No More Tip-Toeing: It’s Time for Action!

When Sam came to see me, he didn’t know anything about life coaching. He just had a problem and didn’t know how to solve it. A friend told him that I might be able to help him, so he made the first appointment.

Sam’s problem was this: he had a family business that was doing okay before the recession. Lately, the revenues started declining. He was contemplating retirement for awhile, thinking that it made more sense to him than to labor twelve hours a day for very little return, and this seemed for him a good time to finally take that step.

The problem was that he had ten employees that had been working for him for years and depended on their jobs even more than usual in this tough economy. He didn’t have the heart to tell them that he was thinking to close. Lately, his accountant was saying that he had to either come up with a new idea to revamp his business or he would run out of money by the end of the year. And the longer he waited to make a decision, the less money he would have left in his retirement fund.

Sam did not want to think about reinventing his business. He was done. He had worked all his life and now he was dreaming of a small house in Costa Rica where he could live part of the year in the middle of nature.

“How much longer,” he asked me in the first meeting, “should I tip-toe around my employees

before I break the bad news to them?”

“Do they know that anything is up?” I asked.

“It would be impossible for them not to have figured out by now that sales are down and we are running out of money.”

“If they already know things are bad, perhaps all they would like to find out from you is when they will be out of a job, not if.”

“Yeah, perhaps,” he said with a heavy sigh. “I just can not bring myself to set that meeting. Every week it’s on my agenda and every week I postpone it.”

“When you imagine yourself in that meeting, what makes you the most uncomfortable?”

“Their disappointed faces. The fact that I failed them.”

“Didn’t you want to retire anyway?”

“Yes, but I wanted to do it well, like my father did. He had this great party, then he left and the business kept going strong…” he said nostalgically.

We started talking about how being a business man implies making decisions that make sense from a business standpoint and how he needs to find a way to let go of the image of him retiring in the same fashion as his father. The times are hard and it isn’t his fault. He needed to take back the control of his business.

Holding in his mind’s eye the image of his cottage in Costs Rica where he will not have to deal with business decisions or money or spread sheets did help. Reviewing his ever decreasing saving accounts also helped. But what helped him make his move was the understanding of the psychology of his “tip-toeing.” And that meant understanding his own fear of change.

In fact, his “tip-toeing” behavior had a name: phobic avoidance. It means avoiding something that makes you fearful and uncomfortable, even when you know that avoiding it can cause you more discomfort and harm in the long run; if it is avoided for the moment, it’s a moment longer before you really feel the pain here and now. This was exactly what Sam was doing. He did care for his employees. Still he could have let them go months ago, with good severance packages and good recommendations—all he, as an employer, could be expected to do. They will have to take their chances out there in the work force anyway, as he was ready to retire.

Ultimately, this is what Sam did: he gave them generous bonuses and took the time to write individual letters of recommendation in which he highlighted the merits and qualities of each employee. He then organized a fancy retirement party at an expensive restaurant in town, which allowed him to feel prosperous and benevolent. It also gave him the feeling that he was still in control, even though he had to adjust to a bad economy and harsh business decisions. In other words, he faced his fears and took steps to overcome them.

Using his entrepreneurial instincts, he managed to rise above the situation and solve it.
To his surprise, his employees took the news very well. They said they knew it was time to close. Some of them were already looking for new jobs. Some of them thanked him for ending their agony of not knowing when and what would happen to their company and had a sigh of relief when Sam brought the situation into the open.

Everybody understood and supported his decision to retire. It turned out that, using his business contacts, Sam was able to be very instrumental in helping his people find new jobs even in the recession. No one felt let down by the time Sam was through.

At our last meeting, I asked him if he was happy.

“Things couldn’t have gone better,” he answered, patting reassuringly his shirt pocket where he kept his recently purchased Costa Rica plane ticket. “I can’t believe that after all these years in business, I still kept staying in my own way. I was the biggest obstacle to move forward--not the economy, or my business or my employees. I could have done this a year ago.”

“But you did it and it went very well,” I reassured him. “In fact, everybody, even the savviest businessman, has a soft spot. Yours was the concern for your people. Fortunately, you figured out ways to take care of them and at the same time did what’s right for the business. You’ve created a win—win situation. What would your father think?”

