- Jun 17
- Professional Events
Dr. Mark Pirtle joins us to talk about addiction as a chronic stress illness. He is an integral therapist who works with clients suffering from mental and physical pain. Combining the disciplines of living systems theory, neuroscience, positive psychology, and mindfulness meditation, he developed an evidence-based program called SkillfullyAware for healing stress-related illnesses.
Addiction as a Chronic Stress Illness – Webinar Transcription
Arnold: Hello everybody, welcome to the first iteration of our second inspiration series with Dr. Mark Pirtle. My name is Keith Arnold I am the Chief Marketing Officer of Gateway Foundation and we’re so glad you’ve joined us today and to celebrate the ending of mental health month these last few days of May.
May has been designated as mental health month, and what a month considering everything that’s going on today to celebrate people who help others in this field whether it’s addictions, depression, co-occurring disorders, you know we are so grateful that the people on this webinar today are there helping people. There’s a terminology called death of despair and we know with everything going on with COVID and this disease you know many many people horrible things are happening they’re dying they’re losing their jobs. Death of despair is the secondary effect that can occur because of these catastrophic consequences. So people are depressed, leads to suicide. They’re drinking, which leads to car accidents. They’re overdosing. A lot of bad things are happening and people like you who are listening, people who are case managers, therapists, psychiatrists, are alumni who are here helping to reach out to other alumni, people who are struggling. Everybody on this webinar, thank you so much for the work that you do, for the role that you’re playing, for how many people you are helping day in and day out you are the heroes.
You see the heroes on TV, you hear everybody talk about heroes. You, today on this call, every single thing that you’re doing to help people who are struggling, you are heroes and we are indebted to you so thank you very much for doing what you do to help people today and for joining us at this webinar. I want to point out some of our heroes at our own facilities at Beacon House. They celebrated their staff, the upper-right corner. Our staff, our Aurora site down in the left-hand corner, some of our staff at our independent site and then over in the right-hand corner some of our staff nurses, therapists, executive directors, know people who are on the front lines helping those struggling with substance use disorders. Imagine the fear when this COVID first came out and people still needed help and then your staff person. You could be a case manager right now or somebody at a hospital, you have to help these people and yet you don’t know if you are gonna get sick, but you can be infected. Imagine the stress and strain and pressure, fear, and yet our staff, you know who is listening, many other treatment professionals, you’re risking your life to help people every single day so we just want to say thank you, you know big hats off and salute. I can’t imagine what it’s like to do what you do. The care, the love, just the professionalism, it’s just it’s amazing. Thank you.
I wanted to go over a few things in terms of control. Some of you may be new to GoToWebinar, there is a copper arrow there that you can minimize your controls. It’s getting in the way of Mark’s presentation. We will, we’d love to gauge with you asking questions so there is the ability to ask questions in the question bar. We may have a poll later on depending on, you know, what happens in the webinar wherever Mark takes us and what we want to know. And if you have technical issues with if you’re listening through your computer if you want to dial in if
that’s going to be a better choice for you. You know we have the dialing information above.
Attending today. Oops, sorry. Some of you attending today are interested probably in the CE’s, so after this 90-minute presentation, questions. You will receive an email with an evaluation. Please fill out that evaluation, send it back to us and then we’ll send you the CE’s. We would like to thank the Higher Thought Institute, they are providing some of our CE’s today. They are a leading provider of educational services to the behavioral health field in person as well as webinars.
Gateway Foundation here in Illinois, we have over 14 locations. We are the largest provider substance use disorder treatment in the country and we have an evidence-based model at the core of what we offer for every one of our programs. We offer detox and withdrawal management, inpatient programs, and residential, outpatient, partial hospitalization on some sort we’re living. All of our programs are open. We have in-person, like clients today in person are in our facilities and same with outpatient. We offer in-person outpatient, as well as virtual outpatient, for those that are not comfortable coming in or can’t or don’t have the resources. It could be in an outer line area.
Skillfully Aware! So Dr. Mark Pirtle’s program in Tucson, Arizona focuses on the disciplines of neuroscience and living systems. He offers consulting on chronic stress illnesses to people, treatment centers, and organizations companies. So we’re very excited to have skillfully aware here. And I’m excited personally to have Dr. Mark hurdle today because Mark and I go back a long way. Hello Mark.
Mark: Hello Keith!
Keith: How are you?
Mark: Doing good, thanks.
Keith: So, I just want to say a few words about you, Mark. You know, Mark and I worked together at a program called Sierra Tucson years and years ago, and he set up the first pain management program there, and that’s really where I never even heard of the word chronic stress illnesses. That was like the profound paradigm shift for me and something that you had been working on for a very long time, and it could now have blossomed and grown. you know you’re a doctor of physical therapy, you’re a mindfulness meditation practitioner, you are on faculty at Andrew Wiles Center for Integrative Medicine at the U of A, you’re a clinician a speaker, a writer, and now a filmmaker, you’ve just done so much and I know at the core and the base of what you do Mark, and one of the reasons I just appreciate you so much is the passion that you bring to helping people with chronic stress illness and, and that different paradigm shift that people can look at some of these disorders and diseases, maybe through a different lens to help explain what’s going on. So Mark, thank you so much for joining us today. So good to see you have a sunny Tucson Arizona.
Mark: It’s sunny, it’s hot too.
Mark: Sunny and hot, yeah. We’re approaching June, the hottest time of the year. But it’s all good, we’re lizards out here we got thick skin.
Keith: Well awesome, I am going to make you the presenter. I’m really excited that you have joined us today and agreed to be on our inspiration series. I’m going to hand over the controls to you and then I will disappear. Let me know when you have the controls.
Mark: Okay I think I do and now I’m showing my screen. How do I share my screen? Let’s see, show me.
Keith: It’s green, it’s green. I can see your screen.
Mark: Can you see screen two?
Mark: My, uh.
Keith: We see your presentation.
Keith: Good to go. I’m gonna disappear.
Mark: Bye, Keith, thank you so much.
Keith: Yes, take care, okay.
Mark: Alright, hi everybody!
Keith: And if people have questions, just go ahead and put them in the question bar.
