Feelings About Feelings

Some time ago I noticed a common problem, or perhaps I should say problem about problems, that many clients shared– People would be down on themselves for being depressed, or angry with themselves about their anger problems, or would worry too much about their anxiety. This, it seems to me, creates a “chasing your tail” mentality that makes it almost inevitable that you will spiral into the very emotion that is bothering you.

I suppose it’s also equally problematic to worry about depression, or be angry about anxiety,  but my purely unscientific observation has been that people tend to spiral in on a particular emotion.

My suggestion on how to break the spiral has always been to start by accepting the reality of the initial feeling: “I’m depressed. That’s how it is for right now.” This acceptance seems to make it easier to move on to the next feeling, even if the feeling is another negative feeling. We have to admit that sometimes life just plain sucks. Any student of statistics and probability will tell you that pure bad luck can sometimes pile up. But accepting the bad prevents (or at least minimizes) rumination, obsession, and general stuckness. It also, in my opinion, makes it possible to be open to the next positive emotion– perhaps in my time of trouble a friend or family member is supportive, or I take comfort in a little thing, like a beautiful sunset, or the friendship of a pet. Getting off the wheel of self-judgment is what opens us up to the next thing– makes emotional life an open system rather than a closed one.

Does it sound reasonable? Well, now there’s evidence. A study cited by the Center for Greater Good found that people who are better able to accept feeling bad end up having fewer mood disorder symptoms. Remember, we all have moods, ups & downs, and there’s no getting out of having bad days, or even bad months. If I’m struggling financially and it’s due to caring for a family member with a chronic illness, not feeling bad at least some of the time that would be very strange. I might be very resilient, have great family or community support, have a strong spiritual practice– and still feel negative moods. Bad things happen to good people. BUT the thing that, in my opinion, makes me much more likely to have a mood disorder is getting caught up in the spiral. The evidence in the article suggests that people who push away negative emotions (denial?) are also likely to have mood disorder symptoms down the line also. So perhaps it comes down to that old standby, acceptance.

image from http://a1.mzstatic.com

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Posted in Depression, Emotions, Feelings, happiness, mental health, Recovery, Renewal, Sadness, spirituality, Uncategorized | Tagged , , , | 3 Comments

Save That Relationship!

Just took a quick peek at a piece from https://greatergood.berkeley.edu/article/item/what_to_do_when_you_hate_the_one_you_love?utm_source=Greater+Good+Science+Center&utm_campaign=9536544767-EMAIL_CAMPAIGN_2017_07_12&utm_medium=email&utm_term=0_5ae73e326e-9536544767-51254567 and wanted to excerpt  my favorite part, as follows:

So how do you increase understanding during conflict? Here are seven suggestions for how to think and act to do so.

Older couple

1.Instead of asserting your own point of view, try to take your partner’s perspective. Make it your goal to understand why your partner feels the way they do.
2.Avoid the four horsemen of the apocalypse—criticism, defensiveness, contempt, and stonewalling.
3.Give your partner the benefit of the doubt. Assume that their intentions are not malicious.
4.Take a moment to reflect on your partner’s positive traits. You can even try some gratitude-inducing techniques.
5.Think of you and your partner as a team, rather than opponents. Your goal is to figure out together why you do not see eye-to-eye and find a solution; it is not to win the fight and prove your partner wrong.
6.Recognize that it won’t always be easy to follow these suggestions, especially if your partner isn’t playing by the same rules.
7.Give yourself a mantra to repeat when you start feeling angry to help you remember your goal—even something as simple as “be understanding.”

Some of the best stuff I have learned about working with couples trying to get the wrinkles out of relationships I learned from a couple who I worked with for a long time despite the high level of conflict in their relationship. I used to refer to them as the  “Killeachothers.” In fact, progress for them meant that they no longer engaged in mutual combat, but merely verbal conflict. They had one of the common problems that couples bring to counseling (from a process point of view): he wanted her to take care of her diabetes better and she wanted him to work on his substance abuse issues. They didn’t do many of the things on the list above. Criticism and defensiveness were big with them, and they frequently acted like opponents. But some of the other things they could do, such as reflecting on the other’s positive traits, and recognizing that change is hard, and they went back & forth on giving each other the benefit of the doubt versus thinking the other was being malicious. But after being brutally stuck for a long time, the thing that really got them moving toward change was a very simple communication drill. I will give it, but it is almost impossible to follow without a third party to act as a communication coach. It is as follows:

  1. First person says something in 25 words or less, but no conjunctions.  For people not into grammar, think of it as no ifs, ands, ors, or buts.
  2. Second person repeats it back, either verbatim or as understood.
  3. First person confirms that the message was correctly understood. (if not, go to step one– see below)
  4.  Second person then responds to the message in the initial format of 25 words or less, no conjunctions.
  5. First person repeats it back, either verbatim or as understood.
  6. Second person confirms message understood.
  7. repeat steps one through six to continue.

note to #3– If the first person says their message was not understood, they have to restate what they said, still using 25 word format, or otherwise clarify the initial statement in 25 words or less using no conjunctions.

