PASEO Program Adventure—Day 52: Huanchaco y El Porvenir, Peru

This morning (Monday) began with our Terapia Conductual Dialéctica course, which focused on Distress Tolerance, TIPP, and Emotional Regulation. During times of crises, TIPP is a useful tool that one can utilize to take a step back from the crisis to de-escalate the situation. TIPP can be used when one is about to engage in dangerous behaviors during a crisis, when an individual needs to make an important decision, but is too overwhelmed to think/make a decision, the individual is not processing information effectively, the individual is emotionally overwhelmed, and/or the individual isn’t able to use his/her abilities.

TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation. With regards to temperature, the individual can put cold water or a bag of ice on his or her face, while bending over and maintaining respiration (holding his/her breath). The individual can also put his/her face in a bowl of cold water for 30-60 seconds, or put an icepack on his/her face while bending over, and maintaining respiration (holding his/her breath). This action helps reduce emotional and physiological arousal. The action of Temperature can also be used when the individual isn’t able to sleep due to anxiety and/or while experiencing dissociation during therapy.

According to mindfulnessmuse.com, “In order to get ourselves to a place of being capable of processing information, we must find a way to essentially ‘reset’ the nervous system. Fortunately, all mammals have something called the ‘mammalian diving reflex’ that forces the parasympathetic nervous system to kick in, which functions to relax us and calm us down.

Dr. Linehan explained that this reflex is activated by icy cold water (i.e., not freezing) on the face. In particular, the icy cold water must hit the parts of the face just below the eyes and above the cheekbones for the dive reflex to be activated.”

In regards to Itense Exercise, doing some form of intense exercise for 30-60 seconds can change one’s mood and lessen one’s negative mood, and increase positive affect. This can include running in place, jumping jacks, and/or running up/down a flight of stairs. Our emotions have the ability and tendency to make us ready for action (as in flight or flight), so an intense exercise can make regulate our body to a less emotional status.

Paced Breathing refers to inhaling and exhaling slowly (five or six breaths each minute with a four second inhalation and eight second exhalation). Paced breathing—in addition to the other actions can help us lower our level of emotional arousal and make the switch from utilizing our sympathetic nervous system (which is ready for flight or flight) to our parasympathetic nervous system (our more relaxed state).

Finally, with Paired Muscle Relaxation, the strategy is to tighten your muscles, noting the sensation of tension in your muscles (and you can work on specific muscle groups, one at a time). As you loosen your muscles, you can say the work “relax” aloud, noting the sensation of how your muscles feel. The goal with Paired Muscle Relaxation is to increase one’s awareness of tension and relaxation, and functions as one of the various abilities to overcome a crisis.

While these abilities, or strategies are meant to help during a moment of crisis, they are not by any means a solution to one’s crisis. These abilities/strategies should be paired with other strategies (i.e. confiding in somebody immediately after or seeking help by a professional).

When working with emotional regulation, one of the actions is to act in a manner contrary to the emotion that is currently affecting your behavior. First, you must identify the actions that are affected by your emotions, do the opposite action, and do so completely and fully, without holding back. Simply stated, you’ll want to do the opposite action of what you’re feeling (i.e. if you’re feeling lonely and went to isolate yourself, you would instead spend time surrounded by others). Instead of surprising what we’re feeling, we would simply use our emotions to guide opposite behaviors in order to make a change in how we’re feeling.

After class, we had our weekly meeting with a group of local women and family members in El Porvenir that I spoke about in prior posts. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week’s topic focused on the difference between sadness and depression, as well as the importance of self-care—something that so many of us forget to do on a daily basis.

In order to emphasize the importance of self-care, each participant was taught the acronym CUIDARSE (caring for oneself):

C: Cariño (affection, especially for ourselves, no matter how difficult it may be)

U: Una cosa cada día (one thing per day—engaging in one activity that we enjoy doing on a daily basis)

I: Imitar al bebé (imitate a baby—while babies may not always be able to verbally communicate, they are still able to get their wants and needs met, which is exactly what each of us need to do as well. It is important for everyone to express exactly what they need, just as a baby does)

D: Descansar/dormir (rest/sleep—adequate rest is crucial for everyone)

A: Alimentarse bien (nourish/feed oneself well—proper nourishment is also very important)

R: Relajarse (relax—making time for ourselves to de-stress and calm down each and every day)

S: Socializar/Salir a pasear (socialize/go out for a walk—making time to be around others and taking time to enjoy the outdoors while de-stressing from our daily, hectic lives)

E: Ejercicio (exercise—20-30 minutes each day)

Imagine that you have a bottle of water and give a little bit to each person around you. There would be nothing left for you once you get thirsty. We can’t care for others if we can’t care for ourselves first. We tend to find ourselves telling those around us to care for themselves, but it shouldn’t be any different for us. It is just as important for us to follow the acronym CUIDARSE, and do exactly as it says—take care of ourselves. 

