . or in a restaurant. . . or seated in class or at work . . when all of a sudden it happens – a panic attack.

The DSM-5 defines a panic attack as an experience characterized by four or more of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • A feeling of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, lightheaded, or faint
  • Feelings of unreality (derealization) or being detached from oneself (depersonalization)
  • Fear of losing control or going crazy
  • Fear of dying
  • Numbness or tingling sensations (paresthesias)
  • Chills or hot flushes

The experience of fewer than four of these symptoms may be described as a limited-symptom panic attack, or more colloquially, an anxiety attack.

For those who have suffered panic attacks, these can be some of the most frightening experiences there are, especially when you don’t know what they are. Learning how to cope with them is key – and can reduce their intensity and duration. While the following coping statements don’t serve as a substitute for professional treatment, they can help you begin to weather these attacks.  Some might also be helpful when experiencing difficult emotions or urges to engage in self-destructive behaviors.

Panic Attack Coping Statements

  1. My body is issuing a false alarm. In a few minutes, the alarm should stop.
  2. I am not in physical danger.
  3. These symptoms are uncomfortable/unpleasant, but my health is not at risk.
  4. This is my brain misreading and misfiring. I am actually okay.
  5. My body knows how to breathe on its own.
  6. If I can accept these feelings and breathe through them, they’ll likely go away sooner.
  7. I have survived similar experiences before.
  8. Symptoms of panic do not mean I’m “going crazy” and are not indicative or predictive of other mental illnesses.
  9. Panic attacks are fairly common and short-lived experiences.
  10. I can do this.

Have you used any of these coping statements yourself? Which of these (or others) can you imagine working for you?

Gatewell has a team of therapists specializing in anxiety disorders and can help you implement these coping statements and offer other strategies toward addressing symptoms of panic and anxiety.

How Psychology’s Focus on Obesity Does More Harm Than Good

obesity

Psychology, taking its tune from medicine, has honed in on obesity as a problem its providers need to fix.  Medicine views obesity/overweight as a disease; psychology has co-opted the disease model and posits weight as a behavior demanding therapeutic intervention. But these approaches are flawed, and psychology’s focus on weight-loss interventions is unethical, violating the basic ethical principle of Nonmaleficence (do no harm).

Weight, like height, is a individual variant largely influenced by genetics.  We believe that weight is significantly more manipulable than height, but research suggests otherwise. The body has powerful hormonal and metabolic mechanisms in place designed to maintain its natural weight. When healthcare providers recommend weight loss in order to improve health, they’re dangerously missing the mark and possibly promoting a disordered relationship with food and the body. Instead of getting stuck on obesity, providers are better served focusing on indices of health, such as blood pressure and cholesterol levels, and on predictors of health, such as stress, access to healthcare, mental health concerns, etc., all of which can be improved without losing a pound.

Here’s why we’ve gone wrong:

  1. Most diet/weight-loss efforts fail, with individuals gaining back the weight (and then some).
  2. Since diets are largely ineffective, many will go on and off them, with corresponding ups and downs in weight, a process known as yo-yo dieting or weight cycling. Weight cycling is associated with more negative health outcomes than remaining at a higher, stable weight.
  3. Those who are encouraged to restrict their diet often develop disordered eating habits, with a portion developing full-blown eating disorders. Some might develop Anorexia Nervosa, while dietary restriction might lead others to struggle with compensatory overeating, perhaps developing into full-blown Bulimia Nervosa or Binge Eating Disorder.
  4. Weight-loss recommendations are rich in weight stigma and often lead individuals to feel bad about their bodies and themselves, which can paradoxically lead to emotional overeating and/or to negative health outcomes.
  5. Punitive, compensatory, or un-enjoyable exercise has the potential to negatively influence health via over-training injuries and cortisol spikes. At the very least, exercise adherence will likely be lower if the activity is too challenging and lacks reward.

Here’s what we can do instead:

  1. If providers really want to focus on health, focus on health! What recommendations do you make to those with thinner frames? Those same recommendations can be made to those who live in larger bodies.
  2. Help patients develop a healthy relationship with food by encouraging a balance diet that includes nutrient-dense and fun foods. Labeling certain foods as “bad” or off-limits is likely to backfire.
  3. Help patients find physical activities that they enjoy and can see participating in for the long-haul. This will increase exercise adherence and promote a healthy relationship with movement.
  4. Research and be mindful about the many ways that societal and clinical weight stigma can impact patients’ health.
  5. Get schooled in the Health at Every Size (HAES) approach.

*More extensive info on this topic (along with a host of references) is available in Does Every Woman Have an Eating Disorder?

12-Step Approaches: Pros and Cons for Alcohol and Substance Use Disorders

12-Step

Success of 12-Step Approaches

Most people are familiar with AA (Alcoholics Anonymous), NA (Narcotics Anonymous), and other 12-Step (self-help) groups. In fact, many treatment providers, when learning of a client’s alcohol or substance misuse, will immediately suggest that the client begin attending 12-step meetings. But do these meetings work?

