Resilience

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By MICHAEL SHAPIRO, PhD

October 2020

So here we are, almost a year into a debacle that began as an “outbreak,” grew into an epidemic, and was ultimately declared a pandemic back in March…which now feels like an eternity ago. People have been sickened, lives have been lost, economies have tanked, lines have been drawn in the sand, and every facet of life as we know it has been completely disrupted. No one has been spared. Everyone has been impacted, emotionally if not physically.

Unless you’re super-human (or inhuman), there have been moments in which you’ve wondered whether or not the world will ever recover. When will we again get to stand in line impatiently at McDonald’s, push and shove our way through a crowded bar, or glower disdainfully at that guy in the next row at the movie theater who’s making all that noise with his candy? When will we be able to cough or sneeze in a public place without being eyed suspiciously or asked to go home for fourteen days? Will we ever regain the willpower or emotional energy to return to “life-as-it-was”…that is, if “life-as-it-was” ever wants to return to us? I believe that we will. Why? Because of an invariable and inescapably human commodity known as resilience.

Webster (who, as far as I know, is long deceased and did not have the pandemic in mind when he coined this definition) describes resilience as “…the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress.”  I believe he was referring to clay, metal, marshmallows, and stuff like that; but I think you get the picture and understand how it can be applied to ourselves and our current situation. The Oxford dictionary defines it as “…the capacity to recover quickly from difficulties; toughness.” The American Psychological Association (my people) describe resilience as “…the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress.” Now we’re getting somewhere!

The point is this: resilience is a thing, and we all have it. For all its seemingly innumerable faults, humankind is—and always has been—resilient. Humanity has endured huge collective struggles, including other pandemics and natural disasters, and has lived to pick up the pieces and go home. World wars have threatened to annihilate both the species and the planet…yet here we are. This is not to minimize the loss and misery these incidents have caused; but it serves as a testimony to our collective resilience that humanity has endured, grown a little wiser (hopefully), and is still here for me to make fun of.

As your psychologist, I wish that I could offer you a pamphlet with quick and easy system for becoming more resilient during this time, maybe of a “10 Steps to Resilience” kind of thing. In the world of psychology, it is known that there are some inborn qualities that contribute to resiliency: a positive outlook, an optimistic personality, and a willingness to use tragedies as opportunities for growth. However, regardless of how much of each of these attributes you might already possess, I can tell you this: you’re already resilient, and you know it!

If you weren’t already resilient, you would have quit school immediately (if they had allowed you to) after getting sent to the principal that time in the second grade (yeah, remember that?). You would have never dated again after that pretty girl or boy rejected you in the seventh grade. You would have never sought employment again after getting fired from your first job after getting caught smoking in the parking lot during your shift (wait…you mean that didn’t happen to everyone?). You’ve been sick, and even if you haven’t recovered completely, you’ve learned to adapt. You learned a “new normal” every time you had another child, moved to a different place, had a financial setback, lost a friendship,  or endured the death of someone close to you. Although you may minimize these successes or taken them for granted, you shouldn’t: the fact that you’re still here, reading this blog, means that you’re resilient.

If you’re still not convinced of your own resilience, then take heart in this: resilience can be learned. One of my personal heroes is Dr. Viktor Frankl, who was a psychiatrist and neurologist who survived internment in various Nazi concentration camps for three years, beginning in 1942. Over that three years his father and brother died, and his mother and wife were killed. Frankl himself suffered abuse and starvation. Even so, he survived by finding meaning in what was happening to him. He tried to help despondent prisoners, and in doing so discovered that suffering can be endured if one finds in it a purpose. This culminated in his famous quote about survival (“Those who have a ‘why’ to live can bear with any ‘how’”) and, ultimately, his amazing book, Man’s Search for Meaning (recommended reading for…well, pretty much every person on the planet). His conclusions about finding meaning in suffering have since been borne out in scientific research: according to a study in Health Psychology, people who believed that stress would kill them were 43% more likely to die than those who saw the benefits of stress, or at least believed that they could grow as a result of it!  So, to endure stress and be resilient, we need to learn how to re-frame it as beneficial rather than destructive.

Being resilient doesn’t mean being free of struggles…it means that you have the ability to struggle well. If you’re a member of the human race, you’ve certainly learned something about resilience over the past year, and you most certainly deserve a pat on the back for enduring the dumpster fire that is commonly known as “2020”. As we continue to navigate through whatever is to come, I hope that you will learn to find meaning in your trials…and hope fervently for fewer learning opportunities in 2021!

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The Masks We Wear (or Don’t)

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By MICHAEL SHAPIRO, PhD

May 2020

I’ve never been a Harry Potter fan. In fact, I’m not even exactly sure what the Harry Potter series is about. My understanding is that it revolves around a bunch of kids who ride broomsticks and play some kind of anti-gravity version of basketball at a private school in some place that looks kind of like the Rocky Mountains, but with fewer Starbucks. Oh, and one of the kids has a scar on his head.

