A Short Lesson on Neuroplasticity:
Every time you have a thought, your brain changes.
How is this possible?
“Neurons that fire together wire together.”
With each thought, a synaptic connection is formed or strengthened.
Our brain cells, called “neurons,” communicate with one another via synaptic transmission. Neurons have microscopic space between them, called a “synapse.” One neuron releases a chemical (neurotransmitter) into the synapse and the next neuron absorbs the neurotransmitter–this is how they talk to each other. This process, known as “neuronal firing,” creates a “synaptic connection” between those two neurons. When neurons communicate frequently, the synaptic connection between them strengthens, which allows communication between those neurons to become more efficient. As a result, messages traveling the same pathway in the brain over & over become faster and more efficient.
With enough repetition, messages become automatic.
That’s why we practice things like hitting a golf ball–-with enough repetition, the brain goes on automatic pilot. Psychologists have long known that negative thoughts follow this pattern–-the more we think about, or “ruminate,” on a negative thought, the more entrenched the negative thought becomes. Fortunately, the opposite is also true–focusing on positive thoughts and experiences strengthens the brain’s tendency to fire up the neuronal circuitry involved in happiness and well being.
So, you can shape your neuronal architecture by choosing what you focus on–this is known as “self-directed neuroplasticity.”
Research in the field of positive psychology finds that, unfortunately, human beings are hardwired to focus on the negative–to ensure survival, ward off disaster, etc. Even in less stressful times, our minds tend to focus on problems to solve, things that need to be done, or mistakes we’ve made rather than the positive moments that occur throughout the day. To some extent, this focus can help us improve and stay on top of things. But, an unbalanced focus on problems contributes to negative emotions, and crowds out the positive experiences of the day. Changing this takes conscious effort–this is where a daily “Positivity Focus” comes into play.
Develop Positive Neuroplasticity with a Daily “Positivity Focus”:
At the end of each day, reflect back on at least one positive moment and write it down.
Click here to download a pdf with an easy format for recording your daily Positivity Focus (I also included the Daily Accounting exercise), or simply write it on a calendar or journal. Your positive moment can be significant or something as small as hearing a favorite song. The point is to train your brain to notice, appreciate, and spend a little more time with positive things you experience throughout your day, even if they are just small things. With dedicated practice, here’s what you will find–recollecting positive moments will become easier as time goes on (it can be surprisingly difficult when you first start out–our brains are not wired to focus on the positive!). Then, you will begin to consciously notice positive moments during your day–almost in an “Oh, I can write this in my Positivity Focus!” kind of way.
Noticing your positive moments as they occur is when the real change begins.
As you notice a positive moment, take 30 seconds to let it soak in. Articulate the moment in your mind, take in the visual, and form a mental snapshot. Also, notice any sounds, smells, or physiological reactions you have–smiling, relaxation of tensed muscles, and so forth. What you want to do is imprint this experience in your mind, using as many sensory modalities as possible, thereby strengthening positive neural pathways in your brain. 30 seconds may not sound like a long time, but try it–you will probably be surprised at how long that feels compared to how quickly you usually move on to the next thing.
Positive neuroplasticity helps prune the connections in your brain to weed out unnecessary attention to the negative and strengthen your focus on the positive.
A brain that imprints positive emotions becomes more resilient–you bounce back quicker from negative experiences and disappointments. And, a focus on positive emotions dials down the release of stress hormones, which lessens the negative physiological effects of stress.
Note: What the Positivity Focus is Not:
* Not a positive affirmation, i.e., “I’m a good person.” There’s nothing wrong with positive affirmations, so say them if you like, but the Positivity Focus exercise focuses on something that happened to you that day.
* Not a gratitude focus–gratitude is good, but different from your Positivity Focus. You are not thinking of what you are thankful for as much as you’re recollecting a positive experience. Example–gratitude is “I’m thankful for the nutritious food I had for breakfast.” A Positivity Focus is “It was so nice to have a leisurely breakfast this morning. I loved smelling the freshly brewed coffee, hearing the birds sing, and how the early morning sunlight dappled through the trees.” Note–you probably won’t write out the complete experience in your Planner, simply for time’s sake, which is fine. But, be sure to recollect the experience in your mind as vividly as possible. Then you might simply write–“Leisurely breakfast–coffee, birds, sunlight.”
* Not mindfulness–this one is complicated, because creating a Positivity Focus begets mindfulness. However, for the purpose of the Positivity Focus exercise, the point is not (just) mindfulness. The Positivity Focus exercise begins with simply recollecting a positive experience and recording it. This will likely develop mindfulness of daily positive experiences, which further contributes to positive neuroplasticity.