Mark: Okay, perfect. All right you guys, thank you so much for joining us today. As Keith mentioned, I’m gonna talk about stress-related illness in, how do I frame that. Um, when we experience stress in our lives, and that can be early life stress, traumas, prenatal, childhood, our stress response is activated, and everything we experience changes our brain in our body. And, and so the way we begin to relate to our lives shifts as a result of stress. Anything that feels overwhelming, um, can actually sensitize us to stress later in life, and so I’m gonna get deep into that. But what I want you to know is this talk is about the mental state that stress puts us in. So I call it the mother of the beast, the mental state that lurks behind all stress-related conditions. And so it may be that you think of addiction and depression and anxiety and PTSD and like everything that could put a person in rehab as sort of a separate thing. I want everyone on this call to understand what they all have in common and they all start from the same mental state and I’m gonna explain what that is. Okay. And if you become adept at meditation and mindfulness, you’ll be able to see this state in yourself and shift away from it. Once you understand the internal mechanics of shifting your own consciousness, you’ll be able to teach it to other people and facilitate their healing. So that’s what we’re on about today.
Now as part of what I wanted to show you today, I produced a film that is going to be released on PBS this Fall, it’s called “Is Your Story Making You Sick?” and what we did was we actually filmed eight courageous participants. They went through four, four-day retreats that spanned over six months. We actually followed these folks weekly over the internet for an entire year, but the retreats happened over six months, and the programming that we provided was based on this educational model that that stress illness has a particular cause, and how to see the cause, and then the other supposition is that you know, we all, we frame who we are through the story in our mind, and because of stress or trauma, we can develop a distorted story of who we think we are, and that distortion sensitizes the mind-body network, and in every other way, how we relate to people places and things. And so we wanted to help people understand how the story that was already on board and imprinted, how they can begin to influence it and open themselves up to experiences where they amplify instead of the negativities that amplify positivities in life.
Beauty is one thing, and beauty is a word that is taught, that I’m going to use to define your interest in the subjective experience of improvement in anything. When you see a sunset, only you are aware of the beauty of the experience of your own personal experience of beauty, right? So, so when you taste a delicious, some food, you are aware of that beauty experience. When you see, or when you feel a fabric that feels good, you’re aware of that beauty experience. So those are in trust objective experiences of positivity, I’ll call those beauty experiences. And the more that you can incline your nervous system towards amplifying beauty experiences, the better you will feel. Next, we are in a relationship with other people, and when we connect with other people, what we’re doing is we’re amplifying goodness. And goodness is that intersubjective back in forth of love and compassion and support and just general positivity. And then lastly, we are embedded in an objective world, and the closer you can hone your nervous system to picking up the truth,
Like, how actual things arise, abide, and pass away. The cause and effect of the reality in which you find yourself. The closer your, um, how you fare it out, how you perceive and appraise what’s happening, the closer you are aligned to the truth, the better you’re gonna feel. So, what I’m trying to teach, not only the clients and everybody I work with now, but what we tried to teach the participants in the movie, is to Incline their nervous system, to amplify beauty, goodness, and truth, okay. So that is a big message, and that’s behind shifting your story. Okay, now what I want to do is, I want to show you a short 15 minute concentrated clip of the movie, and then I’ll get into the science that informed all of the retreats. Okay? So that’s what we’re gonna do right now, and here you go.
Video: So I just got the memo that we are to speak to our hotel.
Video: I really think that through my attempt to teach my children to be more real, what I really try to teach them, is to have more internal fortitude and ability to love and cope with themselves instead of seeking out, seeking it out, of others always
Video: I’m probably becoming more and more accepting of the fact that a good part of my disease is, is affected by the way I grew up, the way I think, the way I compensated for the way I think.
Video: We are like the way that story comes into the world, we are storytelling creatures like fish live in the sea. We live in stories, the stories in here, the counts that we have of everything in our life. If we have a story that doesn’t nap well on to what is actually going on in life stories
that we did you we know that the…
Mark: We know that the audio has stopped, so we are working on that right now.
Video: About letting our attention go, we could mindlessly allow our attention to fixate on that story that hurts us inside, not only mentally and emotionally, but physically too. This is a recording device, and it records everything that we’ve ever experienced, and it reacts to what we’ve experienced in the way that it reacted in the past, and so that’s how we live the past, so new circumstances arise, but we carry this old programming. So how do you change that? Well you’ve gotta get a perspective on your perspective, and people can and do get better if they learn how to meditate skillfully, and they learn how to explore their past programming, and deconstruct that past programming, and construct new ideas and conceptions of self.
Video: The disconnection between me and my mother has a lot to do with why I make
choices in relationships. When I have a full-blown anxiety attack, I’m in the fetal position on the floor crying hysterically. That’s what a full-blown anxiety attack looks for me, and I’ve been having those since I was 12.
Video: Ihad some very traumatic experiences when I was a youth growing up. I was abducted, molested, raped, and it’s made me who I am today. It’s a bag full of hypochondria, obsessive-compulsive behaviors.
Video: The critical self, you know, with that critical putting myself down, not always perfectionism, not being good enough.
Video: I felt like we were backpacking in the Boundary Waters and I was carrying all the bags.
Video: I’m here because I’ve been struggling with depression. I hope to get my spirit back, I hope to get my humor back, my playfulness.
Video: Somewhere along the line, there was some sort of event that may have happened, and the person came to the conclusion that there’s something wrong with them. Maybe they were just told that directly by a significant other- by somebody that had power over them – like a parent or a teacher, or maybe they just made a misinterpretation on their own. But once that belief exists and shapes behavior, and the behavior is reinforced because it leads to an outcome, then that thought takes hold and begins to grow as the downward spiral in trenches further and further, coming tighter and tighter and narrowing the person’s life.
Video: When I think about trauma in the work that I do nationally, we talk about the trauma that is being pervasive. If we do not look at trauma, we are not going to make a difference in this country in mental health, in addictions, and in primary care. What we’ve discovered is 98 percent of the people who cross the threshold of a behavioral health organization, either with addictions or mental health challenges, have experienced significant trauma in their life.
Video: You might say that the fundamental pain is the loss of self, and that is it responds to traumatic events in childhood. If you look at the studies, the more child at the diversity, like emotional, or physical, or sexual abuse, or parent dying, or parent mentally or beating, or another event, in jail depending that they did any of that the more of these adverse childhood experiences add up, the greater risk of not only of addiction but also psychosis also of attention problems, also of immune diseases.
Video: So the abuse started at four and a half, I remember being extremely scared, you know the first time. I didn’t have a childhood, it was taken from me at a very young age. I felt different. I always felt different, like I didn’t really fit you only if people knew the real me, type of thing.
