How do psychologists conceptualize defence mechanisms today in a post-Freudian society?

1. Alcohol (ethanol) enters the body through the oral cavity (i.e., the mouth). The inner surface of the oral cavity is mucosal tissue to keep the cavity lubricated and it is capable of absorbing alcohol into the bloodstream. This absorption is considered “insignificant”.

2. Alcohol flows down the oesophagus to the stomach where 10-20% of ethanol will be absorbed into the bloodstream. Alcohol enters the bloodstream via the mucosal tissue of the stomach wall, and travels straight to the liver. Alcohol can take 5-10 minutes to reach the brain because of the ethanol absorbed via the stomach. If you drink alcohol on an empty stomach, the pyloric sphincter [gateway between the stomach and the small intestine] is going to be more open, and the alcohol is going to immediately enter the small intestine after reaching the stomach. If food is also present in the stomach, the sphincter will open and close at a rate that allows food to enter the small intestine gradually, therefore if alcohol is also in the stomach, it will gradually enter the small intestine.

3. Alcohol flows through the pyloric sphincter into the small intestines where most alcohol absorption occurs. Human intestines are attached the to the posterior abdominal wall by a fold of membrane called the mesentery. Alcohol is absorbed into the mesentery via veins and then travels to the liver.

4. One function of the liver is that it detoxifies toxic elements into non-toxic elements before passing it to the heart and then the rest of the body. The liver sustains considerable “abuse” from a variety of toxic elements and chemicals, and therefore it needs to be capable of full regeneration. NOTE: Many diseases and exposures can harm it beyond the point of repair. These include cancer, hepatitis, certain medication overdoses, and fatty liver disease.

In the liver, ethanol is met with an enzyme called alcohol dehydrogenase and converts ethanol into acetaldehyde [ass-eh-tal-de-hide]. This chemical is more toxic than ethanol, so the liver uses another enzyme to convert acetaldehyde into acetate, which is non-toxic to the human body. NOTE: the amount of alcohol consumed + the timeframe it is consumed [and a variety of other factors] will influence the ability of the liver to effectively convert acetaldehyde all the way into acetate. The liver can’t handle the entire workload effectively therefore ethanol (before being metabolised) will go straight from the liver to the bloodstream and make its way directly to the heart.

NOTE: Genetics will play a role! Certain people do not produce the liver enzymes in enough quantity to properly breakdown ethanol.

5. Blood leaves the liver through the hepatic veins. The hepatic veins carry blood to the inferior vena cava—the largest vein in the body—to the right side of the heart. The heart will beat and send the incoming blood to the lungs to oxygenate and expel carbon dioxide as we breath out. This is how ethanol can be on your breath. Inside the lungs, at the very end of the bronchioles, are hollow air sacs called alveoli where there is a gas exchange. Ethanol evaporates through capillaries into the air sacs and exhaled out of the body. Breathalysers can detect the quantity of ethanol in a person’s system based on the quantity of ethanol in our breath.

6. Not all the ethanol will expel from the body via the breath. The rest will flow back to the heart, with newly oxygenated blood, and then get pumped all the way up to the brain and around the body. NOTE: Ethanol is water soluble. It will be distributed to every cell in the body except bone and fatty tissue [some will enter fat cells but not easily]. Ethanol will interact with every other cell i.e., every organ, gland, nerve, muscle etc.

7. Ethanol will affect and compromise protein synthesis inside muscle tissue. Therefore, if you have been training at the gym, running, swimming etc., your muscles will not effectively be able to repair.

8. Once ethanol has reached the brain, it will cross the blood-brain barrier and begin to affect chemical messengers [neurotransmitters] in the grey matter of the brain. It affects serotonin, dopamine, gamma-amino-butyric-acid (aka GABA), glutamate, endorphins etc. The person will experience pleasure, euphoria, lowered inhibitions [related to dopamine], lowered cognitive ability (e.g., decision making/problem solving, emotion regulation) and lowered coordination and reflexes.

