Next Level Practitioner

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1 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 1 Next Level Practitioner Week 126: How to Help Clients Recognize Their Emotional Triggers Day 5: Critical Insights with Ron Siegel, PsyD; Kelly McGonigal, PhD; and Ruth Buczynski, PhD

2 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 2 Week 126, Day 5: Ron Siegel, PsyD and Kelly McGonigal, PhD Critical Insights Table of Contents (click to go to a page) How to Balance Contradicting Approaches to Working with a Client s Emotional Triggers... 3 The Key to Helping Clients Manage Their Response to Their Triggers... 4 Two Dangers When Working with a Client s Emotional Triggers... 6 Dissecting the Difference Between Reporting and Emoting Feelings... 8 How to Apply Mindfulness to Coping with Emotional Triggers... 8

3 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 3 Week 126, Day 5: Ron Siegel, PsyD and Kelly McGonigal, PhD Critical Insights Dr. Buczynski: Hello everyone. We re back. This is the part of the week where we re going to focus on the ideas from this week. I m joined, as I always am, by my two good buddies, Drs. Kelly McGonigal and Ron Siegel. We re on a new topic: Helping clients with their emotional triggers. Let me start by asking just simply what stood out to you this week? How about if we start with you, Kelly, and then we ll go to you, Ron. How to Balance Contradicting Approaches to Working with a Client s Emotional Triggers Dr. McGonigal: We got two metaphors this week for the experiences that ultimately allow us to be triggered or create triggers. One was the metaphor of an open wound, and the other was a metaphor more like a physical injury that would require rehab. I actually think it s really useful to think about the different implications of those metaphors and how we think about the value of engaging with things that trigger us. If you use the open wound metaphor, the idea is that something hurt you; it was damaging and painful, and the best way to heal is to cover it up and leave it alone. You don t want to be picking at the scab; you don t want to pour salt in the wound; you don t want to dig at it. So from that perspective, often it s about practicing self-care, protecting yourself from those situations or those conversations that are just going to reopen the wound, particularly if you re already feeling stressed out or fatigued and you don t really feel equipped to have that wound open. If you take the other metaphor, this idea of a physical injury, when you have a physical injury, the healing process is a little bit different than a scab. You are still building scar tissue, but how the scar tissue develops plays a very good role in whether you re going to be able to reuse that part of your body again skillfully, with full range of motion and without pain. Often, in the rehab process, you have to go into the injury, and you use that muscle or use that joint in the way that it s meant to be used, but just slowly, and carefully, and with the support of your trainer or your therapist, so that the scar tissue lays itself down in really nice, neat, organized ways so that you become fully functional again. So that s a different metaphor. This idea of triggers is really prevalent in our society right now; people are changing the way they think about it. I was struck by the different implications of that. They could both be right; they could both be right for the same person and the same circumstance, but maybe at different time points.

4 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 4 But I just wanted to call that out because this idea of triggers is really prevalent in our society right now; people are changing the way they think about it. We hear that language a lot. To have a sense in yourself which of those metaphors is maybe operating and how that s relating to how you help other people deal with their triggers. Dr. Buczynski: Thanks. How about you, Ron? Dr. Siegel: I d love to dig in a little bit more because I had the same thought about those two different metaphors and their implications. I m sure we ll get a chance to talk about it. There was something else, though, that struck me, which was that in many ways our speakers this week were helping us to enter the topic by defining what a trigger is. We actually got two I got two different takeaways from this. Our speakers this week were helping us to enter the topic by defining what a trigger is. One of them is that a trigger does involve a wound or injury, and we can discuss the different implications of each of these, but that is somehow being touched, and that the trigger act is an act of it being touched. Shelly did a great job of describing how useful it can be just to recognize this fact, because we do know intuitively something about how to work both with wounds and injuries and we can discuss this difference. The second perspective on this, that Zindel added in, was that triggers involve instantaneous appraisals and automatic reactions. That s another important dimension of this. He described it very well: the appraisal of danger is instantaneous; it really bypasses conscious reflection or consideration; and the reaction is often instantaneous, whether it be anger or withdrawal or even dissociation. He wisely suggested that we need mindfulness and self-kindness to help here, to allow us to slow down the chain of events that go into the appraisal, into the interpretation of the situation, and allow us to take a breath before automatically reacting. As we go forward and examine this topic, it might be useful to keep in mind, This is a general framework, that triggers describe instantaneous appraisals and automatic reactions to wounds or injuries being touched, then dig into some of the various ways that we might work with those phenomena. The Key to Helping Clients Manage Their Response to Their Triggers Dr. Buczynski: Shelly Harrell said that practices like self-compassion and empathy can help soothe wounds that are beneath someone s trigger responses. Can you share anything that researchers have found about the use and effectiveness of practices like these for dealing with triggers? Dr. McGonigal: Yes. A lot of people who work in the area of self-compassion or mindful self-compassion are familiar with the idea of using self-compassion in response to being emotionally triggered or whatever the pain or the stress is.