I also know that an important component of the storyline involves a “Book of Spells” or some such thing. Evidently, this book has all the rules or spells (or whatever) that adolescent magicians need to do their job or learn their craft (or whatever).

So, here in the equally magical world of Behavioral Health, we have also have mysterious book known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (known to you Muggles as “the DSM 5”). This single volume contains a detailed description of every mental disorder anyone has ever had, or could possibly have. These disorders span from the easily recognizable (like depression) to the obscure (like trichotillomania, or compulsive hair-pulling). I’ve often told people that if you look through the DSM 5 long enough, you’ll find some disorder that fits you, no matter how mentally healthy you may feel at the moment.

Anyway, in the DSM 5, there’s a diagnosis called Illness Anxiety Disorder. To qualify for that diagnosis, you have to be obsessively worried about the possibility of acquiring a serious illness. You have to be constantly anxious about your own health, and in an attempt to relieve that anxiety, you have to either engage in excessive health-related behaviors (for example, repeatedly checking your body for signs of illness) or totally avoid healthcare (e.g., staying away from hospitals and doctors’ offices).  Interestingly, another requirement is that this preoccupation with your own health has to be “excessive or disproportionate.”

Ah! Therein lies the big philosophical question: in the days of the COVID-19 pandemic, aren’t we all obsessively and disproportionately preoccupied with acquiring a serious illness? Aren’t we all engaging in health-related behaviors and avoiding hospitals and doctors’ offices?  In fact, haven’t we been ordered to do these things by our local governments? If so, does this mean that we are all suffering from Illness Anxiety Disorder?  More importantly, if we’re all doing these things, then is it really a disorder at all, or are we exhibiting completely normal behavior, just like everyone else?

I’m not exactly sure, but I think my head just imploded while trying to sort this all out. Personally, my hope is that our obsessive preoccupation with the coronavirus can still be considered a “disorder” because that’s good for my business. In fact, I’d like to take this opportunity to thank social media for contributing to my business by fanning the flames of anxiety with an inescapable, constant barrage of false, inflammatory, and often contradictory information. Thanks, Facebook!

But seriously, I have seen many patients over the last two months who are understandably worried and have expressed their anxiety through unanswerable questions and despairing comments like, “Am I going to catch this?”, “Will this ever end?”, “I’m afraid they’re going to lift restrictions too soon!”, and “I feel trapped!” This anxiety has been brought about by a stressful event, sort of like what happens in Posttraumatic Stress Disorder. However, with PTSD, the threat has already passed, and it was probably something very visible (like a tornado or other natural disaster). With the coronavirus, we have an invisible threat, we don’t know when it will end, and we don’t even know if it has touched our lives yet or not. In this respect, a global pandemic is unique amongst stressful events!

So, how can you calm yourself in the midst of so much uncertainty? Before answering that, let me first mention that we here at SR-AHEC are applied scientists–rigorously trained health care providers–who, I’m proud to say, do nothing that isn’t based on solid, verifiable science! We try to rely solely on treatments that have been tested and validated under the cold, dispassionate light of the scientific method! That’s why we don’t bleed patients with leeches anymore (well, except maybe that one time last year. But come on! I couldn’t think of anything else to do, and I made sure that it was covered by insurance first).

The practice of employing only scientifically proven medical techniques is known as “Evidence-Based Medicine” (EBM). What does EBM have to say about dealing with our anxieties in this time? Well, it just so happens that the Centre for Evidence-Based Medicine (no, I didn’t misspell a word. This place is located in the UK, where they spell some things rather oddly) has analyzed many scientific articles on the topic and has come up with the following evidence-based suggestions:

  • Minimize your exposure to the news and other media (I recommend no more than an hour per day to get caught up on the day’s events).
  • Use trusted sources to access information about the pandemic (as I said in my last blog, you can pretty much trust anything that has been bears the CDC seal of approval).
  • Stay connected with family and friends, online or via telephone (just don’t lose your temper when you can’t figure out how to turn on the audio).
  • Provide help and support to other people in the community (like your elderly next-door neighbor, who could use a little help with the groceries).
  • Practice meditation and mindfulness (this can be as simple as stopping whatever you’re doing, taking a deep breath, observing your own body for signs of tension, and asking yourself what you need to do next).
  • Look after your body by maintaining a healthy diet and exercising regularly (see our earlier “Guidance to Good Health” blog about exercises you can do at home. Oh, and keep your hand out of the Cheetos).
  • Avoid unhealthy coping strategies, like drugs and alcohol (interestingly, online sales of alcohol have gone up by 243% during this pandemic! Even sales of Corona beer have, ironically, increased by 50%! How weird is that?).
  • Keep doing activities you enjoy (preferably not playing video games or watching movies that involve death, destruction, or mayhem. Sesame Street is probably OK…just stay six feet away from Cookie Monster. I question his personal hygiene).

