Helping Diabetes Management in Teens | Identifying the barriers to achieving desired A1C

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Assisting people with improved diabetes management behaviors has been a specialty of mine in my psychotherapy practice since 2009. My Wife has a been a senior research coordinator at the Barbara Davis Center for Childhood Diabetes in Denver since 2006, and through bonding with her passion to assist in this area, I have developed my own modes of intervention.

There are a number of factors which make managing A1C particularly difficult for teens including: Social pressures and responsibilities, motivation, personality, nutrition, substance use, sleep habits, brain re-structuring, defence mechanisms (such as denial and avoidance), social justice issues (oppresion – racism), diabetes education, individuation, future-oriented culture, access to health services, family structure and dynamic issues, marital conflict between parents, family and friendship conflict with teen, mental health stigma, academic pressure and responsibility, limited mindfulness and somatic awareness, spirituality (especially concerning death), an under-developed ability to conceptualize long-term cause and effect (this is developmentally normal for teens), co-parenting discrepencies, emotional inteligence, individuation, hormonal changes, the tendency for co-morbidity (people with diabetes can be more prone to additional physical and mental health diagnosis), and many other life/environmental stressors (poverty, grief etc.) .

One of the most significant impediments to proper management is the reality that often times the variables which are most disruptive to diabetes management are outside of the control of the teen. 2 examples: (1) If the teen lives in a household with domestic violence the resulting stress can impede their ability to maintain attention on their management routine. In this instance the ‘cycle of abuse’ needs to be intervened upon – assistance to the teen alone may not render significant results. (2) If for financial reasons the teen does not have access to proper nutrition, diabetes education, insulin or testing strips, the ability to manage diabetes will be near impossible (again an intervention on the teen alone would not be particularly helpful – a social intervention is necessary).

Proper diabetes management requires an unbelievably high level of self-discipline, familial and social support, consistency, mindfulness, finances, education, and organizational skills. Imagine dedicating yourself to an exercise and nutrition regiment that was conducted exactly the same way every day of your life … a routine that was never to change despite the relative influences of changing social, emotional, and environmental conditions… yet, paradoxically… the specific intervention was always to change in response to changing social, emotional, and environmental conditions. (ex. you exercised at exactly the same time every day, but the way you exercised was different and in response to a large number of variables). Wow, this is hard…

In order to best assist an individual in achieving their A1C goals, we must first help in identifying the impediments or barriers to proper management. in other words-

“What are the factors or stressors which are most disruptive to proper management?” 

The answer to this question can then dictate the most effective mode of intervention, and to be realistic, there is most often a need for multiple forms of intervention. Social, emotional, cognitive, motivational, familial, and academic interventions have been the most abundant needs in my experience.

From answering this question we can come up with a treatment plan which is holistic and individualized. Of course, this can become a financial issue as it is rare to find an interventionist who is adept at all these different modes of intervention (many of these interventions come from different theoretical orientations and it is not uncommon for a psychotherapist to specialize in one).

To address this financial reality, perhaps it is helpful to subtly change the question so as to identify the one variable which is most disruptive to diabetes management for the given individual.

“What is the one variable or stressor, once removed, that will have the most positive impact on your ability to manage your diabetes?

note: answering this question will often take a minimum of a session or two with a highly trained psychotherapist (ideally other people who know the teen will collaborate) as it is very likely that the teen is not conscious of the answer… additionally, the answer that the teen initially offers is usually what they believe to be the ‘right’ answer or an answer someone already suggested (ex. I need to try harder) as opposed to the answer which would ultimately serve them most effectively (ex. I need my house hold to be a place of respite, which means I need my parents to stop fighting so much).

I will end with a short list of specific intervention types which have been used to address the ‘most significant stressor.’

Existential and Spiritual Intervention – Stressor = fear of death and resulting apathy. The intervention focuses on increasing tolerance of the fear surrounding death so that it can be contemplated with less stress. Reducing this stress can reduce avoidance behaviors to proper management.