5 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 5 You re already upset and you ve been triggered, and now you re going to roll out a self-compassionate response: words, touch, actions or whatever your practice is, in order to soothe what has arisen because you ve been triggered. People who have higher levels of self-compassion respond differently to things that can be triggering. [ ] Their radar is tuned a little bit differently. I wanted to offer another perspective: to really think about selfcompassion as a resource that you cultivate through practices and through reflections and through whatever/however it is that you re framing it, so that it s there for you. The science says that people who have higher levels of selfcompassion respond differently to the sorts of things that can be triggering. For example, people who have high levels of self-compassion have lower levels of threat bias, which is really interesting. So they re less likely to view things that are ambiguous or mildly negative as highly threatening. Their radar is tuned a little bit differently. When we talk about being triggered, where something is able to touch that wound and set off an automatic reaction, threat bias is a really relevant metric to think about. In particular the element of common humanity of all self-compassion is that element of common humanity feeling like We all suffer sometimes and I m not alone in this. That s the element of self-compassion that most reduces threat bias. We also know that self-compassion can enhance recovery from stressful experiences, so even if you get triggered and you have that automatic reaction, people with high levels of self-compassion are better able to rebound from it, make some sense, maybe even make some reparations if they did something that was harmful to themselves or others in that moment. We also know that self-compassion increases heart-rate variability, both baseline and in response to threat and to emotional triggers. You could think of that as being another reason to cultivate this mindset of selfcompassion, because it puts you in a different physiology so that it s a little bit more difficult to be triggered in the way that is most destructive, even though of course you re still going to have emotional responses to things that bring up past memories or old patterns. Dr. Siegel: Kelly, you d have to instantaneously sift through many, many research studies to answer this, but is your overall impression that secure attachment also would do all of those things that you just described? Dr. McGonigal: Secure attachment definitely helps with heart-rate variability and threat bias. Yes, it would. But the trick is it can be harder to construct the secure attachment depending on your history of selfcompassion. It s all part. You re exactly right. A study was just published recently that showed that getting a dog can improve self-compassion; we know that it can improve attachment too. Everyone should just get a dog. That s going to be my mantra to the world. Dr. Buczynski: But not a cat? Dr. McGonigal: There s not a lot of research on it. I will tell you, from a psychologist s point of view, dogs provide unconditional love; cats teach you how to provide unconditional love. It s a very different psychology. If you want to know what it s like to love, get a cat. If you want to know what it s like to be loved, get a dog.

6 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 6 Dr. Siegel: One clearly could benefit from having one of each. Dr. McGonigal: Yes. My lesson in life is to learn how to love creatures who will not unconditionally love me back. Dr. Buczynski: I m afraid you re right on that. I ve never heard it put that way but I m afraid you re right. Two Dangers When Working with a Client s Emotional Triggers Dr. Buczynski: Shelly Harrell talked about guiding clients to make adjustments in their lives that will allow space for their wounds to heal. The way she put it, we can help clients make choices that Honor the wound in its state of healing. Can you talk about how you would help a client do this in the way that Shelly suggested, without it turning into an unhealthy avoidance strategy? Dr. Siegel: Yes. This is a critical question and it really comes back to the conceptualization that Kelly was bringing up before of do we think of this as an injury requiring rehabilitation, or a wound requiring protection? Shelly clearly laid out two dangers. One was that if we try too much to avoid triggers, we become like an agoraphobic person; our life just becomes narrower and narrower and narrower and that s probably not optimal. Then again, forcing ourselves and here, forcing is the critical word rather than, through kindness, gently inviting ourselves, to face the thing that triggers us also can just be retraumatizing. If we try too much to avoid triggers, we become like an agoraphobic person. [ ] Then again, forcing ourselves to face the thing that triggers us can also just be retraumatizing. Do we think of this as an injury requiring rehabilitation, or a wound requiring protection? So it brings us back to this idea that however we work with it, with the trigger, it has to be in the zone of tolerance, the green zone, the zone of proximal development however we wind up thinking about it: what we can tolerate without being retraumatized. But then, whether we think about it as a raw wound or having scar tissue, or a wound with scar tissue, or a wound that s scabbed over, or whether we think of this as an injury that requires rehabilitation is going to create different approaches to this. The wound in the sense of the scraped knee probably applies in the very short run, until a person has a sense of safety in the world. You just want to bandage it; you just want to provide safety; you don t want to stimulate it. But once a person does have some safety, then it s going to be more like what Kelly was saying about rehabilitation. Or even, to carry the wound metaphor forward, after we have surgery, they used to have you lie around until you felt all peachy and then start moving. Now it s, Oh, you ve just had a major surgery; let s get up and walk up and down the hospital corridors. People are very much encouraged to challenge their fear of movement and to move into their pain in order to stay functional.

