The Treatment of Emotional Trauma With EMDR
Emotional trauma and its components
Trauma is an emotional response to an event. Traumatic events include physical, psychological and sexual abuse, terrorism and war, accidents, witnessing a life-threatening event or violence against others or yourself, natural disasters and domestic violence. Even having a childhood with no support or warmth can create a trauma in some people.
Short-term reactions include flashbacks, shock and denial, and long-term reactions may include flashbacks, mood swings and symptoms like nightmares, insomnia, somatic disturbances, difficulty with intimate relationships, loss of trust, depression, substance abuse problems, or even suicidal behaviours. Survivors often wait years to receive help while others never receive treatment at all.
Sometimes the way people interiorize these traumas is by creating dysfunctional beliefs about one's self. These beliefs may include: “I am worthless, I am not important, I am disgusting, I am unlovable, …” amongst other beliefs.
Possible treatments for emotional trauma
There are a wide range of effective treatment interventions that can help to diminish the severity of these symptoms.
- Cognitive Behavioural Therapy,
- Dialectical Behavioural Therapy and
- Acceptance and commitment Therapy
are evidence-based techniques that alleviate some of the trauma´s symptoms, such as the mood swings, the dysfunctional thoughts and even the suicidal behaviours, the insomnia and the difficulties with intimate relationships. But there are some cases where some of these symptoms are unlikely to disappear with the treatment interventions described above. When this happens, it is important to add different approaches in our treatment plan.
EMDR (Eye Movement Desensitization and Reprocessing) can be a good option for these cases.
EMDR, stress and the processing of traumatic events in our brain.
In some cases when someone goes through a traumatic experience, their brain tends to isolate the synaptic connections between neurons related to that specific event. This is a “survival” mechanism that our brain uses so we can continue with our normal lives after the event. Say, for example, that we witness an accident. Stress begins with something called the hypothalamus pituitary adrenal axis, a series of interactions between endocrine glands which controls our body’s reaction to stress. When our brain detects a stressful situation, our HPA axis is instantly activated and we then secrete a hormone called cortisol, which primes our body for instant action.
Sometimes stress can even increase the activity level and number of neural connections in the amygdala, our brain’s fear centre. And as levels of cortisol rise, electric signals in our hippocampus, the part of the brain associated with learning, memories, and stress control, deteriorate.
The information is stored in the central nervous system, together with the negative core beliefs and the emotional and physical sensations that the person experienced when the traumatic event took place. All this information remains stored as if the trauma was still happening right now. These patterns of thoughts are stimulated, activated or originated by current stimuli that lead the person to react in a similar way as how they reacted in the past.
EMDR enables the person to process all the traumatic memories so they can develop adaptative behaviours. Once all these memories have been processed, there is also a physiological change.
The EMDR allows the person to generalise the positive cognitions by processing the Traumatic memories. These memories are distributed throughout the neural networks and the processing thus enables the person to perform adaptative behaviours in the present.
Once the memories have been processed, a physiological change takes place so that the traumatic memory softens together with the corresponding associated beliefs, feelings and physical sensations. We would have then reduced the blockage (the dysfunctional stored information) and reprocessed, reduced or eliminated the negative beliefs associated with the trauma.
Some human reactions are learnt behaviours. They might be very convenient and serve us for a certain period of time. For example, a woman that suffered repeated sexual assaults from a family member during her childhood, may have developed a dissociative disorder. That was her way to deal with fear and trauma at the time.
Dissociation ranges from a mild emotional detachment from the person’s surroundings to a disconnection from physical and emotional experiences.
It is a coping mechanism in seeking to tolerate stress and involves a detachment from reality and is very common among people who have suffered from trauma. As an adult, that same person might now find herself also dissociating from stressful work-related situations. When she was a child, dissociation was the only way she found to deal with the stressors and it was an adaptative behaviour. As an adult, the dissociation may be hindering other areas in her day-to day life, such as work, family or school.
Another example can be a person that has a completely adaptative life but that feels extreme and intense negative emotions that seem to come “out of the blue”. These emotions are usually triggered by stimuli that remind the person of the trauma, and that the person might not even be conscious of.
EMDR works with eye movements, focusing on memories, thoughts, emotions or physical sensations related to memories about the past, the present or situations that may happen in the future.
Do you think you can benefit from EMDR? Get in touch with us!
Sinews MTI
Psychology, Psychiatry and Speech Therapy
After Life: A learning medium to help understand what happens to people who suffer from depression
Depression, this word is associated with a lot of meanings that we’ve learnt according to the popular meaning of it in our society. The most popular notion that we all have is probably a sad person (be it for something specific or general) who spends the day in bed without being able to do anything due to a lack of energy, and that is how most of us have been sold the disorder through popular series and movies of our time.
There is a reason why depression is the most popularly known mental disorder and it’s that at some point in life we all have a passing episode of it, a period of time where we feel without energy, without the desire to do anything, and with a general sadness about everything or even a lack of emotions in general.
But the truth is that depression encompasses many more things, and the fact of making it a popularly known phenomenon has also generated a large number of myths about it, myths such as depression is just a lack of desire, that over time the person who suffers it overcomes it without help, that depression appears because something bad has happened to us or that we can always see when a person is depressed. The truth is that none of this is totally true, depression englobes many different behavioural patterns and it is more common to find two completely different cases than are the same, even if it is the same disorder.
As we’ve already mentioned, there are a large number of series and movies that deal with depression, although many of them fall into the error (whether intentional or not) of romanticizing it or generating myths, and therefore I want to recommend a series that is a mixture of drama and comedy written by, and starring, one of the world's most renowned comedian Ricky Dene Gervais, called After life. In this series Ricky Gervais plays the role of Tony Johnson, a journalist for a small local newspaper in his town, who enters a depressive state after the death of his wife from cancer.
Tony views suicide as a way to end everything and realizes that he no longer cares about anything, all the 'social' norms, his well-being, hygiene,friends and other things no longer matter to him so he is free to do and say what he wants, but his plans of being 100% free are 'frustrated' by the continued insistence of his family and friends to make sure he's okay and to try to help him, which only makes his situation and feelings worse.
