By Carissa Weber, MA, LPC, CSAC

The phrase, self-care, has been said pretty darn often lately. Every social media post seems to talk about “taking time for self-care.” Heck, even my posts talk about self-care (check out mindfulness: the art of becoming calm, cool, and collected) So I feel it is time to answer that question you have: what in the heck is self-care?

Self-care is a broad, blanket term that is simply defined as “the practice of taking action to preserve or improve one’s own health” (Oxford, 2009). Many of us practice this without giving it much thought. For example, did you change your underwear today? That is a way we take care of our health. Did you eat at least one piece of food today? Again, you are preserving your health by doing an action that continues your life.

When we talk about the above definition, we have to understand the why. Self-care is, essentially, self-preservation. Self-care is what we do to keep our bodies healthy, feeling connected to the world around us, and developing comfort with our lives. Without self-care, we simply cannot exist.

The basic building blocks of self-care are: physical, mental, and social. Think about it, these are all needed to maintain a certain level of health in order to keep surviving. Even if we think about our pets, what happens if they are missing one of these things?

With physical self-care (which I think is the easiest type of self-care), there are actions we do to ensure our body can keep living. These particular actions do something to our brains. When our brain (in particular, that darn amygdala), senses we are in stress, it raises the alarm to the rest of the body. If you recall from my post, Fight-Flight-Freeze: the Ultimate Coping Skill, that darn amygdala releases a whole slew of neurotransmitters into the brain that tells our body that we are stressed. When we engage in activities of physical self-care, our darn amygdala tells the adrenal gland that is safe to relax. Do you know what that means? That means our brain releases GABA to calm your body down, glutamate to decrease muscle tension, and dopamine to say “congratulations! You accomplished staying alive!”

There are plenty of things that constitute physical self-care. These things include (but are not limited to):

I bet some of these things you are saying “I do those already.” To that, I say “Thank you!” When we engage in these activities on a regular basis, we do a couple of things for our brains. First, we are establishing a routine our hippocampus can store into memory. Second, that memory then allows that darn amygdala to know what to expect next, which decreases symptoms of anxiety. Third, the prefrontal cortex can use these items of self-care to check the facts to prove to that darn amygdala that the world is not coming to the end. Fourth, the insula (remember, the part of our brain responsible for coordination), becomes more active. This means we are developing muscle memory and are less likely to forget how to do something. Finally, we increase the size of our hippocampus. Whoah, that is a lot of benefits!

Think those benefits are awesome? I haven’t even gotten to the part of mental self-care! Mental self-care is exactly that: things we do that take care of our emotional health. Just like we talked about above, when we are experiencing stress or burnout, the stress neurotransmitters and cortisol are having a hay day in our brain. When we engage in just 15 minutes of mental self-care on a daily basis, we are:

• Increasing the size of your hypothalamus, which allows us to recall memories faster
• Decreasing our heart rate, which slows down the production of cortisol
• Releasing serotonin into our brain
• Reducing the activity in that darn amygdala
• Increasing the activity in our prefrontal cortex
• Improving the oxygen exchange rate, which decreases the triple F response
• Releasing endorphins which decreases our physical bain levels while feel good at the same time

I told you that there were going to be more benefits! Now, what constitutes as mental self-care? I’m happy you asked! There is a whole list of them (again, this is not an all-inclusive list:

I know we have talked about how participating in both physical and mental self-care can change your mental health, but there are more changes to come! We also have to take care of our social health. Social health is when we participate with the people (or pets) around us. When we engage with the people around us, we release the neurotransmitter, oxytocin. This amazing little neurotransmitter helps us feel connected and safe with the people around us. It also aids in creating an emotional bond and trust. The best part of oxytocin? It helps our darn amygdala remember that we are accepted and appreciated. I bet you can take a guess what that does for our self-esteem, confidence, and overall mental health. You got it! It boosts it all!

When it comes to boosting oxytocin, there are activities we can engage in. Even engaging in these activities for a mere 20 minutes a day can reap all the above benefits. These activities include (but not limited to):

• Petting an animal friend
• talking with someone you care about
• validating someone’s feelings
• Engaging in volunteer opportunities
• Spending one-on-one time with someone important in your life
• Participating in a club/sport with other people

Looking at these lists, you may notice something. There is a bit of overlap. Why is that? Because many of these activities can release more than just one type of feel good neurotransmitter. For example, if you go horse riding with a club of friends, you are releasing dopamine, oxytocin, and serotonin all the while releasing endorphins. Isn’t self-care awesome!

