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ADHD Diagnosis: Complexities and Caveats

ADHD

The Philippines has made significant strides in mental health awareness, thanks to professionals, advocates, and service users’ efforts. Initiatives such as the Philippine Mental Health Act (R.A. 11036) and the recognition of the rights of psychosocial disabilities under the Magna Carta for Disabled Persons (R.A. 7277) have played pivotal roles in this progress. Advocacy groups are also pushing for legislation like the Neurodivergent People’s Rights Act (H.B. 9787).

Despite these advancements, stigma and misunderstanding surround neurodevelopmental disorders, particularly Attention Deficit Hyperactivity Disorder (ADHD). This is a developmental disorder characterized by patterns of hyperactivity, inattention, or a combination of the two. A diagnosis is given based on the severity of symptoms, level of impairment, and the presence of symptoms since childhood. Globally, ADHD affects 5-7.2% of youth and 2.5-6.7% of adults ,,; but Philippine figures are unfortunately scarce and outdated.

Consider a young boy in his Grade 1 classroom, labeled as “makulit,” “pasaway,” and even “bad,” while he struggles with symptoms of ADHD that go unrecognized. Similarly, imagine a woman in a bustling high-rise building, where her difficulties staying organized lead to exclusion from important email correspondences and social gatherings, all because her colleagues are unaware of her ADHD diagnosis.

Unfortunately, ADHD is still so often shrouded in stigma. Those grappling with the disorder find themselves wrestling to keep pace with the demands of daily life, be it at school, work, or social settings.

Recognizing ADHD as a genuine challenge and not a character flaw, is vital for supporting individuals and dispelling misconceptions.This condition, when properly diagnosed, can be life-saving, paving the way for individuals to alleviate suffering and reclaim their power. But however well-intentioned, there is still a risk of overdiagnosis- an issue that is particularly prevalent in the realm of ADHD, but also within the realm of mental health diagnoses at large. Overdiagnosis can occur due to various factors, ranging from clinician practices to caregiver influences, but this often looks like overprescription of medications and unnecessary interventions. In the case of ADHD, changes in criteria in the

Diagnostic and Statistical Manual of Mental Disorders between its fourth and fifth editions have contributed to this concern- it added examples of symptoms seen in adolescents and adults, lessened impairment criteria, and revised the age of onset.

We must also remember that for children, a certain level of kulit is normal and developmentally appropriate. It is a quintessential part of childhood, after all — to dash around, create chaos, and indulge in one’s imagination. However, what distinguishes ADHD diagnosis is the severity and persistence of symptoms over time to the point that there is impairment.

Context also may play a role in facilitating overdiagnoses and misdiagnoses. While legislative progress and heightened awareness have improved access to care, our “digital by default” age has introduced new challenges, further complicating the diagnostic process for mental health disorders. For example, during the pandemic, the proliferation of misleading TikTok videos about ADHD posed a significant risk, as many individuals were facing attention challenges. A study revealed that over half of these videos were misleading, with non-healthcare professionals being the primary uploaders, potentially leading to widespread misinformation and self-diagnosis among their viewers.

On the other hand, many individuals may go undiagnosed until much later, their struggles well-masked by societal expectations and coping mechanisms. There exist gendered differences in the diagnosis of ADHD: boys are significantly more diagnosed with ADHD compared to girls due to differences in presentation. Girls with ADHD often exhibit the inattentive type, which may not manifest as disruptive behavior and consequently may be overlooked for treatment unless their symptoms significantly impact their daily functioning.

And with any diagnosis, whether physical or not, early intervention is crucial. Effective treatment during childhood can significantly improve symptoms and overall functioning, leading to better outcomes. Unfortunately, if left untreated until adulthood, ADHD can result in chaotic lifestyles, other co-occurring mental disorders, and challenges in various aspects of life.

The journey towards an ADHD diagnosis can be unexpectedly complex. For individuals who resonate with ADHD symptoms, every step of the way demands cautious decision-making. It is crucial to be discerning with the information you consume and the healthcare providers that you trust. Ensure that they are equally diligent.

Self-reflection is also essential. Clarify your “why” behind seeking a diagnosis—It could be that receiving ADHD treatment might help you lead a much more fulfilling life. It could also be that you want relief from years of overcompensation. Whatever your “why” is, seeking a comprehensive assessment is essential in this process to tailor-fit treatment to your unique brain. It is not a one-size-fits-all diagnosis, however general the diagnostic manual may make it appear to be; a detailed picture of how your mind works, pinpointing your strengths and challenges, will help specify what you need.

Seeking consultations from various professionals, such as clinical psychologists and psychiatrists, can offer valuable insights and interventions for managing ADHD. Therapy is a crucial component of tailored interventions—it provides individuals with a safe space to learn more about themselves, as well as equips them with essential skills and strategies to cope with their symptoms. Additionally, executive function coaching can further empower individuals with ADHD to navigate daily challenges effectively and achieve their goals. Executive function coaching focuses on enhancing skills like organization, time management, and task prioritization- these are skills that are often affected by ADHD symptoms. By addressing these areas, your quality of life may be significantly enhanced.

Despite the leaps and bounds in mental health perceptions, access, and service delivery, there is still much work to be done. Whether for ourselves or others, there is no time like the present to advocate for better education on mental health concerns like ADHD. Indeed, it is an ongoing journey to challenge misconceptions, develop discernment, and embrace the complexities of these issues. However, it is essential to see the merit in all this effort, to recognize that finally receiving the proper help can save lives. By advocating for improved access to accurate diagnosis and comprehensive treatment, we can empower individuals with ADHD to finally thrive in their communities.

For Executive Functioning (EF) coaching and other clinical services, contact us at clinic@wethriveinc.com.

Sources:

https://lawphil.net/statutes/repacts/ra2018/ra_11036_2018.html
http://hrlibrary.umn.edu/research/Philippines/RA%207277%20-%20Magna%20Carta%20of%20Disabled%20Persons.pdf
https://hrep-website.s3.ap-southeast-1.amazonaws.com/legisdocs/basic_19/HB09787.pdf
Posner J, Polanczyk GV, Sonuga-Barke E. Attention-deficit hyperactivity disorder. Lancet. 2020;395(10222):450–462. doi: 10.1016/S0140-6736(19)33004-1.
 Song P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health. 2021;11:04009. doi: 10.7189/jogh.11.04009.
Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and metaanalysis. Pediatrics. 2015;135(4):e994–e1001. doi: 10.1542/peds.2014-3482.
 Merten, E. C., Cwik, J. C., Margraf, J., & Schneider, S. (2017). Overdiagnosis of mental disorders in children and adolescents (in developed countries). Child and adolescent psychiatry and mental health, 11, 1-11.
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 7, DSM-IV to DSM-5 Attention-Deficit/Hyperactivity Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t3/ 
American Psychiatric Association. (2022). Neurodevelopmental disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
Yeung, A., Ng, E., & Abi-Jaoude, E. (2022). TikTok and attention-deficit/hyperactivity disorder: a cross-sectional study of social media content quality. The Canadian Journal of Psychiatry, 67(12), 899-906.
Bruchmüller, K., Margraf, J., & Schneider, S. (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology, 80(1), 128–138. https://doi.org/10.1037/a0026582 
 Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders, 16(3), 23591.

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Blog Everyday Thriving Thrive at Work

Creating workplaces where “care” matters

culture of care

The month of October is Mental Health Month, and this year we are focusing on how to build workplaces that embody wellbeing. To learn more about our ongoing work with organizations to create these cultures of care in their workplaces, stay tuned for our upcoming activity Leading with Care: The Neuroscience and Practice of Leading a Culture of Care in the Workplace on 07 November 2023.

In We Thrive, we look at mental health as the coming together of many different factors which determine the capacity of a person to live in a way that allows them to reach their fullest potentials. Of course, our individual exercise of our faculties is critical: how we cope with difficult experiences and savor positive ones; how we pay attention to how we feel and think about ourselves and the world; how we interact with others and take part in their lives; and so on. Nowadays, we refer to things like this using the umbrella term “self-care” (ISF, 2023). But as we probably already know, individual efforts are sometimes not enough to reach. We don’t always cope particularly well; we aren’t always able to stop and smell the roses; we aren’t always able to pay attention to what’s happening; and our ability to be part of other people’s lives, or let them be part of ours, is not always at its best. Sometimes, you need help. “The ability to ask for and obtain help is a valuable life skill,” as psychologist Debbie Sorensen puts it, partly as a comment to our culturally-ingrained hyper-focus on independence (Sorensen, 2022). So besides “self-care”, realizing our potentials includes the essential component of togetherness, where interdependence is just as prized as independence, and where reaching one’s potentials is not simply an individual effort. We can call this “community care”: as author and psychotherapist Minaa B. defines as “[using] our power, privilege, and resources to better the people who are both in and out of our scope of reach” (Minaa B., 2021). 

