Why Teenagers Need Social Groups More Than Anything: The Internet Addiction Is Not Helping Mental Health

This past week I had the privilege of attending a conference on technology and mental health by social worker Ozgur Akbas, LMFT. Ozgur presented some compelling date in terms of technology and mental health. In general, people that have difficulties with technology generally spend a lot of lot of time alone with a phone or computer, are defensive and unaware of the impact of their use of technology, prefer time spent with their devices over time spent with others, lose interest in other activities, become moody, socially isolated, and irritable; and have problems with school or work.

One of the big issues around social media also has to do with its accessible use of pornography, the ability to have phone sex/ send nude photos, and the trend creating unrealistic (online) expectations about body image and relationships. In general, Ozgur presented data that shows us that our youth are having much less sex. In the past, only 2-3% of the population showed problems with erectile dysfunction, while after 2008 that number has increased to 26%. More and more people are relying on “safe” ways of interacting that don’t involve risk, intimacy, putting oneself out there, and developing social and dating skills. In essence, our increased reliance on technology has decreased our competence at being able to relate with authenticity and visibility. The socially anxious person has found more places to hide, and their disappearance makes it almost like they don’t even exist. Imagine that!

Problematic use of technology can fill a short term need and provide short term, temporary relief; yet create long term problems- sleep being one of them. Companies, designers, gamers, marketing agencies, and yes- even neuroscientists are part of a burgeoning market of keeping your kids’ attention for as long as possible. Consistent high arousal increases blood pressure, dilates pupils, induces sweaty palms, increases the flight or flight response, and creates problems in a person’s ability to regulate emotion. Persons who have difficulty “turning it off” or regulating arousal are at risk for being wired all the time and thus having problems with attention, aggressiveness, or moody behavior. Therefore, any number of diagnosis (ADHD, ADD, social anxiety, Bipolar Disorder, Mood Disorders, Anxiety Disorders, and even Psychotic Disorders) may show up when technology use becomes a problem- and can be easily treated with the treatment of problematic technology use!

Group therapy puts teenagers in a social situation where technology can’t be relied on to solve social problems. Groups offered in my practice focus on building group cohesion, which means looking for and finding what members have in common. In some cases it means creating a space for abrupt disclosures, tearfulness, honesty, sharing struggles, and openness. This means staying in the room with all emotions -both easy and hard- and struggling at times with knowing what to say, how to say it, or what (if anything) should be said at all. What social media can’t do for your teens is to help them safely navigate tolerate feeling awkward or uncertain. This great and wonderful developmental task is a significant part of risk and survival. How else do teens build self-respect, find integrity, and “show up” with all of their emotions? If it is easier to ghost someone, what is the value in learning how to end a relationship with grace, to bow out on a situation you don’t want to be in, or to speak up and assert oneself? In my groups the commitment is to do the work, show up regularly, give and and receive feedback (even when it is hard!). Most important, when technology takes away our teens’ ability to grow and develop, they stop growing. Group services can help teens continue to grow in real life situations with real life problems- with real people and with real pain.

Is Technology Affecting Your Mental Health? Top Suggestions For Treating Internet Addiction Use In Your Household (Recent tips from conference by Ozgur Akbas, LMFT)

1) Examine the relationship with social media screen time among the adults. In way what way does your use of technology set a standard or norm at home? Tests for internet addictions include Young’s Internet Addiction Test (IAT) http://huibee.com/wordpress/wp-content/uploads/2013/11/GLOBALADDICTION-Scales-InternetAddictionTest.pdf

2) Ozgur presented three determinants of Self-Development theory to take into consideration when considering the impact of technology use: 1) Autonomy- how much are you (or your teen) in control 2) Relational- how capable are you (or your teen) able to form social bonds in life, and 3) How effective are you (or your teen) at being able to effectively deal with environment/ challenges (ie work, school, stress, life?)

3) Create technology free times and places. Technology free zones might be mealtime, a set period of time before bed, overnight, shower time, homework time, family time, outdoor time, exercise time, or other times of day in which no screen time is permitted. Technology free zones may include certain places in the house such as the bedroom.

