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Why is it hard to make decisions?

‘It’s not about making the right choice. 
It’s about making a choice and making it right.’ 

J.R. Rim

Making a decision can be very difficult. Sometimes it doesn’t matter how big or small a decision is: it is the fact that one has to be made at all which engenders an anxiety that can feel crippling at times.

Why is it so difficult to make a decision?

For well-known psychoanalyst, thinker and writer, Irwin Yalom, decision making is linked to one of his ‘Four Givens’ – one of the four underlying anxieties from which all other anxieties spring. Having to make a decision, suggests Yalom, means we have to take responsibility for our own actions – something he feels we all seek to avoid. If only we can pass the decision off to someone else, we will not have to take responsibility for the outcome. Imagine – we might even have someone else to blame if the outcome fails to go as planned.

There are other impediments to decision making. One of the most common is inertia – our natural reluctance to change our state or position. Put bluntly, it is very difficult to make the effort to move. If you need a banal example of this inertia in action, then ask yourself why so many of us choose to stay with our utility providers, mortgage or banking firms, when we know (for certain!) that we would be far better off with a new provider? Our bias towards the status quo keeps us where we are – or, as Yalom would no doubt point out – allows us to use the ‘where we are’ as a useful excuse for us not to have to make a decision at all.

Research also shows that decisions are easier when there are fewer choices. There are many studies available that demonstrate this bias in our thinking. Shoppers, for example, will buy more when presented with fewer options. As the amount of choice grows, it would seem we become burdened with the weight of the process – and end up buying nothing at all (or maybe everything!) as a response to the sense of being overwhelmed.

Finally, we should also think about the condition of decision fatigue, a condition that can feature significantly in people who are suffering burn out in work or domestic environments.  If such a role or lifestyle demands that we make many, serial decisions, there may come a point where we just cannot face making another. You can understand this on a domestic level if you have been in the position where you have asked your friend or partner ‘What shall we have for dinner/ What shall we do at the weekend?’ only to hear the reply ‘I don’t mind: whatever you want.’ Having been in a position where you take decision after decision, sometimes even the most trivial (in this case, ‘what’s for tea?’) can feel like the last – and heaviest of straws.

So what can we do?

We do need to separate the decision-making process from the outcome. The latter is out of our control. In a world which currently seems to be driven by hindsight, it is a wonder how any decisions get made. But we should try to understand that good decisions can lead to poor outcomes.

For example: I toss a coin. I offer you a bet as follows: if the coin falls as ‘Heads’, I will pay you £10; if it falls as ‘Tails’, you pay me £1. Do you take the bet? Fairly easy decision, but imagine you lose ten bets in a row, do you still take the next bet?  Although it would seem still an excellent decision (if your aim is to increase your funds), a concern over outcome will often emerge as a major brake on the decision-making ability. It can even collude with the bias towards inertia which we carry (spoken of above), providing a useful excuse to remain risk averse and avoid the decision entirely.

If we can put outcome to one side and concentrate on the decision itself, there are a number of practical strategies we might employ to help to make up our minds. From pros and cons list-making, to identifying our highest priorities and values in the various options, to listening to the voices of third parties, or studying the experiences of others – all of which might well bring a sense of perspective to an area which seems to be drowning in the waters of confusion and distortion. Remember, though, that there will any number of unconscious forces working to prevent that decision being made, so we have to keep in mind that by thinking these things through so carefully, we don’t provide scope to put any decision off – and thus to avoid the responsibility.

It’s only a simple decision!

If only this were true. As Yalom points out, and as our own experience confirms, the matters which lie beneath ‘a simple decision’ are complex and linked to many of the fears and anxieties we all carry as a consequence of our life experience. Lists and balance sheets may help to some degree, but if we really want to understand how to make decisions more effectively – how to take responsibility for what we want – we need to reach a better understanding of ourselves.

 

Kevin Collins is a UKCP registered Psychotherapeutic Counsellor with an academic background in the field of literature and linguistics. He worked for many years in education – in schools and university. Kevin is available at our Lewes Practice.