The idea that “our wellbeing is contagious” gives us a sense of how embedded the impulses of community care actually is in our human makeup, and how our own health and flourishing depends as much on others as it does on our own efforts in ways that sometimes surprises us (Suttie, 2020). And in relation to workplace stress and one of the primary mental health challenges of “[managing] the pressures so that life is productive and enjoyable” (Teasedale, 2006), the idea of community care can provide a more integrative approach to ensuring the wellbeing of people in the context of groups and institutions. We know for example the consequences of a lack of consideration of wellbeing can be, with losses in the millions whether we’re referring to potential profits or working days lost to attrition or sick leaves (Graveling et al., 2008). Conversely, we know about the even greater benefits taking wellbeing seriously has to all kinds of organizational and business outcomes (Sears, Shi, Coberley, & Pope, 2013). But where do you begin? In this article, we want to share some advice about how to apply the concept of “community care” to thinking about how organizations can build up its practices towards creating workplaces where “care” is integral rather than supplemental to the overall business strategy.

Community care in three categories

Thanks to some clever analysis of the literature, researchers were able to offer a more condensed definition of this widely and wildly defined idea of self-care: “The ability to care for oneself through awareness, self-control, and self-reliance in order to achieve, maintain, or promote optimal health and well-being” (Martínez, Connelly, Pérez, & Calero, 2021). Using these three concepts, we can organize our thinking about wellbeing along these lines and how they might apply to community care. How can workplaces create spaces and relationships where people can support each-other’s capacities for awareness, self-control, and self-reliance?

  1. Awareness. This is about the ability to monitor, measure, and interpret one’s experiences (or “symptoms”, as used in their paper). This awareness is the natural first step to achieving wellbeing: after all, you cannot act wisely without the appropriate information. Applied to community care, this means helping each-other bring attention to our concerns, whether this means identifying specific forms of support or simply articulating some difficulty in or out of work in order to have some much-needed emotional release. Besides this, it also means helping each-other bring attention to our wins, allowing us to become more present to moments worth celebrating and appreciating. And building on the idea of interpretation, awareness is about bringing attention to the “meaning” of experiences, and helping each-other discern how our experiences at work match up with our values, beliefs, goals, and how we want life to be in general.

Reflection: Are employees afforded the necessary resources, opportunities, and structures to cultivate greater awareness? Do the relationships between peers and between team members and team leaders foster a sense of safety and security where people are not only able but encouraged to work together to identify, articulate, and respond to their experiences as a community?

  1. Self-control. In the words of Martínez and colleagues, self-control is the “product of a person acting as a unitary being and engaging in regulation and control of their self and emotions”. Achieving wellbeing, whether we like it or not, requires perseverance, sustained effort, and more than a little strategizing. Applied to community care, this means helping each-other initiate and build on the habits necessary for regulation, maximizing our individual abilities to contain and ground ourselves. It also means creating relationships and systems within the workplace that don’t unnecessarily tax these abilities. Borrowing the researchers’ use of the term, self-control in the context of community care means thinking of the community as a “unitary being”, where each person must in some ways exercise responsibility for another’s capacity to recover and return to states of calm and ease.

Reflection: Are employees afforded the necessary resources, opportunities, and structures to cultivate greater self-control? Do the relationships between peers and between team members and team leaders foster that sense of trust that, to the extent possible, we can rely on one-another as a means of regulating when things get tough? 

  1. Self-reliance. Though not defined directly in the study, the researchers offered a case study about a man who “sustained a wound to his right leg when he slipped in a canyon” but that, while he “was aware of the injury”, the man “did not treat the wound, and his entire leg became swollen, red, and hot”. So while taking consideration of the case study’s particular context, we can think of self-reliance as our ability to initiate the appropriate actions by ourselves, which requires a level of self-efficacy, self-trust, and a general belief that we can do something with our circumstances. Applied to community care, this means helping each-other create the necessary cognitive and behavioral scaffolding in our work to both have the appropriate level of trust in our own abilities (remember: asking for help is an important skill) and the necessary skills for acting on that self-confidence in productive and meaningful ways. Using the case study, self-reliance is both about trusting that your team will help you with the wound and also about your team trusting you enough to at least clean and dress the wound first.

Reflection: Are employees afforded the necessary resources, opportunities, and structures to cultivate greater self-reliance? Do the relationships between peers and between team members and team leaders create an environment that is not only challenging but also encouraging? 

For mental health support services, email us at resilientteams@wethrivewellbeing.com or contact us to sign-up for sessions with our mental health clinicians.

References (in order of appearance)

  1. https://isfglobal.org/what-is-self-care/ 
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488814/ 
  3. https://psyche.co/guides/how-to-ask-for-help-without-discomfort-or-apology 
  4. https://www.wellandgood.com/what-is-community-care/ 
  5. https://greatergood.berkeley.edu/article/item/why_taking_care_of_your_own_well_being_helps_others 
  6. https://www.sciencedirect.com/science/article/abs/pii/S1476179306000188 
  7. https://www.ncbi.nlm.nih.gov/books/NBK75294/ 
https://www.liebertpub.com/doi/full/10.1089/pop.2012.0114
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Blog Everyday Thriving Thrive at Work Thrive in School Wellbeing Practices

To hear and be heard: ideas for meaningful conversations for nurturing life

The month of September is celebrated globally as Suicide Prevention and Awareness Month. To learn more about suicide and how we can support each-other, see this article. If you need to talk to someone or if you are in need of urgent help, please proceed to the nearest hospital emergency room, or proceed to the end of this article for the contact numbers of various local 24/7 crisis lines.

Stereotypes aside, as an organization providing psychological care, We Thrive’s work admittedly has a lot to do with conversations. It is something we take for granted, not always realizing that this very peculiar human capacity is one of the building blocks of human civilization (Crystal et al., 2023). Conversations are also one of the building blocks of human life: as psychologist Lucy Foulkes puts it, when conversations “allow us to learn something important about ourselves, about the other person, or about the world” (Foulkes, 2021), truly remarkable things happen. Such conversations, when they are “meaningful”, can turn even otherwise mundane chatter (what we label “small talk”) into subtle gateways for deeper interactions (Macquire, 2023). They make possible the flourishing of all those aspects of being human: sensing and holding our emotions (Lieberman et al., 2007), articulating the various aspects of the self (McLean and Morrison-Cohen, 2013), developing new behaviors and perspectives (Albright et al., 2016), relieving and easing painful experiences (Kardas, Kumar, and Epley, 2021), making sense of life as a whole (Tarbi et al., 2021), and much more. Speech of this kind has a literal healing effect, hence the well-earned stereotypical predominance of “talk therapy” methods in clinical psychological practice (Lindberg, 2023).  As social beings, as author Arthur Dobrin puts it: “With conversation, we find a place where we belong” (Dobrin, 2011).

In our ongoing observance of Suicide Prevention and Awareness Month, we want to offer some practical points for reflection for having meaningful conversations, particularly those you want to check in on and support through difficult experiences.

The look and feel of a meaningful conversation

The main feature of a meaningful conversation is the experience of being “heard” — an experience which is, without exaggeration, “one of the most basic, yet potent needs we have as social beings” (Fowler, 2022). Most of us know from personal experience how painful not being heard can be, and how influential it can affect our own ability to hear others. Not being heard can have many precipitating factors: maybe there are basic differences in communication style (Khiron Clinic, 2021); or maybe the capacities of one or both people in the conversation to hold big or uncomfortable feelings are limited (Brosch, 2015). It could be some other factor, like adverse childhood experiences (Zlate, 2020), which are not within our present control. Whatever the case, when we are not heard, some of our most fundamental needs — the needs to feel that “we are taken seriously, that our ideas and feelings are acknowledged, and that we have something to share” (Nichols, 1995) — cannot be met.

So how do we get to meaningful conversations where we feel taken seriously, acknowledged, and feel that what we share has value? We may be tempted to offer advice right away or resort to offering affirmation.

But “problem-solving” is not the same as “hearing”, and our impulse to give instructions or shoo away difficult feelings with aspirations of pleasantness, while usually very well-intentioned, may not reflect the other person’s true needs. This is what is often meant by “toxic positivity”: when the resolution to be quote-unquote “happy” is not grounded in the present reality which might demand more emotional complexity.

