Four summary articles are given to my recent series from The New Standard Non Cognitive Psychotherapy: Advancing Mood Management (2001) by Russell Hoover.
The links for these articles summarising Part 1, Part 2, and Part 3 are to be found in respective order here, here, and here.
I have also included a compilation of the three Parts together in one file here.
Thursday, December 27, 2012
Sunday, December 9, 2012
Panic Attacks
I have suffered from panic attacks in the past and know of others who also suffer these distressing feeling unable to do anything about them.
So I've decided to look again at Russell Hoover's work and specifically examine how he deals with these highly unpleasant feeling states in his book, The New Standard Non Cognitive Psychotherapy: Advancing Mood Management (2001). His discussion comes from Part Three titled, In The Trenches, which I have referred to in earlier posts.
Hoover believes that emotional reactions and moods are invariably the result of something we have encountered in our lives which is 'not okay' or is 'an adversity'. He hammers this point earlier in the book with great energy.
Furthermore he says, mood is not 'irrational' but gives us the emotional significance of certain events and happenings in our world. Hence, it is foolish to try to tamper with the operation of our moods because they are benevolently providing us with 'interpreted' information from around us.
All this may appear obvious but cognitive therapy (CT) believes that 'bad' moods (e.g., sadness, depression, anxiety) need to be got rid of.
On the other hand, Hoover opposes CT convinced that it is not therapeutic in character. He believes that such psychotherapy is not helping people today in the long-term largely because it does not accept the 'common-sense' views outlined above.
This failure to help in the long-term occurs because these clients have received therapy that assumes that events external to us--the death of a close friend, loss of a loved animal, exam failure, a car accident--do not cause human distress.
In fact, CT theory states that such events cannot cause our distress; rather, we 'distress' ourselves by our 'catastrophic thinking' and/or our overwrought imaginings. Hence, the way out of our distress is to correct our thinking so that we come to think the 'correct' way (the way the cognitive therapist tells us we should think) about the death, the loss, or the shock of the accident.
Note I've used asterisks * to mark passages in the dialogue that I regard significant.
The client is a woman Bertha (B), a 28 year-old mother of two children. She had come to RH earlier for one appointment some five weeks ago complaining of panic attacks but didn't come for a scheduled follow-up session.
(I acknowledge with thanks using this case from the above book almost verbatim but have been unable to contact the author to seek permission even though efforts were made to do so through his publisher.)
Interestingly, RH informs her about the fact that she might experience more pain if she finds out what is the adversity (X -my term) behind her crying; this is very wise of him because therapists need to tread carefully with regard to the pain of their clients. However, B has got the idea that if she doesn't come to know about X she is going to experience pain nonetheless.
He then asks her if she wants to go on and see what X is. Just in passing, we note that he gets the client's permission before moving on. Always an ethical move to get the client's 'informed consent'.
I pick up the conversation when Russell Hoover says to the client:
'Now what's the clue that tells you something bad has happened?'
B: I don't know.
RH: Well your sadness is a symptom that something is not okay, not right. Would feeling bad be a symptom of something good happening?
B: No it would be a symptom of something bad happening.
This point marks the end of the first stage of therapy in which RH has helped B to name her sadness symptom as something that is 'not okay' and AS caused by something that is 'bad'. Of course it takes much longer to reach this point but I have skipped material to get to the later 'phases'. (Note: that is not to say that 'sadness' is a bad thing in itself; it's a good thing in that it tells us that something not good has happened. So, 'bad' is used in a loose sense about the sadness mood in this context.)
B: Well, I remember I had tightness in my stomach for a few days before I had the crying.
RH: That makes sense because lots of people carry distress around in their bodies as headaches, sick stomachs, stiff necks and other things as well. But you were probably upset before that tightness yet you don't remember what it was over you say. No?
B: No. Can't think of anything.
*RH: Let's try something different. Can you tell me what that tightness in your stomach means to you?
B: Means to me? I don't know what you're getting at.
*RH: Well, could it mean you're sick or something?
B: Yeah it means I could be sick perhaps.
RH: Well how sick? Is that an issue?
B: You're right. I always think the worst . . . . (last 3 words are said faintly as if she had been stuck in something).
RH: And what may the worst be? Do you have any idea?
B: (face begins to flush) I could be sick for a long time. I could get *cancer. (Stops and clears her throat.)
