Where's the Beef?! Challenging Negative Self-Talk

Anyone older than 50 likely recalls the 1984 Wendy’s Hamburger commercial affectionately known as the “where’s the beef” commercial. If you do not recall this ad…or simply want to smile again at this cleaver piece of advertising…visit CLICK https://tinyurl.com/5n7xefn5.

As humorous as the ad may be, it has a parallel that is used by cognitive therapists and counselors to treat self-defeating and negative self-talk, what is often referred to as stinkin’ thinkin’. This counseling strategy begins with a simple question remarkably like that asked by actress Clara Pellar when she exhorts in the Wendy’s commercial, Where’s the Beef! – its clinical parallel being, Where’s the proof?  

 

Too often we fixate on some negative thought, often related to a mistake made or something “stupid” or “hurtful” someone said or did, perhaps some event reported in the news done by “those people.” The more time spent in stinkin’ thinkin’ the angrier or more depressed, or sad, or ___ fill in the blank with whatever negative emotion may result in your situation.

 

In cognitive therapy, individuals learn that it is not events or “things” that cause us to become sad, mad, angry, afraid, or become enraged, depressed, anxious, or terrified. It is what we tell ourselves about the event or “thing” that happened that generates these emotional states and our all too often behavioral reactions that we later regret.

 

Therapists help those with whom they are working to understand that thoughts are not facts! Because I “think” something, that does not make it so. There is a simple little formula that spells this out and may make it a bit easier to grasp when you see it: A + B = C where “A” stands for the activating event or “thing” that happened, “B” stands for the belief I have related to that thing or what I tell myself about it, and “C” stands for the emotional consequence that results from having told myself whatever “B” is…over, and over, and over again!

 

One way to interrupt this negative self-talk is to simply challenge the “B” or what I am telling myself when I feel that twinge of anger/sadness/anxiety or whatever the upsetting emotion is I experience following an event - Albert Ellis, the godfather of Rational Emotive Behavior Therapy, refers to this a disputing the "B". Treatment could then be referred to as A + B/D = C+ where "B/D" represents disputing the "B" and C+ is an improved emotional consequence. How, you ask? With simple questions not unlike Clara Pellar’s “where’s the beef”; Where's the proof?

 

Let’s use an example by way of demonstration. John arrives at work one morning. He enters the parking lot at the same time as a co-worker he knows. They have worked together for several years and socialize outside of work on occasion and he helped jumpstart her car earlier in the week when it wouldn’t start. As they approach the building’s entrance, John says good morning and asks about her plans for the weekend. He receives a non-committal, “mornin’” as they enter the building and she doesn’t make eye contact. “What’s up with her?” thinks John.  As he enters the building, this is the internal dialogue going on inside John’s mind:

 

“What’s she so upset about…what did I do?!”

“She has some nerve…I was just trying to be nice; I didn’t do anything!”

“She must think I’m hitting on her…asking about the weekend?”

“Where does she get off thinking that?! I know she has a boyfriend! What does she think I am, anyway?”

“Wait ‘til the next time she asks me for help when her car won’t start…bitch!”

 

Notice how John’s first thought is “what did I do.” For all we know, his co-worker could have just received some bad news or got a ticket on the way to work, or simply is “coming down with something.” His first thought “lights the fuse” for his subsequent thoughts…his “Bs” if you will…that take him farther down the wrong road resulting in his becoming angry and resentful…in a matter of minutes!

 

Here is where the “where’s the proof question” becomes important. Although his very first thought…“what’s she so upset about”…may have been reasonable, his jumping to the conclusion that it was something he did or said was not. At that “what did I do” question, had John paused and said to himself, “STOP! Where’s the proof that you said or did anything, John,” his entire internal dialogue may have gone in an entirely different and more empathetic direction.

 

True, perhaps John could rationalize the second part of his initial thought, especially if he tends to be

quick with a mildly inappropriate comment, but this is where a second activity used by cognitive therapists comes in handy in helping individuals prevent or at least derail their escalating irrational thoughts and the negative emotional consequences that follow. Referred to as the Downward Arrow Technique, this exercise can help by drilling down to the base or Core Belief, often generated in childhood, that give rise to the automatic negative thoughts that seem to “pop” into one’s mind when experiencing a negative or unpleasant event.

 

This technique is quite simple but nonetheless effective in uncovering these “core beliefs” and once identified, they too can yield to the “where’s the proof” question mentioned above. I will use John’s internal dialogue outlined above to illustrate the technique:

 

“What’s she so upset about…what did I do?!”

\/

Why does that bother you?

\/

“Because she must think I said or did something to ignore me like that.”

\/

Where’s the proof that you said or did anything…and even if you did, why does that bother you?

\/

“Well, she’s a co-worker and I’d like to count her as a friend.”

\/

Again, where’s the proof that you can’t be?

\/

“I must have done something or she wouldn’t be like that.”