Video: So take, for example, a child who is in a family that is abusive to them, either physically abusive or sexually abusive, perhaps emotionally abusive, verbally abusive. These experiences can overwhelm a child, and we know that there are effects on the brain from the stress hormone cortisol that’s released then inherited are probably integrated circuits.
Video: Well, this is me. Obviously this is my world or was the last 30 years. And this played a big part, the bottle. And, and dreamcatchers, this is what I’m working on now. And my dreams literally come true, which is probably more of the release that I need.
Video: I was married to Justin here, that was 15 years ago. I’ve been with a lot of women in my life. I lost my virginity when I was 12, so I’ve been sexually active since 12, but I’ve never been able to maintain the long-term relationship, and so my deepest realization here is that that’s the part of me that needs to be healed in order for me to be happy with someone.
Video: As we watch these time-lapse breaths coming back to remember there were the authors of our own stories, and their stories are always evolving, and this is just one more opportunity to come back to this moment to what you’re choosing to write for yourself. When lifeless helps us to stop the downward spiral, a world of possibility opens up to us. We step back from the negative event or experience that we were fixated on, and then we become freed to shift our attention to the positive aspects of your experience that we weren’t even noticing.
Video: We’re working on a ceremony which is really important. Fears, dreams, imagery, we’re trying to work with the pieces that are not one plus one equal two, we’re trying to work with the non-rational, more intuitive states that actually have tremendous healing power.
Video: When I looked at the people that develop chronic diseases, there were four salient characteristics. Sometimes when people’s autoimmune disease cancer and so on ALS multiple scores – A) they were much more cognizant of the emotional needs of other people than of their own, for their spouses, for example, number one. Number two, there was a rigid identification of the duty role and responsibility job gun never mind like fifty um there was the suppression of anger, a great difficulty expressing at the end. And finally, they tend to believe they are responsible for the people they love and believe they must never disappoint anybody. Those beliefs, they were not mistakes, there were not faulty ways of thinking, there were coping mechanisms that they developed in childhood. For example, your need is to be connected with your parents because without them you don’t survive. Defensively stressed all the time, one way you make the relationship work is to be more interested or more concerned with how they’re doing than how you’re doing, so it becomes one of your characteristics. It’s not how you were born, it’s not who we really are, but it’s how you cope.
Video: It was extremely painful to be…
Video: What’s the feeling right now?
Video: So, you’re like, we’re supposed to be, like shamed and blamed to have somebody come in and destroy who you truly are for their own sense of control was just
so painful. And I wore the mask of perfection and everything’s okay, and I’m fine.
Video: The “I’m fine” mask, that’s what I wore
Video: So as you tap into the shame, what’s underneath?
Video: But maybe it’s true. Maybe I was worthless because all this happened to me. Maybe I shouldn’t sit down my story, because I asked for it.
Video: You want to try and dig my chair back there are a couple of ways you could go. You can go to what’s underneath it, you feel the anger, the injustice.
Video: You could try that, or you can try by yourself. It’s up to you.
Video: Okay. No person should control who you are
Video: That’s right
Video: And what else do you feel? Do you feel the power of the anger?
Video: Does it feel better than these?
Video: Mindfulness is a very simple process of noticing new things. It’s bizarre that something so simple can have such profound effects. By simply noticing new things, you realize you didn’t know the thing as well as you thought you did, so your attention naturally goes to it. We’ve done studies now for 40 years where we teach people the simple thing of noticing new things, and by noticing new things which put you in the present, makes you sensitive to context and perspective, so you’re there, you’re engaged, and that engagement is energy-producing, not consuming. What we find is that the benefits to virtually all aspects of health and well-being are enormous.
Video: Before all of the darkness, before all of the shadows, before all of the trauma there’s a beautiful person inside of each of you.
Video: Open up my phone even if I have a story. Now it’s just gonna be to constantly remind me of that gift of being present for it all.
Video: You are amazing. You need to stop doubting yourself and start realizing who you are.
Video: Weave together a new story of life. A story of our lives as full of meaning. A story of ourselves as strong, resilient, somebody who’s a survivor, somebody who thrives.
Mark: Okay you guys, I apologize for all the audio issues, I didn’t realize if I muted my mic, I would mute the sound. The sound wasn’t coming through my computer, it was coming through my microphone, and you got to hear my visceral reaction to things not going well. So, oh boy.
Alright so anyway now, let’s get into, I hope you enjoyed that. And it’s set up just sort of the context of working with a lot of different, co-occurring issues simultaneously and how to do that. So let’s first talk about where stress illness starts. Let’s talk about the mother of the beast, that one mental state that it all comes from. Okay. And that is a state that I call attentional fixation. Now all of us attentionally fixate. When stress goes up, our attention is biologically programmed to narrow down to a particular, the object of our stress, the object of our pain. And when we have a consciousness that includes awareness but when attention fixates, all of our consciousness flows through the beam of our attention, and we lose awareness. That’s what happens.
Now this little guy right here, is the metaphor for your consciousness. Okay. And I don’t want you to think about, you can see the little guys face there, but I want you to think about his internal experience. And what I want you to do is experience yourself internally right now, okay. So you’re looking at a slide, but I want you to be aware of what’s happening on your subtle insides. Now, how our consciousness works are, we have attention, and attention is like a flashlight of consciousness. It shines from our sense of self, from our subtle interior, and it connects us with an object. There is a subject and object and there’s always this interaction between the two, okay. Can be pleasant, neutral, or negative, all right. But then I also mentioned that we have awareness, and awareness is the whole space of our consciousness. It shines in all, awareness shines in all directions, not just on one thing. Awareness shines into the world, you can see the room in which you’re sitting, you can hear what’s going on around you, you’re aware of the world around you, but you also can be aware of your body and your mind. So awareness goes into three domains. Attention will shine on an object in one of those three domains at any one time, okay it’ll always be shining in the world, shining in the body, or shining in the mind in one of those places. You can always find your attention shining in one of those three places.
Alright, now mindfulness is balancing your consciousness. It means that you have placed your attention consciously on an object, but you’re remaining aware, contextually aware of what’s going on in the world, the body, and your mind at the same time, so there is local attention and global awareness. That’s what mindfulness is, and I invite you to try to do that right now. So pay attention to the slide, and my voice, and in the lesson. But at the same time, peripherally now, be aware of the room in which you’re sitting, the sensations in your body, and the thoughts in your mind. Everything that’s happening in awareness is in the periphery, and your attention is the flashlight that is highlighting something that you’re paying attention to, okay.