The more ethanol ingested, the more dopamine is secreted and communicated between neurons (i.e., nerve cells). One of dopamine’s functions is to make you feel pleasure or ‘rewarded’ for doing things that are good for humans, hence, from an evolutionary perspective, we are likely to do them again to help us thrive in our environment and social world. Dopamine is secreted when we:

• eat healthy foods (but also recently developed processed foods that are high in sugar and salt)
• exercise
• achieve goals
• be productive (e.g., finish a task like cleaning, cooking, work-related tasks)
• master new skills (e.g., learning an instrument or a new talent), and
• have positive and stimulating social interactions

Ethanol influences so much dopamine secretion and communication that the brain becomes unable to make responsible decisions cognitively. The simultaneous experience of euphoria and lowered cognitive ability means we are more likely to be “happy” about making irresponsible decisions.

Increased dopamine is how drinking alcohol “blocks” unpleasant emotions like fear, stress, anxiety, and insecurity. When we don’t feel these unpleasant, yet necessary, emotions we will behave in ways that are dangerous, abnormal, potentially embarrassing, and generally problematic.

Another significant brain region affected by ethanol is the hypothalamus and the pituitary glad [together known as the hypothalamic-pituitary axis]. These structures control the entire hormonal system. The hypothalamus monitors the body, and it will send instructions to the pituitary gland based on information it receives from the hypothalamus. The hypothalamus is aware that ethanol is flooding the brain and it starts adjusting the secretion of hormones via the pituitary gland.

One of the instructions it gives the pituitary gland is to start modulating the adrenal glands to secrete cortisol (i.e., stress hormone) and epinephrine and norepinephrine (i.e., adrenaline).

Now, our cognitive capacity is diminished, inhibitions are lowered, and we will experience a rush of stress hormones and adrenaline coursing through the body. Cortisol and adrenaline will provide a boost of energy. It will increase the heart rate, blood pressure, body sweat, sugar levels in the bloodstream, and enhances the brain’s ability to use glucose. Glucose is a “fuel” source for brain functioning, including the generation of neurotransmitters. Behaviourally, we can see this in children when we say they are “hyperactive” because they’ve ingested too much sugar.

The pituitary gland will also slow the secretion of anti-diuretic hormone (aka. vasopressin). A diuretic is something that makes us urinate. If the anti-diuretic hormone (also called vasopressin) slows down, then we won’t be “holding on” to water as effectively, hence we begin to urinate more. People call this “breaking the seal”.

9. South of the body, blood is pumped into the kidneys via the renal artery which spreads through the renal cortex. The blood is then filtered into urine and expelled from the body. The lowered anti-diuretic hormone will dilate (become wider/bigger or more open) blood vessels in the kidneys which means more blood gets passed through and filtered, but it also means we lose a lot more body water which leads to dehydration. Vasopressin is essential in the control of osmotic balance, blood pressure regulations, and kidney function, therefore, when vasopressin is lowered, we are losing essential water and minerals/electrolytes. Electrolytes are involved in urination because the kidneys need them to make the process of filtering blood more efficient.

The loss of water and electrolytes will contribute to a hangover. Electrolytes play a role in cellular water absorption so if we are losing more water than we are bringing in, and we are losing the electrolytes that support the absorption of water, we become dehydrated very quickly.

10. The Hangover

Symptoms: nausea, fatigue, diarrhoea, vomiting, paranoia, anxiety, anorexia (i.e., loss of appetite), increased thirst, muscle weakness, irritability, sweating, increased blood pressure, and headache.

The exact cause of a “hangover” is not yet known however variables affecting the hangover are:

• individual differences such as sex, size, body fat, genetics etc
• lack of sleep
• general health
• drinking behaviour e.g., frequency, duration, quantity
• food intake before and during
• water intake before and after
• your body’s ability to metabolise alcohol i.e., excessive amounts of acetaldehyde due to fewer enzymes to metabolise alcohol in the liver before entering the bloodstream
• general behaviour while drinking e.g., poly-substance use, dancing, sexual activity, risk-taking behaviours etc.