He just smiled.

“Thank you,” he said, and then he opened my office door and walked purposefully into his new life’s journey.

Occasionally I get a post card from Costa Rica. He is very happy with his new life. He still remembers our discussion about “phobic avoidance” as the thing that’s always best to be avoided.

Has it ever happen to you to tip-toe around an issue only to discover that the solution was much easier than the tip-toeing?

P.S. I think temporarily I suffer from a "post-Vancouver nostalgia." All the pictures you see in this post are from Vancouver.

GREETINGS FROM VANCOUVER

Is a series started by the inventivity of Unknown Mami. She is amazing. Check out her blog! Click on the image of "Sundays In My City" and you will see other travel stories along with her own.

I am traveling to Vancouver this week for a conference on "wealthy thought" leadership. It has been the most illuminating conference and I am working on a full post on it. But for now, let's look together at some of the pictures I took from the city. I hope that, after you see them, you will understand, just as I did, why Vancouver is considered one of the top 10 most beautiful cities to live in in the entire world.

The English Bay--It is in the city and not on some isolated part of Canada. But this is Vancouver, not afraid to allow open spaces whithin the city. If this was Los Angeles, there would have been mansions and expensive condominiums up to the water line.

These birds with open wings are spread all over the city. They have many colors and patterns and pop up on the street when you least expect to see a piece of art.

Quiet Saturday morning on English Bay.

The vehicle of the future? Perhaps.

A psychodilic car we just came across on the street. No one knew its history or why it was parked there. But we were all intrigued by it.

An Inuit symbol is this: INUKSHUK. You see it everywhere. It is meant to look like a stylized man from the distance.

At the end of March, all the trees are in bloom.

The nature and the big city combine in an absolutely unimaginably beauty in Vancouver.

The Olympic flame is still burning. This time for the para olympics.

Hopefully you liked these images of Vancouver. And hopefully you too can visit it soon.

TOXIC STRESS AND HOW TO OVERCOME IT, Part 2

UNHEALTHY CONSEQUENCES OF TOXIC STRESS


Toxic Stress—a generic name for prolonged stress with no apparent end in sight that makes us feel powerless, hopeless, depressed and anxious.

Physical manifestations of toxic stress:

· The increased adrenaline level no longer comes down. The blood pressure and heart rate don’t either, wearing down the circulatory system and leading to hypertension and heart failure.

· Chronic increase of stress hormones (steroids, adrenaline, nor adrenaline) makes platelets more prone to aggregate and mobilize energy in the bloodstream and increase the level of fat, glucose and LDL type of cholesterol which leads to the formation of atherosclerotic plaques.

· The muscles remain tense and ready for the “fight or flight,” but the prolonged tension is weakening them.

· Pain and headaches become daily companions.

· Stress hormones inhibit the formation of leukocytes by inhibiting the thymus function and inhibiting the innate immune response. Stress induces a miscommunication between the brain and the immune system, weakening the body’s response to infections and even cancer.

· Digestive symptoms like discomfort, alternating constipation and bloating with diarrhea

· Increased predisposition for ulcers and irritable bowel syndrome; changes in appetite, eating too much or too little

· Delays healing from wounds and other illnesses

· Accelerates the aging process

(For this section I used information from the book Why Zebras Don’t Get Ulcers by Robert M. Sapolsky.)

Stress and Cancer

Long hypothesized and intuitively believed to be a true link: Galen observed 2000 years ago that women who were melancholy were more susceptible to cancer than other females; Gendron, a British physician in 1700s emphasized the effect of “disasters of life” as a cause of cancer; Burrows, eighty years later, attributed cancer as a reaction to “the uneasy passions of the mind in which the patient is strongly affected for a long time”; in the nineteen century observations were made about cervical cancer more common in sensitive and frustrated individuals; Walshe in his treatise The Nature and Treatment of Cancer called attention to the “influence of mental misery, sudden reverses of fortune and habitual gloomings of the temper on the disposition of carcinomatous matter.” One hundred years ago Snow reviewed 250 patients at the London Cancer Hospital and concluded, “The loss of a relative was an important factor in the development of cancer of the breast and uterus.”