Now, if you are super busy (like me), you may think self-care is one thing you can sacrifice to make the rest of the demands placed on you. Let me tell you now: YOU CANNOT DO THAT!! Remember that post I did on burnout? Yeah, that happens if you don’t take time for self-care.

But when the heck do I find the time to do self-care? Great question! As we have talked about in all of my other posts, we know it takes 66 days to make anything a habit that sticks. Many of these self-care things are things you are already doing. But what about the things I know I need to do but can’t find the time to do it?

That is where those famous SMART goals come in to play. In case you missed them, SMART goals are goals that are:

• Specific in intention
• Measurable (meaning they have a time frame to complete them)
• Actually attainable
• Realistic in nature
• Trackable

These goals are super beneficial when you are trying to create a new habit because they start small and build off of the progress you area already making. By setting one small self-care SMART goal each week, you are preparing your brain to release dopamine (because you accomplished something), serotonin (because there was joy in that accomplishment), endorphins (since you got your body moving), and maybe even some oxytocin (if that goal connected you with people).

Let’s look at an example, shall we? Let’s set the SMART goal of brushing our teeth five times in one week. It is a simple goal, but if your depression is reigning supreme, it is a tough one. This goals is a SMART goal for the following reasons:

• S – it is specific (we will brush our teeth)
• M – We can measure if we meet this goal (by putting a number on it, we can count if it gets done or not)
• A – We know we can meet this goal (missing two days isn’t that bad, right?)
• R – This goal is realistic (especially since the dentist says we should be brushing twice a day and flossing to boot)
• T – We can track the progress towards this goal (we can mark it in a calendar when we did brush our teeth)

Using SMART goals can be helpful when we are trying to make self-care a regular kind of thing in your life. This, along with understanding the things that energize you (like food, friends, or quiet time), will help you make a change in your mental health journey for the better. Thank you so much for taking time with me to learn about why self-care is so important.

Bonus Material

References

• Bell, T (2020). Brain Chemistry: The Importance of Self-Care. Retrieved from https://www.solutionpsychology.com.au/brain-chemistry-the-importance-of-self-care/
• Hassan El-Ghoroury, N (2015). Self-care for the scientist. Retrieved from https://www.apa.org/gradpsych/2015/09/matters
• Joshi, Meera (2017). How Does Mindfulness Affect the Brain? Retrieved from How does mindfulness affect the brain? (bupa.co.uk)
• Powell, Alvin (2018). When Science Meets Mindfulness. Retrieved from Harvard researchers study how mindfulness may change the brain in depressed patients – Harvard Gazette
• Simpson, J. A., Weiner, E. S. C., & Oxford University Press. (1989). The Oxford English Dictionary. Oxford: Clarendon Press. Retrieved from https://languages.oup.com/google-dictionary-en/

Image sources

• Carissa Weber at www.thatdarnamygdala.com
• Breanna Dlask at Breanna Dlask Photography
• Colton Nieman at The_Natural_Perspective
• www.pexels.com

By Carissa Weber, MA, LPC, CSAC

Have you ever noticed how hard it is to say “no?” Why is that? I know many of us (including myself) struggle with the idea that we are able to (and sometimes have to) say no. If you are one of those people who struggle with that famous 2-letter word, this post is just for you!

Although not officially a DBT skill, the art of saying “no” could very easliy be considered one. Why? Well, let me tell you! Saying that formitable word fits right in with interpersonal effectiveness skills (like maintaining healthy and respectful boundaries with people). It also takes a hint from distress tolerance skills (oh you know, like identifying what you don’t need), and helps identify with emotional regulation skills.

The art of saying “no” could also very well be part of the CBT skill set as well. This simple phrase can be seen in Socratic questioning (and understanding why no is a great answer to some questions), identifying unhealthy thought patterns that make it hard to say “no,” or even using facts to calm down that darn amygdala. Regardless of what skillset you want to use, being able to say “no” has to start with PRACTICE!