Following the group, some of the other students and I went out for dinner, and made sure to enjoy the sunset during our last week here.

PASEO Program Adventure—Day 31: Huanchaco y El Porvenir, Peru

This morning (last Monday), we started the second half of our program with a class on Dialectical Behavior Therapy (DBT, or Terapia Contactual Dialéctica in Spanish). DBT believes that people are doing the best they can, but that we can always do better. And if you really think about it, we can do better in any given aspect of our lives- especially in areas we are trying to work on. Trough acceptance, mindfulness, and distress tolerance, the aim is to attain emotional regulation and interpersonal effectiveness.

A big tenant of DBT is Mindfulness, which centers on paying attention in the present moment without any judgments. While at first glance, we may think this is a simple concept, imagine how quick we are to judge different situations we face on a daily basis. The trick here is to put these judgments aside and observe the present moment we are living in and experiencing, both willingly and willfully.

We learned about three different types of minds, so to speak that are important to understand- really in any area of life if you find yourself communicating with others. Some people think with a rational mind (often times parents), others think with an emotional mind (often times adolescents), and others think with a wise mind. None of these are bad or worse than any other, but it’s important to understand that we each make decisions differently. Not everybody thinks alike, and in general, if we can try to understand this concept, we may find that we can work together more easily to come to agreements and find solutions.

After class, we had our weekly meeting with a group of local women and family members in El Porvenir that I spoke about in prior posts. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week’s topic focused on effective communication, because often times, this is a skill that each of us can improve upon.

Think about it. How many times do you get home and have your parent/child/significant other “nag” you about something you did or didn’t do? And how many times do we do the same to those around us? While we may like to think that accusations, assumptions, and commands are part of effective communication, unfortunately they aren’t.

In the group, we discussed ways to empower the participants to express themselves more openly, because often times they may not have the opportunity to do so.

Effective communication is as simple as: 1. Describe the situation, 2. Express how the situation makes you feel, 3. Recognize the good intentions or feelings of the other person, 4. Ask/Make the request of what you would like the other person to do.

If we can feel validated for our effort or intentions as opposed to feeling guilty for possibly making a mistake or forgetting something, we’ll likely try that much harder and work with the other person to get the job done as opposed to arguing back and shutting down.

Even though these steps sound beyond simple, it takes practice to build effective communication, but it’s a worthwhile skill that can take us very far in any kind of relationship.

PASEO Program Adventure—Day 24: El Porvenir y Trujillo, Peru

This afternoon (Monday), we had our weekly meeting with a group of local women and family members in El Porvenir that I spoke about in prior posts. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week focused on psychoeducation regarding anger and ways that anger can manifest and build up if not properly released.

Due to gender roles and societal expectations, in many cases, women are not “supposed” to experience any other feelings aside from sadness (because of course men can only be angry and women can only be sad). For this reason, it’s so important to discuss and normalize feelings of anger because without doing so, it would likely continue to remain an unspoken topic that women “should not” discuss. Throughout the next week, we’ll place more of a focus on how to release such feelings in a positive and healthy manner, now that these feelings have been normalized and accepted.

After the group, we drove into Trujillo for our Psychology in Peru class. During the class, we each participated in Biodanza, “a system of self-development that uses music, movement and positive feelings to deepen self-awareness. Biodanza seeks to promote the ability to make a holistic link to oneself and one’s emotions and to express them.” Biodanza, originating from the Greek word bio (life) and danza (dance in Spanish), translates to the dance of life. The purpose of Biodanza is to focus on human integration, organic renewal, affective re-education and relearning of the original functions of life. Its methodology is to induce integrative experiences through music, singing, movement, and situations of group encounter.

Biodanza has five main tenants including: 1) Vitality: Increased joy of life, vital momentum (energy available for action), motor integration, neurovegetative balance. 2) Sexuality: Awakening the source of desire, increased pleasure, connection with sexual identity, and decreased sexual repression. 3) Creativity: Ability to express, innovate, and construct. 4) Activity: Ability to make connections with other people through love, friendship, altruism, and empathy. 5) Transcendence: Connection with nature and feeling of belonging to the universe.