· Characteristics of cancer prone individuals: frequent feeling of hopelessness, helplessness, an inability to express anger or resentment, an unusual amount of self dislike and distress and the loss of a meaningful emotional relationship


· One hypothesis for the relationship between stress and cancer is that, under stress, according to Yamasaki’s article on non-genotoxic mechanisms of carcinogenesis: “Cancer can be regarded as a rebellion in an orderly society of cells when they neglect their neighbors and grow autonomously over surrounding normal cells.” In essence, the balance and communication at cellular level may be lost during severe stress.


· The good news: spirituality, feeling of social support, learning and practicing stress management techniques, visualization and reframing of stress can all help improve the cancer outcome, in some cases increasing survival rates: and, perhaps, for people able to manage stress effectively, may have a protective effect from cancer.

(I have used for these sections information from the well researched article, Stress and Cancer: Diseases of Civilization, Communication and Control by Paul J. Rosch, M.D., F.A.C.P., President of The American Institute of Stress. You can find it in its entirety on line at )


The effects of toxic stress on the central nervous system

· Amygdala is highly activated by stress and has an inhibiting effect on the hippocampus, which leads to memory impairment.

· The neural connections networks are disrupted, which leads to decreased memory and concentration and, ultimately, to neuronal atrophy

· Excessive and prolonged exposure to stress hormones ultimately causes neurological impairment

· Recent brain imaging research shows that, extremely stressful situations like torture and traumatic head injury produce structural deficits in the prefrontotemporal brain regions, associated with severe depression.


The effects of toxic stress on emotional health


· Anxiety with panic attacks, irritability, even angry outbursts


· Reinforcing the anxiety and avoidance brain circuit in the amygdalar region of the right hemisphere


· Inhibiting the optimistic, future-planning circuit in the prefrontal cortex of the left hemisphere.


· Major depression with anhedonia (lack of pleasure in almost anything), excessive guilt and hopelessness.


Neuroimaging of patients with major depression showed abnormalities in the anterior cyngulate gyrus of the left frontal lobe, the same area thought to be crucial to comprehensive forward planning and executive control. It is believed that the anti-depressants act at that site to boost its activity and by so doing, help the depressed person regain the executive control and ability to make rational plans. The electrical stimulation of the same area showed relief in the depressive symptoms and an improved connection with amygdala, leading to better emotional control. Certain types of psychotherapy, like cognitive restructuring therapy or reframing, may lead to the same neurologic effect.


· Patients with genetically reduced volume of the above mentioned area of the brain have shown an increased risk for developing depression and a weaker connection with the amygdala, giving them less executive control over anxiety and the avoidance-producing brain center.


· PTSD (patients with PTSD due to repeated stress have small hipocmapi. The more severe the history of trauma is, the larger the volume loss.)

(For these sections I used notes from the on line book Psychology: An Introduction by Russel A. Dewey, Ph.D.)



Common Stressors—The Life Stress Inventory

The most popular stress scale is the Holmes-Rahe Life Stress Inventory.
The first five most stressful life events are based on loss, considered to trigger some of the most powerful stressful reactions:
· Death of a spouse, considered the most stressful of all possible life events
· Divorce
· Marital separation
· Jail term
· Death of close family member



What stressors have you found the most difficult to cope with? How did you overcome them?
How do you react under stress to everyday stress?
How do you react to prolonged, long term stress?
How did you manage it?



Try this exercise:


The Navajo Chant:


Happily may I walk


Let there be beauty before me
(Think of one thing for which you are grateful today.)

Let there be beauty behind me
(Think of one thing for which you are grateful today.)

Let there be beauty below me
(Think of one thing for which you are grateful today.)

Let there be beauty above me
(Think of one thing for which you are grateful today.)

Let there be beauty all around me
(Think of one thing for which you are grateful today.)

In beauty it is all fulfilled.

I hope the flowers in my painting made this picture of toxic stress less gloomy. I didn't talk about toxic stress to make you sad or to bring you down. I just wanted you to see in how many negative ways our health at all levels is marked by stress. The good news is that we can do something about it. There are many interventions we can do to shield ourselves from these negative consequences. You will see those interventions in few days, in Part 3 of this series--How to manage stress successfully.