So having said that, what does “hearing” actually look like? Thankfully, a few scholars have looked into this. In a series of studies, the concept of being “heard” — described by the authors succinctly as “a key variable of our time”, given our modern propensities for distractions — was operationalized according to five components (Roos, Postmes, and Koudenburg, 2021). Here, we will present how these were understood and some points for reflection to guide how we apply these to making our conversations truly meaningful. 

  1. Recognizing our “voice”. This is about “being able to express myself freely, that is, being able to say what I want to say.” In meaningful conversations, there must be that sense that, while some social filters might be appropriate in any given situation, we are able to say what we think or feel without fear of being criticized, demeaned, or thought poorly of. It is the sense that, right or wrong aside, what we say is welcomed.

Reflection: In our conversations, do we offer a sense of security that allows the other person to say what they need to say, and that we are willing and able to welcome what they say — even if they’re about something difficult and uncertain?

  1. Receiving “attention”. This is about feeling that the other person “focused their attention on what I said”. In meaningful conversations, there is a conscious effort to home in on the details, verbal or otherwise. It is the sense that what we say merits curiosity, and that there is a richness in what is being said that is worth patiently drawing out.

Reflection: In our conversations, do we offer expressions of interest that communicate to the other person that what they have to say is important, and that we really want to understand them?

  1. Receiving “empathy”. This is the perception that “the other tried to take my perspective and emotionally understand me.” In meaningful conversations, the affective contents of what we say — not just the words, but the conditions that led us to say what we say — are appreciated. It is the sense that the other person is resonating with us at a level that is deeper than the dictionary definitions of our statements, and that we are allowed to speak with more vulnerability, confident that, at the minimum, our vulnerability will be cared for.

Reflection: In our conversations, does our presence invite the other person to let their guard down, even a little, so that what they say communicates more truthfully what their hearts dictate? (At least to the extent possible, given the circumstance. Emotions are complex, after all!)

  1. Receiving “respect”. This is the feeling that the other person “valued what I said (my voice) and me as a person”. In meaningful conversations, while all human activity is prone to human errors of misunderstanding, we are taken and honored as we are. It is the sense that whatever prejudices there may be are set aside — or at least owned up to, honestly — and that the interaction is grounded in a commitment to the fact that we are human beings deserving of compassion.

Reflection: In our conversations, does our approach show the other person that we accept and honor them as they are, however and whatever they may be?

  1. Experiencing “common ground”. This is the perception that we can “understand each other’s point of view”. In meaningful conversations, there is a kind of exchange that allows both people’s perspectives to be influenced in a constructive way, allowing not just greater understanding of the nuances of these differences, but a greater appreciation of how such differences can lead to the same goals of cultivating a more meaningful life. While there may be significant divergences in the way we come to our conclusions, these conclusions are ultimately grounded on a desire for the greatest good — and that our conception of the “good” can be deepened and strengthened by one-another.

Reflection: In our conversations, do we communicate an openness to hearing the other person’s views, and an openness for our own views to be positively influenced by them?

Being able to initiate and sustain such a potent human activity is one of our best means for promoting healing for ourselves and one-another. By cultivating these five components, we can be better placed to leverage the power of conversations to cultivate human flourishing both within and beyond our difficult experiences.

For mental health support services, email us at resilientteams@wethrivewellbeing.com or contact us to sign-up for sessions with our mental health clinicians.

If you need to talk to someone or if you are in need of urgent help, please proceed to the nearest hospital emergency room, or call these 24/7 crisis lines:

DOH-NCMH Hotline

0917-899-USAP (8727)

0966-351-4518

0908-639-2672

(02) 7-989-USAP (8727)

1553

Hopeline PH

0917-558-HOPE (4673)

0918-873-4673 (HOPE)

(02) 8-804-HOPE (4673)

2919

In Touch Crisis Line

0917-800-1123

0922-893-8944

(02) 8-8937603

References (in order of appearance):

  1. https://wethrivewellbeing.com/world-suicide-prevention-day-responding-to-suicide-with-resilience-and-compassion/ 
  2. https://www.britannica.com/topic/language 
  3. https://psyche.co/guides/how-to-have-more-meaningful-conversations 
  4. https://carolinemaguireauthor.com/how-to-make-small-talk/ 
  5. https://www.healthline.com/health/mental-health/talk-therapy#how-effective 
  6. https://pubmed.ncbi.nlm.nih.gov/17576282/ 
  7. https://www.tandfonline.com/doi/abs/10.1080/15283488.2013.776498 
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344154/ 
  9. https://www.apa.org/pubs/journals/releases/psp-pspa0000281.pdf 
  10. https://www.sciencedirect.com/science/article/abs/pii/S0738399121003335 
  11. https://www.psychologytoday.com/intl/blog/am-i-right/201112/conversation-makes-us-human 
  12. https://thedmcclinic.ie/blog-the-importance-of-being-heard/ 
  13. https://www.goodtherapy.org/blog/listen-up-why-you-dont-feel-heard-in-your-relationship-0810154  
  14. https://www.pacesconnection.com/blog/adverse-childhood-experiences-and-interpersonal-relationships 
  15. https://www.compassionate.center/docs/Why-listening-is-so-important.pdf 
https://psyarxiv.com/73jgn/
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Blog Everyday Thriving Wellbeing Practices

Eating to enrich life: understanding and responding to emotional eating

emotional eating

In We Thrive, we work with people becoming their best selves by working with different aspects of who they are. There are the big-picture things: our sense of purpose, for example, which in Dr. Gabrielle Pfund’s research is composed of things such as how our future plans match our interests, how engaging we feel life is as a whole, and so on (Psychology Today, 2023). But there are also the big things when you zoom into that picture: the finer details of life, emerging from moment to moment, which compose the movements towards what we want life to be. These include the patterns of our thoughts, emotions, and behaviors, but also the things which give us the energy to, well, move. Specifically, we get this energy through food, “a fundamental human need that influences both physiological and emotional states” (Hamburg, Finkenauer, & Schuengel, 2014). Nutrition looks different from person to person, but generally speaking, the task of ascertaining life’s movement can be more difficult than it has to be when our bodies aren’t getting the food and drink it needs (MSD Manual, 2023). And as we’ve probably all experienced, those aforementioned patterns of thought, emotion, and behavior can lead us into patterns of eating that can deprive rather than enrich us. In this article, we will talk a bit about what such a pattern of eating is; how we might end up moving in this direction; and what we can do to direct, rather than be directed by, our eating habits.

What is “emotional eating”?

Eating is, as nutritionist Amelia R. Sherry puts it, “an intrinsically emotional experience” (Psychology Today, 2022). Hamburg, Finkenauer, & Schuengel expressed this intuition in concrete terms: “eating behavior goes beyond nutrition and alleviating hunger; family, friends, and cultural heritage shape individual food preferences” (Hamburg, Finkenauer, & Schuengel, 2014). All of life, both the pleasant and the unpleasant, is threaded with the experience of eating. So the term “emotional eating”, while widely used, does not necessarily give us the clearest idea, and might also give the wrong impression that eating in response to our feelings is necessarily a bad thing. Choosing to eat can be a perfectly reasonable way of grounding us, whether by supplementing our present positive emotional states, reliving a positive memory associated with certain foods, or dealing with the occasional difficulty (Rachael Hartley Nutrition, 2016).

The difference between “good” or “bad” emotional eating is in the word “choice”. Whether responding to our emotions by eating deprives or nourishes us depends on the intentions we have (or haven’t) set when we eat. Besides determining how nutrient-dense our diets are, how do we clarify our intentions with eating? Here are some helpful guide questions:

  • How aware are we of the reasons why we choose a particular food at a particular time?
  • Are we eating in a way that aligns with a particular goal we have, such as a health goal?
  • When faced with stressful situations, have we considered whether there may be better ways of coping or resolving these situations other than with food? 
  • To what extent do we actually savor or enjoy the food we are eating, when we do choose to eat at that moment?
  • As a whole, does our experience of eating delight us, or leave us with a lingering sense that something is not quite right?

What moves us towards “eating emotionally”?