4) Turn off push notifications, simplify your home screen, use only what you need, go grayscale, and use settings to decrease accessibility to blue light after sunset (Nightshift on iphone).

5) Other helpful apps to help control screen time include Ublock Origin, InboxWhenReady, Disney’s Circle/ Qustodio (for parental monitors and controls), and Facebook Newsfeed Eradicator.

Can You Get Someone To Change Their Behavior Without Sabotaging Your Relationship?

Giving useful, helpful, and adequate feedback is something that is hard for a lot of people. I constantly witness parents, spouses, friends, family members, and even mental health professionals try to change the person they care about by blame, shame, and humiliation. While negative feelings have important functions and can motivate people to change their behavior, lack of useful feedback can have the opposite effect. For sensitive people who struggle with self-destructive behaviors, internalized shame, self-consciousness, and obsessive self-defeating thoughts, the consequences can be devastating. Here is a list of what not to do, and some food for thought about what to do instead: 

Tell them it is their fault: Getting someone to take responsibly for their actions makes sense. However, telling someone they are at fault is generally not followed up on by some plan of action, support, or help to prevent problematic behavior happening in the future. Generally, telling someone they are at fault does nothing more than make them feel bad. It makes more sense to be able to describe what specific behavior they did and the consequences it had in a non-judgmental manner. Is the goal the help prevent them from doing it in the future? If so, what is your role in this interaction? What are your intentions in blaming someone? Often, saying a person is at fault is simply a way to express anger, and expressing anger too intensely can sometimes destroy relationships. 

Tell them they are mentally ill: If you are trying to write someone off for behavior that you don’t understand well, this is an easy way out. Telling someone they are “mentally ill” can sometimes get people off the hook for providing more specific feedback or expressing anxiety more directly. What specific behavior are you talking about? Is there something in particular you want them to change? Do you have trouble describing their behavior? If people are treated with respect, they generally respond proactively. Mental illness can sometimes be a nebulous term for behavior that is not fitting or appropriate to the situation, and can also be a way to say “I am not comfortable with what you are doing.” However, being ganged up on, being misunderstood, and being shamed only ostracizes the recipient. Is calling someone mentally ill a way to express fear of what you can’t understand? Consider what it is about their behavior specifically that makes you uncomfortable, and see if you can use words to describe it without judgment. 

Tell them that they do things for attention: An attentive, listening audience can be a powerful thing. Just ask anyone who has benefitted from a caring partner, a best friend, or a loving family member! I love it when I receive the type of attention I want, and the type of attention I need. It makes me feel closer, more connected, and warmer towards the people I care about. There is no need to pathologize what is completely normal, and to make people feel bad for social inclusion, affection, and control. If there is a behavior that they actually do that burns you out, overwhelms you, or angers you; it may be time to own your frustration and know and communicate your limits. It may also be an opportunity to provide some feedback on what isn’t working in your relationship, or to clarify what it is you actually need for them to do or change. 

Tell them they have a personality disorder: Describing a disorder doesn’t change a behavior. People often think that if they could only describe something, somehow it will change! Telling someone the reason they behavior x way is because they have personality disorder generally just make them feel bad, and in some cases hopeless to do anything about it. If you want to hold someone accountable, you will have to develop better ways of giving feedback. A more thoughtful approach to changing behavior includes a compassionate and realistic plan to address it. 

Tell them they are a bad (parent, teacher, spouse, child, etc.): In essence, bad is a judgment. Trying replacing “bad” with descriptions of impact, consequences, and feelings about what happens when they behave the way they do. What is it about their behavior is “bad”, and why is it so important to bring to their attention? Are you avoiding expressing your own difficult feelings by judging others? 

In general, people are more willing to do what we want them to do when we have a strong relationship with them, when the feedback we provide comes from a place of caring, and when we validate and encourage others. A person is more likely to take feedback into consideration when they feel valued and cared about. Are there ways you can encourage or enhance the relationship? Focusing on behaviors that you want to increase (such as connection, openness, courage, self-awareness) will probably go a lot further than punitive responses coming out of frustration or anger. While constructive feedback is sometimes called for, aversive consequences manage to prevent problem behavior, and limits around what a person can tolerate is reasonable; punitive responses can also damage relationships.  

