Showing posts with label cognitive therapy. Show all posts
Showing posts with label cognitive therapy. Show all posts

Saturday, March 2, 2013

How I Stay Sane, Part V: Monkey Mind


I just finished Daniel Smith’s short book “Monkey Mind:  A Memoir of Anxiety.”   It’s a vivid and often hilarious account of how one man has dealt with the challenges of severe anxiety for most of his life.  Since I have loved ones who struggle with anxiety and I myself have had a few alarming bouts with it, the book was illuminating in that it explored the actual thought progressions fanning the flames of anxiety as well as the particular approach, cognitive behavioral therapy (CBT), that the author found most helpful after many adventures in the land of counseling and psychotherapy.

I’ve also found that CBT is the best bet for squelching that series of unfortunate thoughts that gets irrational anxiety going.  When you’re in the grips of it, though, it is a huge effort to swim toward the surface, struggling against the riptide, and break through to the air, and BREATHE. And then offer logical counter-arguments to the thoughts attacking you, finding at least momentarily that holy grail of equilibrium that every anxious person seeks.

On the Friday morning before my February vacation as I drove down the last big hill to work, I went beyond my usual smile therapy (“fake it ‘til you make it” – simply smiling makes you feel better).  I went further and applied a little laughter yoga as I coasted down the hill:  “Hee hee hee, ho ho ho and a couple of ah hah hahs; that’s how we pass the day away in the merry old Land of Oz…”  Surprisingly, it felt really good.  Laughing at that moment was what my sister calls “the next right thing.”

Taking care of yourself in small ways, taking a break when you have to go to the bathroom (everybody who delays that to get “one more thing done” at work raise their hands), making yourself a cup of tea, breathing, having a piece of dark chocolate or a glass of wine, sitting by the ocean all day long in the cool breeze and eating green grapes and writing in your journal and reading junk fiction:  all next right things.

The voice in your head shrieks, “No time!  That’s selfish.  You don’t really need to do that.  What will people think?  What have you done with your life, you miserable, boring person?”  Oh my, that voice should be argued with and laughed at and ridiculed into submission because it is truly quite absurd.  Pushing back when you hear that voice is the next right thing.

Since I have been suffering from severe writer’s block for months and I also find that often my worst anxiety is about failing at work, I was interested to read Daniel Smith’s take on writing, work, and anxiety: 

Writers like to believe their job is tougher on the nerves than other jobs.  They like to pass around cool, pithy statements to this effect, like this one, from the screenwriter Gene Fowler:  ‘Writing is easy.  All you do is sit staring at a blank sheet of paper until drops of blood form on your forehead.’    Or this suspiciously similar one, from the sportswriter Red Smith:  ‘There’s nothing to writing.  All you do is sit down at a typewriter and open a vein.’  Or this one, from the poet Graycie Harmon:  ‘Being an author is like being in charge of your own personal insane asylum.’  I don’t subscribe to the exceptionalist school of writing, however.  It’s true that writing has psychological pitfalls—oppressive deadlines, poor pay, baring one’s soul to an indifferent world—but so do all jobs.  Even the imperative to make choice after choice without clear guidance—allegedly the most nerve-wracking part of the profession—isn’t exclusive to writing.  What is probably true is that, for reasons having to do with solitude and a high allowance for self-obsession, writing attracts a greater percentage of anxious people than other professions.  What is definitely true is that writers are better than other people at articulating their neuroses, and more dedicated to the task.

If you want to understand anxiety better, in yourself or somebody else, read “Monkey Mind,” but think carefully about recommending it to that anxious friend.    You may find that a chronically anxious person can’t bear to read it—because it just stirs up way too much (you guessed it) anxiety.  

Thursday, August 19, 2010

Been There, Shrunk That


At M’s recommendation I read an article in the NYT Sunday magazine called “My Life in Therapy” by Daphne Merkin, about one woman’s 40-year epic with psychotherapy—all her hopes for how it would fill the terrible holes in her psyche and finally give her the love and attention she never got enough of from parents and lovers. She describes a sometimes amusing, sometimes harrowing sampling of a wide range of therapies from age 10, including classic Freudian psychoanalysis which I frankly have no earthly use for since I’ve always believed it was demeaning and disrespectful to women (and probably men as well) and seemed more likely to keep people stuck in the past focusing on the inevitable imperfections of their childhoods.

My own experiences with therapy have been numerous. I too was taken to see a woman who was probably a psychiatrist when I was around 10 years old and had suddenly decided I hated school when previously I had loved it. The root cause for this was that I was having difficulties with arithmetic, and this was the first time in my brief school career that I had found anything in the classroom remotely difficult. However, I didn’t talk about this during my session. Instead, I told the attentive white-haired lady about the recurring dream I was having in which I was arguing with a talking skull, and how I had eventually learned in the dream to wake myself up by pushing the skull away with my hand and uttering a “bad word.”