“Emotional eating” is also known by at least two other names: “stress eating”, and “comfort eating”. These terms might be preferable, because it gives a better sense of the context in which these patterns of eating emerge. At the minimum, when people use the term “emotional eating”, they are generally referring to food intake as a means of grounding us when we feel overwhelmed, disrupted, or out-of-balance — in other words, eating as self-soothing (Psychology Today, 2023). If, while going through the guide questions, you realize that the intent of your emotional eating appears to be mostly about self-soothing, then you may be emotional eating in a way that might not be serving your best interests long-term. But this happens to almost everyone, and it is not necessarily about willpower. The research of Dr. Tatjana Van Strien found at least three determinants for emotional eating (van Strien, 2018):

  • Poor interoceptive awareness. This means a person has difficulty distinguishing feelings of hunger and satiety, which can lead to difficulties with determining whether one has eaten too little or too much. For example, this can be due to dietary factors such as regularly eating foods that are high in sugar, which can exacerbate hunger because of the rapid increases in blood glucose (Penaforte et al., 2013).
  • Poor emotion regulation strategies. This means, for example, that a person becomes over-reliant on a particular coping mechanism (in this case, food) to deal with stressful situations. It can also mean that emotional eating becomes the result of an inappropriate coping mechanism, such as when avoidance of stressful situations ultimately leads to more of the stress occurring later on, making one more likely to rely on emotional eating.
  • Disruption of the hypothalamic-pituitary-adrenal (HPA) axis. Among other things, the HPA axis is responsible for regulating appetite. Under normal circumstances, the stress response would be a loss of appetite, but due to various factors (e.g. incredibly stressful experiences, childhood trauma, abuse, or other underlying health conditions affecting the HPA axis), this is reversed and the stress response instead leads to increased appetite.

Keeping these three in mind, we can reflect on a few more questions:

  • What might be causing your urge to eat at a particular time? Is it because of what or how you may be used to eating? 
  • What difficult or stressful situations are you currently experiencing that may be better served by something other than food?
  • Aside from providing nutrition or sustenance, in what ways has food been present in your life growing up? Did you have an abundance of food or a scarcity of it? 
  • When you think of food, what memories are usually associated with it? Were there certain negative and possibly intense experiences in your life which food used to help you get through?

How do we direct our eating?

Eating plays a vital role, not just in the maintenance of regular bodily functioning, but in our journey towards living a purpose-driven life. But eating can either deprive us or enrich us with the energies, both physiological and psychological, necessary to live out such a life. So how do we eat in a way that is more enriching? Depending on your answers to the questions mentioned earlier, co-authors Dr. Gia Marson and Dr. Danielle Keenan-Miller offers some ideas for how best you can set the direction for the way food moves your life (Psychology Today, 2023):

  • Acceptance. This means becoming more accepting of your body and how it reacts to food. This means less judgment, which often leads to guilt and shame, and more kindness, which can lead you to a better sense of how the food actually feels for you.
  • Awareness. This means tuning into the emotional nature of eating and noticing what kinds of emotions emerge alongside the desire to eat.
  • Avoid reacting impulsively. This means when difficult and negative emotions emerge, as they do in emotional eating, we take a pause rather than immediately reaching out to food as we have habituated ourselves. This will give you some room to consider how else you might be able to respond to these emotions.

For mental health support services, email us at resilientteams@wethrivewellbeing.com or sign-up for sessions with our mental health clinicians.

References:

  1. https://www.psychologytoday.com/us/blog/fulfillment-at-any-age/202305/what-gives-your-life-a-sense-of-purpose 
  2. https://www.msdmanuals.com/home/disorders-of-nutrition/overview-of-nutrition/overview-of-nutrition 
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3907771/ 
  4. https://www.psychologytoday.com/intl/blog/positive-food-parenting/202212/when-emotional-eating-can-be-normal-and-even-healthy 
  5. https://www.rachaelhartleynutrition.com/blog/2016/11/emotional-eating-is-okay 
  6. https://www.psychologytoday.com/us/blog/the-binge-eating-prevention-plan/202301/emotional-eating-is-all-about-emotions-or-is-it 
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5918520/ 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627933/
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Blog

Coming out as a starting point for authenticity

In We Thrive, cultivating “authenticity” is a core component of our work. That said, there is vibrant debate across various disciplines over what exactly it is: for example, is authenticity something that is always there and waiting to be “discovered”, something that “emerges” through our various experiences, or some magnificent combination of both? (Psychology Today, 2023) But as a working definition, we can think of authenticity as a process of making the “whats” and “hows” of life work in tandem with the “whys” of life. Adding some specificity, it is the extent to which we are “consistent” (i.e. ensuring “external characteristics” and “internal values” match); are in “conformity” (i.e. ensuring life’s broad strokes meet whatever standards we set for ourselves); are able to “connect” (i.e. how our relationships to a place, a community, or historical milieu align with our sense of self); and have “continuity” (i.e. how much of our sense of self changes or is retained over time) (Dammann, Friederichs, Lebedinski, and Liesenfeld, 2020). Put more succinctly, authenticity “requires us to embrace the reality of our freedom and be responsible for how we choose to live” (Sutton, 2021). To be able to live a life that is consistent, in conformity, is connected, and has continuity, we must exercise an awareness of life’s movements and, to the extent possible, ensure that these movements work in harmony.

Whenever Pride Month rolls in every June, the idea of “authenticity” inevitably comes up. For LGBTQ people, one marker often used to evaluate whether we are living authentically is disclosure of one’s sexual orientation and gender identity (SOGI) — that is, “coming out”. Many LGBTQ people see coming out as a cornerstone to the lifelong task of embracing this responsibility over life and maintaining the harmony of life’s hows and whys. And wonderful as it might be, and as important as it is in our collective imaginations, it needs to be said that it is not the end-all and be-all of authenticity as an LGBTQ person. You do not have to be “out” in order to be true to yourself. So the intention here is not to give undue privilege to coming out, but to ask what coming out might contribute to our own journeys of living authentically. 

Ultimately, it is on each of us to pay attention to what life is specifically asking from us — to “listen to those messages”, as the therapist Andrea Matthews explains, “listening long enough and deeply enough to really suss out the most essential parts and then begin to act as needed” (Matthews, 2023). Whether coming out is what life demands of us in the present is on us to ascertain, and with much necessary struggle. But thankfully, that difficulty is at least a good sign: as the professor of psychology Dr. Stephen Joseph puts it: “the most authentic people, because they know themselves so well, recognize their struggles in living authentically” (Joseph, 2020).

Even if life does ask this from us, coming out can be deeply frustrating. We may have to come out in bits and pieces: to one friend but not another, with a sibling but not necessarily with a parent, and so on. In these scenarios, LGBTQ people can be caught up in an exhausting balancing act of shifting between one’s “personas” from one context to the next.

We may feel unable to come out at all because of what may be real risks to our wellbeing and safety, whether that be threats of violence or serious disruptions of important relationships such as those in our families or religious communities. We may even struggle with “coming in” — that is, recognizing and accepting oneself as LGBTQ — whether because of internalized negative ideas about being LGBTQ (e.g. “LGBTQ people are promiscuous”), perceived conflicts with core beliefs (e.g. “same-sex relationships are sinful”), and any number of barriers to our ability to embrace our unique experience of SOGI.

Whatever the case, our response to our circumstances must have at least two features: a loving-kindness; and a gentle recognition that these struggles allow us opportunities for renewal that can surprise us in the way it moves us closer to authenticity than our preconceived notions of coming out ever could.

Speaking of renewal, like other aspects of life, our experience of SOGI is always undergoing this process: we learn more about the nature of our attraction to others; who we are as men, women, or some other gender category; and what influences how we respond to relationships. For example, while the rule of thumb is that sexual orientation is generally stable over a lifetime, some very clever research has shown it can also display a good deal of fluidity, such as in studies that looked at differences in its expression based on birth sexes (Mock and Eibach, 2012) or specific timescales (Diamond, Dickenson, and Blair, 2016). This fluidity is also the case for gender identity (Katz-Wise, 2020), and is readily seen both historically and in the present time both in our own culture and in the surrounding cultures of Southeast Asia (Peletz, 2006). Such fluidity is undoubtedly fascinating in and of itself. But more importantly, it raises many points of reflection: for example, how much of our experience of authenticity is invested in our experience of SOGI, given its potential fluidity? (This question certainly applies to many other areas of life!) Applying this question to coming out: how much of the movements of life — our aspirations, beliefs, talents, interests, and capacities for truth in our relationships — is invested in our coming out, given how fluid coming out can also be?