AA, the largest and most well-known 12-step group, seems to have a varying success rates,  depending on who you ask. In 2014, AA reported the following about its membership:

  • Sober 20+ years: 22%
  • Sober 10-20 years: 14%
  • Sober 5-10 years: 13%
  • Sober 1-5 years: 24%
  • Sober less than a year: 27%

These statistics are misleading, though, as they do not capture those who have tried AA and dropped out. Were the numbers to include this subset of individuals, the success rates would likely be significantly lower. Peer-reviewed studies typically indicate that AA has a 5-10% success rate. In 2006, the Cochrane Collaboration, conducted a large meta-analysis examining the efficacy of AA and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF* approaches for reducing alcohol dependence or problems.”

As success rates might be equivocal, we can also take a look at some of the pros/cons of attending self-help meetings. Members might still benefit from attending, even if they cannot demonstrate long-term abstinence.

Pros of 12-Step Meetings

  1. Community: This might be one of the biggest benefit to participating in 12-step meetings. The fellowship is a remarkable source of community and support. Members can rely on each other when struggling, when approaching difficult situations, and when celebrating their victories.
  2. Modeling: It helps to know that others have struggled in similar ways and overcome similar challenges. Moreover, for some folks who have difficulty imagining what a sober life would look like, being with others in the rooms helps them understand that sober life is possible – and can even be fun.
  3. Helping others: Many members of self-help groups report that their sobriety is reinforced when they reach out to struggling newcomers or take on a sponsee. Helping others strengthens their sobriety muscles.

Cons of 12-Step Meetings

  1. Higher Power: Some people might have trouble with the “Higher Power” concept, no matter how creatively they are encouraged to define this for themselves. For these individuals, the concept of a Higher Power becomes a sticking point that clouds further engagement.
  2. Groupthink: Some people object to the rituals and messaging in AA. While some find them helpful, others complain that the sayings, the teachings from the Big Book, etc. are difficult to stomach.
  3. The shame of a slip: For those who slip or experience a lapse or full-blown relapse, picking up another white chip can be a shameful experience and might even discourage honesty or continued meeting attendance. Some do not like the concept of “starting all over” after a relapse, which seemingly negates the work they’ve already put in.
  4. Meetings are not therapy: Self-help meetings are community run without professional oversight. Members might choose to work the steps with a sponsor, but moving through the steps is not a substitute for therapy.

Summary

Some individuals who struggle with alcohol or substance problems might benefit from attending 12-step meetings, especially as an adjunct to individual therapy. In cases where treatment is not an option, participation in meetings can offer an alternative, rich in community and support. Still, it is important to keep in mind that self-help meetings do not constitute treatment and that groups are not equipped to address co-occurring mental health concerns.

*TSF = 12-Step Facilitation Therapy

Celebrating National Taco Day at Gatewell

taco

At Gatewell, we’re strong proponents of the intuitive eating and “all foods fit” philosophies. That’s why we were thrilled when our in-house registered dietitian, Christine Tellez, shared this easy recipe. Christine’s Taco Meat recipe kicks off a series of easy recipes featuring Latin-American cuisine, in honor of Hispanic Heritage month. So many ingredients associated with Latin-American cooking have gotten a bad rap recently in our current carb-fearing climate. We’re here to take back the beans, the corn, the rice, the tortillas, and to help you develop a healthy, pleasurable, and sustainable relationship with food.

Easy Taco Meat Filling (serves 4-6)

This easy recipe is perfect for a quick weeknight dinner.  By adding beans and mushrooms to the mix, we increase the fiber and add in some extra flavor as well. This makes a good amount of leftovers and can be added as a quesadilla filling, served over rice, greens, and even sweet potatoes. Add your favorite toppings to make it a delicious, balanced meal.

Ingredients:

Taco Seasoning Packet or Your Own taco seasoning
¾ c water
1 lb. ground beef, turkey, or even soy crumbles
1 8 oz. carton of portabello or white mushrooms
½-1 can black or red beans
½ an onion (optional)

Directions:

  1. Dice your ½ onion and mushroom and set aside.
  2. Heat pan on medium and add canola oil and diced onions once oil is hot. (Skip this step if you are not using onion.)
  3. Add in ground meat of choice and cook for a few minutes. Then add in mushrooms.  Cook until meat is browned.
  4. Add in taco seasoning mix, water, and beans.
  5. Turn down heat and simmer until water is soaked up.
  6. Serve in a tortilla, over rice, add to a quesadilla, on greens, or over a sweet potato.  Top with sour cream, avocado, guacamole, salsa, tomatoes, and other toppings that you love.

Happy National Taco Day – enjoy!