Where in our brain is it that makes this polite decline so hard to say? Well, like so many other research I have done, there is minimal research out there on the impact of this word on the brain. So, naturally, I explore the alternatives. After a few weeks of researching, I discovered there was more research done on the anticipation of rejection than there was on hearing this two-letter rejection.

Rejection is a powerful emotion. Even just hearing the word invokes a response. According to The University of Michigan, rejection plays a huge role in saying “no” as well as in hearing the word “no.” What role is that? The role of pain.

In 2013, U of M showed that being rejected (for example, when we hear “no”) creates a reaction in the brain identical to physical pain. Say what? You got it! If we hear “no” when we weren’t prepared for it, our darn amygdala processes the emotion the hippocampus sends to it (in this case, rejection) and triggers a new part of our brain. This new part, called the pregenual cingulate cortex, plays a pretty big role in identifying our moods based on events we are experiencing.

Quick note: the pregenual cingulate cortex is located between the frontal lobe of our brain and the hippocampus. It wraps around that darn amygdala and helps it confirm or deny the feelings we are experiencing. When you are struggling with depression, brain activity is significantly stunted in the pregenual cingulate cortex, which is why scientists believe this may be why we struggle with apathy when we are depressed. The pregenual cingulate cortex also helps us apply what we learn to situations.

Okay, back on track. After that darn amygdala recognizes the emotion we are experiencing, the pregenual cingulate cortex says “holy cow Batman! You are experiencing pain! Let me fix that!” How does it fix that? Simple. It triggers the release of the neurotransmitter, endorphin. If you recall from my post, Neurotransmitters: The Language of the Brain, endorphins are responsible for decreasing the sensation of pain. It does this by releasing a chemical in our brain called opioids

Before you go “I didn’t take any drugs!” let’s talk about opioids that naturally occur in the brain. This naturally occurring opioid is known as mu-opioid. When we are in pain, physical pain, our brain releases mu-opioids into our brain to help reduce the pain. For example: runner’s high. When the endorphins release when we run, it is trickling mu-opioid into our brain that says “this isn’t so bad, keep going!”

The same mu-opioid is released when we are experiencing rejection. For some people, their brain releases more mu-opioid than others. How can we tell? When we say “no” to someone and they say “that’s okay.” While the next person goes “why don’t you love me?” we know the first person is getting more mu-opioid based a: on their acceptance of our response, and b: when we stick their head in an MRI the pregenual cingulate cortex is light up like a Christmas tree. The latter response of, “why don’t you love me?” Not so much.

So now that we understand why it is hard to hear “no,” why is it hard to say it? Think about it. When we are denying someone their request, we are ultimately dishing out rejection. Our hypothalamus and hippocampus remember what rejection feels like. For those people pleasers out there, the feeling of rejection can be as painful as a busted arm. Why would we, a good person, reject someone?

Our brain has a way of protecting us. By using a cognitive distortion (oh like the example of overgeneralizing above), our darn amygdala is trying to protect us from any sort of pain and discomfort by justifying what the pregenual cingulate cortex is doing. Sometimes, those cognitive distortions end up costing us something: like our self-esteem, money in lots of cases and perhaps even a busted arm.

Have you ever noticed when your self-esteem really sucks that it is harder to say no? When our self-esteem is shot, so is our pregenual cingulate cortex. It isn’t firing like it should, which helps that darn amygdala do whatever it kinda feels like. To protect ourselves from feeling rejected, we tend to compromise our boundaries, time, and energy to ensure people will not reject us. Boss asks you to stay late? Of course you will! Kids are screaming they want something different than what you cooked for dinner? To get them to shut up and eat, of course I’ll make a second (or third or fourth) meal. Wish someone would tell you that you’re amazing? I will jump tall buildings in a single bound to hear it!

The thing is, all of this external validation we are trying to get makes our brain give us the feel good neurotransmitters we are craving to kick-start our brain into gear. That is why we love receiving praise from people that we are doing a good job. The issue with external validation is we cannot count on it. Let’s use covid for example, shall we? How many of us suddenly started working from home, homeschooling our kids, learning new ways to shop and interact with people, all while working during a pandemic? How did it feel when your boss gave you a certificate to order pizza? I don’t know about you, but that pizza party came about one year too late!