If you want to read further about positive neuroplasticity, I recommend Rick Hanson’s book, “Hardwiring Happiness.”
I hope you’ll give the daily Positivity Focus a try!
You don’t have to write out a long description in your Positivity Focus log.
If you like to journal, you may enjoy writing about the moment; if not, feel free to be brief. The most important component of this exercise is to cue up the neural pathways associated with the positive experience. Recall and re-experience that moment as vividly as possible, then you can shorthand your description when you write it down.
If you understand the core concepts of goal attainment, you can “work smarter, not harder.” Here’s how to use Willpower, Habit, and Decision Making to reach your goals:
1. Remember that goals need to be concrete.
I can’t emphasize this one enough! “I want to be healthier” is a value rather than a goal (in terms of behavioral change). “I want to lose 10 lbs” is a goal that needs to be broken down into concrete behavioral objectives that will help you reach your goal.
So define your goal, which should be concrete and measurable. Then identify one specific behavior you are going to add (or subtract) for this week, and define exactly what that behavior looks like.
For example, if your goal is to lose 10 lbs, then specific behavioral objectives for this week might be:
I will eat dessert only on the weekend.
I won’t snack while I’m at work.
I will take 10 minutes in the middle of the day to exercise (in addition to my other activities).
You should reevaluate your behavioral objectives on a weekly basis. Decide which behavioral objectives need to be modified, and if any should become habits. See #5 below for more regarding behavioral objectives vs habits–but remember these distinctions:
- A “behavioral objective” is a specific behavior you’re committing to for a week. After the week is up, you can fine-tune or discard these. Example: “This week, I will exercise three times.” Behavioral objectives are stepping stones toward reaching your goals.
- A “habit” is a behavior you build into the routine of your daily life. It takes consistency and willpower to build a habit, but once the behavior becomes a habit, you do it with minimal thought or effort. “I do 50 jumping jacks every morning right before I shower.” Your habits should align with your goals and values.
- A “goal” is something specific you want to achieve, and it is concrete and measurable–“I want to run a 5K,” or “I want to lose 10 lbs.”
- A “value” is a standard for living, such as “I want to live a healthy life.” It is a concept, and it is not measurable.
Goals are achieved by setting specific behavioral objectives and creating habits.
2. It takes willpower to reach a goal or establish a habit, but it’s easy to use up all your willpower on any given day.
In Dr. McGonigal’s book, The Willpower Instinct, she explains that willpower is like a muscle–it can become fatigued on any given day, but also builds stamina when exercised on a regular basis.
The trick is using your willpower strategically and for the right things! Your willpower is strongest early in the day because:
3. Decision making depletes willpower.
Have you ever experienced “decision fatigue,” where you feel like you just can’t make one more decision that day?
Hint–this is what’s happening when couples get into the “What do you want for dinner?” “I don’t know, whatever you want” spiral. “Decision making” and “willpower” are intertwined, so when you’ve been making decisions all day, you run out of steam–both for decision making and exerting willpower. The end of the day is when you’re most likely to take the path of least resistance.
4. So pace your “decision making” demands by engaging in “pre-decision making,” aka “proactive behavior.”
First of all, don’t use up your decision making/willpower energy on things that don’t really matter to you.
Psychological experiments show that even simple decisions tax your willpower reserves. Steve Jobs famously wore his “uniform” of jeans, black mock neck sweater, and tennis shoes on a daily basis–he felt eliminating this daily decision freed up his mental energy. Even U.S. President Barak Obama subscribes to this notion–as quoted in Vanity Fair:
“You’ll see I wear only gray or blue suits,” he said. “I’m trying to pare down decisions. I don’t want to make decisions about what I’m eating or wearing. Because I have too many other decisions to make.” He mentioned research that shows the simple act of making decisions degrades one’s ability to make further decisions. It’s why shopping is so exhausting. “You need to focus your decision-making energy. You need to routinize yourself. You can’t be going through the day distracted by trivia.”
Secondly, if you’re trying to create a new habit, pare down the decision making related to that habit.
There are a few ways to do this:
Avoid mental negotiation.
Example of mental negotiation: “I promised myself I would exercise Monday morning, but I really want to get to work early today–maybe it would be better to exercise after work instead.” Don’t do this! Mental negotiation uses up your decision making & willpower energy! Instead–“I committed to working out on Monday morning, period.”
When initially setting goals and creating habits, you may find that some of your behavioral objectives just don’t harmonize with your life (like working out on Monday mornings!) and in that case it’s okay to reevaluate–but do it systematically. See #5 below.
