How Do You Experience Your Emotions?

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How Do You Experience Your Emotions?

I often hear people say they are afraid of “going there” in their anger, or “going back there” in their depression. It makes it clear to me that folks often find something very unapproachable about these emotions. Yes, feelings of anger, sadness, or fear are unpleasant, but that doesn’t have to make them unapproachable… just unpleasant, as things in life can be sometimes. So, to understand why we work so hard to avoid negative emotions, we should start by learning how we perceive them.


Let’s start with anger, sadness, or fear… pick one that feels most relevant in your life:


If you think of your depression, is it like a dark cloud that follows you around? Is it like those giant stone blocks in Mario video games that stomp you flat? Is it like a deep pit you fall into and can’t get out of?  If you think of your anger, is it like the red character in Inside Out who shoots fire out of his head? Is it like a closed fist? If you think of your anxiety, is it like a knot in your stomach?


Expand more…

What would it feel like if you touched it?
If you had to give it a color, what color would it be?
How much space does it take up?
How heavy is it?


Once you give your feelings shape, texture, color, volume, etc., you’ve already taken a significant first step towards approaching them. You’ve given them form, and with form comes possibilities…


If your depression is like clouds, clouds move and part with bursts of light interjecting. If it is like a Mario block stomping down on you, have you forgotten how they quickly lift and and you inflate back to size? We can build steps in your pit, and we can unclench your fist and loosen knots. The point is to break down this giant, amorphous, monolith of a thing that makes things feel unapproachable.


A key to experiencing emotions in a healthy way is knowing they contain more possibilities than you think. This includes the possibility that they can be survived without devouring you and everyone you love. You will continue a life controlled by avoidance of difficult emotions if this belief goes unchallenged. No matter the negative feeling, they are not just a concrete block of a thing that plops down and squashes everything you ever cared about for a forever time. Every emotion you’ve ever felt came and also went. And life continues while they exist, which means times of intermittent activity, energy, connecting conversation, lessons, and joy. Colors can change, space expands and contracts, and objects can be taken with you. This is not the whole solution, but being able to name and describe your emotions are the first steps.

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Substitutes, Fiddle Toys, and Blockers

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Substitutes, Fiddle Toys, and Blockers

Employing outside aids - sensory substitutes, fidget toys, behavioral blockers - are not by rule good or bad. I am, however, thoughtful about when I recommend them. The key to me is whether they are being employed honestly and earnestly. Slapping them on yourself in an automatic attempt to stop your picking, pulling, or biting is different from putting them on after you have gone through the hard work of choice.

Our first reactions to our BFRBs commonly involve unanimous censure of, “You need to stop,” which differs from the personally and eventually attained, “I want to stop.” Beanies, vaseline, stress balls, and gloves should not be employed at times when you try to impose a No when you are honestly feeling a Yes (to picking, pulling, or biting). They have to be tools that merely support your decision for a different outcome in a BFRB moment. The root of change needs to be YOU because you will always be more powerful than any piece of fabric, cloth, lubricant, etc. (and thus can simply ditch any of these). They can and will not stop you unless you want them to! Furthermore, expecting these random things to do the work for you instead of because of you will maintain a belief that hope, power, and salvation lie outside of you when they do not.

BFRBs offer a source of comfort, so we turn to them as simply as a child would to their blankie or pacifier. For adults, choosing to go from comfort to absence requires commitment and possibly help. These outside tools come in and ease the burdens of follow through once you have surrendered to the reality of your BFRB, made your choice, and now can simply use some support. (Mindful awareness, internal reflection, emotional vulnerability, weighing of outcomes is hard work!)

I don’t believe anyone should have to “fight” themselves, and it is no longer “restriction” when you are giving yourself what you have resolved you want. Remember that these tools shouldn’t be exploited to “block” you, but embraced to aid you. Invoke them once you have arrived at a feeling in a BFRB epsiode that you truly want to desist and you don’t want to do it alone (because you don't have to!). Remember to leave time for the urge to pass, and that you can also involve PEOPLE and not just things.

Best of luck, devotion, and skill!

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BFRB Group - Call for New January 2018 Members!

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BFRB Group - Call for New January 2018 Members!