RH has been searching for the 'bad' thing in her knowledge about her life that is coupled with the anxiety attacks. Note how how her realisation of '[being] sick for a long time' and then 'cancer' are accompanied by strong, non-verbal physical indicators revealing important meaning for B.
B: (face still flushed) Yeah, I could get real sick.
RH: See. You could have been vaguely aware of that possibility. If you got the 'flu you would only be a bit upset. But cancer, would really grab your attention. So, how upset would you get?
B: A lot.
RH: But there's probably a reason you think about cancer rather than, say, a heart attack.
B: Well, my mother died . . . (B instantly grabs her lips and pinches them together; face flushes again and reddens more).
RH: Here, we've got these here (gives a box of tissues beside her even though she is not crying). Might as well just let it out; that's what we do here.
B: (finally blurts out through her lips and sobs while talking) I just can't talk about it. (Pinches her lips together again.)
RH: That's because of the pain it causes you. After all, if you mother died of cancer that is an ugly way to go.
B: She suffered for five years and just kept getting worse all the time.
RH: And when did she die?
B: Three years ago.
RH: So her death was not trivial for you and wouldn't be for someone who felt about her the way you did. But what's important now is to identify the pain you're having and try to understand it. Kind of knowing how our feelings work. For example, if you know something good, something real nice, then you'd feel how?
B: I'd feel good I guess.
RH: Sure you would. And the size of that good feeling would depend on how good you would know it to be. But when a well-functioning brain like yours knows something bad then, you would have a corresponding bad mood. What would that be?
B: I'd feel like crying.
*RH: Exactly. See your mood's just a reflection of something you know. Others may know it too and not feel bad because it's not really happening to them. They didn't see your mother having all that pain. So they might say that you're just not coping.
B: My husband tells me that.
RH: To him, it doesn't make sense. He can't understand why you still would have pain after that length of time.
B: I can't either.
RH: Well because the way she died represents a threat or burden you're still carrying around today. I wonder what it might be?
B: I don't know. I miss her. She lived right next door so we're always been close.
RH: That tells us a lot. So through the day you find yourself missing her more than at other times. Maybe when you are alone or something. Is that true?
B: Yes, I think so.
RH: And at those times, what happens?
B: Sometimes my throat begins to tighten up. (Clears her throat.)
RH: That's happening now a little, isn't it?
B: (clears throat even more) I get so I just can't breathe (-her eyes begin to water).
Together RH and B have made good progress by drawing out the strands of what is happening in her life combined with understanding that the therapist has of how human moods work.
To summarise: RH believes that it is 'proper' (-'it's the way things work') to be anxious when things threaten us and saddened when loss overtakes us.
B: We get upset.
RH: It's the associated emotion that happens when we know that something bad is happening. So if we knew all that--what it means when you can't breathe--and then we weren't upset, what would you say about that?
B: (pauses) Well . . .
RH: Wouldn't it be a bit weird?
B: Yes you're right. It would be a bit weird.
RH: Weird but nice we could say. But it's important to see that it would be strange and not the normal reaction. If I have a rock in my hand and I let it go, it falls to the ground. That's the way things work. It won't fly upwards. That isn't the way things work.
**RH: But what if you knew something different at the time when you can't breathe: that it's not proper for you to be able to breathe easy. It's proper to have this bad thing happening to me. What might happen if you knew that?
B: (pauses) What?
*RH: If you said to yourself something peculiar; it's not proper that something good be happening to me. It's proper that something very bad be happening; is it always proper that good things happen to us?
B: I don't know.
*RH: Put it this way, would it be proper for you to feel okay then? Is it always proper for you to feel right?
B: Well no.
RH: Then it's proper that you feel bad sometimes: to feel awful and to be unable to breathe. Do you see that?
B: That it's proper for me to feel bad sometimes?
RH: It's perfectly 200% proper for you to be feeling lousy. I mean if you can't breathe, is that something anyone would feel good about?
B: Well, no.
RH: And how would you feel if you knew that odd thing at the time you felt you couldn't breathe?
B: I don't know.
**RH: Let's try it and see. You're home, thinking about your mum just like you do at times and you notice you begin to have difficulty breathing, and then you say to yourself, 'Oh well, it's completely proper that I feel this way. It doesn't even make sense for me to breathe easy'. And, let's suppose that as you say this, you meant it.