I would add to these a brief three-step cognitive behavior therapy exercise that I do with my patients:

Step 1: Ask yourself, “What is the worst possible thing that could happen to me?” Your answer may be something like, “I’m going to catch this and die.”

Step 2: Force yourself to consider the best possible scenario: for example, “I’m going to be completely OK. The statistics are on my side.”

Step 3: Consider the most likely scenario, and develop a plan for that: for instance, “I may get infected, but for most adults, the symptoms are mild. If I get sick, I’ve figured out exactly where to go for emergency care, and I might actually get caught up on all my Downton Abbey episodes while I’m recovering.”

These steps may all seem fairly self-evident, but once again, they are based in fact and have been verified by research, so I trust them. So, Illness Anxiety Disorder or just a “normal” reaction to a really abnormal situation?  Who cares? It’s what all the cool kids are doing. Just do what the science says. Oh, and for social distancing, just use Harry Potter’s “cloak of invisibility.” I think he has one of those.

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Illness Anxiety in the Pandemic Era

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Illness Anxiety in the Pandemic Era

By MICHAEL SHAPIRO, PhD

May 2020

I’ve never been a Harry Potter fan. In fact, I’m not even exactly sure what the Harry Potter series is about. My understanding is that it revolves around a bunch of kids who ride broomsticks and play some kind of anti-gravity version of basketball at a private school in some place that looks kind of like the Rocky Mountains, but with fewer Starbucks. Oh, and one of the kids has a scar on his head.

I also know that an important component of the storyline involves a “Book of Spells” or some such thing. Evidently, this book has all the rules or spells (or whatever) that adolescent magicians need to do their job or learn their craft (or whatever).

So, here in the equally magical world of Behavioral Health, we have also have mysterious book known as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (known to you Muggles as “the DSM 5”). This single volume contains a detailed description of every mental disorder anyone has ever had, or could possibly have. These disorders span from the easily recognizable (like depression) to the obscure (like trichotillomania, or compulsive hair-pulling). I’ve often told people that if you look through the DSM 5 long enough, you’ll find some disorder that fits you, no matter how mentally healthy you may feel at the moment.

Anyway, in the DSM 5, there’s a diagnosis called Illness Anxiety Disorder. To qualify for that diagnosis, you have to be obsessively worried about the possibility of acquiring a serious illness. You have to be constantly anxious about your own health, and in an attempt to relieve that anxiety, you have to either engage in excessive health-related behaviors (for example, repeatedly checking your body for signs of illness) or totally avoid healthcare (e.g., staying away from hospitals and doctors’ offices).  Interestingly, another requirement is that this preoccupation with your own health has to be “excessive or disproportionate.”

Ah! Therein lies the big philosophical question: in the days of the COVID-19 pandemic, aren’t we all obsessively and disproportionately preoccupied with acquiring a serious illness? Aren’t we all engaging in health-related behaviors and avoiding hospitals and doctors’ offices?  In fact, haven’t we been ordered to do these things by our local governments? If so, does this mean that we are all suffering from Illness Anxiety Disorder?  More importantly, if we’re all doing these things, then is it really a disorder at all, or are we exhibiting completely normal behavior, just like everyone else?

I’m not exactly sure, but I think my head just imploded while trying to sort this all out. Personally, my hope is that our obsessive preoccupation with the coronavirus can still be considered a “disorder” because that’s good for my business. In fact, I’d like to take this opportunity to thank social media for contributing to my business by fanning the flames of anxiety with an inescapable, constant barrage of false, inflammatory, and often contradictory information. Thanks, Facebook!

But seriously, I have seen many patients over the last two months who are understandably worried and have expressed their anxiety through unanswerable questions and despairing comments like, “Am I going to catch this?”, “Will this ever end?”, “I’m afraid they’re going to lift restrictions too soon!”, and “I feel trapped!” This anxiety has been brought about by a stressful event, sort of like what happens in Posttraumatic Stress Disorder. However, with PTSD, the threat has already passed, and it was probably something very visible (like a tornado or other natural disaster). With the coronavirus, we have an invisible threat, we don’t know when it will end, and we don’t even know if it has touched our lives yet or not. In this respect, a global pandemic is unique amongst stressful events!

So, how can you calm yourself in the midst of so much uncertainty? Before answering that, let me first mention that we here at SR-AHEC are applied scientists–rigorously trained health care providers–who, I’m proud to say, do nothing that isn’t based on solid, verifiable science! We try to rely solely on treatments that have been tested and validated under the cold, dispassionate light of the scientific method! That’s why we don’t bleed patients with leeches anymore (well, except maybe that one time last year. But come on! I couldn’t think of anything else to do, and I made sure that it was covered by insurance first).

