Do the Next Right Thing

“Alison had an argument once with one of the people from Parkinson’s U.K. about whether you talk about Parkinson’s as a disease or as a condition. Now, in order for her to live a good life on a day-to-day level, she says to herself, ‘I’m not ill. I have a condition, and I’m not ill.'”–Alix Spiegel, Invisibilia

An Unlikely Super Power

The Invisibilia podcast is about the “unseeable forces” that “control human behavior and shape our ideas, beliefs, and assumptions.”

Invisibilia is not about depression or anxiety, but embedded within the tale of “An Unlikely Superpower,” an olfactory sense so sharp that it can actually smell disease, we’re introduced to a woman with a simple, effective strategy for addressing depression, anxiety, or almost any other condition. 

Here’s a lightly edited version of her story.      

Diagnosis and Denial  

Ten years ago, when Alison Williams was 63, she went on a walk with her husband in the snow. His footprints were clear, and her footprints each had a scuff mark behind them. She put it down to her boots not fitting.

But then she noticed that her speech was getting softer. And on one occasion, she became very confused about where she was. She went to the doctor who said it was Parkinson’s. 

Alison said, “I want a second opinion.”  

Then she found a large bucket of sand to stick her head in. For more than a year after the appointment, she refused to engage with her Parkinson’s. She took the medication her neurologist gave her but otherwise didn’t speak of the disease and tried to avoid people who did.

“I Am the Story I Tell Myself About Myself 

She didn’t really want to know what her future might hold. She firmly believes that words cast spells, that “I am the story I tell myself about myself.” So she’s very careful about what story she tells. 

Alison worried that if she focused too much on what was coming, her life would inevitably take on the shape of her worst fears. 

Alison’s mother had rheumatoid arthritis. She had a small, electric buggy that she drove around the streets in because she couldn’t walk properly. And emotionally and mentally, when Alison got her diagnosis, she put herself into that little electric buggy and emotionally and mentally drove herself around in it.

As time passed, everything about Alison got slower and less fluid.

An Actionable Goal

She realized that if she pinned her hopes to a cure, she would just be waiting. And it wouldn’t come, and she would get resentful and disappointed and depressed and be much more likely to fall off her perch quicker. So she pinned her hopes to living a life as well as she could as good as she could every day from one day to the next. She decided she’d had enough of driving around in her metaphorical buggy. She was going to really live her life.

She started taking a whole bunch of classes. Mature Latin Movers was both physically and cognitively demanding. Every week they had to remember a routine. She added another dance class, then leaned more heavily into her practice of tai chi with weapons. She got a personal trainer and took up taiko drumming.

And instead of her symptoms getting worse, she experienced steady improvement.

Focus on Process Instead of Outcome

Alison’s practical advice about living with conditions (whether those conditions are Parkinson’s or climate change or the potential death of democracy, whatever your particular flavor of terror happens to be) is not to focus so much on the outcome, but instead concentrate on the process. The question to ask was not, where will this end, but what is the next right thing to do? What time tonight does Mature Latin Movers start? Can I go to taiko drumming on Monday?

An Unknowable Future

“Do The Next Right Thing” feels like the kind of slogan that would look good embroidered on a tea cozy or T-shirt, but does it rise to the challenge of the actual world we seem to be living in, where every time you turn on the news, there are ten different stories that make you feel like there really is nothing you can do?

Alison wouldn’t accept this. Her bad future had already arrived, but she still managed to move forward without letting the outcome of her disease define her everyday life. She wasn’t saying it was easy. She was just saying it was a viable strategy.

Doing the next right thing might make a difference. It might not make a difference. The answer to that is in the future, and the future is impossible to know.

Ten Minute Exercise

In the spirit of this story, I’m going to conduct a ten minute experiment that might or might not ease anxiety by producing a greater sense of agency.

