Can medications help me zoom in and zoom out from my thoughts and feelings

When thinking about pharmacological solutions for folks with mood disorders, I tend to think in terms of “zooming in” and “zooming out” problems rather the the usual “chemical imbalance” theory.

For folks with excessive zooming in to thoughts and feelings, I tend to think about SSRI’s, SNRIs, Antidepressants in general, Quetiapine, Anitipsychotics etc as “numbing agents” or “detaching agents”. Interestingly, a few years ago at Griffith Uni, they trialed oral Ketamine for severe depression, which is very “detaching” in action.

For folks with “primary” excessive zooming out from thoughts and feelings, some of the above may have more “dissociative/detaching” side effects, so I would use it with a degree of caution.

I do wonder if we can view ADHD as a lack of zooming in OR “loose anchoring” to various thoughts and feelings, and hence, fleeting from one thing to another perhaps. Hence a “zooming in” agent like Dexamphetamine seems to make sense.

The challenge is, most mood disorders are not simply a zooming in problem, or a zooming out problem. Often there is a mix.

Some people have both extreme zooming in, and extreme zooming out problems, and a single drug is not going to be the whole answer unfortunately.

There’s no such thing as a “zooming in and zooming out drug according to context” is there?

Hence, many will have to do the hard work of learning how to zoom out on the things that don’t matter, or matter but can’t control, and zoom into the things that truly matter, or things that they can control.

How can we improve our motivation for positive change

In counseling and coaching, motivation is critical for change to occur because without motivation, one’s knowledge, resources, and skills cannot be mobilized. 

So how can we improve it?

1. We can try to link the “new desired behaviors” to their values and what’s relevant to them. When it’s linked to their values, it’s more emotive, motivating and sustainable.

2. We can try to increase the perceived rewards for doing the “new desired behaviors”.

3. We can try to reduce the perceived rewards for keeping the “existing unhelpful behaviors”.

4. We can try to increase the perceived pain and negative consequences for keeping the “unhelpful behaviors”.

5. We can try to reduce the perceived pain and negative consequences for taking on the “new desired behaviors”.

6. We can do a combination of the above. We can frame the rewards as a “pull motivation”, and pain/consequences as a “push motivation”. Often we have to do a bit of a pull, and a bit of a push all at the same time. How much of each, depends on their personality and context.

What’s is the difference between a punishment and a consequence

With parenting support and counseling, we often explore with parents about the difference between a punishment versus a consequence. 

This is important for the workplace as well, especially for those in management or leadership positions.

A punishment is emotive. Usually, it’s done with judgement, frustration, reactivity, or anger.

A consequence on the other hand, is often more emotionally neutral or compassionate, and less judgemental.

Why is this important?

When a punishment is perceived by the the child who is on the receiving end, it impacts on their connection/attachment with us. It may give them a message that the connection is “conditional” upon that certain expectation is met.

With “consequences” as the “optics”, it’s saying this has nothing to do with our relationship. I love and care for you no matter what. At the same time, these are the consequences to what we have done. That is life. But no matter what happens, I still love and care for you no matter what.

Not easy of course, especially when our needs are not met, and we are stressed due to life’s craziness. Parenting is truly the toughest job in the world. 

We make mistakes. We learn. We grow.

Moving from self as content to self as context

In Acceptance Commitment Therapy ACT, one of the. hardest thing to explain to patients is the idea and concept around “self as context” vs “self as content”. 

So what is it?

One can view it as how one identifies oneself in a “zoomed in” or “zoomed out” perspective.

When one “zooms into” how one identifies oneself, it may sound like this. I am a male Asian.

When we zoom out a bit more, I am male.

A bit more, I am a human and a citizen of the world.

A bit more, I am the “awareness” that observes my thoughts and feelings. I am the “observing self”.

At a more “zoomed in” self identity level, there will be more rigidity, anxiety, stress, fight/flight, and less openness. In this space, there will more “identity wars” and ongoing conflict. It’s at the “us” vs “them” level.

