Shyness Plus Rejection Plus Anger = School Shooters? News from APA Conference

Ah the joy of summer conferences! American Psychological Association had their annual conference in my lovely city of San Francisco this weekend, and one of the more interesting studies discussed was a study of kids who shoot other kids in school in mass murder attacks. They looked at eight teen shooters and rated them on what they call “cynical shyness.” Cynical shyness is a subset of normal shyness that involves anger and hostility towards others, especially when they are rejected.

Bernardo Carducci, lead author of the study and director of the Shyness Research Institute at Indiana University Southeast in New Albany explained:

“In addition to feelings of anxiety about social situations, cynically shy people, who are a small subclass of shy people, also have feelings of anger and hostility toward others and that comes from this sense of disconnect. Shyness has more in common with extroversion than with introversion. Shy people truly want to be with others, so they make the effort, but when they are rejected or ostracized, they disconnect. Once you disconnect, it’s very easy to start being angry and hate other people. It’s you against them, and they become what I call a cult of one. Once you start thinking ‘it’s me versus them,’ then it becomes easy to start hurting these people.”

Rating the eight teen shooters, they found that four of them had scores of 10 (on a 10 point scale) of cynical shyness, three had scores of 8, and one had a score of 6. Both of the Columbine shooters had scores of 10.

Now it should be pointed out that shyness per se is not dangerous. It is only this angry, cynical form of shyness, mainly found in teenage boys, that may be associated with dangerousness. And one weakness of the study is that they only looked at shooters. There may be many teens who score high on cynical shyness that do not escalate into violence. In fact this would be a good study, to identify what allows other cynically shy students NOT to become dangerous.

But shyness in pre-teens and adolescents is a serious disorder, as it can create intense misery in young people. Shy people desperately want to connect, they just don’t know how. Classes and workshops and group therapy approaches may be helpful in helping teens overcome this serious disorder.

Copyright 2007  The Psychology Lounge ™, All rights reserved

Getting Things Done: The Inner Game

How We Don’t Get Things Done

Today I am going to write about a topic that simultaneously seems ridiculously simple and yet is deeply complex. This isn’t based on any article or book, only my own musings, so you have only me to blame if this makes no sense. The question is: “Why can’t we accomplish our goals? Why can’t we get things done that we tell ourselves we want to do? Why is getting things done so hard?”

After all, think about it this way. If you want to raise your right hand and touch your chin, you will have no difficulty in doing so. You think, “Move your right hand to your chin,” and your hand moves completely predictably and reliably. You don’t forget to do it. You don’t struggle to do it. It is easy, almost effortless.

There are so many other examples where we get things done without apparent effort. You go to a restaurant, order food, and eat. No struggle, no difficulty. You don’t have to make a list of what to do. You don’t make a list; “1. Order food, 2. Eat food, 3. Pay bill.” You don’t check off anything. It all happens without drama or hassle.

So why is it so hard to do things like paying bills, cleaning up the kitchen, or doing financial planning? Why is it so hard to exercise? Who exactly is running the show? Which self says, “You should exercise.” Which self refuses to do so? How many selves do we have?

This is a deep mystery of the self. It’s almost like we have multiple warring selves, some of whom want to accomplish tasks and be productive citizens and some of whom want to sleep all day, or go to the beach, or eat crackers in bed.

How can we make sense of this? I’m going to propose a model for understanding this. It will develop as I write, so hang onto your hats.


WHAT DO WE REALLY WANT?

The first Big Question we need to examine is What Do We Really Want? Perhaps the problem is that we tell ourselves to do many tasks that we really don’t have any interest or intention of doing.

Why would we do this? Mainly because of social pressure, which we internalize. We are told you should clean up, pay bills, exercise, call your mother…and so on, and we end up internalizing these demands. But do we really want to do any of these things?

So when I tell myself, “You should pay the bills now,” do I really want to do this? I would argue that the behavior that follows answers the question. If I immediately sit down and pay the bills, then I wanted to pay them. But if I struggle, avoid, and don’t pay them without a lot of internal mental friction, then the answer is I didn’t want to pay them. I can force myself to do things that I don’t really want to do, but it’s hard, and takes extra time and effort. I want the bills to be paid, but I don’t want to pay them. That’s a common dilemma—we want the outcomes of an action, but we don’t want to do the action itself.