Family Structure Intervention – Stressor = overinvolved and under-involved parent creating inconsistent and less useful assistance to teen. In any family system, there is always going to be a parent who is more adept at motivating a teen (this is no one’s fault and mostly has to do with personalities). In many family systems, there is one parent doing all the ‘reminding’ – this reminding often increases avoidance behaviors. The goal of the intervention is to create a family structure and interaction dynamic which motivates the teen towards better management and minimizes stress and avoidance behaviors. This involves getting the parents on ‘the same team’ and intelligently deducing who engages with the teen in what way (ie. who asks about blood sugars and who reminds or collaborates in reminding to give insulin and how they do that).

Motivation and Solution-Focused Intervention – Stressor or factor = lack of willpower, habit, momentum or hope that better management will positively impact a teens life. The collaborative method focuses on identifying what the teen believes that they can realistically accomplish and to ‘cheerlead’ them when successful. The intended result is for the teen to feel empowered to engage in solutions and to be more hopeful about the positive impacts of engaging in solution-oriented behaviors. On an unconscious level this also ‘re-trains’ the mind to focus more on solutions and less on cynicism or ‘problem-focused’ thinking.

Attachment-based Intervention – Stressor = Stress from Family conflict including an inability for the family to offer a supportive and regulating home environment to assist in mediating stress, promoting resiliency, and in offering validation. helping the family in developing the emotional intelligence aptitudes necessary to interact with other family members in a way which supports: bonding, authenticity, vulnerability, and compassionate empathy. Attachment intervention serves to mitigate stress by increasing the family systems ability to offer regulation through connection. In my experience, often it is marital counseling which ends up having the most positive impact on the teen’s stress level = the intervention is with the parents and not necessarily with the teen at all.

Academic Advocacy Intervention – Stressor = Inability to meet the responsibilities of school, which result in intolerable emotions (shame, fear, anger etc) that encourage apathetic behaviors in all areas of the teen’s life – including diabetes management. In my experience, constantly fluctuating blood sugar levels appear to create symptoms similar to ADHD – this makes it extremely difficult for certain teens to use the attention and organization skills necessary to complete tasks on time and independently. Additionally, because of medical leaves of absence, Teens often fall behind in school and find themselves completely overwhelmed by the task of ‘catching up’ (often it is mathematically impossible for them to ‘catch up’). In these instances, the intervention is to advocate for the teen to have an individualized education plan which accommodates their specific needs (ex. certain homework assignment being excused, tutors, un-timed testing etc.)

Education, behavioral and strategic Intervention – Stressor = a lack of understanding of the most effective form of management along with a lacking ability to create an implementation strategy that accommodates all the nuances of the teen. For this intervention, the psychotherapist takes both an expert and a collaborative position to create an individualized behavior plan that the teen can follow to best manage their diabetes. (the plan will include: times to check blood sugar, education about carb counting and taking insulin, and a daily time for the teen to report to his parents about management updates etc. – parents need updates or else they become overwhelmed with fear – often a structural intervention is necessary for the teen to feel comfortable in offering updates.

Cognitive Intervention – Stressor or Factor – thoughts, ruminations, and/or beliefs which negatively influence the teen’s management behaviors. The intention of this intervention is to both dispute unhelpful and possibly irrational beliefs while also allowing new narratives to positively impact the teen’s life. Some examples of an unhelpful belief could be: “if I can’t do it perfectly I shouldn’t do it at all” – or – “If I don’t think about my problems they will go away.”

Mindfulness intervention – Stressor or factor = an inability to observe physiological indicators which could help to inform the teen about current blood sugar levels or an inability to focus attention on the present moment so as to reduce anxiety and increase felt happiness. Mindfulness is the ability to keep your attention in the present moment as opposed to the future or the past. Body awareness mindfulness exercises help a teen to observe the sensations of the body in the present moment. I have found that teens with this ability are far superior at managing their diabetes as they take management action long before they are way ‘too- high’ or ‘too-low” This intervention generally also necessitate one of the above intervention as mindfulness facilitates increased ‘awareness’ and other interventions are often helpful in encouraging responsive action.

 

 

 

 

 

 

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Addiction, Self-determination, Flow, Mindfulness, Culture, Emotional Intelligence, and Human Bonding

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Addiction, Self-determination, Flow, Mindfulness, Culture, Emotional Intelligence, and Human Bonding

What are the components of addiction? why is addiction less desirable? and what aptitudes help us to avoid addiction?