7 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 7 But by the same token, we re advised in the hospital, But for the next six weeks/eight weeks/whatever, I don t want you lifting more than this amount of weight, I don t want you doing aerobics I want you to stay within this range. These are apt metaphors for thinking about how to work with this psychologically: that yes, once we feel safe, we do want to treat it like an injury or a surgical wound that requires rehabilitation now, but we want to make sure not to overdo it. Just the way a lot of discernment goes into figuring out how much to do after surgery, a lot of discernment goes into how much to do and work with the psychological things: taking into account people s attachment histories, people s natural level of self-compassion and capacity to soothe themselves; taking into account the strength of the therapy relationship, the strength of our capacity to be held in other relationships. Not to mention the same way as in surgery our overall health, our general physical stamina, our history of healing in the past. So there are many, many considerations that go into the pacing of this. That s really the critical contribution of the therapist: to help figure that out collaboratively with the client how to proceed. Dr. McGonigal: So many interesting metaphors around this. It s making me think about how also we know that when you re healing an injury or when you re trying to benefit from exercise, you need inflammation. If you take drugs that are anti-inflammatory, it actually gets in the way of both healing and of growing stronger, benefiting from physical exercise. That relationship to What if you didn t choose to get triggered but you were triggered, and now you re really distressed what do you do with that distress? Do you immediately shut it down as a way to process it so that it can be part of the healing process? It s fascinating how many parallels there are to the body and the mind. Dr. Buczynski: Kelly, follow up on that a little bit. What is the role of inflammation in the sense that you need inflammation, to heal? Dr. McGonigal: It ignites the healing process of the body. It increases blood flow. When it s as a result of exercise, it seems to help the muscle fibers and the blood vessels reshape themselves to better support doing the movement next time. Inflammation is part of how the body both heals wounds that have happened and changes itself in a way to prepare for whatever infection or next movement or challenge is. It s not actually exactly the same inflammatory process; it s a little bit different depending on whether you re healing or whether you re benefitting from exercise. But that inflammation in general is an interesting metaphor for the emotions that we feel when we ve been challenged or harmed in some way. Probably almost any technique that is aimed at getting rid of those feelings is going to have an equivalent effect to the understandable but ultimately harmful approach to try to get rid of inflammation when you re healing or trying to strengthen yourself. Dr. Siegel: This is a little bit of a hornets nest to discuss, but the whole movement about trigger warnings on college campuses is extremely germane to this. The question is, Okay, are we preventing wounds from healing, opening up wounds that need to heal, or are we robbing people of the opportunity to work with, have some inflammation but also be able to develop strength and flexibility out of this? That s certainly a wide-open debate at this point.

