My daughter logged in the hours drawing this picture and my sister-in-law logged in the hours coloring it.  Enjoy!

From my quirky clan to yours - Happy Holidays and Happy New Year!

Beliefs and Placebo Response

The trick is not to be scared of our own power - defined as the ability to get things done.   I'm not saying to deny that you feel scared. I am saying don't be paralyzed or outdone by it.

We are stronger than the fears that arise. The fears may be triggered by our mistaken negative thoughts, internalized oppression, and negative core beliefs about ourselves, others and the world.

Somebody may have told us that we couldn't, or that we didn't matter or that it was impossible for us. But what if we refused to believe that? What would we accomplish then? What would that vivid and beautiful reality be like? What would be the picture in our minds eye if we believed that were true?

My mentor, Roberto Gutierrez, tells me all the time that 50% of the work is visualizing it. The rest is doing the work, overcoming obstacles and persisting through setbacks. The miracle is that it can be done. Can you see it? Are you willing to take what you imagine and make it real? What would that feel like? What would that be like when you take what you imagine and make it real? What would the people that you care about do in the service of your dream? What would they do to help you make your vision real?

So this might all just be cheese to the average cynical skeptic. But when I read about the powerful "nuisance" that the placebo response is causing to pharmaceutical companies, I smile and think that what they consider as "noise" or interference in their clinical drug trials may in fact be the power of our own beliefs to heal ourselves at work. Placebos are beating out new drugs, and established drugs for that matter, in clinical trials.

In light of what we are learning about the placebo response, I have all sorts of questions: What are the biological changes that occur as a result of feeling hopeful? What are the biological effects of fear, negativity and hopelessness? Do we fully know and understand the capacity and limits of our innate ability to heal ourselves?

     "In a study last year, Harvard Medical School researcher Ted Kaptchuk devised a clever strategy for testing his volunteers' response to varying levels of therapeutic ritual. The study focused on irritable bowel syndrome, a painful disorder that costs more than $40 billion a year worldwide to treat. First the volunteers were placed randomly in one of three groups. One group was simply put on a waiting list; researchers know that some patients get better just because they sign up for a trial. Another group received placebo treatment from a clinician who engaged in small talk. Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition.
     Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief - widespread in the pharmaceutical industry - that the placebo response is short-lived."

I understand how some patients might "get better just because they sign up for a trial."  It reminds me of when my friends tell me they feel better about a stressful family or work-related problem just by making an appointment with an expert to address it.

I wouldn't call the third condition a "sham treatment" especially when some of the elements described sound like health education or psychoeducation.  Also, there may be a lot going on therapeutically when a clinician displays "optimism" about a patients condition - beliefs, mirror neurons, health effects of optimism, etc.?

I also imagine the thoughts, beliefs and expectations of patients coming to Harvard (!) for a clinical trial as compared to how they feel at their regular health care facility.  "I am going to get world-class treatment!"

So how do we harness the power of our own beliefs to heal ourselves?  Especially in light of their well researched power to best medications.  How do we infiltrate our modern culture with these age old practices of confidence, beliefs, credibility and hope?  How do we consciously and consistently pair these elements with evidence-based interventions and treatments?

When I fell and hurt myself as a kid, there was always someone near who would say to me, "sana, sana colita de rana, si no te alivias hoy, te aliviaras man~ana."  This nursery rhyme of healing words and their intention always helped a little.  How far can we push the limits and capacity of words and hope now?

Reference:  The Placebo Problem by Steve Silberman from Wired and published in The Best American Science Writing, 2010.

Five Essential Elements for Mass Trauma Intervention

"We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting:
1) a sense of safety
2) calming
3) a sense of self- and community efficacy
4) connectedness and
5) hope."

Hobfoll, et al. (2007). Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. FOCUS, 7 (2), 221-242.

I am on a committee of the National Child Traumatic Stress Network (NCTSN) to develop a fact sheet for different audiences about coping with economic downturns. To complement the solid content developed by academicians and community providers, I wanted to add quotes from teachers to bring the information to life. So I reached out to the dedicated educators I know. What they are sending reads like inspiring poetry. I would read it to you, but I get choked up when I do. Thanks and God bless all the responders represented below:

• I feel a sense of safety when... my son is with me.
• I feel calm when... I listen to music.
• I feel I can handle challenges when...I have a plan.
• I feel connected when... I'm with my family or friends.
• I feel hopeful when... my son says " Mama when I grow up..."

• I feel a sense of safety when there are clear boundaries and rules, and those around me are also following them.
• I feel calm when my physical environment is orderly.
• I feel I can handle challenges when I know I have time to make mistakes.
• I feel connected when I receive public kudos.
• I feel hopeful when I am rested, ready, and looking at a short to-do list :).