In addition, we can see how Tony is enduring day by day due to some recordings that his wife left him where he is periodically reminded that he has to keep trying, that he doesn’t have to give up and that he has people who love him, being a magnificent representation of the thoughts that many affected people have and that leads them to continue holding on. Another important aspect is his dog Brandy, who accompanies him in almost the entire series and is painted as a protection factor against the need he has to continue taking care of her, even if he doesn’t care about anything.
The series shows in a very realistic way, but also with very comic touches, what the day-to-day life of a person with depression is like, how they think and rationalize the things they do and the factors that can make the depressive state prolong itself in time, giving us a hard but very accurate notion about what can lead to suffering from a depressive disorder. Proof of its realism is the acclaimed criticism that the series has had not only by its fans but also by some mental health organizations that endorse its realism and are grateful that the taboo to this disorder is removed in a comical but hard way. For all this, I would recommend the afterlife series as a learning medium that can help understand what happens to people who suffer from depression, be it for close people like friends or family, or even for the person who suffers from it.
Currently, the After-life series is available on Netflix and already has 2 seasons with a third season confirmed and in production.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English, Spanish and Norwegian
Your Psychologist with you: Therapeutic accompaniment
By Tommy Norheim, psychologist on the SINEWS clinical team. Tommy has extensive experience in the field of home care for patients with severe mental illness in his country of origin, Norway, and later during his internship in the Master in General Health Psychology at SINEWS.
In our present, in the age of information, the existing figures in the health area are well known to the entire population, figures such as professionals in medicine, nursing, physiotherapy, psychology, assistants of different types, etc. But even with the enormous amount of information we have about these experts, there are still some that are not as well known, and in this article I will try to shed light on one of them that, in my opinion, is still not completely known, specifically that of the therapeutic companion, the functions it performs and how it is done from the area of psychology.
A therapeutic companion is a health professional who performs the task of assisting a person with health problems, whether physical or mental, in those areas where they cannot cope independently, usually in a field other than the clinical or hospital context such as the family home, school, work, etc. Very often, the cases where these tasks occur are with people suffering from severe mental disorders, developmental disorders, autism spectrum disorders, people disabled by reduced mobility or other problems that limit their ability to cope.
Unlike therapies in clinical or hospital contexts, the main job of a therapeutic companion is, whatever the redundancy, accompanying the person in the areas where they have specific problems, making sure to supervise the activities they can do on their own and helping, in the form of guidance rather than substitution, in activities that are difficult.
Having explained and understood what a therapeutic companion is (in general), it is worth asking what role a profesional in psychology who performs this function can play, what kind of problems can a psychologist solve by accompanying a person during their daily chores that are problematic.
Today there is still a lot of misinformation regarding the role of psychology in society, although in general the public begins to form an idea of what psychological therapy would be, and in summary we could say that it consists of speech therapy, describing in words the different problems that a person has in their daily life (regarding habits, emotional state, thoughts, relationship with other people, etc.) so that the professional may help you find ways to change, improve, or accept the problem with which they come, but all this is done in consultation. In the vast majority of cases, the therapist does not have information with which to work beyond that provided by his client through what has been spoken, which, even though it is of incalculable value, it can sometimes make the task of helping difficult due to lost or omitted relevant information. Below I will roughly expose an example of how a treatment can be improved if the role of companion is performed from the area of psychology, using for this a fairly typical example, depression:
Case 1
A person comes to the consultation with an acute depression problem that has been developing for several months. Let us say that the problematic behaviors that are present are the following: feeling of constant sadness, lack of appetite, lack of meetings and social communication, and a general lack of motivation to do things. When evaluating all the problems, talking to the person, we found that there seems to be no ‘reason’ behind all this, it just started to be like that little by little and they feel unable to change it. Let's focus on the social sphere for this example, let's consider that we ask the person what they feel and think when someone contacts them to go out with their friends or make some other type of social gathering and they tell us that they don't feel or think anything in particular, it just happens that they feel no motivation for it and decide not to, which is also influenced by their general state of sadness and lack of appetite. To help change this, the therapist would probably try to design and establish an action plan where the person would have to say yes to meeting up with someone even if the motivation is not present, and before they’d have to eat something to have energy for what awaits them, but this design would be based solely on the information given by the patient, which, although being incalculable as we have already said, could be omitting some important parts for some reason (among them, that they don’t know what information is important since they have no training in psychology).
Case 2
Now, let's change the perspective and suppose that instead of doing the intervention from the clinical context, we go directly to the person's home as therapeutic companions. Suppose we arrive at the house first thing in the morning to be with the person, as soon as we arrive someone calls the person to go out for breakfast and they immediately say no, getting nervous. When asked what they thought about, they say that they cannot do it, they say they’re feeling ill and does not want people to see them like this, they wonder what other people will say about them or what they would think, having an anxiety response to this idea, but when asked how they feel they say good (they’re not aware of the response they have to the situation). Later, we propose the person to clean up the house (assuming that due to inactivity it is not cleaned) and we see that the person becomes paralyzed, begins to see everything that needs to be done and does not know where to start, they see a load of work that’s so big that it gets coupled with the lack of motivation and paralyzes them, when asked what they think they say that there are too many things to do, that they would exhaust themselves to the point that they could no longer do anything else (thought that could perhaps be omitted in the clinic due to not giving it importance or not remembering that they think about it). Our job here would be to guide and tell them that they can do the activity one by one, you don't have to do it all the same day.
As it may have been observed, in the role of the companion, an incalculable amount of information could be received that in another context could be omitted for various reasons, which shows the value of the role the therapeutic companion plays. As we’ve already mentioned, the role this professional plays is not well known today, both in the general population and by health professionals, which is why a good option for both populations to learn about it, in case this small introduction attracts attention, would be the book by Leonel Dozza de Mendoça entitled 'Therapeutic and clinical accompaniment of everyday life'. In this book, Leonel not only explains the different functions of the companion in a language understandable to all populations, but also describes and bases the reasons why the figure of the therapeutic companion is, and will be, a necessity in our society, the benefits it has and why betting on these professionals is a necessary investment in many current cases.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English, Spanish and Norwegian
What not to say when you don’t know what to say
“I don’t know what to say to her.” At 37 years of age Patricia’s best friend was dying of cancer. Patricia stayed at her bedside in the hospital during her last days. The shared moments were limited to short interactions and gestures of care in silence, just sporadically interrupted by the visits of family, nurses and the oncologist.
