Book Review-The Excellence Habit: How Small Changes in Our Mindset Can Make a Big Difference in Our Lives for All Who Feel Stuck

Most folks would say that they would like excellence in their lives. However, understanding what excellence is and how to get more of it seem to be a challenge. In The Excellence Habit: How Small Changes in Our Mindset Can Make a Big Difference in Our Lives for All Who Feel Stuck, Vlad Zachary shares how he sees the struggle to not just desire more excellence but to actually develop it.

Excellence Redux

This is not, by far, the first time excellence has come up in my reading list. It is, in fact, a common topic across all sorts of books. In my review of The Fred Factor, I mentioned that my friends describe my world as being filled with excellence – even though I often don’t recognize it. Sometimes excellence gets another name, as it does in Peak. Other times it pops out of unlikely places, like creativity. (See Creativity, Inc.) It shows up in people trying to better themselves, as in The Art of Learning and The Rise of Superman.

However, Zachary has a slightly different perspective on excellence and how to achieve it. It’s fueled by getting outside our comfort zone and recognizing that we have the mistaken belief that we should be able to be comfortable as adults. However, if we can develop and express our genius, we have to pretty consistently dwell outside of our comfort zones. (See Extraordinary Minds, Daring Greatly and Group Genius for more on dwelling outside our comfort zones.)

Mind the Gap

Most people have two lives. The inner life of their fantasy where they’ve achieved all of the fame and fortune they would like – and the second life of our day-to-day existence. The gap between these two lives will pull us to close them. We’ll want to reduce our expectations or elevate our current situation. Unfortunately, all too often, we compromise. All too often, we defer to prudence and we convince ourselves that we need to be realistic. These are the forces that move the imagined life towards our current reality.

The Excellence Habit is the opposite of this. It is moving our current life closer to our fantasy. It transforms our fantasy into our new reality. It moves us from the someday to the today. As we experience life, we must mind the gap between our two worlds and recognize which side of the gap we want to move to get them closer.

Facing Difficulty

Your character is what you do when doing it is difficult. If you look for the character of a man, you don’t look for what he does when it’s easy. You look for what he does when it seems like it’s impossible for people to do that. That’s great when you get there, but how do you develop this character? Developing character happens as you make individual decisions over a long time. It’s about making hard choices every day.

We want to be known as people of character but often forget that the way to develop character is to do the hard things. In Daring Greatly, we learn to lean into the pain. We learn that often it’s painful before it’s peaceful. We have to go through the difficult to get to the easy. Compelled to Control reminds us to see pain as a signal, not necessarily as a warning.

Sometimes our fear of failure (see Find Your Courage for more on the fear of failure) will block us from the difficult. However, the power of hope is restored when we can see our success through difficult things. (See The Psychology of Hope for more.)

Meritocracy’s Menace

I don’t suppose it was easy to live in a world of caste systems, where one knew their lot in life. They had no belief that they could become something special or elevate their world beyond that of their social rung. That world is past. We now believe that anyone who has a great idea can become a billionaire. We lionize the likes of Bill Gates, Steven Jobs, Mark Zuckerberg, Elon Musk, etc., who have created their own fortune and defined their own worlds. (See Bold for more on some of the people who’ve boldly changed the world.)

The positive potentials of a meritocracy are great. You can have the world on a string. However, there’s a darker side to meritocracy. The darker side is accepting that you are responsible for your own situation in life. No longer can you blame the establishment, history, your parents, the tooth fairy, or anyone else. In a meritocracy, you’re responsible for your own situation. There is no more victimhood. (See more about victimhood in my post Hurtful, Hurt, Hurting.)

What happens when you lose your job? If you believe in the meritocracy, you must admit that you didn’t do good enough. The problem this causes is a natural fear of what will happen if you’re not enough. If you weren’t enough for this situation, what if you’re not enough for the next? What if you get to see the other side of a strict meritocracy, and you die homeless, hungry, and alone?

For those of my Christian friends, the book God Loves You offers some solace that God loves you. For my non-Christian friends, it’s important to remember that this world contains a great deal of randomness and is full of probabilities. It’s not formulaic.

Randomness Reminder

We were taught formula. We were taught that A+B=C – all the time. We’ve been told that insanity is trying the same thing over and over again and expecting a different result. The Halo Effect spoke of the fact that this world is not deterministic. Instead it’s probabilistic. We roll the dice. Sometimes it comes up boxcars and sometimes snake eyes. However, much more frequently, it comes somewhere in the middle. This is important in the concept of a meritocracy because even the most noble system of meritocracy will require randomness to connect people to the place where their unique personality, experiences, and skills are the perfect match – where they merit the great rewards for their high performance.

Most of the time we’re floating through our lives and careers without a single clear direction as to where we need to move to be in the best possible spot. Even Bob Pozen in Extreme Productivity admits that he didn’t have a master course for his life. He was pulled along by the winds of change and happened to end up where he landed.

The Iceberg Principle

In truth, much of what guides us on our paths isn’t the stuff that we see on the surface. It’s not the big, well-known things, but instead are the smaller passions that seem to support our larger development and help chart our course. I started my path towards SharePoint semi-accidentally. I was doing custom development and a customer needed someone to help with a SharePoint initiative. I walked away from it for a few years, then got pulled back in when another few clients needed help and no one else in my sphere knew anything about it.

Risk, adversity, and patience are the characteristics that Zachary describes at the heart of the iceberg principle. We’ll never know the risks that people took, the adversity they overcame, or the patience that it required. I mentioned in my review of Seeing David in the Stone that James MacDonald, who is now a popular pastor, mentioned that he worked for very little compensation for many years just to reach out and serve. Brené Brown mentions in Rising Strong that we do a disservice to others by “gold-plating grit” – that is, minimizing the pain, anguish, and struggle to get to where we are. It’s this grit – the struggle – that people on the outside can’t see. They can only see the result of the struggle.

Wide and Narrow Focus

We have historically lauded those who were at the pinnacle of their respective areas. We’ve looked up to the person who has mastered their one and only area of interest. Sometimes we’ll hold up people who have managed to connect various fields of science and art together, but much more rarely. We hold up Mozart or Einstein more frequently than folks like Edison, who brought together many fields of science to develop his commercially-viable incandescent light. (See Extraordinary Minds for different types of expertise, The Medici Effect for the impact of cross-pollination of ideas, and Beyond Genius for some Renaissance men.)

The reality is that some of the most interesting and practically-useful discoveries don’t come at the pinnacle of an area of science. The most useful discoveries come from the intersection of different fields of science. Edison’s discovery wasn’t about electricity. It was the application of heating materials through electricity to create light. It was the intersection of many different areas of science to get to a commercially-viable light bulb.

It is not bad to be focused on a single area or to seek excellence in that area. However, neither is it bad to have many divergent interests, which pull together to create new and interesting combinations.

Ambiguity

As I’m writing this, my post of The Heretics Guide to Management: The Art of Harnessing Ambiguity just went up, so I’m getting a healthy dose of discussions about ambiguity. That’s probably why a quote about Dr. Kerry Healey, who is, as I write this, the president of Babson college, lit up for me:

“Dr. Healey said that her ability to deal with ambiguity for very long periods of time is probably more important than self-discipline.”

I realized that the wisdom in this statement is that we all have ambiguity in our lives. By accepting that we don’t know what’s around the corner – but it will be OK and potentially even amazing – we live our lives to the fullest. Believing that we have to have our lives all planned out and we have to have it all figured out leads to a lot of anxiety – particularly when we’re getting outside of our comfort zones.

Inner Game

Where there is excellence, there is also an inner game of peace. It’s not that those who are excellent never have disruption in their lives and are never off balance, it’s that they discover it sooner and recover quicker. (To slightly paraphrase my quote of Richard Moon, see more in my post The Inner Game of Dialogue.) Developing excellence as a habit is less about what people see on the outside and more about what people see on the inside. It’s less about visibility and more about internal stability.

How we frame or reframe our lives has a substantial output on our trajectory in the long run. Our internal state having “broken windows” or other areas of minor concern can have a major impact on how we turn out overall. (See The Tipping Point for more on the broken windows theory of crime.)

Despite the value of a solid inner game, sometimes the only attribute we need is simply the persistence to wait it out and a bit of dumb luck.