There are many ways we can break this question down further. But as a starting point for what is ultimately a lifelong process, we can briefly apply some practical points of reflection on authenticity offered by the clinical social worker Zahara Williams:

  • Does coming out allow you to be “in tune with your values and passions”? For example, is being more open about your SOGI directed towards your personal commitment to the principle of honesty? Or does being more open about your SOGI also translate to being more open to embracing interests and desires which norms surrounding gender and sexuality would otherwise stop you from pursuing?
  • Does coming out contribute to a feeling of “being fulfilled?” For example, would being more open about your SOGI open up avenues in your life that allow you and others a fuller experience of who you are and what your life has to offer?
  • Does coming out help you “navigate life with purpose?” For example, would greater honesty about your experience of being an LGBTQ person allow you to act with more honesty about what you want out of life?
  • Is coming out for you “prioritizing what brings you peace”? For example, would disclosing your SOGI, whether or not this is initially difficult or distressing, ultimately give you the peace of mind you need to move through life with more ease and without so many considerations of people’s responses?
  • Does coming out give you more “tenacity and flexibility?” For example, would facing the challenge of coming out as LGBTQ embolden you to face courageously all the other challenges life offers you? (Psych Central, 2022)

To emphasize a previous point, coming out is a “lifelong process”, and our answers to the questions like what gives us a sense of fulfillment or peace are themselves very fluid. You may have also discovered that there were just as many other questions as there were answers which emerged. Perhaps while looking back at your own experience, as I did while writing this article, you realized that there was a time before coming out where the various affections of life came less naturally then than it does now. You may also have noticed that, despite the very real difficulties that entered into life as a result of coming out, there also came very real joys. And perhaps there were things which you would not expect to be at all related to disclosing one’s SOGI — in my case, these were my renewed religious pieties and an enthusiasm for sports — which now have such a profound influence on the movements of your life after coming out.

If these questions seem difficult, that is because they are. But as we see from some of these questions, coming out can be a starting point for a fuller experience of life’s truths. Using the components of authenticity identified earlier on: does coming out allow us to direct the movements of life in ways that allow us to live a life that manifests consistency, conformity, connection, and continuity? Whether or not we choose to come out, what is important is that we are able to exercise that sensitivity to the movements of life so that we are able to be true to ourselves in the present moment.

Whatever the case, We Thrive aspires to be your ally. Whether it’s about coming out, navigating your relationships with others, and figuring out how your SOGI fits into other aspects of life in a beautiful way, we want to be with you in your journeys.

To learn more about how our different activities and programs can contribute to your wellbeing as an LGBTQ person, email us at resilientteams@wethrivewellbeing.com.

References:

  • https://www.psychologytoday.com/us/basics/authenticity
  • https://www.frontiersin.org/articles/10.3389/fpsyg.2020.629654/full
  • https://positivepsychology.com/authentic-living/
  • https://www.psychologytoday.com/us/blog/traversing-the-inner-terrain/202305/how-to-live-an-authentic-life
  • https://www.psychologytoday.com/us/blog/what-doesnt-kill-us/202007/are-authentic-people-more-mindful
  • https://pubmed.ncbi.nlm.nih.gov/21584828/
  • https://www.health.harvard.edu/blog/gender-fluidity-what-it-means-and-why-support-matters-2020120321544
  • https://psych.utah.edu/_resources/documents/people/diamond/Stability%20of%20sexual%20attractions%20across%20different%20timescales.pdf
  • https://www.jstor.org/stable/10.1086/498947
  • https://psychcentral.com/lib/ways-of-living-an-authentic-life
Categories
General

We Thrive Clinicians finish ACT training series with Dr. Susan Wilkens

Last Wednesday May 3, 2023, We Thrive clinicians wrapped up their Acceptance and Commitment Therapy (ACT) Training Series with Susan Wilkens, PhD entitled “Using ACT with Parents and Caregivers”.

The training series was conducted via zoom and comprised of four once a month sessions from February to May. Some of the topics covered were basics of ACT, psychological flexibility, mindfulness and acceptance, commitment and action, case conceptualization and case application.

The We Thrive team sends our gratitude to Dr. Wilkens for sharing her time and expertise with us!

Categories
Blog Everyday Thriving Thrive at Work Thrive in School

Helping Out a Friend Through a Mental Crisis Using ALGEE

Have you ever heard of the statement “That’s what friends are for”? It implies the role of a friend as someone you can count on to help you out. So when a friend reaches out and opens up about a problem, it seems natural to listen, comfort, and support them as best as you can. But there are times when you may not feel confident enough to help them. You may feel like you don’t understand the problem very well because you have not experienced it, or you have probably dealt with a similar problem before but could not understand why your friend is struggling with it. Sometimes, the idea of saying something wrong and making things worse for your friend is daunting in and of itself. Fortunately, there is one way for you to help your friend in times of mental distress.

So how can I help my friend out?

Like with medical concerns, you can provide first aid for mental health concerns.

Mental Health First Aid (MHFA) is done to help someone experiencing a mental health crisis when professional help is not yet available. ALGEE is a tool that is used to provide MHFA. It won’t teach you how to become your friend’s personal therapist, but it will help you provide them with the support they need to cope with what they are going through in that moment of crisis.

ALGEE is an acronym that stands for the following: Assess for risks of suicide or harm; Listen without judgment; Give reassurance and information; Encourage appropriate professional help; and Encourage self-help and other support strategies.

How do you use ALGEE?

ALGEE can be done in any order, depending on what you think your friend needs at the moment. Below is an overview of how you can approach and what you can expect to happen in each step. 

1. ASSESS for risk of suicide and harm

This step involves observing for any signs that would tell that a person is in distress. Such signs can be a sudden change in behavior or an unusual reaction to a particular topic or situation. You should also be alert to mentions or jokes of your friend contemplating suicide, as well as self-harm behaviors such as cutting, engaging in excessive substance use (such as alcohol, cigarettes, or drugs), or doing risky activities that can harm them physically.

If you find out that your friend is actively hurting themself or has plans to commit suicide, then it is important to persuade them to get help as soon as possible.

2. LISTEN without judgment

People who are in distress want to be heard. That’s why it is important to give them the opportunity to say what they want to say uninterrupted. Keep an open mind about what they are saying, even when you do not agree with them. Avoid making speculations or giving advice, unless your friend specifically asks for your opinion on the matter.

Show that you are actively listening by keeping an open and receptive body posture (that is, arms and legs uncrossed and palms resting comfortably on the lap or desk) and maintaining eye contact. You can also make appropriate verbal responses to show that you understand and follow what they are saying. Responses may be in the form of reinforcements (“I see.” or “Uh-huh.”), acknowledgements (“That’s tough.” or “I can imagine how confusing it is to be in that situation.”), questions (“What did you do to cope with that situation?”), and reflections (“This is what I heard from you. Am I understanding it correctly?”). If you’re talking with your friend through text or chat, you may need to rely more on verbal responses to better understand each other.

3. GIVE reassurance and information

In an effort to cheer your friend, you may sometimes find yourself telling them that everything will be okay or that they can do things if they only believe in themselves. However, people in distress may feel so overwhelmed and hopeless that they cannot see their situation improving or believe that they can act on their problems. To give reassurance, you need to make them see the possibility. You can do this by providing evidence and information. Are there ways to deal with their problem that they may not have thought of? Have there been situations that contradict a negative thought that’s been running through their mind? Helping them find evidence that there are things that can be done is an effective way of instilling hope in them.

There may be times when your friend thinks that undesired feelings or behaviors, such as lashing out at other people or being too afraid to speak in public, are their fault. However, such feelings or behaviors may actually be symptoms of a particular mental illness or of significant distress that could lead to a mental illness if untreated. Thus, it is important to emphasize that mental illness is real and the symptoms they are experiencing can be treated with the right help.

4. ENCOURAGE appropriate professional help

The earlier your friend gets help, the more likely they can recover. Find out what kind of support your friend needs at the moment and help them find professionals, agencies, organizations, or institutions that can make things a little easier for them.

If they need psychological help, there are various mental health services and programs available. Some universities and organizations offer free therapy sessions, although they may be limited in terms of slots or the number of sessions that can be availed. For long-term and more intensive help, paid therapy sessions in clinics and hospitals may be necessary. You can check out the directory of mental health facilities in the country created by #MentalHealthPH here. Additionally, 24/7 crisis lines come in handy whenever there is a need to overcome a mental crisis or to prevent a suicide attempt. A list of these hotlines can be found here. Regardless of whether payment is involved, simply being able to attend therapy is already a huge step towards healing.

5. ENCOURAGE self-help and other support strategies

Mental health services aren’t always available, and this can be a problem when your friend experiences a panic attack or suddenly feels overwhelmed by suicidal thoughts. Knowing how to deal with these emergencies helps them develop the skills to cope with crises on their own. Coping strategies such as breathing, grounding, and self-soothing techniques are useful during panic attacks. Utilizing tools for mindfulness and emotion regulation also helps practice control and lessen chaotic situations caused by outbursts. Exercising, spending time with friends and families, and engaging in hobbies and other recreational activities can help improve one’s quality of life. For some mindfulness breathing exercises, you can check out Circle of Hope’s Hingalangin videos on their Facebook page.

To see a demonstration of ALGEE, you can watch this roleplay video on YouTube.

Are there things I should consider when using ALGEE?