  1. Choose a circumstance beyond your control that you’re describing to yourself in negative language.
    Examples: I have a disease.
    I am quarantined.
  2. Change the description of the circumstance to neutralize the language.
    Examples: I am living with a condition.
    I am practicing physical distancing.
  3. Choose an actionable goal that you can achieve under the current circumstance.
    Examples: I am going to participate in physical activities that exercise motor function.
    I am going to participate in social interactions that do not require physical proximity.
  4. Focus on the action instead of outcome.
    Examples:
    Action Focus: I signed up for a six-week taiko drumming class.
    Outcome Focus: I will conduct six weeks of research choosing a form of physical activity optimal for exercising motor skills.
    Action Focus: I’m trying new Zoom group meetups this week.
    Outcome Focus: I will study the effects of online interaction proven to help one feel connected.
  5. Review and repeat.
    What new information did I gain from the action?
    What’s the next right circumstance to reinterpret?
    What’s the next right goal I can act on?
    What’s the next right action to try?

Four Tendencies Toward COVID-19

“Knowing our Tendency can help us set up situations in the ways that make it more likely that we’ll achieve our aims. We can make better decisions, meet deadlines, meet our promises to ourselves, suffer less stress, and engage more deeply with others.” – Gretchen Rubin

COVID-19 Anxiety

Since we’re living in the midst of a global pandemic, there was never a question whether I would write about COVID-19 anxiety, but how I would write about it.

The answer: with a little help from Gretchen Rubin, who is “known for her ability to distill and convey complex ideas with humor and clarity in a way that’s accessible to a wide audience.”

I laughed more while reading her book The Four Tendencies than at any comedy series I’ve seen in recent years. Its insights into human nature are so spot on.  

She writes, “We all face two kinds of expectations—outer expectations (meet work deadlines, answer a request from a friend) and inner expectations (keep a New Year’s resolution, start meditating). Our response to expectations determines our “Tendency”—that is, whether we fit into the category of Upholder, Questioner, Obliger, or Rebel.”

In this time of worldwide uncertainty, let’s see if we can use it to “suffer less stress, and engage more deeply with others.”

If you’re not certain of your tendency, click here to take the quiz

Obligers Need Outer Accountability 

Obligers meet outer expectations (work deadlines, answering a request from a friend) but are challenged by inner expectations (keeping a New Year’s resolution, starting a meditation practice).

They are likely to do well with all of the outer expectations recommended by the Centers for Disease Control and Prevention.

The challenge obligers most likely face is the inner expectation of managing anxiety and stress.

I spoke to an obliger friend on the phone yesterday. We were scheduled to meet in a city park where we could enjoy some Vitamin D producing sunshine, get some exercise, and have a conversation while maintaining the appropriate social distancing. He was too anxious to leave his apartment.  

I disclosed that I’m a member of the high-risk group because I have asthma, but I feel it’s more important than ever to remain physically and emotionally healthy. Outdoor exercise is ideal for that. 

We laughed a lot during the phone conversation, also good for boosting the immune system, and agreed to touch base next week.

Fellow Obligers, Upholders, Questioners and Rebels can all be accountability partners to help Obligers manage stress.

Upholders Need to Know the Rules

Upholders meet both outer expectations and inner expectations. To the extent that they have clear rules about what to do, (like the CDC instructions above) they’ll follow them. 

The challenge upholders most likely face is disruption to routine.

On Monday, March 16, my partner and I had tickets for an Oregon Symphony concert. On Thursday, March 12, I learned that all March Oregon Symphony concerts had been canceled.

As a writer, I’m used to scrapping my first idea when it doesn’t pan out, so I found a live performance of the piece by the featured artists from the canceled symphony concert on YouTube. We heard the same music, by the same performers, in concert, via video. 

Upholders sometimes have trouble thinking outside the box when schedules change, but Obligers, Questioners, and Rebels, who are more used to changing plans, can offer alternate solutions.  

Questioners Need Reasons

Questioners meet inner expectations and outer expectations only if they make sense. I am a Questioner.

Before I read Mark Manson’s article “Things Are Not As They Seem,” I wasn’t sure whether the COVID-19 scare was as big a deal as the media made it out to be or just a really bad flu.

His blog post explained that it was both. 

