Middle and Late Adulthood: Self Development PDF

Middle and Late Adulthood: Self Development Learning Objectives: Middle and Late Adulthood Self Development 1. Review self-development over the lifespan. 2. Define healthy self-development. 3. Define constructs pertinent to self-development 4. Discuss the I-self and the Me-self and relate these to episodic memory and narrative identity. 5. Name and describe the evidence-base for narrative therapies. 6. Discuss disorders of the Self in adulthood. 7. Describe self-development after early adulthood. 8. Define self-transcendence and related constructs. 9. Describe and make sense of self-transcendent experiences. 10. Summarize the link between self-transcendence and wellbeing. 11. Prepare clinicians to assist clients who have had self-transcendent experiences. 12. Provide a biopsychological account of self-transcendence. In Parts 1 and 2 of this book we discussed how children, adolescents and young adults develop a sense of self and identity. We also discussed the functions of the self, including conscience, self-direction, and self-regulation. In this chapter we will apply these concepts to adulthood and discuss growth and change in the self and its functions in middle and late life. We further explain what it means to have “a self.” Although the self is perhaps the most important psychological construct to mental health and well- being, basic researchers and clinicians are just beginning to study and describe its role in healthy function and disorders (Table 1) (Luyten & Blatt, 2011). Level of Health Identity Development High Has ongoing awareness of a unique self; maintains role-appropriate boundaries. Good Has relatively intact sense of self, with some decrease in clarity of boundaries when strong emotions and mental distress are experienced. Impaired Depends excessively on others for identity definition, with compromised boundary delineation. Very Impaired Has a weak sense of autonomy/agency; experience of a lack of identity, or emptiness. Boundary definition is poor or rigid: may show overidentification with others, overemphasis on independence from others, or vacillation between these. Table 0-1 Definition of healthy and impaired adult identity development in DSM 5tr, Part 3. DSM 5tr, Part 3 Alternative Model for Personality Disorders gives definitions for levels of impairment in self-development (Table 5). Individuals with healthy self-development are aware of their self-concepts and their own values. They also have a strong sense of identity. Impaired self-development is part of personality disorders, and predisposes to mood, anxiety and psychotic disorders. This chapter; Part 2 Chapter 6; and Part 1, Chapters 5, 7 and 10; together present a complete discussion of the self and self- development over the lifespan. The role of the self in various aspects of wellbeing is also discussed. The Self is a Constructed Perception As ancient people discovered 2500 years ago, the human mind turns sensory input into perceptions. People then relate to the world through their perceptions rather than through their senses (Goldstein, 2016). Sensory input about the person is no different, the mind takes sensory input and automatically generates self- perception. Take a minute to scan your mind and try to find your “self”, can you find it? In common with ancient people, philosopher Hume (1740) said regarding the self, “I am certain there is no such principle in me… (I am) nothing but a bundle or collection of different perceptions” (Hume, 2000, p. 165). People relate to their perceptions not directly to reality, this is true for both the inner world of the self and outer world of the five senses. In the first year of life, an infant comes to recognize the body parts as self; recognition of thoughts and emotions as self evolves in early childhood. By age 7 or so individuals experience a sense of self― feelings of singularity, coherence, individuality, and unity that create “I” (Prebble et al., 2013). During middle childhood, adolescence and young adulthood self-perceptions become self-concepts. The construct we call “the self” is a collection of perceptions about one’s own body, mind and behavior and beliefs about this collection. A person’s identity consists of their self-concepts and the stories they tell about themselves that explain meaningful events in their lives. The self is not a thing, but people relate to this constructed idea as if it were as real as the chair you are sitting on. Sense of self, self-concepts and narrative identity interact to give a person the feeling of being grounded, consistent and the same over time (Luyten & Blatt, 2011; Prebble et al., 2013). This feeling of being grounded by consistent self-concepts is so important that the mind has “defense mechanisms” to guard against thoughts and emotions that threaten self-concepts. As people live their lives, their bodies, mind and relationships give them information about the Self. Sometimes this information is consistent with self- concepts. When it is not, people may selectively attend to information that gives them a sense of self-consistency. Selective attention to congruent self-relevant information is called assimilation (see Figure 1). Growth and change with respect to Self is only possible through accommodation or changes in self-concepts as new information makes old self-beliefs impossible. Term Definition Ego The self, particularly the conscious sense of self (Latin, “I”). In its popular and quasi-technical sense, ego refers to all the psychological phenomena and processes that are related to the self and that comprise the individual’s attitudes, values, and concerns. 2 Term Definition Sense of Self The mental processes that provide one with feelings of singularity, coherence, individuality, and unity that define one as a unique and particular human being (Prebble et al., 2013). Self- The part of consciousness that is able to introspect, reflect, and Awareness evaluate subjective experience; a reflective process that is assumed to involve the construction of mental models of the self (Prebble et al., 2013). Self-Concept Declarative knowledge structure that contains traits, values, episodic and semantic memories about the self and that controls the processing of self-relevant information (Diehl et al., 2001). Self- The number and diversity of self-aspects developed for meaningful Complexity aspects of one’s life (Linville, 1985) Self-Concept The extent to which an individual’s self-concepts are clearly and Clarity confidently defined, internally consistent, and temporally stable (Lodi-Smith & Roberts, 2010). Self-Concept The degree to which a person feels and acts the same across roles Differentiation and environments (Diehl et al., 2001; Pilarska & Suchańska, 2015). Self-Coherence The degree to which a person’s many selves are logically connected (Fournier et al., 2015). Self-Continuity How connected one feels to past or future versions of the self- concept (Sedikides et al., 2023) Defense Automatic psychological processes that protect the individual Mechanisms against anxiety and from the awareness of internal or external dangers or stressors (DSM-IV-tr). Coping Strategies for regulating emotional states. Mechanisms Self- Process in adult development that involves moving beyond the Transcendence limits of the self Table 0-2. Definitions of constructs pertaining to the self and self-functions. Self and Identity Development During Adulthood Although most adults experience a single “self,” after adolescence the Self varies from person to person according to the number of parts, the ways the parts are organized and the way the parts are expressed in social roles. Self-Concepts are the answer to the question, “who am I?” Self-complexity refers to the number of distinct concepts a person has about the Self (Diehl et al., 2001). Self-knowledge is not always accurate (Vazire & Carlson, 2010) because self-concepts in turn organize and control what information contributes to self-perceptions. The mind takes in sensory information and creates perceptions. People believe their perceptions and tend not to question whether perceptions truly capture reality. Look at Figure 1 to appreciate how the same sensory information can lead to perceiving oneself or another as old or young. It all depends on how you look at the picture! 3 Figure 0-1. My Wife and My Mother-in-Law William Ely Hill, 1888 Self-perceptions occur in the many relationships, roles, and environments people find themselves in. Repeated self-perceptions lead to self-concepts which are organized by the mind into many selves. A person is a collection of selves, and the number of selves depends on the number of social roles the person has. People may be consistent or inconsistent in thoughts, feelings and behavior from one setting to the next. Some people’s self-concepts change a lot from setting to setting and some people’s self-concepts are more consistent. Self-concept differentiation is the degree to which a person feels and acts differently across roles and situations (Pilarska & Suchańska, 2015). Self-Concepts: Complexity, Clarity and Differentiation In theory the idea of self-complexity is compelling. Some people have more detailed self-knowledge and greater self-knowledge could contribute to wisdom and resilience. However, research into self-complexity shows that problems measuring the construct limit its usefulness (Pilarska & Suchańska, 2015; Rafaeli-Mor & Steinberg, 2002). A person who can talk about many different self-concepts could have a lot of self- knowledge or they could be unsure of who they are. Self-knowledge predicts resilience whereas lack of identity predicts difficulty assuming adult roles. For this reason, self- concept complexity does not consistently correlate with well-being, and lifespan studies of the construct have not been done (Rafaeli-Mor & Steinberg, 2002). Self-concept clarity is a more reliable construct (Table 2) and is the extent to which an individual’s self-concepts are clearly and confidently defined, internally consistent, and temporally stable (Lodi-Smith & Roberts, 2010). Self-concept clarity increases after early adulthood as individuals assume careers, partner, and become parents. Participating in these social roles enables self-concept clarity and leads to further identity development in middle adulthood (Rafaeli-Mor & Steinberg, 2002). This 4 development continues into later adulthood for those who remain healthy. Decreased health can cause role limitations and decreased self-concept clarity after age 60 (Lodi- Smith & Roberts, 2010). Self-Concept Clarity Scale 1. My beliefs about myself often conflict with one another.* 2. On one day I might have one opinion of myself and on another day I might have a different opinion.* 3. I spend a lot of time wondering about what kind of person I really am.* 4. Sometimes I feel that I am not really the person that I appear to be.* 5. When I think about the kind of person I have been in the past, I’m not sure what I was really like.