Patricia wanted to do the right thing and be there for her friend. She was trying to find her voice in a situation that left her speechless. Between the sadness and anger caused by losing her friend way too soon Patricia asked the questions that we would all have: What to say, when you don’t know what to say.
The real matter behind this question has nothing to do with words. Patricia was searching for a way to express her support and love to a dear friend in a crucial moment.
She called me because I am a clinical psychologist, and apparently that makes me an expert in knowing what to say in tough situations. The truth is that I did not respond as a psychologist, but as a friend and someone who has been in that same situation, attending the process of dying without words. I also responded as a former hospice volunteer, that gave me some specific training on the subject. Also, my experience as a therapist has shown me that there are certain moments in which words are overrated. Death is just one of them.
When a person faces any painful experience like a physical illness, depression, anxiety, discrimination, a breakup or being made redundant, words are not necessarily the first thing needed. Receiving empathy, company, love and support are much more vital. True empathy is rooted in understanding, presence, and commitment. If you want to convey true empathy, turn over the floor and start listening, give a hand instead of an opinion.
During the COVID-19 lock-down in March 2020 many of my clients referred not feeling taken care of by their loved ones and even closest friends. Often, what they said did more harm than good.
Let me tell you what they told me, in their words and experiences.
The following list is not meant to make anybody feel guilty but to raise awareness about the effect of some of the most common phrases we use when we genuinely do not know what to say.
When I am feeling down and you say…..
During the COVID-19 lock-down in March 2020 many of my clients referred not feeling taken care of by their loved ones and even closest friends. Often, what they said did more harm than good.
Let me tell you what they told me, in their words and experiences.
The following list is not meant to make anybody feel guilty but to raise awareness about the effect of some of the most common phrases we use when we genuinely do not know what to say.
- “Don’t cry.” … I feel I must swallow my tears when I really need a should to cry on. Give me a hug or give me your hand, so that I can embrace my tears.
- “Don’t worry.” … I feel insecure, because truth is, I am worried and afraid. Tell me you understand my fear, so that I don’t have to feel so alone in it..
- “It’s not that big of a deal.” … I feel ashamed that I even said anything, am I really just making fuss? Please understand that this is a big deal for me, even if it’s not rational.
- “Don’t be so negative.” …I feel scolded like a misbehaved child. Please, make it OK for me to be negative for today, I will feel better tomorrow.
- “At least it’s not (anything worse).” …. I feel guilty and ungrateful with life. Give me some time and I will see the silver lining, just bear with me until I see the light again.
- “You must be strong.” …. I feel it’s my obligation to tough it out, although I really want to acknowledge my vulnerability and exhaustion. Gently remind me of my strengths and I will use them when I feel ready.
- “This is so terrible .” …. I worry that I must protect you from my pain. I don’t want you to worry about be. It’s nice that you recognize the issue, but please, don’t scare me even more..
- “I am here for what you need”… but then you don’t call me again, I wonder if I can really count on you. Asking for help is hard, just take care of some basics, it helps a lot.
- “You should… ” … I feel pressured and even more tired. I don’t need more advise, but your emotional support. Sit with me in silence and I will find my own solutions..
- ….many things but never stop to listen….I won’t have the strength to interrupt. Give me time and space to find my words and listen to what I have to say, whether you agree or not.
- “I know exactly how you feel.” … I ask myself if you really do. Ask me how I feel, as I am desperate to be heard, help me share my experience, and make sense of what is going on inside of me.
If you want to be there for someone in pain, stop searching for words. Don’t pretend to know, just try to understand. Get out of your head and connect with your heart. It takes some courage, but it’s worth it.
Brene Brown puts it best when she says: “Empathy is not connecting to an experience. Empathy is connecting to the emotions underpinning the experience”.
The Author
Eva Katharina Herber is a Clinical Psychologist and Expert in Positive Psychology at Sinews Multilingual Therapy Institute in Madrid. She helps her clients through times of pain and loss by acknowledging the process of grief, accepting what no longer is, practising mindfulness self-compassion and finding meaning and hope throughout the experience. www.sinews.es
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Diary of a Global Therapist: Third Entry
It is 5 pm in Madrid and 10 am in the United States city where the person with whom I have a session today is. It's my "tea time" and her morning coffee.
Today's session is a follow-up session with an employee of a multinational company in the Gas & Oil sector, she is an expatriate in this American city and today's session is not so simple.
Mrs. X has been going through a difficult emotional situation for months but it was three weeks ago when she summoned up the courage to ask for help and that is why we are here today, in our third session together.
Mrs. X arrived more than a year ago at her new destination; she was traveling alone since after two months her partner with whom she had a relationship for 5 years would join her.
As she told me in the first session in which we met and began the evaluation, the first two months were difficult since she had to adapt to new tasks and in a language that despite being proficient was not her mother tongue, she also felt considerably alone outside of work. Still, Mrs. X was encouraged thinking that her partner would arrive soon and they could explore the area and make all the plans together that she was organizing.
Days before the first two months in that new destination, she received the news that her partner wanted to end the relationship, he had not felt the same for a while and these two months had helped him to understand that he no longer saw Mrs. X as the person with whom to share his life.
Since then her mood and well-being went through ups and downs but it is especially since three months ago that Mrs. X feels daily sadness, sleep issues at night and the need to spend the day in bed, she has altered her patterns of physical activity and eating and all this is affecting her work performance.
From the department of international mobility, they have told her about the possibility of returning to Spain if she continues like this since there are days when she does not go to work and if she feels hardly concentrate and very irritable with her colleagues.
What I have just described, the alterations in routines, mood, sleep, and concentration are clear symptoms of a depressive episode but I consider much more interesting the thoughts and emotions that are feeding these symptoms and that we have explored in previous sessions.