On a personal level, I should be extra vigilant and follow guidelines so as not to get or spread infection. On a societal level, the pandemic could overwhelm the healthcare system and create a worldwide economic depression.  

Since the media tends to focus on the sensational, they are exacerbating the problem by fueling the exact anxiety and stress that weakens our immune system. 

It made sense for me to follow social distancing recommendations, wash my hands, avoid touching my face, and continue exercising, meditating and other healthy practices, but not to dwell on the larger societal issues I could not control.

The information I’d share with my fellow Questioners is that our individual risk is low if we follow the guidelines, but our social risks are high if we don’t.

Rebels Need Freedom to Choose

Rebels don’t meet inner or outer expectations.

While out walking, I happened upon a Rebel who was speaking to a neighbor about how this whole face touching thing was nonsense. He demonstrated his lack of fear by rubbing his hands over his face. The neighbor, whose wife was in a high risk group, looked horrified.

I spoke to the Rebel from a safe social distance, but didn’t mention that the reason for not touching your face with unwashed hands is that it’s easiest for coronavirus to enter the respiratory system through the eyes, nose, or mouth. That would have worked for a fellow Questioner, but not for a Rebel.

Gretchen Rubin suggests the way to persuade a rebel is to appeal to their values of freedom and self identity and to offer information, consequences, and choice.

To appeal to freedom, I might have tried:  

“You know, if we don’t social distance, wash our hands, and avoid touching our faces, the next step is likely to be martial law. How might we avoid that?”

Rebels also hate being told what they can’t do. “I’ll bet that you can’t avoid touching your face without washing your hands or remember to cover your coughs for 24 hours, let alone fifteen days.”

Rebels also love choice. “The only three ways I can think of to deal with possibly contaminated surfaces are hand sanitizer, hand washing, and using disposable tissues or towels to touch things with. Can you think of other ways to tackle that problem?”

Twenty Second Exercise

The Ten Percent Happier with Dan Harris podcast posted an episode entitled “How to Handle Coronavirus Anxiety.” 

Two 20-second practices mentioned on that episode, can help us stay safer. 

Washing Our Hands for Twenty Seconds:

To time your hand washing, try reciting these friendly sentences based on the World Health Organization’s definition of mental health: 

May we be well in body, thoughts, and feelings.

May we face and cope with life’s inevitable stresses.

May we work productively to benefit ourselves and others. 

May our actions contribute to our community.

Reason it works: Upholders will follow the rule. Obligers will do it for others. Questioners might appreciate that studies have shown metta (friendliness) practice makes us less anxious. Rebels: give it a try or come up with your own twenty-second habit-forming tool.

Twenty-Second Mindfulness of Facial Sensations

Notice how often you put your hand to your face. Bring awareness to the sensation that immediately precedes it.

When you notice an itch, turn your attention to the sensation for 20 seconds, or as long as it lasts, with genuine curiosity.

Use the time to reflect on whether you’ve washed your hands since last touching a possibly contagious surface. 

Reason it works: Upholders will follow the rule. Obligers will take care of themselves in order to protect their loved ones. Questioners will appreciate the reason for the pause. Rebels might enjoy the freedom this exercise gives them from a life long habit.

Bonus Materials:

How to Do Social Distancing Correctly (8 minutes)

How to Protect Yourself Against COVID-19 (1 minute)

Moving through Depression

exercise-antidepressant

When I left my job in advertising, three depressing things happened. My health insurance premiums skyrocketed because I was a suicide risk. My new insurance excluded depression treatment as a pre-existing condition. The antidepressant I had been taking had disrupted my brain’s natural ability to experience joy and control anxiety.

No longer able to afford the drug, I went off it cold turkey. After a couple of weeks in withdrawal, I found myself banging my head against the wall. None of my thoughts or feelings were familiar. I felt like I had lost my mind. 

Waist Management

I had put on 30 pounds, and several waist sizes, since starting the medication. My partner was feeling her clothes were becoming a bit snug herself, so she asked me if I’d join her in taking regular walks around the neighborhood. 

After six months or so of this, I shed 25 pounds of that drug-related weight gain.