 

Further reading by Kevin Collins –

Communication, communication, communication

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Why read Nietzsche?

Nietzsche reflected on and wrote much about the lived experience of human beings. He discussed many things that were seemingly in conflict with the last thing he wrote. I have sometimes heard this used as a reason not to read Nietzsche. This apparent paradoxical nature might sometimes leave you confused and resistant to look again.  However, I feel he is always worth returning to, especially if we are curious about life.

According to Kaufman (2004) Nietzsche depicted himself in Ecce Homo as “a psychologist without equal and many consider his philosophical work to have a deeply psychological understanding of the human experience.”  [1]

Freud apparently discussed the level of introspection Nietzsche reached as being greater than anyone else past or potentially in the future. [2]

When I began to read Nietzsche, I was actually surprised at how engaged I became, despite how little I seemed to understand. He inspired me then and continues to each time I return to his texts, often seeing it from a different perspective each time.  I feel his rhythmical and metaphorical offerings were made to stimulate exploration and awaken emotional responses rather than offer conclusive truths. He was purposely ambiguous and contradictory. For me, Nietzsche was on the side of experiencing and embracing the significance of creativity, music and dance. He
welcomed understandings about fluidity, multiplicity, becomings and going beyond. I feel he invited us to see that we are so much more than we have dreamed of thus far, and there are many dimensions to be explored.

My understanding of Nietzsche is that he was not one to be dogmatic, and he challenged scientific reductionism. Bazzano (2019) discusses how Nietzsche did not see science as able to explain life, only describe it. He challenged people to see how structures and systems were filled with our attempts to the bring natural dynamic and conflicting forces (both internal and external) into order and control [3] .

Or sometimes, perhaps, as a way to avoid taking responsibility.  In fact, Nietzsche was often suspicious of the systematisation of life, “I mistrust all systematizers and I avoid them. The will to a system is a lack of integrity.” [4]   (Part 2, sec 26)

Nietzsche welcomed the dance of life. His writings pointed to the multiple dynamic perspectives and interpretations that direct human experience, and the oscillating movements between chaos and structure that we all seemingly exist within on a macro and micro level. He championed understandings and explorations that focused on active over reactive forces. He centred the ‘need to know’ that can monopolise human thought and perhaps gave consciousness and intellectual knowledge its origins and apparent semblance of supremacy as, in fact, secondary
to the primacy of the body. The latter being a direct experience of active forces experienced through feeling the body’s affects. [5]

Nietzsche has both inspired and disturbed me. He manages to shake the ground beneath you, leaving you adrift at times. Equally he evokes a desire to live this opportunity to exist and experience more fully, within all facets presented. I feel he provokes a desire to feel, listen and move. To take responsibility for this existence we are living in all its uncertainty, intensity and affect and utilise creatively their influence in our transformations. [6]

Sadly, his thinking can be overlooked and dismissed due to his fall into apparent madness. I feel that is a fruitful encounter missed. He is worth reading if only to find out if any gems touch and inspire something within you.

Susanna Petitpierre, BACP Registered, is an experienced psychotherapeutic counsellor, providing long and short term counselling. Her approach is primarily grounded in existential therapy and she works with individuals.  Susanna is available at our Brighton and Hove Practice.

 

Further reading by Susanna Petitpierre –

Magnificent Monsters

A consideration of some vital notions connected to Existential Therapies

Existential Therapy

Being embodied in Therapy: Feeling and listening to your body

 

References –

1 Kaufman (2004). Nietzsche, Heidegger and Buber- discovering the mind vol 2. New York: transaction publishers.

2 ibid

3 Bazzano, M, (2019) Nietzsche and Psychotherapy. London: Routledge

4 Nietzsche, F. (1888/1969) Twilight of the Idols, trans, R. J. Hollingdale, Harmonsworth: penguin.

5  Bazzano, M, (2019) Nietzsche and Psychotherapy. London: Routledge

6 ibid

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Am I cracking up or is it my hormones? Pre-menstrual Dysphoric Disorder and the importance of tracking symptoms

It is not comfortable being told that you are feeling the way you do because of your hormones. This kind of biological reductionism is not helpful to any gender but the extremely severe symptoms of Pre-menstrual Dysphoric Disorder are completely aligned to the menstrual cycle. They manifest during the week before menstruation and end when or shortly after the start of menstruation. Like a switch going on and off.