Thoughts related to decision-making to travel to the destination where she is since she would have preferred another project that was offered to her in another country where she knew the team and was more interesting to her, but she chose this American city since it made it easier for her ex-couple could travel with her. She is disappointed with the situation and with herself for having made this decision but also for the possibility of having to return before having learned and grown everything she expected.
Thoughts on the other hand related to guilt and comparison at a social level since she had previously had two similar breakups and the idea of “What is wrong with me? ; "The same thing always happens to me." Adding to this an absolute feeling of loneliness since most of her coworkers lived in family and she felt out of the plans they were making and without the possibility of having a support group.
All these emotions and thoughts of guilt, sadness, loneliness and disappointment with herself and with the situation make Mrs. X live on a roller coaster of constant decisions (which has a lot to do with the alteration of rest and concentration) on whether to going or staying and what to do in both cases. It seems like every time she makes a decision a voice flares up in her head in favor of the opposite and she ends up feeling hopeless at the feeling that whatever she does she won't feel better.
I began this post by saying that it was not a simple session since, on the one hand, it may not be time to make a decision taking into account your mood but on the other hand the well-being and health of the employee and being in a place where she feels alone, without her family and in a stressful environment is not the ideal environment for her mental health.
These types of sessions also produce a waterfall of emotions in me, not only because of concern for Mrs. X's health but also for others like empathy.
Although each experience is unique and personal I think that all of us who have lived outside at some point have had similar thoughts and emotions such as nostalgia, the feeling of loneliness, guilt for not enjoying as much as we should, the comparison with the experiences of other ex-pats and disappointment with certain situations.
I have also experienced weeks in which those monsters in my head did not stop appearing at the least opportune moments and I have also had the feeling of changing my mind several times a day regarding my future.
Of course, almost all of us have also felt anguished after a breakup and blaming ourselves for what happened, thinking about what we have done wrong.
But not all the emotions that appear in me during the session are so difficult, I also feel curious and comfortable.
It is curious that before starting to work on this type of projects with multinationals and of course before the COVID-19 crisis, I thought that online therapy was a way to replace face-to-face if there was no other possibility but today the I find it very interesting and pleasant not only because of the possibility it gives us to help people who are far from us but also because of what we learn from each other.
Mrs. X, like many other clients, has our sessions from home and unless I am in Sinews' office, I usually do them from mine as well.
I see behind her a set of different photos framed in what looks like three white-painted weathered wood frames, they are symmetrically arranged and especially beautiful. In them I can see Mrs. X in what seems like different trips, in one of them she is skiing with some mountains and snow-covered pines behind her, in another she seems to be in a swamp doing a kind of water skiing and in another, I think she is with a group of people. It is curious that although I have asked her in our sessions about her interests and hobbies she has not mentioned any of these activities.
But she can also learn a little more about me on a personal level after these sessions. Even though I try to have a neutral and distraction-free environment when I work from home, there are things that we cannot avoid such as the appearance of my dog, a mastiff as large as it is affectionate during sessions whose head is common to appear or one of his huge legs asking for love. I have also seen the dogs and cats of different clients over the past few years and have occasionally heard relatives or Amazon dealers calling home in the middle of the session. At first, this made me a little uncomfortable, nowadays and as long as it is not a great distraction, I think that these details humanize us, help us to get to know each other and connect us much more despite the distance.
Besides, doing the session from our home, with our favorite tea and mug and the comfort of a rug or the wood under our feet creates a feeling of safeness and self-care very optimal for therapy. Today at the beginning of the session Mrs. X tells me that she wanted to have it, that this morning she returned to do a little exercise, she had breakfast and made a coffee with her favorite vegetable milk to take it with me in session because she has thought that this is a morning that she wanted to dedicate to herself and to take care of herself physically and mentally. This attitude on the one hand surprises me and makes me very happy and on the other it makes me feel similar, comfortable with her, and willing to share and work together during this hour.
We will work together on the importance of normalizing certain emotions, of giving them space but trying not to give them all our attention, we will talk about emotional regulation and we will begin to carry out certain practical exercises and we will also try to incorporate behaviors and activities very little by little and progressively that she used to enjoy.
It is still too early to know how Mrs. X will progress and experience tells me that it is better to be cautious and go step by step, but we will try to learn from this experience and finally decide what to do.
We finish our time together and I send her by email different materials to practice, that, and the invitation to the next session.
See you next week for our next coffee/tea time together. Thank you for sharing so much with me, Mrs. X.
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
How to handle Procrastination in the midst of a Pandemic
You might have heard the term “procrastination" before, and it is likely you might have experienced it more than once. The definition of the word is: deciding to delay or not complete a task for no valid reason despite the negative consequences of doing so. Making time for doing something of more importance or urgent than the task we are delaying, would not be considered procrastinating. Neither would be making time for an unforeseen event. We procrastinate when there is no good reason to delay the action.
The procrastination cycle has the following steps: I face a task that generates discomfort or negative feelings (I don’t feel like doing it, it’s frustrating, boring, difficult, makes me anxious…) à I try to avoid that discomfort by engaging in another pleasurable task or postponing my goal à I immediately feel better à I face negative consequences long term.
The problem with this cycle is that we tend to repeat actions that have positive short term consequences, despite them having also negative long term consequences. We are wired to prefer immediate gratification despite the possible long term consequences. That is why we might struggle to keep a diet when offered a chocolate cake, or fail to remain focused on completing a boring report.
The negative impact of procrastinating can be severe, depending on the frequency and severity of the behavior. For starters, it deteriorates our healthfor two different reasons. The first one is procrastinating increases anxiety and remorse levels, which in turn create a state of heightened stress that weakens our immune system (particularly if this state is maintained for long). The second reason is when we are procrastinating, we also postpone other important health behaviors, such as getting enough sleep, exercising or keeping a balanced diet. Another negative effect would be decreasing our work or study performance and having to relinquish activities that matter to us. Lastly, other than creating strong and frequent negative emotions, procrastinating also alters the way we perceive ourselves: as less efficient, therefore lowering our self-esteem.