I’ve heard all my life that combining a sensible diet with exercise was the way to stay “in shape,” but I always thought of physical and mental health as two separate things. I could see the effects of exercise on my body. I had no idea what it was doing to my brain.  

The Off-Label Antidepressant

At the time, there were good reasons why my doctor didn’t recommend exercise as an off-label antidepressant. The tools of neuroscience were still in their infancy. Scientists hadn’t yet thought to attach electrodes to the brains of stationary meditating monks, let alone athletes in motion.

But, in her new book, The Joy of Movement, Kelly McGonigal examines what movement does to the brain through the lenses of neuroscience, psychology, anthropology, evolutionary biology, memoirs, ethnography, and philosophy. Her research helps explain the mysterious effect that exercise was having on my mind.  

The “Don’t Worry, Be Happy” Chemical 

Though it’s commonly known as “runner’s high,” the increase of endocannabinoids in the brain (and no, the name’s similarity to cannabis is not coincidental), is a side effect of any moderately challenging physical activity sustained for twenty minutes or so.

When I selected a meditation group, I chose a Zen group that was a thirty minute walk from my house over an Insight group (the type of meditation I actually practice) that was twenty minutes away by car. I knew about the research that said meditation helps regulate the stress response. I wasn’t consciously aware that the walk to and from meditation did the same. Driving to meditation is sedentary and traffic makes it potentially stressful.

It makes no difference whether the walk improves my meditation or the meditation improves my walk. I’m happy to learn that the combination therapy naturally achieves the anti-anxiety effect that antidepressants do artificially.  

Capacity for Joy

I learned that the withdrawal symptoms I experienced when coming off my antidepressant may have been responding as the brains of opioid addicts do.

When we take a chemical to flood our brain’s reward system with dopamine, it tries to restore balance and protect us by shrinking our dopamine receptors. The more pleasure we try to force on it, the less it accepts.

Since physical activity has so long been linked to our survival, the brain has evolved to reward it by increasing our dopamine or pleasure receptors. It literally increases our capacity to experience pleasure. This may explain why on days when I venture out in foul weather to get my daily steps in, the only people I encounter are runners. We addicts will go through a lot in pursuit of our high. 

Quieting and Stilling the Mind

It’s no secret among writers that the antidote to writer’s block is to go for a walk or a jog. I do it all the time when I get stuck. My preferred route goes through Wilshire Park, which features a growth of older trees and a newly restored section  of native plants. At some point during almost every hike we take in nearby Forest Park, my partner refers to that natural setting as “tonic for the soul.” 

McGonigal describes it as soft fascination. There’s simply more novel sensory input and variation in a natural setting than there is facing a computer display. When the brain has more environmental inputs to process, the language center of the brain calms down. Whatever thoughts were chasing each other around like a hamster on a wheel start to settle. What’s truly important often rises to the top.

In terms of depression, moving through a natural environment both reduces rumination and improves concentration.   

All Together Now

In April I started walking to a weekly free Tai Chi/Qigong practice session in the basement of a local church. The round trip just about tops off my daily 10,000 step goal, and ever since writing about moving in sync with others, I was eager to experience the benefits first hand.  

Apparently the mechanism for this benefit is endorphins, which make us feel good, help us bond with others, and actually increase our tolerance for pain. When I mentioned this side effect of Tai Chi to a newcomer, I accidentally said that it affected the social security of the brain (instead of social circuitry).

I felt socially secure enough to acknowledge that it was a misstatement but not a mistake.    

Depression-wise this sense of belonging can greatly impact our feeling of self-worth. 

The Weight of Life

The last time I was close to suicidal was when I went off my antidepressant.

Proprioception is our sense of how our body moves through space. For me, the relative “lightness” after I’d dropped my first 25 pounds was also reflected in my mood.    