Strategies for Controlled Drinking

• Setting personal drinking limits and sticking to it
• Alternating alcoholic drinks with soft drinks i.e., one alcoholic drink then a water, soft drink, or juice
• Have a meal before drinking
• Switching to low alcohol drinks
• Having regular alcohol-free days/weeks/months
• Identifying high risk situations for heavy drinking and creating a management plan

Engaging in alternative activities to drinking

I was recently browsing some of the units I completed for my counselling diploma – for revision. The human memory has not evolved to store, organise, categorise and recall all the large amounts of information we collect every day, nor is our memory always accurate. It’s important for counsellors and therapists to keep up to date with new approaches to counselling, and it doesn’t hurt to read over learned materials from college days. I thought I’d provide some learning about Acceptance and Commitment Therapy for readers.

Just to acknowledge the work of others, most of what is written below, I have retrieved and paraphrased from ACCEPTANCE AND COMMITMENT THERAPY Published by: Australian Institute of Professional Counsellors Pty Ltd.

Acceptance and commitment therapy, known as ACT (pronounced as the word ‘act’), is an approach to counselling that was originally developed in the early 1980s by Steven C. Hayes, and became popular in the early 2000’s through Hayes’ collaboration with Kelly G. Wilson, and Kirk Strosahl as well as through the work of Russ Harris. You can look them up on Youtube or Google if you’re interested in what they might have to say about ACT.

“Unlike more traditional cognitive-behaviour therapy (CBT) approaches, ACT does not
seek to change the form or frequency of people’s unwanted thoughts and emotions. Rather,
the principal goal of ACT is to cultivate psychological flexibility, which refers to the ability to
contact the present moment, and based on what the situation affords, to change or persist
with behaviour in accordance with one’s personal values. To put it another way, ACT
focuses on helping people to live more rewarding lives even in the presence of undesirable
thoughts, emotions, and sensations.”
(Flaxman, Blackledge & Bond, 2011, p. vii)

ACT interventions tend to focus around two main processes:

• Developing acceptance of unwanted private experiences that are outside of personal
  control.
• Commitment and action toward living a valued life (Harris, 2009)

In a nutshell, ACT gets its name from its core ideas of accepting what is outside of your personal control and committing to action that improves and enriches your life.

Cognitive Defusion is the process of learning to detach ourselves from our thought processes and simply observe them for what they are – “transient private events – an ever-changing stream of words, sounds and pictures” (Harris, 2006, p. 6). I think this component of ACT is incredibly beneficial if we practice it daily. I like to say, just like the function of the heart is to pump oxygenated blood around the body, one of the brain’s functions is to have thoughts. We can observe thoughts without taking them to mean more than what they are. Some thoughts are automatic, some are subconscious, and some are unconscious or preconscious beliefs that we consider to be true and factual and “rules” about how the world operates and how we have to operate in it. If someone is defused from their thought processes, these processes do not have control on the person; instead the person is able to simply observe them without getting caught up in them or feel the need to change/control them.

Acceptance is the process of opening oneself up and “making room for unpleasant feelings, sensations, urges, and other private experiences; allowing them to come and go without struggling with them, running from them, or giving them undue attention” (Harris, 2006, p. 7). Practicing acceptance is important because it encourages the individual to develop an ability and willingness to feel uncomfortable without being overwhelmed by it (Flaxman, Blackledge & Bond, 2011). It’s important to acknowledge that to accept something doesn’t mean we like it or have a passive attitude. It is to accept something exactly as it is and then we choose what to do with it. Think of the Serenity Prayer: Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.

