Posts Tagged ‘Cognitive Therapy’

How You Think, How You Feel

November 18, 2019

This title of this post is identical to the title of a chapter in a book by Martin Seligman, Ph.D., titled Learned Optimism: How to Change Your Mind and Your Life. This is the fourth post on this book. By the late 1960s Joseph Wolpe and Tim Beck had drawn the same conclusion about depression. The conclusion was that depression is nothing more than its symptoms. It is caused by conscious negative thoughts. There is no deep underlying disorder to be rooted out: not unresolved childhood conflicts, not unconscious anger. Emotion comes directly from what we think: Think “I am in danger” and you feel anxiety. Think “I am being trespassed against” and you feel anger. Think “Loss” and you feel sadness. HM would like to note that biological causes of depression should not be ruled out, but most psychological processes, with the exception of thinking, should be ruled out.

Rumination is having the same depressing thoughts over and over. It is called rumination because people are chewing over and over the same thoughts. Seligman writes that rumination combined with a pessimistic explanatory style is the recipe for severe depression. Seligman continues, “The difference between people whose learned helplessness disappears swiftly and people who suffer their symptoms for two weeks or more is usually simple: Members of the latter group have a pessimistic explanatory style, and a pessimistic explanatory style changes learned helplessness from brief and local to long-lasting and general. Learned helplessness becomes full-blown depression when the person who fails is a pessimist. In optimists, failure produces only brief demoralization.”

Seligman continues, “The key to this process is hope over hopelessness. Pessimistic explanatory style consists of certain kinds of explanations for bad events: personal (“It’s my fault”), permanent (It’s always going to be like this”), and pervasive (It’s going to undermine every aspect of my life.)

Seligman’s theory follows: “there is one particularly self-defeating way to think: making personal, permanent, and pervasive explanations for bad events.” People who have this most pessimistic of all styes are likely, once they fail, to have he symptoms of learned helplessness for a long time and across many endeavors, and to lose self-esteem. Such protracted learned helplessness amounts to depression. People who have a pessimistic explanatory style and suffer bad events will probably become depressed, whereas people who have an optimistic explanatory style and suffer bad events tend to resist depression.” Consequently, pessimism is a risk factor for depression in the same sense as smoking is a risk factor for lung cancer or being a hostile, hard-driving man is a risk factor for a heart attack.

Cognitive Therapy is an effective therapy for depression for the following reasons:

First, you learn to recognize the automatic thoughts flitting through your consciousness at the time you feel worst.

Second, you learn to dispute the automatic thoughts by marshaling contrary evidence.

Third, you learn to make different explanations, called reattributions, and use them to dispute your automatic thoughts.

Fourth, you learn how to distract yourself from depressing thoughts.

Fifth, you learn to recognize and question the depression-sowing assumptions governing so much of what you do.

The concluding section to this chapter is titled “Why Does Cognitive Therapy work? This section is presented in its entirety.

“There are two kinds of answers to this question. On a mechanical level, cognitive therapy works because it changes explanatory style from pessimistic to optimistic, and the change is permanent. It gives you a set of cognitive skills for talking to yourself when you fail. You can use these skills to stop depression from taking hold when failure strikes.

At a philosophical level, cognitive therapy works because it takes advantage of newly epitomized powers of the self. In an era when we believe the self can change itself, we will try to change habits of thought which used to seem as inevitable as sunrise. Cognitive therapy works in our era because it gives the self a set of techniques for changing itself. The self chooses to do this work out of self-interest, to make itself feel better.

Passion’s Slaves

March 13, 2018

Passion’s Slaves is the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” Since the time of Plato a sense of self-mastery, of being able to withstand the emotional storms that the buffeting of Fortune brings rather than being “passion’s slave,” has been praised as a virtue. The ancient Greek word for it was “sophrosyne.” Page DuBois, a Greek scholar translates it as “care and intelligence in conducting one’s life; a tempered balance and wisdom.” The Romans and the early Christian church called it “temperantia”, temperance, the restraining of emotional excess. The goal is balance, not emotional suppression. Aristotle observed, what is wanted is appropriate emotion, feeling proportionate to circumstance. The passions discussed in this post are anger and rage, worry and anxiety, and depression and melancholy.