\/

And if you did, what would that mean?

\/

“That she doesn’t like me and we can’t be friends.”

\/

Why does that bother you?

\/

"Because I have always had a tough time making friends.”

\/

What does that suggest?

\/

“That there is something wrong with me and people don’t like me.”

\/

What are you worried that might mean?

\/

“That my father was right when he said I won’t amount to anything.”

\/

And where is the proof that he was right?

 

At this point, a cognitive counselor might ask John how the accomplishments in his life jive with his father’s prediction. A bit further in their conversation…or after John has cataloged his personal accomplishments…an appropriate question may again be, “…and getting back to your co-worker, where’s the proof that you said or did anything wrong or upsetting? Might there be another reason for your co-worker's distraction this morning?

 

Again, the downward arrow technique gets at CORE BELIEFS and this may not be necessary for use each time one becomes aware of emotional upset. Often the simple, "Where’s the Beef” question is sufficient to derail a runaway and irrational train of thought, but identifying core beliefs is an effective way to prevent future automatic thoughts and derailing negative self-talk.

 

Often absolute thinking fuels the automatic thoughts that result in this negative self-talk, thoughts like, “They shouldn’t have/should have done this or that” or things like, “This always happens to me” or “This is terrible/awful; I can’t bear it.” In closing, a couple of “Where’s the Beef” type questions to ask whenever catching yourself thinking in absolute terms:

 

·      “They shouldn’t have/should have done whatever” – Says who? And so what if they did/didn’t, they have a right to be a jerk, right?

·      “This always happens to me!” – Nothing ALWAYS happens! It may happen a lot recently, but nothing always happens.

·      “This is terrible/awful; I can’t bear it.” – It may be difficult to deal with and totally unexpected, but where’s the proof you can’t bear it? This too shall pass.

 

There is any number of useful resources, essays, and exercises available online related to dealing with irrational thinking and its role in fostering anxiety, depression, anger issues, etcetera. For more on the downward arrow and other related exercises, CLICK https://tinyurl.com/yxvs77hz; for core beliefs CLICK https://tinyurl.com/bdmduja8.

 

What do you think?

Dr. Robert

The Self-Directed Daily Inventory

It is tempting to think that a "good" or "bad" day results from a single event. Although a particularly wonderful event can buoy one’s spirits or an equally upsetting experience result in sadness or emotional upset, most days tend to be typical, the result of a series of events or experiences…some “good” and some “not so good.”

Individual events that become the exclusive focus of one’s attention can impact we evaluate a given day. When assessing a given day as “good” or “bad,” considering an isolated event or series of events restricted to a narrow focus of experience during that day can result in frustration if not depression. This is especially likely if several such “bad days” occur in a row. Such experiences foster what professional counselors and therapists refer to as “negative self-talk” or what those familiar with A.A. call, stinkin’ thinkin’.

The purpose of the exercise outlined here is to increase the likelihood of considering the “big picture” when evaluating a typical day. The Self-Directed Daily Inventory (SDI) is a daily activity designed to help one slow down their thinking, step back to consider multiple variables that affect mood, and look at the “big picture.” In doing so, it is possible to realize that things are not always the way they appear to be when considering just a “snapshot” of events in one’s day to evaluate it.

When employing the SDI, identifying specific categories of experience that YOU view as important in evaluating your day and then considering them independently to assess how “good” or “bad” your day was in each of those categories provides a more objective and therefore accurate assessment of one’s true experience. Using a set of evaluating criteria you establish for each of these categories facilitates this “stepping back” to consider the bigger picture. For example, identifying a minimum of five and a maximum of seven key assessment categories you deem important areas in your life and then evaluating your day in each category provides a more realistic overview of that day. Averaging the individual scores assessed for each of these 5 to 7 critical areas then yields a more accurate “score” regarding the day.

Specifically, use a simple “1 to 5” scale to evaluate each category. Describe the criteria that denote the lower and upper ends of this scale for each category with conditions or experiences you believe describe “bad” or “good” for that category. Next, total the scores for each category, find the average score (the total of all daily scores divided by the number of scores), and post this average on a graph to view progress or “change” on a daily basis.

This simple technique “forces” consideration of the “big picture” when determining progress or improvement in regaining personal control in one’s life.

To create your own step-by-step set of instructions, using 7 sample categories. You will need to choose your own important life categories and define the scale used for evaluation for this exercise to be effective. You can find a sample set of worksheets and instructions at https://tinyurl.com/S-DDaily-inventory

Becoming Your Own Best Friend: Affirmation #1

Negative self-talk or "stinkin' thinkin' " sabotages self-confidence, fosters procrastination, and is a primary contributor to doubt, irrational fear, and anxiety. It often results from long-forgotten but nonetheless influential criticism, the thoughtlessness of others, or the disregard or neglect of someone important in your life.