I am reminded of two stories that shed light on this dilemma. The first is a famous Zen story. A young monk visits the old Zen Master, telling the old master that he wishes to study with him to gain enlightenment. He goes on and on about how great it would be to study with the old master. The old Zen master says “walk with me.” They walk up a hillside, through a forest, and then come to a lake. The old Zen master walks out into the lake. Figuring that this is what Zen masters do, the young monk follows him out into the water. Soon the water is up to their necks. Calmly, the old master reaches out, forces the young monk under water, and holds him there with remarkable strength. The young monk struggles, and just when his lungs are bursting, he fights to the surface, and takes a huge breath. He looks with horror at the old Zen master, who simply smiles calmly and says, “Come back when you want enlightenment as much as you wanted that breath of air.”

Clearly we have no difficulty getting things done when we want those things done as much as the monk wanted that breath of air.

The second story is something I learned from a friend of mine who is a large animal veterinarian. I was always curious about the psychology of large animals like horses and cows. Carol worked with those, but also with more exotic beasts like buffalo. One time she mentioned a “buffalo bridle.” I was curious about what kind of bridle could be strong enough to control a buffalo, and asked her about it.

She looked at me with a sly smile, as if to say, “What a city slicker you are!” Then she explained that the buffalo bridle was not a thing, but rather something you know. Falling for it, I asked the obvious question: what do you need to know to control buffalo?

She said, “You only need to know two things.”

“What are they?” I asked.

“The first thing is that you can make a buffalo go anywhere you want…

as long as the buffalo wants to go there.”

“And let me guess the second principle,” I said. “You can keep a buffalo out of anywhere you want…. as long as they don’t want to go there.”

“Exactly!” she said.

So that’s another clue. We are a lot like buffalo. We get lots of things done, mainly the things we want to. And we are really good at not doing the things we don’t want to do.

So there you have it, a simple theory of why we get things done or don’t get things done. The things we get done easily are the things we wanted to do, and the rest is just a bunch of internalized “shoulds” that we never really wanted to do in the first place. In this radical notion there is nothing wrong with our “getting things done” mechanism. We simply have to stop fooling ourselves that we want to get all these things done. Accept our limited ambitions, and be done with it!

But there is a problem with this elegant and simple model. If this model is right, then what do we do? How can we get things done? It wouldn’t really work very well if everyone stopped doing the things they don’t want to do, like paying bills, cleaning the dishes, taking out the garbage, going to meetings, and so on. Unfortunately, sometimes we really need to do the things we don’t particularly want to do, like working at job, for an example.

Yet there is a simple allure to this model. And maybe we can use it to sort out the genuine wants from shoulds in our lives. Here’s an exercise. Take out a piece of paper right now. Make four columns vertically. In the first column list all of the tasks you find hard to get done. You can stop after 10 or so.

Next, label the second column “Want Rating.” In this column I want you to rate the degree to which you want to do each thing. This is your genuine desire to do the task, not the degree to which you think you should do it. Use a 0-10 scale where 10 is intense wanting.

In the next column rate the degree of should that you feel about the task. Again use a 0-10 scale.

Now look over the tasks where the rating for want is low, and should is high. In the last column write down what would happen if you never did the task. What would be the consequences?

This exercise can help sort out the wheat from the chaff, and help us eliminate thankless tasks or at least outsource them. For instance, I hate mowing the lawn, and can’t think of anything I’d rather not do instead. So I pay a gardener to do it. And I hate paying bills, so I don’t. Instead, I have most of my bills automatically deducted from my checking account or Visa card. If we analyzed all of our lives this way, perhaps we could spend more time doing our wants, and less time doing shoulds, and thus find happiness.

But let’s continue on our journey into the land of getting things done. Another question we need to ask is how can we want to do certain tasks? How do we increase our wanting? How do we become like that monk who desperately wants that next breath of air?

A Brief Digression into the Language of Wanting

But before I discuss that I want to take a slight detour through the intellectual forest, and talk about how we figure out what we want and perhaps more important, what we don’t want.

People often talk about doing things in terms of “having to.” “I have to go to work today. I have to take out the garbage, I have to pay the bills, I have to exercise, I have to take the kids to school.” Then there are other things that we don’t use this language about. No one really says, “I have to do the crossword puzzle, or I have to watch TV, or I have to kiss you.” But the truth is that the words “have to” don’t mean what they say. I don’t really have to go to work today. I don’t have to pay the bills. I can let the kids stay home and watch television. I can even let the garbage rot in the pail.

