13 Things Mentally Strong People Don't Do

I have to admit, lists rankle me, especially when they are lists of shoulds.*

But Amy Morin wrote a list of should nots. The book, 13 Things Mentally Strong People Don't Do, pulled me in, just like Where Have I Been All My Life, life coach Cheryl Rice's biography, last week. Love those book tours.**

The good news is that the list of don't isn't as focused on avoidance as it  leads on. That's good, because avoidance isn't generally therapeutic. In fact, it can be anti-therapeutic. Just don't  ___ (fill in the blank), never works, not for very long. Humans are far too willful, prone to habit and addiction. Therapy is a process, an examination of the whys and the wherefores of pain--the opposite of avoiding problems.

We even suggest that patients lean into problems. Don't avoid. "Bring it up in a safe place" (before leaning in in vivo). Enough focus and we get sick of feeling sick, leave it for awhile.

Remember what the late Morrie Schwartz suggested to his biographer in a different kind of book, Tuesdays With Morrie?  Morrie's path: embrace the pain, feel it, pass through it. This is mindfulness and it works for some, but it isn't a be all, end all. Yet I find myself referring patients to that book lately, especially when therapy is about a materialistic obsession with success.

So you see why  just don't is too simple. In therapy, we do. Or we intentionally postpone tackling a problem, give it a time and date for re-examination. Timing is everything.

This book, these 13 Things, does manage to focus on doing, thankfully. The "tips"embedded in each chapter are rational-cognitive-behavioral strategies, in list form.*** Alternative behaviors (huge on her suggestion list) add to self. Morin's formula: monitor behavior, regulate emotion, and think about thoughts are basic CBT steps, a steal (totally kosher) from the well-known Beck A-B-C's, affect, behavior, and cognition.

A glimpse inside the mentally strong, the first chapter:

They Don't Waste Time Feeling Sorry for Themselves.

If anyone has the right to feel sorry for herself, our author qualifies, having lost her mom, her husband, and her beloved father-in-law in a few short years. Any loss can throw us into another universe, center us on ourselves. And self-pity, if you're a 12-step aficionado, is stinking thinking. Amy uses herself, just once, as proof that we can rise above it, our pain, use our strengths to take the negative and make something good out of it. In her case, a book, and a good one.


We could and maybe should stop here, but the idea for this particular book tour is that the reviewer choose one of the 13 and personalize it. The chapters apply to most of us, so this isn't all that hard. Look at the first eight.

Mentally strong people . . .

Don't Give Away Their Power
Don't Shy Away From Change
Don't Focus on Things They Can't Control
Don't Worry About Pleasing Everyone.
Don't Fear Taking Calculated Risks
Don't Dwell on the Past
Don't Make The Same Mistakes Over and Over
Don't Resent Other People's Successes

I stopped at the last, because I remember telling friends that I never envied what others have, wasn't quite sure of the meaning of the word jealousy, not until my daughter and son-in-law moved to California. He would attend graduate school, ostensibly, but had family, close family, in L.A. The likelihood of their return to the cold Midwest seemed dismal at the time.

The negative feeling, however, whatever one calls it, jealousy or envy, set in after the grandchildren started coming along. His parents had them. FD and I did not.

Me, to the fellow on the left at the zoo: We have to stop meeting like this.

Then in February, when the temps are below zero in Chicago and I'm visiting a little guy at his other grandmother's pool: We have snow in Chicago. Isn't that better?

And to those children scampering ahead on a hike in the mountains: Wait up!

I tried to keep it in, and truly, my son-in-law's parents are wonderful, and if anyone is going to be good for those kids, they are. To manage my negative feelings, all a person like me has to do is share with others (long dinners with friends, my preference), remember that things do change (there are universities in Chicago), find conferences in Los Angeles (and stay a few weeks, why not), and stay creative, be a grandparent that grandchildren want to talk to, want to visit. Be your best possible self.

It isn't easy, as we say, to rise above it.

therapydoc



*I tried to like BuzzFeed, ended up writing that list, Ten Things to Do Other Than Text While Driving. Went nowhere.