The practice of employing only scientifically proven medical techniques is known as “Evidence-Based Medicine” (EBM). What does EBM have to say about dealing with our anxieties in this time? Well, it just so happens that the Centre for Evidence-Based Medicine (no, I didn’t misspell a word. This place is located in the UK, where they spell some things rather oddly) has analyzed many scientific articles on the topic and has come up with the following evidence-based suggestions:

  • Minimize your exposure to the news and other media (I recommend no more than an hour per day to get caught up on the day’s events).
  • Use trusted sources to access information about the pandemic (as I said in my last blog, you can pretty much trust anything that has been bears the CDC seal of approval).
  • Stay connected with family and friends, online or via telephone (just don’t lose your temper when you can’t figure out how to turn on the audio).
  • Provide help and support to other people in the community (like your elderly next-door neighbor, who could use a little help with the groceries).
  • Practice meditation and mindfulness (this can be as simple as stopping whatever you’re doing, taking a deep breath, observing your own body for signs of tension, and asking yourself what you need to do next).
  • Look after your body by maintaining a healthy diet and exercising regularly (see our earlier “Guidance to Good Health” blog about exercises you can do at home. Oh, and keep your hand out of the Cheetos).
  • Avoid unhealthy coping strategies, like drugs and alcohol (interestingly, online sales of alcohol have gone up by 243% during this pandemic! Even sales of Corona beer have, ironically, increased by 50%! How weird is that?).
  • Keep doing activities you enjoy (preferably not playing video games or watching movies that involve death, destruction, or mayhem. Sesame Street is probably OK…just stay six feet away from Cookie Monster. I question his personal hygiene).

I would add to these a brief three-step cognitive behavior therapy exercise that I do with my patients:

Step 1: Ask yourself, “What is the worst possible thing that could happen to me?” Your answer may be something like, “I’m going to catch this and die.”

Step 2: Force yourself to consider the best possible scenario: for example, “I’m going to be completely OK. The statistics are on my side.”

Step 3: Consider the most likely scenario, and develop a plan for that: for instance, “I may get infected, but for most adults, the symptoms are mild. If I get sick, I’ve figured out exactly where to go for emergency care, and I might actually get caught up on all my Downton Abbey episodes while I’m recovering.”

These steps may all seem fairly self-evident, but once again, they are based in fact and have been verified by research, so I trust them. So, Illness Anxiety Disorder or just a “normal” reaction to a really abnormal situation?  Who cares? It’s what all the cool kids are doing. Just do what the science says. Oh, and for social distancing, just use Harry Potter’s “cloak of invisibility.” I think he has one of those.

Lemmings, Toilets, and Reptile Brains: How Should We Respond to COVID-19 Hysteria?

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By MICHAEL SHAPIRO, PhD

February 2020

A quick peek at my calendar reveals that it’s February. Ah, February…the month that hosts the most famous holiday that isn’t really a holiday: Valentine’s Day. As of the time of this writing, we’re now about a week past this annual high-pressure reminder to do some nice stuff for (or to) someone you love. I believe I’ve dodged marital suicide for one more year by making sure I took my wife out for an extravagant and lavish dinner. Fortunately, Applebee’s never disappoints.

As the number of Valentine’s Days that are left to me slowly dwindles, it has caused me to contemplate the value and importance of relationships (not just romantic ones). According to Harvard Health Publishing, positive connections with others yield benefits for both physical and emotional health. Numerous studies have shown that people who have social support from family, friends, and the community have fewer health problems and actually live longer than people who are solitary or socially withdrawn. Evidently, this is because positive relationships reduce stress; and stress is known to interfere with cardiac functioning, the immune system, and even the health of your gut. Engaging in “caring behaviors” has even been found to trigger stress-reducing hormones (and, it’s far cheaper than a spa day)!

This all makes sense if consider the fact that humans are extremely social animals. We depend on each other. We have to. We’ve always had to. Think about it from the standpoint of evolution: unlike lions and wooly mammoths and alligators and such, primitive man was not blessed with tremendous strength or speed or stealth. However, we “aced” it in the brain department. Man quickly figured out that if we worked together, we had a better chance of survival and reproduction (especially the reproduction part, which doesn’t work particularly well when you’re alone). As a result, in order to encourage mutual survival, man developed a highly social brain that actually allows us to feel good when we experience social interactions, and to feel a kind of pain when we are socially rejected or marginalized. Even the emotion of sympathy (feeling sorrow or pity over someone else’s misfortune) served an evolutionary function by making sure that we were motivated to work cooperatively to help each other survive.