Almost three years ago, I began running a psychotherapy group which oriented group members to the full spectrum of their body-focused, repetitive behaviors (e.g. hair pulling, skin picking, nail biting). We reviewed the demographic backdrop to these behaviors, treatment options, and factors such as motivation that affected their outcomes. We began exploring our own pulling/picking profiles and uncovering the emotional and sensory factors that fed them. I started this group to foster intellectual understanding, and even more so, to foster relationships between individuals and not just ones with our bodies. In the safe and controlled space of a psychotherapy group dedicated to BFRB sufferers, we began to heal shame and rely on one another. This group that began in 2015 proved incredibly rich and fulfilling, and lasted approximately 6 months. Since then, I have now run four chapters that have grown longer and stronger every time. Each round I become even more convinced of the importance of having this unique space for encountering sameness, difference, sharing, and receiving with like peers.

I have been getting a number of calls these days and believe we have reached a critical mass to begin a new group January 2018. The curriculum will include familiar and novel components that focus on overt behavioral management of the BFRBs, and also tackle discomfort, relationships, self-compassion, and self-assertion. All of this learning will happen experientially and through guided exercises and conversations.

I am aiming to begin this group January 2018, but will adjust according to members' availability. I am currently envisioning a meeting time of Wednesdays from 6:15 - 7:30 pm, and meeting place as my usual office at Post and Divisadero in San Francisco. Session fee would be $80/session, which if you submit for reimbursement can be claimed on your insurance superbill as well.

If you have any interest in the group, please let me know by email: dr.nmayeda@gmail.com, or by phone: 415-735-0029 in the next couple of weeks. Again, please reach out to me if you have any interest at all. Your inquiry will by no means by a commitment, just a chance to get more information so we can mutually determine fit.

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5 Major Variables

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5 Major Variables

Everyone's #1 question is usually how to get over their BFRBs. The answer is that there won't be a way over or around, you will have to go through and work with them. This entry is meant to help distill this sort of behavioral change down to 5 major variables. Perhaps the most important thing I've learned as a general approach is that surrender contributes to change more easily and sustainably than any overt management efforts.

I may add to or modify this list over time, but it does encapsulate that change is about much more than pure will:

  1. Objectivity - This is 90% of the work to me. Most people have such judgmental thoughts and feelings about their BFRBs that they can't incorporate the reality of them into their planning or decision making. Imagine someone who chronically loses track of time. They desperately don't want this to be true so they keep acceptance of it at bay, clinging onto belief (even if entirely wishful) that they will remember to feed the meter or move the car when it's street cleaning this time. Tickets and towing fees pile while no ameliorative measures are put in place. Once this person can come to terms with the fact that they have weaknesses when it comes to time, they can begin setting alarms, using mobile parking/payment apps, or handing over the task of moving the car on street cleaning days to their partner! Objectivity is required to be able to evaluate a situation like this clearly, and to determine what is needed within it. Too often what we WANT to be true gets in the way of dealing with what IS true. Returning back to BFRBs, this means that you have to be able to approach you and your situation with enough non-judgment to be able to anticipate pulling-prone moments, to say when you really would like to continue biting for another 5 minutes, or to recognize that what you really need in this moment is not smoother skin but a hug from a friend.

  2. Ownership - The capacity to choose does not always translate to the willingness to choose. We can be stubborn as human beings, and resistant to doing things we feel like we "should" or that someone else wants of us. This is true with BFRBs too. Even if you possess enough objectivity to make clear decisions, the feeling that your good outcome is going to belong to someone else is hardly reinforcing. This is why someone else swatting your hand away or telling you to stop usually inspires the opposite. It is also why reminders to track, suggestions to go for a walk, or utterances of, "I knew you could do it" or "I'm so proud of you" can irritate even if well intended. Unless this was aid or feedback you explicitly asked for, it can feel like unwelcome insertions of another's feelings or preferences about YOUR behavior. Even if it is a "bad" behavior, it is still YOUR possession pertaining to YOUR body. Change will not come until you feel agency over your moment-to-moment decisions to pull or not pull/pick or not pick/bite or not bite, which is understandably difficult to cultivate internally in a society that features clearly and ubiquitously expressed opinions!