Now attentional fixation is something different, that’s when you get triggered by something, and all of your consciousness goes through the beam of your attention and you can see how the awareness dims, so that’s something I want you to take away and realize for yourself. This is a truism, okay. When attention fixates, awareness dims. That is true for everyone. And we’ve all had an experience of this, we’ve been driving home and maybe we were triggered by something that happened at work, and so we’re not crashing on the drive home, we’re going through the green, we’re stopping at the red, we get all the way home and then we realized how in the world did I make it all the way home? Well, we were driving on autopilot, we were fixated on the story in our head, and our body was driving the car, we weren’t there, so our awareness had dimmed, okay. That’s what happens when a person becomes addicted to something. The person is probably unaware of the background radiation of discomfort or feelings that they want to medicate or numb, they get triggered, not necessarily aware of the trigger and the connection to their suffering. Their body, this process, happens where their awareness, I mean their attention, narrows down on the object of addiction, they start fixating and in planning the use or the acting out, right? But they’re not aware of that, that’s what’s happening. And then they do it, right? So attentional fixation lies at the heart of every single addiction, but think of depression, too. Thoughts that captivate your attention, depressing thoughts, keep you from being aware of what you’re doing to yourself, and a downward spiral starts. The same thing happens with anxiety. You get fixated on whatever is scaring you and the distortion happens, okay. So this is the mother of the beast, attentional fixation.
Now, the mind-body network. There’ a mind, I mean a body, attached to everything that your mind is doing, and so if you’re fixated in your mind, you’re sensitizing your body. And the body, you can think of sensitization and amplification as synonyms because – think of a downward spiral. When you become sensitive to something, you need less and less of the stimulus to get a response so everything becomes amplified. Now how does that happen? There’s a triggering event, attention fixates, and then, and I’ll show you the connection to emotion in the next slide, but you get an amplified emotion, and what basically is an emotion. It’s a contextual understanding of your mind-body world, the story that is coming from you, you’re appraising this event as being a loss or a threat or an injustice, and the emotion corresponds to the appraisal, I will explain that. So you can amplify emotion, and amplified emotion is a distortion. Your brain is involved in that experience, it dumps chemicals, and produces physical brain changes. Basically, you’re activating the hyperarousal circuits, and then if you’ve done it enough, you’ll just keep repeating it. This cycle of fixation, amplified emotion that changes the brain and the body, and you repeat, and you will begin to sensitize yourself no matter what, and to anything. Okay, all right.
Now in this slide, I want you to understand the relationship. This is the slide that explains how stories make us sick. When we have experiences, experiences come with meaning. When we were born, our nervous systems were open and took in so much more information than they do now. They were fully receptive to information, and what our nervous systems had to do was organize that information and make sense out of it, and part of making a model of the world and ourselves is a process of deletion. So, some stuff we stopped paying attention to but other stuff we pay more attention to, stuff that is more salient, related to pleasure and pain. And so there’s, we develop a sense of ourselves, in our relationship, to the world. And when we become verbal, when we become toddlers, a story starts in our head about who we are and that the ongoing life narrative is encoded in us. Now when we have subsequent experiences later in life, we’ve already been programmed with this meaning, with this story. So we already know how to relate to the world. So if you’re in the world as an adult and you lose something that’s precious to you, I’m going to start with the first appraisal in the left-hand column, a loss appraisal. If you lose something like a loved one or a love relationship, you’re going to have an emotion, and that emotion is going to be sadness. That’s universal in all human beings. So the meaning of an experience, loss, will produce sadness in all of us.
Now, there are two threat appraisals, one is an acute threat, and one is a chronic threat. I’ll show the emotions here. Now, as we grow up, it’s appropriate for us to feel fear at times, and fear in and out of itself is not a distortion. It’s when we’re overwhelmed. However, that’s when we start saying to ourselves like, I can’t handle this anymore, that’s a threat. Like this whole COVID crisis has got the world in a little bit of a threat to the situation, alright. The economy is not doing so well, you may have known someone close to you who has passed, or just the struggle, you may have lost a job. So there’s a lot of threat going on right now, and your mind-body network is feeling this because it’s contextually relevant. It’s up for you right, now it’s up for all of us right now.
Now, when we feel, it might be that a part of our self-narrative is that we are inadequate. Like Jewels in the movie you saw, well maybe I think there is something wrong with me, maybe I should feel shame. Well, she got all of that information interjected into her by her family and the traumas right, and so she carries around this shame base. And a lot of us do in certain contexts, all right. What shame comes from is feeling inadequate. If something happens to you that feels unjust, you’re gonna get angry. Okay. I just want you to know the reason I’m showing you this. It’s because I want you to connect the emotions that you feel to the context in which you’re in. Emotions are contextual. Something’s happening in the world, in the body, and in your mind, you put all that together and there’s this story that emerges in a certain theme. And, based on the theme, you’re gonna get a certain emotion. Okay. That’s the important thing to know.
Now, a challenge appraisal can be positive. The first five appraisals arise as a result of contacting some sort of negative experience. A challenge appraisal is a positive reaction to a negative experience, it’s where I, where you might say – well this is a spiritual experience, I’m gonna handle this in a good way – and you feel determined. Okay. Like all of these emotional responses, other than shame, are sort of normal responses to contexts. Shame has already come out of the gate as a distortion. Now, what I’m saying is, nothing’s wrong with emotions. Stress-related patterns, however, is a greater distortion. That’s when you can’t let something go and your attention stays stuck, and because it stays stuck, your brain changes, the emotion amplifies, you repeat, your attention stays fixated, and you make something bigger. Okay. Sadness, if you focus on an experience of loss long enough, you’re gonna bypass sadness, and you’re going to become depressed. Fear goes from being a normal reaction to some sort of threatening situation to becoming a distorted reaction. And the anxiety-related reaction. And there are lots of different kinds of anxiety-related disorders, they’re all distortions. Fears, fear is an emotion that you need to have, anxiety is an emotion that does no one any good. Distress and overwhelm often, and shame, often turn into addictions. The distress and overwhelm that we might be sensitized to because of traumas in our lives and what God interjected into us, and we’re just sensitized people.
And just normal life feels overwhelming. And we may have found a way of coping by medicating or numbing our emotions, and that’s where addictions come from. Or we may be trying to fill our self up with people places and things because of our shame, and addictions can come from that as well. Anger doesn’t stay, angers a normal emotion, it can activate you, it can get you to right or wrong, but if it’s distorted, it turns into rage. That’s not good for anybody. And determination, even determination, can turn into an OCD type. I don’t mean frank OCD. And, I should change this slide, it shouldn’t say OCD.
