Understanding Flow
 
“Flow” is so aptly named – like the beautiful whooshing waterfall, flow describes the mind-state of total absorption into a task. A dancer in flow loses sight of the world around her and becomes totally enmeshed with the present moment. She becomes one with the rhythm and melody, and internally, she may feel pride, accomplishment, and in other words: an endorphin rush. Even though she worked very hard to get to her level of skill, one does not have to be deeply skilled to attune themselves to flow.
 
Flow contains eight main aspects:

1. Total concentration
2. Clear goals and instant feedback
3. Time speeds up and time slows down
4. Sense of intrinsic reward
5. Lack of effort and experience of ease
6. Challenge and skill are equally matched
7. Loss of self-evaluation and rumination
8. Sense of control

(Oppland, 2021)     Researchers are asking – what role does flow play in depression and anxiety? One study of Swedish twins showed that flow has a significant genetic and environmental factor. It’s possible to be born with a capacity for flow, but it’s also possible to engage in flow based on what one has learned. They also pointed to flow as a possible protective factor against depression and emotional burnout (Mosing et al. 2018). The more flow one is able to achieve on a regular basis, the more they may be insulated against stress if an extreme stressor comes to their emotional world.
              Other studies showed that people who experience large amounts of anxiety may experience greater challenges entering the flow mind-state (Kranjčev & Hlupić, 2021; Ullén et al. 2012). The data is not clear as to the exact link between anxiety and flow, nor does research clarify any impacts on anxiety from learning how to more regularly achieve flow. However, Ullén et al. could conclude from their sample that flow was not related to intelligence (2012). One does not have to be a genius chess player or virtuoso pianist to enjoy flow!
              Regardless, the originator of flow, Mihaly Csikszentmihalyi, maintains that it is an important aspect of wellbeing. Through his original research, he collected a vast amount of accounts, creating a huge qualitative sample of artists, writers, teachers, rock climbers, and professional athletes. Csikszentmihalyi drew the conclusion that flow is an integral aspect of living the “good life,” and that people who are missing daily flow experiences are seriously missing out (Csikszentmihalyi, 2009).
 
How do I achieve flow?
 
              Flow is simple to achieve with the right structure. Drawing the eight qualities from above, see the below step by step.

1. Choose a task
   1. This could be a skill or a chore
   2. For chores, often the skill you’re building is mindfulness and not necessarily increasing the quality of your work
2. Recognize my current level of skill
   1. Eg. On piano I can play Minuet in G but not Moonlight Sonata
   2. Eg. I can pay attention to the sensations of folding the laundry without any other distractions for 3 second before going on autopilot
3. Choose the next step to building my skill
   1. On piano, I need to practice each hand separately for Moonlight Sonata
   2. With laundry, I need to turn off all outside distractions and engage mindfully with handling the fabric, returning my attention to the fabric, being in sync with my bodily movements rather than lost in thought
4. Just do it: engage with your activity at a scheduled time
   1. I practice piano every day at 4pm for 20 minutes
   2. I fold laundry at least twice per week, Sundays and Thursdays

 
Flow is achieved when the level of skill matches with the level of challenge. However, there is a personal responsibility in understanding what level of skill we have and our degree of attention to the moment. An expert pianist could certainly enter a feeling of flow when playing Moonlight Sonata despite the fact that the piece would be easy for the pianist. Why? An expert pianist is able to achieve flow by creating a challenge from the piece, perfecting their form, accents, dynamics, etc. Essentially, anything could be a flow activity if we search for the craft in the activity.  

Is Flow Just Mindfulness?
 