  3. Momentum - This one is rather simple but commonly overlooked. Momentum has to do with the energy to keep going. It is MUCH easier to maintain a state of non-pulling when you're boasting a whole head of hair - there is something you can concretely feel you're protecting. Inversely, it is really hard to get motivated when you have all your fingernails whittled down to barely-there stubs. The resignation of "What's the point?" is strong. A feeling of POSSIBILITY is critical to motivation, so be compassionate that you may not be able to do the most with the least.

  4. Facilitative environment - Not all this work is internal. There is a real external world that plays into your success. I have not come into my "success" (always subjectively defined) with my BFRB from internal work alone, but it was my internal work that helped me to initiate concordant, external changes. This included changes to my occupation, which is now based primarily on human instead of computer interaction, and on private practice instead of corporate membership; my hobbies, which grow the relationship with my body to offset the one with my mind; and my people relationships, which I have narrowed down to compassionate, flexible thinking, and emotionally honest types. You can do all sorts of intellectual or insight-oriented work and not see progress if you remain in toxic workplaces or with ill-fitting people.

  5. Whole and real relating - It can be hard to give up your BFRBs when they are a physical manifestation of your private truth that you don't have it all together. Individuals with BFRBs tend to hold oppressively high standards for themselves, and picking, pulling, and biting can serve as a confined place for not caring, not thinking, and not controlling. It can also be the container and the proof of your messiness, failures, and fear so that you can temper the burden of total perfection. But everyone deep down wants to be seen as they truly and fully are, and if you can learn to allow for your needs, questions, and suffering to be represented openly, outwardly, and in their original form, there will be no need for them to be expressed on your face, scalp, back, hands, or legs. Choosing to relate to yourself and others in a whole and real way means that it will be OK to not have it all together - this will be an expectable part of being HUMAN. It requires a decentering of your lifelong preoccupation with what is smart, good, agreeable, or right, and favoring of personal congruence instead. The things you don't know, the times you hurt or hate, and the times you just don't feel like it will no longer be dangerous. Refuge isn't necessary when you live with freedom!

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Why I Work the Way I Work

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Why I Work the Way I Work

The people who have come through my office have consistently been bright, intelligent people. Their minds are effective, often in fact overly so. This has meant that they can master handouts, articulate behavioral chains, identify healthier alternative behaviors and thoughts, and still see little to no changes. To me this occurs because all of these tasks can stay circumscribed to the intellectual realm. Clients can go through the motions of superficially recognizing their triggers, reciting more adaptive thoughts, or pausing before acting. However, the energy to actually choose something (e.g. grab a fiddle toy, go for a walk) that goes against inertia and immediate gratification continues to be absent.

To me, what is missing from usual cognitive-behavioral approaches is an appreciation that people are always divided. It is a not a matter of simply pointing out what the healthier or more logical thing to do is or BFRB folks would have done it a long time ago.

Here is some of my experience:

  • I can give tracking sheets but clients quickly stop filling them out because they are too confronting
  • I can elucidate problematic ways of thinking and clients can see them but still choose "indulgence"
  • I can teach about boundaries but clients just cannot get themselves to frustrate or disappoint others
  • Clients can see progress and then be filled with impulses to undo 
  • Clients are hyperaware of others' needs and expectations but struggle to know what they really need or want
  • Clients are unready to detach from the idea that they can magically stop picking/pulling/biting tomorrow or next week
  • Clients cannot relax into being because they are so caught up with doing
  • Clients can get frustrated but not vulnerable

Christina Pearson, founder of the TLC Foundation, has framed BFRBs as a long term relationship. So, like any long term relationship, it's complicated. Part of us wants to give up our BFRBs and part of us doesn't. This means that we can't expect to simply tell people how the "healthy" way to be and expect them to simply walk through that door. There are anxieties and there are attachments we need to speak to and honor first.

What also has become increasingly evident over time is that folks with BFRBs are tired (exhausted). They are always "on," figuring out the "right" thing to say or do in every situation. This means that (1) they are expert at assessing external scenarios but poorly motivated by internal agreement, and (2) even after absorbing therapy lessons about antecedents, mental sets, or consequences, in a moment of pulling, picking, or biting, they just don't want to think critically or correctly. There isn't enough ease or gratification in their lives in general so they are protective of and hungry for this chance to turn off and not think.