Contact with the present moment is the concept of being “psychologically present” and bringing full attention to the “here-and-now” experience (Harris, 2009). I’d also argue that to psychologically present, we must also be aware of our physical body and the sensations within it and outside of it. Because we have the ability to think about the past and about the future, sometimes it can be difficult to stay in the present (Batten, 2011; Harris, 2009). Having contact with the present moment is essential because that it where we find out anchor and power. We have the ability to pay attention in a flexible manner to the present moment and connect with that experience rather than ruminate on past events or future possibilities (Lloyd & Bond, 2015). Some of you might say “What if I can’t stand the present moment?”. True. If you have extreme emotional experiences or have a history of trauma, it may be functional for you to use distraction or talking to someone when the present moment is “too much to take”. What we want to work towards is using healthy coping strategies in the present moment mindfully, instead of behaviours that no longer serve us.

Values, and identifying them, (i.e., what is important to the individual) is a central element of ACT because it assists clients to move in the direction of living and creating a meaningful life. One of the central goals of ACT is to help clients to connect with the things they value most and to travel in “valued directions” (Stoddard & Afari, 2014).

Committed action is the process of taking steps towards one’s values even in the presence of unpleasant thoughts and feelings (Harris, 2009). Behavioural interventions, such as goal setting, exposure, behavioural activation, and skills training, are generally used to create committed action. The ACT model acknowledges that learning is not enough, one must also take action to create change.

Self-as-context, or what I prefer to call “the observing self” or simply just our self-awareness, creates a distinction between the ‘thinking self’ and the ‘observing self’ (Harris, 2009). The thinking self refers to the self that generates thoughts, beliefs, memories, judgments, fantasies, and plans, whereas the observing self is the self that is aware of what we think, feel, sense, or do (Harris, 2009). “From this perspective, you are not your thoughts and feelings; rather, you are the context or arena in which they unfold” (Stoddard & Afari, 2014). Being aware of the observing self allows an individual to have a greater ability to be mindful and in the present moment, as they can separate themselves from the thoughts, beliefs, and memories they have.

Did you know that through a series of controversial (and incredibly sad) experiments, psychologist Harry Harlow, was able to demonstrate the importance of early attachments, affection, and emotional bonds on the course of healthy development. Harlow discovered that love and affections may be primary needs that are just as strong as or even stronger than those of hunger or thirst.

1 Think positive

This sounds easier said than done. I challenge you to intentionally consider alternatives to your habitual, default thinking pattern. We all want to be liked by others – because we want to belong to a group and to feel valued, needed and wanted. Worrying about social situations is very natural because we want to be perceived by others in a certain way. Other people’s perceptions are out of our control. So, we worry about it. We worry about things that are out of our control. We also know that we control our own behaviour, therefore, we feel responsible for behaving in ways that will mesh with others. We believe the likelihood of being liked will increase if we behave in certain ways.

Worrying can become problematic if we overthink past and future interactions, and perhaps we choose to avoid some or all interactions to protect ourselves. But then we don’t get the social connection we need.

I challenge you to think positive. Choose that instead. It will take energy because it might not be your default thinking pattern. Set your positive intention. Use mental energy. Trust that the opposite of your thinking can be true as well.

2 Forget comparison – unless you are a clone of someone else, you don’t have their genes, their life experience, their upbringing, their family history etc. It’s kind of illogical to compare yourself to someone else if you think about it, hey.

Don’t be concerned if others appear to have more or better friends than you. Quality and enjoyment matter more than quantity. Savour the moments of connection, wherever you can find them.

3 Anticipate change

Our life circumstances can leave us vulnerable to a sense of isolation. Relationships shift over time, and we may lose touch with friends who were once important. People form new relationships, move away, start families, become busier at work or start studying etc. Accepting change as normal can help you adjust to a change in your relationships. Just as we grow, evolve, and change, so will our relationships. Couples who were once in love will fall out of love. And friendships that were once enjoyed may become less enjoyable overtime.