And think of the diagnosis, I want you to think of OCD type behaviors, where you just can’t let anything go anymore, alright. So you see how these on the right-hand column, these are patterns of distress, these are distorted patterns, stress-related illnesses that arise out of distressing contexts. Okay.
Now once you’re wired up to experience this, you’re in a feedback loop. Like for example, if you’re depressed, that’s depressing, do you see? And that’s why it’s so hard to get over and heal these stress-related conditions, because they’re amplified and the feedback brings more, more gets more in these cases, all right. I hope you understand that.
Now let me give you another way to think about what I just showed you in those columns. So the appraisal, start here on the left, so the appraisals. You’re minding your own business going through your life, but the appraisals that are coming from you, are coming from you automatically. You encounter something in your life, and your judgment, your preconceived, pre-programmed judgment, the appraisal comes from you, which might trigger you to have some automatic thoughts. Let’s just say you were engaged in a workgroup and there’s six of you, and one of the leaders of the group said “Okay everybody, can you guys clean your stuff up now?”. And you, for, and you weren’t aware of this, but you heard that, can you clean your stuff up right now, and all of a sudden you took offense. It’s as if it seemed like the person was scolding you when none of the other people took it that way, so the appraisal of injustice came from you, started you automatically thinking about “who the heck does that person think they are?”, and then you start thinking, you know, group leaders are so high and mighty, right? And then you go home, and maybe your coping habit is to complain and to the point where you feel like you need a couple of glasses of wine to calm yourself down.
Okay, that’s just one way it could cause the process to unfold, right, and perpetuate a habitually distorted story. Now, oh I wanted to talk to you about catastrophizing and hypervigilance. Let me just mention two psychological features of people who are sensitized. One is they catastrophize, and there’s been a lot of research done on catastrophizing and, in a lot of this research I did, as I mentioned I’m a doctor of physical therapy, I did when I started a pain program at Sierra Tucson. Pain patients tend to catastrophize, they see the worst and expect the worst, and that puts their nervous system already on a sort of shaky ground. And hypervigilance, what hypervigilance is, it’s a quality of consciousness where you have fixated attention. It’s not like you’re aware of everything, because you’re not. There is actually very little awareness in a hyper-vigilant person, the person’s attention is hyper magnetized to go towards, and sort of suss out potential dangers in the environment, so you’re going from one potential danger, and then looking for another potential danger. With your attention, a narrowly focused hyper fixated attention, that’s what hypervigilance is. And when people are programmed to be in the world that way, you have to begin to work with their defenses, make them feel safe. And I’ll explain all of this in setting up the way in which you begin helping people dial down the sensitization.
Okay. So now I want to talk about how we are a living system, and you can think of the living system as a story machine, a system that’s making its own story. Okay. And here’s how it does that. We’re taking any energy and information in from the world, we process energy and information in our body in the form of sensations, and we also have energy and information cycling through our mind in the form of thoughts, alright. So, and all three of these domains, remember I said awareness is open to three domains, world, body, mind, so these three domains in which you could be aware, are taking in information, whether you know it or not. Okay.
Coming in from the world, processing in the mind in the body, and how you are programmed to process is how you’re programmed to process. And so you, me, everybody else, finds a way of interacting with the world that really sort of generates some repetitive themes. And people with stress-related illnesses, their attention is magnetized towards negativities, and so the repetitious themes could be loss, threat, or injustice, or inadequacy. You could also magnetize yourself towards positive themes, Amplifying goodness, truth, and beauty, for example. I mentioned that earlier. Okay. That’s an alternative where you’d have to sort of consciously programming your nervous system to pay more attention and to amplify the beauty experiences inside of you, the goodness experience between you and others, and the true experiences that you have, all right. So that’s what spiritual practice is all about.
Now, how does the information get in and how do we process it and make the meaning? Well, I got this shorthand, these six words: sight, sound, talk, image, touch, feel, from my first meditation teacher Shin San Young. Sights and sounds come in for the world that those, the word sight and the word sound represent just what you think. What you see in what you hear. Now in the mind, talk represents thoughts that resemble mental sounds, so if you’re talking to yourself inside of your head, or if you have a song stuck in your head, we’ll call that talk. We’ll agree that that’s what a sound like thought will agree with. A picture like thought, however, is image, alright. And we process what we see here in the world in our mind through talk and image. And then in the body, we process meaning not verbally, but somatically through touch sensations, which are physical sensations – warmth, coolness tingling, pressure, pains, joint, position, sense – like if you’re sitting right now and you close your eyes, you still know that you’re sitting because touch sensations are telling you. Feel sensations, think of those as emotional feelings. You, if I had a lump in my throat because I was sad, it wouldn’t be telling me about my trachea, it would be telling me that I was sad. So all of those six – sight, sound, talk, image touch, feel – that’s the basic meaning. Then, how do I want to say this, then, think of it as the letters that form the alphabet, that writes the words, and the sentences, and the paragraphs, and the chapter of your story. Sight, sound, talk, image, touch, feel – it’s always flowing in, and it’s producing the story of you right now, and the story of me in a lot of our clients, the ones that are really suffering. The story of me is the primary fixation. Do you see? They’re locked in there, they’re not aware of sights and sounds and the influence of sights and sounds, they’re not aware of the influence of talk and image or touch and feel, they’re just in their story. Their story has them, they’re fixated.
Now, the way to begin to heal through mindfulness is, you begin to deconstruct the story.
Oh, I’m sorry.
So repetitive self-talk keeps you locked in, that’s what creates the stress-related illnesses. Now, here’s what the deconstruction looks like. When you become aware, you can become aware, you can right now as you listen to me, be more aware of the sights and the sounds in the world that aren’t related to me. Just everything else and how that’s contributing to your experience. Now you’re more aware of the part that we’ll call the world based on your broad experience. As you sit there right now, become aware of the sensations, all of them, touch and feel, in your body and how that is a part of your experience in a sense in your psyche, isolate that part. You can become aware of just that part of yourself. Now you’re being mindful. Now you’re deconstructing your experience. You could even be aware of thoughts as they arise, not like thoughts have you, but can be aware of thoughts arising. You have your thoughts aware of the mind. Do you see that? I hope you’re able to understand what I’m trying to demonstrate with this slide, that you can learn how to deconstruct your experience, and this is vital for people that are suffering from a stress-related illness, no matter what it is, they have to learn at some point, once they feel safe and resourced emotionally, to begin to work with and deconstruct their constructions.