              This is a question that is yet to be meaningfully answered and I’m afraid I don’t know either. In dialectical behavioral therapy (DBT) skills training, Linehan connects to the experience of one-mindfulness to flow, but only briefly and without extensive research cited (2014). One-mindfulness is a type of informal mindfulness where the participant pays close attention during any sort of mundane task. An example of one-mindfulness can be found when washing the dishes. With one-mindfulness, we learn to love the act of washing the dishes through attention to the senses. Mindfully smelling the soap, feeling the hot water, scrubbing the dishes as if someone we love is immediately about to eat off them – by doing these things we create a mindful activity. Or do we create a flow activity? One gap in research involves the lack of comparison between neurobiological markers of the flow state and the concentration/bodily awareness mindful state. If there’s any discrimination on the face level, the sense of achievement is certainly separate from mindfulness, which often has no goal other than completing the activity for its own sake.
              Either way – whether we want to achieve new heights, or just want to do something to get into the present moment – flow offers a chance for growth. Flow also offers a promise for pleasant feelings of internal reward.
 
“Of all the virtues we can learn no trait is more useful, more essential for survival, and more likely to improve the quality of life than the ability to transform adversity into an enjoyable challenge.” – Mihaly Csikszentmihalyi
 
 
References
 
8 ways to Create flow according to Mihaly Csikszentmihalyi [+TED TALK]. (2021, February 15).
Retrieved May 10, 2021, from https://positivepsychology.com/mihaly-csikszentmihalyi-father-of-flow/
 
Kranjčev, M., & Vukasović Hlupić, T. (2021). Personality, anxiety, and cognitive failures as
predictors of flow proneness. Personality and Individual Differences, 179, 110888.
doi:10.1016/j.paid.2021.110888
Ullén, F., De Manzano, Ö, Almeida, R., Magnusson, P. K., Pedersen, N. L., Nakamura, J., . . . Madison, G. (2012). Proneness for psychological flow in everyday life: Associations with personality and intelligence. Personality and Individual Differences, 52(2), 167-172. doi:10.1016/j.paid.2011.10.003
Linehan, M. M. (2014). DBT Skills Training Manual, Second Edition (Second Edition, Available
separately: DBT Skills Training Handouts and Worksheets, Second ed.). The Guilford Press.
Mosing, M. A., Butkovic, A., & Ullén, F. (2018). Can flow experiences be protective of work-related depressive symptoms and burnout? A genetically informative approach. Journal of Affective Disorders, 226, 6-11. doi:10.1016/j.jad.2017.09.017
Csikszentmihalyi, M. (2009). Flow: The psychology of optimal experience. New York: Harper and Row.

Article & Illustration by Aaron Reslink, MHC-P

              “Self-care” seems like the new and woke response to any mention of anxiety or depression. “I’ve been really anxious today.” “Self-care!” The word gets said again and again until it means almost nothing at all. For many, this could feel invalidating without recognizing a deeper definition of self-care. Here goes some clearer definitions of self-care that won’t leave you feeling ignored, as well as some reasons why “self-care” as a suggestion might stand as an avoidance tactic.  
             
The Internal Parent
 
Many people find themselves moving on from their parents into independence. They get a house or apartment, an automobile, and sometimes even a white picket fence. But just as children need to be directed: “Brush your teeth!” “Do your homework!” sometimes we need to be directed as adults. Dr. Thomas Harris invented an entire style of therapy centered around the “parent-tape” inside of our own thought patterns (see: I’m OK – You’re OK). Basically, the things our parents once told us to do – whether for better or worse – still play on repeat in our minds.
From the view of Dr. Harris’s text, self-care could have more to do with the way we fulfill our own basic care activities without external prompting. Nobody is telling us to brush our teeth, but we do. No parent is present telling the depressed person to put on their clothes in the morning during that exact moment – but by choosing this activity, they start a whole chain reaction that could lead to a less depressed day. Following the helpful aspects of this internal parent script might act as the most basic form of self-care.
 
The Self-Soother
 
              When therapists tell clients and each other to practice self-care, usually they mean self-soothing. “Soothing” conjures up images of babies chomping on their own feet, or a box of fluffy kittens. Adults ignore their own need for self-soothing on a daily basis. It’s part of being an adult, since so many moments of the day are not worth our limited emotional energy. Unfortunately, those moments add up, and then we have a big pile of anxiety, muscle tension, irritability, that seems otherwise unexplainable.
              The simple solution that everyone is talking about? Yes, a robot-shaped bath-bomb from Lush. But also – anything that satisfies that need similar to a baby eating her own foot. A warm blanket, a cup of tea, a chance to listen to the birds outside. The challenge might be in finding the time to do this activity, and getting your head into the pleasurable moment. (For a hilarious example of self-soothing in this regard, see Parks and Recreation – Season 4 Episode 4). But just as Donna and Tom find out in Parks and Recreation – the challenge also lies in experiencing this hedonism not as pleasurable means-to-an-end, but as a full and mindful experience.
 