During the Coronavirus crisis, it is possible you may have noticed your productivity taking a dive. Tedious or difficult tasks require a great deal of self-control, which is a limited resource that needs to be recharged often by resting. Disordered habits, the loss of access to pleasurable leisure and social activities, fear and uncertainty create a great deal of stress that make it difficult to recharge our capacity for adequate self-control. It is possible we might feel overwhelmed or unable to properly respond to the current situation, which impacts our ability to function normally.
However, despite being confronted by a situation we cannot change, it is important we don’t get carried away by the paralyzing anxiety and instead we focus on what is actually on our power: our own behavior and the way we manage our time. To avoid procrastination, we recommend the following strategies:
1. Identify whats tasks you procrastinate and why.
The first step to stop procrastinating is to identify which tasks you usually postpone unnecessarily and why. First, you can ask yourself what type of tasks you have the most trouble initiating or concluding. Are you postponing your chores or budgeting? Work or study activities? Leisure or social events? Health related or self-development tasks? When we identify the type of task we have the most trouble initiating, we can better prepare for it by mustering all of our self-control and motivation.
On the other hand, as we previously mentioned, we usually avoid tasks that generate negative emotions . In order to gain insight on how our feelings are playing an important role in the difficulties we may be having, we can develop a simple list of tasks we are procrastinating. In that list, we can write how we feel about each task. It is possible we feel the task is not appealing or fun, that we do not know how to start because we lack information, or that we feel we must complete the task perfectly and those rigid standards prevent us from even starting. Identifying why we are reluctant to start or engage in something will gives clues to solve the problem. el porqué de nuestra reticencia nos dará claves para solventarla.
2. Recognize and confront your excuses
When we decide it is preferable to postpone an important task until the following day without a proper reason and despite the negative consequences, we have found an excuse that allows us to feel comfortable with that decision, at least momentarily. The excuses are usually not adjusted to reality despite seeming believable in the moment. Some examples of the type of justifications we might use are: “It is too late to start it now”, “I won’t get much done, so I’ll just leave it for now”, “It is better to do it when I am in the mood or feeling inspired”,“I will do it once this other thing is finished”, “I have plenty of time, so I can do it later” or, “I work better when I am stressed, so I will leave it to the last minute”. We can find a myriad of examples, but it is likely that you have recognized some of the excuses in this list.
Once we have become aware of how our thoughts are mere excuses to cope with the remorse of not having started or completed an important project, we can refute those thoughts. In order to do so, we will use more adjusted thoughts. Some examples are: “I will not be more motivated to start this tomorrow” “Even if I don’t have time to finish everything, I can start this and make it easier for tomorrow”, “It is not true I work better under pressure, I simply finish things faster but my work suffers”, “I have other things to do, but this one is the most important now”.
You can use your list of identified excuses as a sign that you are about to start procrastinating. This way, you can try to prevent it beforehand.
3. Tolerate discomfort
As we have previously mentioned, procrastination is a habit triggered in part by a low tolerance to discomfort: We avoid a task that generates negative emotions so we don’t have to experience or deal with them. Tolerating discomfort is an ability that can be trained with some practice so it does not become such an obstacle.
One way of achieving this is to expose yourself to the dreaded emotion for a short period of time. For instance, if the emotion we are trying to avoid by procrastinating is boredom, we can remained bored (by not doing anything) for 5 or 10 minutes before starting a boring task. After we have done that, we will be more able to withstand the negative emotion when we start working. The more we practice exposing ourselves to uncomfortable emotions, the easier it will be to stop postponing important activities.
Another way of improving our tolerance to discomfort is to think about negative emotions as something temporary, as a wave that we can surf: First, the emotion intensifies or rises, then it reaches its highest point (the crest of the wave), and finally, it diminishes until it disappears. Being aware of the temporary aspect of emotions makes it easier to tolerate the negative ones.
Another effective strategy to combat procrastination is simply starting a task, even if it is during a short period of time, or if everything we will do for that day is creating a new file and write the title, or reading necessary information. We usually overestimate how negatively we will feel about doing a task before starting it. However, once we start it, the discomfort is not as intense as we initially assumed and we can power through it.
When we cannot manage to start an action, we can ask ourselves: What is the amount of time I am currently motivated or willing to dedicate to this task without postponing it? Is it 30 minutes? 15? 5? Once you have set a time limit, you can start the task without dreading it so much. If you feel motivated to continue working once the time limit you had initially set finishes, you may do so.
We hope this advice has been useful to you. We will also like to remind you of the importance of setting rewards for yourself once you have exposed yourself to the task or completed it. This will make you more motivated towards the task, and help you replenish your energies after.
Division of Psychology, Psychotherapy and Coaching
Psychologist
Adults and adolescents
Languages: English and Spanish
Reseña de Libro: Controle su ira antes de que ella le controle a usted
El propósito de las siguientes líneas es esbozar de forma breve aquellos aspectos más importantes del libro de Albert Ellis y Raymond Chip Tafrate “Controle su ira antes de que ella le controle a usted”. En un primer lugar, se expondrán los motivos por los cuales se considera pertinente hablar de esta temática en términos generales y en términos más actuales. El Trastorno Explosivo Intermitente (TEI) consta de una prevalencia entre el 1,4% y del 7%. Por otro lado, a la época actual de confinamiento tan longevo se suma la sombra de la violencia intrafamiliar. De ahí se desprende, a juicio del autor, la necesidad de abordar este tema, apoyándose en el libro que motiva esta reseña.
La época que estamos viviendo demanda de nosotros recursos que hasta hace poco teníamos olvidados o a los que habíamos tenido que acudir en momentos muy puntuales o por períodos breves de tiempo.
Se puede hablar en estos casos de aspectos como la resiliencia, la paciencia o la perseverancia entre otros. Esta situación y sus características pueden producir en nosotros reacciones de irritabilidad y enfado.
Muy probablemente el lector haya sentido, al salir a la calle, las miradas de desconfianza de otros ciudadanos, o cierta irritabilidad referida a la mera presencia de otras personas en el supermercado o el transporte público. Además, la preocupación por la salud se ve acompañada de una preocupación de corte económico que no facilita alcanzar estados de ánimo especialmente positivos. Si a esto le sumamos un confinamiento extendido en el tiempo, con la sombra de la violencia intrafamiliar flotando sobre nuestra sociedad, obtenemos una mezcla de lo más explosiva y necesaria de aplacar. Con todo esto, es más que probable que se den reacciones de enfado o ira. He aquí la utilidad de este libro tanto para el momento presente como para otros momentos no exclusivamente relacionados con el confinamiento y las consecuencias de éste.