* 6. I seldom experience conflict between the different aspects of my personality. 7. Sometimes I think I know other people better than I know myself.* 8. My beliefs about myself seem to change very frequently.* 9. If I were asked to describe my personality, my description might end up being different from one day to another day.* 10. Even if I wanted to, I don’t think I could tell someone what I’m really like.* 11. In general, I have a clear sense of who I am and what I am. 12. It is often hard for me to make up my mind about things because I don’t really know what I want. Table 0-3. Self-report measure of Self-Concept Clarity (Campbell et al., 1996). Self-Concept differentiation causes a person to feel like a different person when they are with different people or are performing different social roles (Table 2). A person with high self-concept differentiation can feel like an interpersonal chameleon, with no inner core of identity (Block, 1961). Self-concept differentiation research consistently shows that regardless of age, the greater the differentiation and the lower the integration among a person’s self-aspects, the weaker is their sense of identity (Diehl et al., 2001; Lodi-Smith & Roberts, 2010; Pilarska & Suchańska, 2015). Self-concept differentiation is highest in early adulthood and then decreases as people enter middle age (Lodi- Smith & Roberts, 2010). High self-concept differentiation was shown to be stable over 30 years and associated with poor emotional adjustment in one study (Donahue et al., 1993). This finding indicates that the tendency to experience “too many selves” can be an enduring problem that goes along with clinical disorders after early adulthood (as the DSM 5tr definitions suggest) (Shinebourne & Smith, 2009). People who know who they are and who feel like the same person in all their relationships have higher wellbeing. High self-concept clarity and low self-concept differentiation synergistically predict measures of psychological wellbeing including feelings of autonomy and purpose in life, personal growth, healthy relationships and self-acceptance. Individuals who are both fragmented in their roles and confused about who they are have the lowest levels of wellbeing (Diehl & Hay, 2011). The need to feel self-consistent and clear about the self is the same across adulthood. Young adults have lower levels of self-consistency and clarity than do middle and older adults (Diehl & Hay, 2011). Developmental changes in these constructs over the lifespan indicate that people learn about themselves as they take on different roles and 5 navigate changes in their lives. Self-knowledge is part of the wisdom that goes along with getting older. Low self-knowledge and consistency is more abnormal for older adults compared to young adults. Self-Esteem During Adulthood Self-esteem is a person’s subjective evaluation of their worth as a person that leads to self-acceptance and a positive attitude toward the Self (Orth et al., 2018). Many studies demonstrate that self-esteem enhances people’s success and well-being in the domains of social relationships, education, work, and physical and mental health. Despite these studies that suggest self-esteem enables development, the excessive self-esteem found in narcissism predicts low empathy and antisocial behavior. The two constructs are different with respect to how and individual values self and others. Individuals high in narcissism value themselves more than others and believe themselves to be superior to others (R. P. Brown & Zeigler-Hill, 2004; Hyatt et al., 2018). Individuals with high self- esteem can simultaneously make positive evaluations of themselves and others. Self-esteem increases from the late teens to peak during the 50s and then decreases a small amount between 70 and 90 (Orth et al., 2018). This developmental trajectory is seen in both longitudinal and cross-sectional studies that include a range of birth cohorts. Genetic studies show that self-esteem is influenced by genetics, but that environment makes a significant impact. The increase in self-esteem over adulthood is associated with people partnering, starting families and maintaining careers. The small decline in self-esteem in later adulthood is related to retirement, relationship losses and declines in health (Orth et al., 2018). Defense Mechanisms, Coping and Adult Development Feeling self-consistent and having clear positive self-concepts brings security and empowerment. Self-esteem provides the energy a person needs to get through life’s difficult moments and climb the social ladder. Self-concepts and self-esteem are so important that the mind defends itself against information that might lower self-esteem or challenge the truthfulness of self-concepts (Orth et al., 2018; Perry et al., 1993). The mind uses defense mechanisms to protect the Self from negative emotions because these impair cognition, especially when a person is outside their Window of Tolerance (see page ). Defense mechanisms (Table 3) then keep people from fully perceiving reality or may result from faulty thinking that occurs when people are overwhelmed (Haan, 2013). Regardless of the cause-and-effect direction, defense mechanisms and associated faulty thinking reduce arousal and protect the Self (Cramer, 2003). Over a period of several years, people’s use of defense mechanisms is stable and trait-like (Diehl et al., 2014). Some defense mechanisms are more adaptive and mature (Table 3, Column 1). Mature defenses help a person cope with stress in a healthy way. Mature defenses demonstrate that a person can tolerate distress and maintain contact with reality. Neurotic defenses signal a compromise with realty such that some threatening 6 information is kept from conscious awareness. Immature defenses signal more extreme reality distortion and psychotic defenses signal a loss of reality contact. Immature defense mechanisms occur more often in individuals who have experienced severe childhood trauma (Zerach & Elklit, 2020). Immature defense mechanisms are predictive of poor social functioning and health and low achievement by later adulthood (MacGregor & Olson, 2005; Soldz & Vaillant, 1998). Defensive Levels Categories of Defenses Defense Mechanism 1. Anticipation 2. Affiliation Level 7: Highly Adaptive 3. Altruism Mature Conscious Awareness of 4. Humor Experience 5. Self-assertion No compromise with reality 6. Self-observation 7. Sublimation 8. Suppression 9. Displacement 10. Dissociation Neurotic Level 6: Mental inhibitions 11. Intellectualization Potentially threatening ideas, feelings, 12. Isolation of Affect Formation of a compromise memories, wishes, or fears kept out of 13. Reaction Formation with reality awareness 14. Repression 15. Undoing Immature Level 5: Minor Image Distortion 16. Devaluation (Narcissistic) 17. Idealization Consistent minor distortions Distortions in the image of the self, (of Self or Other) of reality body, or others that may be employed 18. Omnipotence to regulate self-esteem. (Self or Other) Level 4: Disavowal Unpleasant or unacceptable 19. Denial Keeping some reality out of stressors, impulses, ideas, affects, or 20. Projection awareness responsibility out of awareness with or 21. Rationalization without a misattribution of these to external causes. Level 3: Major Image-Distorting 22. Autistic Fantasy Consistent major distortions (Borderline) 23. Projective Identification of reality Gross distortion or misattribution of 24. Splitting of Self-Image the image of self or others or Image of Others Outward actions to negate 25. Acting Out reality Level 2: Action Level 26. Apathetic Withdrawal Dealing with internal or external 27. Help-Rejecting stressors by action or withdrawal. Complaining 28. Passive Aggression Psychotic Level 1: Defensive Dysregulation 29. Delusional Projection Pronounced break with objective 30. Psychotic Denial reality 31. Psychotic Distortion Table 0-4. Defense mechanisms defined in DSM-IV, Appendix (see also this link for definitions (Di Giuseppe & Perry, 2021). DSM-IV-tr, Appendix, names (Table 4) and defines defense mechanisms and gives guidelines for their assessment. In 2013, defense mechanisms were unceremoniously dropped in the change to DSM-5. Although many published articles discuss revisions in 7 DSM-5, none explain the reason for not including defense mechanisms in the current DSM. Clinical researchers have developed reliable self-report and interview methods for identifying which defense mechanisms a person uses most often (Di Giuseppe & Perry, 2021; Vaillant et al., 1986).The existence of defense mechanisms, defensive changes over development and the relation of defense mechanisms to disorders has much empirical support (Perry et al., 1993; Vaillant et al., 1986). People cope with stress intentionally using skills and so avoid emotional dysregulation. Coping skills are deliberate and conscious strategies for dealing with stress and threats to Self, whereas defense mechanisms are automatic and nonconscious (Silverman & Aafjes-van Doorn, 2023). There is a continuum between coping and defense mechanisms such that people who are functioning in their Window of Tolerance cope and use mature defenses to maintain coping (Zerach & Elklit, 2020). In many respects, defense mechanisms appear to be failed coping strategies (Haan, 2013). For example, one coping strategy is thoughtful tolerance of ambiguity. When arousal makes thoughtfulness impossible, cognitive distortions (devaluation and idealization) lead to black and white thinking and predispose to depression. Defense mechanisms operate when a person is unable to cope with a situation or the meaning of a situation (Diehl et al., 2014; Silverman & Aafjes-van Doorn, 2023; Zerach & Elklit, 2020). The use and understanding of defense mechanisms follows a developmental sequence over childhood and adolescence (Cramer, 2003). Stress and trauma during early development may lead to immature defenses persisting later (Zerach & Elklit, 2020). In adults, use of defense mechanisms predicts nearly 40% of the variability in maladaptive personality traits (Granieri et al., 2017). The maladaptive traits of negative affectivity, detachment and antagonism are associated with different patterns of defense mechanism use (Granieri et al., 2017). As people get older the use of mature defense mechanisms increases in parallel with better emotion regulation skills. Furthermore, when individuals with high levels of maladaptive personality traits are taught coping skills, the use of immature defenses decreases (Euler et al., 2019). Individuals who show high levels of narcissistic defenses (Table 3) do not improve as much with skills training. This finding is consistent with the idea that excessive dominance interferes with treatment (Johnson et al., 2012). How do adults experience and understand themselves? The sense of self provides adults with perception of Self as singular, coherent, individual, and time invariant (Prebble et al., 2013). Through sense of self people know they are without doubt the owner of their actions, thoughts, emotions, perceptions, and memories. Both sense of self and identity define one as a unique and particular human being. Whereas sense of self is privately experienced, identity is interpersonal or relational (Self and Identity - an Overview | ScienceDirect Topics, n.d.). The sense of self is the maker of the “I-self” and identity is the maker of the “me-self” (Part 2, Chapter 6) (Table 3). Other people see “me” and as I am seen and imagine being seen, I come to know me. 8 “I-Self” “Me-Self” Continuity (Sense of Self) (Identity) Timeframes Experienced Self Known Self Present Moment Self-Experience Self-Concepts Self-Awareness Past and Future Autonoetic Consciousness Semantic Consciousness Reliving the Past Self-Concepts over Time Imagining the Future Narrative Accounts Table 0-5. How the experienced- and known-self interact to produce self-continuity and the Self.