But we choose to do these things, mainly because we don’t want the negative consequences of not doing them. I don’t like the smell of rotting garbage, nor do I like bill collectors or truant officers banging on the door. The reason we don’t use the “have to” formulation for doing crossword puzzles, or watching television is because we enjoy them, and there are no negative consequences for not doing them.

Another difference is between process and outcome. Tasks that are easy are usually fun during the process of doing them, and have a good outcome. So watching a good show on television is fun during the watching, and leads to a satisfying outcome, assuming you are not watching the cliffhanger “24.” But paying bills is a mostly thankless process, and the only outcome is that you are poorer.

Another distinction is that easy tasks lead to some reward in the outcome, while hard tasks often the outcome is simply the lack of any negative outcome. When I pay bills, at the end I am a little poorer, and my creditors richer. All I have accomplished is to avert financial disaster.

So what happens if we change the inner and outer language we use? What happens if instead of saying “I have to _____” we instead say, “I choose to do_____” or even “I choose not to do _____?”

What is interesting is that saying “I choose not to do ____” is very powerful. It forces one to confront one’s actions as a conscious choice, rather than pretending that forces beyond your control are determining your actions.

And sometimes, when we say, “I choose not to do ____” we discover that that is just fine. For instance, my garage is a mess, but this weekend I choose not to clean it up. Instead I will take a bike ride.

Capitalism is to some extent based on altering what people choose to do. Forbes recently had a survey of the highest paying jobs in the United States. Almost all of them were medical jobs. Surgeons, anesthesiologists, dentists, and oral surgeons were all on the list. CEO’s were actually a little lower on the list.

Let’s think about this. We tend to think of these as good jobs. But let’s get real. Surgeons stick their hands inside the bloody guts of sick people. Anesthesiologist watch people sleep and try not to fall asleep themselves. Dentist and oral surgeons poke around people’s smelly mouths with small sharp tools. In order to get people to take on high stress, bloody, and often disgusting jobs, we pay them really well. Imagine if these jobs paid $40,000 a year. No one would do them. Most jobs that pay well require either lots of training, high stress, or great talent, and people are willing to work towards these jobs because they pay well. Salary is one way we get people to want to do things more than they would otherwise want to do them.

I often do a mental experiment with clients. When they are struggling to get something done, I ask them if they could do it if, upon completion, I wrote them a one million dollar check (and the check wouldn’t bounce.) Invariably, they say they would have no problem. So this tells us that one of the challenges of getting things done is that hard tasks have inadequate rewards. Or the rewards are too far off in the future to matter much. If I tell them instead of giving them a million dollars on completion, I will pay them 30 years later, then my offer loses most of its appeal.

How to Alter What We Want

So if my simple model is correct and we fail to accomplish things because we don’t want them enough, how do we change our wanting?

It seems that the key is to understand the basic principles that make us want to do things. Those things we do easily either are pleasant and fun during the actual process of doing them, or they have powerful rewards that follow their completion.

So understanding this we can begin to think about modifying tasks so that we can get them done. The first step is to improve the actual process of doing the task. For many boring, repetitive tasks, the easiest way to do this is to add another activity you do simultaneously. For instance, I usually clean the kitchen while on my headset phone talking with my mom or my brother long distance. This makes the experience almost painless, and I also benefit from staying in touch with people I love.

Or I will watch a baseball or football game on TV while sorting and filing papers. I have a rolling filing cabinet which I roll out into the living room, and this makes filing fairly painless.

Or I will listen to a podcast while grocery shopping.

Almost any task can be improved by adding good music, or an audiobook to the background.

The other strategy for lowering the aversiveness of tasks is time. If instead of trying to do an hour or two of boring paperwork, I instead break it down into 5 or 10 minute pieces, I can tolerate that much more easily. Some tasks are just too annoying to tolerate for very long, so breaking them down into smaller pieces makes good sense.

Another strategy is to change the reward structure. Let’s say you have 4 hours of filing to do. Although your papers will be filed at the end of the day, this is too small a reward to really motivate. You could break it down into 10 minute pieces, but this would mean you’d be still filing in 2050! The best strategy here is to create an artificial reward structure. Establish a reward you get when finished. Maybe you get to buy that Ipod Shuffle ™ you didn’t really need. I like to think in terms of an hourly rate of pay, even for nonwork tasks. I’ve set mine at $30 per hour, so after a four hour task I get to spend $120. Yours might be higher or lower, just be sure it’s high enough so that you are motivated. Pay yourself well for scut work!