What if your depression and anxiety was not something you actually “have”?

Depression and anxiety are often considered something that a person “has”. Once they “have” depression and anxiety, there seems to be a mentality both in the general public and among mental health professionals that it is very hard to not have. Or that the obvious solution is to get rid of it- and in most mainstream ways of thinking, that solution is often medication.

Part of being a successful professional means that I need to help people think about the treatment of their think depression and anxiety differently- and figure out what to do about it. If depression and anxiety were a thing a person had, it would be a permanent condition: not subject to change. There would be no point in getting help. When people think of depression as a thing a person has, it becomes a noun. It is a reified, concretized, objectified, thing. People might think of it as actually existing or residing within them, somewhere in their brain or their heart. It feels bad and they will do anything to avoid or get rid of it if possible.

Depression is not only seen as a “thing” a person “has”, but it is also often cited as a cause. In other words, the reason you may be depressed is because don’t get out of bed. Yet the reason you don’t get out of bed is because you are depressed. The reasoning is not only rhetorical; it doesn’t solve any problems. Telling people that the reason they have problems is because they have anxiety or depression isn’t usually helpful- and doesn’t provide any solutions. If only people were interested in what actually causes depression or anxiety!

I think of depression and anxiety as verbs: aspects of experience and subject to change. Emotions, depression, and anxiety is caused; it is not a cause. It is something that can increase or decrease based on a wide range of factors. Those factors are worthy of exploration and can help a person feel more in control. If a person believed that depression and anxiety was caused, and those causes could be better understood and addressed; a person might have better options for not being depressed. Knowing when and how depression might show up also might make a person more able to predict and control its occurrence; and have less experience of depression and anxiety as an unknown “thing” that creeps up “out of the blue” and remains a static “thing” a person “has.” It’s mysterious, stigmatized entity prevents us from understanding or treating it.

Part of working with people is helping them gain an awareness on causes, reasons, triggers, and stimuli that evoke high anxiety and severe moods. Much of the time people don’t always realize the extent to which they are bothered by losses or threats; and the lack of paying attention can sometimes cost them in very painful ways.

What’s The Fuss About? A Super Brief History Of Behaviorism, Cognitive Behavior Therapy, And What Is Really Meant By Third Wave Behavior Therapies.

Behavior therapies have been around for a long time in helping people address problems of depression and anxiety. Here is a short article about old ways of thinking about behaviorism and what newer “third wave” therapies have to offer.

Old behavior theories are often criticized for this idea that there is no “person” on the “inside”, rather everything was a matter of stimulus and response. For instance, the presence of a stop sign (stimulus) would prompt the behavior or stopping (response), and behavior could be controlled by stimulus in the environment. Criticisms of this way of thinking included the lack of free will or choice. Behaviorism in the current way of thinking would take into account learning history, which would explain how different persons have different responses to the same situations. It also takes into consideration how the context of the situation may influence the outcome, such as snowy weather conditions or the fact that a person was busily distracted with their cell phone when coming to the intersection.

Old paradigms of thinking about behaviorism include methodological behaviorism; the gist of it being that if behavior was not observed, it did not exist and was not worthy of study. Clearly this created problems for people who want to understand emotions. Current ways of thinking of behaviorism (radical as opposed to methodological) refutes the idea that behavior has to be publicly observed in order to exist. All the “stuff” that occurs within the skin (emotions!) are alive, real, in existence, and worthy of study. The more global way of understanding behavior is that any behavior is worthy of analysis and understanding. Thus, an emotion or a highly conflictual altercation (the stuff that comes up in therapy) is clearly worthy of study.

Cognitive Behavior Therapies (CBT) often emphasized the thought process that ensues when a person reacts to a situation. People have a tendency (especially when panicked or a in a bad mood) to think the worst will happen, jump to conclusions, and make assumptions about situations and people that are not accurate. Cognitive Behavior Therapies have often emphasized the thought process/ thinking/ cognition; and often challenged persons’s perceptions of reality. This can get tricky when dealing with paranoia, post-traumatic stress, or psychotic thought processes; and can create even more problems when people are told their perceptions of reality are not, indeed, real. Focusing solely on cognitive ways to solving problems can result in trying to think one’s way out of pain and discomfort, which sort of backfires when people have problems with rumination, over-analyzing, or overthinking. That being said, CBT has been helpful to numerous people and has had a key role in reducing suffering, depression, and anxiety.