I once read a study that was conducted by the Gallup organization, which (as you may know) is an analytics company based in Washington, DC. In this study, when people were asked why they became homeless, why their marriage failed, or why they overeat; they often attributed these problems to the poor quality (or complete lack) of friendships. A subsequent study on friendship yielded some surprising findings. For example, a majority of married people indicated that friendship is more than five times as important to them as physical intimacy within the marriage (okay, I presume these weren’t newlyweds). Similarly, it was found that if you have a “best friend” at work, you are seven times more likely to feel engaged in your job! If this is true, your office should sink some money into a nice water cooler (which is the traditional hub of gossiping, lollygagging, and other “friendship at work” activities).

So, now that we know how important it is to have close relationships (both family and friends), why doesn’t everyone have them? Because, like a high-performance sports car, they are often difficult (and expensive, both economically and emotionally) to maintain. They require work, time, commitment, and even money. If such a high level of effort seems repulsive or exhausting to you…just look around you. This may be why you’re alone right now, sitting alone in your grandmother’s basement, eating Cheetos and playing World of Warcraft (is that still a thing?). In contrast, if you’re willing to make the effort in the interest of enriching your life with positive relationships, here are some steps to take:

Be intentional. I’m no farmer (in fact, I’m notorious for my “brown thumb”), but from what I understand, a domesticated plant is unlikely to grow on its own. It has to be made secure in the soil and then nurtured, pruned, fed, and watered. Like growing a plant, one must be intentional about cultivating a friendship. Don’t wait for it to happen; take the initiative. Call a friend and make that appointment for a cup of coffee, or to go to that movie you’ve both wanted to see. However, remember this: friendships are built around common interests. Just because you’ve been dying to see that Monster Truck Jam, it’s entirely possible that your companion may find all that noise and mechanical mayhem to be a little, shall we say, “off-putting.” Also, as I mentioned in a previous blog, men and women tend to cultivate friendships differently: men bond “side by side” (i.e., by participating in a common activity, like playing golf or fixing a car); while women value “face to face” activities (like talking over a cup of tea). Make a plan, then take some initiative!

Communicate. Those of us who are married know that unspoken feelings and hidden secrets are like flesh-eating bacteria to a long-term relationship. Unspoken feelings burrow, fester, and eventually begin to erode the framework of the relationship that you’ve taken so much time and effort to build. If you harbor unresolved anger over a past offense but don’t want to undergo the aggravation and effort of “fighting it out” until it’s resolved, it will grow and become distorted. What actually happened will soon become your perception of what happened…which, with so many feelings behind it, gets magnified and ends up looking very little like the truth. So, before things get out of hand, voice your feelings in a non-confrontational way. Marriage therapists are big on the “I message.” This is a technique wherein you express a complaint from the perspective of how you feel, rather than accusing or blaming the other person. For example, instead of, “You’re always late! You’re never on time!”, you might try, “When you’re late, I feel like I’m low on your priority list.” Another good prelude is, “Help me understand.” Using this helpful technique, “You went out motorcycle riding with your buddies instead of taking me out for Valentine’s Day?” becomes “Help me understand how you thought that going out with your friends would be a good idea” (just a random example, of course. Not like this has ever happened to me). As I tell my patients, when it comes to having an emotional discussion with someone, it’s all about paving the road first (in case the metaphor eludes you, I’m talking about carefully choosing your words to smooth out the bumpy hazards ahead).

Forgive. The way I see it, each offense that hasn’t been talked-through or forgiven becomes like a nuclear warhead, waiting to explode. Over the years, each of these armed missiles gets “stockpiled” in the back of your mind. If you know anything about nuclear physics (and I sure don’t), you know that there is only a limited amount of fissionable material that can be stored together before the whole pile reaches critical mass, resulting in an explosion of tremendous magnitude. I’ve seen this happen with couples who have been married for many years. Rather than putting the work into dealing with resentments, they amass these nuclear weapons until they’re finally ignited by something that, on the front end, seems very trivial (like leaving your underwear on the floor. Once again, not a personal example). The spouse is left to wonder, “What the heck brought that on?”

Believe it or not, there is a significant amount of scientific literature that cites the actual health benefits of forgiveness. Research from Stanford University’s Forgiveness Project and Clinic (yeah, there’s really such a thing!) has shown that forgiveness not only benefits the other person, but it’s critical for our own physical and mental health. Studies have revealed that people who are more “forgiving” have fewer health problems, less depression, and fewer symptoms of emotional stress. In contrast, failure to forgive increases the risk of a number of illnesses, including cardiovascular disease and even certain forms of cancer. Even the risk of injury by accident is higher in people who do not forgive! In the laboratory, people who were merely asked to imagine not forgiving someone showed unhealthy changes in blood pressure, muscle tension, and immune response. The exact opposite happened when people were asked to imagine a “forgiveness” scenario.

