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.

Boston Area Depressed/ Anxious Adolescents: Why Should My Teenager Be In Group?

Teens face many developmental challenges throughout high school. Some of them are normative and stressful, and some of them become bigger than life overnight. Peer relationships can be life or death in terms of social isolation. Teens want to rely less on adults as they become more independent, but sometimes they get in over their heads.

Teens can be fine one moment and in crisis the next. Getting rejected on social media or having a shift in the friendship circle can imminently impact one’s desire and willingness to go to school and focus on schoolwork. Sometimes teens are fine.

And then, suddenly, they are not.

Ongoing group therapy presents a kind of “soft contact” where there are multiple prompts to talk about what is hard to talk about, rehearse ways of dealing with anxiety, and address “the thing” before it becomes a bigger “thing.” Some kids have a way of holding stress within, putting on a mask, and pretending things don’t bother them. Sometimes it is easier to dismiss how isolated one feels than to make a “big deal” out of something that shouldn’t be “all that bad.” One can spend a lot of energy trying to convince oneself that they are “okay” when really, they are not.

Ongoing group provides consistently, familiarity, and a stable peer cohort. If conflicts arise within their school, they can take it outside of school and gather advice about how to address it. Teens that tend to take on everyone else’s problems can be encouraged to consider their own needs, set limits, identify what they can and can not do, figure out their feelings, and communicate more clearly. They can learn to tolerate emotional discomfort more readily, be more prepared when conflicts come up, and stay in conversations that may bring up a lot of emotion. Being socially connected means hanging in there when things are hard- and sometimes being willing to give and receive feedback.

Being in an ongoing peer group creates opportunities for intimacy, growth, open sharing, and a way to hang in there together with people who are really struggling. It means learning how to address the awkward pause after an embarrassing moment, a tearful outburst, a shameful incident, or an expression of pain. It also means having some help for when someone just simply doesn’t know what to say or do.

In general, people tend to share more personal information with people who are familiar, available, and near- and whom they see regularly. When teens are having “a thing” that may “not be a thing” or “may become a thing”, and there is no consistent person to open up to, the “thing” that was “not a thing” can suddenly become a crisis. Teens are on the brink of engaging in risky behavior, relying more on peers and less on parents, and wanting to be independent. Telling mom or dad may seem childish and immature; yet teens need to do things that keep them safe.

Group is different than individual therapy because there are multiple perspectives in the room, peers can “get it” in ways that adults don’t always pay attention to, and there are lots of resources for help, feedback, and validation. Sometimes kids who are shy, self-conscious, and sensitive are missing out on real life connections- and this can keep kids isolated, ashamed, and lonely. While talking to an adult one one may be a source of comfort and relief, ongoing group therapy offers an entirely different context for problem solving and addressing anxiety.

For more information on teen groups, click here.

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.

 

Are your socially anxious teens surviving school?

Socially anxious adolescents struggle in the presence of others. Some don’t know what to say, some become self-conscious, and some feel as if they have nothing to contribute. Others feel judged and go out of their way to avoid being the center of attention. Simple things like accidently dropping a pencil, asking to use the bathroom, or getting up to throw something in the trash are treated as a crisis. Social anxiety can create problems in other areas of life, including the inability to simply feel at peace with oneself in large groups, classrooms, and school.

The dilemma: Avoidance of social situations can result in isolation, loneliness, despair, depression, increased stress, and suicide risk. Approaching social situations, especially without confidence, can be downright painful. Classes may be skipped and grades may drop.

Individual services for social anxiety is a challenge: The task is to make a connection without overwhelming the individual. Sometimes teens find “therapy” downright painful. Sometimes it “works” for a short period, but teens also need to find their way within their own peer groups.

Groups allow teens to participate passively, contribute without disclosure, and to experiment with finding their voice. It is not all about them all of the time. What a perfect venue for providing a service that is indirect yet direct! While individual services are helpful for solving emotional problems, group services replicate reality more realistically than 1:1 services with an adult. If teens are in places where peers offer spontaneous interactions while brainstorming solutions to conflict and emotional problems, the teen will be exposed to what life could be like if they open up. The increased comfort of speaking up and participating will translate into other peer settings- including school and eventually work.

Feeling comfortable speaking up and finding one’s voice is a powerful thing!

Does your teen have debilitating social anxiety? Please don’t hesitate to contact me…

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.

 

 

 

 

When Things Fall Apart by Pam Chordron

Here are some paragraphs from this book:

“When the bottom falls out and we can’t find anything to grasp, it hurts a lot. It’s like the Naropa Institute motto, ‘Love of the truth puts you on the spot.” We might have some romantic view of what that means, but when we are nailed with the truth, we suffer. We look in the bathroom mirror, and there we are with our pimples, our aging face, or lack of kindness, our aggression and all that timidity– all that stuff.

