- Boston DBT Groups

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.

How group therapy works: Behavioral activation, personal relationships, groups, intimacy, connection, and growth.

Newer behavior therapies are looking at how people can change their behavior despite how they feel. The difficulty with focusing on behavior change is that most clinicians think that by focusing on behavior, private experiences such as thoughts and emotions are ignored.

The truth is, most people exhibit certain behaviors when they are feeling a certain way. For example, an anxious person might become overly chatty, focus on “safe” topics, avoid talking about anything personal, or present as very “intellectual”. Someone who is afraid of being disliked or judged might acquiesce easily, become a people pleaser, and become excessively compliant. Someone who is afraid of being excluded might become critical and judgmental in order to avoid the vulnerability of feeling more ostracized. Someone who has a hard time with intimate relationships might inhibit self-disclosure, refrain from sharing personal information, or lie to avoid the risk of discovery. Someone who has a lot of self-hatred might be dismissive of compliments, avoid positive feedback, or avoid rewarding activities.

The benefit of looking at how you behave when you feel a certain way increases opportunities for therapeutic interventions. All of the examples listed in the above paragraphs are behaviors that matter in personal relationships- and will likely show up in group settings. Being able to identify what you do when you feel a certain way is one of the steps to understanding what alternatives are available. Knowing where and how you get stuck is the first step to experimenting with how you can get yourself unstuck.

Here are some examples:

If you are anxious and tend to be chatty or intellectual, try experimenting with the following: Tolerate pregnant pauses, awkward silences, and situations in which there doesn’t seem to be anything to say.

If you have a tendency to be a people pleaser, try asserting yourself in minimally threatening situations. Ask for one thing and then change your mind at the deli counter or a restaurant. Experiment with introducing small things that may be somewhat different from the norms of your social circle.

If you tend to have prickly relationships and often feel threatened, try softening your facial expression, making gentle eye contact, focusing on what you have in common with others, and refraining from criticism.

If you struggling with intimacy, connection, feeling visible, or being “known”; or you have extreme social anxiety, you may want to consider small ways that you make yourself a bit more visible or known. If being the center of attention is too much, find ways in which you can start to voice your thoughts, feelings, and opinions in less riskier situations.

If you have a lot of self-hatred, practice being receptive to the positive things. Make eye contact when receiving positive feedback, allow yourself to feel the warm fuzzies, and treat yourself with kindness on purpose by doing things that are personally rewarding and enjoyable.

Part of identifying how services can be helpful is being able to observe and describe one’s own behaviors. This includes being sensitive to the impact it has on other people the consequence of how it makes you feel- as well as the ways in which current behavior simply doesn’t work. Being able to figure out what specific alternative behaviors you can do when you have the urge to do what you’ve always done is one of the keys in successful treatment. Increasing meaningful relationships and creating a fulfilling life takes work, feedback, sharing, and challenges. Changing one’s behavior often puts people in touch with emotional discomfort. What is the benefit? The benefit is that if one acts and behaves in a way that signifies being “better”, one will be less controlled by emotions and thoughts- especially thoughts and emotions that don’t “go away”! Taking risks is scary, but the cost of not making these changes is sometimes worse.

Should you change your behavior or change your beliefs? A closer look at self-compassion.

Social psychology research indicates that it is easier to change behavior than it is to change attitudes or beliefs. Part of what characterizes third wave behavior therapies (such as DBT) is behavioral activation. In other words, there is a focus on changing behavior over changing attitudes.

Here is one of the most predominant ways this shows up in DBT: A client with extreme self-hatred or self-blame won’t do things that are nurturing, caring, or compassionate towards oneself. The argument goes something like this: “I don’t deserve, I would feel guilty, I have to take care of everyone else, it’s always my fault anyway, I deserve to be punished…” It is easy for others to follow up with this argument by challenging, cajoling, or even opposing the argument. “Why do you think this way, of course you deserve, you can’t cater to the whole world, stop talking that way…” The dialogue of I don’t deserve/ yes you do deserve can become rather exhausting. If you’ve ever participated in one of these conversations, you could probably relate.

Part of the skill set for tolerating distress has to do with treating oneself with compassion. More specifically, engaging in behaviors that are self-soothing, calming, respectful of sadness, and a soft acknowledgement of the rough and painful aspects of life generally help people through the rough times. People who don’t do enough of this and treat themselves harshly are going to have an even harder time getting through the roadblocks of life. Self-attacking just isn’t a very effective way of solving problems.

If you are extremely miserable and you would like to feel better you may have to change your behavior despite whatever argument is going on in your head. If you could do something to make your current distress more tolerable, why wouldn’t you do it? If you could treat yourself with kindness and compassion, be understanding, and acknowledge your deepest fears and hurts- at least to yourself- why wouldn’t you? If this made your life easier, more livable, and more hopeful- why wouldn’t you do it? Arguing about deserve-ability certainly isn’t doing anything for you.

In order to feel differently you have to act and behave as if self-compassion and kindness matters. You may have to tolerate some guilt, set some limits on your time, or even say no to the demands of others. The point is that you should get started on acting and behaving in ways that are worthy or deserving of you. Over time, your attitudes may change right along with your behavior. And in addition to feeling better because you are behaving as if you have more self-respect, you will have more resources for coping when other people put you in demeaning situations, take advantage or you, or assume that you are willing to be treated poorly.