Category: Triggers

Depression - Dealing with and Taming the Beast Within

7/14/2014

I think I mentioned this story in another post, but I'll tell it here again because I really like the analogy. This was written by a teenage girl who had been dealing with chronic depression. She wrote that it starts with having a bad day. Everyone has bad days, though, right? You don't think about it too much, and go on living your life. Ok, so you have a few more bad days mixed in here and there, but again - everyone has bad days, so it's nothing to really worry about...Then you realize that you're having more bad days than not, but you don't want to think about it because it might jinx you and bring on more bad days - everyone knows that if you let it get to you, then it gets worse, right? So...finally you realize that the bad days are winning - you feel awful, life doesn't seem to have a whole lot of purpose and the future looks bleak. You realize that the beast has caught up with you again, and that you're depressed.

Depression feels like a heavy weight, a wet blanket, and day upon day of lousy weather all rolled into one. AND, it's more than that. To use the example of an antidepressant commercial, depression hurts in a lot of ways - physically, emotionally, mentally, and interpersonally. You feel rotten, it's hard to think clearly and/or move, life sucks and nobody around you seems to understand or care, or care enough. You feel like things will never change or get better. It's bleak.

I'm not going to lie and say there's an easy way out - there isn't. Honestly, what I've found works the best is a combination of medication and psychotherapy, and I'll tell you why. From what I've seen, it's like fixing a house with a cracked foundation. Having the foundation cracked doesn't mean that the house is broken or useless - far from it. It means that some repair work needs to be done, and that the house can be and is worthy of saving.

So...to begin the repairs, you first have to shore up the house, right? Using medications is like shoring up the foundation - it helps get the biological, chemical piece working again so you can get at the root cause and work on that. That's where psychotherapy comes in. Even if there is no deep, dark past to examine, therapy can help you figure out what triggers depression for you, how to recognize it and the warning signs, how to cope when it hits, and how to let other people know how to help you. Therapy also gives you a chance to really let loose and talk about what it's like to feel and deal with depression - with someone who's not going to judge you, tell you to "pull yourself out of it," or try to fix your problems for you. It will give you someone to talk to, who's got some training in how to deal with it, and can help you develop and practice skills for dealing with it.

Now, that said, I realize that for some people depression is more biochemical than anything else - therapy can help you too, though - in the ways I mentioned above. If you do happen to have things in your past that are affecting your mood, therapy will almost certainly help you with that - but you don't have to have had trauma, abuse, or other painful past experiences in order to benefit from therapy.

Ok, before I start sounding too much like an informercial...what can you do on your own? As trite as it sounds, I usually recommend that people start at the beginning. Accept the reality that you're dealing with depression. For some people, that alone is a huge step - there is still stigma out there about "mental illness" and many people don't understand what depression is, or how it affects you. So, accept reality and then realize you have a choice in how you're going to deal with it. (Yeah, I'm taking a page from my DBT training - radical acceptance again!)

Dealing with depression takes a LOT of energy. Depression is a condition that saps your strength - emotionally and physically. It feels sometimes like you're trying to slog through thick, sticky mud and is every bit as exhausting. You can choose, though, whether you're going to stay in it or not, and there are consequences either way.

Choosing to try to move out of it means choosing that you're going to move, even if it's just a little bit. It's a form of opposite action. It may mean something as simple as getting up and taking a shower, or making yourself go outside for a few minutes.I tell the people I work with that I don't underestimate how much of an accomplishment getting out of bed is. It might be the only major movement someone has made in days or weeks. Moving may mean more - calling a friend, a doctor, or someone you trust and asking for help (and believe me, I know that's HUGE.) Either way - if you're going to choose to deal with it, it means YOU have to do something. And, as I always say (and mean), seeking help really is a sign of strength, and not a weakness in any way, shape, or form. Moving - and then moving consistently are important parts of this process.

If you choose not to deal with it, then you have to be willing to take those consequences - it may mean that someone else has to make decisions for you, if you're not able to do so. It may mean giving up some control so that someone can get help for you...it may even mean hospitalization for some.