McGonigal writes, “Physical accomplishments change how you think about yourself and what you are capable of, and the effect should not be underestimated. One woman I spoke with shared a story about when she was in her early 20s and found herself severely depressed, with a plan to take her own life. The day she intended to go through with it, she went to the gym for one last workout. She deadlifted 185 pounds, a personal best. When she put the bar down, she realized that she didn’t want to die. Instead, she remembers, ‘I wanted to see how strong I could become.’ Five years later, she can now deadlift 300 pounds.”

10 Minute Exercise

I first encountered Thich Nhat Hanh’s 10 Mindful Movements as part of the Palouse Mindfulness-Based Stress Reduction course.

Every morning, I go into my back yard (a somewhat natural setting) and do four repetitions of each movement for about a ten minute routine. It helps me focus, wake-up and get centered for my day. 

I haven’t shaved my head, I don’t wear robes, and I don’t think of this as a spiritual practice, other than aligning my breathing with the movement. So, don’t let the folks in the shaved heads and robes scare you away. 

Move along with the 10 Mindful Movements.

If you’re more comfortable with the weird animal head (and tail), you can try this version instead. 

Faith, Doubt, and Small Change

Any small change we make to treat depression has to be an act of faith because built into depression is doubt in its cure.

change
Faith Without Doubt

Before a Qigong/Tai Chi practice session last Thursday, the instructor asked me if I had other spiritual practices. I mentioned that I meditate daily and participate in a mindfulness discussion group on Saturday mornings. 

He said that he had been reading an article about one of the world’s major religious figures and was trying to understand the difference between faith and faith without doubt.

Though I couldn’t put the difference into words on the spot, it’s something that the authors of the original mindfulness manual had addressed as well.

The next day I took a shot at an answer. The instructor had done enough research on the work of Roger Jahnke to muster the faith he needed to give Integral Qigong and Tai Chi a try. As he practiced it, he experienced the benefits of the movements for himself. By the time he decided to train so that he could teach the technique, he had arrived at faith without doubt.

Doubt Without Faith

In The Upward Spiral: Using Neuroscience to Reverse the Course of Depression, One Small Change at a Time, Alex Korb writes, “The big problem with the downward spiral of depression is that it doesn’t just get you down, it keeps you down. All the life changes that could help your depression just seem too difficult. Exercise would help, but you don’t feel like exercising. Getting a good night’s sleep would help, but you’ve got insomnia. Doing something fun with friends would help, but nothing seems fun, and you don’t feel like bothering people.”

I’ve written about my own seasonal tendency toward a downward spiral in “Depression’s Early Warning System” and “Help to Make it Through the Night.” My sleep cycle gets out of whack, I perceive simple exercise to be much more daunting than it actually is, and I’m less inclined to socialize.

Habit and Neuroscience

Two things keep me doing what’s good for me in the absence of tangible reward. Habit and neuroscience. I’ve made a conscious effort to form habits around sleep, taking walks, and scheduling social connection because neuroscience tells me how and why they’re so beneficial.   

Korb’s neuroscience does a good job calling out the culprits of depression. “The prefrontal cortex worries too much, and the emotional limbic system is too reactive. The insula makes things feel worse, and the anterior cingulate isn’t helping by focusing on the negative. On top of that, the prefrontal cortex has a hard time inhibiting the bad habits of the dorsal striatum and nucleus accumbens. Depression is so hard to overcome because each circuit pulls the others downward.” 

Ironically, it’s understanding why what I’m doing isn’t making me feel better that helps me stick with it…until I feel better.  

The Upward Spiral

Korb writes, “It turns out that positive life changes actually cause positive neural changes—in the brain’s electrical activity, its chemical composition, even its ability to produce new neurons. These brain changes alter the tuning of your brain’s circuitry and lead to further positive life changes. For example, exercise changes the electrical activity in your brain during sleep, which then reduces anxiety, improves mood, and gives you more energy to exercise. Similarly, expressing gratitude activates serotonin production, which improves your mood and allows you to overcome bad habits, giving you more to be grateful for. Any tiny change can be just the push your brain needs to start spiraling upward.”

Ten Minute Exercise

In the Upward Spiral section of the book, Korb offers enough scientific information on the effects of each small change (or well-being practice) to give you faith in trying it.