Anger and Rage

The design of the brain means that we very often have little or no control over when we are swept by emotion, nor over what emotion it will be. However, we can have some say on how long an emotion will last. Consider the anatomy of rage. Say you are cut off in traffic by a driver. You think, “He could have hit me! That bastard—I can’t let him get away with that!” Your knuckles whiten as you tighten your hold on the steering wheel, which you regard as a surrogate for strangling his throat. You body mobilizes to fight not run—leaving you trembling, beads of sweat on your forehead, your heart pounding, the muscles in your face locked in a scowl.”

Compare that sequence of building rage with a more charitable line of thought toward the driver who cut you off. “Maybe he didn’t see me, or maybe he had some good reason for driving so carelessly, such as a medical emergency.” Such thoughts tempers anger with mercy or at least an open mind, short-circuiting the buildup of rage. Aristotle’s challenge is to have only appropriate anger reminds us, is that more often than not, our anger surges out of control. Benjamin Franklin put it well: “Anger is never without a reason, but seldom a good one.” There are different kinds of anger. The amygdala is a main source of the sudden spark of rage we feel at the driver whose carelessness endangers us. On the other end of emotional circuitry, the neocortex, most likely foments more calculated angers, such as cool-headed revenge or outrange at unfairness or injustice.

Rage seems to be the most intransigent of al the moods. Researcher Diana Tice found that anger is the mood people are worst at controlling. Anger is the most seductive of the negative emotions; the self-righteous inner monologue that propels it along fills the mind with the most convincing arguments for venting range. Unlike sadness, anger is energizing, even exhilarating. Anger’s persuasive power might explain why some views about it are so common: that anger is uncontrollable, or that it should not be controlled, and venting anger in “catharsis” is to the good. A contrasting view holds that anger can be prevented entirely. However, a careful reading of research findings suggests that all these common attitudes toward anger are misguided if not outright myths.

The train of angry thoughts that stokes anger is also potentially the key to one of the most powerful ways to defuse anger: undermining the convictions that are fueling the anger in the first case. The longer we ruminate about what has made us angry, the more “good reasons” and self-justification for being angry we can event. Brooding just fuels anger’s flames. Seeing things differently douses those flames. Tice found that reframing a situation more positively was one of the most potent ways to put anger to rest. Timing matters. The earlier in the anger cycle, the more effective. Anger can be completely short-circuited if the mitigating information comes before the anger is acted on.

The second way of de-escalating anger is cooling off physiologically by waiting out the adrenal surge in a setting where there are not likely to be further triggers for rage. This is a common way of dealing with anger according to Tice’s research. One such fairly effective strategy is going off to be alone while cooling down. People go for a drive or a walk. Of these two, the second is preferable. Exercise also works. Relaxation methods such as deep breathing and muscle relaxation, perhaps because they change the body’s physiology from the high arousal of anger to a low-arousal state, and perhaps too because they distract from whatever triggered the anger. [enter “Relaxation Response” into the search block of the healthy memory blog to find relevant posts].

However, a cooling-down period will not work if that time is used to pursue the train of anger-inducing thought, since each such though will trigger more cascades of anger.

Distractions like TV, movies, reading and the like work, but not shopping or eating.

Ventilation does not work. In fact there is a ventilation fallacy. Ventilation may feel satisfying, but it is counterproductive. Tice found that ventilating anger is one of the worst ways to cool down: outbursts of rage typically pump up the emotional brain’s arousal, leaving people feeling more angry not less.

Worry and Anxiety

Worrying is at the heart of all anxiety. The reaction that underlies worry is the vigilance for potential for potential danger that has, no doubt been essential for survival over the course of evolution. When fear triggers the emotional brain, part of the resulting anxiety fixates attention on the threat at hand, thus forcing the mind to obsess about how to handle it and ignore anything else. Worry is a rehearsal of what might go wrong and how to deal with it. The purpose of worrying is to come up with positive solutions for life’s perils by anticipating dangers before they arise.