This is the end of Part 1. In the next Part I will talk about the perils of prediction, the limitations of memory, and I’ll comment on the official Getting Things Done system.

Copyright 2007 The Psychology Lounge/TPL Productions

The Physiological Mechanism for How Stress Affects the Brain


For those readers curious about the mechanisms by which emotional stress affects brain function, I found an interesting piece of research about the physical mechanisms for how chronic stress can induce brain changes that could lead to cognitive impairment.

Scientists at Salk Institute for Biological Studies subjected mice to mild chronic stress for two weeks. What they found was fascinating. First some background on the physiology of Alzheimer’s disease. As the article explains:

“Alzheimer’s disease is defined by the accumulation of amyloid plaques and neurofibrillary tangles. While plaques accumulate outside of brain cells, tangles litter the inside of neurons. They consist of a modified form of the tau protein, which–in its unmodified form–helps to stabilize the intracellular network of microtubules. In Alzheimer’s disease, as well as various other neurodegenerative conditions, phosphate groups are attached to tau. As a result, tau looses its grip on the microtubules, and starts to collapse into insoluble protein fibers, which ultimately cause cell death.”

So basically, when phosphate attaches the the tau molecules, it causes them to change from helpful molecules to damaging the neurons.

The mice research found that the brain-damaging effects of negative emotions are relayed through the two known corticotropin-releasing factor receptors, CRFR1 and CRFR2, which are part of the body’s central stress mediation system.

So what does this all mean? It suggests that we have to protect our brains from stress, particularly chronic stress. Occasional stress doesn’t cause problems, but daily chronic stress does. The mice only showed permanent brain changes after 2 weeks of daily stress.

So stress management through cognitive behavioral therapy (CBT) or other means is not just a nice comfort option, but may be essential if you want your brain to last. Emotional pain doesn’t just cause emotional damage, it also damages the brain.

Perhaps scientists will be able to develop drugs that change CRF1 and CRF2 levels, but in the meantime, better take up that yoga, meditation, relaxation exercise, or CBT stress management program!

Copyright 2007 The Psychology Lounge/TPL Productions

Your Brain Wants You to Be Mellow: New Evidence Shows Chronic Emotional Stress Can Increase the Risk of Mild Cognitive Impairment in Later Life

So you’ve been putting off getting therapy, even though most of the time you feel anxious and upset? Well, a new study suggests that you may be putting your brain in danger.

Researchers at Rush University Medical Center in Chicago, Illinois, followed more than 1200 men and women who were 65 and older, average age of about 76. At the beginning of the study they made sure that none of them had mild cognitive impairment (MCI), and measured their emotional distress using a simple 6 item scale of neuroticism. Items such as 1) “Are you the type of person whose feelings are easily hurt?”; 2) “Are you the type of person who is rather nervous?”; and 3) “Are you the type of person who is a worrier?” make up this scale.

At the beginning of the study the average score was about 15 on this emotional distress scale. Patients were followed up for up to 12 years. About 38% developed MCI during the study. Those in the top 10% of emotional distress at the beginning of the study were about 40% more likely to develop MCI.

What is interesting is this relationship held even after researchers statistically removed the effects of depressive symptoms at the beginning of the study. So the results were from emotional distress, not from depression. The risk for MCI increased by 2% for every 1 point increase on the distress scale. This is a pretty strong correlation.

So what does this mean? I think what it means is that chronic emotional upset is hard on the brain. It makes sense, since emotional stress raises stress hormones such as cortisol, which we know can damage the brain, especially the hippocampus, which controls memory. What we don’t know is whether this study was picking up some early brain changes in the elderly, changes which correlate with both emotional distress AND a tendency to develop MCI. A better study would look at younger people, and see if emotional distress in those aged 40 or 50 leads to the development of MCI in later life.

Since about a third of those with MCI will develop Alzheimer’s Disease, any reductions in the prevalence of MCI would be tremendously beneficial to society. Perhaps psychotherapy should be mandatory for all those over 65!

What can you do to lower your brain risk? First of all, honestly evaluate whether you suffer chronic emotional stress. Ask yourself if most of the time you feel calm and happy, or upset and worried and stressed. Also ask your close friends and/or family what they think. If you are someone who suffers chronic stress, then get help. A cognitive behavioral psychologist can teach you good stress management skills, and may help break lifelong patterns of emotional stress. Another good option is to learn mindfulness meditation and yoga and practice them daily. These are known to reduce psychological distress.