People who are familiar with active listening will recognize this as being a very carefully controlled version. It works to smoke out people’s assumptions, interpretations, extrapolations, and plain old distortions. If we think of a normal conversation as being like a movie, this is a way to take it frame by frame– and see where things start to go wrong. The original post from Greater Good points out that people can have a high level of conflict, but if they feel the other understands them, the relationship can still work (my words).

If you want a simpler protocol to follow to reduce conflict & bad vibes while arguing, you can follow the one step laid down by Miss Manners (and a host of others):

  1. Don’t Interrupt. I would expound on this, but do I really need to?

Image from https://www.cdc.gov/aging/emergency/index.htm

Posted in arguing, behavioral health, communication, Couple communication, Couples and relationships, fighting | Tagged , | Leave a comment

Suicide Prevention Awareness Month

Did you know about National Suicide Prevention Week? I must confess that I didn’t, except for the fact that I work in an environment that raises awareness about things like this.  In fact, NAMI has expanded it to National Suicide Prevention Awareness Month.  Many people are not aware that suicide is the tenth leading cause of death in the U.S. While it is a high-ranked cause of death in younger people– who,after all, are relatively healthy and unlikely to die from thinks like stroke or heart disease, the rate of suicide is actually higher in older populations. Similarly, while reports of suicidal ideation are high in the 18-25 age group, the older groups have the higher rates of actually attempting suicide.

Regardless of what age group someone might be in, people do give signs that they may be suicidal, and there are things one can do to respond. The first point that I want to emphasize is that it’s better to talk about it than not. The link has a pretty good basic outline of how to help. I want to add a couple of thoughts based on having lost two cousins to suicide as well as having had many suicidal clients and having lost more than a couple.

No matter how lonely, isolated, and alone you may feel, there are people who care.

When I worked with a population of older, socially isolated, mentally ill, addicted, physically ill, poverty-stricken men– an extremely high risk group– every time someone died from suicide, afterwards there were always people who were saying, “If only I had known–” they would have been willing to be there for the person.  If you are the person considering suicide, don’t make the mistake of thinking/hoping people are mind readers.

Getting high is not going to help.

Again, from my work in addiction treatment, there were many people who would become suicidal when they drank or used drugs. The poster child was one client who really suffered more from alcoholism than depression. In fact, he was in treatment for a suicide attempt– jumping out of a window– which occurred in an alcoholic blackout. When he wasn’t drinking, he wasn’t even depressed. Another person I knew jumped out of a sixth floor window (and lived, with minor injuries) while intoxicated.  There are a lot of statistics out there, but I don’t want to go the number-wonk route in describing this. Getting high doesn’t help anybody’s judgment, and it doesn’t take a pack of researchers to verify it. If you’re making a life or death decision, getting twisted on anything won’t help. If you’re trying to get your nerve up to kill yourself, why not get your nerve up to talk to someone? It’s equally hard, sometimes, but…

If you’re in therapy, use your therapist– if not, get a therapist.

Therapists have spent many an hour exploring with people the most basic question of existence– life or death– and are far less inclined to panic when someone talks about suicide. It has famously been called “a permanent solution to a temporary problem.” This is not inevitably true, but  frequently is true. Depression makes it harder to think, and especially hard to see alternatives. Talk it over with someone if you’re thinking about suicide. There is always the National Suicide Prevention Lifeline– (800) 273-8255.

 

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Attraction in Real Life

When I started this blog I wanted to limit myself to original content, but I haven’t been posting lately & sometimes an item from somewhere else is just too good not to pass on.People using their mobile phones

NPR reported on computer dating versus speed dates/ and the result was that compared to face to face speed dating  a matching algorithm based on people filling out a questionnaire could not predict who would be attracted to each other. In fact, the algorithm had zero success . Many years ago, Dear Abby was right: take a class, get a volunteer job, join a church, support a cause–anything to bring you into contact with a different group of people.

The article points out that it’s a long road to travel from first attraction to a successful relationship, but we have to start somewhere before we travel the road. But really, think about it– haven’t we all known unlikely, but happy, couples?

What I will add to this from both personal and professional experience is that having too clear an idea of who you think will be the perfect mate can stop you from having a lovely time with someone who doesn’t fit your preconceived idea. There’s much more to be said about this but I don’t want to make a promise and not keep it.