We know what we learn and learn what we are taught, hence, how often do I have to hear "you will never amount to anything" or "you are a real disappointment" before I start to believe what I am being taught?

But although I know what I have learned and learned what I was taught, that does not represent all there is to know. Someone else's opinion is not synonymous with fact. And my negative self-talk is simply the thoughts I have that echo those opinions of others and THOUGHTS ARE NOT FACTS.

Because thoughts are not facts, we can challenge and refute them. Referring back to my previous post, I might ask myself, "Robert...where's the proof that ____ is fact? And even if there is some history that suggests it was so in the past, what's to say it must always be?"

What follows is the first of several affirmations or "negative self-talk challenging messages" that may help improve confidence and self-respect as well as turn down the volume just a bit on the "stinkin' thinkin' "

If one or more of these affirmations resonate for you, write it down and look for opportunities to speak it aloud (if alone) or read it to yourself several times a day...the more you practice, the lower the volume on negative self-talk. (if you want an exercise designed to help you accomplish this, leave a note in the comments section below). NOTE: Established negative thinkers will react to these affirmations when first reading them as if they are nonsense. Say/read them anyway..."fake it till you make it"

AFFIRMATION #1: • Everything that happens around me shall work out for the good of all concerned o When I do my best and work my hardest I will succeed. If success in my specific task eludes me, then the success is learning from the experience - What do I do next time? What could I do differently next time? What can I avoid next time? What can I add to my plan next time? No one ever fails, we simply succeed at learning what to try differently next time.

3rd Person Self-Talk and Self-Directed Behavior Change; How to Talk Sense to Yourself

Has a friend or family member ever approached you seeking advice on how best to deal with a personal issue or approach an important personal decision? If you are like most humans, the answer is yes. And when approached, were you able to proffer an opinion or provide the requested advice? Again, the answer is likely yes. This is because most of us are relatively good in such situations because we view ourselves as “detached” from the situation. Because of this detachment, we are more objective and offer reasoned advice.

 

Ethan Kross, a psychologist at the University of Michigan, has published research that finds that when individuals conduct their self-talk in the 3^rd person, that is referring to themselves by 1^st name or as he/she, him/her we can achieve that same degree of psychological detachment that enables us to provide more logical and rational advice to ourselves. Consider this example:

 

Instead of thinking, I can lose the weight needed to look good on the beach this summer, I say to myself, Robert, you can lose the weight needed to look good on the beach this summer.

 

Thinking in the 1^st person is a habit that is difficult to break. Why? Because we have likely been doing it for decades! However, when finding myself thinking in the 1^st person, I can “translate” those thoughts into the 3^rd person easily by simply inserting a 3^rd person pronoun or my first name, a nickname I go by, or my last name if that is how others generally refer to me – think “Gibbs” on NCIS – and create that psychological detachment that brings added clarity, reason, and logic to my thinking.

 

This can be a very helpful aid to accomplishing self-directed behavior change. Engaging in 3^rd-person self-talk about losing weight, quitting smoking, drinking less, or exercising more can help prevent self-doubt from derailing a change plan.

 

Before dismissing this idea by saying you do not want to sound like Dobby the House Elf in Harry Potter, remember we are talking about "self-talk" here...that is $10 psychobabble for "private personal thoughts," the ones no one hears except you :)

 

Robert – remember that willpower is a skill that you develop with practice rather than, I don’t have the willpower necessary to succeed; I’ll never be able to change.

Change is an inside job, Robert; one that you can accomplish because it is more about attitude than effort rather than, Change is just too hard for me; I will never be able to do this.

 

What do you think?

 

To read more about 3^rd-person self-talk as an aid in stress management, ending negative self-talk, or quietening anxiety, CLICK HERE.

 

Dr. Robert

Professional Identity and the Internet

A question I sometimes found myself addressing in the classroom and individual conversations with

students was the importance of establishing a personal sense of professional identity as a counselor. Most entering graduate students present in their first-semester counseling classes with a sense of the profession and what its practitioners do. Their assumptions about counseling and how practitioners ply their trade were something ripe for a challenge if not adjusting during the earliest stages of training. Although many of these students were eager to learn and devour texts, handouts, lectures, and classroom discussions, many tended to focus on some individual counselor, real or theoretical, who they attempted to emulate.

 

This propensity to channel an accomplished practitioner became apparent early in their education and training. Perhaps my awareness of this trait in entering students because I could recall my own initial exposure to counseling and the wish to establish myself in the profession. A desire to “do the right thing” and “not screwup” led me to also emulate faculty I admired, theorists who described counseling and human development with philosophical concepts that reflected my worldview. I described my personal theory of counseling as my students often did at the end of their first course in counseling theory, as eclectic. This did not so much mean the blending of several theoretical systems in a deliberate attempt to formulate a “personal theory of counseling,” but rather, amassing a collection of techniques that were employed in a rather “seat of the pants” approach to counseling. The emphasis of such an approach was on attending to technique at the expense of the spirit of the profession. Although I do not see this as uncommon in novice counselors, I do see it as resulting, in part, from a trainee’s lack of a well-defined and concise understanding of the significance of a clear sense of professional identity as a counselor.

