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.

 

 

 

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.

 

What if I’m wrong?

Here are a couple of thoughts on the business of being “wrong.” First, the question itself begs a certain dichotomy to form in a relationship. It implies a one-up, one-down position. It can make one person more powerful, keep another at a distance, or in extreme circumstances serve as an opportunity to belittle or berate. What does being “wrong” imply about the relationship, the importance of keeping a relationship, or the way that people will continue to relate to each other? Is it worth it to damage or hurt a relationship to be “right”? If one person is “wrong”, then how is the relationship handled in the future? How do people move forward?

Next, being “wrong” might be rephrased as being technically inaccurate. If you are responding in a way to that does not match reality in a reasonable sort of way, you may be considered “wrong.” However, in some circumstances this begs the question of differences in opinion, perception, feelings, and agendas. A person can have a valid point of view, see things differently, or see aspects of a situation that another person is not able to see. This can prevent communities from being rigid, thinking “inside-the-box”, refusing to consider alternatives, or being racist or non-diverse in their thinking. Trying to understand the validity in where others come from can help us be more understanding, have better relationships, be more forgiving, and become less “stuck” in the right/wrong dichotomy. If you are technically “wrong”, this also might be your opportunity for self-correction, learning, or growth. Consider teasing out the differences of being “wrong” vs. being technically accurate, and if being “wrong” has anything to do with conflict around perspective, perception, intention, or emotion.

In addition, there is a certain cost to being “wrong.” Everyone at some point in their life has probably had an experience in which they thought something to be true, accurate, or reasonable but found this to not be the case. The cost to being “wrong” is often related to embarrassment, shame, humiliation, or perhaps the loss of trust or leadership. Are you able to correct your actions based on what happened? Can you tolerate the pain of your own humiliation and consider what really matters? If the inability to bear the cost of being “wrong” results in isolation, criticism, withdrawal, and becoming more adamant that you were “right”; you may want to give some thought to what it is costing you in terms of your relationships.

Here are some final questions for you to consider:

  • What are your intentions? Sometimes we are in long term work, romantic, or family relationships that must be giving careful consideration.
  • What are the intentions of the other person? (Are you sure, or are you assuming? What evidence do you have?)
  • What is the true cost of being told you are “wrong”? What do you have to gain by making sure others know you are “right”?
  • If you are “wrong,” can you tolerate your embarrassment enough to grow, learn, regroup, or reconsider how you will handle future situations?
  • Is it more important to be right than to be effective? (Consider what the relationship means to you and if your own self-respect in handling the situation is on the line).
  • Are you unforgiving of other people when they are “wrong”, thus unable to forgive yourself? Is your own criticism preventing you from moving on, getting unstuck, or responding in a way that is potentially painful but perhaps necessary?

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.

Is everything really going to be okay?

When people tell you that everything is going to be okay, sometimes it is helpful to hear. Sometimes it is soothing, and can give you a sense of hopefulness and shared understanding. There are many ways in which other people try to soothe us, and which we find help and assurance in cases of extreme distress.

However, people sometimes use this statement in a way that is unhelpful. For instance, the statement that everything is going to be okay may be an attempt to avoid the subject, offer a platitude, or inhibit communication of distress. Sometimes it is more helpful to obtain some acknowledgment or understanding of how you really feel. Sometimes worries, fears, or concerns about the future just need to be openly expressed. In addition, it is hard to know that things are going to be okay when you don’t have a way to solve the current problem.

The statement that everything is going to be okay is a statement of expressed hope. It can be offered to the person who is going through the most severe of all crises, and even though there may be some irony to it, there is some truth to it as well. Sometimes when we feel very hopeless it is hard for us to hear the usefulness of this statement. Sometimes in the worst of moments we can find and create experiences of hope and joy- despite significant loss. Being able to find and participate in these moments help people survive.

Thinking about the ways in which this statement is both helpful and not helpful at the same time can help us to create space for different perspectives. When we can see things from different angles, we have more flexibility in addressing situations, responding to our environment, and finding help that may actually be helpful. There is always some element of truth to things turning out okay, but there are also moments when hopelessness prevails. Sometimes it is nice to consider the kindness of another person’s intentions, even if their attempts to be helpful aren’t always exactly what we need to hear in our moment of our pain.

When you have no reason to feel the way you feel

People tell me all the time that they don’t deserve to feel the way they feel. When they start to feel sad/distressed/upset, they immediately think of all the positive things they have in their lives, convince themselves that they have no reason be upset, and spend a considerable amount of time in their heads trying to argue away the existence of their emotions. The problem with this kind of response is that it doesn’t make emotions disappear in the long run.

If you are one of these people who has “no reason” to feel the way you feel, here are a couple of things you can try:

1)   Make a list of all the stressors going on in your life. Brainstorm every little thing, even if it seems small. Little things (like an annoying smell) can actually create a lot more stress than actually realize. Doing this exercise can help you actually identify the extent of your stressors. Some people find it quite validating.

2)   Identify if there have been recent changes, losses, or shifts in relationships or life situations that have been hard on you. Sometimes these things seem subtle; such as no longer being able to have lunch with a friend who is suddenly preoccupied with something else in his/her life. This person may have a good reason to stop meeting with you, but the interactions and what they meant to you are suddenly no longer available. This naturally may elicit sadness.

3)   Consider if your environment tends to diminish, dismiss, or ignore your requests to be heard, get your point across, or communicate what you feel. Sometimes people end up in pretty harsh environments and then blame themselves when others ignore or dismiss them.