** Next post, seriously, we won't review anything and it won't be about me.

***For those who like to write up reminders and tuck them into their wallets, just a mantra is a good idea, something like, Do I really want to stop at the bar on my way home? (Watch another show on Netflix?) Maybe it is time I worked on myself, or helped somebody, somehow.

Summertime Snapshots

1.  CAD, better known as Cub Affective Disorder

Anthony Rizzo

It has never been easy, being a Cub fan.

If you don't follow baseball, then you might not know that the Chicago Cubs always lose.  They always finish either last of second to last.  It is their legacy, with few exceptions.

Lucky for those of us who live in Chicago, there is another major league team, the White Sox, and they generally win.  So nobody really has to be a Cubs fan if they don't want to be. They can don black and white, as opposed to blue and red, and call themselves Sox fans.

But if you live on the north side of the city then you are supposed to be a Cubs fan because the Cubs play on the north side at Wrigley Field, whereas the Sox play on the south side, now US Cellular, formerly, Comiskey Field.

Comiskey Field before it became US Cellular

 Indeed, some people don't know this, that when you move to the city, depending upon your address, you sign up to support either the Cubs or the Sox.  Some spend the rest of their lives regretting their error.

Every year, we Cub fans are offered hope, either in the form of a new owner, or a new manager, perhaps a trade.  This year's tease is Anthony Rizzo, the new first baseman who hit a home run on Saturday to win the game for the Cubs.  He won another one for us today.

And here we are, suddenly yanked around like yoyos, and all it takes is a homer, albeit the first, off the bat of an Anthony Rizzo.  All of sudden, out of nowhere. . .hope.

The joke is that some of us were just about about to coin a new disorder, CAD, thanks to a patient who made it quite clear that it made sense.

CAD, Cub Affective Disorder would be like SAD, Seasonal Affective Disorder, that winter blues diagnosis of choice for those who live in colder climes.  Except that those likely to suffer from CAD would be Cub fans in the summer.  Sadly, because Chicago is a city of the north, Chicagoans are vulnerable to both.  We can be a sorry lot.

Whether or not we'll suffer from CAD is yet to be determined, of course.  Things do change for the better.  There is certainly room, and we still have time.

One thing for sure.  Cub Affective Disorder is a seasonal thing; it has a beginning and an end.  We'll get over it, although some of us recommend acceptance, and low expectations, to soften the blow.

2.  Termination Issues

It is so easy to make jokes at the expense of clown fish.  Kids in therapy laugh as soon as they see them.  They ask, What are their names,  Nemo 1 and Nemo 2?

Uh, duh.

No, not terribly funny, you're right.

Another joke:  What's up with the fish?  How are they doing today? 

Oh, they're just clowning around.  You know.

The fact is, that being an aquarist in a small office means that your fish get a lot of attention.  And when you suddenly remove them, leave an empty tank, patients get really upset.

Where are the clowns?
Send in the clowns!

You tell them that you found them a better home.  Your son has a reef tank with an anemone, the clown's natural lover, and his reef looked lonely with no fish.  His own jumped ship while he was at work toiling away until late into the night; his feelings, loss, guilt, sadness, sheer horror, something he can't even talk about.

So this solution worked for everyone.

Everyone, that is, except for people who had no idea this was in the works, who never had a chance to say goodbye to the clowns.  Termination, you know, is huge in therapy.  We take it very seriously.  When we go on vacation, everyone knows months ahead of time.  If we're leaving town, six months, minimum, notice.  Nobody, no patient, nor fish, nor therapist, simply doesn't show up in therapy one day.

I'm sorry.

3. CBT and the Pool

I have a swimming pool in my building.  An outdoor, heated swimming pool.  Not that I love to swim.  At my age, swimming means something has to hurt, in my case, the elbow, a tennis injury almost ten years old, one that hadn't hurt for about a year, until now.  But I'm not complaining.  Getting out to do laps with FD early in the morning has proven to very beneficial, a high you could say.

But here's the thing.  Every morning I go through the same routine.  Do I want to do this?  Do I have to do this?  Maybe I shouldn't do this!  Why do this?  The water might be cold, and as a cold averse individual, why would I volunteer to dive into cold water?