 

Professional identity involves developing an awareness of who the counselor is as a person and professional and is more than just an awareness of and proficiency in what a counselor does. It is the result of blending proficiency in practice and technique with a sense of purpose and commitment. Professional identity is what enables the practitioner to fully commit to a career rather than simply develop proficiency as a tactician performing a job. So, how do professional counselors develop this sense of professional identity? There are likely numerous aspects to the answering to this question, however, there is one unsung facet that I wish to highlight in this missive. I submit that the Internet itself—and more specifically the various professionally-oriented online discussion groups, e.g., “listservs”—may well play an important role in developing a personal sense of professionalism.

 

By subscribing to online discussion groups or forums, students can observe virtual exchanges between more experienced practitioners and educators in the field of counseling. This “real-time” opportunity to observe such discourse and theoretical discussion is invaluable. Often conducted by individuals who have authored journal articles and other professional publications read by students in class, such experience

cannot be duplicated short of a chance encounter at a conference or when noted practitioners are “guest lecturers” invited to present a colloquium on or lecture at a student’s university. And for students to observe these discussions between established practitioners and theorists who participate in these virtual online discussions as they would if in person over coffee in a café, enable students to see “us” as tangible and therefore approachable participants in the field of counseling. Such virtual encounters enable the issues to “come alive” and take on a sense of practical significance for the novice counselor.

 

With the time it takes to prepare a manuscript and then have it reviewed, edited if accepted, and then published, it is not uncommon for the time between author insights and “the field’s” exposure to them in published form to be 12 to 18 months. Add to this the difficulty for students to review and discuss such publications in class not to mention respond to the author directly, and we begin to sense the historically exclusive environment in which students of counseling have had to develop their sense of professional identity. In one sense, established counselors have essentially functioned in a rather parochial and almost parental fashion with the official way to dialogue amongst ourselves being publications in refereed journals. From the perspective of a student, this is tantamount to the adage, “children should be seen and not heard.” No wonder new students of counseling adopt their counseling heroes’ theories and practices like they do their parent’s religion or vote for the candidates championed by admired relations.

 

Please do not misunderstand my position to be a soapbox from which to rail on professional publications; quite the contrary. I embrace this vehicle by which thoughtful and provocative ideas enter the mainstream of our profession for scrutiny where critical peer review fosters the advancement of our profession. But as important as this process of sharing professional information may be, it is somewhat chauvinistic in that it frequently denies access to those at the front of the timeline with regards to gaining counseling experience.

 

Online discussion forums provide an important vehicle for cultivating a sense of professional identity for the novice counselor by expanding the field’s two-dimensional view of counseling from simple research

and scholarship to include crowd-sourcing as a third dimension, thereby creating depth and perspective. An argument can follow that no other place provides the opportunity for students in training to observe firsthand the inner workings of the counseling profession. The online exchange of ideas, the proffering of suggestions, the collegial debate, and the sharing of information and resources, all under the guise of “FYI” highlight the professional identity of counseling. What better source of learning about professional identity as a counselor than by observing a virtual display of the professional identity of the profession?

 

Developing a sense of professional identity necessitates the introduction of self-efficacy. To be blunt, how do counselors hope to develop a personal sense of what counseling is or how they “fit” without first developing this sense of self-efficacy? And how does one develop self-efficacy as a counselor? Not until and unless having the opportunity to venture out into the mainstream of public opinion to test the waters? Although it is true that practica and internships are designed to accomplish this, what more convenient, and some might add a “safer” place to augment these experiences than by participating in online discussion forums?

 

Having participated in online discussions on the net over the years, I have grown as a counselor and as an educator. I followed discussions where established counselors debated ideas that echoed thoughts that I had already considered. As a result, I became more confident in the value of my opinions and professional ideas. When I eventually venture down from the virtual safety of the front porch that was my home computer where I observe the rest of the world on the net, I discovered I too could “run with the big dogs.” I have received thoughtful comments from respected authorities in the field on ideas I have shared and seen how they could evoke spirited collegial discussion. Such experience enhanced my sense of professional identity as a counselor and an educator. It is for this reason that I believe that online discussion forums may well be one of the more important tools to add to the budding counselor educator’s toolbox. With this resource, we can encourage students to observe virtual discussions about topics on an infinite variety of subjects of vital importance. These students can see kudos delivered and constructive criticism proffered, often on the same subject within a span of hours. Likewise, these same students can receive encouragement to participate in discussions, even if by simply asking questions via personal emails directed to those who have been participants in the virtual conversations and then considering their replies. As mentioned earlier, where else can a student observe, if not participate in a discussion with those already established in this field? And where else can one observe the musings of professional counselors, better than online in a discussion forum, and in real-time no less?