Worrying becomes a problem with chronic repetitive worries that go on and on never getting nearer to a positive solution. Goleman writes that a “close analysis of chronic worry suggests that it has all the attributes of a low-grade emotional hijacking. Worries that seem to come from nowhere and are uncontrollable generate a study hum of anxiety, are impervious to reason and lock the worrier into a single, inflexible view of the topic of worry. When this cycle of worry intensifies and persists, it crosses over the line into a full-blown neural hijacking, the anxiety disorders: phobias, obsessions and compulsions, panic attacks.

For each disorder worry fixates in a distinct fashion: phobic anxieties rivet on the feared situation; obsessive disorders fixate on preventing some feared calamity; panic attacks can focus on fear of dying or on the prospect of having the anxiety attack itself.

Researchers have observed that anxiety comes in two forms: cognitive, or worrisome thoughts, and somatic, the physiological symptoms of anxiety, like sweating, a racing heart, or muscle tension. Insomniacs are suffering from anxiety attacks. Their main problem preventing them from sleeping were intrusive thoughts. No matter how sleepy they were, they could not stop worrying. The one technique that worked in helping them get to sleep was getting their minds off their worries, focusing instead on the sensations produced by a relaxation method. In summary, the worries could be stopped by shifting attention away.

Unfortunately, most worriers seem unable to do this. These worriers get a partial payoff from worrying that reinforces the habit. It seems that there is something positive in worries: worries are ways to deal with potential threats. When the work of worrying succeeds, it is to rehearse what those dangers are, and to reflect on ways to deal with them. But Goleman writes that worry doesn’t work that well. “New solutions and fresh ways of seeing a problem do not typically come from worrying, especially chronic worry. Instead of coming up with solutions to these potential problems, worriers typically simply ruminate on the danger itself, immersing themselves in a low-key way in the dread associated with it while staying in the same run of thought. Chronic worriers worry about a wide range of things, most of which have almost no chance of happening; they read dangers into life’s journey that others never notice.”

Still chronic worriers report that worrying helps them, and that their worries are self-perpetuating. So why should worry become what seems to amount to a mental addiction? Borkovec notes that the worry habit is reinforcing in the same sense that superstitions are. Since people worry about many things that have a very low probability of actually occurring, to the primitive limbic brain there appears to be something magical about it. “Like an amulet that wards off some anticipated evil, the worry psychologically gets the credit for preventing the danger it obsesses about.”

Borkovic discovered simple steps the can help even the most chronic worrier control the habit.

The first step is self-awareness, catching the worrisome episodes as near their beginning as possible. Borkovec trains people in this approach by first teaching them to monitor cues for anxiety, especially learning to identify situations that trigger worry, or the fleeting thoughts and images that initiate the worry, as well as the accompanying sensation of anxiety in the body. With practice people can identify the worries at an earlier and earlier point in the anxiety spiral. People also learn relaxation methods that they can apply at the moment they recognize the worry beginning, and practice the relaxation method daily so they will be able to use it on the spot. [Much has been written about relaxation in the healthy memory blog. Enter ‘relaxation’ into search block of the healthy memory blog.]

Goleman offers the following precaution: “for people with worries so severe they have flowered into phobia, obsessive-compulsive disorder, or paid disorder, it may be prudent—indeed a sign of self-awareness—to turn to medication to interrupt the cycle A retraining of the emotional circuitry through therapy is still called for, however, in order to lessen the likelihood that anxiety disorders will recur when medication is stopped.

Melancholy and Depression

The single mood people put most effort into shaking is sadness: Tice found that people are most inventive when it comes to trying to escape the blues. Melancholy like every other mood has its benefits. The sadness that a loss brings has certain effects: it closes down our interest in divisions and pleasures, focuses attention on what’s been lost, and saps our energy for starting new endeavors, hopefully for the time being. It causes a reflective retreat from life’s pursuits, and leaves us in a state to mourn the loss, mull over its meaning, and make the psychological adjustments and new plans to continue with out lives.

Although bereavement is useful, a full-blown depression is not. In a major depression, love is paralyzed: no new beginnings emerge. The very symptoms of severe depression place a life on hold. For most people psychotherapy can help as can medication.