Exposure therapies are often considered under the umbrella of cognitive behavior therapies and include specific treatment for anxiety disorders. This is where a person comes into contact with a feared stimulus and behaves differently from the typical response. The goal is to increase one’s tolerance to anxiety, increase the repertoire of responding adaptively, and not let feared stimuli control one’s life. Here are some typical examples of treating anxiety through exposures: Obsessive Compulsive Disorder (people that are disgusted by dirty things are encouraged to touch dirty things such that they become less bothered by dirty things over time: watch the move Dirty Filthy Love), Social Anxiety (people are encouraged to join a small group and share more openly than they otherwise would and feel less isolated and have better social abilities), and Borderline Personality Disorder (exposures help people tolerate emotions better such as practicing breathing when angry instead of ranting angrily or picking a fight).

Behavioral Activation is a treatment for depression that includes engaging people in life situations that increase natural reinforcers. In a nutshell, the behavior of depression is often one of detachment, withdrawal, inhibition of activity, loss, flatness, tearfulness, loss of focus, and sometimes aggravation. Activating behavior may include increasing pleasurable activity, engaging in meaningful behavior, doing things to build mastery and challenge oneself, managing stress and time management, and decreasing commitments that result in being overwhelmed. These are ways of managing mood that don’t include medication. (A really great book on this is Overcoming Depression One Step At A Time, which can be found under “books I recommend.”)

The newer behavior therapies or “Third Wave” therapies are often considered an offshoot of Cognitive Behavioral Therapy. Technically, behavior is given an emphasis over cognition. This is because behaviorists consider the thought process to be only one aspect of behavior and is not given any kind of special treatment. For political purposes (and for the general lay population) this distinction can be confusing and for some, probably not necessary. However, all behavior is open to analysis and one’s thought process is not the only focus of treatment. The idea of Third Wave therapies is a return to radical behaviorism (hence the analysis of behavior), an acknowledgement of the ways behaviorism has been both hurtful/ helpful/ misunderstood, and an expansion of how behavioral ways of thinking have been making phenomenal comebacks (and changes) on intimate, psychotherapeutic relationships.

Third Wave behavior therapies are different in that they are interested in two things: 1) Context and 2) Function. Behavior (which can include anything you want to analyze for the focus of your therapy session, such as an emotion) can happen anywhere in time and space. Current conditions (ie., the context under which behavior occurs) will influence behavior. Behavior does not happen in a vacuum and is not situationally isolated. It is fluid and subject to change. Consider how “repressed” memories “show up”, and if you more or less likely to remember repressed memories if you have a warm, caring therapist who is expressing curiosity about your past. How you remember, what you remember, and what you are willing to tell this person are all influenced by the current context. If, in your learning history, people are not to be trusted; a warm caring person asking you this personal information may result in you changing the subject or talking excessively. Learning history clearly plays a part in how a person will respond to a therapist, and again shows how the overly simplistic stimulus-response models of early behaviorism fall short.

The function of behavior has to do with the purpose it serves. The same behavior of two people can have very different purposes, show up in different settings or circumstances, and have different outcomes or consequences. The behavior of vomiting after eating (such as the case of bulimia) can serve to communicate, validate, express anger, maintain privacy, prove a point, assert independence, or prevent the discomfort of feeling full. The fact that the same behavior does different things for different people and has different consequences makes it such that two people with the same diagnosis can need very different treatments. This is partly why there is so much confusion and controversy over mental health diagnoses and their varying treatments, and why any one “template” approach doesn’t work the same way for any two people.

Third Wave Behavior therapies are also coming to terms with spirituality. While past therapies focused on making unwanted emotions/ thoughts etc. dissipate, new wave therapies are getting people to look at what they want more of, what they value, and what is important to them. Instead of saying “What do you want to avoid or get rid of in your life?” they are saying “What do you want more of in your life?” or “How are you missing out on what is important because anxiety/ depression gets in the way?” There is a renewed focus on mindfulness and acceptance and a recognition that painful thoughts and emotions are part of human existence.