Long Enough to Get Lucky

In my conversations with business leaders, I often hear encouragement to just keep going. They share their stories of struggles and how they overcame them to remind me that sometimes the only way to get ahead in business is simply to be in business for a long time. That’s why the quote from Taffy Williams, CEO and author, is so perfect: “Part of the game is being able to stay functional long enough to allow for your lucky break to come. I personally believe that luck is part of every success story. Talent is important, but if you are at the wrong time, at the wrong place, things won’t happen.”

The trick to becoming successful in business is luck. Luck is not completely random. It, as Pasteur said, favors the prepared. You create the opportunity for luck by being prepared. You are prepared by practicing – intently and intelligently. (See Peak for more on purposeful practice.) Sometimes you have to just plug along trying new methods to find something that will be successful for you.

Until your ship comes in, maybe you just need to practice The Excellence Habit.

Book Review-Motivational Interviewing: Helping People Change

While working on a community project to help teens who are struggling with life, I had the pleasure of talking to some real professionals who work with teens every day, and one of them shared one of his techniques for having dialogues with teens in trouble. That technique was motivational interviewing. I picked it up and started reading Motivational Interviewing: Helping People Change, and realized that it addressed some of the challenges that I’ve seen in my work with my children as well as conversations with other adults.

Spirit and Attitude

In many therapeutic relationships, there’s an expectation. The expectation is that the person being consulted has the answers to the questions that are plaguing the seeker. The idea is that the expert in the situation is the one with more training, more degrees, more experience, etc.. However, this expectation directly faces the reality that every human is unique, different, and special. The seeker is the one who knows their life best. They may be missing the knowledge or support to improve their life, but they are the undisputed experts in their own life – and in their condition.

This is the fundamental shift in perspective that sits at the heart of motivational interviewing – that is that the relationship is not a one-up/one-down, where the one being consulted is the expert and the seeker is the novice. (See Compelled to Control for more on one-up/one-down.) Instead, there are two people who are coming alongside one another for the betterment of both. The seeker is looking for specific growth and the one being consulted can be enriched by the seeker’s experience in their own life.

The Heart and Soul of Change cited therapist alliance to be the most powerful factor that influenced outcomes. This is the idea that both the therapist and the patient have the same goal. This is the spirit of motivational interviewing – that the seeker (patient) has the same perspective as the therapist (consulted). Drawing on this powerful truth, motivational interviewing can move people from places of resistance, ambivalence, and into a place of willing change.

Change Models

When you’re focused on changing people, whether to get them to stop a bad habit or start a healthy one – or ideally both – there are several different models that can be used. There is Kurt Lewin’s model of unfreezing, changing, and refreezing, as well as the stages of change model, which speaks of precontemplation, contemplation, preparation, action, and maintenance. Precontemplation maps to Lewin’s unfreezing – that is, becoming ready to consider change. Lewin’s change is broken into contemplation, preparation, and action in stages of change. Maintenance maps to refreezing in Lewin’s model.

Of course, there are other models, like John Kotter’s model for organizational change. (See Leading Change and The Heart of Change
for more on Kotter’s model.) There are other approaches, like the idea of New Year’s Resolutions, that you may find helpful. (You can see my post Keeping Your New Year’s Resolutions for more.) Motivational interviewing follows the stages of change model and recognizes that people are in different places in their walk towards change.

In my experience, an awareness of the journey of change is something that distinguishes motivational interviewing. Instead of just blindly assuming once someone has the knowledge of what to do that they’ll magically make it happen, motivational interviewing recognizes the complexity of the change process.

The process of personal change is much like the process for adopting an innovation. Diffusion of Innovations shared that there is a hierarchy to adopting an innovation (or change):

• Knowledge – Awareness of the innovation or change which can be gained from mass media
• Attitude – A change in perspective about the innovation or change typically garnered from close associates or friends.
• Practices – Making the change is a personal decision.

This is the same process; you can hardly make a change until you’re aware of it and until you accept that the idea is a good one. If you want to address recidivism rates, you must get past the inmate understanding the law – in most cases they do. You must get to the heart of their attitudes about the law, being law-abiding, or how their status would be impacted by doing the right thing. This precedes the decision to make the change.

The Motivational Interviewing Process

Motivational interviewing relies on a set of skills that are important to cultivate (which I’ll address later in this review) but there’s a process for doing motivational interviewing. However, this isn’t a strict process, but is instead a flow, like waves that are continuously lapping the shoreline of the relationship. Some of these waves are large and take a long time to return to the ocean and others barely make a mark. The process isn’t intended to be a strict linear process with achievements at each step like they’re levels in a game. Instead they’re pieces of an overall process to lead people to the lives they want to have. It’s recursive and reflexive, happening repeatedly.

The four components of the motivational interviewing process are:

• Engaging – Developing a rapport, or what The Heart and Soul of Change would call a therapeutic alliance. More simply, building a relationship.
• Focusing – Guiding towards a specific, achievable goal.
• Evoking – Fanning the flames of desire to make the change.
• Planning – Developing the set of specific action steps.

Let’s look each of these components in the following sections.

Engaging in the Relationship

In any work, the first step is to build into the relationship with the other person. Sometimes that work is quick and easy, because the other person needs only to perform a transaction with you; but when you’re helping them shape, change, or redirect their lives, the need to build a relationship is key. So while a McDonald’s worker may solidify their relationship with you with the simple phrase, “What can I get you today?”, someone who is intent on helping another human grow needs to do more to build trust and safety. (See my post Trust => Vulnerability => Intimacy for more.)

It was Theodore Roosevelt who said, “People don’t care how much you know until they know how much you care.” Until they know that you care about them as a person, they don’t care about your degrees, experience, techniques, or tools. They care when they know that you have their best interests at heart.

There are many pitfalls on the way to building relationships. Some of these traps were covered specifically.

The Traps

Despite the best intentions to hold to the spirit of peers in a discovery process to help the seeker, there are traps laid out which can derail the conversation into the authoritarian, one-up/one-down situation, where the situation is no longer collaborative.

• The Assessment Trap – The belief that we need to know a lot of information before we can begin to help (and add value).
• The Expert Trap – The expert, professional, or volunteer knows the right answers and they need to impart it on the client.
• The Premature Focus Trap – Beginning to work on a problem before you develop a relationship or understanding of perspective.
• The Labeling Trap – Assigning a label to someone and assuming they are that label – not that it is an aspect of them – or maybe it’s wrong and it’s not even that.
• The Blaming Trap – Falling into the game of finding the fault and assigning the blame to someone – either the client or someone in their world.
• The Chat Trap – Instead of working through a guiding process, just talking with no direction or intent.

The good news is that escaping the traps is nearly as simple as being aware of the traps’ existence – in the moment – and acknowledging it. In this way, it’s like the boxes from The Anatomy of Peace but easier. Boxes are hard to recognize that you’re in — but these traps are easier to see.

Listening

Listening to another person might seem to be an obvious and easy thing that one can do to build relationships, but in truth most people are crummy at listening. We’re distracted by our devices, we don’t make enough eye contact, and we are generally distracted by our own thoughts, instead of giving the person that we’re listening to our full attention.

The basics of listening seem obvious. We remove the distractions that prevent us from paying full attention to the other person. The way that we communicate that we’re paying full attention to them is by making and maintaining eye contact. It’s not necessary to maintain 100% eye contact – in fact, the other person is unlikely to let you. However, giving the other person the opportunity for a large amount of eye contact is important. They then can take – or leave – as much eye contact as they feel comfortable with.

There are techniques for reflective listening, including simple and complex reflections, as well as strategies to lead the conversation so that the person will elaborate on how they feel and you have ways to check your understanding. I’ll discuss that later, but in the elicitation stage, there’s a more important set of constraints that can make or break the relationship.

Non-Reactive

The first constraint is that your listening should be non-reactive. That isn’t to say that if the seeker asked if you’re, excited you can’t respond with a yes, or that you should appear to be only barely conscious. Instead, it means that when people share something vulnerable with you, that you shouldn’t indicate a great deal of surprise as if your opinion of them has changed. For folks to build trust in you and to become vulnerable with you, they must feel safe. (See my post Trust => Vulnerability => Intimacy for more on building trust.)

Non-Judgmental

The second constraint is related. You cannot appear judgmental in your responses. This leads to the one-up/one-down perspective or The Expert Trap – both mentioned above. But more importantly, it reduces the feeling of safety necessary for someone to move further into the relationship. If you respond in a judgmental manner, the seeker will learn that they need to defend themselves. They’ll perceive that you’re not a safe person and that isn’t a good way to develop a relationship.