I close by suggesting that the use of the online discussion forums is of no more value in counselor

education than any other tool in the educator’s toolbox, but neither is it less. To participate in these discussions and encourage our students to do the same, not only creates a vehicle for the establishment of professional identity, it demonstrates that we are real people accessible in real-time, to students who are struggling to find the headwaters of counseling theory and practice.

Looking for a Bit of Good News

Let’s Look for a Little Good News

© 2022 Robert J Chapman, PhD

 

Preoccupation with tracking the latest on the pandemic has caused me to overlook that COVID is neither the only nor the most persistent pandemic we should be worried about. Our tendency to think in binary terms, that either–or way of thinking, where anything outside, beyond, or different from my view of the world is, at best, wrong and, at worst, dangerous. Binary thinking requires living in an "us and them" world, where to protect "our" view of what is right and to defend against "theirs,” we fall into many cognitive biases that tend to sabotage our capacity for rational thought and therefore hinder our ability, if not willingness, to show compassion and embrace our innate humanism.

 

Confirmation bias and the availability heuristic are two common biases that foster much of the negativism, doubt, and suspicion experienced when considering “them” and their attitudes, values, and beliefs. The result is the frequent display of contempt that shows itself in disregarding authority, distrusting those who differ from our thinking, and the civil and political strife that afflicts our planet in the 21^st century.

 

Confirmation bias is the tendency to seek out information that supports my beliefs and represents "the truth" while ignoring any argument or evidence that contradicts them. The availability heuristic—where “heuristic” is simply a fancy term for a mental shortcut—supports cognitive bias by making what we see and hear most often seem like reality. When these two biases happen together, I tend to look for evidence that backs my views on the truth and makes yours seem wrong or even dangerous—creating plenty of “available” information that strengthens my beliefs. 

 

As tough as the times we live in can be, there's good news and more than just a hint of hope: a sort of

vaccine to protect against these cognitive biases. To support this bold claim, I share a couple of my favorites as examples.

First, Playing for Change. This project records music performed by street musicians and people from all walks of life around the world, then edits them into very moving and uplifting covers of some of the most memorable 20^th-century songs, especially those with lyrics of hope and love. Two of my favorites are the 1960s Sly and the Family Stone's "Everyday People" - https://www.youtube.com/watch?v=-g4UWvcZn5U and Ben E. King's "Stand By Me" - https://www.youtube.com/watch?v=Us-TVg40ExM. To hear more examples, search "Playing for Change" on YouTube.

 

For good news about current events, visit the Reasons to be Cheerful website: https://tinyurl.com/27w7zs6v. This site curates stories from around the world that showcase the good in the world and promote a sense of hope, if only we seek it.

 

Humans tend to fall prey to many of the cognitive biases mentioned above. To prevent these common pitfalls, we need to seek information beyond our usual sources. Note that none of the hopeful examples cited above relate to politics, religion, or any specific ideology. Each one focuses on highlighting our potential as humans to move toward a celebration of "we the people” and a “both-and” approach to thinking.

 

In conclusion, watch any episode of John Krasinski's Some Good News on his YouTube channel (https://www.youtube.com/c/SomeGoodNews) to, once again, boost your sense of hope and reaffirm that some people are trying to do something to counteract the negativity, gloom, and catastrophizing that "seems" so widespread in the world today.

 

What do you think?

 

 

Does Administration Bear Responsibility for Burnout in Collegiate Student Affairs Professionals?

 Google “student affairs” and “burnout” and you get 91,000 total hits; nearly 8,000 in “scholarly articles,” 3,650 published since 2017.[1] This is neither a new nor “back-water” topic in higher education.

 

Working in higher education for 30-years—as a student affairs (SA) professional for 20-years and professor of behavioral health counseling for another 10—and as a behavioral health practitioner for almost 20 years before that, the formal and informal attention this topic receives comes as no surprise. As a higher ed insider, my general thoughts on the topic start with a belief that burnout among SA professionals or what some refer to as compassion fatigue (CF), is not unlike the quality of life (QOL) issues that affect student satisfaction with their collegiate experience. These student QOL concerns are known to the administration as is their association with retention and recruitment, hence their efforts to address them. The same cannot be said, however, regarding its awareness of the association between burnout in SA professionals and their retention—when perceived workplace satisfaction is low, retention is low. Unfortunately, senior administration in higher education appears oblivious to these similar phenomena.

 

Recruiting and training qualified SA professionals is a costly proposition for institutions of higher education (IHE). Experienced SA professionals are an important factor in the calculous of improving & maintaining positive student perceptions of QOL on campus. Although recognizing student perceptions of QOL as issues of significant institutional concern rather than personal maladjustment, the administration does not appear to view employee burnout and CF similarly. By perceiving burnout and CF as individual employee issues, the administration signals a lack of awareness that these matters, like the negative perceptions of QOL by students, are more related to the environment in which employees work than to the employees themselves (Moss, 2019)[2].