El interés de este libro reside en varios pilares. Por un lado, la manera en la que está escrito lo hace enormemente asumible para pacientes y profesionales de la salud mental. Su lenguaje ameno y explicativo le proporcionan una notable utilidad. Por otro lado, el libro aúna varios aspectos enormemente importantes y que se podrían enmarcar en las terapias de tipo cognitivo-conductual: aborda el poderosísimo componente cognitivo de la ira, así como técnicas más procedimentales y comportamentales para amansar reacciones propias del enfado. El libro, asimismo, no edulcora el tema que le compete: la ira presenta unos efectos devastadores para el individuo y su entorno. Mi experiencia en el campo de la clínica con personas que sufren este tipo de problemática me reafirma en el acierto de comentar este último aspecto y en la enorme necesidad de darle su cabida a lo largo del proceso terapéutico: estas consecuencias devastadoras no son en absoluto eludibles.
Este libro es además una extraordinaria oportunidad para adentrarse y comprender la principal aportación de Albert Ellis, que podría resumirse de la siguiente manera: uno no se siente de determinada manera por el acontecimiento o hecho en sí, sino por el significado o la interpretación de ese mismo hecho. Esto significa que el resultado emocional no dependerá del evento, sino de lo que pensemos al respecto. Si me molesto porque mi familia no me presta ayuda, no es solamente por ese hecho, es por lo que significa para mí (“Yo siempre les ayudo y ellos no me ayudan nunca”). Aquí reside la importancia del libro objeto de este análisis. La ira, o el resultado emocional, no es debida al acontecimiento o a “lo que ha pasado”: es debido a qué significa para la persona lo que acaba de pasar.
Por ejemplo, un hombre puede sentirse molesto cuando su mujer le dice que no presta suficiente atención a sus hijos. A ese evento puede, muy probablemente, seguir un pensamiento como “Estoy harto de me vea como un mal padre”. Su mujer no ha dicho que él sea un mal padre, ha dicho que no presta suficiente atención a sus hijos. Hemos ahí el poder de las interpretaciones que nosotros hagamos en relación a lo que nos ocurre. Ese hombre se siente mal por pensar que su mujer le vea como un mal padre, no por lo que ella dijo.
Diversos estudios encuentran una relación positiva entre la impulsividad, la ira y la impaciencia. Cabe, en este contexto, mencionar la elevada de tasa de abandonos (egosintónico y suele provenir por parte de otra persona) cuando la ira es motivo de consulta. Como decíamos, la ira correlaciona con la impaciencia. Esto podría explicar que las personas que padecen este problema cuando no obtienen resultados deprisa, abandonan el tratamiento; cuando obtienen resultados deprisa, abandonan el tratamiento; cuando la pareja les deja, abandonan el tratamiento y cuando la pareja no les deja, también suelen abandonar el tratamiento.
Esto es una llamada a la responsabilidad y el compromiso por parte de aquellas personas que se sientan identificadas con lo que se ha descrito a lo largo de estas líneas. Lejos de culpabilizar, el propósito es también hacer visible el sufrimiento de la propia persona, no solamente de su entorno. A pesar de ser la familia, los amigos, los compañeros de trabajo el termómetro más fiable, la cara visible de las consecuencias, el sufrimiento que padece la persona está lejos de ser un villancico.
Quien “tiene” arranques de ira, explosiones de enfado y actitudes enormemente hostiles a ojos de los demás, también “tiene” una arrolladora sensación de culpa, disgusto e inadecuación, que, sostenidos en el tiempo, facilitarán a su vez un nuevo episodio de enfado.
Este libro puede ser de enorme utilidad también para ellos: hablar de nuestros aspectos más lesivos y “repugnantes” con un desconocido puede no ser plato de buen gusto para todos. El uso de un libro como el que se está comentando puede servir de hoja de ruta, de material a modo de refugio al que acudir. Además, este libro no es indiferente a esto que comentamos: lejos de aplastar cualquier tipo de enfado futuro, también se hace referencia a la función de un enfado adaptado a la situación, como el establecimiento de límites, el hacer partícipes a los demás de aquello que hacen y nos disgusta, etc. Es decir, el enfado forma parte de la vida y cuenta con una función necesaria, siempre y cuando exista una pertinencia y proporcionalidad.
Sinews MTI
Psychology, Psychiatry and Speech Therapy
Diary of a Global Therapist: Second Entry
Madrid, 4 pm
After a morning with interviews prior to expatriation processes and writing the corresponding corporate reports and recommendations, my afternoon begins again on the Sinews-online platform. I have a follow-up session with an employee of a multinational in the Oil & Gas sector.
These follow-up sessions that large companies make available to their employees are intended to help them with the emotional management of expatriation processes, their adaptation to a new life, and the prevention of problems or assistance. Today it is Mr. H who is waiting for me connected to the other side of the screen and the Indian Ocean!
Mr. H is already in his new destination, he has been in it for more than three months, he is in an Asian country and despite the fact that at the beginning his adaptation was simple, in recent weeks it has been complicated and his mood has suffered.
Mr. H has established good social relations and meets his family at the destination, they have also adapted without major problems, but his discomfort comes from another route, actually two different paths:
1) On the one hand, the tasks you perform are not exactly what you thought you would be assigned and, although you like them and see them as an opportunity for growth, they consume much more time than you expected.
2) On the other hand, before moving he had some expectations: travelling to nearby places, different family activities, learning the country's language ... and due to the process of adaptation and tiredness, he does not have time or energy to carry out all these activities.
All this generates in Mr H the feeling of "not taking full advantage of the experience" and of feeling disappointed with himself.
After years of working with expatriates, this problem is familiar to me, sometimes, very positive and enthusiastic people create high expectations and it is not that they are not met, but that they are not met at the exact time we want. Mr. H and I reflect on the need to be patient with yourself and to be consistent with the moment you are living. The image you created of what the experience would be like is probably not wrong, but it may not be realistic for the first few months. In this way we try to work to be kind to ourselves and consistent with the situation we are living in, assuming that other stages of adaptation will come in which your dreams will be more viable.