There are a wide range of physical symptoms some not usually recognised as linked to pre-menstruation – changes in vision, heart palpitations, numbness and easy bruising – along with those that are familiar. In this post I am concerned with the psychological symptoms.

The ones we might expect like irritability, confusion and weeping to excessive anxiety, deep depression and suicidal thoughts and feelings. It is the severity of these psychological symptoms, far more severe than normal pre-menstrual symptoms that make PMDD so disturbing and destructive.

Women suffering with PMDD can find themselves unable to cope with everyday life in the week or so leading up to their period. Ordinary tasks at home or at work can be insurmountable. Getting out of bed to dress and wash is impossible. The ‘personality changes’ put relationships under enormous duress. The sudden change in symptoms at the onset of a period is a relief but much of the next three weeks will be spent in repairing and picking up the pieces. It is not surprising that women can feel they are cracking up.

Unfortunately many women are undiagnosed, incorrectly diagnosed and they can feel as if they are regularly in torment for a long time until their PMDD is recognised and treated. An example of misdiagnosis is a diagnosis of bi-polar disorder. This is because the cyclical nature of mood swings is a feature of both conditions but it fails to recognise the correlation between emotional lability and the menstrual cycle. The predictability of the changes in thoughts and feelings that is a key feature of PMDD and this raises the importance of tracking symptoms. Tracking symptoms provides information over time that may reveal a pattern, in this case the menstrual cycle. Informed diagnosis leads to appropriate treatment, this means a woman will be treated for a severe problem with her endocrine system rather than a psychiatric illness. Sometimes it is your hormones.

 

Angela Rogers is an Integrative Psychotherapeutic counsellor working with individuals and couples in Hove.

 

Further reading by Angela Rogers –

Viagra for women? Medical treatment for women’s sexual problems focuses on the brain rather than the genitals

New Year’s Resolutions – Why change might be so difficult?

Viagra: Some ups and downs of the little blue pill

The Menopause – Women of a Certain Age

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Supporting children and young people with stress and anxiety

Stress is caused by an existing stress-causing factor or stressor. Stress can be ‘routine’, related to everyday activities or ‘sudden’, brought about by a change or transition, or ‘traumatic’, in relation to an overwhelming event.

During stressful events our adrenal glands release adrenaline, a hormone which activates the sympathetic nervous system, our body’s defence mechanism which causes our heart to pound, blood pressure to rise, muscles to tense, and the pupils of our eyes to dilate. Historically, this prepared us to respond to attackers with one of three responses – fight, flight or freeze.

This stress response can still be helpful to us today. It provides a burst of energy which can help us to stay safe when suddenly facing a speeding car, for example. Or, it might help us meet deadlines and goals through increased efficiency and focus. Our stress response ceases to be helpful if it is activated too easily or at a level which is too intense or if it goes on for too long, preventing us from returning to a relaxed state.

Anxiety is stress that continues after that stressor is gone. When we are anxious, fear can take over whenever there is worry and apprehension. This can lead to irritability, low mood, social withdrawal, lack of motivation, poor concentration and nervousness, as well as physical symptoms like chest pains, disruption to eating routines, dizziness, shortness of breath, fatigue and panic attacks.

There are multiple triggers for stress and anxiety in young people today. Those most commonly reported include school, exams and future prospects; social difficulties including peer pressure, social media issues and bullying; family concerns such as conflict or financial problems; and major world events. For some, these factors can become overwhelming.