Finding Focus

Sometimes the context of the interaction will drive the focus for the engagement. Say the seeker approaches the consulted party in the context of therapy for addiction. Sometimes the context won’t help to focus the interaction at all. Now consider a seeker walking into the office of the pastor of a church. In this case, the context doesn’t prescribe the kind of focus that the conversation will have. Even in the first case, knowing that someone has an addiction doesn’t indicate their desire to change their behavior – as the seeker may be fulfilling the requirement of a third party, like a spouse or a judge.

Whether there is a clear focus at the start or not, in order to be intentionally helpful, it’s necessary to understand what the objective is for the interaction. This is the reason that there is a focusing phase to motivational interviewing to develop and agree to a common objective.

Planning Possibilities

The seeker entering the arena of the consulted can come with four basic situations:

• Clear Direction – The seeker knows exactly (or nearly exactly) what they want to accomplish in their lives and is looking for the consulted to help guide them toward that path.
• Multiple Choices – The seeker sees multiple options for how they could proceed to fix one area of their life; but it’s unclear exactly which change they should make, and are first looking for the consulted to help them determine which they should work on first.
• No Clear Direction – In many non-acute settings, the seeker doesn’t have a clear vision of what they want to improve in their life, nor clear directions they could take to improve it. In these cases, the consulted and the seeker need to collaboratively define what the options even are before seeking to focus on one.
• No Therapeutic Direction – The fourth case, which is a variant of no clear direction, is where there is no clear direction and the consulted doesn’t see a therapeutic direction. There’s no reason to encourage one behavior or another. In these cases, the consulted need not advocate any direction.

When the seeker has a clear direction, the planning process is very short. Essentially planning becomes a simple confirmation. With those with multiple choices, the planning process is relatively short, as one of the options is selected from the list. Planning gets longer when there aren’t a predefined set of options for direction, and even longer still when the consulted person has no specific therapeutic direction to provide.

In those cases, where one needs to determine directions or identify potential directions to be selected from, sometimes the best thing for the person being consulted to do is to practice a bit of selective reflection.

Evoking the Desire for Change

It’s 1955 and we’re listening as Dr. Raphael Level, the founder of the Global Medicine Forum, speaks. His words are as startling then as they are now: “A relatively small percentage of the population consumes the vast majority of the health care budget for diseases that are very well known and, by and large, behavioral.” He continues, “Many articles demonstrated that eighty percent of the health care budget was consumed by five behavioral issues.” He didn’t name the issues, but too much smoking, drinking, eating, stress, and too little exercise are the presumed list. (Much of this story comes from Change or Die.)

The funny thing is that he could have been speaking last week. In the over sixty years between his speech and today, little has changed. Perhaps we could shuffle the five and maybe swap out smoking and drinking for addictions in general – but fundamentally the situation hasn’t changed. The greatest challenges that we have in medicine isn’t medicine. The greatest issues we have in medicine are human behavior.

If you want to scare yourself, go look at the World Health Organization’s (WHO) reports on global handwashing rates in acute care settings. No one is missing the knowledge that handwashing prevents infections since Ignaz Semmelweis made his discovery. Yet global handwashing compliance in acute care is at a 20% level. In the US, you might get between 50%-80%. We’re not talking about a lack of soap. (See Diffusion of Innovations if you want an interesting story about how the availability of soap changed outcomes.) However, we’re not talking about an availability problem. We’re talking about a behavior problem.

How then does motivational interviewing accomplish the sorts of behavior changes that we’ve been unable to accomplish as a society? The answer is that, rather than demanding change, it relies on gently guiding the seeker into their desire to change through increasing engagement and reducing disengagement.

Increasing Engagement

In a formal debate the parties are assigned their sides and they square off. Everything that one party says, the other side refutes. That’s the way the debate works. You seek to minimize what the other party says and maximize the impact of your statements, even to the point of hyperbole. This is the way the situation is structured. Unfortunately, even if we don’t formally get assigned sides, the roles of the seeker and the consulted in traditional therapy would square off, with one suggesting change and the other suggesting status quo. The first tool to encourage a change is selected reflection of what the seeker is saying.

Selective Reflection

Motivational interviewing grew out of Carl Roger’s work, and he commented that he didn’t direct his patients. However, upon review of his work, one of his students could demonstrate that, while he didn’t overtly provide direction, he was differentially reflecting certain comments and allowing others to pass by. By selectively reflecting comments, Rogers influenced the thinking of his patients without directly expressing his opinion on what they should do.

Choosing what to reflect and how to reflect what the patient – or seeker – is saying can provide them significant support in pursuing the direction that the therapist – or consulted – believes is best. By simply choosing to provide affirming reflections around certain paths and not making comments on others, it’s possible to subtly shift the path of the seeker without them even realizing it’s happening.

Righting Reflex

It’s more common for the consulted to desire to set the seeker straight. That is, to tell them how they’re wrong or what they “must” do. This invites the seeker to defend their position. Because we learn about our perspectives by the way we talk, we’re unintentionally creating additional resistance as we ask folks to defend their position. Therefore, those being consulted need to carefully ask for permission before providing information (or judgement) on the seekers’ situation. The consulted party isn’t imbued with unrestricted power to inflict their thinking on the seeker. Instead, they’re granted the opportunity to petition to get their thoughts into the mind of the seeker.

Staying Behind the Person

My friend Bill Caskey taught me a long time ago to stay behind the prospect when selling. The idea is that if the client says that the solution you’re proposing is great, respond slightly behind them. The idea is that they’ll try to continue selling you that your solution is great. Obviously, this is a skill that needs a bit of finesse; however, done well, it further reinforces the buyer’s perception of your product or solution.

In motivational interviewing, staying behind the seeker causes them to talk more about the reasons for the change. The more they talk about the change, the more likely they are to do the change because we learn our beliefs as we talk them out. Specifically, we become more aware of our desire as we start to discuss it.

Change Talk

The kind of talking that a seeker does exposes their interest in the change process and ultimately their chances for success. As seekers can articulate their reasons for changing, including its importance and what they expect to get, they are more likely to be successful in changing their world. Specifically, there are five factors that can influence the probability of success:

• Desires or Goals – Being able to articulate the objective is important because, as the saying goes, “If you don’t know where you’re going than any road will take you.”
• Importance – Understanding why the change is important or essential provides the energy to compel the seeker into action.
• Positivity – Generally, experiencing the change process in a more positive way will support continuing effort at the changed. If the seeker sees hunger as a signal rather than a pain, they are more likely to be successful.
• Expectations – Knowing how to set realistic expectations and knowing what you expect helps to remove barriers to the change.
• Hope – The seeker’s sense of hopefulness about the change can carry them through when setbacks occur. (See The Psychology of Hope for more about hope.)

Obviously, the objective is to encourage the seeker to have more of these positive factors for change. However, sometimes it’s not entirely possible.

Addressing Ambivalence

Ambivalence is the not the land where there is no motivation in either direction. Ambivalence is the land where there’s not compelling pull towards or away from the behavior change. This is the place where either the forces are both low – or they’re both high and are tugging at the heart strings of the seeker. It’s like brackish water, water between the ocean and freshwater sources: the currents can be strong or they can be nearly non-existent.

Ambivalence occurs when there’s insufficient energy in the psychodynamic system to have “stay the same” displace “change”, or vice-versa. In my review of Inside Jokes, I mentioned that jokes work because of a conflict of ideas, which isn’t quietly filed way but is instead either cooperatively or more frequently uncooperatively resolved. That is, the ideas either become aligned because of new insight or one forces the other out. Getting out of ambivalence requires the energy to have one idea force the other idea out – ideally for good.

Building strength in the argument for change so that it can overwhelm the status quo is the point of motivational interviewing, but increasing the force of the change argument isn’t enough. Often it’s necessary to dissolve the disengagement (reduce the resistance).

Dissolving Disengagement

It can be that the person feels caught between two worlds. They are trapped in their current thinking and destructive behaviors, unable to climb out of the pit. In this view, the person needs the “waypower” component of hope (see The Psychology of Hope) to know how to accomplish the change. This is every consulted person’s dream. All they must do is impart the knowledge of how to do the change and it will happen. Except, as we have discussed, this isn’t the state that most people arrive in. Most seekers come with a fair amount of disengagement and resistance to the process – sometimes to seeking (they’ve been told to come), and frequently with the situation itself.