As one “zooms out” more on the “spectrum” of self identity, one is moving from self as content towards self as context. There will be more understanding, more appreciation, more unity, and less conflict perhaps.

The important question is, how “zoomed in” or “zoomed out” are we with self identification?

Knowing where we are will help us to shift to a more helpful level, and shift perspectives. 

In counseling, at the core of it, we help people shift self identity from self as content, to self as context.

Using values in a more conscious way to guide our actions

In counseling, we often see “values” as a very powerful tool to guide people’s actions and behaviors. 

Values around justice and equality. 
Values around competence and excellence. 
Values around duty and responsibility. 

Values around freedom and autonomy.

Values around fun and novelty.
Values around compassion and kindness to name a few. 

Like any tool, we can use it consciously and with precision, or we can use it unconsciously and reactively. 

If we use a knife consciously and with precision to prepare food, then it’s wonderful. If we use the knife unconsciously and reactively, then it’s extremely dangerous. 

So what is the key point?

We often see people in the home, groups, and society, fighting/debating over the “utility of a value”, but often fail to debate over the “mindsets and skills” of the users. 

It’s like arguing over the usefulness of a knife or a drill. No one can deny that those are very useful. But if we give it to a young infant, then that may be a terrible idea. 

In history, we have seen “equality and justice” done badly at times. 

But if “equality and justice” can be done consciously, with the right mindset, with precision, and not reactively, then we may have a better world. 

The same goes with our other values and beliefs.

Learning to find balance

In counseling and coaching work, we often see folks at the extremes of various traits, and so we try to to help them “rebalance” that for better workability and adaptation.  

We see folks who see the world through “extreme logic”, and rely very little on “feelings”, so we help them to follow their heads but take their hearts with them. 

We see folks who see the world through “intense feelings”, and rely very little on “logic”, so we help them to follow their hearts but take their heads with them. 

We see folks who are extreme at following the “outer compass” or the crowd, and lose touch with who they are, so we help them to find themselves, their principles, values, and follow that more. 

We see folks who are extreme at following their “inner compass”, and forget that they do have to adapt to the world and conform at some level to function.  So we show them “outer empathy” and “group think” when required. 

As Family Doctors or Mental Healthcare Professionals, we have to be “multilingual” in order to understand and speak your “language”, and show you the other “languages” to balance, or at least understand and appreciate. 

How do we measure our self worth?

I often ask patients to do the following exercise as homework. 

Finish off these sentences for me....

1. I feel significant or adequate when .....
2. I feel insignificant or inadequate when .....
3. I am significant or adequate because .....

The common answers to the first question are....

When I achieve.
When I can be of service to others.
When others accept me.

The common answers to the second question are....

When I fail.
When I can’t help others.
When others reject or dislike me.

The common response to the third question is....

“I am not too sure”. They often struggle with this one for some reason.

It’s no wonder why so many of us have emotional vulnerability. Self esteem purely based on achievements, being of service to others, and how others feel about us, can be very fleeting and unstable.

Consider finding multiple ways of measuring our self worth, including values like kindness, authenticity, simply being who we are, growth focused, loyalty, curiosity, responsibility, hardworking which are less dependent on achievements, popularity, or other people’s opinions.

Once we feel significant, adequate or “enough”, it’s a great foundation from which we can face life’s many challenges.

Maybe you should try to answer those questions too.....

Mindfulness, zooming out and into our thoughts and feelings

As Family Doctors, we see a lot of people with worry.   But worry is not necessary a problem. It’s the “titration” that is the issue.

Like stress, too little stress is a problem with performance. Too much stress is also a problem with performance.

So how do we “titrate” the degree of stress or worry that is required for any given context?

With great difficulties, but we can try with a bit more emotional literacy.

Titration requires zooming in and zooming out.

The more we fused or zoom into a thought or feeling, the more we judge, stress, or worry about that.

The more we defuse, detach, or zoom out from a thought or feeling, the less we judge, stress, or worry about that.

Mindfulness helps one to “hold space” for the thoughts and feelings without getting sucked into the “vortex”.