“What was this bad word?” asked the psychiatrist.

“I can’t say it out loud.”

“You can say anything in here.”

“Shut up,” I said.

“Excuse me?” she responded with surprise, since up to this point I had been a very good little girl in the session.

“Shut up was the bad word—we’re not allowed to say ‘shut up’ at our house.” And indeed we weren’t—it was literally considered an unacceptable word in our household.

Later in my 20s and 30s I struggled with shifting moods and depression, and a few severe cases of a broken heart along with a profound fear of failing at school and later at work. I drifted from one therapist to another with little or no progress in my estimation. It was only the year after my mother died, in 1999, that I was forced by a vicious darkness of the soul to do real work in therapy in order to survive that grief and the several more that followed. My therapist then told me that there was no way out but through…and introduced me to the cognitive behavioral therapy. And from that point, I did find a few good therapists who helped me make some progress; I also began reading a large number of books on my own, centered around letting go of rumination about past and worry about future and focusing on living more in the present. And also paying more attention to that blathering negative voice in my head and how to step outside its influence and talk back to it (even telling it to “shut up” on occasion).

Can therapy be an addiction? This is suggested in Merkin’s article and it likely can be, but for me it was more like a journey that simply took a long time and that in the end was productive. It just takes time and experience to finally wake up and see through the fog to notice what’s really going on and how much power you hold in the search for serenity.

Daphne concludes the article with: “Therapy gave me a place to say things I could say nowhere else, express the feelings that would be laughed at or frowned upon in the outside world—and in so doing helped to alleviate the insistent pressure of my darker thoughts.” I agree—in other words, it helped me find my voice.

She also says therapy “provided a space for interior examination, an education in disillusioned realism that existed nowhere else in this cacophonous, frantic planet.” Agreed again—in other words, it helped me wake up.

What about your experiences with therapy good or bad?

Saturday, May 24, 2008

Loops

I’ve been thinking a lot lately about loops—defined particularly as circular repetitive thoughts in my head that cause anguish and prevent joy. In my case it is a loop-the-loop, really. The two loops are: 1) how can I keep the people I love happy and 2) how can I keep the people I love safe (read: alive). Yes, these are both noble thoughts in moderation, but the loop-the-loop comes in when I obsess on them. These people I love—they are all grownups now, so it is primarily (or solely) their job to keep themselves happy and safe. By the ways, sometimes the happy/safe goals are in conflict; just ask my 21-year-old rock-climbing devil-may-care son if you don’t understand this.

And so, I spend a lot of time in the loop-the-loop coming up with new schemes for keeping the people I love happy and safe. And many of these schemes are irrelevant, impractical, invasive, inconvenient, impossible, idiotic, irrational, ill-advised, or some other word beginning with “i.” So…here are the top ten ways to get out of an unproductive mental loop, or for the really unfortunate, a loop-the-loop:

Top 10 Ways to Escape a Loop

10. Switch to another line of thinking or get a new perspective. Change the subject. This is the basic principle behind “The Work” and “Feeling Good” or CBT (cognitive behavioral therapy) – see previous blogs on this. However, make sure the new line of thinking is not another loop.
9. Argue with the loop. Counter the loop. Find the flaws. Another principle behind “The Work” and “CBT” – but be sure the argument does not itself become a new, even more obsessive loop.
8. Do something physically demanding that requires effort and concentration to stop the loop. Clean out the fridge. Dig up the dandelions.
7. Write the loop down, and keep writing about it until the pain of writer’s cramp distracts you from the loop and you start to see beyond it.
6. Do something mentally demanding that requires enough concentration to stop the loop. A timed game of Scrabble is one example – have I mentioned Scrabulous lately?
5. Have a conversation with someone else (but not about your loop!). Really listen to them, even if it is about their loop, for a while. But don’t try to fix them or their loop, especially if that tendency is part of your loop.
4. Read a really good book (for example, murder mysteries and the Harry Potter books work well for me).
3. See a really good movie, preferably one in which people are not dwelling unproductively on their loops (perhaps the latest Indiana Jones movie – Roger Ebert loved it).
2. Perform a random act of kindness for a stranger. Pay it forward.
1. And the number one way you can get out of your loop – be aware that you are in a loop to begin with (this is the hardest part). Hint: if people are telling you that you are in a loop or mentioning concepts like broken records when in conversation with you, this is a strong indication that you are in a loop.

Comments? What is your loop? What is your last act of random kindness? (If you can’t remember, it’s been too long.)

Saturday, April 26, 2008

Digging Up Dead Thyme

Mark mentioned a conversation he had with our next door neighbor Jim while Mark was in the front yard “digging up dead thyme.” We both laughed at the irony of this phrase and agreed it should go in at least one of our journals; he told me that it was a gift to me and I should record it in mine. Why is the phrase so amusing? I suppose because I do spend a good deal of my time (hah!) thinking thinking thinking about past events, losses, things that could have gone better, mistakes and mysteries.