B: Well, I don't know for sure but I suppose I would feel better.
RH: Yes, to the degree that you meant. As it's not something you usually know, you probably wouldn't think of it. But if you worked at it until you knew it better and were able to do it at that time, then you'd have trouble not feeling better. So let's do it again. There you are at home, and you notice your throat tightening. Now say it to yourself out loud so I can see if you've got it.
B: Well, I guess it's proper . . . . you said it was proper? Is that right?
B: To feel bad.
RH: Excellent. Try it again. You can't overdo it even if you try.
B: Okay, . . . It's proper, yes, it's proper for me to feel this way.
RH: Yes, it's not proper for me to feel comfortable.
B: Then I'd feel better.
RH: Well, wouldn't you? How do you feel now?
B: I don't know. I don't think I am quite as scared.
RH: It's probably starting to work a little bit even though you don't know it well. So, we're going to go over it again and again. But let's look at something else that is very important. If you said to yourself in a convincing way, 'It doesn't make sense for me to feel here; it's proper to feel this pain', then the pain would go away. Now is that relief real or are you just stuffing down your feelings?
B: I don't think I'd be stuffing down my feelings, would I?
RH: You could be. How could you tell the difference?
B: Well if I didn't feel any pain.
RH: That's the key . . . . if you were stuffing down your feelings you'd still be upset and you'd feel pain. But it's hard to believe that if you knew what we've discussed doing, gave it to yourself at the appropriate time, and gave it with sufficient force that you wouldn't then experience some relief. So if the relief was real why might it come back later? [**Important therapy move to forestall relapse!]
B: You mean the pain could come back?
RH: You see I have people tell me the pain went away but then it came back later. Do you know why that happens?
B: I don't understand that. Perhaps they didn't mean it.
RH: Or, maybe they didn't know it that well and so their head forgets about it. That's why it's important to give it to yourself every so often while you're still learning it. that way you're re-programming those neurons in your head. So what does this tell you?
B: I'd better do it over again.
RH: Right. So let's do that now again, only let's do it with something else that bothers you a lot. In fact, let's look at the fact that you miss your mum so much. Remembering that it's proper for some bad things to happen, sometimes some very awful things. So, isn't it proper for you to be missing your mother at times; I mean missing her a lot.
B: I really don't think I should be missing her so much after all this time.
RH: Well, you're right about that too. Your mind is aware that your life would be better if you could forget it. But can people always do what they should?
B: No.
RH: So which is proper. For you to miss her or not to miss her?
B: That I miss her.
RH: Somehow you feel that you'd be doing something wrong. So, how would you feel about missing her if you knew that, 'It's proper for me to miss her. It's not proper for me to forget her and feel no pain'. How would you feel if you knew that peculiar bit of truth?
B: Well I don't think I would be so bothered then.
RH: Interesting and you'd then be able to do something that is otherwise a bit strange. So why don't you do it again right now so I can hear you again.
B: Okay. So, I trying to understand that it's proper to miss her?
RH: You're getting it. It's getting easier. But you want to remember that this procedure isn't something you know very well yet. It's pretty easy to get mixed up with it. For example, proper and okay are NOT the same. So, we can say that it's proper to miss her but it's not okay. Anyway we will deal with this in the future. Right now, can you say what you said above about your mum?
B: It's proper for me to miss mum (said with more certainty as an obvious tear comes to her eye).
RH: Correct, and the more you remember that, the less likely you are to get carried away with missing her. Now before the next session, I want you to take time every day to practise saying that sentence, just as you did here, at least 3 times a day. Let's try it again.
'Proper' is not to be confused by saying that the two events above are 'okay'. RH is against any attempt to accept the events as 'all right' and bludgeoning the client's consciousness to accept something as 'all right' which is clearly 'not all right', 'not okay'.
If a relapse in feeling better occurs then perhaps the person has forgotten to say and mean that it's proper to be this way given what has happened.
Therefore, she is to say aloud when these situations arise, 'it is proper for this to happen'. She is to say this with as much intensity as she can muster and she will practise saying the phrase at least 3 times per day.
Furthermore he says, mood is not 'irrational' but gives us the emotional significance of certain events and happenings in our world. Hence, it is foolish to try to tamper with the operation of our moods because they are benevolently providing us with 'interpreted' information from around us.