“Let’s Turn the conversation towards Efficiency and Away from Morals”

The Psychobiological and Relational causes of undesired, addictive, and compulsory behavior:

Flow (peak experience) – Humans are most fulfilled when: Goals are clear, there is regular feedback concerning progress towards the goal, and you have the aptitudes necessary to make the challenge at the sweet spot between too hard (anxiety) and too easy (boredom).

  • Implications – Many electronic devices contain software that was developed to create a sense of flow. This creates a radical craving to engage with the software.

 

  • Solution – We need to ensure public access to ‘flow’ promoting activities that increase biological, relational, and existential wellness. Historically this includes extracurricular activities such as the arts and sport. Self-discipline with also be necessary – such as not having your cell phone at dinner or while on hikes etc.

Implicit System Conditioning – Most human emotions, thoughts, and behaviors are controlled by the implicit system. Our implicit system is evolutionarily older and significantly faster (more intelligent) then our intentional and rational explicit system. This system is adaptive – ex. you couldn’t drive a car with you explicit system.

It is very important to note that most interventions in the past have focused entirely on an explicit override of the implicit system – for example, we attempt to ‘rationalize’ away from a person’s automatic emotional response to stimuli. Unfortunately, this is not how the brain works (If I give you a rational explanation for why something ‘isn’t’ disgusting this will have no impact on your automatic disgust response).

  • Implication – Most of us have been primed to have automatic behavioral responses (towards a vice) in response to various emotions or environmental stimuli. example of stimuli that often lead to drinking: anxiety (emotion) or watching a sporting event (environmental).

 

  • Solution – We can set up our environments which allow a mindful reflection on our emotional and somatic realities so that we can our observe our desired impulses, emotions, and sensations with calm attention and without action. We then can learn to feel our feelings without reacting automatically to them. Increasing our ability to tolerate intense emotional experiences will have a positive impact on our ability to avoid the compulsory behavior.

Brain wiring and neurotransmitters – there is some overlap here with the implicit system. “What fires together wires together” Experiences that happen together can wire together – this creates predictable emotional reactions to stimuli and can create associates that are not necessarily rational. 

Neurotransmitters help to control our psychological wellness – deficits and surpluses create issues ranging from depression to mania to attention issues to psychosis etc. Adding substances to a developing mind (or a developed mind) can have unpredictable effects on our neural chemistry. Additionally, substances can impact the brain’s ability to properly uptake, release, and create neurotransmitters – which then leads to deficits or surpluses.

  • Implications – Substances such as ecstasy have been shown to dramatically impact the production of important neurotransmitters.
  • Solutions – Modeling and appropriate structure – We can ensure that we are modeling healthy relationships (including abstinence when necessary) with behaviors that can be unhealthy for our biology. We also should have regular access to nutritional items that promote a healthy biology and a sense of enjoyment.

Human Bonding and Attachment – Many vices (especially substances) impact or interact with the brain area responsible for human bonding and attachment. This means that instead of seeking out a secure relationship with another human – the substance is used (ineffectively) as the relational surrogate. This often leads to isolating behaviors – which leads to dysregulation and depression – which leads to more substance use.

  • Implications – Many people will use pot or alcohol as a means of feeling less lonely and dysregulated – though this can feel helpful in the start – the process can create a feedback loop which leads to exacerbated feelings of loneliness and dysregulation without the substance.
  • Solution – Emotionally significant/vulnerable and authentic connection. It is easier to use electronics or to engage in a substance than it is to be vulnerable enough to share your true self with another person. It is hard to remain open, empathetic and compassionate in front of a person who is suffering or who is offering their authentic self in a way that we don’t yet understand (Our impulse is generally to fix or to categorize). When we grow in our ability to stay present, honest, openminded, and compassionate, we naturally dissipate feeling of loneliness… in turn we gain a felt sense of regulation (and we, therefore, are not in need of the vice to mitigate our fears).

Anthropological Importance of Inclusion – We are a tribal animal. Our cortex developed to its’ current sophisticated state in response to the need to track an ever-increasing amount of social information (currently we max out at about 200 people). Exclusion from the group generally resulted in death for the vast majority of human existence – we tracked information to ensure inclusion (and to track ‘unsafe’ people). This reality has created a substantial fear response related to exclusion – this fear will propel us to make poor decisions to mitigate our fear.