Addiction is a construction, depression is a construction, anxiety is a construction, it’s something, it’s an epiphenomenon, an attractor that their mind-body has learned to create. And so if you don’t want it there anymore, you have to learn how to deconstruct it, okay. That’s why mindfulness helps with all of these conditions, because mindfulness meditation is a deconstructive practice, okay good. And please write down all your questions related to this slide if you have them for me at the end.
All right so now let’s get into what my clients and what the participants of the movie were doing and working on. So this isn’t, per se, the mindfulness piece. You use mindfulness while you’re doing this work, it’s where you learn to see that your story is a construction and how it gets constructed by itself. Now, shadow work, narrative revision, shadow work, let me just define shadow for you all. Okay just so we’re all on the same page, and I know we might have different definitions of shadow, but the shadow is any unconscious dynamics that have an effect on our personhood. So hidden motives, desires, impulses, patterns, that operate out of our awareness, but have a significant impact on our lives. Okay.
And there are three forms of shadow. There’s introjection, you got to see in that movie Jewels working with an introject, we hadn’t gotten to the place where she could see the interject yet but the fact that she was sort of shame-based she got a lot of that interjected into her from her childhood. Projections, as you know, that’s it, well I shouldn’t say as you know. So the three types of shadow are interjections, projections, and split ego states. Now let me just define these.
So interjections are material that we absorb from the outside, and either it comes in distorted, like from Jewels parents, or we distort it. And then once it’s inside, then we hold it as true. Okay, so interjects arise because when we’re babies like I said before, we are a hundred percent receptive to information. We’re in that receptive phase of our life at that beginning in those early stages, and when you work with interjects, you have to use release techniques. You don’t use re-owning techniques because the interjects have to be released back to where they came from. You don’t want to integrate an interject.
Now, projections are material that we have inside of us already that we project out onto others in the world. Projections arise naturally because, as toddlers, our perspective is that everyone sees the world the way we see the world, and the way we see the world is true. That’s what we as toddlers believe, and there’s always a part of us we transcend that ego state, the toddler ego state we have left that, and we have transcended that but it’s still included in our psyche. In a sense, we’ve split off. There’s part of us that still wants what it wants when it wants it. That toddlers driving the bus. Okay now for projections, you have to use re-owning techniques, and let me write these things down. Okay, here we go.
And split ego states are what we’re talking about. Now, those split ego states arise in a bunch of different ways. They can be developmental, like when you grow from being a hundred percent focused on yourself to realize that relationships are important. And maybe I need to give up on my needs so I can relate better with others. That’s going from a first-person to a second person perspective, and that’s healthy. There can be some unhealthy dynamics there too, but they’re there. We can develop unhealthy split ego states. For example, if we start to see that our needs aren’t worthy of being met and we see our first-person perspective as selfish, or wrong, okay, that’s a split ego state that has a little bit of dysfunction in it, okay.
And so now the shadow work that people do involves five steps. Shadow, of course, the first step is that the person is unaware of what’s going on, and even of their symptoms. Then, at a certain point, like when you’re in the unaware stage. Let’s say you’re working with an alcoholic who’s in the unaware stage. They, that person, aren’t aware that alcohol is a problem for them. They’re unaware. And because they’re not really aware of the symptoms. Now the second phase is, they become aware of the symptoms – the hangovers, the loss of the job – and relationships are hurting, right, and so when you become symptom aware, it’s not like you get the full picture. You think when you’re symptom aware if you can just get rid of the symptoms, the problem goes away, and so for the hangover, you might take some ibuprofen, problem solved right? Well, the problems are not solved. Then at some point, a person waking up to his or her shadow becomes aware of the triggers. The triggers in their life then become the problem, like the person, this alcoholic that I’m talking about sees his boss as a trigger and the work that he was doing that he doesn’t like as a trigger, his nagging wife at home. And like then, just like the symptoms were the problem in at the lower stage of awareness, now the triggers of the problem. And still, the problem is outside of you, and what you’re trying to do is gain some semblance of management over your triggers, all right. This is actually the first step when you become aware of when you start self-managing a little bit, it’s not a hundred percent healthy like you’re trying to distance yourself from the triggers. And sometimes, isolating yourself creates its own problems, but you’re attempting self-management at the trigger aware stage.
Then at some point, this is the fifth level, you become process-aware. Now let me see, do I have another slide that shares this? Yeah, okay, let me, so you guys can write notes. The fourth step is process-aware. Now process awareness is when you’re aware of the symptoms, and you’re aware of the triggers, and you’re aware of the link between the triggers and your symptoms inside of yourself. Like you’re starting to notice how your insides are reacting to the experience that you’re having. This is a major step forward in waking up because now all of a sudden you’re a little bit more open to feedback. You’re working with a therapist, and the therapist primarily is helping increase the process awareness. This is where mindfulness really comes in, and that skillfully aware slide that you saw two slides ago working with energy and information in the world, the mind, in the body. You’re starting to become aware of perhaps very subtle images in your mind or talk, or feeling states in your body, well before you’re aware of the symptoms, well before you start acting out, okay. A very important part of waking up.
And then also what happens a lot in therapy is, you have a therapist that helps you come to a resolution through conscious conceptualization. And what conscious conceptualization is is that you’re aware of sort of the core lie that was interjected into you, perhaps, or the projection that’s keeping you stuck, and you’re able to deconstruct that and reconceptualize and make sense of the self-narrative and re conceptualize it in a way that frames you as surviving. And going forward in a way that you can project that you could thrive, right. You’re reconceptualizing your story and projecting it into the future where you have some expectation of a positive outcome, alright. That’s a very basic shadow resolution technique.
Alright, so now I want to give you guys experience of the mindfulness piece that I do with people. And what we’re going to do is, we’re gonna affect the flow of the energy and information, right, that’s cycling through each of you. And I’m talking about your interior space, that subtle inside that’s listening to me, okay. Listen to yourself, listen to me right now, that space that’s listening, we’re gonna affect the flow of energy and information by working with your mind.
Okay so, um, the mind is like a space, and if you can see me, I’m not sure if you can see me, I’m gonna make a cube and outline a cube with my hands. And if you can’t see me, just imagine an invisible cube in front of you, and then remove the sides of the cube. And you’re looking at a space, right. Well, the mind is like that in a couple of different ways, the qualities of mind are that my mind itself, and when I say mind think awareness. Awareness doesn’t have an edge. If you really look like a deep meditator, you will not ever be able to find the boundary of your consciousness. Doesn’t stop at your head, doesn’t stop at your skin. And this is, again, one of the truths of a higher perspective, and the person can open themselves up to.