One thing I want to make crystal clear here is that I don't think that being hospitalized is shameful. In fact, I believe that it's helpful, and that getting well and being able to function is the goal - and I realize that there are many of you who disagree with me, and I respect your right to do so. After all - I'm not walking in your shoes. However, if you're not able to or are unwilling to make decisions for your care - or if you're self-harming or threatening to self-harm, hospitalization is a possible outcome for your safety and well-being.

The point of all this is that I'm assuming you don't want to deal with feeling depressed. You can't control what's coded in your genes, but you can choose how you're going to deal with it. And I'm not saying that positive thinking, affirmations, etc. are going to magically pull you out of it. These may help, but depression is a lot more complicated than just negative thinking. You can choose to shore up your foundation with meds, or you can choose not to. You can choose to use therapy, or not. You can choose a combination of the two - the point is, you have a choice.

When you're in the throes of a major depression, it may not feel like you have any choices, or that no matter what you do it's not going to work. This is where you have to use your active trust - your emotions are not necessarily giving you the best information, and you may have to let your head overrule your heart on this one. Get help if you need it, and help yourself. Depression is nothing to be ashamed of, any more than kidney disease or diabetes is. It's a treatable condition, and there is hope.

Does getting help mean it's going away for good? For some people, maybe...for others it means that the beast is pushed away again for a while, but will keep following you. For you...well, learning about your triggers, symptoms, etc will help you. Learning this stuff also helps you feel more in control and stronger - nice side effect, huh? One great program, developed by a lady who both does therapy and has bipolar disorder is called the "WRAP program."

WRAP (Wellness Recovery Action Plan) is a system that helps you recognize your triggers and symptoms, and put into place a plan to help yourself feel better. If that plan doesn't work, WRAP also helps you develop a plan that tells who you want involved in your care, how you want to be treated, and who can make decisions for you. It's a great system, and Mary Ellen Copeland (the creator) has some great articles on her website: www.mentalhealthrecovery.com. The purpose of WRAP? "Getting well and staying well." Copeland is also the author of several wonderful self-help books/workbooks for coping with depression and manic-depression - her work is widely respected and used. (I highly recommend her books both to clients and non-clients.)

So, bottom line is that even if it feels like there is nothing you can do or that nothing you do works or has an effect, there ARE things that will help. Talking to a therapist (heck, talking to someone you trust, period!), working with medications, using some great self-help resources, and your own strength all help. (And yes, you ARE strong - it takes a lot of energy to deal with this!) Cognitive behavioral therapy is one route that seems to help a lot of people - Copeland's books actually use a lot of CBT-style work. DBT skills help too - trying them won't hurt, and you have a lot to possibly gain.

Just remember - you're not alone, even if it may feel that way. There are many, many people who are dealing with and have dealt with depression. I have tremendous respect and admiration for those of you dealing with this, whatever the root cause may be. It takes a lot of energy and strength, and pulling yourself out takes even more. You're not alone - really.

As Always:

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, or are thinking about hurting yourself, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com

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You Are Not Your Mood

7/14/2014

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Emotions are weird. They have a way of changing so fast we hardly know what hit us, and they can change our outlook on a situation, person or perception nearly as quickly. It helps to remember that as much as our emotions affect us, they do not define us. We are more than our emotions.

A few months ago, I struggled with this. I was feeling down - I was being impatient and it seemed like nothing was going right. Now, if you've been reading these blogs, you know as well as I do, that this is not the case. Red Flag #1 - feeling down about things does NOT mean that the feeling is reality. Ok, good enough - and I was still feeling lousy.

So, I thought...if I were the client, what would I be doing in therapy? (Yeah, I know... I'm a therapy geek.) Most likely, I'd be looking at the situation and testing out whether my emotions were really reflecting reality, or whether they were masking reality. How do you do this?