As a mental health first aid tool, the main purpose of ALGEE is not to diagnose your friend or solve their problem, but to help determine their needs and provide appropriate support. While your closeness can help your friend be more comfortable opening up to you, it is important to always be objective, express empathy, and abide by the principle of “Do no harm.”

Here are ways that you can do this.

  1. Keep what is said confidential, unless help from other people is necessary.

It takes courage for a person to open up about their struggles. Some people refuse to share what they are going through for fear of exposing themselves to the wrong people. Reaching out to you means that they trust you to keep what they have said only to yourself. Before going through ALGEE, it is best to set up a time and a place to talk to your friend privately. This will give your friend a chance to be vulnerable in a safe space. However, keep in mind that if there is a high risk that your friend would commit suicide, ensuring their safety by asking for help from other people and authorities is necessary.

  1. Do not force your friend to share their problems with you.

Sometimes, people are just not ready to talk about their problems. If your friend outright tells you that they do not want to talk, do not force them to. Instead, encourage them to talk to someone that they trust or assure them that you are available to listen to them whenever they are ready. You can also simply ask them what they need at the moment. Show them that there is someone who is willing to listen and help, and they have the option to choose who or when they seek help.

  1. Refrain from invalidating them or trivializing what your friend is going through.

Some people keep their worries to themselves because they believe that no one would hear them out or make the effort to understand them. When your friend opens up to you, listen well and try to see the situation from their perspective. If there are things they said that you do not agree with, do not reject or dismiss what they are feeling or thinking about. If you think that their problems are too simple, remember that every person is affected by situations differently. What may be easy for you may be too much for them. Likewise, if you have experienced a similar problem and have resolved it successfully, take note that what may have worked for you may not work for them. Thus, when providing help and support, consider their strengths and weaknesses.

  1. Give your friend the control that they need through options.

One of the reasons why people usually feel distressed is because they feel that they cannot control their situation. Thus, if solutions are imposed on them, the feeling of having a lack of control will increase. If you have a solution in mind, ask first if they are open to hear advice. If they are, assure them that your advice is simply a suggestion and is open to modifications until they find one that they are comfortable with.

  1. Improvise, adapt, and overcome.

There are times when it can’t be helped to expect something from your friend or from the situation. However, it is important to be open to the possibility that things may not go your way. Something may keep your friend from getting help despite your agreement or keep the situation from improving as you both hope. Identify the challenges, seek alternatives, and try again. And remember, it’s okay to make mistakes!

  1. Watch out and prepare yourself for compassion fatigue.

While being there for a friend during their toughest times is admirable, there are times when their problems, emotions, and negative thoughts can get to you too. When you feel overwhelmed with helping your friend or are starting to feel affected by what they’re going through, you may be experiencing compassion fatigue. It is important to be mindful of the symptoms of compassion fatigue and to prepare yourself to prevent it or address it when it comes. Remember to take a break if you have to and to take care of yourself first every once in a while. It’s also important to not be too hard on yourself if things don’t go as well as you hope. If your friend deserves compassion, then don’t you deserve some as well? You can practice some self-compassion exercises to help you combat compassion fatigue.

Using ALGEE is a great way to create a mental checklist of what you can do to help out a friend during a mental crisis. However, this does not mean that you have to strictly abide by it or be overly concerned if you skip a step. The most important thing about helping a friend is being there for them and showing them that you care.

References:

Altta Wellbeing. (2019, September 30). ALGEE – 5 letters, 1 life saved every time. https://wellbeing.altta.co.uk/algee/

Jorm, A. (2016). Key Elements of Mental Health First Aid. Alan J Fisher Centre for Public Mental Health. http://cpmh.org.za/wmhd/wp-content/uploads/2016/08/Key-Elements.pdf

Martinelli, K. (2023, February 20). How to Support a Friend With Mental Health Challenges. Child Mind Institute. https://childmind.org/article/support-friend-with-mental-health-challenges/

Mental Health Foundation. (n.d.). How to support someone with a mental health problem. https://www.mentalhealth.org.uk/explore-mental-health/articles/how-support-someone-mental-health-problem

Thurrott, S. (2021, June 11). Watch for These Key Warning Signs of Compassion Fatigue. Banner Health. https://www.bannerhealth.com/healthcareblog/teach-me/watch-for-these-key-warning-signs-of-compassion-fatigue

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Blog Everyday Thriving General

The Fawn Response: How Pleasing and Appeasing Patterns Impact Women’s Wellbeing

fawn response

“Perhaps the biggest tragedy of our lives is that freedom is possible. 

Yet each day we listen to inner voices that keep our life small.”

Tara Brach

As we faced frightening and stressful times during the pandemic many of us became familiar with the vocabulary of fight, flight, and freeze responses to stress and trauma. When a threatening situation arises, our nervous system sets off an automatic response toward safety and protection. This process happens unconsciously, without us having to think or be intentional about it, with the goal of survival being the immediate priority. The brain prepares the body to deal with the threat in different ways: to engage with it aggressively (fight), to run away or avoid it (flight), or to shut-down and numb the pain if the danger is deemed to be insurmountable (freeze).  In our modern world, these stress reactions are mostly triggered by emotional or social threats such as our fear of failure, loss of control, rejection, abandonment, and feelings of worthlessness. Although useful and necessary for coping with real danger, being chronically caught in the habit of these defensive responses severely compromises our physical and mental health. 

The fawn response is a lesser known stress and trauma response mechanism that deserves much more attention than it gets. Natureza Gabriel Kram, in his book Restorative Practices of Wellbeing (2021), describes the fawn response as a survival structure that utilizes our capacity for connection to disarm a threat. It usually emerges in contexts where the source of danger is someone we are intimately connected with. In these circumstances fighting, fleeing, or freezing would not have achieved our adaptive goals either because the threatening figure is someone we depend on for our survival or that using a more overt defensive response would have worsened the potential harm. A lot of times the fawn response gets reinforced early in life as a way of coping with emotionally unavailable, critical, or abusive caregiving. In the absence of supportive and empowering connections, young children may become hyper-focused on pleasing parents and caregivers by being sensitive to their distress and taking care of their emotional needs. 

Dr. Arielle Schwartz characterizes the fawn response as a pattern of pleasing and appeasing behaviors aimed at taking care of the needs of the aggressor in order to diffuse danger. It’s a rather sophisticated process that taps into the social engagement system, manifesting in different forms of accommodation that serve to befriend an aggressor in order to ensure one’s safety. In a broader sense, we could be dealing not only with physical aggression but as is often the case, our safety could be undermined by emotional threats—being harshly criticized or put down, shamed, rejected, and dismissed.  The fawn response gets activated to manage these threats. Fawning behaviors commonly manifest as being overly agreeable or helpful; never being able to say no; constantly prioritizing the needs and happiness of the other over one’s own; and forfeiting one’s boundaries, rights, and needs to avoid being attacked or shamed. Perhaps not surprisingly, the fawn response has been observed to be more common in women than in men. Evolutionarily, women have had to defend themselves against male aggressors. However, fighting, escaping, or shutting down might not have been viable responses because they had children to protect and care for. Therefore, it became a matter of necessity for women to engage in a survival strategy that disarms aggressive and controlling male figures by turning toward them and by being over-accommodating  to their needs.    

As we can see, the fawn response can become a very deeply embedded behavioral pattern which patriarchal societies have culturally entrained.

Pleasing and appeasing behaviors have become implicit expectations in females, preserving the status quo of inequitably distributed power and resources that favor men. The perpetuation of fawning patterns has immense ramifications on women’s lives. Being brought up in families and communities where females are rewarded for fawning has kept our lives smaller than the horizon of opportunities that we deserve. 

Psychologically, the consequence of fawning is that it leads us to abandon ourselves. We lose clarity about who we are and disconnect from our truth. Although fawning behaviors may appear functional and even socially desirable from the outside, on the inside what is really going on is a persistent bypassing of our internal signals.  While we can project an image of adapting well to external demands, our nervous system is actually in a vulnerable state of threat because we don’t feel safe to be our authentic self. Beneath the surface, we are constantly experiencing stress from the invalidation of our true needs and desires. Women’s physical and mental health are believed to be negatively impacted by the habituation of the fawn response. World-renowned physician and trauma expert Dr. Gabor Maté in his book The Myth of Normal (2022) makes the case that women’s acculturation into society to automatically and compulsively prioritize the emotional needs of others while ignoring one’s own is associated with the very high prevalence of autoimmune diseases and non-smoking related cancers among women. It could also help explain why women make up a vast majority of chronic migraine sufferers (Migraine Research Foundation) and take twice as much antidepressants and anxiety pills compared to men.   This is not to say that fawning behaviors are biologically determined, but that a patriarchal society thrusts this predicament upon women. 