Now when we look at a lower more concrete perspective, you think you do end at your skin, but as a person develops their consciousness, they become very clear, absolutely clear, that consciousness does not stop at the boundary of your skull or your skin. And that if you are really tuned in, you can’t find any edges to your consciousness and the mind itself, like a space is also empty. The ultimate mind doesn’t have anything in it, okay. Now energy and information flow through it, but the mind itself is the space in which those objects of energy and information flow. So there’s a space of mind, and there’s the objects that flow through, all right.
Now here’s our little guy, that’s our conscious symbol for consciousness again. There’s the flashlight of attention, which is directed outward, here is the awareness okay, awareness is the awareness in all directions. And mindfulness again, just to repeat, mindfulness is placing your attention, so consciously place your attention, and stay aware of the whole space. Now, what’s the whole space? World, body, mind. Here’s what I’m gonna do, I’m gonna ask you to meditate now on this orange dot. There’s nothing special about this orange dot and I’m not gonna hypnotize you, because you’re gonna stay aware.
All right so look at the orange dot and don’t move your eyes. Now start to discern with your attention the qualities of the orange dot. Notice that it’s brighter on top and darker on the bottom. And if you really stare at it, notice that it’s a little bit pixelated. You may even see sort of an aura around the outside if you keep your eye on the dot. If you keep your eyes perfectly still, your nervous system has a hard time clarifying the edge, and so you’re gonna see a little smearing of probably what looks like a greenish aura around the outside, almost looks like a solar eclipse kind of a thing.
Okay. So you’re looking at the dot, now don’t move your eyes, but become aware of the whole rest of the space of the room in which you’re sitting. Peripherally now, don’t move your eyes. See right, left, up, down, even notice the space between your nose and the computer screen, notice the space, use your ears in the same way, listen right, left, up, and down, behind you, and remember, I said, listen to the middle of your head as you listen to me. Direct your hearing since inwardly, listen, inside, good. Now you’re a hundred percent aware of the world, the space of the world, I’ll use that word quite a bit, the space of the world. Good, now you may not be, but I want you to become aware of your body right now. And some of you had no awareness of your body, all of a sudden it blinked on, from the tips of your toes to the top of your head, feel everything, all the touch, and the feel sensations. And I really want you to feel what you can feel, but also try to feel what you can’t feel. Their parts in your body that are empty of sensation. Like you can’t feel your femur bones, notice that. It’s just empty space that feels like the body.
And now I want to show you, if you’re really in tune, don’t move your body, and you may even decide to close your eyes. Try to feel the edges of your skin and notice that you can feel a whole bunch of sensations, but there’s nothing that communicates an edge. And if you’re having a hard time feeling edge lessness, just pick warmth, pick your warmth, feel isolated warmth with your attention, attend to warmth, and notice that warmth doesn’t have a beginning or an end, it doesn’t have a place where you can feel it like it starts or stops. Like it’s trailing your warmth, is trailing away from you like a fog. Warmth has radiation into the space, and remember I said that the higher perspective that you have, the less solid you’re gonna feel, so I’m trying to turn your body into a space right now.
And now let’s go into our mind. And if you don’t know how to go into the mind, imagine where your brain is, it’s right behind your eyes. Now I know you cannot perceive your own brain, but you can place your attention in the space where you think your brain is. Be attentive to that place behind your eyes and in between your ears, and notice what you notice there. Notice it just feels like an awake space looking through eyes and listening. Now don’t move, just notice, that awareness, the qualities of it, the quality is like space, it’s empty. It’s spacious, nowhere where it starts or it stops, but it’s also luminous, it has the capacity to know.
For example, you’re hearing the sound of my voice right now in the space of your mind, but the sound of my voice is not a part of your mind, per se, it’s just a coming and going. Just like the orange of that dot. Your mind is not orange, your mind is not warm. Notice that the mind doesn’t have any qualities at all, it’s empty. Okay, now you’re really aware, now you are deconstructing your experience. Do it right now, notice the part that’s the world, notice the part that’s the body, and notice the part that’s the mind. And you could put it all together into one whole space of awareness, and when you meditate this is what you do but you direct your attention to one thing, you want to train your attention, you want to train yourself to have more influence over your attention. And so part of the game with meditating is to place your attention on the breath and try to limit the time that your mind wanders. You stay globally aware but locally attentive to breath, and you set this mental balance up, and then if the balance degrades, and your attention fixates, and your mind starts to wander, you just set it up again. That’s skillful meditation.
Ok, well let’s talk about, so come back to me right now and to yourself, thanks for meditating. Ok, we’re getting to the end of our discussion here, I just want to review the objective. So we discussed the critical roles of attention and awareness, attention is the flashlight of consciousness, awareness is the whole space. Awareness has the big picture role. You have to stay aware to know where your attention is, all right. And when a person has a stress-related illness, they have a bias towards being attentionally fixated, and you have to work to open their awareness and teach them to notice when they are fixated, all right that’s the beginning of the change. All right and I want to list three mindfulness-based attunement practices. Now, I haven’t mentioned these yet, but I want to mention these.
The first is that deconstructive practice where you break things into the world, body, mind, all right. So that’s a practice that you can teach your clients, all right. The next one is a very simple practice, and this also comes from my meditation training, it’s called strong determination. And, excuse me, a strong determination is basically teaching someone when they meditate to sit perfectly still. Now, why would you want to do that? You’d want to do that because there are very subtle impulses to move and react and to disconnect from our feelings, and we do that when we move our body. And when we meditate, the more you move, the less you’re able to concentrate, it disrupts your concentration. And so if part of the concentration is being used to help you deconstruct your experience so you can use meditation therapeutically, then you have to learn how to sit still. Now this practice, strong determination, isn’t something that I give, you know, a person on the first day who had trauma and doesn’t feel safe, because sitting perfectly still can feel very unsafe and overwhelming, so you have to reiterate this. But it’s a very powerful practice, okay.
You can teach a person to meditate, but if you don’t give them the added instruction, let’s say they’ve been meditating and you’re making progress, your progress will plateau and not accelerate if they keep scratching every itch on their face, for example. You know you have to get them to the place where they’re metabolizing, they’re processing and purifying, all of the discomforts that are coming up from them to disrupt the meditation, and they’re working with those distractions in this those disruptions in real-time, so you this process embeds resilience, it embeds distressed tolerance, all right. That’s strong determination. And you’ll ask. Yeah?