Self-Care as Everything Healthy
 
              Notable self-care and mindfulness researchers Dr. Catherine Cook-Cottone and colleague Dr. Wendy Guyker created a comprehensive, two-part definition of mindful self-care: “. . .an iterative process that involves (a) mindful awareness and assessment of one’s internal needs and external demands and (b) intentional engagement in specific practices of self-care to address needs and demands in a manner that serves one’s well-being and personal effectiveness,” (Cook-Cottone & Guyker, 2017). Simply put, these researchers view mindful self-care as an ongoing process where one connects to oneself about what could help, then intentionally engages in what could help.
              Their mindful self-care scale includes six categories:

1. mindful relaxation
2. physical care
3. self-compassion and purpose
4. supportive relationships
5. supportive structure
6. mindful awareness

(Cook-Cottone & Guyker, 2017)
 
              The researchers’ original article encompasses a wide definition of self-care, but maybe that’s needed for such a comprehensive topic. At the same time, this definition could be overgeneralizing – can anything a person does that is purposefully healthy really be considered “self-care?” The scale was tested for validity in a 2019 study, showing that the scale does target the concept of self-care (Hotchkiss & Cook-Cottone). While this definition may be the broadest, it also shares the strength of containing layers with detailed aspects of self-care.
 
Why is “Self-Care” As a Suggestion so Invalidating?
 
              Asking someone to perform “Self-Care” without further specification is basically saying “Oh, look over there!!!” It’s deflection, distraction, and ignoring the root of the problem. As Linehan’s DBT states – there’s many moments where this ability is crucial (Linehan, 2014). Sometimes there’s no option to address the problem and we must bide our time by addressing the feeling of crisis instead – and why not enjoy that time if possible? However, in cases where the other person may be playing a role or hold responsibility to the problem, such as workforce complaints or relationship conflicts, suggesting “self-care” is the ultimate modern avoidance tactic.
              Self-care also holds a deeply personal connotation. Each unique person will soothe differently – I may love Rocky Horror as a comfort movie but my partner might hate it! To follow, employers suggesting self-care also ignore the root of the problem within one’s own workplace, while acting overly vague to the point of inertia. It’s like asking an ice cream vendor for simply “ice cream.” Well do you want the SpongeBob shaped popsicle or do you want soft serve? Asking a person to “do self-care” without specifying meaning is as empty as asking someone to “make me lunch.” Well – what’s your order – sandwich, soup, escargot? 
              Therapists and supervisors must do better when it comes to teaching about self-care, and remain close to evidence-based practices like DBT, which promotes specificity when teaching about soothing and distraction as specific, separate skills. And for the rest of us – we might benefit from taking that mindful self-care survey to find out exactly what areas we’re ignoring…
 
 
 
Cook-Cottone, C. P., & Guyker, W. M. (2017). The development and validation of the mindful self-care scale (MSCS): an Assessment of Practices that Support Positive Embodiment. Mindfulness, 1-15.
 
Linehan, M. M. (2014). DBT Skills Training Manual, Second Edition (Second Edition, Available separately: DBT Skills Training Handouts and Worksheets, Second ed.). The Guilford Press.
 
Hotchkiss J. T., & Cook-Cottone C. P. (2019). Validation of the mindful self-care scale (MSCS) and development of the Brief-MSCS among hospice and healthcare professionals: a confirmatory factor analysis approach to validation. Palliative and Supportive Care, 1–9.
 
Harris, T. A. (1999). I'm OK -- you're OK: A practical guide to transactional analysis. New York, NY: Galahad Books.