We’ve worked really hard to eradicate pain and that hasn’t worked, so what can be done instead? Making peace with our discomfort by not letting anxiety and our depression control our life is done through some applied principles from Bhuddism, mindfulness, and the concept of being “zen.” Spirituality clearly has helped many people cope, come up with their “why”, and rely on powers outside of their control to help them survive emotional pain. (Ie., “Let go and let God”). The shift in Third Wave Therapies is to look towards a more expansive way of thinking and also addresses a more existential concern. You don’t have be clinically depressed to benefit from examining values, enhancing your quality of life, and growing as a person. And at least one of these treatments, ACT, is being used in non-psychotherapy settings such as organizational and business consulting. (The Association for Contextual and Behavioral Sciences is the umbrella organization of the growing interest in Third Wave Behavior therapies, and offer an annual international conference to interested parties. Click here to visit their website.)

Third Wave Behavior Therapies are generally considered to be Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Functional Analytic Psychotherapy (FAP), and various mindfulness and compassion based therapies. DBT was somewhat of an early forerunner in bringing acceptance based practices to psychotherapy, the “dialectic” being that of acceptance vs. change. This was somewhat in response to the fact that Cognitive Behavior Therapy, despite the multitude of people that it helped, was a therapy based solely in principles of what needed to be changed. DBT skills include prayer, radical acceptance, finding meaning, and value-based goal setting. DBT’s founder, Marsha Linehan, grew up Catholic and developed the treatment based on her exposure to Eastern thinking and Bhuddism; she has written multiple articles on spirituality.

ACT is complex and a bit tricky to explain, but here are two principles that ACT encompasses: 1) Flexibility, or a flexible repertoire of responses to life’s challenges. A metaphor I heard recently was like a car hitting a pot hole- a car with no “bounce” or “give” is like a person who has difficulty adapting to life’s bumps. The more shock absorption that a car has, the more likely the car can navigate the pot holes and not get “tied up” or “stuck”. 2) Impermanence, or “self-as-context”. This means that the self that is “you” will change over time but still be the same “you”, and this “you” can change perspective in time and space. This matters in the sense that people who are really and truly “stuck” sometimes experiences their situations and self-criticism as permanent. The self-as-context concept often entails compassion focused exercises that allow you to see yourself differently; with compassion, and as an observer who can take a step back form being “fused” with emotional pain and rigid thought patterns. Compassion based practices have capitalized on the approach and address concerns related to extreme self-hatred, shame, and the ubiquity of human suffering. (Compassion Based Therapy is also considered it’s own independent treatment).

FAP at its heart has based its tenets on the principles of Awareness, Courage, and Love. (Known as the ACL model). Clients are encouraged to consider how their relational problems outside of session also show up inside of session, and to bring these similarities under direct observation as they show up in the relationship with the therapist. Immediacy (ie., What are you feeling right now as you are telling me this?) can evoke the discomfort clients often feel when in intimate situations, and encourage clients to develop more meaningful and fulfilling relationships via the interaction with their therapist. FAP is highly evocative, and clients grow in the courage to address things in therapy they tend to avoid. Because lack of intimacy is associated with mortality, intimacy and connection is a value that shows up consistently across FAP. If you think about this treatment from a behavioral standpoint, the environmental context (how a therapist responds) can have a profound influence on generating change. If the relationship with the therapist had no influence on the client, there would be no such thing as psychotherapy. Thus the focus on the environment (ie, the behavior of the therapist) is consistent with a behavioral approach to treatment.

The best way that I think of behaviorism is that there is no permanent, fixed, or reification of private experience such as thoughts, emotions, or sensations. The fluidity and impermanence of how we experience “self” changes across time, contexts, and situations. Problems often ensue when our thoughts are treated as structures, things, or objects. Problems crop up when we think we “have”, possess, or own the experiences within our skin. In order to “not have” depression, something would have change. Consider the difference between “having” depression vs. “experiencing” oneself as depressed. Which do you think is more hopeful, temporary, and subject to change? Third Wave Behaviorism, or “radical” behaviorism is making its comeback.