This is where the tenderness comes in. When things are shaky and nothing is working, we might realize that we are on the verge of something. We might realize that this is a very honorable and tender place, and tenderness could go either way. We can shut down and feel resentful or we can touch and I met throbbing quality. There is definitely something tender and throbbing about that groundlessness.

Things falling apart as a kind of testing and also a kind of healing. We think that the point is to pass the test or to overcome the problem, but the truth is that things don’t really get solved. They come together and they fall apart. Then they come together again and fall apart again. It’s just like that. The healing comes from letting there be room for all of this to happen: Room for grief, for relief, for misery, for joy.”

(pages 7-8).

Quick tips on ways to manage your irritability

When did you last eat? Irritability because you are hungry is common, but many people underestimate how important it is in managing emotion. Irregular eating habits, using caffeine/ sugar/ carbs to fill oneself up, and overeating when overly hungry can have a big impact on mood management.

Are you going through biological changes? Medication changes, alcohol use, dehydration, sickness, pain, smoking habits, caffeine dependency, and menstrual cycles all affect how we feel. Taking care of your biological wellbeing will help you take care of your psychological well-being. If possible, consider saving that “difficult conversation” for later- and not when you are at your biological worst.

How is your sleep hygiene? Get to bed at a reasonable hour, use the bedroom only for sleeping, and generate calming routines before bed. Don’t overestimate how irritability is more likely to s how up when you stay up extremely late or sleep all day.

Is the weather getting to you? Extreme temperatures can make people irritable. Get out of the cold or the heat. Make use of bright lights, warm temperatures, and potential social gatherings when it gets dark early.

When is the last time you did something you liked, enjoyed, or looked forward to? Doing things you enjoy will put you in touch with positive feelings, even if they are temporary. Do more of what you love, especially if you are in the middle of a crisis. Making time to do so is critical.

When is the last time you worked hard to accomplish something difficult? Building mastery and surviving challenges gives us a sense of accomplishment that can happen despite painful life circumstances.

When is the last time you had a tricky relationship situation and you feel proud of how you handled it? Remember that approaching situations with some element of acceptance can enable us to be more flexible; creating more options for the other party and making them feel less trapped.

Have you been told to change your “bad mood”?

Here are some steps to figuring out your mood- and what to do if, indeed, you want to change it.

Our moods- or our feelings- can be extremely important in helping us understand ourselves, organize our behavior, know what matters, and have better relationships. One of the first steps to figuring out feelings is to be able to describe, understand, and put words on experience. Think beyond just being in a “bad mood”: Try figuring out what, exactly, you are feeling. Instead of thinking about your mood as bad or good, try approaching this task with curiosity. Are you down, flat, depressed, lethargic, or disinterested? Are you irritable, angry, frustrated or impatient? Are you struggling with loss or sadness? Remember that feelings give us information about ourselves, our situations, and the people around us.

Next, consider what is valid, relevant, and sensible about what you are feeling. Some reasons that others tell us to stop being in a “bad mood” is because they want us to behave a certain way. Consider this: If the person telling you to stop being in a “bad mood” got what they wanted, what specific action would that entail? If you stopped being in a “bad mood”, would you stop avoiding conflict, go to work, keep a relationship, participate fully in an activity, or attend a social event or function? We may know and understand our mood, and have a good reason to feel the way we feel, but our mood gets in the way of rising to the occasion and meeting an obligation.

Expressing negative feelings frequently or pervasively can hurt relationships; on the other hand never being to share our innermost pain can prevent us from having more meaningful and connected relationships. In other words, ranting, venting, or complaining can join people in their beef against the universe, while expressing vulnerability can increase caring and intimacy. Consider how acting or expressing how you feel works or doesn’t work for you. Does it bring you closer to the people you care about, or does it tend to push them away?

Next, consider if you want to change how you feel. Is someone else trying to get you to change how you feel? If so, trying to change how you feel can be much less effective.

One way to change how you feel is to act in ways that are incompatible with how you feel. In some situations, acting on how we feel can enable us to feel congruent and genuine with what is going on for us on a more personal level. However, sometimes moods are so pervasive that they interfere with our lives. If your “mood” is interfering with your ability to organize action, meet obligations, make deeper connections with others, keep relationships, or engage in meaningful activity, it might be time to experiment with alternative behaviors to shift gears, engage your brain differently, or do something you wouldn’t typically do.

Here are some suggestions: Express appreciations to other people, talk about what you value in the relationships you have, avoid “complaining”, practice not talking about anything negative, shift gears by doing an activity that demands your attention, shift gears by doing a something physical (washing dishes, raking leaves, taking care of a child), become invested in someone else’s problem or dilemma, try generating compassionate reasons for why people behave the way they do, soften your body and facial expression, wish other people well, do something that challenges you, do an activity you like or enjoy, or do an activity for someone else that they like or enjoy. Doing these things even if you don’t feel like it– may help you change your mood all by yourself.