On the other hand, it might be cold.  But it might be warm.  Peggy, my new best friend who swims every day, probably more than once a day, tells me that it only feels cold because the air is warm.  When the air is cold, the water feels warm.   When the air is warm, the water feels cold.  Makes sense.  So swimming when it's cooler feels sublime.

No matter, not the point.  The point is that I have to consider this, that it will feel cold sometimes.

The trade-off is that even if it does feel cold, it won't for very long, as the warm-up is only a minute, and the benefits, the physical and psychological benefits of the swim are worth it.

Thus the rational answer to the dilemma is, Swim, you bum.  Just swim.

So I approach the elevator early in the morning wearing a sweatshirt and carrying a terry-cloth cover-up and towel, a change of clothes, resigned to whatever will be.  In my head there is no feeling of depression at this moment, no matter what might have bothered me the day before.  Resigned to swimming, it is as if I can predict that the day will go well, start well, at any rate, a certain sense of accomplishment, confidence, the Neo syndrome, will take over.  The Neo syndrome is something someone keeps trying to explain to me.  Neo is a super person straight out of the movie The Matrix.  I tried to watch this movie but when Neo started to turn into an ugly creature, I had to turn it off.

All this to tell you that there is a book that New Harbinger Publications sent to me that is totally worth buying (and I rarely, if ever say this, worth buying).  For the price of a co-pay, maybe a few pennies more, you not only get a workbook that is well-written, infused with poetry and contemporary thinking (Depression is beatable!  We can do it!), but the author also values metaphor, teaches the reader how to think metaphorically.  And best of all, he's a naturalist.  He's the closest thing we have  in psychiatry to Thoreau.  He'll put you on Walden pond and you will like it, or we'll throw you out of Eden (yes, yes, we're mixing metaphors, sue me).  Get away from the grind, think out of the box, and most of all, get off your ___.

Theoretically all of cognitive behavioral therapy is this way, encourages thinking and behaving in ways that are different, better.  But frankly, it is a much easier thing to talk it, than walk it.  Your therapist can yell at you, Just take a walk every day or don't come back!  And you might never come back.

Bill Knaus (William J. Knaus), however, makes it easy.  He illustrates how to push off, quit procrastinating, take each step, one at a time, just as we do in therapy, week after week, in that fight against a most difficult, but treatable disorder, depression.  Not surprisingly, one of the first directives in the Cognitive Behavioral Workbook for Depression is exactly the one nobody likes hearing, "JUST DO IT."

So yeah, I'll be sad, after Labor Day, when they close the pool.

therapydoc

I'm Not Depressed

A patient tells me that watching the old guy across the street upsets him because the man looks like his father. Before his father passed away, a little over a year ago, his father, too, was old, skinny, and sick. Seeing this man struggle down the front steps triggers the patient's depression.

Go help him, I say.

Contrary to popular belief . . . I'm not depressed.

If you catch that I am, what you're feeling is my V62.82, Bereavement. I don't even have the newly touted grief disorder, which would be cool in a sick kind of way, to have a brand new disorder, fresh off the press, Complicated Grief Disorder, or Prolonged Grief Disorder, so far as I know.

We diagnose a person who has lost a loved one with Major Affective Disorder only if that person is experiencing sadness, insomnia, poor appetite, and depressed mood beyond two months post loss. If major clinical features like these disappear at the two month mark, it's Bereavement.  My friend who lost his father over a year ago, is suffering from bereavement.

We call it depression if a survivor has

1. excessive guilt about things other than actions taken or not taken at the time of death,

2. thoughts of death other than feeling he or she would be better off dead or should have died with the deceased

3. morbid preoccupation with worthlessness,

4 marked psychomotor retardation,

5. prolonged and marked functional impairment,

6. hallucinatory experiences other than thinking that he or she hears the voice of, or transiently sees the image of, the deceased person.

If you have those features (you might add the loss of appetite and problems sleeping) then you're talking Major Depressive Disorder.

So let's talk about me.

Slept great last night, 5.45 solid hours, dreamed of the Black Hawks playing hockey on a black and white TV set over forty years ago.  Had to have been nine or ten, but in the dream, can't tell.  It's cool that when you get older and you talk about things you did as a kid, you might dream about them.