Make decisions ahead of time so it will be easier to stick to your behavioral objectives.
If your behavioral objective is to work out Monday morning, take a few minutes on Sunday to set out your exercise clothes and decide what your workout will be. Proactively taking care of a few seemingly simple “decisions” will contribute greatly to your chances of following through when faced with a task you’re not enthusiastic about.
5. Established “habits” don’t require decision making, so habits don’t require much willpower. Therefore, establish habits that will help you reach your goals!
What’s the best way to establish a new habit? Start with setting weekly behavioral objectives–by committing for just a week, you can reevaluate and modify without “failing.”
Behavioral objectives strengthen your willpower because you persevere through the week, knowing it’s only a week until you reevaluate. Quitting just because it’s tough undermines your willpower. So “quitting” is bad, but “reevaluating” at defined intervals is smart & recommended!
As you accomplish weekly behavioral objectives, identify which ones you want to become habits.
Some behavioral objectives will have more payoff than others, or fit more harmoniously into your lifestyle. These are good choices for habits.
To repeat–habits become a part of your daily life, things you do no matter what. No mental negotiation, no weekly reevaluation. The payoff is that once the habit is ingrained, it takes minimal willpower because there’s no decision making!
An example of establishing a habit is brushing your teeth. When a client says, “It just doesn’t come naturally to me to exercise/be on time/keep my home organized, but I wish I could!” I counter by explaining that none of us are born with a natural propensity to brush our teeth, either–but we all learn to do it, and we do it every day–even twice a day. While there may be occasions when you think “I’m just too tired to brush my teeth,” chances are you do it anyway. And if you do skip, you get back on track pretty soon. That’s because you were taught this habit long ago and you do it without thinking–you don’t make a daily decision about whether you should brush your teeth, you just do it.
Now you know how to establish habits that align with your goals by removing the decision making and conserving your willpower!
Want to share the goals you’re working toward?
Why not begin 2014 with a microresolution? A “microresolution” is exactly what it sounds like–a small, concrete goal that you can enact with minimal disruption to your daily life.
But don’t be surprised if the microresolution leads to bigger changes!
Here are 5 Steps for Setting a Microresolution:
1. Decide which area of your life you want to focus on.
For example, do you want to focus on relationships, health, or career? Let’s say you decide you want to focus on health.
2. Narrow your focus.
Your microresolution should be specific and obtainable. For example, “eat healthy” falls under the “health” category–but that is still too broad. Narrow it down and keep it manageable–for example, “I will eat breakfast everyday.”
3. Define your “aspirational” and “minimum acceptable.”
It’s good to aim high, but life gets in the way. So, for the “eating breakfast” goal–“My aspiration is to prepare a healthy (albeit quick!) breakfast–oats, eggs, or a fruit smoothie (notice that I’m being concrete & specific!). My minimum acceptable is to have something in my stomach by 9:00 am, even if it’s just a glass of milk or piece of fruit.”
4. Once you’ve decided on your microresolution, create some accountability.
Low tech–mark your progress on a calendar or share with a friend. Or on your smartphone–use an app such as Streaks or HabitMaster. Research shows that new behaviors become automatic for most people at 66 days–this is the point at which the behavior is habitual as opposed to requiring effort. Missing a day here and there doesn’t mean you have to start over, but consistency is key to building a new habit.
Another aspect of creating accountability requires what I call a “mental health check-in.”
Even if you’re successful at making a behavior habitual, life gets in the way. Whether it’s because you’re traveling, become ill, have a family emergency, or any other number of things, something will happen to knock you off your game. And we all seem hardwired to “revert to baseline,” or fall back on our old behaviors. Even if you’re able to articulate how good it felt when you were successfully implementing your microresolution, chances are you will fall off your game when life gets hectic. So, set up reminders for yourself at 2 or 3 month intervals to reassess your progress. At the time of your mental health check-in, fine-tune your microresolution if necessary, and recommit. The “minimum acceptable” can be very helpful in getting you back on track.
5. Reward yourself!
Unlike longer term goals that require significant effort before payoff, a microresolution is self-reinforcing almost immediately! Using our example of “eating breakfast”–you feel better when you eat breakfast and it feels good to accomplish a goal each day! And the microresolution is aligned with your most important life values/goals (take care of your health), so you’re also progressing each day toward the things that are most important to you.
If that’s not enough reinforcement for you, consider rewarding yourself more concretely when you do your “mental health check-in.” Decide on a treat for yourself that you will allow only when you’ve accomplished a level of consistency that is acceptable to you.