  • Implications – We will often compromise our beliefs, emotional needs, intuition, and ration in order to protect ourselves from the fear associated with exclusion – this can mean that it feels terrifying to be without social media or to ‘just say no’ when the dominant group is engaging in unsafe behavior.

 

  • Solutions – Create emotionally intelligent communities that promote acceptance of differences and encourage open-minded and vulnerable communication. Through a compassionate dialogue, we can create a sense of culture which is best suited to the needs of the individual and the collective. Within this space of openness and acceptance, we reduce judgment and make it safe to express differences (therefore the culture will be inclusive of people who avoid behaviors that are harmful, though ‘normal’.

Faced paced society with ever increasing stimuli, social dynamics, and expectations with a corresponding reduction of health-promoting options – Currently, our society is not set up to be optimal for our psychological health. We are over inundated with stimuli, we lack sleep, we are responsible for monitoring more social dynamics than is possible, we lack access to nature, there is less access to arts and athletics, we are constantly encouraged to think about the future as opposed to the present moment, and we are often held to unrealistic expectations (such as the average workweek for an adult).

  • Implications – Often it can feel like the only way to ‘deal’ with our life is to disassociate from it, avoid it, repress it, or escape from it. Many electronics help us to completely leave (disassociate) from our current reality. Many substances produce a feeling similar to a state of mindfulness – you are absorbed in the present moment and free from the suffering found by attending to the past or the future. Lastly, many substances give us the permission to be who we want to be – inhibition. Both electronics and substances help us to deal with our anxiety resulting from feelings overstimulated, unrested, unfulfilled, and over-extended.
  • Solution – Intentionality and authentic prioritizing our life choices and values. We can enact intentionality and discipline so as to live within a set of values that promote our well-being.  health diet, appropriate boundaries, authentic expression, secure relationships, exercise, and access to nature are vital for our psychological well-being – these should not be compromised if we have the privilege to not be oppressed from accessing them (many, if not most, people in our world are oppressed from access to these variables).

Variables Impacted by Addiction

Freedom and Self-Determination. Reduced Intentionality – Increased automaticity

  • Remember Pavlov and the salivating dog (rang a bell every time the dog was fed – led to the dog salivating by the bell – even when no food was present)? As humans, we are constantly conditioned to have predictable and automatic responses to certain stimuli (this is adaptive). We can, therefore, develop automatic (and often unconscious) emotional, biological, cognitive and behavioral responses to substances, electronics, and other vices.
  • Conditioning Targets the implicit system to create unconscious associations with the vice (drugs, electronics, alcohol, shopping etc).

Experience: you have a huge problem and there is nothing that you can do about it in the moment – what vice do you want?(sibling lost all their money and they are on their way to your house to live with you)

  • Anxiety = conditioned to have a strong desire (sensation and emotion) for vice – often followed by an automatic behavior to engage in vice
  • The teenage brain is already in a state of re-structuring – pre-frontal cortex (executive control center) is less integrated into brain functioning. (this is an important time for the development of intentionality and good habits).
  • Solutions –
    • Mindfulness – focused attention on the present moment. The ability to notice without judgment and without automatic reaction. With mindfulness, we can observe the stimulus and our mind and body’s desired reaction to the stimulus. With practice, the pre-frontal cortex can override the automatic behavior (though the automatic emotion will likely stay mostly the same).
    • Willpower to engage in life intentionally despite a strong impulse to avoid or otherwise retract from discomfort. (without self-determination we are controlled by the external world and our urges)

Emotions and Body Awareness. reduction of sensory and emotional experience along with a reduced ability to tolerate emotions or sensory experiences.

  • What sensations are experienced in an elevator with a stranger (what does it feel like in your body)What emotions do you have as a result? What behaviors are we likely to engage in?
    • Now imagine all the experiences that a teen is going through – Away from home, love interests, making friends, meeting expectations, and figuring out who they are
  • After you have looked at a screen for 5 minutes where is your consciousness?
    •       What effect might this have on emotional aptitudes such as empathy?
    • Electronics and substances often disassociate us from our body (and relationships).
  • We must learn to continually be aware of and to tolerate our emotional and somatic experiences to achieve our ambitions – substances and electronics can rob us of the ability to develop this capacity.