Women’s pathways to wellness need to consider the role that fawn response patterns play in keeping us entrenched in toxic stress cycles. People around us, most of the time those who are close to us, have been accustomed to our dutiful yeses, complying so as not to disrupt the comfort of old ways. Continuing the fight for women’s liberation means challenging ourselves to pull away the curtain that keeps our needs out of sight and daring to listen to our real self.  What would happen if we stepped boldly into directing more care and attention to ourselves, to giving voice to our truth, and to saying no to the inequities we experience at home and at work? Where would these acts of self-love take us?  Quite simply, they would bring us home. 

Unlearning our fawn response is a journey into embracing the freedom that comes from self-authenticity and in recognizing the one treasure that we really are. We are in different circumstances and indeed some women struggle with more severe threats to their safety. Acknowledging  the ways we get hooked into fawning is not about self-blame but a compassionate awakening. We can practice and take everyday steps to turn our caring gaze toward ourselves, gradually exploring the new territory of taking action on our behalf and being immensely proud of the courage we’ve found.      

Practices in Unlearning our Fawn Response

1. Connecting with our Safety Anchors

Psychotherapist and author Deb Dana espouses a nervous system approach to resilience and wellbeing that emphasizes anchoring on safety. Genuine safety means honoring our internal signals to tell us when are feeling safe or unsafe about different situations. To strengthen our safety ancbors, we are invited to notice WHO, WHAT, WHERE, and WHEN we feel safe. Who are the people who make us feel safe? In which relationships do we feel heard and validated? What activities bring us a sense of safety and calm when we’re feeling overwhelmed? Which physical spaces support our feelings of safety and ease? What moments allow us to listen deeply to ourselves?  

2. Self-Compassion

Unlike self-criticism which asks if you’re good enough, self-compassion asks what’s good for you? This is according to Dr. Kristin Neff, pioneer researcher on self-compassion. The practice of self-compassion calls for the integration of tenderness and fierceness. We practice the tender side of self-compassion by being with ourselves in an accepting way, comforting and reassuring ourselves, being present to our moments of difficulty without self-judgment. On the other hand, we exercise the fierce side of self-compassion by standing up to protect ourselves, to provide ourselves what we need, and motivate ourselves toward committed action. Sometimes it means saying no, drawing boundaries, and fighting injustice.  Speaking our truth can be a form of fierce self-compassion. Dr. Arielle Schwartz suggests exploring incomplete conversations or unfinished business by journaling about the following prompts:

  • When you hurt me I felt . . .
  • The worst thing that you said or did was . . .
  • What I was most afraid of was . . .
  • What I wish I had said to you then, but never told you was . . .
  • What you could never take from me is . . .
  • I know that I am strong because . . .
  • What I want you to know about me now is . . .

3. Boundary Clarity/Observing Limits

Natureza Gabriel Kram explains that “developing boundary clarity is about learning to tune into and experience, at a visceral level, the direct energy of the defensive responses.” Because fawning overrides the fight response, which is at times necessary for self-protection, practicing boundary clarity helps us reconnect with the limits that we’ve surrendered to accommodate others. One way to do this is to allow ourselves to experience and validate anger. Instead of automatically inhibiting anger, allow it, feel the biological energy of anger in the body, and invite it to take the form of an action toward assertive self-advocacy. It could mean expressing what we don’t feel good about, making a direct request to address our need, and perhaps sometimes pulling away from relationships that curtail our authenticity. 

4. Allyship

We can draw strength and courage to end toxic stress cycles through the power of allyship. When we become aware of the cultural forces that shape the fawn response in females, it awakens us to the need for standing up together. Allyship means standing up for ourselves, for our mothers, our daughters, nieces, friends, co-workers and fully embracing our value. Allyship can be practiced in everyday life by assertively responding to micro-aggressions experienced by women. A Harvard Business Review article (2022) notes that most commonly, these micro-aggressions involve invalidation of competence, invalidation of physical presence, and diminishing or denying gender bias when it is brought up. It is important that we educate ourselves on what to look for, to speak up, and reach out to one another. 

About the Author:

Dr. Joanna Herrera is a licensed psychologist in the Philippines and in California. She obtained Master’s and Doctoral degrees in Clinical Psychology from The Wright Institute in Berkeley, California and completed predoctoral and fellowship training at the UCSF-Benioff Children’s Hospital Oakland. She has been a clinical supervisor for MA/PhD clinicians, developed mental health programs, and became the director of a community mental health program in the San Francisco-Bay Area.  She currently holds practice as a clinical psychologist, provides services and consultation to organizations, and is involved in the training and supervision of mental health professionals in the Philippines. Dr. Herrera is President and Co-Founder of We Thrive Consultancy and Wellbeing Services, Inc. and the Executive Director and Co-Founder of Circle of Hope, a non-profit organization.  She started formal mindfulness training in 2008 and is a mindfulness practitioner. She is intensively trained in DBT (Dialectical Behavior Therapy), trauma-informed treatment, early childhood mental health, clinical supervision, and mindfulness-based clinical interventions among others.   

Categories
Blog Everyday Thriving General Thrive at Work Thrive in School Wellbeing Practices

Navigating the Road to Healthy Boundaries

Boundaries

Have you ever driven a car? Driving is a useful yet rigorous skill to learn.

Similar to driving, setting healthy boundaries is a rewarding skill that can help us go places. We are the driver navigating our way through the busy district of interpersonal relationships. Learning to set healthy boundaries needs conscious effort, and it can make us feel a mixture of excitement and fear – like driving for the first time.

Following the rules

Since childhood, we have been taught to follow the rules: obey the elders, be agreeable to our peers, consider others’ feelings, and be mindful of how others view us. These rules usually remain with us until adulthood as we continue to defer to our parents, comply with our supervisors, and yield to our partners. More so, these rules help us maintain harmonious relationships with others.

The downside of rigidly following these rules is developing our fear of interpersonal conflicts. The need for belongingness and acceptance drives us to indulge others even with a heavy heart. Some demands
can make us feel uncomfortable, but we do them anyway to avoid the guilt and anxiety of saying no.

Sometimes people misinterpret the rules of social relationships. We become compliant instead of compromising to maintain “conflict-free” relationships. Giving in to the backseat drivers can be exhausting; we have to take the wheel ourselves.

Keeping safe distance

Being too close to other cars raises the chance of collision. The same goes with having little to no personal space. It may appear counterintuitive, but saying no to others can improve our relationships.

Boundaries are the limits we establish for ourselves on our participation in social activities to preserve our integrity. They make us feel comfortable genuinely expressing ourselves and still safe around others. They are not meant to keep people away but to provide us enough space to assert our needs, wants, and expectations of others.

Dr. Sheri Jacobson, a retired senior therapist and founder of Harley Therapy in the United Kingdom, listed the adverse effects of having poor boundaries. We become vulnerable to stress, anxiety, depression, and burnout. While we try to avoid interpersonal conflicts, we may still have bad relationships. Others can take advantage of us even unintentionally at times. Our frustration, resentment, and anger will eventually accumulate, and passive aggression may seem like the only way to stand up for ourselves. The worst case is losing our own identity as we prioritize others more than
ourselves.

Paying attention to the signs

As you journey through setting healthy boundaries, you need to look out for the signs of being a people pleaser. According to Nedra Glover Tawwab, a therapist and author of Set Boundaries, Find Peace, poor
boundaries manifest in four ways:

1. Neglecting self-care

Whenever you accommodate others’ wishes, you give a part of yourself to them – your time, energy, and resources. A telltale sign of having poor boundaries is not having enough of these for your own. It is neither selfish nor inconsiderate to give yourself some space. Remember, you cannot run with your gas tank empty or battery drained. You have to take care of yourself first to take care of others.

2. Overwhelmed

People with poor boundaries feel overwhelmed most of the time as they tend to accept more tasks than they can manage. They constantly worry about fitting everything into their schedule. You need to know your limits and work only within your limits. Going beyond them results in exhaustion and burnout.

3. Resentment

People who are compelled to do something may feel annoyed. Worse, those taken for granted feel hurt, bitter, and angry. Resentment will pile up and negatively affects your relationships in the long run. The little things we used to enjoy doing for and with others start to feel like duties – boring and tiring. Note that relationships should not be a burden; instead, they should be one of your sources of happiness, hope, and support.

4. Avoidance

When you cannot assert yourself, you will likely respond to resentment by avoiding others. It is passive aggression to ignore or cut off people. Delaying responses and bailing out of trips are some avoidant strategies that can isolate you. These are not helpful because they do not convey to others why you evade them; hence, they will continue to ask you favors.