((Prebble et al., 2013). The sense of self is a perception related to bodily sensations whereas identity results from remembered facts about the self and the life narrative. Many studies point to the insula as the brain region most critical to the experience of the present moment sense of self (Prebble et al., 2013). The present moment experience of sense of self may be altered in neurologic disorders, psychiatric disorders, trauma, and substance use disorders (Prebble et al., 2013; Shinebourne & Smith, 2009). Absent a pathological process, sameness in the present moment sense of self is continuous over adulthood and is much of what makes a person feel continuous over time. (LJLs father (a physician) said at age 74, “I’ve felt the same since I was 14.”) Sense of self makes people aware that they exist, experience the world and perform actions. Through self-awareness they can reflect on their consciousness, actions, and abilities. Self-awareness is not affected by healthy aging but is impaired in neurocognitive disorders such as Alzheimer’s Disease. Self-awareness is required for episodic memory because without self-awareness a person would not know the difference between present experiences and past reexperiencing through memory (Prebble et al., 2013). Life would feel like a constant déjà vu episode (A. S. Brown, 2003). When Working Memory Includes the Self The I-Self is the experienced self, and the Me-Self is the known self. Table 3 summarizes the experience of self-continuity and the Self. The I self and the me self, known from the present and past, form the impression of who one is. When that impression is activated into working memory by an event, strong emotions can arise. For example, when you are praised or criticized the Self is remembered in a way that can evoke emotions. Furthermore, through strong emotions the Self is also activated. In depression, low mood activates Self perceptions and negative thoughts about the Self. Cravings for substances also capture the Self. When the Self is activated in working 9 memory a person becomes absorbed in their experience and its relevance (either positive or negative) to the Self. Emotions elicited are strong and self-regulation is more difficult. Mindfulness Mindfulness means focused attention on exclusively present moment experience (Table 3, Quadrant 1). During mindfulness practice Quadrants 2-4 are not suppressed but are simply not attended to. Through this strategy, a person can learn to observe their thoughts (ideas, intentions, memories) and emotions and not become wrapped up in these. In the last chapter you learned that working memory has limited capacity and decreases with age. If the mind is focused on sensory stimuli there is no room for the Self in working memory. That feature of mindfulness improves with age. From a mindful perspective adults can question the truth of extreme self-concepts. Mindfulness-based therapies are effective for mood, anxiety and personality disorders as well as addiction (Crane, 2013; Linehan, 1993). Autobiographical Memory and the Self in Older Adults Semantic Self-Knowledge & Narrative Meaning Episodic Memories with Identity Strength Re-experiencing Figure 0-2. The impact of episodic memory on identity strength is mediated by self-knowledge (Haslam et al., 2011). The building of autobiographical memory is a complex process that starts with episodic memory (Table 3, Quadrant 2) and leads to the assimilation of facts about life events and the narrative stories that tie life event facts together. Consistent with the model presented in Table 4, a person can tell a story about themselves without reliving the event in their mind (Quadrant 4) or can relive the event as they tell a story (Quadrants 2 and 4 together). Figure 2 shows that episodic memories contribute to identity primarily through stimulating semantic self-knowledge and narrative stories (Haslam et al., 2011). As previously described, episodic memory declines somewhat with healthy aging and declines dramatically with neurocognitive disorders. Identity strength does not decline until the later stages of neurocognitive disorders and is not impacted by healthy aging. Identity strength can also impact what is known and remembered about the Self. People who strongly believe themselves to have certain 10 qualities may even create false memories that support their Self view. Older adults are more prone to making false self-referential memories (Rosa & Gutchess, 2013). Identity construction continues until death. People over the age of 95 still actively construct their identities through self-concepts and narrative stories (Anderson et al., 2022). Narrative Identity Changes During Adulthood Narrative identity consists of the stories people tell to construct the Self and sustain the Self through time and to reveal the Self to others. A person’s narrative identity is the story of how they came to be who they are, including their triumphs, failures, dreams, and regrets (McAdams, 2008; Reischer, 2021). Narrative identity arises in the late teens and early 20s and then grows over adult life. Narratives highlight how people pursued valued goals; people use their stories to understand their own emotions, thoughts and behavior. Narratives explain core beliefs about the Self, others, and the world (as in cognitive behavioral therapy) (Beck, 2005). Clinicians, especially mental health clinicians, hear important narratives in their work with adults of all ages. Because these narratives and the beliefs that they justify are tied to the Self, they can be very resistant to change (revision). The counseling techniques of motivational interviewing are needed to help people examine and change the core self-concepts and narratives that support unhealthy behavior (Miller & Rollnick, 2012). The impact of narratives on beliefs and behavior can be explicit and conscious or implicit and nonconscious. In practice, not all people tell life stories spontaneously. Sometimes clinicians and researchers must draw narratives out using prompting questions. Researchers study narrative identity by posing prompting questions that ask participants to reflect on major life events and how they changed with age. Participants are also asked to consider the significance of events to their bigger “life story” (McAdams, 2008; Reischer, 2021). The content and structure of people’s narrative stories can be evaluated and linked to outcomes such as life satisfaction, wellbeing and clinical disorders (Lind et al., 2020; McLean et al., 2020). The stories that form narrative identity contain positive or negative feeling tone, motivational themes and may convey the meaning of experiences. Narratives vary according to clarity and detail. They can be detailed and straightforward or vague and confusing to follow. These aspects of people’s stories predict wellbeing in unique ways. As reviewed by Adler and colleagues (2016): 1) motivational themes reflect people’s goals and sense of purpose such that themes of agency, communion/relatedness, autonomy, and competence predict wellbeing and life satisfaction; 2) positive tone in stories predicts happiness in life; 3) integrative meaning making predicts hedonic wellbeing and personal growth; and 4) coherent stories are told by people with greater wellbeing. In common with Friedrich Nietzsche and Kelly Clarkson, many people discover that “what doesn’t kill me makes me stronger” (see video). Accordingly, on average, the quality of narratives and the strength of narrative identity increase over the decades between 30 and 70 (McLean, 2008). Story telling is a pastime that many older people 11 enjoy and researchers have found that storytelling ability increases in later adulthood (James et al., 1998). Autobiographical reasoning defined as the construction of connections that link experiences to the person’s sense of self also improves until late adulthood (Pasupathi & Mansour, 2006). Older adults are more likely to use their narrative stories to teach lessons to other people. Narrative identity factors also foster resilience in that older adults who score high on resilience “story” their lives in a healthy way (Randall et al., 2015). Narrative Psychotherapies Several psychotherapies make use of the fact that people’s beliefs and behaviors are influenced by the narratives they create. These therapies help people either tell different stories, create coherent narrative identity through stories, or derive greater meaning from stories. In Narrative Therapy, one goal is to examine problems and detach the Self from problems so that people stop seeing the Self as the problem. For example, in our culture, “people who experience hardships are sometimes seen as failures or deficient in some ways. They may view themselves as the problem and create stories of themselves that depict a lack of power and worth. Problems may not be seen by them as external events that affect and influence their lives…” (Etchison & Kleist, 2000, p. 61, emphasis added). Narrative therapists objectify the problem by making it an additional character in the person’s story (White & Epston, 1990). Objectifying the problem detaches it from the Self (see decentering below). Trauma therapies such as TFCBT, and the ARC Framework help individuals integrate the trauma story into a life narrative that is healing (Deblinger et al., 2011). Therapists working with traumatized adolescents and young adults help them create a narrative identity that considers their strengths in the context of the challenges they have faced (Blaustein & Kinniburgh, 2018). Life review is an important developmental task for older adults (Erikson, 1959) and therapists have used forms of life review to improve wellbeing in this age group (Pinquart & Forstmeier, 2012). Narrative techniques such as simple reminiscence and life review have been incorporated into supportive therapy and in the 1960s Butler (1963, 1974) developed Life-Review Therapy. Simple reminiscence involves unstructured autobiographical storytelling for the purposes of sharing and