 

As the result of the difference in perception of these two similar issues, the administration has failed to recognize its role in producing the very issues responsible for SA burnout and CF. Instead, it believes that stress management and wellness-oriented training are enough to prevent these personal problems experienced by SA professionals. Put succinctly, although the administration recognizes that student concerns regarding QOL is an institutional issue for which it has responsibility, it views burnout and CF as the responsibility of SA employees to address individually.

 

Although stress management and wellness-oriented training are helpful/useful, they are, at best, Band-Aids placed on a problem that is administration's to solve. By this, I suggest that institutional responsibility stems from its role in at least fostering if not creating the very burnout and CF when generating the workplace stress that leads to SA burnout and CF via heavy workloads, job insecurity, frustrating work routines, and the expectation that ALL issues outside the classroom are essentially student affairs responsibility to handle. Worse yet, the administration may believe that it has addressed these issues by its hiring of SA professionals to do the heavy lifting. Consequently, the lowest-paid professional staff members find themselves saddled with some of the more time-consuming and emotionally taxing responsibilities that occur on a college campus. Is it any wonder that SA pros burn out or experience CF?

 

So, what do we do now? Perhaps we start by reflecting on Albert von Szent-Gyorgyi’s observation that discovery consists in seeing what everyone has seen and thinking what nobody has thought.

 

 

What do you think?

---

[1] As of Dec 2021

[2] (2019) Moss, Jennifer. Harvard Business Review https://hbr.org/2019/12/burnout-is-about-your-workplace-not-your-people

A Possible Reason High-risk Drinking is So Intractable in College?

Students Who Limit Their Drinking, as Recommended by National Guidelines, Are Stigmatized, Ostracized, or the Subject of Peer Pressure: Limiting Consumption Is All But Prohibited in a Culture of Intoxication - https://journals.sagepub.com/doi/full/10.1177/1178221818792414

First, I realize that this is a study conducted 3+ years ago and in New Zealand no less, however, its points seemed to resonate with me given my experience working with collegians in a small, private, urban university.

The gist of the argument presented is that the cost in social capital for students to identify, by declaration and/or behavior, as moderate drinkers or abstainers is high. In addition, "the labels" proffered by students when asked about their peers who drink, seem positive when a peer reports what we preventionist would classify as high-risk and derogatory regarding moderate or abstaining peers. There is more to the article than this but it got me thinking.

We know that student misperceptions about collegiate drinking are significant. We also have learned that when designed and conducted correctly, social norms marketing can be quite effective. We also know, however, that there is a stubborn core of high-risk drinkers that does not seem to budge no matter what preventive steps we take or programming efforts we mount. I am wondering if there is a "social capital" concern in this high-risk core regarding these negative if not derogatory labels affixed to moderate drinkers and abstainers...someone looking for a topic for a master’s thesis or doctoral dissertation? :)

Related to this stubborn core that appears immune to our prevention efforts to date, I was reading an article recently that suggested that social norms marketing can actually backfire if messages convy a social norm that is perceived by peers to be vastly out of their reach, as learning about this norm can actually discourage pursuing change. This got me thinking again...it would not surprise me to learn that the proportion of collegiate drinkers who meet the criteria for a diagnosis of an alcohol use disorder is higher in the persistent 22-23% of students reporting frequent "binge drinking" than in the general student population. If this is the case, especially if those AUD students have tried to change and were unsuccessful, might the traditional social norms marketing message that reports something like "X% of students report drinking 4 or fewer drinks when they drink" trigger a 'why bother' or what is called a "what-the-heck" reaction to our social norms messages?

The article I was reading suggested that if a target behavior is growing in popularity -- in our case, 

the number of moderate drinkers and abstainers is increasing -- especially if by modest amounts, instead of reporting actual percentages, simply report the upward trend, sans the details. So, instead of reporting that "X% of State Univ students report consuming 4 or fewer drinks if they choose to drink," reporting "for the Xth month/semester/year in a row, an increased number of State Univ students report moderating their drinking if they choose to drink." Where the 1st message could alienate high-risk drinking if construed as indicative of a peer group w/which I cannot or do not wish to identify, the 2nd is inclusive and uses positive peer pressure to affect change. True, someone who is drinking 10 drinks per outing 2X/wk and decides to "moderate use" by having 7 drinks 1X/wk is still engaging in high-risk behavior, but, hey..."any port in a storm."

Just a couple thought...what do you think?

What if Mary Poppins was a Collegiate Preventionist?