Marsha Linehan has a really cool tool that she uses in DBT called "chain analysis." You start with the event, behavior or situation that was the problem. In my case, I looked back to when I started feeling down, and the even had nothing to do with what seemed to be the situation. I was feeling lonely on the afternoon before, because I couldn't reach my family members to talk. That spiraled into feeling somewhat depressed. Specifically, I remember thinking, "I guess no one wants to talk to me. I might as well not exist." Red Flag #2: I was getting caught up in "Stinkin' Thinking."

In doing a chain analysis, you identify the event/situation that started the problem, describe the event, including what you were feeling and/or thinking at the time or what you did as a result of what you felt, and then describe how intensely you behaved, thought, or felt. In my case, the loneliness, sense of failure and depression were pretty strong. I ended up thinking, "I"m never going to be able to do this. I might as well just quit." Red Flag #3 - Stinkin' Thinking again. The idea here is that you want to describe all this in as much detail as you possibly can. Here's a good litmus test: Could someone recreate *exactly* what you went through? If so, then you've done it.

Next, you describe what led up to the feeling, thoughts, or behavior. In my case, not being able to talk to someone was the situation. This "precipitating event" (also called a "prompting event") is usually what we point to when we say that "such and such" caused the problem.

From here, you do a detailed description of all the things that affected the situation - Linehan calls them "vulnerability factors." In my case, I was tired from not sleeping well, I still had an annoying cough from a cold and didn't feel well, I was stressed by all the details stemming from running a new business as well as being worried about several emotionally intense client situations. I was overwhelmed, tired and not feeling good. I was also feeling emotionally exhausted by family situations and childcare issues.

Ok, here's where chain analysis gets tedious - you describle in minute, excruciatingly clear detail the chain of events - starting with the all the way at the beginning with precipitating event(s) and going all the way to the consequences. Ok - here goes: I called my mother and got her answering machine. I then called each of my sisters in turn and had the same result. I started feeling like I didn't matter. I called my husband, who was out at the park with our kids, and he didn't pick up. I started feeling depressed, and went to work on my task list for this week concerning my business and the paperwork I had to complete. Looking at the things I had to do, I felt overwhelmed and incompetent, and felt more depressed. I remember thinking, "Why bother?" and which led to a deeper negative mood. The consequences were that I was not present when my husband did come home and wanted to talk. Right then, I just wanted to be left alone to marinate in my own misery.

At that point, I recognized what was going on, and took steps to counteract the mood. The last step in the process is to describe in detail a prevention strategy and what you are going to do to repair negative consequences that resulted from your behavior or mood. In my case, my prevention strategy was stay mindful of my moods and to write. Writing in my journal, for me, is a safe place to vent and analyze what's going on. When I write, I feel better and so that's a good strategy for me to use. I can also go for a walk, and/or do something artistic. I could take a bubble bath, or have a hot cup of tea. Those are all things that help me - developing a list of what helps you will help you have something to turn to when you get feeling low. Nurturing and caring for yourself really IS important and necessary.

Luckily, the interpersonal consequences here were small. I went upstairs and apologized to my husband, and explained what was going on. I also told him that I needed some extra time to myself to write and sort out the depressed feelings.

If you're interested in more information on doing a chain analysis, you can go to a great website called DBT Self Help (www.dbtselfhelp.com) to get an idea of what this might look like in therapy or in practice. This website has an incredible array of tools, worksheets, handouts and articles.

Hope this helps - DBT helps with a lot of things - I highly recommend looking into it. Even if you don't go for it, learning about these coping tools and other tools available to you can help you get through these tough situations.

As Always:

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com

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It's the Little Things...

7/14/2014

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Have you ever noticed how something small can be a "tipping point" that changes your day from "good" to "bad" in an instant? It can be a critical comment from someone at work, or a family member saying or doing something that makes you pause and think, "Wow...that was out of line." It can be something impersonal, like getting flipped off or cut off in traffic because someone else is in a hurry and not driving carefully...there are any number of things that can really mess up our day, and leave us feeling drained, irritated and/or angry, and feeling like everything's going downhill.