remembering positive past events and can take place in group or individual sessions. Life-review usually takes place during individual therapy and is more structured. The therapist assists the elder in making meaning of life events and with the integration of positive and negative life events into a coherent life story (Pinquart & Forstmeier, 2012). Life-Review Therapy is for people with clinical disorders, most commonly depression. In this therapy, the individual, their family members and therapist work together to create an extensive autobiography of the older person. A written or recorded memoire of the individual is created for family and friends to keep (Butler, 1974). A recent meta-analysis found narrative therapies improve ego integrity, reduce symptoms of depression, increase sense of purpose in life, and assist with death preparation. The medium to 12 large effect sizes for narrative therapies in older people demonstrate these therapies are helpful and efficient (Pinquart & Forstmeier, 2012). The use of narratives in trauma therapies also is strongly supported by evidence. The evidence base for Narrative Therapy in younger populations is not large enough to determine effectiveness. Disorders of the Self According to DSM 5, dissociative disorders are “characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.” These are in essence disorders of the Self and self-experience, and include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder. In dissociative identity disorder, individuals experience fragmentation and division of identity that is accompanied by loss of memory for self-states. Loss of autobiographical memory is seen in dissociative amnesia. In depersonalization/derealization disorder individuals experience depersonalization or experiences of unreality or detachment from the mind, self, or body; and/or derealization which includes experiences of unreality or detachment from the surroundings. Schizophrenia is a disorder that occurs on a spectrum that can include― an extended prodrome (symptoms prior to onset), and paranoid, schizoid and schizotypal personality disorders. Disordered self-experience is associated with the schizophrenia spectrum such that some consider this to be the core of the disorder (Sass, 2014). People affected with schizophrenia experience their own thoughts and actions as coming from outside the self. They may feel possessed or controlled by an outside force. It is important to distinguish these and other disorders of the Self from healthy Self- Transcendence as discussed below. Self-Development After Early Adulthood: Self-Transcendence Transpersonal Psychology Branch of humanistic psychology that focuses on the exploration of the nature, varieties, causes, and effects of “higher” states of consciousness and transcendental experiences. Transpersonal refers to the concern with ends that transcend personal identity and individual, immediate desires. Read more from the Journal of Transpersonal Psychology Home Page. To transcend means to go beyond the limits of something. Self-transcendence means going beyond the limits that self-concepts and life narratives place on change. The Self can be a form of bondage for people if they regard self-concepts as unchangeable so self-transcendence can bring greater freedom (Cloninger & Cloninger, 2022). In this chapter you learned that the Self is a constructed perception and that autobiographical memory contains concepts and stories. Furthermore, psychological suffering can arise when working memory is occupied by Self perceptions including self-concepts and narrative stories. Over identification with Self is behind ordinary suffering as well as mood, anxiety, trauma-related and substance use disorders (Vago & David, 2012). 13 If this constructed perception can cause so many problems, perhaps it is possible to bypass or deconstruct and reconstruct it? Indeed many consider self-transcendence to lead to the highest levels of human development (Garcia-Romeu, 2010). Self- transcendence enables people to make meaning of otherwise incomprehensible life circumstances (Frankl, 1985). Self-transcendence happens slowly over time in some people as they put aside their old self-concepts (Reed, 2010). It also happens in sudden episodes as we will explain. According to Humanistic Psychologist, Maslow, “Transcendence refers to the very highest and most inclusive or holistic levels of human consciousness, behaving and relating, as ends rather than means, to oneself, to significant others, to human beings in general, to other species, to nature, and to the cosmos” (Maslow, 1971, pp. 269, emphasis added). Aspects of Self-Transcendence (Maslow, 1969) 1. Self-forgetfulness which comes from getting absorbed. fascinated, or concentrated. 2, Sense of transcending one's own skin and body and bloodstream, as in identification with the B-values so that they become intrinsic to the Self itself. 3. Transcendence of time. 4. Transcendence of culture. 5. Transcendence of one's past. 6. Transcendence of ego, self, selfishness, ego-centering, etc., when we respond to the demand-character of external tasks, causes, duties, responsibilities to others and to the world of reality. 7. Transcendence as mystical experience, Mystic fusion, either with another person or with the whole cosmos or with anything in between, 8. Transcendence of death, pain, sickness, evil, etc., when one is at a level high enough to be reconciled with the necessity of death, pain, etc. 9. Transcendence is to accept the natural world, is to let it be itself in the Taoistic fashion, is the transcendence of the lower needs of the self-that is…of one's egocentric judgments 10, Transcendence of the We-They polarity. 11. Transcendence of the basic needs (either by gratifying them so that they disappear normally from consciousness, or by being able to give up the gratifications and to conquer the needs). 12. Identification-love is a kind of transcendence, e.g., for one's child, or for one's beloved friend. This means "un-selfish." This means transcendence of the selfish Self. 13. In this sense one can transcend all kinds of bondage, slavery, etc., in the same way that Frankl could transcend even the concentration camp situation. 14. Harmonious participation in something larger than oneself—a relationship, a social group, a cause, an ordered universe. 15. Transcending the opinions of others, i.e., of reflected appraisals. This means a self-determining Self. 17. Transcendence of one's own weakness and dependency, 18. Transcending the present situation, "to relate to existence also in terms of the possible as well as the actual." 14 Aspects of Self-Transcendence (Maslow, 1969) 19. Transcendence of dichotomies (polarities, black and white oppositions, either-or, etc.). To rise from dichotomies to superordinate wholes. 20. Transcendence of the D-realm into the B-realm, (Of course this overlaps with every other kind of transcendence “D-needs,” are motivated by a lack of satisfaction, whether it's the lack of food, safety, affection, belonging, or self- esteem.) 21. Transcendence of one's own will (in favor of the spirit of "not my will be done but Thine"). 22. The word transcend also means "surpass" in the sense simply of being able to do more than one thought one could do, or more than one had done in the past, Table 0-6. Definitions of self-transcendence compiled by Maslow. Maslow theorized that there is a motivational hierarchy of human needs. Self- transcendence is part of this theory of human motivation and prior to his untimely death he planned to add it to the top of his need hierarchy pyramid (Koltko-Rivera, 2006). At the bottom of the hierarchy are D-needs (D for deficit). D-needs involve Self- preservation― food, safety, affection, belonging, or self-esteem. At the top of the hierarchy are B-needs (B for Being)―Self-actualization, creativity, reaching one’s potential. Transcendence of D-needs is required before the B-needs can be explored (Table 6, #20) (Maslow, 1943, 1962b). Maslow theorized that the construct of self-transcendence is multifaceted and the process of transcending the Self occurs at different levels of intensity (Maslow, 1969) (Table 6). Maslow tied self-transcendence over the long-term to what he named “peak experiences” (Table 6, #1, 7). He discovered peak experiences when he studied healthy people functioning at the top of his motivational hierarchy. “I found that these individuals tended to report having had something like mystic experiences, moments of great awe, moments of the most intense happiness… when all doubts. all fears, all inhibitions, all tensions, all weaknesses, were left behind. Now self-consciousness was lost. All separateness and distance from the world disappeared as they felt one with the world, fused with it, really belonging in it and to it, instead of being outside looking in” (Maslow, 1962a, pp. 9, emphasis added). Increased consciousness or Awakening occurs with peak experiences, “in these experiences (people had) the feeling that they had really seen the ultimate truth, the essence of things, the secret of life, as if veils had been pulled aside” (Maslow, 1962a, p.9 emphasis added). Self-transcendence can happen as a gradual shift and/or in life-changing episodes and can be associated with higher stages of adult development. Self-transcendence can include altered perception of the body (Table 6, #2, 11), and time (#3). It occurs with love and connection with others (#6,12,14). Self-transcendence enables people to go beyond― their present or past circumstances (#5,18), adverse circumstances (#13), their own limitations (#8,17,22), their desires (#21), other people’s influence (#15), habitual ways of thinking (#9, 19), cultural conditioning (#4), and alliance to a social group (#10). Maslow was the first to report that self-transcendence occurs as both a temporary state and a more lasting trait linked to mature development. 