 

Imagine, if you will, that as we emerge from 17+ months of pandemic with its related lockdowns, social distancing, and virtual meetings it is a beauteous September day much like that date in the opening scenes of the 1964 Disney film, Mary Poppins. As you walk across campus after your meeting to discuss concerns about collegiate drinking and how best to prepare for the return of partying students to campus, you notice drifting down from an azure blue sky; why it is none other than Mary Poppins herself.

 

As she stands before you, quite prim and proper with her umbrella in one hand and satchel in the other, Mary Poppins announces that she is aware of the advertisement in The Chronicle of Higher Education for

an alcohol & other drug (AOD) preventionist and was on campus to apply. She adds that she is aware that your students, much like the adorable yet incorrigible Banks children, Michael and Jane for whom she had been a Nanny, have presented your Student Affairs establishment with quite the conundrum, a “can’t seem to live with them but cannot live without them” dilemma. She suggests that she just may be able to proffer some assistance in bringing resolution to the concerns you have just addressed in your meeting.

 

Your face betrays your wonderment as to just how does she know about your recent meeting let alone its focus on high-risk and dangerous collegiate drinking, but she is just assertive enough—and you are just concerned enough as the V.P. of Student Affairs has charged YOU with the responsibility to address the collegiate drinking problem—that you agree to hear her out and you invite her to your office hear her out…and for some tea.

 

I could continue this scenario and detail a hypothetical dialogue with Mary in some detail but I choose this introduction to proffer a thought not frequently considered when entertaining ideas about how best to prevent high-risk student behavior, AOD use in particular…the gamification of AOD programming.

 

Historically, prevention has focused on, as the profession’s name implies, preventing high-risk and dangerous behavior. To accomplish this objective, its efforts almost exclusively fixated on “the problem.” Such problem-focused approaches unwittingly suggested that high-risk AOD use was an all but insurmountable collegiate problem. Like a closeup photo of an object devoid of any reference in the frame for comparison, determining the extent of “collegiate drinking” as a problem becomes somewhat subjective, left to the interpretation of the observer. This, coupled with a decades-long history of preventionists almost exclusively addressing “the problem” of high-risk and dangerous drinking, has left some wondering if collegiate drinking is actually the problem we have been led to believe it is.

But back to Mary Poppins…gamification is exactly what Mary does when she assumes the responsibility of Nanny for the Banks children. To re-establish order through the introduction of routine and the instituting of basic procedures for the children to follow, she “gamifies” said routines and procedures, rules if you will, to entice compliance and, as a result, behavior change. It is, as one of the more memorable songs from the film goes, a “spoonful of sugar” that “make the medicine go down.” In that same song, Mary sings, In every job that must be done, there is an element of fun. You find the fun, and  snap! The job’s a game.[1]

 

Now I am not so naïve as to suggest that moderating student behavior is a simple matter of making low-risk decision making fun. Is there, however, a way—or are there ways—to increase the likelihood that students buy into some of our existing approaches to prevention? Can we “gamify” any of our prevention efforts?

 

To modify their behavior, students must conduct a cost-benefit analysis of any proposed change, realizing that if made, it will yield access to what they perceive as having a greater value than what they must give up to obtain it. Unfortunately, risk avoidance has not historically proven effective as such a motivator.

 

A major barrier to change is impulsivity or what Katy Milkman[2] calls present bias or the tendency to opt for the short-term reward over a longer-term benefit. For students this is avoiding the short-term reward of an “instant party”…just add alcohol…with all its social promises for the long-term benefit of better grades at the end of term. As the WWI song queried, How ya gonna keep ‘em down on the farm, after they’ve seen Parie?

 

“So,” as an effective parent says to a complaining child, “what do you propose we do?” What might the gamification of AOD prevention look like…or at least what might be a straw man to pull apart as we kick-about this idea? Again, as Katy Milkman suggests—can you tell I just read her book--

 

Gamification is another way to make goal pursuit instantly gratifying. It involves making something that isn’t a game feel more engaging and less monotonous by adding gamelike (sic) features such as symbolic rewards, a sense of competition, and leaderboards (59).

 

 

Perhaps it could involve offering “symbolic rewards” as a student “advances through successive levels” in an online alcohol awareness program. Perhaps it could involve incorporating geocaching into a social norms campaign to make it “more engaging.” Perhaps it could use a “leaderboard” to introduces a “sense of competition” between first-year resident halls for completion of a required online alcohol program. Perhaps voluntary referrals to B.A.S.I.C.S. would increase if B.A.S.I.C.S. was one stop on a term-long “campus services scavenger hunt” with an appropriately enticing prize for those who complete the hunt where a clue/direction to “the next” service came as each service is completed/visited.

 

Limits to the possibilities for the gamification of collegiate prevention efforts know no end. The creativity and resourcefulness of those who choose to incorporate the concept into a campus prevention program represents the only boundaries.