Participating in Biodanza was truly an eye-opening and enlightening experience. Seeing as not everyone may be able to verbally express themselves the way they may like, being able to express oneself through natural and fluid movements in a safe and accepting group environment may be a beneficial alternative—especially when “talk” therapy is considered taboo in many cultures.

PASEO Program Adventure—Day 17: El Porvenir y Trujillo, Peru

This morning (Monday—yes, still behind), I completed my final observation at another school in El Porvenir. It was definitely an interesting experience because the school I observed is a Catholic school (considered more private than the others), as opposed to a national school (or public school, which is what every other school I’ve observed so far is considered). Since students from the secondary school were on a field trip to local historic sites for the day, I was only able to observe students in primary school.

Upon speaking with a local social worker, I was informed that there is a lot of crime among the students, including extortion and theft. When I spoke to the director of the school, she mentioned that a lot of the children have difficulties at home that influence their behaviors, including lack of parental support and/or parents having to work long hours, leaving their children unsupervised upon returning from school. This recurring theme seemingly continues to make its way into every school that I observe. There are so many challenges that these children face both inside and outside of school, but especially once they leave school grounds each day. The risk factors are substantial, and we have to focus on fostering more protective factors in order to provide these children with substantial support so they can have the futures they deserve.

In the afternoon, we had our weekly meeting with a group of local women and family members in El Porvenir that I briefly discussed last week. Each week, two students from the program are responsible for teaching the group members relaxation and emotional regulation techniques for them to utilize at any given moment and teach others in their community. This week, one of the other students and I were in charge of working with the group members’ children—some of whom have physical disabilities and/or difficulties with motor skills and/or verbal communication deficits. We had each child write their names and draw something that corresponds with each letter of their name. The creativity and abilities in these children are truly incredible.

After our group, we went back to Trujillo for our Psicología en Peru course. Tonight, we focused on statistics within the country, all of Latin America, as well as throughout the world. When we look at a global scale, depression happens to be the most common mental illness. However, in Latin America, only five percent of the adult population reportedly suffer from Depression. According to the NIH, “In 2015, an estimated 16.1 million adults aged 18 or older in the United States had at least one major depressive episode in the past year.” If so many people in the United States alone have experienced depression, why is the percentage so low in Latin America? It’s because so many people do not seek or receive mental health services. This number is merely what is reported.

Among so many other challenges, stigma is the biggest problem pertaining to bringing attention to mental illness in Latin America, and especially Peru due to discrimination against mental health. If you seek any type of help or treatment, you’re considered “weak” or “crazy.” You’ll likely be asked, “Are you weak? You’re not strong enough to deal with this?” Alongside stigma, shame and misconceptions about having a mental illness come into play as well.

Even if we were to put stigma aside, psychoeducation is another challenge. If someone does in fact have a mental illness, many times, they’ll go to the local clinic with the belief that it’s a physical illness as opposed to a mental illness. In a perfect world, hypothetically speaking, of course, let’s say that someone does in fact go to the hospital for an issue pertaining to their mental health. As I mentioned the other week, you would have to wait days in the hospital before getting an appointment, and when you finally do get one, your appointment would only last a few minutes, and would consist of being asked a few “yes” or “no” questions to determine if you have depression.

There isn’t enough time to converse with the patient, so the odds of someone actually getting the help he or she needs and deserves are slim to none. But first, you’d have to overcome the stigma and shame in order to even make it to this point. And you’d have to hope that your family wouldn’t abandon you due to shame as well. Now if you want to talk about services, there is about 1 psychiatrist per every 300,000 people in Peru. If we were to look at another country, let’s say Colombia for example, there, you would find 2.1 psychiatrists per ever 10,000 people. Pretty significant difference, right?

The following statistics have been taken from Según el Instituto Nacional de Salud Mental (INSM) (2014): Nearly 5 million people (11.8%) in Peru suffer from some type of mental illness. 700,000 out of 1 million Peruvians suffer from depression, while 200,000 out of 1 million Peruvians suffer from some type of anxiety disorder. Less than 4 percent of these individuals receive services in specialized centers. Why, you may still ask? Fifty percent of such individuals believe they can overcome their mental illness on their own. Thirty percent don’t believe in treatment, and thirty percent don’t know where to go to receive services. (Yes, the percentages overlap.)

This is why education is so important. We must spread the word about mental health because until we can do so, millions of people will not receive the necessary services they require.