15 Trait self-transcendence causes people to feel connected to others and to nature and to behave selflessly as opposed to selfishly (Stellar et al., 2017). Tales of sudden self-transcendence have been told by people for at least 2500 years (Garcia-Romeu, 2010). Today worldwide many seek peak or Awakening experiences; about 30% of adults report having had them (Taylor, 2018; Yaden et al., 2017). Eckhart Tolle (born 1948) is an example of such a person. He had an Awakening experience at the age of 29 while recovering from depression. He subsequently wrote about his experience; his books were recommended by Oprah Winfrey and today he has over 2.4 million Instagram followers (read more). Tolle’s popularity is evidence that people are drawn to self-transcendence. Construct (Discipline) Definition and Measurement Tool Self-Transcendence The Self-Transcendence Scale (STS) (Reed, 2010) 15 items relating to (Nursing) the specific behaviors or perspectives involving the expansion of self- boundaries inwardly through introspective activities, outwardly through involvement with others, and temporally by living in the present or holding perspectives of past and future that enhance the present. Spiritual Transcendence The Spiritual Transcendence Scale (Piedmont, 2011) is a 24-item rating (Personality Psychology) scale containing three subscales: Universality, Prayer Fulfillment, and Connectedness. Spiritual Transcendence refers to the capacity of individuals to stand outside of their immediate sense of time and place to view life from a larger, more objective perspective. Self-Transcendence The Adult Self-Transcendence Inventory (Le & Levenson, 2005) is a (Humanistic (Transpersonal) 10-item rating scale that measures decreasing reliance on externals Psychology) for definition of the self, increasing interiority and spirituality, and a greater sense of connectedness with past and future generations. Self-Transcendence The 29-item Self-Transcendence Subscale of the TCI measures (Personality Psychology) “identification with everything conceived as essential and consequential parts of a unified whole” (MacDonald & Holland, 2002) Self-Expansiveness The Self-Expansiveness Level Form, Transpersonal Scale is 6 items (Personality Psychology) that assess the willingness of individuals to identify with future descendants and other life forms. The Self extends beyond the here- and-now, such that there is a dissolution of the individual's perception of self as an isolated biosystem existing only in the present (Friedman et al., 2003; Pappas & Friedman, 2007). Unselfing Unselfing, is seeing the world with clarity, inspiration in beauty, (Moral Philosophy, Iris attending to others with loving appreciation in such a way as to Murdoch) overcome our egoistic tendencies (Driver, 2020). Selflessness vs Egocentrism Self as an interconnected transient event; vs an unchanging (Positive Psychology) independent entity with sharp boundaries (Dambrun, 2016) Nondual Awareness Nondual Awareness Dimensional Assessment-Trait (NADA-T) and the (Positive Psychology) Nondual Awareness Dimensional Assessment-State (NADA-S) (each 13 items) measure nondual awareness. NDA defined as a state of consciousness that rests in the background of all conscious experiencing – A field of awareness that is ever present, yet typically unrecognized, obscured by discursive thought, emotion, and perception (Hanley et al., 2018). Flow Flow is a subjective state that people report when they are completely (Positive Psychology) involved in something to the point of forgetting time, fatigue, and everything else but the activity itself. 16 Construct (Discipline) Definition and Measurement Tool Decentering The EQ is a 20-item self-report inventory designed to measure a (Clinical Psychology, decentering or disidentification with content of negative thinking, which Positive Psychology) is hypothesized to be a process of change in MBCT. The Toronto Mindfulness Scale, Decentering Subscale is 7 items. Decentering is the capacity to take a detached view of one’s thoughts and emotions― the ability to observe one’s thoughts and feelings as temporary events in the mind, as opposed to reflections of the self that are necessarily true. Table 0-7.. Definition and measurement of self-transcendence and related constructs. After Maslow’s death, researchers defined and operationalized the construct of self- transcendence and measured outcomes associated with it (Table 7). In what follows we discuss research regarding the psychological construct of self-transcendence and relate this construct to lifespan development and people’s peak and Awakening experiences. The construct of self-transcendence has been defined and studied as a variable in lifespan development and transpersonal psychology. Successfully coping with illness, disability, adverse life events and aging means people have to revise self-concepts no longer useful and find meaning in life despite hardships (Haugan et al., 2022; McCarthy & Bockweg, 2013; Reed, 2010). In this context self-transcendence is defined as an “inherent, gradual, non-linear developmental process, resulting in increased awareness of dimensions greater than the self and expansions of personal boundaries within intrapersonal, interpersonal, transpersonal, and temporal domains” (McCarthy et al., 2013, pp. 179, emphasis added). Within the developmental literature, self- transcendence connects to spirituality; and is measured by the Self-Transcendence Scale (STS) (Reed, 2010). According to a recent large meta-analysis, 13 studies using the STS demonstrate that self-transcendence predicts meaning-in-life, resilience, sense of coherence, and low levels of depression (Haugan et al., 2022). A continuum of self-transcendence occurs in the developmental model that links wellbeing to flexibly revising and expanding self- concepts as a response to adversity. Flexibility of self-definition when faced with challenges enables people to adapt and find continued meaning in life. STS self- transcendence even predicts more wellbeing and personal development in individuals over 90 (Norberg et al., 2015). Personality researchers have studied self-transcendence as a personality trait and have used several different definitions of the construct. Essentially personality researchers measure individuals’ dispositional tendency to― feel connected with nature and other individuals and extend their self-definition beyond themselves. Personality researchers also connect self-transcendence to spirituality and belief in the supernatural. Although the personality measures listed in Table 7 generally correlate, the amount of shared variability is not high enough to prove they measure a single construct well. Trait self-transcendence appears to be multifaceted but the details of the facets are not well-established (MacDonald & Holland, 2002). The TCI Self-Transcendence subscale has been widely used in studies of personality. However, its reliability and validity have not been established. In one study, the reliable 17 facets of TCI Self-Transcendence were 1) Spiritual and Religious Beliefs, 2) (sense of) Unifying Interconnectedness, 3) Belief in the Supernatural, and 4) Dissolution of Self in Experience and not the subscales proposed by the scale author (MacDonald & Holland, 2002). These components are consistent with Maslow’s idea of self-transcendence and include elements of flow and peak experiences. Spiritual and Religious Beliefs and Unifying Interconnectedness had the strongest relationship to other measures of self- transcendence. Eliminating items from the TCI Self-Transcendence scale results in a single construct that has excellent reliability (Table 8) (Kirk et al., 1999). Genetic factors predicted 61-64% of the variability in this revised scale in one study of middle-age twins (Kirk et al., 1999). Representative TCI Self-Transcendence Scale Items I often feel a strong spiritual or emotional connection with all people around me. I often feel that I am a part of the spiritual force on which all life depends. Sometimes I have felt as if I was part of something with no limits or boundaries in time or space. I sometimes feel a spiritual connection to other people that I cannot explain in words. Sometimes I have felt my life was being directed by a spiritual force greater than any human being. I have had personal experiences in which I felt contact with a divine wonderful spiritual power. I have had moments of great joy in which I suddenly had a clear, deep feeling of oneness with all that exists. Table 0-8. The set of the most representative and valid TCI Self-Transcendence items (Kirk et al., 1999). In summary, it appears that personality trait of self-transcendence is related to spiritual beliefs and a tendency to view oneself as connected to others and to nature. In turn these beliefs correlate with peak experiences as described by Maslow. Self-Transcendence: Clinical Psychology and Behavioral Medicine 1 After WW II, many Western psychologists and psychiatrists had contact with Buddhism, Taoism, and Yoga as practiced by aboriginal populations. Arguably ancient Asian people were the first to invent psychological science over 2500 years ago and they transmitted their knowledge through these spiritual traditions. Close reading of the biographies of the leaders of Western psychology (including Maslow’s) reveals their work was influenced by Eastern Figure 0-3. Dr. Aaron Beck, Founder of Cognitive spiritual traditions. Also, Westerners Behavioral Therapy and Buddhist leader HH The Dalai seeking spiritual teaching went to Asia and Lama of Tibet source.. brought their teachers to the United States and Europe (Connelly, 2016). Many centers for the study and practice of these 1Positive psychology is tied to behavioral medicine and is the study of factors that make life worth living and that lead to wellbeing (read more). 18 traditions were started and Westerners learned the ancient languages and practices. Among the leaders of psychiatry and psychology are researchers and clinicians with personal ties to Eastern spiritual traditions (Figure 3). There is now a discipline called Contemplative Neuroscience (read more from Harvard University). Ancient Asian psychologists did not have Skinner Boxes, fMRI, or PET, but they conducted science nonetheless using a tool they developed― meditation. During episodes of various forms of mediation ancient scientists made systematic observations of their own minds. With their methods they discovered conditioning and came to understand that the Self is a cause of psychological suffering. They were able to figure out that the Self is a constructed perception (Connelly, 2016). On an individual level, this discovery enabled people to use meditation to have peak (Awakening) experiences and long-lasting personality change. Letting go of Self can be such a cause of joy that for centuries some people have given up “householder” life to pursue meditation fulltime (Gyatso & Chodron, 2014). There is an element of self- transcendence in many religious traditions. Ancient findings regarding the mind, the Self and suffering (Gyatso & Chodron, 2014) have empirical support from modern psychological science. Furthermore, ancient remedies for suffering― mindfulness, mindful movement (yoga) and meditation have become part of present-day mental health practice. Beyond ending suffering, these practices also promote adult development through self-transcendence. Positive psychologists working in behavioral medicine have developed methods for teaching mindfulness and meditation to clinical populations and to those wishing personal growth (Kabat-Zinn, 2011). Clinical researchers have also developed measurement tools to assess constructs related to adult self-development and self-transcendence (Table 7). Measurement tools make it possible to study the physiological basis for the continuum of self-transcendence (Figure 4). Flexible view of Self, Self-centeredness and self- perception of inter- Selflessness and absorption connectedness of all life non-dual awareness and the human family Figure 0-4. Continuum