BLOG: Embrace emotional dysregulation and attain clarity
Click Here to Manage Email Alerts
We are all called to make innumerable decisions every day, especially in surgery. Trouble is, many of us decide courses of actions in haste or amidst fear, fatigue or brain fog.
We are most wise when we are calm and collected, when our minds are free of all the “static” that can cloud clarity. We can all learn techniques which can help us to become centered and engage in our best mind.
Wise mind
Marsha M. Linehan, PhD, a noted psychologist and founder of Dialectical Behavioral Therapy (DBT), introduced the concept of “wise mind,” which is a state where optimal decision-making prowess is attained. Wise mind lies between “emotional mind,” where our feelings predominate, and “reasonable mind,” where facts and rational thinking have primacy. In wise mind, we are aware of our emotions, but we also consider the facts and the implications for long-term effects. Decision-making ability is greatly potentiated when we can balance our emotions with reason.
When purely in reasonable mind decisions are ruled by logic, facts, reason and pragmatics. Yet ignoring our feelings and emotions may betray our intuition and core values. In addition, a decision based solely on reasonable mind forfeits any consideration of joy and love, two powerful and sustaining virtues.
Consider buying a home that has a suboptimal price, inadequate size, overly modern design and maintenance issues. However, your wife loves the home and the neighborhood. Wise mind incorporates meaningful inputs to arrive at an effective solution.
Emotion mind is ruled by feelings, moods and urges to say things. However, decisions made purely on emotion can lead to poor outcomes and damage relationships resulting from poor impulse control. Consider the angry boss who terminates an employee over one indiscretion. The boss’s rage blinded him or her to the facts of the employee’s several years of dedicated service and that the employee was dealing with a personal serious illness.
Wise mind affords us the capacity to think, feel and act from a balanced perspective and to be true to our values and goals. When we are in wise mind, we may feel more objective and detached from a decision but feel more at peace once a course of action is taken.
You will know when you attain wise mind when you can reach the point that essentially proclaims, “I feel and know what to do.”
For those of us who believe in a higher power, many of the great spiritual writers encourage a “centering prayer” where we can quiet our minds and connect to our “source.” Meher Baba is a venerated spiritual teacher in India who has been known to say, “a mind that is fast is sick, a mind that is slow is sound, and a mind that is still is divine.” ’If you practice a particular religious tradition, you will certainly connect to your source, and wise mind, far more readily in a quiet, mindful state.
How to cultivate a wise mind
How do we cultivate a wise mind? Like me, you likely need to devote time in regulating emotion mind. The following practices have greatly helped embrace emotional dysregulation and gain clarity.
- Dedicate quiet time every day. A daily “silence practice” will help us slow our minds and help us to escape the barrage of dysfunctional thinking. Mindfulness practice helps us to become aware of racing thoughts without taking stock of their content. Our brains can become rewired for more focus and purpose with practice and there are many great books on the subject.
- Create a thought record. A gifted cognitive behavioral therapist years ago taught me how to write down troubling thoughts and answer them with evidence (or lack thereof). We are all subject to cognitive distortions which can consume us and generate poor moods and anxiety. When we write down these thoughts and challenge them, looking for evidence, we usually find our worries are without substance. I recently beat myself up over a surgical complication for which there was no evidence I caused. Many sources are available to learn how to overcome dysfunctional thinking, and I have found Dr. Burns’ handbook especially user friendly.
- Get away. Stressful events can affect all our thinking as we descend into a principally emotion mind operating system. When we limit the adrenaline provoking thoughts, with even a short respite, we can return to wise mind much more readily. It is amazing how I see all of life differently when my wife and I frequent our modest condominium at the New Jersey shore.
- Go on a retreat. The two most consequential decisions of my life were choosing a bride and a vocation. For each, I invested into a weekend long religious retreat where I was able to quiet my mind in addition to gaining perspective from a priest whom I trusted. The result was all aces! I love my vocation and soon my wife, Marie, and I will be celebrating our 37th wedding anniversary. Taking the time to get away and to quell the cascade of overflow from emotional mind resulted in a more wise mind like decision.
- Use the HALT method. HALT stands for hungry, angry, lonely or tired. All these states detract from clarity and can lead to poor decisions. In addition, when under the influence of anything – not just drugs, alcohol but both peer and family pressure, we may be inclined to make choices that compromise our goals. Similarly, when we find ourselves in an especially needy state, our wise mind had taken a backseat. Be aware when you are in one of these compromised states and delay major decisions, if possible.
- Seek personal coaching for direction. It appears that there has never been a greater need for coaching as life seems to demand more and more. We can all benefit from personal coaching or at least from the advice from a trusted source of counsel. I engage in spiritual coaching regularly with a priest who always seems to find meaningful ways to help ease confusion and help clarity. For best results, coaching should factor in some measure of accountability for action steps and not just be a simple “complaining sounding board.”
When we nourish wise mind throughout the day through a mindfulness practice, our inner wisdom will carry over to the more stressful moments we all encounter in both surgery and clinic. Your clinical decision-making and your surgeries will yield the results of your best self.
Try this
Try this tomorrow.
- Develop the habit of daily silence and continue throughout the day with a mindfulness practice. Stretching, yoga, deep breathing and mindful walks in nature can be transformative. You will see the world differently.
- Keep a thought record and refer to it frequently. When stressful thoughts manifest, write them down and honestly look for evidence to support them. You will be surprised at what you will find.
- Become aware when emotion mind has taken over and simply breathe in “wise” and out “mind” for several breaths and note the change in perspective.
- For those who believe in a higher power, read about centering prayer and ask your source (wise mind) about any impending important decisions.
References:
Baba M. Avatar Meher Baba Perpetual Public Charitable, and Ahmednagar Trust. Gems from The Discourses of Meher Baba. Elizabeth C. Patterson, 1945.
Burns DD. The feeling good handbook: The groundbreaking program with powerful new techniques and step-by-step exercises to overcome depression, conquer anxiety, and enjoy greater intimacy. Penguin, 1999.
Ferguson JK, et al. Centering prayer as a healing response to everyday stress: A psychological and spiritual process. Pastoral Psychology. 2010;305-329.
Kabat-Zinn J. Wherever you go, there you are: Mindfulness meditation in everyday life. Hachette UK, 2023.
Linehan MM. DBT? Skills Training Manual. Guilford Publications, 2014.
Lynch, Thomas R., et al. "Mechanisms of change in dialectical behavior therapy: Theoretical and empirical observations." Journal of clinical psychology 62.4 (2006): 459-480.
For more information:
John D. Kelly IV, MD, is a professor of orthopedic surgery at the University of Pennsylvania and can be reached at john.kelly@pennmedicine.upenn.edu.
Collapse
Expert Submission