On many occasions, we need to normalize the discomfort. Understanding that all emotions have a function (for example exhaustion is our signal that we must rest and recover energy and stress alerts us that there are new stimuli and we must be vigilant to learn how they behave and thus be able to react). When we are able to understand what is happening to us and accept it, we can begin to make it easier for ourselves, be compassionate with ourselves and allow ourselves to live what we have to live.
Thus, after reviewing the functions of emotions together and sharing with him some strategies for managing discomfort, we end up laughing at the "pressure to do, do, smile and smile" that we often impose on ourselves and begin to think together about other ways to enjoy of current learning and set realistic goals for activities to do with his family. Instead of continually being concerned with “getting the most out of it and having to enjoy it” we can simply feel the experience day by day.
As I said at the beginning of my diary, the most globalized and diverse world of work we find ourselves in is an exciting challenge and a wonderful source to foster learning and commitment.
As in any challenge we need to incorporate the tools to face it in our luggage, here I share some of those who work in our services to companies in expatriation processes, we hope they are as useful as they have been for us:
1. Consciousness, the first and main. the knowledge of the difficulties that we will encounter due to the characteristics of the destination but also due to our personal characteristics.
2. The ability to create meaning in each task we do and experience we live, why is this important to you? What impact does it have on your personal growth? What impact does it have on the lives of others and on society?
3. The preservation of our habits and our identity, since only by being better with ourselves will we have a clearer and more open mind to understand, empathize, and adapt to differences.
4. Normalization and management of difficult emotions such as frustration or uncertainty
5. The amplification of our personal strengths, both innate and those created in previous experiences.
If we travel with a suitcase ready with resources to enjoy and others to handle the difficulties, without a doubt our experience will be easier and more exciting.
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Diary of a Global Therapist
Madrid, 9 am
Today I start my morning by connecting through the Sinews Online platform with an employee of a multinational company who is going to be an expatriate in northern Norway.
As usual, the interview begins with our respective presentations and exploring where in his professional career this assignment to the international mobility program arrives and what his expectations are. Right there the routine ends.
I enjoy this work above all because of that, each case is different, not because of the destination, not because of the job, but because of the person.
Today the employee who is on the other side of the screen and who speaks to me from Canada has vast international experience, he worked in Latin American and Arab countries and in his country of origin, but he has always done so accompanied by his family, in this new assignment it will not be like this, his children start college and the place where he is going to is considerably isolated so he will travel alone.
Throughout the interview we discuss his experience so far, he shares what he knows about where he will reside for the next three years and what he knows or needs to know about his new tasks. We also go over the personal resources he has from his previous experiences (many! I love to see such competent people) and we analyze his personality traits, those that will help him adapt and those that can give him problems and reflect on the difficulties which he anticipates he will face.
Mr. Z takes responsibility and he is looking forward to make the most of this new challenge but he is also aware that it will be very different since he will miss his family, he will be more isolated than on other occasions and the weather and food will not be the best.
In this increasingly global world of work, with more mobility and with more diverse environments, accepting the challenge of moving to another country for work can be, at the same time, the most enriching work experience of your life and one of the most complicated. We know, getting out of the comfort zone costs but helps to widen your borders
By now, you may be wondering about the purpose of this interview. First of all, let me clarify that I am a General Health Psychologist and that I work for SINEWS, a company that since its birth has been dedicated to caring for expatriates and their families in their native language. Companies that move employees around the world ask us for these psychological accompaniment programs because of different reasons:
- They help both the company and the employee to assess the risk that their mood and mental health may be in making such a significant change.
- They encourage the professional to explore the possible difficulties that may arise at the destination and to be more aware of their coping strategies: what previous learning can be useful to them and what personal strengths and coping styles they have to handle these difficulties.
- They improve the link between the company and its workers since, far from being a human resources process, it focuses on the well-being of the employees. Putting the focus on people's well-being and not only on their productivity, we know that it is one of the best ways to retain talent and create a climate of trust and commitment.
As the interview progresses we also explore the social areas and relationships with other colleagues and here comes the most interesting part that will probably be the key to the adaptation of our client today. Already in the psychometric personality evaluation that he went through before conducting the interview (a super complete test that is done online and that I carefully review before contacting the employee), I found a high score in social indifference and in difficulty in managing interpersonal situations. Mr. Z affirms that he is not very proactive when starting social relationships and that he has not trained him in previous expatriations since traveling with his family it was not necessary because they frequently did sports or tourist activities on their own.
It is interesting that despite not considering himself a person with high social capacities, he admits that his well-being depends largely on relationships with other people since the best thing he has taken from his previous destinations is the people he has met and the feeling that you can trust the team and create a "small family".
To be completely honest this does not surprises me, neither in the case of Mr. Z nor in any other case, I apply it perfectly to myself. As human beings we are social beings, inevitably and despite our differences, we all depend on our state of mind and well-being on the quality and warmth of our relationships with other people.
The company Mr. Z works for is from the Oil & Gas sector and his next destination is a very isolated one, so generating a good social climate a working environment there will be crucial.
In my conversations with employees in the international mobility program, when we review what they have learned from their previous moves, a very high percentage of professionals talk to me about how “you learn that your way of seeing or doing things is not that it is more or less correct than others, it is only yours and you have to understand and learn that there are other equally valid forms ”, many also mention the power of listening as a key tool for adaptation and for creating bonds with other people.
But there is a question from these interviews that excites me and from which Mr. Z and I will propose a social adaptation strategy in his new destination. It is a question about the personality traits that facilitate our day a day. Throughout the scientific literature, they have been called personal strengths, virtues, values ... but I find it very useful to speak of them as facilitators. We all have traits of our personality that complicate our daily lives, which makes us feel bad ... but we also have facilitating traits, those that make us grow and bring us well-being. We found out that one of the most important for Mr. Z is curiosity, perhaps he is not very outgoing but his eagerness to meet different people and realities and his desire to learn may serve to create new relationships with those who will be his "little family" at his new destination.