A good place to start when helping children and young people with stress and anxiety is to be aware of what we are thinking, feeling and doing ourselves. This will help us to tune in to kids and look after ourselves so that we can stay calm, alert and responsive. There are many routes to self-care – the 5 Ways to Wellbeing is one of them – How are you doing right now? What steps might help you to build your own self awareness and take care of your own support needs?

Secondly, psychotherapeutic work is naturally based on a belief that by talking and thinking about difficulties we create space for creative exploration, digestion/ processing, increased understanding and new perspectives/ opportunities. It can be helpful to take a moment to consider where you stand yourself with regards to talking about feelings.

And do you think your child/ teenager believes it is okay to have feelings? Whether the answer is yes or no, how might he/she have picked up this message? What do we think is likely to help give a message that it is okay to feel feelings and to talk about them?

We can begin by making time to notice how young people are doing, listen to their concerns without judgement and then take them seriously. In ‘How To Talk So Teens Will Listen’ and ‘Listen So Teens Will Talk’, Faber and Mazlish (2006) advocate: “Identifying thoughts and feelings . . . Acknowledging feelings with a word or sound . . . Giving in fantasy what you can’t give in reality . . . and . . . Accepting feelings as you redirect behaviour.” (p31).

To make the above possible, it helps if we can stay calm and avoid becoming either frustrated or overwhelmed with our own worries about the child’s worry. We also want to steer clear of trying to fix things too quickly as this can seem like we’re not really interested in a child’s felt experience.

Being listened to can start to give shape to what might often feel like a formless mass of uncontrolled emotion. Feeling understood can, in itself, help to bring anxiety under control. It then becomes more possible to actively build self-awareness through tools like a stress-graph or diary, which maps stress intensity across a day, week or year. Other visual systems using scales and colours can be helpful too. A 0-5 scale, for example, can enable children to identify the difference between a slight glitch, a small/ medium/ large problem, and a situation which feels quite huge or even like an emergency. Other systems like the ‘Zones of Regulation’ or the similar ‘Just Right State Program’ (widely used in Brighton and Hove schools) help young people to notice their emotional/arousal state at any given time and to learn what helps them either to up-regulate or down-regulate in those moments in order that they can relate and learn effectively.

Specific calming approaches can be taught such as deep belly-breathing or simple, unobtrusive techniques for the classroom like hand-breathing or square breathing. Positive self-statements can also help – in place of an ‘all or nothing’ catastrophic approach (“I’ve messed up this essay, I may as well give up”) the young person might say to herself, “I’ve done it before, I can do it again” or “this feeling will pass”. Others may benefit from being helped to express thoughts and feelings through writing or drawing. Others might need to move around, take sensory breaks, do Yoga, make a mess with clay, cook a meal together, make a special den, imagine a calm place, complete a puzzle, make a list or listen to a favourite story or a book about anxiety, like ‘The Huge Bag of Worries’ by Virginia Ironside. Lots of helpful ideas for activities can be found in Karen Triesman’s ‘Treasure Deck of Grounding, Soothing, Coping and Regulating cards’.

Young people who are feeling sufficiently safe and regulated might also be able to consider the bigger picture of how their thoughts, feelings, body sensations and behaviour all inter-relate and where they might be able to make one small change which could then have a beneficial knock-on effect. Read more on these approaches in books like ‘Starving the Anxiety Gremlin’ (Kate Collins-Donnelly) and ‘Overcoming your child’s fears and worries’ (Cathy Cresswell).

For young people who are specifically stressed about exams, the following links may be helpful:

– The #NoStressSuccess series of video clips on Youtube about a wide range of opportunities for education and training post-16, made by Brighton Met College students.
– The ASAP Science Youtube clips: 9 Best Scientific Study Tips and 7 Tips to Beat Exam Anxiety.