I once had a client tell me, "It's like I can't sustain the health" when her skin picking was lower. She felt impulses to attack her face. This is an important testament to how hard it is endure success. Enduring success means having to bear belief which, when you have been skin picking, hair pulling, or nail biting all your life, can feel instinctually stupid and dangerous. Staying skeptical and disbelieving has grown to feel smart and safe. I think usual, cognitive-behavioral approaches overlook the attachment clients can have to their failures and their failure mindset. Deep parts of clients have emotional reasons for resisting the belief that they are both worthy and capable.

While stopping pulling/picking/biting may technically be in clients' best interest, no one likes to have something taken from them and that's how it often feels for clients. Therapists have to appreciate that messaging from society internalized day in and day out is that BFRBers are wrong as they are and need to get right. This means it's hard for clients to look at BFRB cessation with enthusiasm or pride. Getting "treated" only means finally being able to fall in line with a way of being that other people have always been. The decision to pull or not pull doesn't and has never felt like it belonged to them. For them, the expectation was always clear and they've only been disappointing. Therefore, relinquishing their BFRBs is a reform they have been burdened with and thus can harbor resentments about too.

To me, BFRB treatment is not just about managing thoughts and behaviors, it's about becoming a whole person. And I don't think change really comes from overt knowledge, it comes from love. Individuals with BFRBs are learning to have a relationship with themselves as whole beings instead of relating to parts of themselves (hair, skin, nails) which they treat more like objects. And once they can be fully embodied, then they can relate to others and allow others to relate to them in a full and meaningful way.

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2017 BFRB Group - Call for New Members!

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2017 BFRB Group - Call for New Members!

Back in April 2015, I began a psychotherapy group for individuals with body-focused, repetitive behaviors (e.g. hair pulling, skin picking, nail biting). We reviewed the demographic backdrop to these behaviors, behavioral management strategies, and factors such as motivation that affect treatment outcomes. Members began exploring their own pulling/picking/biting profiles and uncovering the emotional and sensory factors that feed into them. I started this group so BFRB sufferers could gain understanding and, even more so, grow relationships with like individuals. Group members have worked to tackle discomfort, interdependence, self-compassion, and self-assertion experientially and through guided conversations. In the safe and controlled space of a psychotherapy group, they began to heal shame, open up, and rely on one another. The experience proved so rich and fulfilling that I launched a second BFRB group chapter in February 2016 and a third in March 2017. My conviction about the importance of this unique space for sameness, difference, sharing, and receiving with peers only continues to grow.

This brings me to now. I would like to respond to building interest by launching a third chapter with all new group members. I am aiming to begin this group in September 2017, but will adjust according to members' availability and reaching of a critical mass. The meeting time would be Thursdays from 6:00 - 7:15 pm, and meeting place would be my office at Post and Divisadero in San Francisco. The fee would be $75/session, which I can include on your monthly superbill for your insurance company.

If you have any interest in this new group, please let me know by email: dr.nmayeda@gmail.com, or by phone: 415-735-0029 in the next couple of weeks. Again, please reach out to me if you have any interest at all. Your inquiry is not a commitment, just a chance to obtain more information so we can mutually determine fit.

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Wholeness over Goodness

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Wholeness over Goodness

“I would rather be whole than good.” - Carl Jung

Carl Jung’s quote pertains to a personal and collective problem: We are not good at being whole. We internalize from a young age that being anything other than “good” has no intrinsic value.

Feeling lazy is only a signal that we need to get motivated again.
Wanting to depend on another is only a sign that we need to become more independent.
Gaining weight is only a sign that we have to get back to the gym.
Being quiet at a party represents that we have to grow our social skills.

Why can’t laziness be an expression of our need to go slow sometimes?
Why can’t wanting to depend on another be a sign that maybe we are feeling securely attached?
Why can’t weight gain be because we are taking advantage of a culinarily delightful holiday season?
Why can’t quietness at a party be because we enjoy being in an observer role?

We proceed in life constantly assessing our deviation from ideal states, as if the goal of life is to make sure we never drop below imagined levels of “perfection.” Thus, we spend our time trying to manage ourselves instead of being selves. The problem is, we are not just objects to be corrected, we are people to be experienced and expressed.