It's Friday and on Fridays I like to have dinner prepared before leaving for work.  The idea is that when I get home I can just do what I want, meaning visit my mom, talk on the phone, clean, maybe even go to the movies with FD. So this morning I wake up and mumble a couple of things under my breath and stumble into the kitchen to see if the coffee's on.

Yes!

I'm only writing the list below because (a) I like lists and (b)  to illustrate the difference between depression and bereavement. A person suffering from depression would be hard-pressed to get all of the following done (not bragging, just saying) in about an hour, between 6-7 a.m.  My wave must have crested yesterday.

(1) small corn salad, generously seasoned
(2) three loaves of bread, punched down for a second rise,
shaped and proofed
(3) nine raisin muffins.  Not sure why my recipe only makes 9, but it's okay.
(4) fish-- fairly tasty, not my best, but not bad
(5) introduction to this post--jotted on napkin--
Contrary to popular belief . .I am not depressed.
(6) grocery list appended--chocolate chips, zip-locks, decaf beans, rice
(7) added to the "to do" -- "Pay Gary" -- auto mechanic

Forgot the last.  The miracle is nothing burned.

Oh, and I changed the format to this blog.

The last, of course, was a tough call, because if you notice, to the right there's no blog roll, no Blogs I Love! It got lost in the shuffle and I'll have to do it by hand, add my resident buddies, many of you.  Time consuming, for sure.  When you grieve a loss you become painfully aware of how little of this you have, time,  and how important it is to use it wisely.  So email me if you're in a hurry to get me moving on it.

therapydoc-at-gmail-dot-com.

The new blog looks better though, doesn't it?  Eventually I tired of admiring my new look and wrote today's post. Here you go.

Some of you may have noticed that for the past four months (!) therapydoc's moods have been a little low, the tone a little lifeless. You can just feel the sadness, I'm sure, the palpable loss.  But that feeling's gone, virtually arrested.

You don't have a father for over fifty years and not lose a piece of yourself when he dies. I keep finding new questions for him that he refuses to answer.  Things like,

Dad, how to I fix this watch? I replaced the battery and it still won't run!

Or Dad, what DO you do with this gadget. It looks like a watch-maker's kit. Is it?

Or Dad, why did you make barrels of wine if you never intended to drink it or even serve it to anyone?  (He had a glass of wine perhaps once every couple of months, maybe.) 

One of my more fond memories is sitting on the couch and watching a ball-game with him, sipping his beer. (He had a beer maybe once a month, too.)

Or Dad, what do you want on your headstone? How about we go with your name and the date of birth, date of death.  Wait.  Nobody even agrees on your birthday! Your parents made it up at Ellis Island.  A little help here?

Or Dad, where did you put the (too many of these to list).

Things like that.

My mother is upset because she can't tell him about her day. Something amazing might have happened, like a visit to an assisted living place; and he's not around to hear about it. Or she gets herself to physical therapy, she's back in the driver's seat, literally (to our dismay). He would love that, knowing she's still driving.

Or she would tell him that now that he's gone, the neighbor who always harassed him about the landscaper is now harassing her.

My brother would ask him why he never got rid of old sets of golf clubs.  And why are there a hundred decks of cards in a file cabinet, each individually gift wrapped.

Enough. You get the idea.  This kind of dialogue, this kind of thinking, this is grieving, not depression. Sure, there are waves of sadness, tears, fewer at the four month mark than at the one. And sure, the thought of entertaining people or being entertained is loathsome.  So you don't. You just don't.

But there's no hopeless-helpless. There's no worthlessness, although apathy, yes, there's some apathy; and stresses add up faster, fencing these is harder.

In general a person's coping skills are less powerful, don't generally work. The things that made you happy, won't make you happy,   You're compelled to feel bad.  But you get your zip back, just when you think you've lost it, then you lose it again, maybe a few days, even weeks later. That's just the way it is.

Under depression, Major Affective, or an Adjustment Disorder,  you walk through fog, you try to force yourself to do things you know you have to do, and the same holds for bereavement.  Sometimes you accept that you can't force yourself, that you'll have to sit out a dance or two. 