The far more common sadness that at its upper limits becomes a “subclinical depression” is sometimes referred to as melancholy. This is a range of despondency that people can handle on their own, if they have the internal resources. Unfortunately, some of the strategies most often resorted to can backfire, leaving people feeling worse than before. One such strategy is staying alone. However, more often than not this only adds a sense of loneliness and isolation to the sadness.

Tice found the most popular tactic for battling depression is socializing. Going out to eat, to a ball game or movie. Doing something with friends or family. This works well if the effect is to get the person’s mind off his sadness.

One of the main determinants of whether a depressed mood will persist or lift is the degree to which people ruminate. Worrying about what’s depressing us seems to make the depression all the more intense and prolonged. In depression, worry takes several forms, all focusing on some aspect of the depression itself, such as how tired we feel, how little energy or motivation we have, or how little work we’re getting done. Typically this reflection is not accompanied by any concrete course of action that might alleviate the problem.

Cognitive therapy aimed at changing these thought patterns has been found in some studies to be on a pair with medication for treating mild clinical depression, and superior to medication in preventing the return of mild depression. Two strategies are particularly effective. One is to learn to challenge the thoughts at the center of rumination. The other is to purposely schedule pleasant, distracting events.

Tice found that aerobic exercise is one of the more effective tactics for lifting mild depression, as well as other bad moods. A caveat here is that the mood-lifting benefits of exercise work best for the lazy, those who don’t work out very much. For those with a daily exercise routine there is a reverse effect on mood: they start to feel bad on those days when they skip their workout. Exercise seems to work well because it changes the physiological state the mood evolves: depression is a low-arousal state, and aerobics pitches the body into high arousal. Relaxation techniques, which put the body into a low-arousal state work for anxiety, a high-arousal state, but not so well for depression.

Tice reports that a more constructive approach to mood-lifting is engineering a small triumph or easy success: tackling some long-delayed chore around the house of getting to some other duty they’ve been wanting to clear up. Lifts to self-image were also cheering, even if only in the form of getting dressed up or putting makeup.

One of the most potent antidotes is cognitive reframing. For example, stepping back and thinking about the ways a relationship wasn’t so great, and ways you and your partner were mismatched, seeing the loss in a more positive light is an antidote to sadness.

This post offers some tips for dealing with emotional problems. Should problems persist and become chronic, please see professional help. Should you ever fear that you are a danger to yourself or others, SEEK PROFESSIONAL HELP IMMEDIATELY. If necessary, go to an emergency room.

Focusing on Your Breathing

November 20, 2011

A short article1 in Scientific American Mind reported a couple of studies that demonstrated the benefits of focusing on your breathing. One study reported in the May issue of the International Journal of Psychophysiology and conducted at the Toho University School of Medicine in Japan taught research participants to breathe deeply into their abdomen and to focus on their breathing. They did this for 20 minutes. They reported fewer negative feelings. More of the mood-boosting neurotransmitter serotonin was found in their blood. The prefrontal cortex, an area associated with attention and high-level cognitive processing, exhibited more oxygenated hemoglobin.

Another study reported in the April issue of Cognitive Therapy and Research conducted at Ruhr University in Germany examined the effect focusing on breathing had on depression symptoms. The research participants were asked to stay in mindful contact with their breathing and to try to maintain continual awareness without letting their minds wander. During 18 minute trials the researchers asked the participants whether they were successful in doing so. Those who were successful reported less negative thinking, less rumination and fewer other symptoms of depression.

You can do this. You can sit up comfortably and breathe naturally (or deeply, if you prefer). Focus your attention on your breath and feel it in detail, in your nasal cavity, in your chest, and in your abdomen. Don’t be critical if your mind wanders, just try to refocus. With practice, you should improve your ability to stay focused. Try to build up to 20 minutes. Once you become skillful, even a few minutes of this mindful breathing can help you become more calm and collected.

See the Healthymemory Blog Post “The Benefits of Meditation,” for more information. It does not appear that you need to be a Buddhist monk to benefit from meditation. It is thought that even very short periods of meditation can be beneficial.

1Rodriguex, T. (2011). Therapy in the Air. Scientific American Mind, November/December, p. 16.