 

 

 

Should I Get Back On The Horse? Two Ways To Approach Your Fear That Won’t Work.

If you get thrown off a horse, should you get back on? Some people will suggest that you need to get back on the horse immediately so that you will gain mastery over your fears. If you don’t get back on the horse, then your fear will haunt you the rest of your life.

Is this really true? Here are some ways of approaching fear that isn’t very effective. The first is to fight your fears or treat the situation like a battle zone. It means taking the reins, having control of the situation, bucking up, grinning and bearing it, tightening your muscles, and powering through. It can be coercive and forceful. In some cases it means blinding yourself, dissociating or disconnecting from the fear, or minimizing or reducing the value of what your fear might be trying to tell you. Generally it is doing the thing that you are afraid of as a way to prove yourself or prove your point.

The reason this doesn’t work is because it often means engaging in life as if it is a battle. Staying in the battle field often means getting hurt, risking relationships with others, being coercive, or putting the other on the defensive. Getting back on a high strung or agitated horse to gain mastery over fears is not an effective way to manage fear.

The other ineffective way of handling fear is to completely avoid anything associated with the fear. This means that any mention of the feared object or situation is avoided. Conversations stop, people stop making eye contact, the air becomes stilted and stale, people avoid people, and people avoid a wide range of stimuli that becomes associated with the feared situation. The person may be humiliated that they gone thrown off a horse, so they go out of their way to hide it. While people lead perfectly fulfilled lives without riding horses, the person who can’t drive past a barn, watch a television show with a horse on it, have a conversation about what happened when they were thrown off a horse, or set foot on a farm may find themselves restricted in ways that have nothing to do with riding the horse itself.

Handling fear effectively means being able to approach the situation with a flexible style that involves both challenging oneself, listening to the validity of the fear, being kind to oneself, backing off when things are too overwhelming, identifying smaller steps to approach the fear, and figuring out why the situation/ issue/ activity is important to you.

Fear is a useful emotion in that it provides information about oneself and one’s situation. Fear protects us from danger, gets us out of threatening situations, and helps us cope adaptively. Fear can also be so extreme that it takes over our lives, restricts our ability to do the things that are important to us, or prevents us from having a life- the life we want.

Here are a few questions to help you figure out your fear:

  • What about the situation, event, activity, or relationship is important to you? You may decide not to ride horses ever again, but does this fear bleed over into other areas of life that prevent you from doing what matters? If riding horses is not important to you, and it doesn’t get in the way of your life otherwise, it may not be an issue.
  • What does your experience- and your fear- tell you? Your fear may be telling you that getting back on an agitated horse is indeed a bad idea. So don’t go out and get hurt if it isn’t necessary. If horses aren’t your thing, let it go and move on. Don’t let your humiliation keep you attacking something that isn’t going to service you.
  • If you want to approach your fears, what would be the smallest step? Watching a TV show about horses, visiting a barn, feeding a horse, brushing a horse, walking a horse, and hanging out with horses are all behaviors that don’t include absolute avoidance but don’t force you into a situation that is potentially unsafe. You could also ride a smaller, more mellow horse with the help of a trainer.
  • If you are going to do the smaller steps, don’t white knuckle it. Relax your facial muscles, soften your jaw, breath slowly/ deeply/ evenly, maintain an open body posture, and take in the situation fully. If this feels threatening, do a smaller step- or limit the time you spend doing the activity. For instance, you could watch a TV show about horses for one minute, five minutes, or fifteen minutes. If this doesn’t challenge you, up the ante by going out to a barn. Find your middle ground, back off when you are overwhelmed, give yourself credit for your efforts, treat yourself kindly, and challenge yourself at some point in the future when you are in a better place.

Manchester By The Sea- A Psychologist’s Point Of View On How To Work With Lee

Recently I went to see an excellent movie: Manchester By the Sea. Here are some thoughts I have about how I would work with Lee.

As a provider of clients who experience intense, severe, and painful emotions; Lee really does fit the bill. General questions that I might consider asking include: What would it take to reduce pain, survive loss, and manage or cope in a way that made things better? What would help Lee feel less stuck? What resources or connections could sustain him better, enable him to bear the weight of his pain, or enhance his quality of life? What could him grieve more fully and to get through this crisis? What is he doing that is working, and what is he doing that is not working? Could he be more likable to himself, sustain the burden or his guilt, or have more fulfilling relationships?