All this may appear obvious but cognitive therapy (CT) believes that 'bad' moods (e.g., sadness, depression, anxiety) need to be got rid of.
On the other hand, Hoover opposes CT convinced that it is not therapeutic in character. He believes that such psychotherapy is not helping people today in the long-term largely because it does not accept the 'common-sense' views outlined above.
This failure to help in the long-term occurs because these clients have received therapy that assumes that events external to us--the death of a close friend, loss of a loved animal, exam failure, a car accident--do not cause human distress.
In fact, CT theory states that such events cannot cause our distress; rather, we 'distress' ourselves by our 'catastrophic thinking' and/or our overwrought imaginings. Hence, the way out of our distress is to correct our thinking so that we come to think the 'correct' way (the way the cognitive therapist tells us we should think) about the death, the loss, or the shock of the accident.
Phases in the therapy of a young woman with panic attacks
(I don't wish to over-emphasise the 'phases' terminology in the above heading. It's not a technical use of the term 'phase' by me. But RH, the therapist, sets out his transcript in terms of five definite phases, each of which uncovers an important piece of therapeutic knowledge for us. So it's just a convenient way to navigate through the vignette.)Note I've used asterisks * to mark passages in the dialogue that I regard significant.
The client is a woman Bertha (B), a 28 year-old mother of two children. She had come to RH earlier for one appointment some five weeks ago complaining of panic attacks but didn't come for a scheduled follow-up session.
(I acknowledge with thanks using this case from the above book almost verbatim but have been unable to contact the author to seek permission even though efforts were made to do so through his publisher.)
First Phase
She tells RH that she had been managing well until last week when suddenly she started to have times of intense crying. She has no idea why. RH believes that a reason exists and says to her that her 'head knows' but perhaps is keeping it from her because it would cause her more pain.Interestingly, RH informs her about the fact that she might experience more pain if she finds out what is the adversity (X -my term) behind her crying; this is very wise of him because therapists need to tread carefully with regard to the pain of their clients. However, B has got the idea that if she doesn't come to know about X she is going to experience pain nonetheless.
He then asks her if she wants to go on and see what X is. Just in passing, we note that he gets the client's permission before moving on. Always an ethical move to get the client's 'informed consent'.
I pick up the conversation when Russell Hoover says to the client:
'Now what's the clue that tells you something bad has happened?'
B: I don't know.
RH: Well your sadness is a symptom that something is not okay, not right. Would feeling bad be a symptom of something good happening?
B: No it would be a symptom of something bad happening.
This point marks the end of the first stage of therapy in which RH has helped B to name her sadness symptom as something that is 'not okay' and AS caused by something that is 'bad'. Of course it takes much longer to reach this point but I have skipped material to get to the later 'phases'. (Note: that is not to say that 'sadness' is a bad thing in itself; it's a good thing in that it tells us that something not good has happened. So, 'bad' is used in a loose sense about the sadness mood in this context.)
Second Phase
RH: So let's see whether we can find this bad something. Let's see if you've felt something that was unpleasant recently.B: Well, I remember I had tightness in my stomach for a few days before I had the crying.
RH: That makes sense because lots of people carry distress around in their bodies as headaches, sick stomachs, stiff necks and other things as well. But you were probably upset before that tightness yet you don't remember what it was over you say. No?
B: No. Can't think of anything.
*RH: Let's try something different. Can you tell me what that tightness in your stomach means to you?
B: Means to me? I don't know what you're getting at.
*RH: Well, could it mean you're sick or something?
B: Yeah it means I could be sick perhaps.
RH: Well how sick? Is that an issue?
B: You're right. I always think the worst . . . . (last 3 words are said faintly as if she had been stuck in something).
RH: And what may the worst be? Do you have any idea?
B: (face begins to flush) I could be sick for a long time. I could get *cancer. (Stops and clears her throat.)
RH has been searching for the 'bad' thing in her knowledge about her life that is coupled with the anxiety attacks. Note how how her realisation of '[being] sick for a long time' and then 'cancer' are accompanied by strong, non-verbal physical indicators revealing important meaning for B.
Third Phase
RH: You might get cancer?B: (face still flushed) Yeah, I could get real sick.
RH: See. You could have been vaguely aware of that possibility. If you got the 'flu you would only be a bit upset. But cancer, would really grab your attention. So, how upset would you get?
B: A lot.
RH: But there's probably a reason you think about cancer rather than, say, a heart attack.