On the other hand, sometimes yard work has to be done to clear out dying vegetation and then it is quite necessary to “dig up dead thyme;” to finally understand what happened long ago and how it is influencing the present dream.

I just finished a book called “Loving What Is,” by Byron Katie, another book about accepting and living in the present. In this book, Katie (as she calls herself) talks about emerging from a deep depression with a sudden understanding of how to do “The Work” to look at the problems of life in a new way. She sums up the work as follows: “Make a judgment, write it down, ask four questions, turn it around.”

I make it sound a little simplistic or a little crazy, but what it does is make you look at a problem that is causing you great unhappiness and see it in a new light. This follows the same path as other approaches such as cognitive behavioral therapy and the Power of Now—the idea is to be mindful of the thinking that is causing suffering and to dispute or counter that thinking. When it works (and I have found that it can work), it can alleviate some of the suffering. It is a focus on the pure reality of now.

Telling someone else about it, however, in the hopes that you might help them alleviate their own suffering, is alas a very different matter and quite difficult to do. A person is not ready for this until they’re ready, and until they’re ready, it sounds off the wall, boring or both. (Hello? Still there?)

What are your experiences with techniques for changing your moods for the better? Feel free to post here. For my other blogs on this topic, see Sanity.

Thursday, May 31, 2007

Broken Record

Have you ever found yourself repeating the same story over and over again? If you say no, think again, because I think this tendency is part of the human condition. I’ve caught myself doing this with my closest family members and best friends—people who patiently listen to my stories and vents and are too courteous to tell me that I am repeating myself, again.

So I have a theory on why I (and other people) do this. I believe that in telling and retelling and retelling the story again and again, I am seeking resolution—some way to explain the sorrow or injustice or fear or pain at the center of the story, so that I can move on. But it’s like a broken record—it skips at the very same place and will keep repeating over and over again until I am able to take action by lifting up the needle and setting it down in another groove. (for those of you from generation whatever, see this link for the mechanics of phonograph records and needles.)

How, oh how, do you get to the next groove? That is the question.

You (and others if they get too tired of your repetition) can scream, “Stifle yourself!” at the first sign of broken record syndrome. But this does little or nothing to fix the problem...just as yelling at a skipping record album will not reset it to a new groove.

You have to finish the story. Explain it to yourself in a positive “I can move on now,” sort of way. Cognitive therapy is about this to some degree—hear the distorted thinking in your story (the catastrophic fear, the all-encompassing assumption, the unfounded guilt) and then offer yourself an counter-argument to keep it in perspective.

Suppose one of the repeating stories is about being a mother and making a mistake. Great mothers do make mistakes, because we are talking about on-the-job training here for one of the hardest jobs in the world, and nobody is perfect. Instead of going over and over the mistake you made, think of the ten things you did well as a mother recently—and write them down. Oh yes, you will come up with them once you get started. Because in all likelihood you are a good person, a good mother. Not perfect, but doing the best you can. This is what you would tell yourself if you could step outside and look back in.

And when someone else is being a broken record, help divert that person too—help him or her remember all the good things and finish the story in a positive way. As my Dad would have said, “I’d do it for a dog.”

Friday, December 15, 2006

How I Stay Sane, Part III - Feeling Good


Once during a therapy session I was asked what my goal for therapy was. “I just want to consistently feel good about myself,” I said. Easier said than done sometimes.

The book “Feeling Good” by David D. Burns, M.D. talks about the voices in your head. You know, the nasty little whispers and mutters about how you’re going to fail, you always fail, because you’re an impostor who inexplicably fell into this role of responsibility, certainly not because you earned it or know what you are doing, and everybody thinks you’re in over your head, etc. etc. etc.

Dr. Burns writes about a concept called “Cognitive Therapy.” The idea is that you can change how you feel by noticing and altering your thinking patterns. In particular, he recommends that you focus on forms of “distorted thinking.” For example, it is one thing to acknowledge that you have failed in some way (and ideally learn from the mistake and move on)—it is quite another to make the leap that you are a failure and to label yourself as a failure. This kind of exaggerated, catastrophic thinking is guaranteed to make you feel bad. If you can first recognize these types of feelings and then argue yourself out of them, you are on the way to feeling good.

Another kind of distorted thinking is “mind reading” – when you are sure that a friend, family member or co-worker is angry with you, or disappointed in you, or sad because of you, with no real evidence of this.

One of the ones I am an expert at is personalization – where I blame myself for things not in my realm of responsibility and take on ownership for all manner of things that have nothing to do with me. In other words, it is all about me – I knew it, I knew it.

Not only does Dr. Burns go over each of these types of “cognitive distortions,” but also he discusses in great detail, with lots of practical suggestions and worksheets, and stories and examples, how to fight off these “automatic thoughts” with rational responses – what I think of in my own case as “talking back to myself.” I strongly recommend this book – it has made a big different in how I respond to events in my life.