Processing and working with the thoughts or feelings rather than being engulfed by them through excessive fusion or zoomed in. 

So good titration requires mindfulness along with good zooming in and zooming out functions.

Fix the stuff at the core rather the stuff on the surface

In counseling, we get the big “wins” from time to time.
These are the times when we can “collect the harvest” after “planting the seed”, nurturing and watering it.

One of those moments is when our patients make a shift from “I am not enough” to “I am enough”.

When this happens, everything in their life may suddenly change. On close analysis, nothing at all may have changed. The dramas are still there, but their perspective and relationship with the dramas may have changed.

So what’s the main point?

Fix the stuff at the “core belief” level or “behind the curtain”, and the stuff in the front of the curtain will organically change, or at least can be changed, with less difficulties.

Alleviate the loneliness to alleviate the fear and anxiety

I often see folks who suffer chronic loneliness, or even if they are not “lonely”, there connection with their tribe is very labile. It’s an insecure connection. They sense that they can lose it at anytime. 

Most of their connection is often conditional. Conditional on them being a certain way. Being agreeable perhaps. Being of a certain standard.

Like they say, everyone needs at least one source of unconditional love from at least one creature. If you don’t, you might be in trouble.

This can give them a lot of fear and anxiety, and if not resolved, are in a constant “fight or flight” response.

This “flight or flight” response will then emulate through all aspects of their lives. It can be very destructive, as they may “fight or flight” with whatever is in front of them.

Alleviate the loneliness, and the “fight or flight” may lessen. Challenge the “fight or flight”, and it might just escalate, worsen, and create more loneliness.

So how do we “fix” loneliness?

At a societal level, more education in relationships perhaps.  We can provide more support and create more opportunities for people to connect.  We can provide more support and create more opportunities for people to connect.  

At a primary care level, more support for families and individuals around what we are doing already, and possibly more interpersonal skills, parenting support work, family therapy work, couple counseling, and more counseling/coaching work in general.

I understand that it’s not easy, and at the same time, that may be what is required, to shift society in a more “positive” direction perhaps.

Gaining emotional literacy for better communication

One of the key skills for couples and groups is to be able to acknowledge each other’s position and point of view authentically. If not done authentically, it can sound condescending or avoidant.

So how does one acknowledge something authentically if we don’t have the emotional literacy to understand the other party’s perspective and personality style?

The answer is, with great difficulties.

In counseling, it’s common to observe that folks tend to interpret and judge what others say or do through their own lens, and personality styles. This will lead to a lot of misunderstanding, conflict, pain, and suffering.

A more accurate way is to interpret and judge what others say or do through the other person’s lens, and personality style.

A simple example would be an emotionally fused personality vs a more emotionally detached personality. The more emotionally detached personality style may say something in a very matter of fact tone and non emotive in nature. It’s a simple fact in their mind. The more emotionally fused personality style interprets that through their own lens as sounding very critical, insensitive, unfair, and harsh. Suddenly, we have an escalation on our hands.

Having better emotional literacy around this will assist in better understanding, acknowledgement, and communication for better relationships and collaboration.

How to leverage for better health

In golf, a small shift in the angle of the swing, will lead to a much bigger difference in the distance at the end point. A small shift at the core, will lead to a bigger shift on the surface. 

So in counseling, we try to fix the problem at the core rather on the surface. Behind the curtain rather than what’s in front of the curtain. It’s more efficient and effective that way.

Imagine if we can shift these 3 core beliefs for people.

1. From “I am not good enough” to “I am enough because I am who I am. I am not perfect but I will learn and grow throughout my life.”

2. From “toxic shame” and “I am not lovable” to ”I am lovable or likable”.

3. From “It will never change” to “Things can change in any given moment”.

What would the world look like then? 

Will we be healthier physically, emotional, and socially?

A simple life reminder around fear of failure

Life is like playing Angry Birds. We sometimes need to make two crappy moves to show us the right move.

Failures do not have to be “bad thing”.