What normal aspects of everyday life require a high level of emotional awareness and tolerance? Public Speaking 😉 Creating an emotionally intimate relationship.

Attachment and inter-regulation through Human bonding

  • New research is finding that substances and electronics target the same area of our brain used for human attachment and bonding (bonding is a primary need like water (orphanage example & cast away example)— the pull is extreme)
  • We are a social animal, and through millions of years of evolution we have developed a very sophisticated system of bonding with other humans that radically improves our ability to survive – Human connection is the #1 predictor of happiness (slope of a hill appears less steep, reduced amygdala activation in FMRIs when shocked)
  • We need to help our teens to bond with each other, with us, with the community
  • Electronics and substances mimic the feeling we get from positive human connection BUT they do not lead to lasting happiness and they do no facilitate regulation (human bonding is the cure for stress).

Conclusion – Our goal is to mentor our community towards becoming Self-determined, Emotionally intelligent, and Relationally able people. This doesn’t need to be a moral argument – Drugs and Electronics are not intrinsically bad or good… Instead, let’s change the discussion to efficiency – what are the most efficient means of developing the above Aptitudes?

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Reflection and Psychotherapy

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Reflection is the ability to hold a stimulus in the present moment without reacting automatically. In a state of reflection, a person can notice or observeSONY DSC the presence of a thought or feeling that they are experiencing… noticing or observing can then lead to two different reflective actions; either the person can continue to observe the stimulus (thought or emotion) without judgment or the person can choose to use judgment as a means of guiding their next action (“what do I want to do as a result of this thought or feeling?”).

Without reflection, a person would believe that their actions can be controlled by their environment. This is because of the unconscious belief that the environment MAKES us feel or think a certain way… further, when a certain emotion is felt or a thought is experienced we carry the belief that we MUST react a certain way.

Emotion Examples would be:  “he made me hit him because he made me feel disrespected.” (emotion governed behavior externalized)… or … “He made me stay at home in my despondency because of how disrespected he made me feel.” (Emotion governed behavior internalized)

Thought examples would be:  “He made me hit him because he was being unfair.” (Thought governed behavior externalized)… or…  “I could not go to the same function as him as he is not fair.” (thought governed behavior internalized).

I will go out on a limb and say that the ability to reflect may be the single most important component to mental health. With reflection we become emancipated from automaticity… we are no longer governed by thoughts or emotions as reflection serves as the tool to dis-identify our core self from attachments.

This is where the confusion sets in as people interpret the message of attachment as essentially disputing the validity of emotions… this is absolutely not what I am suggesting. Emotions exist… trying to rationalize them away is a form of avoidance that ironically leads to a life in which there is a dramatic increase in unconsciousness.

To accept a stimulus one must allow the stimulus to exist… denying the existence of a stimulus (such as an emotion) is a form of forced unconsciousness which could be said to be the exact opposite of reflection.

If I can allow myself to feel the sadness which does exist… If I can hold the emotion in a state of non-judgmental reflection, then the burden of that sadness will lessen as I do not fuel the sadness with resistant action (defensiveness, aggression, substance use etc.) or with over identification (ex. “I am the sadness” instead of “I am feeling the presence of sadness.”

As mentioned earlier there are two results of reflection…

The first is intrinsic … reflection is a state of allowing; it is a state of acceptance and presence which allows the clarity and completeness of the moment.  In this moment there is serenity as everything simply is…

The second is instrumental … in a state of reflection a person is given the freedom to choose what actions they would like to engage in as a result of the emotion or thought they are holding in calm observance.

This creates the following sequence: environmental stimulus – automatic thought based on beliefs – reflection (can influence resulting emotion occasionally) – automatic emotion (usually this is automatic as well though with an advanced reflective ability it is not always) – Reflect on the emotion – Choose action based on what would feel most authentic in the relative moment.

The sequence without reflection is generally: environmental stimulus – thought and emotions surface mostly outside of conscious awareness (the person is generally aware of the secondary emotion – ex. “I am pissed” but not conscious of the preliminary emotion = ex. “I am embarrassed.”  Additionally the thoughts tend to be viewed with dogmatic dichotomies ex. “this is the only valid belief concerning this stimulus.” – automatic action or behavior results.