For more on habit formation, check out The Power of Habit, which I blogged about here, or Small Move, Big Change, available January 16.
I recently read an inspiring post by Carolyn Hax–“Defining One’s Best Self.” She hits all the relevant questions–please take a moment to read it.
For my New Year’s Microresolution, I’ve decided to commit myself to Daily Accounting for a year! (Read about Daily Accounting here.)
I often recommend this technique to clients who tell me, “I know what I need to do, I just can’t seem to do it.” The Daily Accounting process really helps push through the emotional barriers that keep people blocked, but it takes a little time. And there’s a tendency to make it too complicated–keep it simple and you’ll be more likely to stick with it and see the benefits.
Want to join me in committing to a Daily Accounting in 2014?
People are often surprised to learn that the holidays are my busiest time of the year, but think about it–the holidays are stressful!
During the holidays, people reminisce about happy times and want to recreate that emotion.
But this is challenging if you’re going through difficulties, have lost a loved one, or you’re away from family. Add in the pressure of travel, coordinating schedules, preparing elaborate meals, and buying perfect gifts. . . Well, you get the point–people can get edgy, anxious, or even clinically depressed.
Here are 5 tips to keep you balanced during the holiday season! Let’s start with the basics:
1. Maintain Healthy Habits, Especially Getting Enough Sleep
During the holidays, people want to get in as much celebration & togetherness as they can! But this is often at the expense of sleep, downtime, healthy eating, and exercise. A few days of this, and most people get sluggish, cranky, and sensitive–a bad recipe for all that togetherness!
Decide ahead of time what your “non-negotiables” are. For example, everyone can fit in 5 minutes of exercise or stretching a day. Or 5 minutes of mindful meditation. Decide on at least one core healthy habit and commit to it for the month–no matter what. And balance out the indulgences–if you sacrifice sleep one night, take a nap or turn in early the next night. If you enjoy too much food or drink one day, go on the light side the next.
2. Know Whether You’re an Introvert or Extravert, and Plan Your Time Accordingly
If you’re an introvert, you’re going to need time to yourself. This is especially true if you’re a houseguest or hosting others in your home. Let others know ahead of time that you’ve got a few things you’re going to do on your own–this helps to avoid hurt feelings (but keep in mind #4 below!). To recharge your introvert batteries, go for a walk, go to a bookstore or diner, or just curl up in your room to read a book or flip through a magazine. It really is okay to have a little down time! For more information about introverts, check out Susan Cain’s book, Quiet.
If you’re an extravert, you may feel let down if you find yourself alone at times during the holidays, so you may want a heavier schedule of outings and get-togethers. If you anticipate stretches of uncommitted time, plan ahead and volunteer, offer to babysit a friend’s children, get out somewhere to people-watch, and Skype with your out of town family and friends!
3. It’s Okay to Say “No”
Another version of this is, “Don’t over-schedule!” You don’t have to accept every invitation that comes your way. Feeling rushed and behind because you’re over-committed is not the way to enjoy the the season! And it’s okay to postpone get-togethers until January, when everyone feels less pressed for time. Feel guilty for saying no? Read #4 below!
4. Remember That You Are Not Responsible for Other People’s Feelings
Another version of this is, “Keep your side of the street clean.” As an adult, you should have a code of conduct for yourself–what behaviors you deem acceptable or not. If you abide by your personal code of conduct and someone’s feelings are hurt, that’s unfortunate, but it’s not really your problem to solve. This is not a free pass to be callous, but someone else’s happiness is not more important than your own. Bonus: Adopting this attitude also provides immunity to passive aggressive efforts of others.
5. Don’t “Yardstick”
To quote Theodore Roosevelt: “Comparison is the thief of joy.” So true. “Yardsticking” is comparing yourself to others, usually in a way that makes you feel inferior. See more on my post here. Another way of looking at this–“Don’t compare your insides to someone else’s outsides.”
Take good care of yourself this holiday season!
As a consumer, there are several things you need to know about “minimum essential benefits,” mental health parity, deductibles, and preexisting conditions.
The catchphrase “Minimum Essential Benefits” refers to the ACA mandate that, moving forward, health insurance policies cover basic health care services that were previously optional. The ACA is clear that mental health care, including substance abuse treatment, is a minimum essential benefit. So what are the implications of this provision?