Frankly, it sucks. We've all been there, and know what it's like. I'm not going to lie and say I never get stuck in it. It's easy to let things add up and take over, and may feel like we're riding a wild, out-of-control, roller coaster. So, what do you do? Well...as usual, there are some answers and tips from the therapeutic couch that may help. These aren't necessarily the only things you can do, or "THE ULTIMATE COSMIC ANSWER" - rather, they're things you can try to help YOU feel better. Unfortunately, there's no magic wand to change the world around you, and we can't make your husband/kid/boss/coworker/"idiot on the road" change. That's just beyond our control. (In therapy I sometimes take a kid's pretend magic want, whap it on the table or chair and say, "See? It's broken - it doesn't work! NOW what do we do?")

Well...now what do we do? The first thing, in my experience, is to try and separate yourself from what's going on. You can't make your boss be nice, or make that person on the road or in the grocery store be polite and reasonable. You can't make your family members stop making comments about your appearance. However, you can set up some good boundaries and realize that you don't have to allow them to get you upset. I'll fully admit, though - some situations are easier to do this with than are others.

Easier said than done, isn't it? Trust me, I know - from tons of personal experience myself. And yet, it's important to know what's your stuff and what's their stuff. (Remember the definition of a boundary? It's where you end and I begin.) Eastern faith traditions call this compassionate detachment - you can look at what's going on and realize (or even say to yourself) that "this is what's going on for him or her. If I have something to apologize for, I can do it. But their anger or their irritation is NOT me."

It sounds a little weird, I'll admit. And it does take practice to become a habit. But if you think about it, it's incredibly freeing to realize that you're not responsible for someone else's anger, or even their feelings in general. Now, don't get me wrong - certainly what we say or do affects the way other people feel - this isn't a "get out of jail free" card to say or do whatever you want. In fact, our actions can be the tipping point for someone else - so it pays to watch what you say and do as well.

Anyway - realizing that you are separate from someone else's emotional reaction can help you deal with what's going on in a more rational "wise mind" kind of way. (If you don't know what "wise mind" is, see the post for DBT Skills, Part 1 )

So, knowing what's you and what isn't you helps. Another trick from the DBT bag is to try "opposite action" - this is where you do the exact opposite of what you want to do (part of the DBT Emotion Regulation skills). I know...it sounds hard, and it is. When you want to spit back a sarcastic response, you instead say something nice. "Thanks for your input. I hope you have a great day from here on." It might be the last thing in the world that you want to do - and it does help. You'll have to trust me on this one - but think of it this way - if nothing else, it confuses the heck out of the other person!

Another thing to do is just take a quick breathing break - practice distress tolerance skills (another DBT post: Distress Tolerance Skills) or relaxation and stress reduction skills: breathing, distracting yourself, self-soothing (a coffee or tea break can work wonders), a little bit of exercise (say a walk at lunch), or anything that helps you feel better (and doesn't harm anyone - including the person who ticked you off to start with ;p ). All these things can help. Finally - all the CBT stuff I talked about earlier will also help.

These may not completely turn around your day, but they can help you feel better. The key point is to remember that you don't have to let someone else's bad mood or bad day ruin yours. So...have a great day, and remember that someone out here is rooting for you!

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com

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CBT: Dealing with Stinkin' Thinkin' and The Shoulds

7/14/2014

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Ok - in the last post, we ended on kind of a "down" note (reminds me of "The Empire Strikes Back - who wanted it to end with Han Solo getting iced and Luke losing his hand? C'MON!) Anyway - back to CBT...

In this post, we're going to talk about what to DO with these shoulds, absolutes, and other negative thought patterns that get in our way. CBT is, as I've mentioned, a very flexible orientation, and there are many systems of therapy that are based in CBT concepts (like DBT, for example.) So, instead of going into a whole lot of specific techniques based in one system, I'm going to touch on some general techniques that you'll find a lot of CBT therapists using. I've mentioned a few of them in the first post, but I'll review those here again.