The purpose of this essay, however, is not to suggest HOW to gamify prevention—let alone suggest that any of the ideas just mentioned above are good or even likely to meet with student acceptance—but to simply ask WHAT IF we were to consider gamification as another arrow in the preventionist’s quiver? Perhaps if we were, we just might see Mary open her umbrella and drift off into the evening sky, barely audible as she hums, a spoonful of sugar…

 

What do you think?

__________

1 Milkman, Katy (2021). How to change: The science of getting from where you are to where you want to be. Penguin Random House, N.Y., N.Y.

2 Milkman, Katy (2021). How to change: The science of getting from where you are to where you want to be. Penguin Random House, N.Y., N.Y.

Harm Reduction and Substance Use Disorders

Harm reduction (HR) is an important tool for the behavioral health professional’s use when considering how best to address the issue of substance use. It is a fact, however, disturbing it may be, that we human beings have used, continue to use, and will likely always use licit and illicit substances. Although most users do so without experiencing a substance use disorder (SUD), their use, as well as the use of those who do develop a SUD too often, involves health-related risks and problems, some of which result in death.

 

HR. is essentially a collection of principles[1] that acknowledge that although substance use is and will likely continue to remain a fact of life, it is imperative for society in general and healthcare professionals specifically to champion adherence to these principles and strive to reduce the likelihood of untoward consequences resulting from the use of any psychoactive substances, licit or illicit.

 

Substance use, licit or illicit, is neither a moral nor legal issue, it is a healthcare issue. As such, efforts to interceded in the use of such substances should seek to minimize the likelihood of harm for those who use and advocate for the treatment of those whose use has resulting in a SUD. Unfortunately, the use of illicit substances in general and “addiction” specifically carry the stigma of problems realized by those morally weak and/or criminally disposed members of society.

 

Addiction is, in many ways a social construction - A social construct is something that exists not in objective reality, but as a result of human interaction. It exists because humans agree that it exists[2]. In other words, addiction is a collection of behaviors that society has deemed outside the bounds of its vie of normal and therefore aberrant. Because those with addictions do not behave in accordance with what society deems acceptable and appropriate behavior, these individuals must, therefore, suffer from some degree of moral turpitude or be criminally inclined. This “moral model” view of addiction explains our societal reaction to those who use illicit substances or display the symptoms of what we call a substance use disorder. It also justifies our proclivity as a society to arrest and punish rather than diagnose and treat those who use illicit substances.

 

To pursue the specifics of the moral model and its impact on the history of the treatment of SUDs is

beyond the scope of this essay. It is the prevention of harm to those who use substances, licit or illicit, irrespective of their reasons for use…physical dependence or hedonistic reward…that is the reason for this piece.

 

The pursuit of harm reduction can lead a healthcare professional in one or two general directions. The first, regarding treatment, results in the practitioner’s efforts to engage individuals in a way that increases the likelihood of motivating users to reconsider their use, thereby increasing the likelihood of reducing the frequency and/or quantity of that use. The second regards simply reducing the risk of untoward consequences resulting from use. Treatment is not the primary objective, just the reduction of harm associated with the use, both to the user and to the society in which that user resides.

Interestingly, HR. efforts in pursuit of the second objective can and often do result in the opportunity to pursue the first, treatment. An example of this is the evidence that comes from harm reduction efforts like “user room.” In the Netherlands, Amsterdam specifically, user rooms are places where individuals can go to consume their substances…drugs…safely. Trained staff supervise these locations, often with EMT experience and access to Naloxone. At such facilities, users can shower, wash their clothes, get something to eat, and have their basic human needs addressed. While visiting a “user room,” individuals would often establish a rapport with staff and over a period of visits, begin to talk about their use with staff. The staff, often trained in Motivational Interviewing techniques, then engage users in a discussion about the benefits and costs of their use, helping users to take a critical look at the “return on investment” related to their substance use, a more than occasional result being the user’s entering treatment.

 

Harm reduction efforts related to substance use are more concerned with the user and those with whom the user has contact than with the legality of use or the socially constructed barriers that distinguish between the “appropriate use of licit substance,” like alcohol, or its “inappropriate use” or the use of any illicit substance. It is an approach rooted in the belief that the prevention of harm is rooted in the promotion of health and therefore a quintessential exemplar of health care.

 

And before rejecting this argument by citing concerns about needle exchange programs, the encouragement of use  by user rooms, or state-supported addiction in methadone maintenance programs, notice how dependent we all are on harm reduction in our lives already: seat belts, airbags, antilock brakes, fire retardant clothing, smoke detectors, CO2 detectors, hand railings, antiskid strips on steps, sunscreen, etcetera, etcetera, etcetera.

What do you think?

Dr. Robert

 

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[1] See Principles of Harm Reduction at https://harmreduction.org/about-us/principles-of-harm-reduction/ for a summary of these principles.

[2] Bainbridge, Carol (2020). CF - https://www.verywellmind.com/definition-of-social-construct-1448922