We know that egos have defensive techniques that allow us to walk through our days instead of curling up in a ball in fear of the impending asteroid that’s hurling towards the planet. (See Change or Die for more about our ego.) It’s these defenses that we’re seeking to reduce. We’re trying to prevent the minimization of the damage caused to ourselves and others by our existing behaviors and responses. We’re trying to hold up the mirror to ensure that people can see themselves more clearly. (See Incognito for more on how we deceive ourselves.)

Behavior-Values Gap

We talk the talk but can we walk the walk? We can have espoused beliefs that sound good but aren’t how we act. This is less episodic and subtler than the boxes that The Anatomy of Peace was speaking about. In that case, we’re situationally triggered towards behaving inconsistent with our ideas. The gap between our values and our behaviors is much more persistent than that. (See The Fifth Discipline, The Happiness Hypothesis and Dialogue for more on the gap between our espoused beliefs and what we do.)

The gap is a natural artifact in human beings. Even students in seminary school will miss the proverbial Good Samaritan test, as demonstrated by Darley and Batson in their research study, “From Jerusalem to Jericho” published in 1973. Students pressed for time were substantially less likely to help someone who they perceived needed their help.

Milgram demonstrated the startling ease with which most people could be manipulated into delivering what they believed were lethal shocks. (See Mistakes Were Made (but Not by Me) for more.) It’s not that there was a question about whether the subjects valued human life – the question is what psychological pressure they were willing to confront to protect those values.

Closing the Gap

The simple – too simple – answer for closing the behavior-values gap is to hold a mirror to the face of the seeker. To show them how their espoused values and their behaviors are in conflict. The Outward Mindset told a story where Ivan’s father saw his own violent behavior when Ivan copied it, thereby revealing his own behaviors and causing an immediate and permanent change. While holding the mirror up for someone to see can be an effective and permanent way of creating a change, it’s also risky, as the response of breaking the proverbial mirror or running away are very real responses.

The confrontational style isn’t what motivational interviewing is about. It’s about allowing the seeker themselves to hold up their own mirror and hopefully not be so scared by what they see that they drop it. Getting folks to raise the mirror and turn it towards themselves is the beauty of motivational interviewing done well.

Planning

By the time you reach the planning phase of motivational interviewing, the hard work is done. The planning exercise is important so that your hard work in the previous phases doesn’t get undone because of poor planning.

Way Power

Planning is specifically developing waypower in the mind of the seeker. That is, you’re helping them discover that they do have the capacity, ability, and skills necessary to make the change. You’re helping them feel safe in their decision to change, because they will be successful through their capabilities and the capabilities of the relationships around them, including their close relationships as well as the communities that they are a part of. (See High Orbit – Respecting Grieving for more about circles of influence.)

Baby Steps

The easiest way to make any change is to convert large, seemingly insurmountable challenges into a set of small steps. The more you can create a set of reasonable steps that a person can take to reach a goal, the less daunting and therefore more doable it becomes. Every change should be wrapped in the cloak of actionability.

If someone needs to exercise more, you don’t start with exercising five days a week for an hour at a time. The first step might be to get running shoes and workout clothes. The next might be selecting a gym to become a member of. The next step might be a 30-minute workout once a week. Each step moves you towards the goal – but isn’t so large that it’s not manageable. I wanted to start eating healthier. I switched from white to wheat bread. It was a small change and it was something that I can do.

Interpersonal Influence

Before sharing some of the specific techniques and approaches that are discussed in motivational interviewing, it’s worth pausing and talking about governing principles for the use of these skills. Here, motivational interviewing defers to Principles of Biomedical Ethics in four broad categories:

• Nonmaleficence – Not inflicting intentional harm.
• Beneficence – The desire and belief of doing good
• Autonomy – The belief in human freedom and dignity
• Justice – Genuine respect for people

These ethics are necessary since the approach can be powerful and can easily be abused to coerce people without their knowledge.

Manipulation

I pause here to talk briefly about manipulation, because as a word it’s gotten a negative connotation. However, if I were to tell you that all of us have been manipulated, you might passionately argue the point that you’re beyond manipulation. However, nearly everyone wears seatbelts in cars. One could argue against the practice, but the truth is we’ve all been manipulated into this behavior based on laws.

This – but not all – manipulation is a good thing. It saves countless lives each year as injuries and death due to automobile accidents are lowered. Manipulation in and of itself is not a bad thing – manipulation which places the benefits of the person doing the manipulation above the benefits of the person who is being manipulated can be a bad thing.

Techniques

There are some practical techniques and approaches which are indicators that motivational interviewing is being used, and the assessment of these techniques can reveal whether the practitioner is following the guidelines that motivational interviewing sets forward. Here are some of the key techniques in the system.

Reflective and Active Listening

Motivational interviewing uses the language of reflective listening rather than the more popular active listening. It does so in part because there’s a distinction that’s raised even inside of reflective listening. There are simple reflections, those which don’t provide much interpretation of what the seeker said. There are also more complex reflections, which process the information to try to make sense of it. These reflections are termed as being more complex.

There are good examples of reflective listening which is at the heart of motivational interviewing, but perhaps my favorite quote for reflective listening, which I discovered in Emotional Intelligence, comes from Haim Ginott: “When you did X, it made me feel Y, and I’d rather you did Z instead.” I change the language a bit to, “When you did X, I felt Y, and I’d rather you did Z instead,” because I don’t believe that others can make us feel anything – I think we choose our own feelings. (See Choice Theory for more.)

DARN

DARN is a way of viewing the seeker’s chances for making a successful change. This is their preparatory talk to ready themselves for the change. The more that you can get a seeker to verbalize in these four categories, the more likely they are to ultimately be successful with their change effort.

• Desire – The root is obviously the desire to make the change in the first place. Without desire, nothing happens.
• Ability – The seeker needs to believe they can make the change. This may be very practical in terms of the specific behaviors or more generally in their belief of their ability to stick to the change.
• Reasons – Having clear reasons for the change, not just broad ideals, will make them more likely to stick with the change when there are setbacks.
• Need – The urgent reason to get started. The specific impetus for change now.

These are the kinds of language that you need to hear from someone as they are preparing for the change. However, it’s the CATs language that will help sustain them through the change itself.

CATs

CATs are the language of commitment. They’re the language when the decision has been made that there are no more questions about a course of action. The CATs are:

• Commitment – This is the signal of the likelihood of action. The change is now.
• Activation – Signals of a willingness – but not commitment – to act.
• Taking Steps – Actual behaviors that demonstrate progress in a direction. These aren’t crossing the goal, only moving in that direction.

This language is the language on the other side of the hill from motivating the person to do the change.

OARS

OARS are what drives the boat of motivational interviewing forward. They are the core techniques that help the seekers respond in a way consistent with their desires.

• Open Questions – Questions that are designed to elicit long responses rather than short ones begin the process of getting the person talking and getting the ball rolling.
• Affirming – Affirming the person helps to build positive affect and allows for the development of a relationship through safe and trusted interactions.
• Reflecting – We all seek to be understood, and reflective listening allows the seeker to know that at some level they were understood. If they aren’t understood well enough they can refine that understanding.
• Summarizing – Putting things all together helps to tie a bow around the package of the conversation or part of the conversation. It affirms that you understand not just the individual statements but the overall picture as well.

These tend to become a rhythm for folks who are providing therapy, like the steady beat of hooves on a path when a horse is walking. Still, in this there’s no room for addition of information – that’s what the elicit-provide-elicit technique does.

Elicit-Provide-Elicit

If everything is reflective listening, then there’s no opportunity for the consulted to share their experience with the seeker. This is obviously not the point. Neither is it right for the consulted to download their view of the world on the seeker. The elicit-provide-elicit sequence was designed to create a safe structure for sharing that doesn’t cause the seeker to feel unsafe (and therefore defend themselves).

The sequence starts by the consulted asking the seeker’s permission to share. This is the first elicit. It’s very rare for the seeker to say no unless there is serious damage to the relationship; so while it may feel as if you’re asking to get told no, you’re asking to increase the willingness of the seeker to accept your feedback.

During the provide step, the consulted provides a little bit of information, just enough to get the point across, and then stops and launches into the final elicit step, which is checking to see if the seeker is still OK or needs additional information. This final elicit step.

By packaging the information you provide in this sequence, you reduce the chances that someone will resist the information.

Getting Motivated

While not everyone is in a counseling situation, all of us interact with others who are stuck, confused as to which direction to go in, and conflicted. Maybe we can pick up some skills for Motivational Interviewing
and help someone else find their way – or maybe we can find out more about ourselves.