Keith: Just wanna let you know we have about five or six questions and
Mark: Okay, all right. So then I’m gonna move on really quick here, I didn’t get to explain my last practice, and maybe I can do that through the questions, okay. Identifying the role of narrative revision and shadow work. Okay, I think I did a reasonable job with that. All right you guys, I’m ready for questions, let’s do it.
Keith: Awesome okay. So the first question from Laura Redmond is – How does in utero trauma fit into this model?
Mark: Okay, so.
Keith: Fetal alcohol syndrome, too
Mark: Yeah. So the person who was traumatized in utero is born with a sensitized nervous system, and so the introjects and the sensitivities are more profound. The earlier and more profound trauma is, the harder it is to work with. And so it’s not that what I just explained that trauma piece in reader or trauma doesn’t fit in, it fits in, it just, when I think of in utero trauma, and I’m working with a client right now whose birth father tried to kill the mother while he was gestating inside, and so he’s this young man is living with a very sensitized nervous system. And so I’m doing all of these same techniques and in-process work with him, but I’m recognizing, like, how it works for me when I’m sitting with somebody that’s highly sensitized like that, I have to sit in the seat of my highest compassion. It’s probably my answer to your question. So it’s more how it relates to me than how it relates to the client, the clients are going to be more sensitized, and I have to be more compassionate.
Keith: Excellent, thank you. And from Peter Lorenzo: Thank you for the presentation. How do you respond to clients who hate meditation out of the gate and get grumpy about doing it? How do you, how do we support them in a nuanced way?
Mark: Yeah well teach them that they don’t know what meditation actually is. So meditation, at first, just get them to breathe and attune to their own body. You don’t have to have somebody sitting in the lotus position and meditating to begin the process of teaching them breath awareness, right. And if a person is receptive to breath awareness, teach them relaxation breathing and calming down and then they have a positive association with that type of self-care. Then you can introduce, okay so now what we’re gonna do is we’re gonna incorporate this breath practice with some sitting and, what I want you to do is, we’re gonna and you can relate the symptoms that you’re having with the therapeutic nature of meditation. If the symptoms that they’re having are based on their attention running all over the place and then getting fixated, you have to encourage them and have them see the value of gaining influence over where their attention goes. And so that’s a way you can begin to get them to consider meditation but start with breath practice first I think. And in Lorenzo contact me Skillfullyaware.com, I’ve got tons of resources to help therapists get people started meditating alright.
Keith: Excellent thank you. And we have another from John Marquette: How do genetics factor into the stress illnesses and addiction as a brain disease? How does it all fit together?
Mark: Okay so addiction is a system dynamic, meaning it is not just genetics, but genetics can play a part. But your family plays a part, the traumas play a part, the culture in which you grow up in, they’re the pain that you’re experiencing. The level of financial stability in your home, whether your parents stay together, a divorce. Like there are so many factors. So it’s, I teach an addiction class for a company called a mindful, and when I help addicts understand the nature of the disease of addiction, I tried to de-emphasize the disease part, because then they mostly think it’s a brain and gene problem, and yes there is a brain and genes, but there are so many other factors. And, if you start working on all of these other factors and begin to raise your awareness and create behavioral change and positive education and peer group support and like all of that, then the brain that was, and I’m doing air quotes now, “diseased in the past” changes to where it’s not so diseased in the future. And people begin to revalue what they used to value in the past.
I used to be addicted to smoking pot, I smoke pot every single day. And I know they say it’s not, you know, it’s not physiologically addicting, but I couldn’t stop smoking pot. And until my life changed and so many other things in who I was changed, now I have not a scintilla of a hook that pot has on me anymore. I’m a completely different person. And so was I addicted? Yes. Am I now? No, absolutely not. And if I took a hit of pot right now I wouldn’t be addicted, I wouldn’t all of a sudden go back into smoking pot again because it doesn’t make sense for who I am now, it just doesn’t make any sense anymore.
Keith: Awesome thank you. And another one from Laura Redmond: How do multiple different kinds of traumas overtime work together to define the themes or over sensitization?
Mark: Okay so I so again this is
Keith: For sensitizing.
Mark: Yeah so you’re almost answering your own question. That slide that I showed you which is the table all the way across, I didn’t want you to get a sense that it’s linear all the way. Our lives are complex and there are many different themes we primarily when we’re sensitized we focus on negativities, whether it’s an injustice, whether it’s a loss, whether it’s a threat, all of these themes flow into one another to produce the unique expression of our personality in our coping habits like we have our, we created our own distortions, so there’s not this one-to-one, you know loss equals depression. Loss could equal a whole bunch of things, depending on how we relate to it. But the more trauma, the more distress, the more light, and the earlier on, the more likely for stress-related illness in the future.
Keith: Excellent, thank you. All right well thank you so much, Mark Pirtle, excellent presentation.
Mark: Thank you, thanks, everybody!
Keith: This will be online for folks to see and we’ll send you an email to let you know about it, just again very quickly, and we’re running up against the clock, you know to get your CES we will be sending each of you an evaluation to fill out and once you fill out the evaluation and send it back to us, you will get a nifty certificate like this of attendance of 1.5 CEs.
I want to just talk briefly about some of our other thought leaders coming down the road over the next few weeks. Dr. Colin Ross will be back with us talking on trauma, attachment, disassociation, and EMDR. Dr. Sonny Whedon will be presenting the eight ways to well being. And Dr. Allen Berger who works with Beacon House will be talking about creativity and counseling, integrating left and right brain hemispheres, and working with clients, so I just want to say once again thank you, everyone, so much for your participation today. Thank you Dr. Mark Pirtle for joining us today. Thank you to my staff who really work so hard and tirelessly to put these presentations together. This is new for us, and so out of adversity comes innovation, and we’ve been able to do that. And we couldn’t have done it without the work and support of our staff. Thank you to each one of you out there who are touching people’s lives and helping them cope with all of what’s going on today. The loneliness, the despair, the loss of a job, depression, anxiety, etc. I think some of the things obviously that Dr. Pirtle talked about today now if you could work with your clients on them would be helpful as they go forward. Enjoy the weekend. Thank you so much, everybody, we’re so appreciative and have gratitude for you for the work that you do, and for, you know, spending time with us this afternoon. Take care and have a great day everybody
Mark: Thank you. Thanks, Keith.
Keith: Thank you, Mark.