One thing I mentioned in the first CBT post bears repeating again: this is NOT a "quick fix" solution to problems. These techniques, and change itself require commitment to practicing the techniques and to changing the way you think and interpret things. This takes time, and does not happen overnight. CBT has been accused also of being a feel-good way of saying that if you think happy you'll be happy. While this criticism has some merit, it's just not that simple. CBT does assert that if you change the way you think, you'll likely feel somewhat better, but does not promise results (like any therapy) and is way more complex than the simple "if you think better you'll feel better" platitude.

Ok - on to the nuts and bolts again. When you're involved in doing CBT or going through one of the many CBT-based workbooks you can find in the self-help section, you will see that there are many commonalities. First, you are likely to be asked to either talk about what the problem is (to help the therapist understand your interpretations and perceptions as well as your thought patterns) and/or fill out some paper-pen type questionnaires (called "inventories" in the clinical field.). These inventories will ask about a variety of symptoms (to help therapist or you get a handle on what's going on.) For example, if you come in thinking or feeling depressed, you might be given something called the "BDI" (Beck Depression Inventory - guess who developed that? ) This questionnaire asks you to rate the severity of common depressive symptoms that you might be experiencing. There are other inventories and symptom checklists that are useful as well. Well and good, so when do we get to the CBT stuff?

A-ha...remember the "B" part of CBT? That stands for "behavior" - in order to work well here, your therapist (or you, if you're working in a workbook) needs to know what you're experiencing and doing, as well as what you're thinking. There really is a reason behind the stuff we do - promise! How we act often reflects the way we're thinking - we interpret things, we feel an emotion related to the interpretation, and we act based on the interpretation and the emotion. Ok...so you've filled out the inventories, done all the paper work, described the situations and what you've been feeling - now what? That's where the "behavior" part - what we do - comes in. A lot of the "homework" and activities in CBT is, quite frankly, behavioral.

Here's where the workbooks and being in therapy differ some. The workbooks will go straight into the things that we typically call "homework," where a therapist will explore the situations more in-depth, provide support, and help you see and work with the stuff that brought you in. This is why I really recommend therapy (ok - I'm biased, too - I admit it). The workbooks can be really valuable resources; I use them myself as part of the work I do with clients sometimes. I've recommended them to clients, and I use them in session, when appropriate - they make my job easier because I don't have to reinvent the wheel here in terms of homework. BUT, they don't provide you with that ongoing sense of support and empathy that you get with a well-trained therapist. It's a choice you make, though.

When you're working with a therapist, the therapist will help you identify the thought patterns that are getting in the way for you - are you thinking in absolutist terms? Are you overwhelmed by "shoulds"? What about feeling like everyone should like you - or that you should do everything to make people like you? You get the idea...the therapist will spend time talking with you and helping you identify where your thinking and/or interpreting get in the way of you feeling better. The workbooks may have you answer a lot of fill-in-the-blank questions or do a lot of sentence completions, but the goals are the same: helping you identify the types of negative thinking or interpreting that are not helping you.

Typical homework assignments include keeping a record of your thoughts and how those thoughts affected your emotions and behavior, or keeping track of how many times you catch yourself sliding into one kind of thought pattern. There are also behavioral challenges or assignments to help you practice a new way of interacting with and intepreting the world around you. I once kept track for a week of all my "shoulds" - I filled an entire 70-page mini-notebook! It's really eye-opening when you realize how often we engage in these ways of thinking, and how much they affect our moods and behavior - which is, of course, the point of the exercise!

Next, what may happen is that you may be asked to work on contradicting or "softening" these patterns. For example, if you're overly harsh with yourself, you might be asked to come up with thoughts or phrases or sentences to tell yourself that are loving, accepting and/or nonjudgmental. If you're stuck in a pattern where you're overgeneralizing things or magnifying/minimizing, you might be asked to come up more realistic interpretations. Many times, some of this work is done in the therapy room with the therapist helping you, because for many people in therapy these thought patterns have become habits. It may have happened out of ongoing abuse or neglect - these patterns are likely part of what helped you survive, or it may be something that's resulted from some situational things going on like, "I've been out of work for a year, and I'm worried I may not have enought money left to meet my or my family's basic needs" or "I can't seem to get myself to feel better even though it's been two years since my great-aunt Clara passed away".