8 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 8 Dr. Buczynski: Right. The idea of getting rid of anything that would trigger someone is there an element of coddling that s not necessarily healthy for growth? Dr. Siegel: Right. Dissecting the Difference Between Reporting and Emoting Feelings Dr. Buczynski: Kelly; Terry Real talked about the difference between reporting a feeling and emoting a feeling. Can you talk a little bit about how and why those two processes are different? Dr. McGonigal: Yes. One is about communication and the other is about infection. Let s say the pain that you re feeling or the feeling that you re feeling is that somebody just plunged a knife into your heart. One way you could communicate it is, Look, there s a knife in my heart and let me tell you about what I m feeling and how much it hurts, and maybe you can help me with this. That s the reporting of feeling. But the emoting of feeling is like I take that knife out and I m like, Look there s a knife in my heart. This is what it feels like to have a knife plunge into your heart! and I plunge it into yours. Now I ve vented what I m feeling, and you re going to really understand what I m feeling because I ve now given it to you. I ve emoted it. We know that that almost always backfires because now that person has a knife in their heart and their first priority is going to be, Why is there a knife in my heart? Why did you put a knife in my heart? Often, people emote the feeling both to make themselves feel better they think it ll make them feel better; it doesn t always. I also think that they are trying to communicate and they feel like enacting it boldly is the best way to communicate it. But we know from compassion research and empathy research that if you want to be able to respond to somebody else s suffering or emotions skillfully, you need a taste of it that s like a pale shadow rather than a full immersion. You need to have maybe a cognitive understanding of their situation and what they re feeling. You need to share their distress a little bit but not to be overwhelmed by it. If I were trying to work with someone who had a habit of emoting the emotion rather than reporting it, I really think about what the goal is: If you want someone to be able to respond to you with empathy and compassion, what would it mean to allow them to understand without trying to pull them into the full blast of the emotion that you re feeling? Dr. Siegel: Your heart example is memorable and poignant and hits the spot. How to Apply Mindfulness to Coping with Emotional Triggers Dr. Buczynski: Zindel Segal talked about the automatic nature of being triggered and how he uses a mindfulness approach to help clients open up to more choice in their responses. Can you share some mindfulness/a mindfulness practice that might help someone get the kind of distance that Zindel was talking about?

9 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 9 Dr. Siegel: Absolutely although I would say, just as that question s framed, that it s not exactly distance that we re looking for here because actually we have an even greater intimacy with the feeling when we approach it with mindfulness, but we have less automatic reactivity. I d like to make that distinction to what we re going for here with the application of mindfulness. Let me give you an example. There s a client of mine who has had a painfully authoritarian father who s both bossy and narcissistic. Not surprisingly, this client is readily triggered by aggressive men, particularly if there s a narcissistic edge to their aggression, and he immediately feels the need to stand up for himself. While I have asked him to examine this use of language, as he puts it and it s offensive language he says, I ve got to prove I m not a pussy and all the gender issues with that acknowledged. I try to get him to examine, What exactly is happening in this moment? How might we approach it with mindfulness? and I ve gone through this with him on a number of occasions. First, when the aggressive, narcissistic guy bosses him in some way, to simply notice what s happening in the body. We ve discussed this before that if you can notice your bodily reaction, including the angry reaction, feeling the anger and not discharging it into emoting, into stabbing the knife into the other If you notice your bodily one s heart, if you will, just sitting with it for a moment, you actually feel it more vividly. If you just stab the other person, then the thing s reaction, you actually feel been discharged and you don t actually get to feel it. it more vividly. We start with just feeling it, and feeling it in the body, and then notice the associations. This is not strictly something that you get from Buddhist traditions around mindfulness practice, but certainly their application in modern psychotherapy is, Okay, what does this feeling remind you of? When else have you felt this feeling? Didn t take long: Oh. I m with my father here. Then notice what other feelings may be associated with it. In this case it s tuning in to the feeling of being small, of being vulnerable, of having your self-esteem collapse, of feeling like I m not a real man and all of this kind of stuff. Then practice staying with that hurt what Marsha Linehan would call distress tolerance skills. You first might practice by holding an ice cube, or feeling an itch and not scratching it, but then just staying with that bodily sensation and trusting that it won t last forever. Then, finally, generating some kind of self-soothing or self-compassion and empathy for the fact that of course this hurts; this hurts all of us when we re in situations like this. Of course it was so painful to feel this repeatedly as a kid; no wonder it hurts so much to feel it now. Then taking the time to breathe and be with this whole rich soup of responses. So it s not distancing, but it isn t reacting automatically either. It s very much being with the full complexity of it. The interesting thing is, people can learn to do it. This fellow, for example, used to always go through the world getting into fights and stuff because of his automatic reactions. It doesn t happen anymore. He feels the complex ride of it. Dr. Buczynski: Thanks. That s it for us for this week. Now we want to hear from you: how are you going to use what you heard this week in your work with your patients? Please leave a comment below and we ll be back next week.

10 Next Level Practitioner - Emotional Triggers Week 126, Day 5 - Critical Insights - Transcript - pg. 10 Next week we re going to focus on why clients get stuck in patterns of reactivity. That s next week we have a great week coming up there. Thanks for being here. We ll see you next week. Don t forget to leave a comment. Take good care, everyone. Bye-bye.