of Self-Transcendence. Self-transcendence occurs along a continuum ranging from self-centeredness and self- absorption (no transcendence) to viewing the self flexibly, and as interconnected with 19 others and/or nature (intermediate transcendence) and finally to selflessness and “nonduality” (Figure 4) (Dambrun & Ricard, 2011). Self-transcendence is both a temporary state of mind and a personality trait because mental states activated repeatedly over time become habits characteristic of a person (traits). In addition, in some people the process of self-transcendence occurs slowly over time. Self-Transcendence is part of normal psychological functioning for most people and self-transcendent experiences are common during adulthood. Positive psychology research links intermediate and high levels of self-transcendence with wellbeing. Both selflessness and wellbeing increase with advancing age (Dambrun & Ricard, 2011). People from middle childhood onward can experience selflessness in flow states (see Part 2, Chapter 6, p. 95). During flow states individuals become completely absorbed in an activity; this absorption leads to loss of perception of Self and altered time perception (Csikszentmihalyi et al., 2014). Positive emotions are also part of flow. DBT teaches trying to achieve flow in activities through the mindfulness skill, “Participate.” Flow states increase wellbeing and life satisfaction; the relationship between flow and wellbeing is partially mediated by the level of achieved self-transcendence (Lynch & Troy, 2021). Decentering Another intermediate form of self-transcendence is decentering. Clinical researchers investigating mechanisms of improvement after CBT and meditation discovered several related phenomena now collectively referred to as decentering (Bernstein et al., 2015; Fresco et al., 2007). Decentering is the ability to observe one’s own mental processes, as one would observe other sensory stimuli. “Through this objective observing from a distanced perspective by stepping outside of one’s own mental events, people are enabled to realize that their mental events are no unchangeable truth, but only a constructed reality of the self” (Kessel et al., 2016, pp. 1, emphasis added). Look again at Table 0-5. (How the experienced- and known-self interact to produce self- continuity and the Self). Decentering involves a person practicing awareness of the present moment without paying attention to autobiographical knowledge and memories. Awareness resides in Box 1, and the content referred to in Boxes 2-4 is regarded as is any other sensory input. Three abilities contribute to decentering, 1) awareness of thoughts and emotions; 2) capacity to detach from thoughts and emotions and 3) capacity to tolerate negative emotion (Bernstein et al., 2015; Oliveira et al., 2024). Of these three abilities, only the ability to detach from self directly correlates with self- transcendence (Oliveira et al., 2024). Many people decenter at times over the course of the day (Kessel et al., 2016) but maintaining this frame of mind takes practice. Decentering can be practiced through reflection on thoughts and emotions (as in CBT or reminiscence therapy), through connecting with others (in friendship or therapy), and through mindfulness practices (including meditation). Improvement in wellbeing with each of these practices is directly related to the amount of decentering a person can achieve (Fresco et al., 2007; Hoge et al., 2015; Moore et al., 2022; Safran & Segal, 1996). Mindfulness interventions may be 20 particularly effective for adults over 40 whose personal development enables more self- transcendence (Mahlo & Windsor, 2021). Mood and anxiety disorders are associated with at least three processes that treatments target, 1) increases in negative affect; 2) rumination; 3) reactivity to negative affect and rumination. Antidepressant medications target the first two and psychotherapies target the latter two (at least initially) (Bieling et al., 2012). Decentering can be thought of as a coping skill that assists with relapse prevention through first decreased reactivity then habituation to negative affect (Bieling et al., 2012). As a person “sits with” and tolerates negative affect, these emotions decrease in intensity with time. Over a one-year period the treatment effect size for decentering is medium. To put that into perspective, the effect size for cardiovascular exercise in treating depression is large (Schuch et al., 2016). Exercise and medication directly decrease negative affect whereas the effect of decentering is indirect through detachment and tolerance. Ideally adults should be advised to both exercise and practice mindfulness. If they must choose between the two, exercise has the highest benefit as a function of time spent. Self-Transcendent Emotions Trait and state self-transcendence predict three positive emotions―compassion, gratitude, and awe (Stellar et al., 2017). Causality is bidirectional such that these emotions also predict trait self-transcendence and self-transcendent experiences (Stellar et al., 2017). Emotions reflect activity in brain behavioral systems as has been emphasized throughout this book. It follows that individuals’ experiences of compassion, gratitude and awe in the context of self-transcendence can tell us about which behavioral systems participate in self-transcendence. All three self-transcendent emotions increase altruism and so signify activation of the caregiving system (Piff et al., 2015; Preston, 2013; Stellar et al., 2017). Compassion, gratitude and awe are positive emotions and so are part of the behavioral approach system (Stellar et al., 2017). When people experience these emotions, their attention is focused on others and not on the Self. “Compassion arises out of appraisals of others’ undeserved suffering; gratitude out of others’ generosity;” and awe out of others’ esteemed qualities or accomplishments (Stellar et al., 2017, p. 201). Compassion motivates caregiving behavior and is part of the caregiving system (Breines & Chen, 2013; Preston, 2013). The attachment system enables people to get their needs met through others. Gratitude is a response to care received from others and activation of the attachment system. Expressions of gratitude increase the likelihood the person will receive care again, and reciprocate care (Stellar et al., 2017). Insecure attachment styles predict difficulty getting needs met through others as well as lower gratitude (Zhang et al., 2017). Secure attachment predicts the ability to give and receive care and so is positively associated with both compassion and gratitude (Mikulincer & Shaver, 2005, 2010). 21 Awe “Standing on the bare ground, my head bathed by the blithe air and uplifted into infinite space, all mean egotism vanishes. I become a transparent eyeball; I am nothing; I see all; the currents of the Universal Being circulate through me; I am part or parcel of God.”―Ralph Waldo Emerson 1836 Awe is the emotion that most correlates with self-transcendence and awe is a marker for self-transcendent experiences (Yaden et al., 2017). Lifespan studies of awe have not been done, however children experience awe (O’bi & Yang, 2024). Awe increases prosocial behavior in children as it does in adults (Stamkou et al., 2023). The experience of awe increases from middle to older adulthood (Yaden et al., 2019). Psychedelic drugs induce awe and this emotion makes episodes of intoxication more impactful as self-transcendent experiences (St. Arnaud & Sharpe, 2023). “Awe has several qualities that place it on the border between an emotional state and altered state of consciousness due to its capacity to alter the senses of time, space, and self” (Chirico & Yaden, 2018, p. 222). Facet Name Example Items Time I noticed time slowing. Self-Loss I felt that my sense of self was diminished. Connection I had the sense of being connected to everything. Vastness I felt that I was in the presence of something grand. Physical I felt my jaw drop. Accommodation I felt challenged to mentally process what I was experiencing. Table 0-9. Facets and representative items of the Awe Experience Scale (AWE-S) (Yaden et al., 2019) Inspection of the aspects of Awe (Table 9) shows that self-transcendence is part of the emotion. Feelings of self-loss and connection are common as are other features of self- transcendent experiences such as altered time perception and physical sensations. Physical sensations can include chills, goose flesh, warmth in the chest, tingling and teary eyes (Maruskin et al., 2012). Awe is elicited by natural wonders, scientific and mathematical theories, beauty (found in ideas, architecture, music and art), perception of others’ ability or virtue, and the supernatural. Awe research is now being conducted with virtual reality that simulates some of the aforementioned stimuli (Chirico & Yaden, 2018). Early research uncovered two aspects to awe triggering situations― the experience of vastness and the need to accommodate (Keltner & Haidt, 2003). The experience of vastness can be related to the size of the stimulus or to its beauty or complexity (Ihm et al., 2019; Weger & Wagemann, 2021). As Piaget first described (Part 1 of this text) when individuals encounter new situations, the mind first tries to make meaning by tying the new situation to existing knowledge. Then if the new situation does not fit with existing knowledge, the mind accommodates by creating new meaning. The need to accommodate shows that the person’s existing schemas are not sufficient to make meaning of the awe-inspiring stimulus. When a person experiences awe, that experience indicates the meaning making systems of the brain are active and open to change (Ihm, 2021). 