B: Well, my mother died . . . (B instantly grabs her lips and pinches them together; face flushes again and reddens more).
RH: Here, we've got these here (gives a box of tissues beside her even though she is not crying). Might as well just let it out; that's what we do here.
B: (finally blurts out through her lips and sobs while talking) I just can't talk about it. (Pinches her lips together again.)
RH: That's because of the pain it causes you. After all, if you mother died of cancer that is an ugly way to go.
B: She suffered for five years and just kept getting worse all the time.
RH: And when did she die?
B: Three years ago.
RH: So her death was not trivial for you and wouldn't be for someone who felt about her the way you did. But what's important now is to identify the pain you're having and try to understand it. Kind of knowing how our feelings work. For example, if you know something good, something real nice, then you'd feel how?
B: I'd feel good I guess.
RH: Sure you would. And the size of that good feeling would depend on how good you would know it to be. But when a well-functioning brain like yours knows something bad then, you would have a corresponding bad mood. What would that be?
B: I'd feel like crying.
*RH: Exactly. See your mood's just a reflection of something you know. Others may know it too and not feel bad because it's not really happening to them. They didn't see your mother having all that pain. So they might say that you're just not coping.
B: My husband tells me that.
RH: To him, it doesn't make sense. He can't understand why you still would have pain after that length of time.
B: I can't either.
RH: Well because the way she died represents a threat or burden you're still carrying around today. I wonder what it might be?
B: I don't know. I miss her. She lived right next door so we're always been close.
RH: That tells us a lot. So through the day you find yourself missing her more than at other times. Maybe when you are alone or something. Is that true?
B: Yes, I think so.
RH: And at those times, what happens?
B: Sometimes my throat begins to tighten up. (Clears her throat.)
RH: That's happening now a little, isn't it?
B: (clears throat even more) I get so I just can't breathe (-her eyes begin to water).
Together RH and B have made good progress by drawing out the strands of what is happening in her life combined with understanding that the therapist has of how human moods work.
To summarise: RH believes that it is 'proper' (-'it's the way things work') to be anxious when things threaten us and saddened when loss overtakes us.
Fourth Phase
RH: What kind of emotions happens to us when we know something bad is happening to us?B: We get upset.
RH: It's the associated emotion that happens when we know that something bad is happening. So if we knew all that--what it means when you can't breathe--and then we weren't upset, what would you say about that?
B: (pauses) Well . . .
RH: Wouldn't it be a bit weird?
B: Yes you're right. It would be a bit weird.
RH: Weird but nice we could say. But it's important to see that it would be strange and not the normal reaction. If I have a rock in my hand and I let it go, it falls to the ground. That's the way things work. It won't fly upwards. That isn't the way things work.
**RH: But what if you knew something different at the time when you can't breathe: that it's not proper for you to be able to breathe easy. It's proper to have this bad thing happening to me. What might happen if you knew that?
B: (pauses) What?
*RH: If you said to yourself something peculiar; it's not proper that something good be happening to me. It's proper that something very bad be happening; is it always proper that good things happen to us?
B: I don't know.
*RH: Put it this way, would it be proper for you to feel okay then? Is it always proper for you to feel right?
B: Well no.
RH: Then it's proper that you feel bad sometimes: to feel awful and to be unable to breathe. Do you see that?
B: That it's proper for me to feel bad sometimes?
RH: It's perfectly 200% proper for you to be feeling lousy. I mean if you can't breathe, is that something anyone would feel good about?
B: Well, no.
RH: And how would you feel if you knew that odd thing at the time you felt you couldn't breathe?
B: I don't know.
**RH: Let's try it and see. You're home, thinking about your mum just like you do at times and you notice you begin to have difficulty breathing, and then you say to yourself, 'Oh well, it's completely proper that I feel this way. It doesn't even make sense for me to breathe easy'. And, let's suppose that as you say this, you meant it.
B: Well, I don't know for sure but I suppose I would feel better.
RH: Yes, to the degree that you meant. As it's not something you usually know, you probably wouldn't think of it. But if you worked at it until you knew it better and were able to do it at that time, then you'd have trouble not feeling better. So let's do it again. There you are at home, and you notice your throat tightening. Now say it to yourself out loud so I can see if you've got it.
B: Well, I guess it's proper . . . . you said it was proper? Is that right?