• I feel connected when people listen.
• I feel calm when I'm on vacation with no to do lists. :-)

• I feel a sense of safety when the work day is over and I'm home.
• I feel calm after I read the Scriptures.
• I feel I can handle challenges after I slow down and pray for strength.
• I feel connected when I make time to spend it with my loved ones.
• I feel hopeful when years later my students come back and tell me what their educational goals are.

• I feel calm when I'm doing the dishes (!) and making art.
• I feel a sense of safety when someone acknowledges that I've done a good job.
• I feel I can handle challenges when I've had time to think about the problem first - even if it's only a short while.
• I feel connected when other people work with me on a solution to a problem or to create something new.
• I feel hopeful when I see progress in something I was working toward - or when a break is coming and I know I'll have time to distance myself for a little bit and come back recharged.

• I feel a sense of safety when I'm at home.
• I feel calm when there's nothing pending.
• I feel I can handle challenges when I have my husband's support.
• I feel connected when I'm with my family.
• I feel hopeful when I go to church.

• I feel a sense of safety when I have positive relationships with others.
• I feel calm when I am prepared and my environment is orderly.
• I feel I can handle challenges when I am supported.
• I feel connected when I have a mutual participation in community.
• I feel hopeful when work is completed and I work with others.

Wanna try this sentence completion activity and add to the list?

Do We Believe We Can?

According to Bandura, the concept of self-efficacy asserts that expectations of personal mastery are the primary determinants of changes in behavior.

(Do we let our beliefs make us give up before trying? Or do we try in the firm belief that we can do it.)

Expectations of self-efficacy determine the initial decision to perform a behavior and the amount of effort to expend in the behavior, as well as the amount of persistence in the face of adversity.

(Do we let our beliefs make us quit trying too soon? Or do our beliefs make us refuse to give up no matter what, until we get to where we choose to go?)

Self-efficacy has a direct influence on the choice of activities; people avoid situations that they believe they cannot cope with and become involved in activities they feel capable of handling.

(It is one thing to avoid something that we don't want - that is self-determination - that is us choosing our own behaviors, path and destiny. It is quite a different thing to defer our dreams because someone done told us that we were not capable of handling it. To which I say on our behalf - Fuck 'em. Continuing to believe that baloney after that person is / those persons are long gone is what I would call internalized oppression. Yes, that means now we are doing it to ourselves - holding ourselves down. To which I say on our behalf - Fuck 'em.)

The stronger the perceived efficacy, the more effort is expended in an activity. Those who persist in threatening situations and master the experience gain efficacy reinforcement, whereas those who choose to avoid threatening situations or cease their activities early reinforce negative efficacy expectations (Tollett et al, 1995).

If we believe that we can, then we will choose to try.
We will dig deep and double our efforts. We will persist - "do it or die trying."
Most of the time the only difference between success or failure is whether or not we give up (sure failure) or persist.
Because we refuse to give up, we will achieve whatever it is we set out to do.
Undaunted by obstacles and barriers, we overcome or cope with these stumbling blocks by problem-solving, trouble-shooting, and just plain figuring-it-out. However. long. it. takes.
This accomplishment gives us a sense of competence, mastery, confidence and control.
The next time we are faced with a choice to try something new, a sense of accomplishment from past experiences makes it more likely that we will give something new a shot again.
We are developing a track record of success. We are amassing evidence to support our belief that we can do it, through the expenditure of enough energy (work) and the logging of enough hours.

Let's Talk About It for Good Health

Facilitating open communication between parent and child is a worthwhile treatment goal when addressing childhood trauma.

Openness in discussing one's emotions is often described as an essential component in coping with anxiety that may be associated with distressful events.

Many theoretical perspectives, such as psychodynamic and cognitive-behavioral theories, hypothesize a direct relationship between healthy coping and openness in disclosing information about one's emotions and feelings.

Research supports the theoretically defined relationship between disclosure of emotions and healthy coping. Talking about feelings associated with traumatic or distressing events is linked to psychological well-being, improved functioning, better self-reported health, and better immune responses (Lutz, 2007).

Family members may be out of sync about willingness to communicate: one may continue to be quite upset as others feel ready to move on.

A breadwinner, caregiver, or single parent may suppress strong emotional reactions in order to keep functioning for the family; children may try to help by stifling their own feelings and needs or trying to cheer up parents.

Communication processes foster resilience by bringing clarity to crisis situations, encouraging open emotional expression, and fostering collaborative problem-solving.

It must be kept in mind that cultural norms vary considerably in the sharing of sensitive information and expression of feelings (Walsh, 2003).

It has been my clinical experience (working with parent and child dyads) that these difficult and often painful conversations need a clinician to mediate or facilitate the exchange in a therapeutic session if the conversation is to occur at all and be successful - with rewards that are worth all the effort.

IHI: Defining Quality: Aiming for a Better Health Care System