The Thinking Tree Is Shaped By the Power of Our Own Thoughts

“If you leave me in the room without a computer or TV, I can keep myself busy for weeks worrying. I can endlessly think of everything I didn’t do, or I did wrong, or I completely forgot to do,” said Suzanne with a big sigh of frustration in one of our recent sessions.

“You are going to laugh at this,” she continued, “but sometimes I am thinking that all my thoughts take the shape of a tree. Something like…like a thinking tree. But I can see how badly misshapen mine must be. If every branch is a thought, then my thoughts are so much of the time so out of balance that it will only lead to an ugly, off putting kind of a tree, right?”

I imagine it will look something like this:

I wasn’t laughing; I was actually amazed at the power of her metaphor.

“So what can you do to shape this tree more beautifully?” I asked.

“I need to change the way I think; but of course if I knew how, I would have done it long ago.”
Suzanne is a young lady but she is no stranger to the struggle with anxious and obsessive thoughts. Often they don’t allow her to sleep, making her lay awake for hours “thinking,” as she calls it. They are all ruminating thoughts, filled with regret, guilt and unhappiness.

When she first came to see me a few months ago, I made the comment that antidepressant medications could help her quite a lot. But she wouldn’t hear of it. She felt that if she took medications, that meant she accepted her defeat against these anxious thoughts, and she wouldn’t have it.

We started talking about cognitive behavioral techniques and how to recognize and stop the negative, ruminating, emotional thinking with the power of the logical mind. She learned the 10 dysfunctional patterns of thinking from Dr. Burns’ book, Feeling Good, and gradually she became very good at catching herself when her negative emotions threaten to overcome her.

As we speak, she is in the process of learning how to control these emotions one by one, as soon as she identifies them. It’s slow and difficult work. But she is very brave and she decided that quitting is not an option.

I thought this would be a good moment for her to use visualization to help her better stop the negative thoughts. I used her own metaphor and applied to it the neuroplasticity theory. According to this modern and very sophisticated theory, our brains are remarkably adaptive. The brain has an incredible power to act, react and ever change its patterns according to what happens outside and inside of us.

What Suzanne didn’t know, which shows how creative her mind is, was that forming new synapses in the brain happens in a way that looks a lot like pruning and it’s called just that: “synaptic pruning.” Through this process, the brain can erase old connections and develop new ones—highways of information on which the neuronal impulses travel at amazing speed. Even more surprising is that these new synapses are molded, among other things, by the power of our thoughts and our own way of thinking. That is way, if we change the way we think, we break some old connections and build new ones—a lengthy process that requires a great deal of motivation and persistence. Suzanne has both. In addition, she has a sparkling intelligence.

“Imagine,” I said, “that your thoughts are like branches of a tree—the more beautiful and complex your thoughts are, the more intricate the branches’ patterns become and the more colorful the tree becomes, lighted up with bright, sparkling thoughts. Every time your thoughts go again and again over the same obsessions, you kill the spark. That area of the tree becomes gray and dead. But every time you stop that negative thought process and replace it with fresh, creative thoughts, you can light up that area of the tree, making it shine with colors. So you have a choice. What kind of thinking tree do you want to have?”

“The bright and colorful one, of course!”

“Then take care and don’t kill any portion of it. Use the power of your rational, practical mind and stop the obsessions. You do have a choice and it is up to you how beautiful of a thinking tree you create. And the good thing about having a beautiful thinking tree living in one’s mind is that the thinking will improve along with one’s actions and attitudes. If you manage to carry that kind of thinking in your mind, everyone will be surprised by your brightness of spirit, pleasantness and enthusiasm. ”

“Me like that? Doctor Forest,” she said with a slight irony, “who are you talking about?”

“Why, you, of course!” I replied, dead serious.

Then we made an agreement. I will paint the two thinking trees: one overcame by obsessions and dead branches, looking empty and sorrowful; and the other, a thinking tree brightened up by positive, enthusiastic, new and renewed thoughts--beautiful and diverse products of an active, spontaneously creative mind.

Her part of the bargain is to make sure that she will nurture and cherish her thoughts and her thinking so that she will know that her brain, just like my healthy thinking tree, will be light with beauty and liveliness.

She agreed with this wholeheartedly.

And here it is--my part of the bargain. We will see in due time how well she does.