We are already finishing our conversation and now we explore together life habits and strategies for coping with stress and emotional management . Finally, we end the interview reviewing the information we have seen and reminding Mr. Z that if problems arise at his new destination we are at his service for sessions online, proving him psychological support if needed.
I was delighted to meet Mr. Z and I am sure that he will do well, he is a flexible person and he has clear strategies. The plan that we have drawn together will help him.
Now it is time to put in writing the results of the test and the interview, I am now with Mr. Z's report, both the one that I will write for him and in which he will be able to read our plan and see a list of readings that I have given him. This report includes recommendations on how to deal with distance with his family and how to improve his interpersonal skills. I will also do a brief report with suggestions for the company.
I confess that this part is a bit more tedious, but I find it very useful and that helps me roll up my sleeves. I know it is important. I write with one thought in mind: Good luck with your new stage, Mr. Z!
Division of Psychology, Psychotherapy and Coaching
Psychologist and Coach
Adults and couples
Languages: English and Spanish
Literacy development and identifying bilingual children with difficulties
Each person has a particular rate of growth and development. The area of literacy (the process of learning to read and write) does not escape this determination. Each child has their own learning speed and this can vary even more in bilingual children.
Detecting the difficulties that an individual may present in this area early and effectively through an early evaluation can represent a significant improvement for the well-being of the person. For these reasons, diagnosis, evaluation and treatment can be decisive in the development of children.
Although we live in an increasingly digital world, reading and writing continue to be an essential tool in most people’s lives and it seems it will continue to be so at least in the near future.
In general, as adults we have forgotten how we learnt to read and write when we were children and simply carry out the process automatically, but it is in fact a complex and lengthy learning task for children, which requires effort and continuous practice. In order to start reading, it is necessary to understand that oral language is divided into isolated sounds, each with its matching graphic representation, which are the letters of the alphabet. As children learn the different sounds for each letter, they can join them to form words and in time will create mental representations of whole words that they can then recognise visually, helping them to read at a faster rate. Therefore, reading has a visual component, identifying letters and words, as well as a linguistic component providing access to the meaning of words, sentences and texts, enabling comprehension of written information.
Children tend to develop these abilities at a different pace, often based on the amount of stimulation received. In general, at 5 years-old they begin to recognise the sounds of certain letters and to identify some words commonly found in children’s books. Around 6-7 years of age, children are considered to have enough tools to start formal literacy learning and progressively begin to decode words and sentences. At the same time they will also start writing some words. In the following years, the process continues to be gradually perfected, achieving independent reading and a progressively improved access to meaning. It is important to highlight that learning to read and write can be done simultaneously from the start in more than one language and that bilingual children learn these skills in the same way as monolingual children do.
Although there are many different definitions of the term bilingualism, in a broad sense it can be understood as the common use of two languages by an individual or a group of individuals inside a community of speakers. However, people who use more than one language do not often belong to a homogeneous group with many differences regarding the moment of language acquisition, the frequency of usage and the level of competence in each language, amongst other aspects. In the past, bilingualism was believed to be potentially harmful and have a negative influence on children’s linguistic abilities. In fact, today there is enough evidence to disprove that this is the case. Therefore, it can be concluded that bilingualism in itself does not cause oral language, literacy or learning difficulties, or any other cognitive or emotional issues whatsoever.
However, bilingual children can have difficulties when learning to read and write, just like children who only speak one language. As there are several factors that need to be taken into account, it is essential to analyse the reasons why the child is experiencing difficulties in each individual case. The following are some red flags that can arise at different stages: early difficulties in recognising or remembering letter-sounds, later slow reading and letter or syllable substitution, addition or omission errors, letter inversions, persistent spelling mistakes, difficulties organising ideas on paper, etc.
In any case, if there are signs of a possible difficulty, it is vital to carry out an early and individualised assessment, using specific tests in order to determine in which areas the child needs help, as well as providing specific recommendations and steps to follow, and establishing the right support at school as soon as possible.
On one hand, some children might show a mild delay, due to developmental delays or lack of stimulation and with the right help they are able to reach the level of their peers in a relatively short period of time.
On the other hand, other children show significant and persistent difficulties, presenting considerable differences compared to the expected level for their age with no apparent reason. In these cases a specific learning difficulty for reading and/or writing must be considered as a possibility. It is estimated that dyslexia, a specific learning disorder of neurobiological origin is present in approximately 5-10% of the population, whether or not there exists a bilingual situation. Bilingual children will show difficulties in both languages, and in all cases dyslexia requieres an early evaluation in order to avoid a possible scenario of school failure in the future.
When dyslexia is suspected, a multidisciplinary assessment and diagnosis should be carried out by a speech and language therapist and an educational psychologist. However, in Spain, speech and language therapists are the main professionals in charge of the detection, evaluation, diagnosis, and specific intervention, which needs to be individualised, explicit, systematic and designed with a mid-long term period in mind. This is different from English speaking countries like the UK or the USA, where the professionals are usually specialised teachers or tutors. In Spain, speech and language therapists specialise in reading and writing issues, as these are considered to be equally related to language, even though the communication channel is written instead of oral. Intervention consists of a specific approach to treatment focused on the rehabilitation of the reading routes and any other aspect detected during the evaluation, together with a series of recommendations regarding school adaptations.
In other cases it may also be useful to work with an academic tutor, whose job is mainly focused on supporting children with school-work and training them in study techniques. This is principally to help children with mild difficulties or those who have already received therapy. This type of support will be of great help to improve time-planning, organisation and self-monitoring skills, etc.
It should also be mentioned that oral language difficulties can affect reading and writing development, either because of specific issues in this area, or due to lack of development in the first language or in the language of instruction (vocabulary, sounds, etc.)
In every situation, oral and written language stimulation at home and at school will be essential with the aim of encouraging curiosity and a life-long love of reading. By making it as fun as possible, a reading habit can be established for life, and not just for studying or working purposes. If children are motivated, improvement will be consistent and observed on an academic and also a personal level, helping in their general well-being.
Sinews MTI
Psychology, Psychiatry and Speech Therapy