Unresolved grieving, what we used to call it before it became Complicated or Prolonged Grief Disorder, when the grief of loss is seemingly interminable-- can kill some people.  When it's that bad it meets the criteria for Major Depressive Disorder and it should be treated medically, meaning medication and talk therapy.  You have to want to talk about it, however. 

I still tell most people, if it's a loss and it doesn't meet the criteria for Major Depressive Disorder, skip the anti-depressants. Just grieve.  Feel bad so it doesn't bite you later.  Resolve it. And keep it rational.

Before you blink, you'll have worked it through.  And you'll feel like dancing.

therapydoc

Angry, did you say?

Like I've said in other posts,

Just about all of my interventions weave in some form of cognitive behavioral therapy somehow.

I like CBT for anger management especially. And I personally use it all of the time to control my emotions. But people who see red can't slow themselves down long enough to work the therapy. And they make friends and family very uncomfortable.

So something has to be done.

The rule is that if it's hard for a person to control an outburst then a med eval (medication evaluation) is a good idea. Once chilled a bit, Cognitive Behavioral Therapy (CBT) is pretty useful. Plus there's no harm in getting a med eval. Nobody can make a person take drugs.

I'm forever telling people, We have better drugs!

We do have some really good ones now, meds that take the edge off, and they're not all addicting, either. But you can develop quite a tolerance to some of them, so if that's a concern, check it out with your doc.

Anger's a totally different animal you know, than anxiety or depression. It's sometimes hard for a person to tell exactly what it is that's causing the bad feelings in anxiety and depression, but we know very well who or what is making us angry.

Like this morning. I had almost finished this post when FD asked me calmly, “Where are the car keys? They're not on the hook.” His stress was palpable.

Little One is home from yeshiva and he had the keys last night. FD was leaving. It was 6:30 a.m. He was late. “I’ll find them,” I said. "I'll wake him up."

The keys were in Little's pocket. I said thanks, never yelled. FD didn’t yell. We remained polite and calm throughout the whole drama. But it was tense.

Me empathizing with FD's frustration motivated me to jump and hurry up, wake up the kid. The kid jumped to find the keys.

Negative emotion motivates people like nothing else, for better of for worse.

But what if we'd lost it? What if FD had had a tantrum, then it could have become ugly! I would have been angry and defensive with FD for his tantrum and somehow my anger and defensiveness would have trickled down to Little and we'd all have had a nasty morning. And it was a beautiful morning.

So to me anger's the symptom that best exemplifies how emotions affect family systems. Anger isn't at all fuzzy. You know why you’re angry, you know who you're angry at. Or do you?

If we hold that irrational core beliefs about ourselves drive our emotions, and we have to rationally counter them to feel better, then we have to figure out the core belief. There has to be a little psychotherapy going on for CBT to work.

The emphasis in CBT is on rationality, which is not nearly as sexy as emotionality, like I've said before, which is why people resist being rational. Depression and anxiety make us look vulnerable. Angry people don't give off vulnerable vibes. So anger is not sexy.

Nobody wants to take an angry person in their arms and say, There, there, it'll all be fine, don't worry (although that's exactly what we need sometimes). Most of us wish that angry people would just go away.

I for one am allergic to them unless they're paying me to help them.

But even though I’ll deal with angry people all day long, if you're in my family you know that I won’t listen to you if you’re screaming and that I need about twenty degrees of separation. I can handle anger better on the telephone than in person, or in writing. Violent books are sometimes okay for me. But violent movies? Never.

Nobody’s perfect.

Now. Most therapy docs will agree that a rational argument, meaning measured verbal expression without drama and screaming, slammed doors, fists and silverware flying is a good thing. The way to solve problems is to discuss, debate, present feelings, thoughts, new solutions—with relative calm.

Notice I didn't say dump your anger all over the house to get it out of your system. You can get it out of your system in some other way. If you were in the army you’d have to do a hundred push-ups. So you can do that rather than rant and rave. Push-ups. Or clean out the basement.

Or rearrange the furniture. Weed. You'll lose your rage.

But let's take a quick peak at the psychological/social system and CBT before the weekend begins and people start drinking and throwing things.

We'll use a new fake, fictional totally imaginary couple, Reg and Ranata (choose different genders if you like, gay or straight makes no difference).