Situations have a LOT of power - we tend to interpret our stuff in terms of the situation ("I was speeding because I needed to get home to a sick child") but we tend not to give others the same benefit of the doubt ("They were speeding...what jerks. I bet they cut everyone off and run red lights too"). As a side note: If you've taken introductory psychology, you'll probably recognize a few concepts here: self-serving bias, fundamental attribution error, actor-observer effect...

So, your therapist may use some gentle challenges, some reflecting, some humor (when appropriate), summations, "check-ins" (making sure they understand what you're telling them), etc. In therapy, you may also use some of the "workbook techniques" - they're very useful as homework.

With both the workbooks and in therapy, you'll also examine what triggers the thoughts, the emotions, and the behaviors - you may find that a certain style of thinking or way of interpreting things is behind the way you feel or behave. Or it may be something in your environment - a certain authority figure that reminds you of someone in your past who'd been critical, or a certain place, smell, sound that triggers memories and experiences from a a traumatic event - it's hard (or even impossible) to think clearly and well when you're re-experiencing something traumatic. (Here's where working with a therapist is really helpful - the therapist can help with the PTSD symptoms as well as the cognitive stuff.) From there, you can work to change, heal and hopefully start to feel better.

One thing I want to say about triggers: If you're dealing with PTSD or things that trigger severe emotional distress, please see a therapist. The therapist can provide a safety net where you can work on and process these triggers, and can again provide support for you while you're working on these. Any time you're dealing with severe or chronic emotional distress, it's best to see a professional who can do more than anything you'd find in a workbook or web site. A therapist can also help you go more in-depth and safely explore the event(s) or trauma behind the triggers. Workbooks and web-sites can provide tremendous support and information, and they don't take the place of a really good therapist. I don't want to diss support groupgs and websites - they are incredible and filled with fantastic people who have been through, treated or supported people through some pretty traumatic stuff. However, if you're in the throes of serious distress, adding a good therapist to that mix will only help you.

Ok - back to nuts and bolts: Another area you'll want to concentrate on, again with both the self-help stuff and in therapy, is what to do to help you maintain any changes you make and/or improve on them. Changing things in your lifestyle may help (for example, if you're dealing with depression, building in some exercise into your routine will likely help you feel better), as would continuing to use some of the tools you've used in therapy (like the mood log, or examining realistic vs unrealistic thinking). These aspects of therapy or self-help can help you manage situations in the moment and help you realistically process and think about them afterward.

The nice thing about CBT is that what you do and how you do it really is individualized. It's not about unconscious motives, Oedipus complexes, penis envy or any of that - it's about what YOU can do to help yourself think in a healthy manner, feel better and change your behaviors so that you're interacting with the world in a way that creates a better life for you. It's not a one-size-fits-all orientation either - CBT, through research, is always working to incorporate things that help and are validated by research. That said, sometimes it can seem "manualized" and "remote" - if this is the case, bring up how you're feeling about it in therapy, and process that with your therapist. If you're using a workbook, ask yourself what you're hoping to see in the workbook, and where you're missing what you wanted - then get recommendations for something new, or scale down your expectations and continue to work the program. (And expectations are a whole AREA of cognitions to work on, by the way!).

So...if you have questions about specific techniques, or want to know more about a specific area of cognitions and/or disorder where CBT may be helpful, feel free to comment or send me an email. I'm always happy to help, and answer all the comments and emails I get.

Take care and think well!

Please Note: The content on this blog is intended for informational purposes only. This is not therapy, and if you wish to work in therapy, please contact your local mental health agency or your physician for a referral.

If you are in crisis or danger, please call 911 for immediate help. Please, again, realize that seeking out help really IS a sign of strength and not a sign of weakness. You don’t have to be alone in facing these things – there are people who care and who will help. Email me at: thepowerofeachother@outlook.com

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Depression - Dealing with and Taming the Beast Within

You Are Not Your Mood

It's the Little Things...

CBT: Dealing with Stinkin' Thinkin' and The Shoulds

Laura Burlingame-Lee:

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