If you want your own thinking tree to go from this:

To this,

dare to be curious, to ask yourself and the world questions rather than passively accepting reality, to decipher the mystery of life and to allow yourself to wander at the marvels of the world.

What has been your experience with changing the way you think in order to make better decisions or feel better about different situations in life? Have you has to change old ways of thinking or doing things? With what results?

TOXIC STRESS AND HOW TO OVERCOME IT, Part 1

I have been working for the past two weeks on a paper on stress for a workshop I will be presenting soon. After giving it a lot of thought, I decided to divide it in three parts which will be the subjects of the next three blog posts:

Part 1: What stress is and what is a healthy adaptive reaction to manageable stress
Part 2: How much damage toxic (unmanageable) stress can cause us mentally and physically
Part 3: How to effectively manage toxic stress, overcome stress related complications of anxiety and depression, and how to find one’s way toward happiness


To help you better cope with this potentially stressful subject, STRESS, I have peppered the posts with details of my recent paintings. Hopefully they will lighten the subject.


Part 1:

What stress is and what is a healthy adaptive reaction to a manageable stress





What is stress?
In general, any change in our environment that requires or triggers a mentally or physically painful adjustment can be perceived as stressful.


Types of stress:

Eustress: Dr. Selye coined the term Eustress to differentiate positive stress from toxic stress. Eustress—the optimal stress level of each individual. It is commonly perceived as a feeling of “rush” and excitement, like skiing fast down the mountain or riding the bike with the wind blowing in your hair and you only want to go faster and faster. Eustress is a manageable type of stress that leads to taking on and conquering new challenges or getting excited about performing well on a project or on the stage. It drives positive changes in one’s life.

Try this:
Can you think of examples from your own experience of “positive stress?”
How did it feel? What were you able to accomplish in that state?

Acute Stress: brief, intense, stressful episodes like narrowly avoiding an accident or dealing with the mess in your teenager’s room.

Episodic Acute Stress: recurrent, repeated episodes of stress creating a chaotic day-to-day life; leads to feelings of being overwhelmed by the never ending “small stuff.”

Chronic Stress: a long term stressful situation like a dysfunctional marriage or chronic illness that seems inescapable and without an end in sight; usually leads to burnout if no intervention is made.

Burnout: the feeling of inescapable stress with no end in sight; inability to function; feeling paralyzed mentally and powerless to make the changes that will solve the problem; usually accompanied by anxiety and/or depression.

Major types of stressors:


Biological: an illness or physical discomfort
Life situation: breakups, marriage, divorce, empty nest syndrome, the death of a parent
Behaviors: addiction, poor coping
Cognitive Activities: mental challenges like sitting for an exam,
Occupational stress: losing or starting a job, coping with the corporate world, patient’s demands and distress, finding the balance between the empathy we feel for our patients and our inner emotional resources to avoid burnout.

The nature of stressors:


The impact of stressors depends on how they are perceived by each individual who experiences them:
Importance assigned to a stressor: a breakup versus losing a job
Duration: we may manage one week but one day more than that may become too stressful
Cumulative effect: having a demanding job and a difficult boss and tight deadlines
Multiplicity: job change plus illness plus relocation
Imminence: how soon the stressor will end
Expectation: we expect a stressor of one kind, but we get hit with one that we have not anticipated; or we expect one stressor to last a certain time, but it ends up lasting much longer.

Try this:


In managing stress it is useful for you to know what your stress level is on average.


Take your stress temperature: think about the last five days. What was your stress level by evening of each day, on a scale of 1 to 10?


This simple exercise will help you develop more awareness of your stress. Be honest with yourself. Acknowledging your feelings, even feelings of stress, anger and fear, is not a sign of weakness but of strength. Only by being aware of your feelings will you be able to take corrective actions.