Coping Skills Alert!

This late external validation can also come across as feeling rejection. So how do we handle the most powerful two-letter word in the dictionary? Despite popular belief, avoiding people when we want to say no is not the answer (shock and awe!). This simple two-letter word is in our human dialogue for a reason:

• It helps us provide a natural boundary for when we need time to recharge our energy
• It allows us to participate in activities that are more in tune with our goals, our beliefs, and our safe support network
• Make our needs known (and meet them)
• Taking back the power and control over our mental health, and most importantly, our life!

Simply put, No is a powerful action word. In order to use this word, we first must know what our needs are. Needless to say, self reflection is crucial in order for us to be comfortable saying no. How do we do this? We have to use one of the many skills we have already talked about the practice slowing down one and thinking before we offer an answer. STOPP is one of my favorite skills to use the help identify what our needs are! Another one would be wise mind.

Once we know what we need, we next need to use our interpersonal effectiveness skills to be able to clearly, assertively, and respectfully decline a person’s request. Keeping our communication clear and assertive will ensure we are being as nice as possible about saying no. For all those people who like the phrases “I don’t know” or “maybe” or “I’m not sure,” that isn’t clear. If anything, this releases the stress hormone, cortisol, and the person you’re communicating with, increasing their own symptoms of anxiety.

“No, in itself, is a complete sentence!”

– Carissa Weber

Another thing to keep in mind about clear communication is that you don’t necessarily have to elaborate as to why you are saying no. No, in itself, is a complete sentence! Think about that for a moment. The answer no is a complete sentence. If you feel compelled to explain why you are unable to say yes, keep your explanation to the point. You don’t need to go over how your aunt’s dog is sick. If it doesn’t entail direct information as to why you’re saying no, you don’t have to say it.

If you can’t get over your people pleasing just yet, this would be a great time to offer the person you are saying no to an alternative that is respectful of your time, your boundaries, and your own needs. For example, if I have a friend who wants me to hang out at the same time I already have something else scheduled, I can show gratitude for the offer and extend the alternative that we hang out on a different day. This alternative is respectful of my time and my plans I already had in place, but allowing someone to know I would have availability on a different day.

Saying no will be tricky and uncomfortable at first, especially when you’re use to being a “yes-man.” Remember, it takes 66 days to change a routine. You know what that means? You got it! That means you actually have to practice saying no on a regular basis for it to feel comfortable, safe, and overall, confident.

I want to thank you for allowing me to help you gain confidence in the ability to say no. This is something we all struggle with at some point in time. It is my hope for you that this information will help you gain the understanding as to why no is hard to say all while gaining confidence in being able to say it.

References

• Bohns VK. (2016). (Mis)understanding our influence over others: A review of the underestimation-of-compliance effect. Revtrieved from
  ecommons.cornell.edu/bitstream/handle/1813/74812/Bohns1_Misunderstanding_our_influence.pdf;jsessionid=34E1889FF25CD08EA193888E012A83B5?sequence=1
• Kross E, Berman MG, Mischel W, Smith EE, Wager TD. Social rejection shares somatosensory representations with physical pain. Proc Natl Acad Sci U S A. 2011 Apr 12;108(15):6270-5. doi: 10.1073/pnas.1102693108. Epub 2011 Mar 28. PMID: 21444827; PMCID: PMC3076808. Retrieved from https://pubmed.ncbi.nlm.nih.gov/21444827/
• Nicola Palomero-Gallagher, Felix Hoffstaedter, Hartmut Mohlberg, Simon B Eickhoff, Katrin Amunts, Karl Zilles, Human Pregenual Anterior Cingulate Cortex: Structural, Functional, and Connectional Heterogeneity, Cerebral Cortex, Volume 29, Issue 6, June 2019, Pages 2552–2574. Retrieved from  https://doi.org/10.1093/cercor/bhy124
• Roberts, Nicole (2015). Rejection And Physical Pain Are The Same To Your Brain. Retrieved from https://www.forbes.com/sites/nicolefisher/2015/12/25/rejection-and-physical-pain-are-the-same-to-your-brain/?sh=6a901b514f87
• Tartakovsky, Margarita (2021). How and When to Say No. Retrieved from https://psychcentral.com/lib/learning-to-say-no