Fifth Phase
RH: That's right: 'It's not proper for me to feel good. It's proper for me to feel how?'B: To feel bad.
RH: Excellent. Try it again. You can't overdo it even if you try.
B: Okay, . . . It's proper, yes, it's proper for me to feel this way.
RH: Yes, it's not proper for me to feel comfortable.
B: Then I'd feel better.
RH: Well, wouldn't you? How do you feel now?
B: I don't know. I don't think I am quite as scared.
RH: It's probably starting to work a little bit even though you don't know it well. So, we're going to go over it again and again. But let's look at something else that is very important. If you said to yourself in a convincing way, 'It doesn't make sense for me to feel here; it's proper to feel this pain', then the pain would go away. Now is that relief real or are you just stuffing down your feelings?
B: I don't think I'd be stuffing down my feelings, would I?
RH: You could be. How could you tell the difference?
B: Well if I didn't feel any pain.
RH: That's the key . . . . if you were stuffing down your feelings you'd still be upset and you'd feel pain. But it's hard to believe that if you knew what we've discussed doing, gave it to yourself at the appropriate time, and gave it with sufficient force that you wouldn't then experience some relief. So if the relief was real why might it come back later? [**Important therapy move to forestall relapse!]
B: You mean the pain could come back?
RH: You see I have people tell me the pain went away but then it came back later. Do you know why that happens?
B: I don't understand that. Perhaps they didn't mean it.
RH: Or, maybe they didn't know it that well and so their head forgets about it. That's why it's important to give it to yourself every so often while you're still learning it. that way you're re-programming those neurons in your head. So what does this tell you?
B: I'd better do it over again.
RH: Right. So let's do that now again, only let's do it with something else that bothers you a lot. In fact, let's look at the fact that you miss your mum so much. Remembering that it's proper for some bad things to happen, sometimes some very awful things. So, isn't it proper for you to be missing your mother at times; I mean missing her a lot.
B: I really don't think I should be missing her so much after all this time.
RH: Well, you're right about that too. Your mind is aware that your life would be better if you could forget it. But can people always do what they should?
B: No.
RH: So which is proper. For you to miss her or not to miss her?
B: That I miss her.
RH: Somehow you feel that you'd be doing something wrong. So, how would you feel about missing her if you knew that, 'It's proper for me to miss her. It's not proper for me to forget her and feel no pain'. How would you feel if you knew that peculiar bit of truth?
B: Well I don't think I would be so bothered then.
RH: Interesting and you'd then be able to do something that is otherwise a bit strange. So why don't you do it again right now so I can hear you again.
B: Okay. So, I trying to understand that it's proper to miss her?
RH: You're getting it. It's getting easier. But you want to remember that this procedure isn't something you know very well yet. It's pretty easy to get mixed up with it. For example, proper and okay are NOT the same. So, we can say that it's proper to miss her but it's not okay. Anyway we will deal with this in the future. Right now, can you say what you said above about your mum?
B: It's proper for me to miss mum (said with more certainty as an obvious tear comes to her eye).
RH: Correct, and the more you remember that, the less likely you are to get carried away with missing her. Now before the next session, I want you to take time every day to practise saying that sentence, just as you did here, at least 3 times a day. Let's try it again.
Brief Summary of Case
1. Feeling bad is a symptom of something bad happening
2. Find what the 'bad happening' was
3. Greater detail re the 'bad happening'
4. Certain emotions happen to us when bad things occur
It's weird (abnormal) to feel good when something bad happens or is happening.5. Cure is verbally connecting 'feeling' to 'properness'
Bertha, the client has the bad feelings that go with 'not being able to breathe normally' and 'the thoughts surrounding the slow, lingering death of her mother'. According to RH, it is not 'proper' for her to feel comfortable. (By 'proper' he means, 'suitable', 'logical' and sensible'.)'Proper' is not to be confused by saying that the two events above are 'okay'. RH is against any attempt to accept the events as 'all right' and bludgeoning the client's consciousness to accept something as 'all right' which is clearly 'not all right', 'not okay'.
If a relapse in feeling better occurs then perhaps the person has forgotten to say and mean that it's proper to be this way given what has happened.
Therefore, she is to say aloud when these situations arise, 'it is proper for this to happen'. She is to say this with as much intensity as she can muster and she will practise saying the phrase at least 3 times per day.
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