Book Review-Why Zebras Don’t Get Ulcers – The Causes and Cures for Stress

In this final installment of my three-part review of Sapolsky’s book Why Zebras Don’t Get Ulcers we walk through the causes of stress and what we can do to “cure” stress by minimizing its impact on us. We started this review with The Physical Impacts of Stress and followed that up with The Psychological and Neurological Impact of Stress.

It’s good to understand the impacts of stress on our bodies and on our minds, but what do we do about it? How do we avoid stress and deal with it when it does come? Partial answers to these questions are what makes Why Zebras Don’t Get Ulcers so useful.

Lack of Control

Humans have evolved rapidly from creatures totally dependent upon dumb luck to survive. We’ve created agriculture (which ironically created its own stress-related problems). We’ve put men on the moon and brought them back home. We’ve learned so much about our bodies and our worlds. We like to believe that we’re in control. We enjoy the illusion, but it’s just that. It’s an illusion. (See Compelled to Control for more on control.)

Why would someone voluntarily work half time – 12 hours a day, every day – for very little, if any pay, a large degree of risk, and the associated health risks of higher stress? The answers vary, but the label for all of them is the same – entrepreneur. What do entrepreneurs believe that they get with their decision to “be their own boss”? Some argue that there’s a financial upside (and there is). Others argue that there’s no one telling them what to do (which isn’t true – they’ve got customers who are the ultimate bosses). One real answer is the freedom. Yes, you can and perhaps too often do work 12 hour days – but you get to pick which 12 hours. The freedom to choose when you work and what you work on mitigates the stress that you might feel from the other factors.

Studies have proven that when you give animals the perception of control of – or influence on – their situation, their stress levels are lower. Perhaps that’s why we have so many religions and superstitions. Marx said, “Religion is the opiate of the masses.” Perhaps our superstitions are our way of trying to make ourselves believe that we have control of our world.

Frustration Outlets

Even if we can’t get control, we experience less stress when we have an outlet for our frustration. When we have something – anything – that we can do, it makes it better. You probably know people – perhaps when looking in the mirror – who obsessively clean when they’re stressed. In truth, this helps them feel better along multiple vectors. First, the exercise itself will increase blood flow and will generally lighten someone’s mood. Secondarily, and more importantly, the belief that you’re doing “something” will help.

If you’ve ever been stuck in traffic waiting on other people to get out of your way, you’ve experienced that lack of control. Many people will choose routes which take longer if they are able to travel at a reasonable speed, because they don’t experience the helplessness of being caught in traffic. We’ve also seen those folks who constantly switch lanes as they try to relieve their frustration.

Giving Ulcers

Have you ever considered what you want someone to say at your funeral, or what you would want on your tombstone (and not the pizza kind)? While it may be morbid to think about, consider the guy whose answer was, “He didn’t get ulcers, he gave them.” There are some folks who follow their animal kingdom ancestors and inflict random terror on others in their lives. While this isn’t a helpful technique for the receiver, the sender gets the benefit of a frustration outlet. So, in giving ulcers, he avoids getting them himself. (Obviously, this isn’t literally true.)

Unfortunately, the animal kingdom speaks to the hierarchies of domination and the undeserved infliction of pain that travels down the social hierarchy. There are also intergenerational impacts of the competition for social status and being able to continue your genes in the next generation.

Evolution

Darwin stumbled across the idea of survival of the fittest. Since then, we’ve come to realize that the genetic mutations that are favorable get the chance to reproduce, and those that aren’t advantageous don’t get a chance to replicate. Thus, those genes which are the most suitable to the situation get copied. This has created a set of behaviors in the animal kingdom where new social leaders will exterminate the offspring of previous leaders and even harass the pregnant females to the point where they’ll abort pregnancies that are in progress.

If you’re looking to get your genes to replicate into the next generation, killing off the offspring of the previous social leader means that your children won’t have to compete with that lineage. Terminating the pregnancies increases the number of wombs available for creating your progeny. Obviously, this emphasizes the genes which can take control of the social order at the expense of those who are not. However, strangely, genetics aren’t the only way that behaviors and patterns are replicated.

Fetal Origins of Adult Disease

Adverse Childhood Events (ACE) was a study that indicated the downstream impacts of a set of adverse events on children. The number of these events could predict, years into the future, the health and longevity of the children being studied. (See How Children Succeed for more on ACE.) However, this study focuses on what happens after the child was born. David Barker, in a study called “Fetal Origins of Adult Disease” (or FOAD), studied the impacts of stresses before birth.

Prenatal care is well known to be important. How a baby starts out life is a strong predictor of many health measures in childhood; however, what David Barker found was that it’s a strong marker for long-term health issues as well. For instance, a low birth weight predicts an increased risk of diabetes and hypertension. The presence of a high number of glucocorticoids during the fetus’ development – because the mother is stressed – seems to program the child for a stressful world.

Strangely, the change in the glucocorticoid levels for the child remain high even when they’re an adult, so it’s possible for the mother to expose their child to the same high levels of glucocorticoids that they were exposed to intrauterine – thus replicating a cycle of stress without the benefits of gene replication.

The relationship we have with our environment is sometimes spooky. A famine can replicate impacts across generations just by changing the environmental factors in the first generation’s mother’s body.

Relationships

While factors like FOAD and ACE do have an impact on our worlds as adults, those effects aren’t a destiny. We’re shaped by our past – including our distant past – but we’re also shaped by our here and now. Once you get past the necessities of food, water, and shelter, a huge predictor of your life expectancy is the relationships you have. The fewer the relationships, the shorter the lifespan. (See my post Trust => Vulnerability => Intimacy for more.)

It’s not just any relationship that matters: you need not go out and collect the most Facebook friends, Twitter followers or connections on LinkedIn. The kinds of relationships that matter most are those relationships that are intimate – people with which you can share, on whom you are not just projecting some sort of an image. (See High Orbit-Respecting Grieving for more on types of relationships.)

The Facebook Effect

Interestingly, the number of Facebook friends we have can reduce our health instead of improve it. The factors at play are the same ones that led Sapolsky to conclude that one of the most harmful things that we may have done is come up with agriculture.

The problem seems to come back to our social rank. It seems like we’ve got an engine for comparing our status with those around us. If our neighbors have a new car and we don’t, then we’re not as high up in the social status as they are. Though we may live in a big house and drive a nice car, we don’t have as nice of a car. We evolved not to assess whether we have enough food, but whether we get the pick of the best food. We assess our socioeconomic status (SES) not by an absolute measure, but rather through a subjective or relative measure – a subjective SES.

Our relative perception of our SES drives our long-term health. If you remove or reduce the supports of SES such as education, income, or occupational position, a person’s overall health declines. So, what is Facebook’s role?

In the past, we didn’t get to see all the fun activities that people are doing all the time. We didn’t get to see their new car or the fact that their child just got accepted to a prestigious school. Once a year, we’d get a Christmas letter from them, and wonder whether you were still on the list so they could brag or if they really did value their relationship with you.

With the barrier of postage and a printed card removed, we’ve become Facebook friends with people that we’d never send Christmas cards to in real life. We now get to see their travel, their excursions with their presumably loving family, and their new purchases. Now we get nearly constant reminders that our SES is lower than that of our “friends.”

To me this is sad on multiple levels. First, we’ve got more consumer debt and more spending of money we don’t really have than at any other time in history. We’ve mortgaged our futures to pay for our perceived economic status today. Second, most of what we’re talking about here is fleeting. The car will eventually break down. The child who got into the prestigious school may get kicked out. Third, who cares? Obviously most people care. We’re wired to care, but should we? If you knew that you were never going to truly need anything you wouldn’t have, would you still be worried about what everyone else has? The kinds of things that really matter in life aren’t the kinds of things that can be posted on Facebook. The thing that really matters is your ability to love other people.

Love and Tenderness

If you want to reduce stress, pet a dog. (Unless you’re allergic to them.) Quite literally, the neurochemicals that are released when you pet a dog help to calm you and reduce stress. You may have seen pet therapy pets in hospitals. Having friendly domesticated animals is just one form of love that can reduce stress.

I’ve mentioned several times before that the ancient Greek language had three words for what we today in English simplify into one word: “love”. (See How to Be an Adult in Relationships.) What the Buddhists would call “compassion”, the Greeks would call “agape”. There’s a tenderness to this concept. There’s an acceptance of where people are and accepting their faults. When you practice compassion, you accept others’ faults – and in doing so, you make your own faults and limitations easier to accept in yourself.