Image Sources

• Carissa Weber at www.thatdarnamygdala.com

By Carissa Weber, MA, LPC, CSAC

Welcome to the third installation of interpersonal effectiveness skills! I’m so happy you were able to join us and learn more about how these set of important skills can:

• Improve how we interact and communicate with the people (and the world) around us
• Identify and ask for our needs to be met in a respectful (and assertive way)
• Gain the ability to remain responsible for our own reactions, not for others

In this post, I will be talking about a crucial part of interpersonal effectiveness: self-respect. Now, this may be a touchy post for people to read, mostly because a lot of us struggle with this novel idea of respecting ourselves. Don’t worry! This post is designed specifically to help you start to take those small steps to recognize where you deserve self-respect. You ready for it? Let’s go!

Self-respect has become an infamous sign of not loving ourselves. This is a common (and dare I say popular) belief that is taking over our world. By nature, humans are people pleasers and strive for acceptance and love. When we feel rejected or abandoned, it is easy to turn our frustration inward. This frustration soon fuels that darn amygdala to do something about it. Unfortunately, what that darn amygdala does is something we don’t like.

That darn, stubborn, and impulsive amygdala does not like rejection. It turns to our good friends, cognitive distortions, to figure out why we were rejected. As you recall from my previous posts, that darn amygdala asked FAST to keep us safe. Sometimes, that darn amygdala justifies its actions by pointing out things about ourselves that we truly dislike.

This, in turn, initiates the process of creating negative core beliefs about ourselves. The more our darn amygdala feels rejection, avoidance, or even conflict from people, the more strength those core beliefs gain. Now, some of you may be saying “I get that Carissa, I know how to challenge that.” But do we really? When you look at the stats out there, 85% of adults world-wide (that’s right, world-wide) report issues with their self-esteems (Nyguen, 2019). That number is massive!! Negative core beliefs and the reaffirmation of them through how our darn amygdala filters information leads to how we view ourselves and how we should be treated by people around us.

For those of you who got the opportunity to miss out on the formative years of being a teenager, self-esteem is having confidence in your own worth and abilities. We have all experienced, at some point in our lives, being unsure of ourselves. But if you find yourself constantly doubting yourself, avoiding doing things you are unsure of, or even saying hurtful things about yourself, you may have low self-esteem.

Anyways, back on track. A study was done in 2017 by UCL (University College of London) to track where self-esteem originates in the brain. When study participants were faced with negative situations, like rejection, as well as positive situations, like being accepted, what researchers found was pretty darn cool: people who struggled with a sense of self had lower function in their prefrontal cortex. In fact, only one part of their prefrontal cortex lit up like a Christmas Tree: the Insula. What the heck is that? The insula is this amazing part of the brain that is responsible for self-awareness: both physically and emotionally. It can support spatial awareness, taste, sensation, and processing pain. It also plays a huge role in addiction, but that is for another time.

When we have low self-esteem (in turn, now self-respect), the insula is totally confused about what it needs to do because it is receiving information from the thalamus (thanks to the filtering of that darn amygdala), that we are in pain and afraid. This makes us question what we really need because the sensory input doesn’t match the message that darn amygdala is sending.

What was interesting in this study is people who had a stronger sense of self and confidence in their ability had less insula activity and more prefrontal cortex activity. Even when they were experiencing rejection, their prefrontal cortex was still able to remain in control. Notably, these are the same test subjects that shared they felt good about themselves and what they believed.

So how does this trace back to interpersonal effectiveness skills? Have you ever heard of the saying “treat others the way you want to be treated”? We often treat people with respect, but do not extend the same curtesy to ourselves. When our darn amygdala has the insula in hyperdrive, we really get hard on ourselves and start hating everything wrong with us. Here is a news flash: we all have stuff wrong with us!

Using self-respect in day-to-day life is crucial as it safe guards us against several things:

• maladaptive coping skills like using illegal substances, choking that annoying co-worker, or self-harming behavior
• overstepping boundaries we need to keep to maintain our physical and mental health
• Engaging in unhealthy relationships
• Ignoring our basic needs in order to be accepted
• Increase symptoms of anxiety and depression

As we start to engage in self-respect, we are acknowledging we have basic human needs, just like everyone else. Self-respect allows us to be fair to ourselves while being respectful to other people. Self respect gives us the ability to be honest and assertive when communicating with people around us. Lastly, self-respect gives us a chance to become comfortable in our own skin.