So, it’s important to forgive when we believe we’ve been mistreated or misunderstood. Of course, easier said than done, right? In an effort to forgive someone, it might first help to understand what forgiveness is not. It does not mean what we condone hurtful actions (like abuse). It does not mean that we forget what happened (“forgive AND forget” is a poetic but often impossible standard). Most importantly, it does not always mean that we completely repair the relationship or reconcile with the offender (especially when the offender has no interest in fixing things). Instead, forgiveness is a choice; an action that we decide to take, regardless of how the other person feels or responds. It’s a decision—often difficult to make and subsequently stick to—to not hold the other person’s offence against them. It often takes time, and it’s often a decision that has to be renewed every day! It will become easier over time, although everyone’s timeline is different.

So there it is. If you understand the importance of relationships and want to help them thrive, you can be intentional, communicate, and forgive. Takes some work? Yes. Sometimes confusing? Certainly. However, here in the 21st century, when relationships are becoming progressively more remote and toxic (thanks again, social media!), there is no single more valuable pursuit when it comes to ensuring our own health and survival! Now…it’s almost March. Where did I store those chocolate Easter eggs from last year?

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Relationships. Who needs ‘em?

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By MICHAEL SHAPIRO, PhD

February 2020

A quick peek at my calendar reveals that it’s February. Ah, February…the month that hosts the most famous holiday that isn’t really a holiday: Valentine’s Day. As of the time of this writing, we’re now about a week past this annual high-pressure reminder to do some nice stuff for (or to) someone you love. I believe I’ve dodged marital suicide for one more year by making sure I took my wife out for an extravagant and lavish dinner. Fortunately, Applebee’s never disappoints.

As the number of Valentine’s Days that are left to me slowly dwindles, it has caused me to contemplate the value and importance of relationships (not just romantic ones). According to Harvard Health Publishing, positive connections with others yield benefits for both physical and emotional health. Numerous studies have shown that people who have social support from family, friends, and the community have fewer health problems and actually live longer than people who are solitary or socially withdrawn. Evidently, this is because positive relationships reduce stress; and stress is known to interfere with cardiac functioning, the immune system, and even the health of your gut. Engaging in “caring behaviors” has even been found to trigger stress-reducing hormones (and, it’s far cheaper than a spa day)!

This all makes sense if consider the fact that humans are extremely social animals. We depend on each other. We have to. We’ve always had to. Think about it from the standpoint of evolution: unlike lions and wooly mammoths and alligators and such, primitive man was not blessed with tremendous strength or speed or stealth. However, we “aced” it in the brain department. Man quickly figured out that if we worked together, we had a better chance of survival and reproduction (especially the reproduction part, which doesn’t work particularly well when you’re alone). As a result, in order to encourage mutual survival, man developed a highly social brain that actually allows us to feel good when we experience social interactions, and to feel a kind of pain when we are socially rejected or marginalized. Even the emotion of sympathy (feeling sorrow or pity over someone else’s misfortune) served an evolutionary function by making sure that we were motivated to work cooperatively to help each other survive.

I once read a study that was conducted by the Gallup organization, which (as you may know) is an analytics company based in Washington, DC. In this study, when people were asked why they became homeless, why their marriage failed, or why they overeat; they often attributed these problems to the poor quality (or complete lack) of friendships. A subsequent study on friendship yielded some surprising findings. For example, a majority of married people indicated that friendship is more than five times as important to them as physical intimacy within the marriage (okay, I presume these weren’t newlyweds). Similarly, it was found that if you have a “best friend” at work, you are seven times more likely to feel engaged in your job! If this is true, your office should sink some money into a nice water cooler (which is the traditional hub of gossiping, lollygagging, and other “friendship at work” activities).

So, now that we know how important it is to have close relationships (both family and friends), why doesn’t everyone have them? Because, like a high-performance sports car, they are often difficult (and expensive, both economically and emotionally) to maintain. They require work, time, commitment, and even money. If such a high level of effort seems repulsive or exhausting to you…just look around you. This may be why you’re alone right now, sitting alone in your grandmother’s basement, eating Cheetos and playing World of Warcraft (is that still a thing?). In contrast, if you’re willing to make the effort in the interest of enriching your life with positive relationships, here are some steps to take:

Be intentional. I’m no farmer (in fact, I’m notorious for my “brown thumb”), but from what I understand, a domesticated plant is unlikely to grow on its own. It has to be made secure in the soil and then nurtured, pruned, fed, and watered. Like growing a plant, one must be intentional about cultivating a friendship. Don’t wait for it to happen; take the initiative. Call a friend and make that appointment for a cup of coffee, or to go to that movie you’ve both wanted to see. However, remember this: friendships are built around common interests. Just because you’ve been dying to see that Monster Truck Jam, it’s entirely possible that your companion may find all that noise and mechanical mayhem to be a little, shall we say, “off-putting.” Also, as I mentioned in a previous blog, men and women tend to cultivate friendships differently: men bond “side by side” (i.e., by participating in a common activity, like playing golf or fixing a car); while women value “face to face” activities (like talking over a cup of tea). Make a plan, then take some initiative!