Map to healthy boundaries

When you recognize the warning signs, hit the break and take the route to setting healthy boundaries. Adapted from Tawwab, you can follow this roadmap:

1. Identify your boundaries

The first step in setting healthy boundaries is to know your wants, needs, and expectations. Observe yourself and reflect on your emotions and thoughts.

  • Do you want to do this?
  • Are youcomfortable doing that?
  • What do you need?
  • What do you expect others to do to you or for you?

Ask these questions to know more about yourself and your limits. Honesty is crucial in this step.

2. Communicate

People are not mind readers; you have to tell them our boundaries. More importantly, you must state them clearly and directly – not just signals of maybe’s or I-don’t-know’s. In doing so, others become aware of how you want to be treated. You may beat around the bush because you find confrontations agonizing, but indirectly communicating our boundaries can only be confusing.

3. Deal with the discomfort

Setting boundaries can initially elicit some discomfort. You may feel guilt for being “selfish” or “mean.” You may feel fear that your future interactions will be awkward. You may also worry about saying the right words in the right tone at the right time. However, practice can make it feel easy and natural. Remind yourself that you are setting boundaries for your wellbeing. Engage in other self-care activities as well to improve your mood while learning how to say no.

4. Follow through

Despite feeling some degree of discomfort, you have to commit to honoring your boundaries. Consistency is key. Show people that you take your boundaries seriously, and they should, too. Immediately speak up when others go overboard. Tell them how you feel about it and what you prefer them to do. Do not let anyone slide, as it only encourages others to continue disregarding your boundaries.

The roadmap may appear short and straightforward, but it can be a long and winding road. You may find yourself going in circles, and it is definitely okay. When this happens, pull up and refer to the map to find your way again. You can also ask a reliable friend to hop in for a while and help you stay on track.

Establishing healthy boundaries leads to an enjoyable life. You become true to yourself, and others learn to honor your decisions. You get the most out of your relationships because you are respected – by yourself and others.

Now that you know the rules, the signs, and the map, may you continue to share your adventures with others while enjoying some healthy space for yourself.

References:

American Psychological Association (n.d.) Boundary. APA Dictionary of Psychology.
https://dictionary.apa.org/boundary
Jacobson, S. (2015, March 24). The Psychological Cost of Never Saying No. Harley Therapy.
https://www.harleytherapy.co.uk/counselling/saying-no.htm
Tawwab, N. G. (2021). What the Heck are Boundaries?. Set Boundaries, Find Peace: A Guide to Reclaiming Yourself. Penguin Random House LLC

Categories
Blog Everyday Thriving General Restorative Practices Wellbeing Practices

Tune In: How Music Fosters Wellbeing

music

“‘Cause when you get older, life gets colder
Sometimes I just wanna hit pause, but I’m afraid I’ll never press play again…”

Clara Benin

When was the last time you checked in with yourself and asked how you’re truly doing?

With all the demands that life throws at us, we may easily fall into the trap of mindlessness, juggling many things all at once without examining ourselves in the process; thereby, running the risk of wearing ourselves out in the long run. Add to it the culture we live in where busyness, overproductivity, and urgency are being glorified. Who has the luxury to be still a few minutes in a day when work pressures you to submit it now? Who even cares about how you feel when outputs have become implied measures of one’s worth? If we won’t make deliberate choices for our wellbeing, these can be detrimental to our health and our ability to flourish as we live this one precious life we’re gifted with.

Press Pause and Tune In

Think of the self like a musical instrument, say, for example, a guitar. It would be pointless to sing and be accompanied by it if the instrument is out of tune. In order to maximize the value and function of a guitar (and this goes with most instruments), it has to be set in proper tuning. Too much tightness could cause the strings to break. On the other end, when you don’t plan to use the guitar for quite some time, it’s best to loosen up the strings in order to prevent them from possibly breaking. 

The same goes for us, human beings. When we’re constantly exposed to stress and we’re unable to release the tension, it affects how we think, feel and relate with others in negative ways. Moreover, our bodies will eventually suffer and it may manifest as physical illnesses. In order to be at our optimal selves, we need to pause, tune ourselves, and acknowledge where we are at the moment with gentleness and self-compassion. 

Tuning ourselves may look different for each of us, just like getting quality sleep, eating healthy foods, ensuring that we’re regularly connected with the people we love and who support us, having a me-time, creating space to feel both pleasant and unpleasant emotions, being mindfully aware as thoughts and feelings come and go in the present moment. The last two may take time some practice in order to cultivate such awareness, but one tool has been helpful in making it happen— music.

Permission to feel

music

Who gave you permission to feel?

Music.

What seemed to be just a moment of mindless scrolling on Twitter ended up as an “aha!” moment that eventually led me to reflective mode, just like how you listen to a song for the first time, and it suddenly hits right in the feels. Familiar, isn’t it?

Whether as a listener or creator, one cannot deny the power of music in evoking emotions. We know from experience how music gives us the comfort we need when going through difficult times, the focus and energy boost in completing tasks, and even transporting us back into key events in our lives where we try to make meaning and reconstruct our own narrative. It serves a myriad of functions, most especially in enhancing our wellbeing.

Music and wellbeing

1. Music as a safe space for feelings

“Perhaps the therapeutic use of music allows people to
experience emotions safely… (Wilkinson, 2018).” Remember the moments you listened to music when you needed a good cry or you need to feel calm. Maybe the lyrics resonated with what you’re currently going through, which gives you a sense of comfort, the feeling of being held, and the validation that you’re not alone. Or, if you’re a musician and you’re trying to capture your feelings into melodies, the act of playing your instrument becomes cathartic for
you. A song is like a friend who provides that safe, grounding, and non-judgmental space that gives you permission to feel in that present moment. Joy, sadness, fear, anger, hope, love, awe— all emotions are welcome here. These “permission to feel” moments are important in maintaining our wellbeing since it allows us to acknowledge the complexities of our emotions which is key to emotion regulation, instead of running away or numbing them.

A qualitative study by Saarikallio (2010) explored music-related strategies of emotional self-regulation during adulthood and found that participants turn to music for:

  • happy mood maintenance
  • revival and relaxation especially when tired
  • strong sensations and powerful emotional experiences such as intense enjoyment, deep concentration and emotional involvement in music (e.g. being part of an opera production or watching a live concert)
  • diversion or distraction from unwanted thoughts and feelings
  • discharge and disclosure—that is, releasing and venting anger or sadness through music that expressed these emotions
  • mental work such as being able to face, contemplate and work through unsettling emotional experiences,
  • solace— acting like a comforting friend who understands and accepts you when you feel sad, melancholic or hopeless; and
  • ‘psyching up’— uplifting one’s mood and raisingone’s energy levels for an activity.

2. Music helps us get “in the zone”

Being completely absorbed in an activity that you lose track of time is known as flow or commonly known as “in the zone”. This intense and focused concentration on the present moment can be achieved through the help of music. You  may recall a time that listening to an ambient or instrumental music helped you stay focused in finishing a task such as writing or studying for an exam. According to Mihály Csíkszentmihályi (2014), the main proponent of the concept of flow:

“merely having music playing in the background does not evoke flow, but listening to music as the main activity so that attention can be focused on the music is an important precondition for getting into and staying in flow.”

Mihály Csíkszentmihályi (2014)


The key then is to listen mindfully to the music. To practice, set aside at least five minutes to listen mindfully to a song of your choice (one that doesn’t have lyrics), sit with it and listen to all the elements used in the song, from the instruments used to how it’s arranged. As you cultivate mindful listening to the music, it increases your likelihood of getting into flow.

3. Music as a tool for enhancing social connections

There is no doubt that music is best enjoyed when it is experienced and shared with others— whether that could take in a form of singing together in a group (karaoke sessions), teaching another person on how to play an instrument, meeting strangers who have turned into friends in a concert of your favorite band, curating a playlist for your loved one and sharing it to them ‘cause that’s your love language, or being part of a fan group and interacting with the artist. Sometimes, when we’re having difficulty in articulating our thoughts and feelings to our friends, it helps to share instead a song that relates to our experience so that our friend would understand where we are. Koelsch (2013) reviews the social functions of music such as being able to increase contact, coordination and cooperation with others, engage in social cognition wherein the listener tries to understand the intent and message of the artist expressed in the song, participate in co-pathy (a social function of empathy), which all leads to social cohesion— satisfying our human need to belong.

Truly, music allows us to feel connected to all of humanity.  Music indeed is a gift to us, especially as we continue to take care of our wellbeing. May we practice tuning in to ourselves with the help of music, allowing it to take us to places of our souls that need some tending. And just “be”.

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