One agenda item I have is getting Lee to stop doing things that could potentially make his current situation worse. Often times I have clients who have severe emotional pain and it is so intense and unbearable that they are looking for any distraction to take away the pain. The distractions sometimes have a short-term effect of feeling better, which makes them hard to stop. However, in most cases these distractions can make problems worse- and are not effective long-term strategies to mitigate the severity of what they feel.

So one treatment agenda is to reduce risk taking or crisis-generating behavior. Specifically, Lee tends to get drunk, pick fights, and throw punches. The natural consequences for this behavior can result in serious injury, concussions, brain damage, head injuries, broken jaw, soreness, swelling, or other various medical trauma. Drinking heavily can result in poor decision-making, hangovers, dehydration, and liver damage. Other natural consequences of his behavior include legal problems, court dates, jail time, being seen as a threat in the community, increased relationship conflict, and isolation. Grabbing the gun of an officer might result in unintended harm to other people. Not only would Lee have the current dilemma of living with the intense and painful losses he has suffered, but he would have to address the above consequences in addition to everything he has already gone through.

Some people actually believe Lee’s behavior is justified. They would say that because he is in unbearable pain, he should be able to act the way he does. Or he should be let “off the hook” because his behavior is understandable. I would encourage those people to consider: Would you recommend your closest confident or best friend- who is deeply hurting- do something that could result in head trauma? Liver disease? Incarceration?

Another “justification” for Lee’s behavior is that he has significant guilt and self-hatred and he is trying to punish himself. After all, the law did not punish him enough! What would be an effective punishment, and how long does he need to punish himself for his actions? Are self-inflicted/ high-risk behaviors actually effective in making him feel less guilty? What if a police officer was shot by accident? What type of effective repair work needs to be done? What lifestyle habits could he change to prevent bad things from happening in the future? What would he need to do to redeem himself in the community? And what would it take for members in the community to find forgiveness, employ him, or tolerate him being around?

How would treatment move Lee towards growth, movement, and decreased pain? There are several ways to approach this- the key being a sensitivity and flexibility to what Lee would be able to handle at the time he seeks help. One is a baseline ability to talk about what happened. As he pieces together his story, there may be parts that are difficult to talk about. Avoiding these topics might show up in the form of escaping, not talking about it, dissociating, becoming numb, becoming argumentative, keeping one’s distance, staying detached, avoiding intimate relationships, leaving, drinking, or even picking more fights. The difficulty is that there are multiple reminders (or stimuli) that will show up throughout his life that he may not be able to avoid. These may include:

  • Conversations about young children
  • Seeing a house fire in the news
  • Talking to his ex, Randi
  • Seeing Randi’s newborn
  • Getting news that young children die or are dying
  • Randi saying “I love you”

For instance, what if he is watching the evening news and suddenly there is coverage about a house fire? What if Lee has a building tenant who loses a child to death, and Lee is present when the tenant tries to discuss it with him? What if Randi tries to contact him again or “shows up” in an unexpected manner? Maybe Lee can try to avoid these situations in the short term, but inevitably life, reminders of life, and young children are the life that surrounds us.

Therapy would work on staying present with emotional discomfort when these topics come up; and doing so in the presence of one or more people. That means not attacking, hiding, or getting drunk. It means being willing to experience grief, pain, discomfort, or tears. It means staying in a conversation and having a willingness to tolerate the stuff that seems unbearable. The more Lee does to avoid it, the worse it is going to get.

Healing results when a person’s grief can be managed, survived, and tolerated. Healing is about experiencing, talking about, and coming to terms with what happened in the presence of others. Healing happens when people can forgive themselves and each other and can make changes to prevent bad things from happening in the future.

Healing doesn’t happen when a person is literally “stuck” in blocking out all things reminding them of pain, and lives a life where they are blind and deaf to such triggers; avoiding any stimulus in real life that will inevitably show up at some point.