HEALTHY RESPONSE TO MANAGEABLE STRESS

Nervous system’s reaction to stress:


Activating the sympathetic response of “fight or flight” reaction:
• Dilates the pupils to improve vision
• Quickens blood clotting to reduce bleeding from lacerations and other possible wounds
• Raises the blood sugar level by mobilizing the glucose and fat from storage tissues and thus provides fuel for the muscles and brain
• Increases blood flow to the brain to facilitate decision making
• Diverts the circulation from the internal organs, like digestive system, into the muscles to provide them with oxygen, glucose and rapid disposal of metabolic waste to ensure best conditions for muscle strength to prepare for combat

Endocrine changes induced by stress:


The stress hormones are adrenaline and steroids. Their effects potentiate each other’s actions and complement the nervous system’s reaction to prepare the body for “fight or flight” reaction:
• Adrenaline rush within seconds triggers the fight or flight response with vasoconstriction, increased heart rate and muscle tension
• Increase in glucocorticoids, steroid hormones, will continue the effects of adrenaline for minutes and hours facilitating the stress response by enhancing the power of heart pulsations and mobilizing energy resources like glucose, which make energy available to the muscles to do their job
• Increase in prolactin in stressful situations inhibits the release of sexual hormones during the “fight or flight” state—thinking of sex while running for your life could get us killed
• Increase in vasopressin, which contributes to an increase in heart rate and blood pressure
• From the pituitary gland and the brain, endorphins and enkephalins are secreted, which blunt the pain perception
• In some women, the oxytocin secretion increases—dulls out the aggressive instinct and induces a “let’s befriend my enemy instead of fighting him” type of reaction (perhaps the biological basis of passive aggression???)

(For this section I used information from the book Why Zebras Don’t Get Ulcers by Robert M. Sapolsky, professor of biology and neurology at Stanford University, who dedicated his research to stress and stress related problems in humans and primates.)

Try this:
What has been your experience with the “fight or flight” reaction? How did you manage it?


How did or would you manage this reaction in your patients? Have you had any incidents you would like to share with the group?


Learn how to listen to your body: Where does your body feel tense?


Follow your breath. Take five slow, deep breaths and watch what happens. Are the tension areas loosening up a bit?

Cognitive response to stress


• “Freezing”—being unable to think straight or remember important information
• Tendency to simplify one’s thoughts, feelings and actions, which reduce them to a minimum because the brain needs to focus on the stress (emergency) and shoots down other functions not involved in managing the stress
• Stress triggers an intense negative emotional reaction.
• The importance of learning how to cope and adapt to stress, which triggers in the brain the formation of new connections, highways of information, leading to actually changing the inner structure of the brain—neuroplasticity.


Emotional Response to Stress


• The instinctive emotional reaction to stress was first presented by Dr. Selye in his classic General Adaptation Syndrome (GAS): stage 1: alarm reaction—the first encounter with stress in the form of novelty or threat; stage 2: recovery or resistance—the organism repairs itself and stores energy trying to get back in balance; stage 3: exhaustion—if the stress continues burnout sets in, represented by emotional flatness, loss of drive and motivation, dulling of responsiveness to the needs of others.
• Challenging events are stressful “only when accompanied by negative emotions” according to Arnold Lazarus (1993)
• When we feel in control of a stressful event, the event becomes less stressful
• Stress is not an inevitable consequence of a particular event but rather depends on how we appraise and interpret the event
• Trying to appraise stress realistically and learn from it transforms the negative emotional perception into constructive lessons
• Managing the expectations of a stressful situation contributes a great deal to managing the situation itself. Stressful events that are expected, anticipated, and in some ways prepared for emotionally, have less damaging consequences.


(For this section I used notes from the on line book Psychology: An Introduction by Russel A. Dewey, Ph.D.)

Many Thanks to "This Stop Willoughby" for hosting my post

I offer my deepest thanks to "This Stop Willoughby" for hosting my post BULLDOZE YOUR WAY THROUGH LIFE AND YOU WILL BECOME A VICTIM OF YOUR OWN ANGER.

From the very beginning of my blogging adventure, she has been extremely supportive of me, and I am very grateful to her for that.

I am an avid reader of her blog, which is filled with sensitive insight, practical advice and warm kindness.


Check out her blog. You will enjoy it a lot!


Dear "This Stop Willoughby," this picture is for you!

I konw should have thanked you much sooner, but I was too absorbed in my research for my paper on STRESS (see the next few blogs). I was also feeling guilty that I have not posted on my blog for two weeks--way too long. My sincere apologies to you and to all my readers. I have absolutely no intention to let you down. I will do my very best to post at least once a week.