Note: this is not to say that an automatic reaction is never authentic… in fact the resulting action could possibly be exactly the same despite the sequence used, but reflection allows choice, which increases the probability of authenticity (an action which is congruent with the core self).

I have been toying with the hypothesis lately that all effective psychotherapy interventions are essentially doing the same thing… increasing reflective ability and decreasing automaticity.

The reason that this result would be most impact by the therapeutic relationship is that perhaps increasing reflection necessitates a reflective, safe, and accepting space… this would possibly answer why technique (CBT, EFT, DBT, narrative etc) has shown to have very little impact on outcomes… the most important thing that the therapist is doing is holding space.

More on this later

In being a soft reflective water unrippled by judgments we allow the observer to placate the waters of their own existence…  and reflection grows

In reflection we find the existence of dialectics and in this space of co-existing opposites acceptance becomes authentic.

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Why should I focus on my Breathing? – Worry reduction.

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Quick summary –Normally breathing is something which is done automatically – you don’t think about breathing it just happens. When you intentionally focus on your breathing you give your mind something to do and this limits your minds ability to worry, which is often the source of your distress. Breathing is happening in the present moment (as opposed to the future or the past) – when breathing is done intentionally our minds must focus on the present moment (and generally speaking there is often nothing to worry about that is occurring at your present location in the present moment).

People in the wellness professions will often recommend that you focus on your breathing to increase wellness and to decrease stress and anxiety. There are many reasons why this is effective and today I will focus on the cognitive effects – future blogs will cover the physiological, behavioral, emotional and spiritual effects.

Often our minds ruminate or worry about situations that either theoretically could happen, are likely to eventually happen, or already did happen… our mind does this under the assumption that if it can work though various troubling scenarios this ‘worrying’ will increase our likelihood of survival if the ‘worried about situation’ were to happen in the future.

We will also ruminate about negative occurrences that took place – we do this under the assumption that either we can create meaning from the occurrence or we believe (unconsciously) that we could learn to avoid the reoccurrence of the negative instance in the future.

Unfortunately life is not fair, life is not 100% predictable, and things happen for reasons that are not easy for our minds to accept. Our minds believe that worrying is a helpful process which increases our likelihood of both surviving and of avoiding suffering – the problem is that this doesn’t seem to be true.

For one thing, the ‘worried about instance’ might simply never occur in which case your mind created suffering (which is a normal bi-product of worrying) over something that doesn’t and will not ever exist.

There is also a strong possibility that you can worry about something that will definitely happen in the future (ex. you know that your company is bankrupt and you will lose your job)… in this example your mind causes suffering in the present for absolutely no future benefit at all.

Do you know the expression “ignorance is bliss”? – perhaps this expression is meant to suggest that people who have less active minds tend to be happier. I would encourage you to answer the following questions for your self…

How much of your suffering is caused by something that is happening in the moment?

-ex. 1) I just was bit by a rattlesnake and my leg is swelling.

                                  Or

-ex. 2) My best friend is telling me right now that he does not like me.

How much of your suffering is created by your minds desire to worry about the past or the future?

-ex. 1) I have two friends that have separate birthday parties in a week and I can’t go to one party without the other friend getting upset.

                      Or

-ex. 2) “My boss had no right to accuse me of not doing the evaluation correctly as I did it the way he taught me to do it.”

 – Ask yourself – in what way is it beneficial to you to let your mind ruminate on thoughts such as these?

Try to focus on the breath to help with these unwanted automatic thoughts… below is an exercise designed to help you. As with most things… the more you practice … the more effective the exercise will be.

Exercise –

 

 sit or stand with your spine straight…follow the breath… breath in deep through your nose for 6 seconds…as the air moves in expand you abdomen, (stomach area) push the stomach out as this will pull air in… now exhale for 4 seconds… repeat this process… notice what is feel like as the air passes down the back or your throat… does it make a sound?… feel the gentle rub of your clothes on you skin as you stomach expands and contracts… your mind will try and tell you something – to get you to think about a plan, a should do, or a have to do… allow this to happen while returning your focus to the breath (if you resist your thoughts your mind will win)… if thoughts enter your mind imagine your thoughts to be leaves floating down a river or clouds expanding, traveling and disappearing…some people enjoy a mantra to further occupy the mind and to add positivity… breath in while saying the word relax to yourself without sound…. breath out while saying release… repeat… notice your heart beat… notice the movement of air as it passes your face… breath.