Perhaps the best way to reduce stress is to learn to love. Sapolsky mentions an interview where he has a fabulous marriage. I can tell you from my experience that it’s a great way to reduce your stress. Having someone who will take care of you – and you know you’ll take care of them – is the pinnacle of love and tenderness, but any relationship that is close and mutual can reduce stress.

For our children, they know they’ll never have to worry about starving and they’ll always have a place to stay. These commitments are a part of the safety net that we put underneath them to help them understand that they will be OK. Their stress is reduced by the knowledge that they don’t have to fear and by the simple fact that they are loved. Our children are for the most part lucky; they’ve won the cortical lottery.

Cortical Lottery

In The Happiness Hypothesis, Johnathan Haidt spoke of a set, internal point for happiness, and how some folks have a higher happiness “default” than others. In effect, these lucky people have won the cortical lottery. They get to be happier than their peers – even in the same circumstances with the same coping strategies. They’re just happier by their makeup.

While one can’t change their “default” happiness point, nor can they change their basic biological responses to stress, they can choose to change their mindset on how they approach stress and how they cope with it.

Mindset

Carol Dweck’s work Mindset exposes two fundamental mindsets about a person. The first mindset, a fixed mindset, is that what the person is capable of is fixed. The second is a growth mindset, that they can change and grow. A similar split exists between approaches to stress.

One can view stress from the entirely emotional point of view, with threats to survival creating the stress; or they can view stress from the lens as a biological response driven by basal, neurological processes without the benefit of higher-order reasoning. In the language of the Rider-Elephant-Path from The Happiness Hypothesis, the emotional elephant can be left to his own devices, or the rider can hop down from his position on top of the elephant, always trying to reign him in and gently patting the elephant’s shoulder, letting him know that it will be alright.

The most practical example of this is a game called “worst-case scenario.” Some people play this game and they somehow connect the trivial to the end-of-the-world. However, others work through this game with a reasonability filter applied. For instance, in doing this blog post I could assume that the worst-case scenario is that Robert Sapolsky will have great issue with what I’ve written and sue me for libel or something like that. Is that possible? Probably not. He’s much more likely to send me a note correcting me or asking me to take the posts down than suing me. So I can take the view that he’ll sue me – and be totally under the control of my elephant – or I can apply the reasonability filter and say, he’s substantially more likely to ask me to correct something or take the posts down. When you play worst-case scenario with the reasonability filter applied (sometimes you may need help from a friend with this), then you can decrease your stress.

The opposite view, which is appropriate when you’re willing to entertain the worst case, is the “best-case scenario.” Here, too, reasonability should be applied. The unreasonable response might be to get an invitation to spend the weekend with Sapolsky and his wife at their house. A reasonable response might be that he and I get to start a conversation that leads to a friendship.

If you do worst-case scenario first and best-case scenario at the end, you’re likely to think more positively about whatever stressful situation you might be considering.

God

Sapolsky’s end to the book includes references to his beliefs about God – or the lack thereof. He cites evidence from recognized researchers that praying for someone when they don’t know about it doesn’t improve outcomes – though praying when the person knows about it may. This seems like it might be our old friend hope reaching in to lend a hand. (See The Psychology of Hope.) It could be that we evolved to believe in God because it gave us greater belief of our control – through our ability to petition God. (See Spiritual Evolution for more.)

While Sapolsky says that he recognizes that belief in God improves health outcomes, he cannot himself believe in God. This for me is sad. I believe in God because it leads me to be and become the best person I can be. I care very little whether my belief is validated or disproved in the future. The truth of the matter is that my belief helps shape who I want to become. If I’m wrong about my belief, it’s still been helpful to me. Perhaps it is my own placebo. But I’ll take it because it helps me not be stressed. Maybe zebras believe in God and that’s Why Zebras Don’t Get Ulcers.

Book Review-Why Zebras Don’t Get Ulcers – The Psychology and Neurology of Stress

In this three-part review of Sapolsky’s book Why Zebras Don’t Get Ulcers, we walk through the psychological and neurological differences between humans and zebras – at least some of the ones that are important. We started this review with The Physical Impacts of Stress and we’ll finish up with The Causes and Cures for Stress.

There are numerous physiological impacts of stress, but none of them are nearly as interesting as the relationship between stress and the brain. It’s interesting because prolonged stress can kill neurons, and in some cases the neurons that stress destroys are the same ones that are necessary to prevent the additional release of the glucocorticoids that caused some of the problems in the first place.

Preprogrammed Die Offs

Salmon are known for their journey back up rivers from the ocean to the place that they were born. They will swim upstream and go to great lengths just to return to spawn. What is less well-known is that, after spawning, their bodies initiate a sort of self-destruct where their endocrine system dumps large amounts of glucocorticoids into their system and very effectively kills off the salmon. Salmon aren’t alone in this approach to preprogrammed die-offs. In other species as well, when it comes to killing an organism fast, nature’s method seems to be to elevate glucocorticoids.

It turns out that the control the brain has to regulate the production of the glucocorticoids – the main actor in the play of stress – is powerful. Sometimes it’s powerful enough to put people in an emotional hole that they can’t get out of.

Depression

It’s estimated that by the year 2020, depression will be the second leading cause of disability on Earth. It’s more than just “being blue.” While everyone has times that they don’t feel up to it, depression is marked by the inability to feel happiness or joy. While the loss of a loved one can trigger depression, the sadness that we feel after their loss is not in and of itself depression.

People with depression seem to overgeneralize and amplify negative events. They develop a pessimism about the world – particularly as it relates to their abilities in it. (See The Psychology of Hope.) They develop a learned helplessness. (See Mindset and The Paradox of Choice for more on learned helplessness.) The neurophysiology of depression is real. Not only is there the physiological component of higher than normal glucocorticoids, indicating the stress that the depressed person is feeling – between the person they want to be and how they actually feel. However, what’s more interesting is that their reactivity to antidepressants is different than how folks without depression react. In a normal brain, reactivity to the antidepressants occurs within hours – within the mind of a depressed person it can take weeks.

It’s worth mentioning here that there are no easy answers. Glassier spoke about depression in Choice Theory and described it as “choosing to depress.” Certainly, in my experience there are those that give the appearance of wanting to be depressed. The awareness of the psychological components, like over-generalizing negative events, certainly point to the psychological (and therefore influence-able or controllable) nature of depression but the research showing different chemical reactivity of anti-depressant drugs seems to indicate that it’s a chemical problem beyond the control of most people.

One of the concerns for anyone with depression is the tendency for depression to coexist with the risk for suicide. The good news – if there is any when you’re discussing such painful and debilitating topics – is that the natural tendency to do nothing – psychomotor retardation – tends to reduce the occurrence of suicide attempts in people with depression. Despite this, there are still over 800,000 deaths due to suicide each year, so clearly the effect isn’t large enough. Suffering people still believe the only way out of their pain is to end their own lives.

Pain

Of all the useful feelings that we get in our body, pain isn’t likely our favorite. Pain is a warning that you’re damaging (or potentially damaging) your body. It’s a warning signal that something bad is or could happen. It’s an evolutionary tool that motivates us to take steps to protect ourselves. It also happens to be a signal that triggers a stress response.

Pain is, however, a very subjective experience. It’s well-documented that stress can suppress the feeling of pain. Soldiers walk in presenting gunshot wounds with little or no awareness of the problem. Two different people can experience the same event totally differently. How is this, given that the neurology of pain is relatively consistent across humans?

The answer seems to be not that there are radically-varying intensities of pain receptor firing – though there is some of that – but instead, the dramatic difference appears to be the way that the brain processes and responds to pain. Some people at some times can deemphasize the impact of the pain and make it appear smaller.

One of the most powerful drugs known to man is the placebo. Nearly every study controls for its impact, and in most cases its effect size is much larger than that of the actual drug or procedure being tested. (See The Psychology of Hope and The Heart and Soul of Change for more on the placebo effect.) However, the power of the placebo isn’t powerful enough to change brain chemistry.

Are You Down with ACC?

The anterior cingulate cortex (ACC) is the part of the brain that is most responsible for how you feel about pain. It’s not regulating or mediating the actual pain but is instead responsible for the emotions surrounding the pain. Unfortunately, when the ACC is involved, it’s mostly about negative emotions. So ACC activation seems to make people feel worse about the pain. As a result, this is an area that is consistently identified with depression and folks struggling with pain management.

It isn’t, however, the only region of the brain that impacts our emotional state. Negative emotions may be centered in the ACC, but the prefrontal cortex (PFC) is all about moods with a distinct split. The left side of the PFC is associated with positive moods, and the right side of the PFC is associated with negative moods.