I view the goal of therapy to help you get free. Not simply to help you recover passing levels of societal acceptability until the next time you experience another debilitating lapse into humanness. Even if I help you to climb out of the red (e.g. to have a productive week at work, to remit hair pulling), you will be governed by fear as long as lava is still perceived below (e.g. the threat of falling behind at work or hair pulling again). We can do more than string together moments of temporary and conditional safety. Real freedom comes with the feeling that you can exist anywhere on a spectrum at any given time. Then there is nowhere you have to run and nowhere you have to hide.

Too often people with BFRBs feel they can only be in the world when they are at or above par. Clients have reported they cannot attend a party if they are feeling lower energy, they cannot turn in their homework if it is half completed, they cannot share with their romantic partners if it will involve anger, they cannot go to work if their mind is feeling distractible, they cannot get married if their nails are short, and they cannot meet up with friends if their face features any visible blemishes.

Good is limiting. If you live according to an insistence on goodness, you have lost half the range of human experience. Did you see the movie Hitch? Do you remember this later scene?

Albert: You know, honestly, I never knew I could feel like this. You know? I swear I'm going out of my mind. It's like I want to throw myself off of every building in New York. I see a cab and I just wanna dive in front of it because then I'll stop thinking about her.
Hitch: Look, you will. Just give it time.
Albert: That's just it. I don't want to. I mean, I've waited my whole life to feel this miserable. I mean, and if this is the only way I can stay connected with her, then... well, this is who I have to be.

Albert is able to embody our opening quote through his prizing of wholeness over goodness. He is reflecting in this scene on his romantic misery when Hitch makes a very common assumption about upward mobility as the agreed upon goal. Albert then checks Hitch with his appreciation of feeling fully, not just feeling “better.” I believe this ability to embrace, hold interest in, or even simply tolerate ourselves in ALL states is critical to general and specific (i.e. BFRB) freedom.

When we give ourselves permission to be anywhere on the human spectrum, there is nowhere we cannot be. This means we do not have to get stressed and start tearing at ourselves when we are in angry moments, lazy moments, antisocial moments, made-a-mistake moments, or not-knowing moments. We get to simply go on being the variable and finite humans we were meant to be without feeling chased from behind. Success in therapy to me means that you get to live harmoniously WITH yourself, not in constant pursuit of rising above it.

Life is flexible and people are resilient, so make your only task to focus on being your most authentic self.

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"Opting Out of the Self-Esteem Game"

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"Opting Out of the Self-Esteem Game"

"Having contingent self-esteem can feel like Mr. Toad's wild ride - your mood swinging from elation one moment to devastation the next. Let's say you derive your self-worth from doing well at your marketing job. You'll feel like a king when you're named salesperson of the month but a pauper when your monthly sales figures are merely average. Or maybe you tend to base your self-esteem on being liked by others. You'll get an incredible high when you receive a nice compliment but crash in the dust when someone ignores you - or worse - criticizes you." 

- Self-Compassion by Kristin Neff

 

Living wholeheartedly and in wonder of our complexity - our complete humanness - is not just a concept. It requires that we actively fight the temptation to live off or in retention of positive estimations EVERY. SINGLE. DAY. For many of us with BFRBs, our self-worth becomes largely contingent on our skills and performance. And our society, built on capitalism and ideas of meritocracy, reinforces this. It becomes routine to reduce ourselves to one-dimensional evaluations of "good/bad" or "success/failure" re: skin picking, hair pulling, or nail biting, and all across the board. We get feelings of pride, contentment, and security off of being "special" or "better than" others instead of being able to relax into knowing our specialness is innate to being a finite human with everyone else. To "opt out of the self-esteem game," we have to appreciate the breadth of our experiences, the returns of connection, and the sincerity of our needs. Think of how this preoccupation with performance / overreliance on self-esteem applies to your life. Does it exist broadly, or is it circumscribed to your BFRBs? Does it play into your urges to pick/pull/bite? Does it render your mood variable? Does it affect the activities you choose to undertake? Does it make you more inclined to perceive others as friend or foe? Does it ever lead you to any real or lasting satisfaction...?

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