Ranata is the identified patient, the one who chose to come to therapy for her issues. But I brought in Reg to get his point of view, of course, to rat out Ranata. After a couple of months of depression Ranata is just now getting in touch with some flammable anger that she says she’s always had.

"It's never bothered me," she says. "I don't hit anyone, I just . . . go off. It's Reg who's uncomfortable with it." He hates it.

This going off thing tends not to work in most relationships. In some cultures the exaggerated expression of emotion is totally expected and even encouraged. This is why sometimes it's best to date within your own tribe so your behavioral mores don't clash.

But I think that even within a cultural context that values the free expression of emotion, it's dangerous to express anger violently.

Your partner, even if he or she grew up in an emotionally expressive family still might not have developed a "tough skin." Sometimes having grown up in a very emotionally expressive family can make us even more sensitive.

"I have to stop for Reg,” she says. “I need to stop for him."

Actually, not only does Reg find anger a real drag, but he's very embarrassed and turned off when he sees Ranata behave angrily at people. She doesn’t get angry at him. She gets angry at others in front of him.

But she wants to change. This is true love, friends. If it's a problem for your partner, it's a problem for you. If it's a problem for you, it's a problem for your partner.

Quick history: Ranata's father, a very old fashioned, critical man, criticized the way she dressed, the way she put on make-up, her friends. He did not let her date (she had to lie to go out) and her occasional back talk brought out emotional, verbal, even physical abuse.

Despite this she has a survivor in your face personality and very successful in the business world. Aggressive successful.

But her core belief is that she's not good enough and that she’s powerless when it comes to changing people who are important to her, like her father. And she likes letting off steam, displacing her frustration on her office team, sales clerks, telephone solicitors, credit card company reps, etc.

When faced with a problem Ranata starts out rational, even intellectual. But as soon as she gets to the point of frustration she loses all civility, bangs on counters, says mean things. That's when her guy wants out of the relationship.

(It's supposed to be one big table, not three little ones, so use your imagination a little. Thanks)

Let's look at the A-B-C in the table, AFFECT, BEHAVIOR, COGNITION. Remember that you can intervene ANYWHERE. You can change the affect. You can change the behavior. You can change the cognition.

Ranata would say, “If I could change my anger (the affect), I wouldn’t be seeing you.”

So change the behavior or the cognition. Start by identifying the feeling.

Ranata, like most people, can tell when she’s getting angry. Because she went to therapy she knows that she learned to be angry from her father, as opposed to say, being sad. I mean, why do some people (like me) get sad whereas other people get angry?

One reason is that some families prescribe a preferred emotion. They give the kids permission to feel and act in certain ways. Like in my family there was permission to be sad, whereas in a lot of families crying is considered a weakness. But my mom said, Go ahead, cry. It feels really good to get it all out. (thanks Mom!)

So of course, people like me learned that it's okay to cry and that crying will generally evoke sympathetic loving responses in people.

You know about reinforcement from the other behavioral posts, I think.

Long story long in Ranata’s case we know that her anger is really about being frustrated and shut down, powerless with her father who gave permission to be angry. She’s aware that being frustrated in her relationships is dangerous and tends to culminate in verbal violence.

Since anger's an aversive stimulus, she loses friends. Her anger spells doom. It's like Voldemorth’s strength in the Harry Potter books, gains power with the host, the object.

So her job is to catch it when it's on the rise. The cognitive piece is recognizing the anger rising, sensing it, noticing the feeling as it becomes more and more uncomfortable. Then she has to ask herself:

What is this horrible feeling? Oh, it's anger. I know it well. Anger puts the "A" in AFFECT.

She recognizes the feeling, then THINKS. Thinking is the next step (COGNITION). She has to slow down the action to mentally evaluate what's going on, what is happening.

Then she has to challenge her knee jerk thinking on the subject and her automatic behavior (exploding) and think of an alternative response, a new BEHAVIOR.

Wow. All of this is so much work. So much easier to throw the dishes, no?

Have a nice weekend.

Copyright 2007, therapydoc

Therapy = Cognitive Behavioral Therapy

First there was B.F. Skinner, the behavioral conditioning guru. A few years later, the rat in the maze concept didn't sit so well with the intelligentsia and Albert Ellis's rational emotive therapy got the nod.