Hypothalamus-Pituitary Connection

While the ACC and PFC may be centrally concerned with our emotional experience of pain, the hypothalamus is driving the endocrine bus. It’s responsible for triggering the release of glucocorticoids – in a Rube Goldberg, indirect kind of way. The hypothalamus has a closed-circuit circulatory system that allows it to chemically signal the pituitary gland.

The hypothalamus releases corticotropin-releasing hormone (CRH), which in turn triggers the pituitary gland to release adrenocorticotropic hormone (ACTH) – which is also called corticotropin (thus CRH’s name). Ultimately, the release of ACTH causes the adrenal glands to release glucocorticoids.

These back up the epinephrine and norepinephrine whose release was triggered by the amygdala. These two (along with dopamine) are called catecholamine and have a relatively short lifecycle in the blood stream. They provide the body with an initial burst of power until the body can release corticoids, which can then sustain the stress response for minutes – or even hours.

Storytelling

Have you ever wondered why people like watching scary movies? Who likes being scared? Judging by the popularity of this movie genre, quite a few people. The reason seems to be that they’re wrapped up in the story and that their brains can’t tell the difference between the story that they’re watching and the vulnerability of the actors in the story and themselves. Our brains release the same endocrine wash as if we ourselves were experiencing stress.

Our brains are capable of applying the stress response to both real threats against ourselves and future events that may – or may not – happen. They are, however, seemingly incapable of distinguishing between our real worlds and our fantasy worlds. Perhaps because all of our worlds are at some level a fantasy world. (See Incognito for more.) So whether the threat is real or imagined, today or tomorrow, we can and often do experience stress the same. However, strangely, we don’t look at stress in the past the same way that we look at stress in the current or the future.

Recalling Stress

Have you ever wondered why a mother would want to go through the pain of pregnancy and childbirth again? Consider the pain and stress for nine months punctuating the pregnancy and childbirth process, and continuing as a lack of sleep through the first few months of life of the child. Certainly there are immense positives of having children – but if you were just to consider the stress of childbirth, one would expect that no one would want to do it again. However, mothers have, since the beginning of humanity, voluntarily decided to be pregnant again. Even if you exclude the time when they may not have fully understood how it worked, we’ve got a long history of voluntarily becoming pregnant again and again.

It turns out that we don’t recall stress with the same veracity that we experience it in the present or project it in the future. Maybe it’s rationalization, and maybe it’s just the realization that you made it through, so it couldn’t have been that bad. Perhaps it’s just the lack of sleep that prevented us from properly converting our memories of the stress into long-term memories.

Sleep

Most people believe that sleep time is wasted time. The assumption is that you can’t be doing anything productive if you’re sleeping. However, it appears that this isn’t the truth. It seems like sleep is particularly necessary for the formation of long-term memories and for rejuvenating the brain.

Sleep – particularly slow-wave sleep – is an opportunity for the body to prepare the brain for the active work of the next day. It’s when the trash is swept away and the storehouses of glucose are restored. Interrupting sleep has all sorts of bad effects on the body, including increased stress – it seems like the stress response is shut down during sleep. Things like shift work make it difficult for people to get into a sleep rhythm, and therefore to sleep deeply.

There’s another important aspect to sleep that shouldn’t be ignored. That is the process of integrating memories, or converting them from short-term memories to long-term memories. The rapid eye movement (REM) phase of sleep is when the brain sorts through the memories of the day and makes the decision on where (or if) to file them. If you’ve awoken with the experience of some whacky dreams with just hints of the prior day’s activities, you’ve experienced REM sleep and dreaming.

Sometimes these dreams can clue us into our feelings that we didn’t realize we had.

Repressing Emotion

As a society, we’re more anxious than we’ve ever been. Whether it’s a greater instability in the world and in our lives – or just the perception of greater instability – we are living in anxious times. Anxiety is rooted in a diffuse fear – one that has no clear specific cause. In many cases, our anxiety is because we failed to accept and recognize our emotions. (To understand more, look for the Rider-Elephant-Path in The Happiness Hypothesis.)

Repressing our emotions – or more specifically actively continuing to repress our emotions – leads to stress in the same way that trying to project a different self-image requires a great deal of energy. (See How to Be Yourself for more.) The strain of holding back the emotion has the impact of creating a stress response. Sometimes the stress of holding back our emotions bubbles up in the form of an addiction.

Addiction

As I mentioned in my review of Chasing the Scream, addictions are really the result of some form of hurt bubbling up to the surface in the form of a self-soothing attempt that takes on a life of its own. Instead of learning how to address the pain, we lose ourselves in an addiction.

The research supports this idea. Stress a rat before giving it an opportunity to self-administer drugs and it will become addicted. Don’t stress the rat and it won’t become addicted. That’s not to say that all drug addiction is the result of stress. However, it seems like the stress of these hurts seems to make some folks more susceptible to becoming addicted.

Causes and Cures

Having worked our way through both the physical and mental components of the impacts and actors in stress, it’s time to turn our focus to the causes and the cures for stress, in the next and final post in the series.

Book Review-Why Zebras Don’t Get Ulcers – The Physical Impact of Stress

It seems like an odd thing to want to know. Why don’t zebras get ulcers? Is there something magical about zebras like unicorns that protect them from ulcers? As it turns out, it’s more than just zebras that don’t get ulcers: most of the animal kingdom doesn’t get them. The reason why they don’t is a combination of factors; the most critical, to the book’s point of view, is stress.

I started seeing pointers to Sapolsky’s work across multiple books. Why Zebras Don’t Get Ulcers and his name kept showing up. How Children Succeed mentioned the book directly and others like Grit mentioned Sapolsky’s work on stress and its impacts. Ultimately, it was The End of Memory and my quest to understand more about Alzheimer’s that pushed me to reading about zebras now.

This review will be broken into three pieces. This component, which covers the importance of the impacts of stress and why we’re different than zebras, is subtitled The Physical Impact of Stress. The next portion of the review will cover The Psychological and Neurological Impacts of Stress. The final part of the review will cover The Causes and Cures for Stress.

Let’s get started with the physical impacts.

Mind Over Matter

The starting point when looking at the relationship between stress and the body is to realize that, though there are physiological processes in operation, they are mediated by three factors. The first factor is our genetics – our equivalent of hardware. That is, genes drive our susceptibility and reactivity to stress. The second factor is our experiences. That is, what stressors we were exposed to in utero and after our birth. Surprisingly, stresses during our gestation can influence our outcomes much later in life. The final factor is how our brain manages stress. In essence, this is our software; how we cope with our situation. These three factors each influence our susceptibility to ulcers and other long-term effects of stress. There’s no one factor that can rule out the others. They work together to determine our risk.

With definitive thinking, we assume that if we have one factor, like genetics, then we must accept the outcome. However, as The Halo Effect points out, we live in a probabilistic, not a deterministic, world. We all roll the dice and hope that we get the outcome we want. We don’t directly influence the outcome. We only influence the factors.

However, in this case, one of the major factors is the software, how we process stress. Many years ago, the Intel Pentium processors had a defect in its floating point division. The Pentium FDIV bug was a hardware problem, but one for which software workarounds were devised and used. Software was being used to work around what was a known hardware problem. In much the same way, our brains have the capacity to mediate the impacts of the biology that drives our stress responses and potentially mediate some of the negative effects.

What Stress?

If you’re a zebra on the plains and you see a lion, you’ve got a short time to get away before becoming lunch. The stress response leads you to “flight or fight”; given your odds against a lion it’s pretty much always flight as a zebra. The body mobilizes all of the energy it can to allow you to run faster. This means shutting down anything that is long-term and consumes resources, and it also means taking the biological equivalent of high-interest payday loans to get glucose (cash) into the system – NOW.

It’s a nice piece of evolution. Keep long-term processes running except for the few times that you need immediate results, and in that case shut everything down that you don’t need and borrow against future needs to make sure you have a future.

Humans Can Simulate

This elegant set of evolutionary programming gets disrupted when you add the primate – and particularly human – ability to simulate events and to plan. Instead of the stress response being activated for the eminent attack from a lion, the response is activated when we aren’t sure how we’ll pay the mortgage next month. On the surface, the extra energy seems like a good thing – and it can be – but as you look deeper you realize that all the enhanced performance while in the stressful state must be paid for at some point in the future.