4 Tolerate discomfort

Anxiety may cause you to avoid socialising. Understand that feeling awkward or embarrassed in social situations does not mean you are doing anything “wrong”. I remember a period I went through growing up. I noticed people around me starting to use for sophisticated language. I thought I had nothing of value to say, or nothing of interest. I would struggle to form sentences in my head. I was becoming so anxious that my social cognition was compromised. Learning to be comfortable with myself, relaxing into conversations, and listening more deeply to the other person helped me. I remember going on dates thinking I have absolutely nothing to say to this person. That cognition, that thought, wasn’t true. It was part of a larger story that I was creating in my mind.

Reach out to others and your skills will improve with time.

5 Listen well

Practice listening. Ask questions and really listen to the answers, rather than just waiting for your turn to talk, or worrying about how you will respond. If you’re curious about what someone is saying, your mind will naturally form a question or recall a similar experience that you can share.

Respond warmly to people’s experiences through your posture, facial expressions and words. Put the mobile phone away and be present.

6 Rehearse

Out of practice with small talk? Spend some time thinking about questions you can use when conversation stalls. You might ask if the other person has been overseas or travelled, what music do they like, or what movies they like to see at the cinema. A natural question to ask is what did you get up to today? What do you have planned for the weekend?

I once attended a training for work. The facilitator shared her experience of often finding herself in similar situations, and she decided to formulate a “go-to” script for when she became tense, and a conversation stalled. Rather than panic, she had a mental go-to script to bridge the gap until the conversation returned to a natural flow. Sometimes it’s nice to allow for a silence, scan your environment and discuss something happening around you.

7 Go offline

Social media helps many people, but it can also increase disconnection, depression, loneliness, anxiety, and headaches. Ensure you have a healthy offline life. Perhaps invite trusted online friends to an offline meeting to build your relationship.

8 Help and service

Helping someone gives a feel-good rush. Oxytocin and dopamine neurotransmitters have been shown to be involved in human bonding. These chemicals can make us feel pleasure. Create a bond with someone by offering help or asking for it. If we’re not someone who asks for help often, the people who know us well will likely feel closer to you because you need them for something, nourishing the bond you have. Have you noticed that strangers in the street are often very willing to help someone with directions? It makes people feel good to help others and be helped in return. Something as little as assistance with a bag or holding a lift can help people feel seen and cared for.

9 Get involved

I know this one may make some people go “Eeeeek” and cringe. However, evolutionary and developmental psychology … and all psychology, has suggested time and time again, that feeling part of a larger community and getting involved makes us feel alive and part-of. Joining in connects you to other people, unites you in a shared activity, and provides an easy way to get to know people better.

Have you ever watched a group of people in the street having a laugh, or watched people playing a sports game, or doing an activity together – while you’re sitting alone on the outside. You might mock them to yourself to make yourself feel superior or protected. We’d rather be part of. It’s just the truth.

10 Manage stress

Everybody has some social situations they dread. Practice simple stress management techniques, such as breathing deeply and slowly, to help keep your stress in check through awkward moments.

We need stress to perform optimally. Befriend your stress. When it becomes overwhelming, recognise that it’s happening, allow it to be there, investigate where it’s living in your body, and nurture that part of yourself. Talk to a trusted friend in times of excessive or toxic stress. Do whatever you need to come back home to yourself. Rest. Drink water. Eat nutritious food. Shower or bathe. Spend time outdoors in nature. Watch something on tv. Listen to music. Come home to your true self, recharge the batteries, and then jump back in. You’re allowed to switch off for a while.

11. Practice, practice, practice

Relationship skills can be learnt. Don’t be discouraged. Remember that social connections are good for you. If you feel like you need support to build better connections skills, a counsellor or therapist can help.

We learn from new experiences. They create, wire, and strengthen, neural pathways in the brain. You can be silent and listen during social interactions. Get curious about the other person. Ask questions. Share some of your story and ideas. And breath. Practice makes progress – not perfection.