Communicate. Those of us who are married know that unspoken feelings and hidden secrets are like flesh-eating bacteria to a long-term relationship. Unspoken feelings burrow, fester, and eventually begin to erode the framework of the relationship that you’ve taken so much time and effort to build. If you harbor unresolved anger over a past offense but don’t want to undergo the aggravation and effort of “fighting it out” until it’s resolved, it will grow and become distorted. What actually happened will soon become your perception of what happened…which, with so many feelings behind it, gets magnified and ends up looking very little like the truth. So, before things get out of hand, voice your feelings in a non-confrontational way. Marriage therapists are big on the “I message.” This is a technique wherein you express a complaint from the perspective of how you feel, rather than accusing or blaming the other person. For example, instead of, “You’re always late! You’re never on time!”, you might try, “When you’re late, I feel like I’m low on your priority list.” Another good prelude is, “Help me understand.” Using this helpful technique, “You went out motorcycle riding with your buddies instead of taking me out for Valentine’s Day?” becomes “Help me understand how you thought that going out with your friends would be a good idea” (just a random example, of course. Not like this has ever happened to me). As I tell my patients, when it comes to having an emotional discussion with someone, it’s all about paving the road first (in case the metaphor eludes you, I’m talking about carefully choosing your words to smooth out the bumpy hazards ahead).

Forgive. The way I see it, each offense that hasn’t been talked-through or forgiven becomes like a nuclear warhead, waiting to explode. Over the years, each of these armed missiles gets “stockpiled” in the back of your mind. If you know anything about nuclear physics (and I sure don’t), you know that there is only a limited amount of fissionable material that can be stored together before the whole pile reaches critical mass, resulting in an explosion of tremendous magnitude. I’ve seen this happen with couples who have been married for many years. Rather than putting the work into dealing with resentments, they amass these nuclear weapons until they’re finally ignited by something that, on the front end, seems very trivial (like leaving your underwear on the floor. Once again, not a personal example). The spouse is left to wonder, “What the heck brought that on?”

Believe it or not, there is a significant amount of scientific literature that cites the actual health benefits of forgiveness. Research from Stanford University’s Forgiveness Project and Clinic (yeah, there’s really such a thing!) has shown that forgiveness not only benefits the other person, but it’s critical for our own physical and mental health. Studies have revealed that people who are more “forgiving” have fewer health problems, less depression, and fewer symptoms of emotional stress. In contrast, failure to forgive increases the risk of a number of illnesses, including cardiovascular disease and even certain forms of cancer. Even the risk of injury by accident is higher in people who do not forgive! In the laboratory, people who were merely asked to imagine not forgiving someone showed unhealthy changes in blood pressure, muscle tension, and immune response. The exact opposite happened when people were asked to imagine a “forgiveness” scenario.

So, it’s important to forgive when we believe we’ve been mistreated or misunderstood. Of course, easier said than done, right? In an effort to forgive someone, it might first help to understand what forgiveness is not. It does not mean what we condone hurtful actions (like abuse). It does not mean that we forget what happened (“forgive AND forget” is a poetic but often impossible standard). Most importantly, it does not always mean that we completely repair the relationship or reconcile with the offender (especially when the offender has no interest in fixing things). Instead, forgiveness is a choice; an action that we decide to take, regardless of how the other person feels or responds. It’s a decision—often difficult to make and subsequently stick to—to not hold the other person’s offence against them. It often takes time, and it’s often a decision that has to be renewed every day! It will become easier over time, although everyone’s timeline is different.

So there it is. If you understand the importance of relationships and want to help them thrive, you can be intentional, communicate, and forgive. Takes some work? Yes. Sometimes confusing? Certainly. However, here in the 21st century, when relationships are becoming progressively more remote and toxic (thanks again, social media!), there is no single more valuable pursuit when it comes to ensuring our own health and survival! Now…it’s almost March. Where did I store those chocolate Easter eggs from last year?

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New Year’s Reservations…I Mean, Resolutions

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By MICHAEL SHAPIRO, PhD

January 2020

It occurred to me this week that I had not written a blog entry for the month of December, 2019. For the year 2020, I will resolve to pay better attention to deadlines…and then to not make any more resolutions!

Speaking of which…what is the deal with New Year’s resolutions? We’ve all made them; and we’ve all failed to keep them. When we fail, most of us feel guilty. We then resolve to stop beating ourselves up about it…which ends up being the only resolution we keep, at least until next year, when the cycle starts all over again!