22 Out of all the stimuli that elicit awe, most are related to nature and exploration. Awe researchers hypothesize that awe functions to support exploration and learning about the environment (Ihm et al., 2019). Though some awe researchers tie the emotion to low social dominance rank and reaction to dominant group members (Stellar et al., 2017). The self-transcendence that accompanies awe includes the perception of the Self as small compared to the other (Nelson-Coffey et al., 2019). In addition, awe evokes humility. Awe prone individuals also have higher dispositional humility (Stellar et al., 2018). Awe increases prosocial behavior when a person feels humble and small relative to the stimulus (Chirico & Yaden, 2018; Piff et al., 2015). Self-Transcendent Experiences As Maslow discovered, self-transcendence can occur gradually and it can also happen in sudden episodes that range in emotional intensity. Self-Transcendent Experiences (STEs) that involve Awakening are peak experiences in which individuals report a shift in the way they view the Self. They may suddenly realize that the Self is a constructed perception or fabrication. Let’s return to Eckhart Tolle and his story (watch on YouTube). He had a tough night due to depression and “great fear.” This is what he Figure 0-5. Link to Eckhart Tolle’s story, YouTube says occupied his thoughts the next day, “I can’t live with myself. And that thought repeated itself in my mind… and then suddenly I looked at the thought. I kind of stood back from that thought and looked at it and said that's a strange thought. Am I one or am I two? This thought seems to show there are two people here. I and the self I cannot live with.” With Tolle’s story we have a first-person account of what it feels like to discover the the I-self and the me-self. With that discovery, he experienced decentering and the profound impact this stepping back can have on a person. He says this STE helped him recover from the episode of depression. Tolle’s experience occurred around 1977, years before the construct of decentering was introduced into psychology. His story is similar to STEs reported by practitioners of Eastern religions (Kapleau, 1989) and participants of research studies (Taylor & Egeto- Szabo, 2017). Popular psychology books about Awakening abound. As of this writing, according to Goodreads there are 936 books about Awakening. One YouTube Channel hosts a well-made documentary, AWAKE: It's YOUR Turn (A Documentary About Ordinary People and Extraordinary Transformation). Awakening is being discussed online as a way to overcome mental health challenges (as Tolle’s story illustrates). Psychologists, doctors and neuroscientists are among the authors of popular Awakening books. Many of these authors earn money by coaching 23 people through the process of Awakening. We would like students to consider the difference between Buddhist monks and clergy from other faiths teaching Awakening through religious practices and healthcare professionals proclaiming Awakening treats psychological distress. When healthcare professionals and scientists make claims about Awakening, people believe these claims are “scientific” and factual. Data from clinical trials and experiments should guide clinical recommendations whereas faith and religious tradition can guide recommendations made by clergy. Meditation and STEs promoted by secular professionals can have adverse effects that clinicians and the public should be aware of (Stephens & Friedman, 2022). People report STEs during turmoil and trauma, and the aftereffects can be distressing and/or lead to post traumatic growth. People may also need help making sense of the STE and integrating it into their lives (Taylor & Egeto-Szabo, 2017). Mental health clinicians should therefore be familiar with what studies reveal about these common yet extraordinary experiences. STEs have been studied using qualitative and quantitative methods (Searfoss, 2023; Taylor & Egeto-Szabo, 2017) and these studies agree as to their characteristics. Only 7% of STEs have no identifiable trigger and most (65-78%) are not related to spiritual or religious participation. In one study triggers included: psychological turmoil (41%); nature 26%, spiritual practice (e.g., meditation, prayer, yoga, 23%), spiritual literature (17%), love (6%), watching or listening to arts performance (3%) (Taylor & Egeto-Szabo, 2017). Other triggers can be sex (Wade, 2001), athletic activity, fasting, singing in choir, and witnessing altruism. Most STEs last a week or less, with a minority lasting months or years. For some individuals falling in love can be an STE that lasts months (Aron et al., 1995; Sundberg, 2015). STEs that last over a year are labeled persistent (J. Martin, 2020). People have a difficult time describing STEs with words and the experiences do not feel voluntary or self-generated (Garcia-Romeu, 2010). “Symptoms” of STEs include, positive emotion (peace, joy), intensified perception (e.g., aliveness, brightness, energy, light), perceptions of connection or oneness, love/compassion, altered time perception, being in the present, belief in ‘knowing’, heightened awareness, lack of mental thought chatter, and unusual and unexplained bodily sensations (Garcia-Romeu, 2010; Taylor & Egeto-Szabo, 2017). Individuals may or may not experience all of these symptoms. When the STE wanes people often try to recapture it or make sense of it. Many report lasting changes in their attitudes, personality and beliefs (J. Martin, 2020; Searfoss, 2023; Waldron, 1998). In summary STEs are a “temporary expansion and intensification of awareness, in which our state of being, our vision of the world and our relationship to it are transformed, bringing a sense of clarity, revelation and wellbeing. We perceive a sense of harmony and meaning, and transcend our normal sense of separateness from the world, experiencing a sense of connection and even unity” (Taylor & Egeto-Szabo, 2017, p. 45). STEs can have lasting effects on people such that they enter advanced stages of adult development and become more generative (see the next chapter). 24 Sometimes the positive effect of an STE is temporary (Searfoss, 2023; Taylor & Egeto- Szabo, 2017). STEs can also cause people to feel groundless and lost because their usual sense of self has changed or disappeared (Argyri et al., 2024; Kornfield, 2000; Searfoss, 2023; Stephens & Friedman, 2022). The information in this chapter shows that the Self enables adult functioning. It follows that living without this constructed perception is an adjustment. Buddhist writings acknowledge the importance of the Self as well as transcending the Self and label the two relative and absolute truth (bodhicitta) respectively (Gyatso & Chodron, 2014). Religions that encourage self-transcendence contain meaning systems that make the process safer. These meanings may not be present in secular practices. People practicing meditation alone may not have the support they need. The Continuum of Self-Transcendence: A Biopsychological Perspective Developmental and trait self-transcendence predict peak experiences but the reason for that has not been explained. Scientific study of peoples’ peak and Awakening experiences is a delicate matter because these experiences are sacred to the people who have had them, and so Awakening experiences have validity for that reason alone. Awakening is the ultimate goal of all Figure 0-6. Graph of contemplative neuroscience forms of Buddhism (Gyatso & Chodron, article frequency each year according to PubMed. 2014). Contemplative neuroscience then seeks scientific validation of peoples’ sacred religious experiences and beliefs. The objective scientific process is difficult when those seeking to validate the benefits of mindfulness, and the experience of Awakening are themselves practitioners. The field is only 20 years old, and the database is small for contemplative neuroscience (160 articles) (Figure 6); there are 10385 articles about mindfulness, 84% are from the last 25 years. Biopsychological understanding has two levels to it (Part 1, Chapter 1), at the first level we understand the proximate causes of a behavioral phenomenon. That includes mechanisms of the behavior and how it develops. The second level is ultimate causation including the function and phylogeny of the behavior. A complete understanding of self-transcendence includes answers to all four of Tinbergen’s questions. 1. What Causes Self-Transcendence? Trait self-transcendence as well as STEs are often caused by adversity or even trauma. Furthermore, it appears that people who make meaning of aging and adversity and exhibit flexibility with self-concepts have higher wellbeing. When STEs happen, people are often in states of stress or psychological turmoil. The STE promotes meaning making and recovery. Sometimes that effect is lasting and sometimes it is not. The best available explanation for STEs is that they occur in the context of meaning making. 25 Furthermore, this meaning making causes the Self to be less salient and connection to others (including nature and God) to be more salient. Loss of self-salience leads to the experience of compassion and gratitude. These in turn increase prosocial behavior (Stellar et al., 2017). Psychoactive drugs work because they mimic physiologic substances and highjack natural processes. For example, pain relieving drugs mimic endogenous opiates and highjack the pain system. Qualitative and quantitative research reveals that psychedelic drug intoxication can induce STEs and highjack mechanisms of meaning making (Aday et al., 2020; Argyri et al., 2024; St. Arnaud & Sharpe, 2023). Self-transcendence is an important component to therapeutic change resulting from psychedelic drugs (Aday et al., 2020; Kähönen, 2023; St. Arnaud & Sharpe, 2023). Can psychedelics improve mental health? (Podcast). Psychedelic drugs are a collection of psychoactive compounds that act as agonists or partial agonists at the serotonin 2A receptor (5-HT2AR) and that have been used for centuries to induce self-transcendent experiences (Strickland & Johnson, 2022). Lasting change following psychedelic drug use is predicted by self-transcendence induced by awe, also called “unselfing” (Table 7) (Kähönen, 2023). Psychedelic drugs also have indirect and direct effects on social reward system dopamine transmission (D. A. Martin et al., 2024; Nardou et al., 2023). Together these findings suggest that self- transcendence and STEs are inborn psychobiological processes in humans. Before going further to consider what causes self-transcendence it is important to clarify exactly what is being transcended during STEs and adult development. Self-awareness begins with sensations from the body― we call that interoceptive awareness. Sensations are then interpreted and converted to perceptions. Perceptions give meaning to experience and perceptions of emotions and body sensations can contribute to meanings involving separateness from others. Identification with the body and emotions (as in this is me, this is mine, this is myself) especially leads to perceptions of separateness. Qualitative studies that include participant quotes demonstrate that “sense of separateness and identification with body and narrative self are reported as lost in (STEs). However, bodily awareness, spatial self-location, sense of agency, perspectival ownership of experience, thoughts, emotions, sensory impressions, metacognition, and personal identity (are) variously reported as lost or retained” (Lindström et al., 2022, p. 75). Self-transcendence is about meaning attributed to experience and transcendence of the conceptual and narrative self. Stipulating that is important to the interpretation of fMRI and neurologic studies. Neuroscientists discovered the “Default Mode Network” (DMN) of the brain that is active when individuals are thinking about themselves and their lives (Raichle, 2015). This discovery shed light on mechanisms and benefits of mindfulness. As the ancients also discovered during meditation, it is difficult or impossible to divide attention. If a person is looking at, listening to, touching, smelling or tasting a stimulus they cannot be absorbed in thoughts about themselves. The opposite is also true, when a person is absorbed in thoughts about Self, they cannot fully attend to their sensory perceptions. The DMN got 26 its name because cognitive researchers realized that when people are not focusing on outside stimuli, a certain brain network (the DMN) is often active and participants report thinking about themselves. The anatomy of the DMN has been described and its activity investigated in relation to short and long-term effects of meditation (Kitson et al., 2020). The DMN should be inactive during mindfulness and episodes of self-transcendence. Meditation practice should be associated with voluntary control over DMN activation. These predictions are the subject of ongoing research in contemplative neuroscience. The insula and the parietal lobe are the parts of the brain that link to the sense of self and the conceptual self respectively. As discussed in Part 1 of this book, the insula is responsible for interoceptive awareness. Consistent with the observation that self- transcendence does not usually entail loss of interoceptive awareness (Lindström et al., 2022), the insula is more active during self-transcendent states (Haidt & Morris, 2009). In contrast, a well-established finding in neurology is that damage to the parietal lobe (which forms perceptions (Coslett & Schwartz, 2018)) leads to increased self- transcendence (Johnstone et al., 2012; Urgesi et al., 2010). 