By activating the stress response when we’re thinking about how we’re going to pay the mortgage, we can focus attention on it and plan a course of action. However, at the same time, we’re potentially over-activating our stress response – particularly if we’re constantly worried about how we’re going to pay the mortgage.

Thus, we as humans subsumed a process designed for short-term improvements in performance and have started to engage it for longer-term stressors. The problem is that at some point the debts accrued while being physiologically stressed must be paid for. These “debts” sometimes cannot be repaid, as they’ve already done permanent damage in some cases and created challenges that will recover only if tended to over the long term.

Human Ulcers

The chief criminal in the case of human ulcers isn’t stress. The chief criminal is Helicobacter pylori. Despite decades of scientific belief that stress – and stress alone – caused ulcers, it was discovered that a stomach-surviving bacteria called H. pylori was the root cause. This discovery didn’t come easy when the Australian pathologist named Robert Warren wasn’t believed when he made the discovery. It took him literally ingesting H. pylori and showing that he developed ulcers shortly after this to get the scientific community’s attention and eventually acceptance.

To understand the relationship between ulcers and H. pylori, we first should understand that it can survive in the stomach. Despite the acidic environment, it protects itself with a layer of bicarbonate. With its protective armor on it can live relatively peacefully in the stomach. Where things get troublesome for you and I is when our stomach breaks down just a bit and H. pylori decides that the stomach itself is for lunch.

Our stomachs expend massive amounts of energy protecting themselves from the acidic environment that they create. Our stress response does a relatively rapid shutdown of the energy that’s routed for digestion. Sometimes that rapid shutdown can leave the stomach less protected than it should be. When the stress abates for a bit and power is restored to the digestive system, it starts pumping out acid – sometimes before the protective linings have been fully restored. Some of the stomach is killed by the acid and H. pylori starts its attack.

Homeostasis

In most cases, H. pylori and the stomach are in a state of homeostasis. There’s enough going on in the stomach to keep the amount of H. pylori in check. In fact, in our bodies, there are numerous bacteria that are kept in check. Our immune system doesn’t attempt to totally eradicate them, nor does it allow them to overwhelm the system. They’re kept in a sense of balance. Our digestive tract needs some of these bacteria to function properly. If our immune system were to kill off everything foreign, it finds it would kill off some of the bacteria that we need to survive. If you don’t believe me check out fecal microbiota transplant.

The problem with H. pylori and the ulcers that it causes aren’t the presence of the bacteria – it’s the fact that the systems are out of homeostasis. The problem is that the stress response caused disruption in the balance and started turning the knobs of the immune system response.

Immune System Response

It’s no secret that when you’re stressed your immune response is lowered – except that isn’t the case. In fact, the immune system sculpts its response differently, both in terms of time and in terms of how it’s going to address invaders. Consistent with the idea that it will take payday loans that will ultimately have a high payback cost, it changes in a way that has the highest probability of short-term success at the expense of long-term success.

To understand the impact on the immune system, it’s important to understand there are three kinds of immune response cells. There are the T-cells, which are killer cells that seek out and kill. These are the ninja assassin of the group for short-term quick response. There are B-cells, which are created in the long-term to address specific kinds of invaders. They are the antibodies. The last type, the NK-cells, address tumors and viral invaders. These cells are called Lymphocytes collectively. (-cyte means cell, so these are lymphatic cells.) Shortly after an immediate threat, the T-cells are activated and are engaged to address the problem. This is the short-term spike in the immune response.

However, after a sustained release of the glucocorticoids (which are the main actor in stress, described in detail in a moment), they will start to kill the lymphocytes. It appears that this first affects the older lymphocytes, which presumably are able to destroy the invader. If the condition causes a stress response then it’s probably important enough to let the newer, younger cells handle the job. So, there are less lymphocytes circulating, but the ones that are left should be those most capable of subduing the threat.

Glucocorticoids also encourage the return of the lymphocytes into the lymph nodes, which are the store houses of the immune system. In other words, there are fewer guards out on patrol in the circulatory system to identify and confront invaders quickly.

It turns out that it’s the glucocorticoids that are the main actor in the endocrine system. They’re what happens when we get stressed.

Glucocorticoids

Most of the time when we’re talking about the fight or flight response, we’re talking about adrenaline. (Adrenaline is the British name; in American terms, we’re speaking of epinephrine.) This is the initial “hit” that we get from our adrenal gland. The adrenal gland is triggered to produce epinephrine (and cortisol) through Adrenocorticotropic hormone (ACTH). ACTH is released from the anterior pituitary gland – which was triggered by the hypothalamus. For something that happens very, very quickly, there is a long chain of things that must happen. However, epinephrine is a fast-acting chemical. It gives a short burst of energy that is backed up by the glucocorticoids.

These are steroids that are important in the regulation of glucose – the sugar that powers our biology. The glucocorticoids are what allows us to sustain a heightened rate over minutes or hours. It’s also the glucocorticoids that leave us with the most lingering effects of stress. Because they linger in the body and they have so many effects across our physiology, they have the greatest potential for long-term damage. The most prominent damage isn’t from ulcers – the most prominent damage is a vascular system problem called atherosclerosis.

Atherosclerosis

Our body’s circulatory system runs through the thousands upon thousands of blood vessels traversing our bodies. These are the streets of our circulatory system, and they’re designed to accommodate the normal blood flow that we need. However, there are numerous things that can impact the flow of blood. Inflammation temporarily reduces the carrying capacity of the blood vessels, while plaque buildup more permanently restricts the flow of blood. As it turns out, glucocorticoids play a role in encouraging the naturally-occurring crud floating in the blood stream to accumulate on the walls of the blood vessels. The result is the plaque that causes circulatory problems.

Circulatory problems can be their own issue by reducing the flow of blood to the body, or triggering the body to respond with higher blood pressures – to get the same volume of blood needed through the blood vessels that are smaller than they’d normally be without the plaque. This increased blood pressure causes additional stress on the blood vessels and on the pump at the heart of the system – the heart.

Heart disease can be caused directly because of atherosclerosis, or indirectly through the development of diabetes.

Diabetes

Diabetes is a disease with two basic types which indicate problems with processing glucose in the blood. The first type is when the cells in the pancreas, which produce insulin, are destroyed by the immune system. The second type of diabetes, which is far more common, is where the body develops a resistance to the insulin that is being produced.

Insulin is critical to the absorption of glucose. If there’s not enough insulin in the body – or if the cells resist its effect – then the cells get less energy, causing the body’s response to increase the glucose level in the blood. By increasing the concentration of glucose in the blood, even a smaller fractional percentage of the absorption feeds the cells adequately. This seems like a very useful adaptation – and it is – except that it creates a secondary set of problems.

Excess glucose in the blood makes it sticky, like honey or maple syrup. Thus, the blood is harder to pump through the blood vessels, and it has more “crud” floating in it. This drives atherosclerosis and directly increases the strain on the heart.

Glucocorticoids’ name comes from the combination of glucose + cortex + steroid. The effect of glucocorticoids over the long term seems to be the development of insulin resistance, which drives the body into increasing the glucose in the blood. However, there’s more to the glucose problem than just the direct effect of the glucocorticoids in the blood: there’s also how it changes our habits.

Stress Eating

Dieting is big business. Our natural glucose imperative drives a great deal of our behavior. As an evolutionary mechanism, we are rewarded whenever the brain detects something with high calories. A little shot of dopamine rewards finding the sweet, and therefore sustaining, food. This system works great when food supplies are low and you’re creating a system biased towards finding the least expensive fuel possible. However, in today’s world, most of us are not starving, and don’t need to hunt out sweets – but we still do.

Fighting this urge towards sweetness might be the greatest test of willpower that we’ve ever faced. (See Willpower for more about this fight.) Even folks who have a great deal of willpower in most situations will find that dieting and avoiding sweets will be difficult. One of the times that people struggle with making healthy food choices – as opposed to caloric ones – is when their blood sugar is low. In effect, our prefrontal cortex receives less energy and is partially suppressed – giving the amygdala and hypothalamus nearly uninhibited access to scarf down large quantities of glucose.

The other challenge is something called stress eating – or emotional eating. That is, when we’re emotional – or stressed – we tend to eat more caloric items and in higher quantities than normal – even if we’re not hungry. In short, when we’re stressed, the urge to self-soothe and get little squirts of dopamine is powerful.

Of course, eating more calories than we consume means the body stores those extra calories as fat, and fat further increases insulin resistance.

Heading to the Brain

There are many more impacts of stress on the body, but the next part of the review is about its impact on the brain.