On Ellis' heels, Aaron T. Beck engineered a fusion of the two that he called cognitive behavioral therapy or CBT, the Lexus of all individual therapies. We now feel that ALL talk therapies are really forms of CBT because talking is a behavior and listening is cognition.

But there are forms and there are forms. Is a dodo bird a dodo bird a dodo bird?

The relationship therapy I push here on the blog is heavily laced with old fashioned CBT. Using a relationship therapy to reinforce cognitive behavioral therapy is like having a freaking Rolls Royce.

I like driving the Rolls, but totally will accept CBT, the Lexus, if that's all they've got at Avis Rent-A-Car.

The National Institute of Mental Health knocked off the big study on affective disorders and determined that the best way to treat depression is to use a combination of psychotropic medication and cognitive-behavioral therapy (CBT).

Of course.

So you should learn it. You'll get better. You'll stop spleening me, Why aren't I better?

It's an interactive therapy that requires the patient to think and behave differently. One would think they're all like that, all therapies require you to think and behave differently, but this one has a nice structure to it, so anyone can learn it. No huge amount of psychobabble, no tricks. I use it to manage emotions. Yeah, mine, too.

So it can't hurt you to know the basics of CBT to help control your anxiety, anger or depression.
Everyone needs help with at least one of those. Tell me you don't.

The emphasis in CBT is on rationality.

Rationality is not nearly as sexy as emotionality so people resist it like crazy. But at some point you have to grow up.

The path to staying rational is countering irrational beliefs that make us emotional, especially those nasty core beliefs. Irrational core beliefs are deep. They're what makes us deep, all of us. People discover them in therapy, or if they're lucky, when their significant others and friends wriggles them out in intimate conversation.

Sometimes it's perfectly obvious to us, that a negative core belief is disabling, dis-empowering us. They're the windows that slow down our computers, the ones we forgot to close years ago. There may be only one or two programs running back there, using the ram we need for other things, but they're a real pain to shut down. They slow up the whole works.

Sample core beliefs: I'm a loser, I'll never amount to anything, I'm a charlatan, a fake, I'm not a good person.

Such beliefs (thinking) trigger automatic negative feelings. The feelings (always bad) don't let up. They feel unmanageable.

So there you are, feeling down and looking for something to do to feel better, searching for some coping strategy, some behavior to make you feel better. The chosen behavior, unfortunately, driven by uncomfortable arousal (anger or anxiety) or grinding depression, and negative thoughts, tends to be dysfunctional.

Sample dysfunctional behaviors: drinking, over-eating, sending a letter that shouldn't have been sent, having a tantrum, missing work, beating the spouse or kicking the dog, buying a boat.

The dysfunctional behavior fuels a feedback loop. STAY WITH ME HERE. IT'S NOT THAT HARD.

I'm a loser (thought). I feel bad because I'm a loser (feeling). I'll eat a pint of ice cream (behavior). I'm such a loser (thought for having eaten it), I feel bad I'm such a loser (feeling). . .repeated over and over, reinforcing the core belief.

The therapy is as simple as A-B-C.

A stands for affective, or feeling.
B stands for behavior,
C stands for cognition, or thinking

Intervene ANYWHERE, but intervene.

Docs like me have you go home and analyze the events of the day using the A-B-C s. I make you write stuff down, go over it, argue with your thoughts, think twice about your default behaviors. The doc's your worst nightmare, the new program in that computer.

But the doc disappears over time and you take charge of your life pretty soon. You do the therapy yourself. You won't just do it in your head, by the way, you'll have to put the ice cream back into the freezer and find something else to do. But you will challenge your beliefs, become your own advocate, the best lawyer in the hood. Your own best friend.

That said, it helps to have someone else, a friend or a family member help you. Or get a therapy doc. I'll give you some more examples in future posts, I hope. I'll leave out the ice cream, go for the nail biting, pen smashing. Maybe.

The therapy is always about thinking, feeling, and behaving, and how these processes constantly reinforce one another.

Doesn't matter where you begin. Begin anywhere. It'll be work. Sorry about that.

Any questions?

Copyright 2007, therapydoc