Whatever you do, don’t take it lightly if you are in long term distress. Your brain wants you to be mellow!

Copyright 2007 The Psychology Lounge/TPL Productions

Can Cognitive Behavioral Therapy Make a Baby? How Psychological and Behavioral Factors Can Reduce Infertility

An article in the May 7 edition of U.S. News and World Report titled “Success at Last: Couples Fighting Infertility Might Have More Control Than They Think” shows how health psychology can impact even something as basic as making a baby. This fascinating article shows that behavioral and psychological factors may play a big and controllable role in producing the infertility that 1 in 8 couples suffer. It turns out, that the body may be smarter than we gave it credit for. Woman’s bodies may recognize certain states as not ideal for childbearing, and therefore prevent or lower fertility. Two examples are being overweight or underweight. Overweight risks pregnancy complications such as diabetes, high blood pressure, so the extra estrogen produced by body fat interferes with ovulation. Underweight women may not have enough body fat to sustain a baby, so the pituitary gland releases less of key ovulation hormones. Other behaviors strongly influence fertility. Take smoking for example. Multiple studies show that smoking can delay getting pregnant by a year or more. And one study at Columbia University found smokers entered menopause 3 years earlier on average. Or diet. Trans fats, a key component in such unhealthy foods as donuts, cakes, etc. may raise testosterone, which suppresses the ovaries. Research shows that as little as 4.5 grams, which is the amount found in one donut, can have this effect. Even positive behaviors can negatively affect fertility. One study found woman who exercised four or more hours a week were 40 percent less likely to conceive after their first IVF (In vitro Fertility) treatment than women who didn’t exercise. Once again, it may be that the body interprets hard exercise as danger and stress, and shuts down the fertility system.

Even pure psychological stress can affect fertility. Here’s the biological mechanism. A few hours before ovulation, the pituitary gland sends out luteinizing hormone (LH), which tells the ovaries to release an egg. But if you are experiencing psychological stress such as a fight with your husband, or a dressing down from your boss, or a kid having a tantrum, then your LH will be suppressed, disrupting ovulation.

Even mild stress may have a big effect. One study of monkeys found that moving monkeys to a new cage, combined with a little less food and 1 hour on treadmill caused 70 percent of the monkeys to have irregular menstruation! So don’t skip that meal and take a long run when stressed, or you’ll greatly lower you odds of getting pregnant.

What’s worse is that IVF treatment itself may lead to large amounts of psychological stress. One fertility expert found that 40 percent of women in infertility treatment had all of the symptoms of an anxiety disorder or depression: sleep disturbances, difficulty concentrating, and irritability. So if stress lowers fertility, and fertility treatment increases stress, then fertility treatment may actually harm fertility!

But cognitive behavioral therapy may improve the situation. Alice Domar and colleagues at Harvard found that a 10 week cognitive behavioral group therapy program improved the success of fertility treatment from 20 percent to 55 percent in the women who participated in the group therapy. So what can we learn from this research?

  1. A woman’s body is wise. It will respond to behavioral and psychological stressors by lowering fertility. Anything that resembles stress, even hard exercise, will trigger physical responses that lower fertility.
  2. At critical points such as several hours before ovulation, even normal stressors can disrupt the ovulation process. And in stress-prone or perfectionist or angry women, the likelihood of experiencing stress during these critical hours is very high. Thus for women who are experiencing difficulty getting pregnant and who by personality are “stressy” (you know who you are!) cognitive behavioral therapy (CBT) will be helpful in learning to manage and lower stress.
  3. Infertility treatment is by its nature stressful, and this leads to a paradox; infertility treatment may lower fertility if it increases stress. It may be helpful to evaluate stress levels in women undergoing IVF and if stress is high, intervene with CBT group or individual therapy.
  4. The ultimate in infertility treatment may be what I recommended to my friend Jill, who had tried many cycles of IVF to no avail. I told her, “You’re young, why don’t you and your husband stop trying to get pregnant, and just have sex for fun, and enjoy life for a few years. If nothing happens then you can adopt.” She was pregnant within the year, and now has two lovely children. A good long relaxing vacation with no schedule, no hard exercise, healthy food, and no stress may be the best fertility treatment available, and even if it doesn’t work, at least you’ve gotten a great vacation!
  5. Finally, what this research shows us is how linked our minds and bodies are. Changing thoughts and feelings and behaviors changes our bodies, and fertility is just one example of this.

Copyright 2007 The Psychology Lounge/TPL Productions