- As of mid-November, 2013, it remains unclear whether this mandate will be delayed for a year or more. Why? Many individual and small business health insurance policies are being cancelled because they are “catastrophic,” i.e., bare minimum, and do not meet the “minimum essential benefits” criteria. However, problems remain with signing up for coverage on www.healthcare.gov, so millions of people are left in the lurch–they are losing their current health insurance policy, but are having trouble signing up for insurance on the healthcare exchanges. To try to address this problem, President Obama has asked health insurance companies to extend their catastrophic policies so no one loses coverage. However, many health insurance companies say they can’t make this change so late in the game. Additionally, some states have enacted laws that won’t allow the continuance of catastrophic policies. So, right now, no one really knows if catastrophic policies will become a thing of the past.
- If you have a health insurance policy through your employer, and your employer’s policy is “grandfathered,” i.e., no changes to the policy have been enacted since the 2010 signing of the ACA, “You may not get some rights and protections that other plans offer,” according to healthcare.gov’s post on grandfathered plans. Are minimum essential benefits such as mental health care one of the “rights and protections” that may not be available? Perhaps. I searched healthcare.gov exhaustively for specific information about grandfathered plans and mental health care, and couldn’t find a direct answer. So, my guess is that if the issue is not specifically mandated, then insurance companies and employers may not fully cover mental health benefits in grandfathered plans, in the interest of cost containment.
- If your employer is “self insured,” then your employer can opt out of certain “minimum essential benefits” such as mental health care. Here’s the reference on healthcare.gov.
“Mental Health Parity” was originally enacted in 1998 and was intended to ensure mental health services were covered by insurance companies similarly to medical issues. There were many exceptions & exclusions to the law, and it was not diligently enforced. The second round of “Mental Health Parity” became law in 2008, but once again, exceptions and work-arounds rendered it ineffective.
In November, 2013, Health & Human Services Secretary Kathleen Sebelius announced new regulations that once again seek to provide coverage for mental health services at the same level as coverage for medical issues.
- Theoretically, this should eliminate separate deductibles, out of pocket limits, and limitations on coverage for mental health services. The specifics of the mental health regulations are spelled out here–206 pages! However, it remains to be seen whether there are loopholes or whether the regulations will be evenly enforced. A provision of the ACA that limited annual out of pocket limits has already allowed exceptions through 2014 for policies that use “more than one benefits administrator,” which often applies to pharmacy and mental health benefits. Mental health benefits should be excluded from these exceptions on out of pocket limits, but we’ll have to wait and see how the regulations are enforced.
- Exclusions to mental health parity (verbatim from healthcare.gov) include:
- Plans offered by small employers that are self-insured (these are plans that don’t buy insurance from an insurance company, but pay for employees’ health care costs themselves; they may use a health insurance company to manage claims and payments)
- Plans offered by employers that can show the federal government that the parity requirements have caused such a significant increase in plan costs that they qualify for a one-year exemption
- Plans offered by state and local government employers that are self-insured and choose not to apply the parity requirements, as long as they properly notify the federal government
- Plans that are grandfathered (generally those that have not changed their plan terms since March 2010)
- Retiree-only plans
- If catastrophic policies remain in effect (see above), then mental health benefits are unlikely to be covered at all in these policies.
To underscore the uncertainty regarding mental health parity, I quote healthcare.gov: “Do job based plans include mental health parity protections? Some of them do.”
A key provision of Obamacare (ACA) is that individuals with preexisting conditions, physical or mental, cannot be denied the opportunity to purchase health insurance. Further, those with preexisting conditions cannot be required to pay higher premiums and policies cannot be cancelled.
- This is good news for individuals who previously sought mental health care and were subsequently denied the opportunity to purchase health insurance because of their “preexisting condition.” You can no longer be denied the opportunity to purchase health insurance! And your marketplace health insurance policies can’t raise premiums or cancel policies if you decide to use your mental health benefits or become seriously ill, which was a risk with individual policies in the past.
One final relevant point about Obamacare and mental health coverage: To quote healthcare.gov: “Can I keep my current mental health provider? Possibly.”
- If you’ve ever invested time, money, and energy into mental health care, then you know that “providers” are not interchangeable! The therapist or psychologist you’ve been working with knows you, your history, challenges, and strengths. Starting over is not a small thing. As insurance companies are managing costs, they are “containing” their networks, i.e., fewer providers are included in-network. This does not mean that you can’t see a therapist or psychologist that is “out-of-network,” but you may pay more out of pocket than with in-network providers. And in-network providers often agree to accept lower reimbursement, which may dilute the quality of care.
In summary, Obamacare is intended to make mental health care affordable and accessible to every American citizen. However, such an ambitious goal is going to have bumps along the way and soundbites don’t accurately describe the reality. If you have comments, questions, or additional insights, please share!