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Euphoria and gratitude… a runners high at 9,000 feet

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Quick summary: If you can teach yourself to feel gratitude for a greater diversity of things… then you can add a positive association to any experience that you want.I have been thinking about health quite a bit lately and my mind stumbled back to thinking about some research that was explaining why exercise routines are difficult to establish… essentially using behavioral psychology ( = we are products of our environment – our behaviors are dictated by the responses that they receive from our environment) the author suggested that the amount of time between initiating exercise and receiving the ‘reward’ from exercise is too long… therefore our minds do not really associate exercise as being positive and often our minds create a negative association as exercise can elicit a degree of pain. Yesterday I ran for eight miles at around 9,000 feet and I had a very different experience. The combination of the breathtaking scenery, the high levels of positive feeling neurotransmitters (brain chemicals which affect your emotions … and most things) that were released to manage the pain of eight miles with limited oxygen, the limited oxygen itself, and my intentionally focusing on gratitude, created a state of euphoria during the exercise. I am going to suggest that by meditating on gratitude a person can counter the negative influence or association with pain in relation to exercising… to a degree. With this positive counter influence in place, perhaps you might be able to push you body to reaching a state of euphoria which arises when you push yourself as much as you can… without such a counter perhaps it is more “rewarding” to stop exercising a bit sooner than is advantageous.

Gratitude – I was engaged in a mindfulness program about gratitude and I was offered a lesson that was immensely helpful to me…

            Try and experience gratitude without being grateful for any one specific thing… contemplate the emotional experience of gratitude and free yourself to experience this wonderful feeling. Allow yourself to essentially live in a moment which is gratitude…

This can be a very difficult experience so let’s take it down a notch…

Start by contemplating gratitude for subjects which are easier for you to observe without judgment… for example allow yourself to feel gratitude that the universe exists, that colors exist, that plants are alluring, that the natural landscape is aesthetically pleasing, that you have the ability to notice existence etc ..

This too will be hard for many people at first as it is the brains job to categorize things as benign and to take things for granted (this is because the brain serves to ensure your survival… as gratitude for the universe has a limited effect on your survival, the brain will often categorize such things as inconsequential…as boring or as useless.)

I am suggesting that the brain is constantly passing judgments on the environment and because the brain seems to assume that novel subjects and experiences are more important to attend to… the brain hinders our ability to feel gratitude for most things in our lives.

As I have said time and time again… you can control your brain… you can free yourself to feel gratitude in new and extraordinarily euphoric ways.

It is easy to imagine feeling gratitude for someone giving you 10,000 dollars… it is perhaps harder to feel gratitude for the color of a plant.

This is the summary… if you can teach yourself to feel gratitude for a greater diversity of things… then you can add a positive association to any experience that you want… you can make exercise more positive if you allow yourself to experience gratitude to counter the negative associations driven by the pain of exercise.

Easier exercise to experience gratitude – Water.  – Imagine the lack of something to feel gratitude for what you have.

I have done a bit of international travel where it was quite a process to attain safe drinking water… in fact I have had many Colorado backpacking experiences where attaining water meant going out and walking ¼ mile in freezing rain.

 How often do you drink water? And how often are you grateful for that water. Imagine an existence in which water was difficult to attain … imagine that the water attained was full of sediment and tasted ‘funny’… now imagine the ease of turning on your faucet or opening your fridge and having fresh and clean water… Imagine a life where you were able to feel grateful… to feel gratitude every time you drank water… many people in the world have this experience… perhaps it would be helpful in this country if we did not take water for granted.

My Gratitude while I was running… I was grateful for: the love in my life, that love exists, that I am conscious of existence, that life was growing, that I could smell, that I could run in a high altitude environment, that my dog was happy, that the flowers were different shapes, that I allowed myself to go running, that I had plenty of water waiting for me in the car, that I have legs, that I could get back to my car without dying if it started to rain, that my parents always encouraged a healthy lifestyle, that my parents bought me a guitar as a child, that my family has supported the person that I am, that I am learning to not fear my own destiny……………………….

I can feel the effects of the behavioral intervention that I did unto myself… I feel myself associating my grueling run with euphoric positivity.

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.