Self-respect is more than just how comfortable we are with ourselves. It is also how we portray ourselves to people. Think about it for a minute. How we communicate to people around us (you know, like taking responsibility for ourselves and our actions) says a lot about the comfort level we have with ourselves. It is also the base for developing trusting relationships. Self-respect is one of the most important things we can develop.

Coping Skill Alert

One way we can assure we have self-respect when we communicate with other people is to follow the rule of FAST. This rule will help you be kind to yourself, while not taking on more responsibility than you need to in order to keep a relationship healthy. What I love about FAST is it is a road map to check in with yourself to ensure you are treating yourself with the same respect you are showing other people.

Like every other good therapy skill, FAST is an acronym (I bet you’re loving acronyms by now!). Let us dive in and start taking a look!

First, the letter F. F stands for treating yourself fairly. In conversations, people who struggle with self-respect tend to become passive about their needs. Maybe you have put other people’s needs before your own, even if you have a legitimate need and the other person has just a want (are you feeling called out? It’s okay, I just called myself out)? Perhaps you talk down about yourself or even down play your own natural abilities (like that amazing talent of knowing where everything is in your house?)? When we treat ourselves fairly and acknowledge our needs, we are giving ourselves permission to be human.

The letter A is more of a don’t do. A stands for apologies. Are you known for excessively apologizing? Do you even apologize to the wall when you walk into it? I know I have done it. When we over-apologize, we invalidate our own experience. We also give that darn amygdala information that confirms those pesky core beliefs and tear down our self-esteem. Now, apply that to a conversation with a person. We are carrying all of this unnecessary weight in the hopes that someone will validate us. Don’t get me wrong, we need to apologize when we really are in the wrong (like me eating the last piece of chocolate after realizing it was promised to one of my kids), but over-apologizing continues to leave us in a cycle of worthlessness and depression.

I really love S. S is the beginning of sticking to your values. As we’ve pointed out in earlier posts, humans are herd animals. We crave acceptance from the people around us. Unfortunately, at times, this means we sacrifice our belief system in order to be accepted and validated by those around us. DON’T DO THAT! Part of having relationships with people mean there will be conflict. Shoot, there may even be judgement. But that is okay. Know why? Because every person is an individual. We are allowed to have differences in opinions, to value different things. We can be respectful how we share (or hear) another’s value system. You are a human and have the right to be true to who you are!

Last, we have T. The letter T in FAST represents truthfulness. Even though being honest in a conversation is a gimme, let’s talk a bit more about what truthfulness looks like. When you are talking to a person, we are relaying information that represents you and your experience. If you are over-exaggerating, omitting crucial pieces of your experience, or even tell that “little white lie” to spare someone’s feelings, you are not being honest. When the person you are communicating with discover these little discrepancies, their trust in you will be tested (or broken depending on how big the lie is). When we come out and are authentic about who we are and why we need what we need, it allows another person to help us. Talk about a respect builder!

This post contained a lot of information about the importance of self-respect! I want to thank you for letting me help you on your journey towards mental health. Some parts of this journey are not comfortable, but these are the parts that allow us to grow!

Bonus Material

References

• Jan Will, Geert, Rutledge, Robb, Moutoussis, Michael, Dolan, Raymond (2017). Neural and computational processes underlying dynamic changes in self-esteem. Retrieved from https://elifesciences.org/articles/28098
• Nguyen Dat Tan, Wright E. Pamela, Dedding Christine, Pham Tam Thi, Bunders Joske (2019). Low Self-Esteem and Its Association With Anxiety, Depression, and Suicidal Ideation in Vietnamese Secondary School Students: A Cross-Sectional Study. Frontiers in Psychiatry,10, 2019, pg 698 https://www.frontiersin.org/article/10.3389/fpsyt.2019.00698
• Linehan, M., M., (2014). DBT Training Manual. New York, NY: The Guilford Press.

Image Sources

• Carissa Weber at www.thatdarnamygdala.com
• www.pexels.com