4 Steps to Stress Management: An Interview with Jeffrey Schwartz, M.D.
In an earlier post I published Jeffrey Schwartz, M.D’s article focusing on why empathy can be a two edged sword which became very popular, and I later interviewed him about why recent research in the field of neuroscience has been largely a waste of money. Jeff is a psychiatrist, researcher in neuroplasticity and internationally recognized expert in Obsessive Compulsive Disorder. He is also author of the popular books Brain Lock: Free Yourself from Obsessive-Compulsive Behavior and The Mind and the Brain: Neuroplasticity and the Power of Mental Force.
Today I bring Jeff back to tell us about how mindfulness and his 4 step process can not only help us break free from Obsessive Compulsive Disorder (OCD) but be a path toward greater stress management and well-being.
Elisha: In your book Brain Lock you present a four step process for working with Obsessive Compulsive Disorder (OCD) that has gained prominence and is being used by therapy centers around the world. Tell us a bit about this 4 step process and why it works?
Jeff: The four steps came out in brain lock published in 1996. I have a new book that’s going to be out in the beginning of 2011 and the co-author, Rebecca Gladding, is former Chief Resident in Psychiatry at UCLA and now UCLA faculty. In this new book we apply these same 4 steps in OCD to a much broader application and really use it as a means for stress management.
I’ll give you both versions.
First step is the same in both, Relabeling. There’s been great work by Matthew Lieberman of UCLA on the tremendous power of labeling on emotional faces and other things to manage Amygdala hyper-responsiveness, in other words to manage fear and stress responsiveness. This research says if we put a label on our emotion, we can help manage our response to it. So Step 1 is Relabel.
Step 2 is called Reattribute, which in the original 4 steps means attribute the fact that the troublesome feeling or a bothersome emotion that you are feeling is a manifestation of your brain sending you a false message. So don’t attribute it to yourself, your psyche, or your upbringing, but actually attribute it to a maladaptive brain circuit. This helps give you some distance between the sense of who you are and the troublesome feeling which again helps you manage it. Then apply the impartial spectator, which is another term for mindful awareness. We’ve actually just broadened that term to be reframe in the new book.
Reattribute is good in OCD to say “it’s the brain.” In using the brain in a more abstract way we thought the word reframe might be more general than the term reattribute.
The other 2 steps are exactly the same.
Refocus is the 3rd step. Given what I had said about Quantum Zeno Effect and Hebb’s law and self-directed neuroplasticity, it should be pretty clear why refocus is very important. If you change your focus from a negative maladaptive response to a positive wholesome response, that’s going to be conducive to well-being. Refocus will rewire your brain in ways that will be conducive and wholesome and adaptive to your well-being.
Then when you do this regularly, you get to the 4th step which is Revalue. In Revaluing you change the valuation you put on the initial experience. Revalue is a deeper form of relabeling, so you don’t have to go through a whole linguistic process, but you actually just get a sense of immediacy in knowing this is not a good thing to be focusing on. In other words, these feelings are a destructive brain message and I can manage my responses to and focus away from in an adaptive way.
Revalue just means you put a different valuation on the initial negative experience so you no longer need to use the linguistic cognitive reframing, you do it automatically. From a neuroscience perspective we would posit that this means that instead of needing to primarily use the cortex to do that process, it now becomes a wholesome habitual response because doing it repeatedly and intensively actually gets the basal ganglia or the habit center of your brain to take over the process. So Revaluing is basically all the steps being done by your basal ganglia in ways that would be much faster and much more automatic.
Elisha: If you were sitting across the table from someone struggling with lots of stress in their life, what would be your initial approach, what advice would you give to them?
Jeff: Well I’ve almost answered that in the 4 steps. There is a tremendous power in using labeling; putting a linguistic label on it and doing it with a cognitive reframe. Here’s the heart of the answer, as you do these steps you begin using your impartial spectator or mindful awareness. What you want to do is get that 3rd person perspective on 1st person experience. All of these techniques are really geared toward enabling people to get a 3rd person perspective on 1st person experience.
Now being a serious Christian, I’m certainly more than happy for people to bring Jesus in as the impartial spectator. I believe this will be more than just a cognitive reframing, but certainly also a cognitive reframing. It’s probably the best way to get a real 3rd person to have a perspective on your 1st person experience. Because Jesus has access to that and Jesus can help you manage it.
In summary for all people, it’s all geared toward getting a 3rd person perspective on your 1st person experience which is what we mean by impartial spectator, a term I borrowed from Adam Smith, which is what we mean by mindful awareness, a term I borrowed from Buddha.
To the readers: As always, please share your thoughts, stories and questions below. Your interaction creates a living wisdom for us all to benefit from.
Goldstein, E. (2010). 4 Steps to Stress Management: An Interview with Jeffrey Schwartz, M.D.. Psych Central. Retrieved on May 22, 2015, from http://blogs.psychcentral.com/mindfulness/2010/07/4-steps-to-stress-management-an-interview-with-jeffrey-schwartz-m-d/