4)   Even if you can’t figure out why, try focusing instead on the what. What you feel is experienced in your body. A tightness in the chest, a pit at the bottom or your stomach, or a sense of restlessness and agitation are all feelings. When you focus on the what, try to make space for the experience of your feelings to simply exist, without you trying to change them. Your feelings are probably trying to tell you something! This is the opposite of what you do when you can’t figure out why (i.e., ruminate endlessly, suppress feelings, and try to talk yourself out of experiencing what is felt). Give yourself the opportunity to simply allow feelings to be-without a wordy, logistical, or rational explanation.

 

Three things you need to know about anger: Is it mentally “healthy”?

The problem with figuring out if anger is “good” or “bad”; “healthy” or “unhealthy” doesn’t allow any opportunity to figure out what anger does, how it works, and why it makes sense.

Think of your living room couch. Is it a “good” couch or a “bad” couch? Wouldn’t it sort of depend on a bunch of different things- such as comfort, style, how old the couch is, how many people can fit on the couch, or if the couch actually suits you? Usually if a couch has a use, serves a purpose, or does what it is supposed to it is considered valuable. While it is possible that you are sick of your living room couch- perhaps you think it is time to get a new one- your couch may be necessary to hang on to for now. On the flip side, you may be very happy with your living room couch. This could make it more likeable and increase your tendency to say, “It is a good couch.”

Emotions- like anger- are like couches. Instead of thinking about anger as being “good” or “bad”, it is more important to consider the following:

How is anger serving a purpose, fulfilling a function, or doing something useful? Anger can function to communicate, get someone to back off or change behavior, or change a situation for the better. Think of it like a red flag, a signal, or a message.

Is the way in which the expression of anger is effective? In other words, is the way you communicate your anger working for you?  What a person can make use of their anger by being aware of it (experiencing, tolerating, and understanding what it does for them) it increases the opportunity for effective expression (ie, another person heard, understood, and responded accordingly). On the other side, ranting or attacking often hurts relationships and doesn’t always send a clear message about expectations or desired change.

What are the relationship consequences for how the anger is being expressed? Relationships at some point might undergo rifts, misunderstandings, and irritation. The ability for people to tolerate these things in relationships sometimes help people grow, initiate important discussions, and bring about change or intimacy. On the other hand, anger that is overly intense can damage relationships, hurt other people, or add insult to injury.

Why does my teenager cut? A brief guide to understanding self-injury in adolescents

First of all, I’m going to say that focusing on the why this behavior occurs is probably not the most effective approach to addressing adolescent self-harm. I’ll give you some reasons why teenagers self-harm in a minute, but the one fallacy that people often have is that if they could explain why behavior occurs, then they would actually have the tools to fix or change it.  More specifically, teenagers who may not understand the behavior themselves can often be put in an awkward situation in which they are forced to explain the unexplainable. If they don’t understand why the behavior is occurring in the first place, they may end up giving inaccurate reasons simply to appease their environment.

Self-harm behaviors likely have something to do with emotional pain. Possibilities include ways to control feelings, ways to control oneself or one’s behavior, ways to increase intensity of feeling (ie, the need to feel “real” or the need to feel “something”), or ways to decrease intensity of feeling (“If I didn’t cut I wouldn’t have been able to tolerate the situation”). Understanding how emotions work and what they do for people may is critical in understanding the role of self-harm behavior. For instance, feelings are functional in that they give useful information about what matters to us, communicate to ourselves and others, and help us become organized and prepare for action. Without feelings we just wouldn’t care.

In adolescence, self-harm behaviors may play a role in identity, communication, and intimacy. Self-harm may be kept very private or it may be made public. It may be an attempt at controlling one’s environment or letting someone else know that the person doing the self-harm cannot be controlled. The function of the behaviors may communicate to oneself (I know I matter, I know what I have to say is important, I can’t stand by and let nothing happen, I am not pleased by the situation, This is my way of making a statement), or to others (Back off, This is too much, I can control your reactions, I know you will be upset and freak out, There is nothing you can do about this, You can’t claim to know me, You think you know everything and you don’t).

Treatments for self-injury are not as simple as publicizing behavior (ie, making sure that others know about it), invading privacy by doing body checks, or just stopping doing it. If there was no benefit to doing it, no one would do it! That’s just simply how it works. Knowing the benefit can help someone to organize an effective solution. Teenagers who can obtain help in identifying, accurately labeling, understanding, and communicating their feelings effectively will have more options for what they can do when the urges to self harm show up. Increasing options, understanding the short and long term consequences of this behavior, and providing alternatives for how to tolerate intense, painful, and negative emotions is certainly one way to start.

It’s important to remember that teenagers also have their own feelings about this behavior. Some are opposed to changing it, some don’t want anyone to know about it, some want everyone to know about it, and some feel really hopeless that they can’t stop doing it. Most have some degree of mixed feelings. Assuming and communicating that a teenager simply doesn’t want to change is probably not going to help solve the situation. While it might be a likely, blaming a teenager for doing it usually only serves to communicate a parent’s frustration.

Similarly so, parents have their own feelings about it and may feel disgusted, hopeless, overwhelmed, inadequate, or guilty. How parents communicate and address painful emotion will also impact the situation; and thinking through the effectiveness and intensity of one’s own responses may be part of the work involved in addressing teen behavior.

I think it is important to consider that the problem of self-harm behavior has solutions. Sometimes providers, teachers, parents, and community react with an abject horror that stirs the pot, gets everyone all worked up, and in some cases emphasizes the solution (self-harm) and not the problem itself. Emotional problem solving is really just that- emotional problem solving. If a person can figure out how to problem solve (ie, address, tolerate, understand, deal with, validate, survive) painful emotions, then their way of solving problems (ie, self-harm) may decrease. Finding effective solutions means having an adequate way to assess and address these behaviors with a skilled professional who understands the role that these behaviors serve.