2. How Does Self-Transcendence Develop? de Castro (2017) gives a developmental account of STEs, pointing out that infants are born with only sensations and no perceptions. In the first two years of life infants acquire sensory perceptions and self-perceptions and then learn to use these to navigate the world. During childhood and adolescence, individuals develop more sophisticated self- concepts and in adolescence and early adulthood individuals develop narrative identity and autobiographical reasoning. According to de Castro, during STEs the mind focuses on sensations (like a baby) and shuts out learned perceptions and self-concepts. The tension between Love and Power or connection and Self(ishness) is a central theme in the human lifespan. In every section of this book, we detail the development of the attachment and caregiving systems that enable love and the dominance system that motivates agency and power. These systems are in a delicate balance and are mutually inhibitory. The emotion awe and the phenomenon of self-transcendence occur with activation of meaning systems related to connectedness as opposed to separateness. Often self-transcendence leads to letting go of greed and the need for power and expression of caring toward others and nature (Gyatso & Chodron, 2014; Stellar et al., 2017). Self-concepts are important to agency because people function best when they feel confident. Positive self-concepts also contribute to social dominance (Johnson et al., 2012). Individuals find their place in the social group during the first half of the lifespan. This is the time of life when acquiring status/power is most important to people. Most individuals naturally become more caring after early adulthood (as discussed in the next chapter). Across the lifespan individuals who are more loving have less desire for power. Due to aging older people may be less able to compete for status. The loving connections they maintain therefore increase in importance. Shifting from status 27 concerns to caring concerns can be a catalyst for self-transcendence. This shift happens for most people (Tornstam, 2011). 3. What is the Function of Self-Transcendence (for the Species)? According to many religious traditions the function of self-transcendence is salvation or freedom from suffering. Humanistic psychologists of Maslo’s era were perhaps ahead of their time, writing that self-transcendence of individuals would allow the human species to survive and not destroy the planet (Fromm, 2013). The perspectives of Maslow, Frankel and Fromm were shaped by living through WWII. (Listen to this interview of Fromm discussing his book, To Have or To Be.) That said, we will consider the adaptive function of trait self-transcendence, capacity for awe, and STEs. Discussions of the adaptive function of trait self-transcendence, relate this cognitive process to awe and secondarily to gratitude and compassion. One opinion is that awe evolved as a response to exploring the environment and that it reinforces exploratory behavior. The stimuli that trigger awe might bring safety. For example, being high up on a cliff overlooking a valley is a position of relative safety that could trigger awe (Ihm et al., 2019). Another opinion is that awe, gratitude and compassion foster social cohesion (Stellar et al., 2017). That could be understood as a shift away from power-oriented behavior to more caring behavior as discussed above. Ihm (2019) argues that self- transcendence is triggered by meaning making and that meaning making is especially important to humans. 4. Do other Species Experience Self-Transcendence? The great apes have many emotional and cognitive capacities in common with humans. Chimpanzees are territorial and explore their environment, walking miles as they forage for food. They have been observed to show signs of awe in response to waterfalls and other natural wonders. Harrod (2014, p. 9) quotes primatologist Jane Goodall, “Often I am asked if the chimpanzees show any signs of religious behavior. I think perhaps their ‘elemental’ displays are precursors of religious ritual. [She then describes waterfall displays, water watching, and rain dance behaviors she has witnessed.]… Is it not possible that these performances are stimulated by feelings akin to wonder and awe?” Chimpanzee society is shaped by dominance and affiliation whereas human society is shaped by affiliation, caring and dominance (Van Schaik & Burkart, 2010). Chimpanzees show gratitude and remember others’ generosity (de Waal, 1990, 1998). These emotions point to the self-transcendent aspects of social affiliation. Selflessness is sometimes adaptive for group living, especially when there is competition between groups (Duda & Zrzavý, 2013). Studies in mice support the hypothesis that self-transcendence is related to shifts in meaning making. Young male mice value social contact more than adults, such that there is a critical period for social reward. Treatment of adult male mice with psychedelic drugs reopens the critical period and restores the physiology and behavior of social reward (Nardou et al., 2023). 28 Epilogue This chapter was written for advanced undergraduates and graduate students training for clinical careers. Clinicians in nursing, counseling, social work, psychology and medicine can help people (particularly seniors) by listening to their stories. The people you work with will tell you their stories as they try to heal, and the validation they receive from you will help them. We explained how narrative therapies make use of people’s natural desire to tell stories and make meaning of their experiences. We related self- transcendence to meaning making and the shift from power concerns to connecting with others that occurs in midlife. In the next chapter we describe this shift in more detail. We made every effort to explain how secular mindfulness-based therapies arose from contact with practitioners of Eastern religions. We also noted that meditation has potential risks as well as benefits. It may not be advisable for people to practice meditation alone outside of a faith community or therapy with a well-trained therapist. Mindfulness-Based Cognitive Therapy and more so DBT teach many skills other than meditation. These other skills extend the benefits of mindfulness. Decentering is one mechanism by which all therapies reduce psychological suffering. Although the Self is a difficult construct to describe and explain, clinicians cannot appreciate the benefits of decentering without understanding the Self. We recommend that students read Building a Life Worth Living, A Memoir by Marsha Linehan creator of DBT. In her memoir Linehan describes her own suffering, spiritual life, and self-transcendent experiences. She also relates her personal narrative to the skills she made part of DBT. Linehan’s life narrative stands as an example of how a clinician can integrate their own past, their spiritual beliefs, their professional role, and their desire to help others. Our guess is that many who read this book are seeking to do the same. References Aday, J. S., Mitzkovitz, C. M., Bloesch, E. K., Davoli, C. C., & Davis, A. K. (2020). Long- term effects of psychedelic drugs: A systematic review. Neuroscience & Biobehavioral Reviews, 113, 179–189. https://doi.org/10.1016/j.neubiorev.2020.03.017 Adler, J. M., Lodi-Smith, J., Philippe, F. L., & Houle, I. (2016). The incremental validity of narrative identity in predicting well-being: A review of the field and recommendations for the future. Personality and Social Psychology Review, 20(2), 142–175. Anderson, H., Stocker, R., Russell, S., Robinson, L., Hanratty, B., Robinson, L., & Adamson, J. (2022). Identity construction in the very old: A qualitative narrative study. PLOS ONE, 17(12), e0279098. https://doi.org/10.1371/journal.pone.0279098 29 Argyri, E. K., Evans, J., Luke, D., Michael, P., Michelle, K., Rohani-Shukla, C., Suseelan, S., Prideaux, E., McAlpine, R., & Murphy-Beiner, A. (2024). Navigating Groundlessness: An interview study on dealing with ontological shock and existential distress following psychedelic experiences. Available at SSRN 4817368. Aron, A., Paris, M., & Aron, E. N. (1995). Falling in love: Prospective studies of self- concept change. Journal of Personality and Social Psychology, 69(6), 1102. Beck, J. S. (2005). Cognitive Therapy For Challenging Problems: What To Do When The Basics Don’t Work. Guilford Press. Bernstein, A., Hadash, Y., Lichtash, Y., Tanay, G., Shepherd, K., & Fresco, D. M. (2015). Decentering and Related Constructs: A Critical Review and Metacognitive Processes Model. 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Self-concept clarity: Measurement, personality correlates, and cultural boundaries. Journal of Personality and Social Psychology, 70(1), 141. 30 Chirico, A., & Yaden, D. B. (2018). Awe: A self-transcendent and sometimes transformative emotion. The Function of Emotions: When and Why Emotions Help Us, 221–233. Cloninger, C. R., & Cloninger, K. M. (2022). Self-transcendence. The Virtues in Psychiatric Practice, 205–230. Connelly, B. (2016). Inside Vasubandhu’s Yogacara: A practitioner’s guide. Simon and Schuster. Coslett, H. B., & Schwartz, M. F. (2018). Chapter 18—The parietal lobe and language. In G. Vallar & H. B. Coslett (Eds.), Handbook of Clinical Neurology (Vol. 151, pp. 365– 375). Elsevier. https://doi.org/10.1016/B978-0-444-63622-5.00018-8 Cramer, P. (2003). Personality change in later adulthood is predicted by defense mechanism use in early adulthood. Journal of Research in Personality, 37(1), 76–104. https://do

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