Are we really so weak-willed? Do our best intentions always have to go bad? Is the custom of setting New Year’s resolutions just another yearly process to set ourselves up for humiliation and failure? Good questions! Let’s make a resolution to get to the bottom of this!

According to one of my most trusted scientific sources (the History Channel), the first New Year’s resolutions were probably made about 4,000 years ago in ancient Babylon. Each year, after spending 12 days crowning a new king (or pledging loyalty to the reigning king), these ancient partiers would make a promise to pay all debts and return all borrowed objects (like CDs, power tools, and stuff like that), in the hope that the gods would bless them with prosperity during the ensuing year. Later, the ancient Romans (who actually invented “January”) would begin each year by offering sacrifices and making a promise to behave themselves for the rest of the year. We all know how that turned out. At some point, making New Year’s resolutions became a secular (rather than religious) practice. Instead of resolving to improve ourselves as a community, we decided to look inward and make personal goals for self-improvement. Unfortunately, statistics show that although around 45 percent of Americans make New Year’s resolutions, only about 8 percent keep them. Where do you fall in that statistic? Yeah, I thought so.

So, should we throw the New Year’s baby (the cute one with the sash) out with the bathwater? I don’t think so. Setting goals is an admirable and commendable practice! Doing so prevents us from becoming stagnant. A resolution is a promise to ourselves to keep growing, improving, and changing for the better! As a psychologist who works with patients who suffer from medical disorders that are mediated by lifestyle (for example, obesity, diabetes, and hypertension), I’ve seen that goal-setting can be a lifesaver…as long as those goals are set properly! To this end, we health care professionals (or was it the ancient Babylonians?) have come up with an acronym for goal-setting that can easily be applied to New Year’s resolutions: SMART. Specifically, make resolutions that are Specific, Measurable, Attainable, Realistic, and Time-based. Let’s look at each of these individually:

A “specific” goal is one that is, well, specific rather than vague or overly general. For example, rather than resolving to “look better in 2020” or “lose this gut” (yeah, that’s one of my favorites); one might say, “I resolve to lose 10 pounds.” This places the goal in clear view, thereby making it more realistic and attainable (more on that in a minute).

A goal also has to be “measurable,” mainly to help you know when you’ve achieved it! After all, to “look better in 2020” is pretty subjective: my idea of “looking better” probably differs from yours (personally, if I leave home with my hair combed and my underwear on the inside of my pants, I’m looking pretty good!). Whether your goal involves weight loss, exercise, or something else; it’s helpful to have a numerical way to measure your progress, be it in pounds, inches, days, HbA1c levels (for you diabetics), calories, school grades, blood pressure values, or number of good deeds done.

An “attainable” goal is one that is not so far from where you are now, just a small “bump” up or down, thereby making it more easily reached. For example, a weight loss goal of one pound per week is much more manageable than 20 pounds per week…which brings us to the next part of the acronym: a “realistic” goal is one that is reasonable for your body type, your resources, and your circumstances.

I’ll confess that I’ve always held on to two important personal goals: to become an astronaut, and to invent teleportation (you know, like on Star Trek). Unfortunately, now that I’m in my 60’s and have established a fairly stable career path (oh, and don’t have a sufficiently high IQ or even a decent understanding of subatomic physics), I’m beginning to think that these goals may be slightly—and I mean just slightly—unrealistic. Similarly, if your goal is to become a millionaire this year; or to diet and exercise until you look like Natalie Portman or David Gandy (who, according to a study performed in the UK, are the most beautiful people in the world, based on what are considered to be the most universally attractive physical traits); you might want first want to take a look at your bank account, your investment portfolio, and your image in a full-length mirror.

Lastly, a “time-based” goal has a specific expiration date. This will ensure that you stay motivated, which is more likely when you set a definite time limit. When your timeframe is vague or non-existent (“I need to lose weight this year,” “I gotta get around to fixing the house,” “I’m finally going to clean out the basement”), it only give you an excuse to put it off. Besides, time limits provide a “checkpoint” for you to assess your progress. If you haven’t lost that one pound by the end of the week, you can stop and re-assess whether or not that goal was realistic and attainable. If you did meet your goal, you can pat yourself on the back, and then set a new goal that’s even more challenging (“Now that I know I can handle walking one mile a day, I’ll set a new goal for a mile-and-a-half!”).

So, if you’re looking back on all the resolutions you didn’t keep in 2019 but are not yet ready to completely give up on the grand old tradition of making New Year’s resolutions; try making some using the SMART goal paradigm. However, as of the day of this writing, it’s already January 3…so you’d better hurry up and get started. Personally, I think I’m actually only a few days away from finally nailing the whole teleportation thing…

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1601 Owen Drive, Fayetteville, North Carolina 28304 │ Patient Services: (910) 678-0100 │ Continuing Education: (910) 678-7226 │ Privacy Notice

Copyright 2020