Since most can be achieved with little effort, read through these small changes and decide which you’d like to try first.

Choose a Small Change  

The circuits that allow us to plan and solve problems when we’re not depressed are the same ones that lead to anxiety and worry when we are. The simple act of making a decision, any decision, makes things begin to feel more manageable.

None of these small changes are silver bullets for depression, so there’s no need to worry about choosing the perfect small change to make. 

Soak Up Some Sun 

Getting at least a few minutes of mid-day sunshine helps boost the production of serotonin, which improves willpower, motivation, and mood. It also improves the release of melatonin, which helps regulate your circadian rhythm and improves sleep, which improves just about everything.   

When I mentioned my seasonal (winter) malaise to a friend, he loaned me his light therapy lamp, and the tiny amount of faith I had in it based on hearsay from folks who use them overrode the doubt I had in trying it. I needed only enough willpower to carry it home, set it up, and plug it in. I noticed enough improvement in my energy and sleep cycle to give me faith to buy my own. Stay tuned.

Move Your Body

I have faith without doubt that moving my body is my most effective tool for battling depression. It helps with energy levels, makes decision making easier, reduces stress, and I’ll be devoting a separate post to the laundry list of other well-being benefits soon.  

Notice that I didn’t use the word exercise. I do a few minutes of push-ups, sit-ups, and stretches every morning that I consider exercise, but, perhaps based on how much my gym clothes stank when I’d forget to bring them home to launder on weekends, I still think of exercise as a duty rather than a pleasure. 

By contrast, for most of the year, I enjoy my daily outdoor walks, which is a way to get exercise without thinking of it as exercise. Only when it’s cold and rainy do I think of walking as exercise. 

Over the last several months, I’ve also added Qigong/Tai Chi to move different parts of my body than I move during my walks.

Sleep

I wrote about the importance of (and tips for) sleeping better in “7 Shocking Links Between Sleep and Depression.” 

Breathe

This one is so basic that you don’t have to decide to do it. But, if you decide to breathe to alter energy and mood, remember that breathing slowly and lengthening exhales reduces anxiety. Sharper inhales and faster breathing increase energy.

Biofeedback

I had one of my biggest a-ha/duh moments when Korb explained that while we might need a biofeedback device to understand our respiration, heart-rate, etc. our brain doesn’t. Monitoring these things is literally what our brain does for a living. A-ha! Duh!

Given that, here are some biofeedback techniques he recommends.  

Splashing cold water on your face quickly calms you down. 

Want to improve your mood? Try singing along with your favorite playlist, smiling, or laughing. The brain doesn’t distinguish between real and fake laughter. (I guess that explains how the laugh tracks on old sitcoms tricked me into thinking that the shows were actually funny.)

Wearing sunglasses can prevent squinting, which keeps our brow from furrowing, which tricks our brain into thinking we’re slightly upset. (I suspect that this has to be balanced with getting enough sunlight.) Other tips include relaxing your jaw if you store tension there, or clenching and deliberately relaxing muscles.

Spend Time with Others

Though I can and do meditate and practice Qigong/Tai Chi on my own, there’s a benefit to spending time with other people. This reduces pain, anxiety, and stress, and improves mood.

Conversations with friends and family are great, but if you’re really not up for it, scheduling time to engage in a shared weekly activity with others is small change. 

If all you’re up for is surfing the web or drinking a cup of coffee, doing it at a library or coffee shop can be beneficial.  

Gratitude

According to Korb, one of the best things about gratitude is that the more hopeless you feel, the better it works. It also greases those social dopamine circuits to make interactions with others more pleasant.

 My two favorite techniques for working with gratitude are three good things and finding silver linings.

Other Small Change

Developing positive habits or breaking negative ones is also helpful, but I’ll save some habit tips and tricks for another post.

And seeing a therapist can help you pinpoint areas to work and a wider range of therapies when the small changes aren’t enough.    

Bonus Exercise:

Alex Korb’s TedX Talk “Simple Steps for Strengthening Your Brain’s Circuits of Resilience” clocks in at under 10 minutes.