As supporters of children and young people, one challenge we have is to be regulated in the way that we offer help and ideas. If we overload with strategies and things to ‘do’ to make the stress go away, we can be in danger of increasing pressure rather than decreasing it. If we can remember to be accepting of our children and if we model self-acceptance ourselves, we might go a long way towards helping them effectively manage stress in their lives. Dan Millman has said: “Resistance creates suffering. Stress happens when your mind resists what is. The only problem in your life is your mind’s resistance to life as it unfolds.” And in a similar vein, the following Chinese Proverb tells
us that: “Tension is who you think you should be. Relaxation is who you are.”

 

Michael Reeves is a Psychotherapist working with children and young people aged 4-18 and/or their parents/carers. He is available as a clinical supervisor for training or practising therapists and counsellors, whose work is primarily focused on children/ families/ parents. He is available at our Lewes Practice.

 

Further reading by Michael Reeves –

Educational Psychotherapy (2) – developing empathy, mind-mindedness and self-discovery

Educational Psychotherapy (1): supporting social-emotional development and learning

Curiosity: how can children’s behaviour help us understand what they need from us?

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Sleep and Mental Health

We all need sleep, and it is a natural part of our life. On average, most adults need around 8 hours sleep per night although this can vary from person to person. While no one is entirely sure why we need to sleep, we do know that it is significant for brain development, and maintains normal levels of cognitive skills such as memory, speech and flexible thinking. Indeed, if have as little as 15 minutes less than our normal level of sleep this can have measurable affects on our cognitive functioning.

While sleep is a very natural and important part of our lives, many people can struggle with sleep and this can have a serious impact on their mental health. A lack of sleep can lead to daytime tiredness and this lowers our resilience and ability to cope with everyday life. This in turn can lead to a lowering of self esteem and we can start to feel more worried or stressed about life. This leads to more difficulties getting to sleep or staying asleep and the cycle continues. When we have problems sleeping, we are more likely to feel irritable, anxious or depressed. In more extreme cases, it can lead to psychosis or paranoia.

There are many types of sleep disturbances – difficulties getting to sleep, difficulties staying asleep, nighttime panic attacks, waking up too early etc. To opposite of these can also be sleeping too much which might be the case with someone who is depressed. There are also sleep disorders such as Narcolepsy or Sleep Apnoea which can have a significant affect on sleep and physical health. If you think you have sleep disorder, it is import to get this checked out by your GP.

So what can we do if we can’t sleep?

There are some obvious and easy changes that we can make to help our sleep habits:

  • Establish a sleep routine – going to be at the same time every night and waking up at the same time. Setting a habit can help your body get into a routine and make sleep come easier.
  • Make your bedroom a relaxing environment, and if you can, only use your bedroom for sleep and not for watching movies or working.
  • Establish a bedtime routine that allows you to wind down gently.
  • Avoid any caffeine before bedtime, and of course avoid electronic devices an hour or so before bedtime – so switch that mobile phone off!
  • Get regular exercise, but try not to exercise just before bedtime.

If you find you are waking up in the night and unable to sleep try not to worry about it. Laying in bed worrying about not sleeping and how you will function the next day can be torturous. It is better to get out of bed and if you have lots of thoughts, then write these down until your mind is a bit clearer. You could also read for a while to help you relax a little more, and keep a compassionate focus on yourself – getting annoyed with yourself for not sleeping will only make it worse!

Of course, if your sleep problems persist, you should consult your GP as they may be able to offer some medical help. You could also consider psychotherapy if you are finding that worries, stress and anxiety is keeping you awake.

During these challenging times that we are all in, it is vital to get a good night’s sleep, so look after your nighttime routine so you are better equipped to face the days ahead.

 

Dr Simon Cassar is an integrative existential therapist, trained in Person Centred Therapy, Psychodynamic Therapy, Cognitive Behavioural Therapy (CBT), Dialectical Behavioural Therapy (DBT), and Existential Psychotherapy. He is available in our Hove and Lewes clinics and also works online.

 

Further reading by Dr Simon Cassar

Spirituality and mental health

Living with borderline personality disorder

Online Therapy

Student mental health – how to stay healthy at university

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