Healing doesn’t happen when emotions literally control lives, and people can’t engage a full, meaningful, rich, and productive life as a result. Healing doesn’t happen when there is no compassion for self or others, when there is no forgiveness, and when there are no second chances.

 

Depressed? Anxious? Here’s What You Can Gain and Obtain

Most people who have more than their fair share of depression and anxiety are often seeking ways to decrease depressive and anxiety symptoms. In other words, they want to not be depressed and not have significant anxiety. If the symptoms are extreme or significant the person may start to avoid a lot of things, such as getting out of bed and going to places to that prompt panic attacks. Lifestyles can become restricted and the person may stop going to events or venues where they have the feelings they don’t want. Medications might be pursued, evaluated, and re-evaluated to see if they “work” or they “don’t work”.

If you are a depressed or anxious person, it might be worth considering what it is that you want more of, you would like to have, or what you value in your life. Instead of thinking what do I want to avoid start thinking about what you want to have more of in your life. What is it that would make your life more fulfilling, more engaging, more interesting, more desirable, or more alive? What is actually important to you? Sometimes people are so focused on what they are trying to get rid of they stop pursuing what they want.

Figuring out what you want more of ties in to your values, your energy, and your time. Are you sacrificing what is important to you because you are avoiding negative feelings? Have you stopped seeking activities that give you pleasure, fulfillment, obligation, a sense of contribution, or the opportunity to enhance an important relationship? If depression and anxiety interfere, this is a good time to evaluate what you might have to tolerate to go after more of what you want.

Sometimes, if people have more of what they want, their buffer against depression and anxiety can be tolerated more naturally. Some people get panic attacks at work, but because their job is important to them, they find a way to bear with them. Sometimes people get depressed when important things are lost, but because they have other important and meaningful activities in their life, the depression is bearable.

People who have fulfilled lives often have a wide range of things that give them pleasure, provide a sense of work/ mastery, invest in important relationships, and find new relationships when important ones end. Diversity and stability of the good things can help people shore up more resources when things go south and important jobs and relationships end.

 

 

 

 

Do you avoid what you want the most?

Going into the bookstore has always been a positive experience for me. I am always filled with wonder at the millions of things I feel I could learn when I visit a big bookstore. I get the sense that I could just pick up a book, read it, and acquire a new skill, craft, or some time of knowledge that wasn’t there previously.

A few years ago, though, I wanted to write my own book. I was working on The Emotional Extremist’s Guide to Handling Cartoon Elephants. I would go into a bookstore and I would have the sensation that there were so many delightful, treasurable, and competing ideas and books that it almost felt as if I would just become one more competing voice. That my contribution wouldn’t make a difference. That all the ideas were taken. That people had accomplished so much more than I would ever be able to accomplish. The experience of going into the bookstore, as exciting as it was, had the potential to tap into my anxiety and prompt me to stop writing my book.

Sometimes “good” stressors open up in our life. What we really want is at our fingertips. Feeling good, contributing our own ideas, finding our voice, speaking up, influencing the world, and getting out of a place of feeling trapped, helpless, or stuck becomes an option. It’s there in front of us. We have the choice to be powerful and make a difference.

Sometimes these options cause us to shy away, shut down, stop believing in ourselves, not think we are good enough, or feel as if we are undeserving. These types of beliefs get in our way of taking action, having a better life, and surrounding ourselves with things we really want.

Here is a question for you: What is the cost of sitting back, becoming inactive, or avoiding what you want the most? How might your life be different if you approached -and got- what you want?

Ultimately, I was able to finish my cartoon elephant book. My confidence may still vary when I am around lots of beautiful books, smart people, or fabulous contributors to society. But I know that by not giving up on my goals, people have enjoyed my cartoon elephants, given me positive feedback about my book, and have found the cartoon elephant book to be a fabulous resource in addressing their own painful emotions.

What to do instead of criticize yourself

Try softening your stance, gently relax your face, and allow your muscles to become loose and less tight. Put a hand over your heart with an intention of lovingkindness, and try repeating the following statements with a tone of voice that conveys self-compassion:

May I bear this pain with kindness to myself

May I safely endure this pain

May I accept the circumstances of my life

May I find peace in my heart

May I let go of what I can not control

May I remember that others are also suffering