Image http://www.bbc.com/news/magazine-31855389

 

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Don’t ask why

Just a quick note– https://image.freepik.com/free-icon/human-head-with-a-question-mark-inside_318-46475.png

I really mean, don’t ask why. It’s not an answerable question. Instead turn it into one or more of the following types of questions: who, what, where, when, or how. Now it’s an answerable question. You can get unstuck. You may not like the answers, but you’re more likely to find a way to take some kind of action, either external or internal, and get moving again.

Quick example– “Why do my relationships go down the tubes all the time?

This actually breaks down into a series of questions, none of which involve “why.”

  1. What do I do to get into relationships?
  2. What have my exes said when we broke up?
  3. How many of the relationships have ended because I dumped the other person?
  4. How long have the relationships I’ve gotten into lasted?
  5. Have I ever gotten into a relationship when my gut told me it wasn’t going to work out?
  6. Who am I attracted to? Are these unavailable-type people?
  7. What things do I stop doing, if this is the case, that made the relationship good, resulting in it going downhill when I stopped making that effort?
  8. What things can I change about me that will result in my feeling better whether or not I’m in a relationship?

I use the relationship example because it’s kind of a classic– we all question ourselves when relationships go sideways. But the basic technique could work on any question that starts out as a “why” question. Sometimes it turns into only one other question, sometimes a series of questions. Try the technique at home in your own time, or do it with a trained professional. It helps either way.

https://image.freepik.com/free-icon/exclamation-mark-in-a-circle_318-9577.jpg

images from freepik.com

 

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Medication Assisted Treatment for Opioid Addiction

Just got done reading an interesting piece on the headline topic on NPR website: http://www.npr.org/sections/health-shots/2017/06/12/523774660/a-drugmaker-tries-to-cash-in-on-the-opioid-epidemic-one-state-law-at-a-time

Apparently the makers of Vivitrol are lobbying hard to get states to use their product at the expense of other products. This is just a heads-up on the subject. These issues are, of course, controversial, but for the first thing to know is when laws are being made, who benefits and who doesn’t? I find it troubling, however, that a maker of a drug being promoted to treat addiction is trying to get ahead by stigmatizing addiction and stigmatizing competing methods of treating addiction that have been shown by research to be effective.

Thoughts on medication assisted treatment for substance use disorders– I have worked in substance abuse treatment and mental health for about thirty years now. I remember back when there were two possibilities– antabuse (disulfiram) for alcohol, and methadone for opiates. Taking disulfiram was sort of like blackmailing yourself. “If I drink, I’m going to make myself really sick.” The thing was, some people didn’t even get sick if they drank on it, and other people could get sick if a vinaigrette salad dressing had any alcohol content. So at it’s best, it was not a great tool. But thing about was that every day you either took it, or you didn’t. If you took it, that meant you were planning on staying sober. If you didn’t take it, that meant you were planning on drinking. So it was a daily gut check.

Methadone, on the other hand, was still pretty highly stigmatized– and still slammed (as the article above points out, still today) as trading one addiction for another. And you still had to structure your day around it, getting to the clinic in a relatively small window and dosing, and in some cases, dealing with the fact that the dose wasn’t properly adjusted & you might end up too sedated to even use public transit, much less drive safely, or you might start to get dope sick later in the day. And you had to be a little angel for a long time to get take home doses. And don’t even try to get methadone for high levels of chronic pain.

I’m not closely in touch with the part of treatment that’s doing methadone these days, but I’ll bet it’s still a big hassle. I do know some people who have done office-based suboxone treatment and have had great success. And, just like people on antidepressant medication, some people have a long term goal of being off it, others don’t. Personally, I don’t see the fuss, but I’ve been in the treatment world for a long time. Isn’t it about having your life work?

Now let’s talk for a second about my clinical experience with people doing Vivitrol. What the article didn’t mention is that there are doctors doing it for people with alcohol use disorders.  There’s a certain amount of literature about people using it to deal with alcohol cravings. My clinical experience is that this application is pretty hit-or-miss. There are people who’ve done it with a goal of becoming casual or controlled alcohol users.  I haven’t seen that work out. Also, if you look at the substance use treatment literature, no reputable providers think that medication-only strategies really do the job. There has to be some kind of psychosocial component (read: counseling). Granted, that’s what I do, so I’m biased. Without a psychosocial component, though, it’s not uncommon for people do drug switching to something that naltrexone doesn’t affect, like cocaine or methamphetamine.

Now let’s take a sec to talk about the abstinence-only people. Unfortunately, there are a lot of them, including what I have sometimes called the Christian Science wing of AA. They don’t want people taking psych meds, they don’t want people doing medication assisted treatment, they want you to refuse opiates for a broken leg, and maybe will grudgingly allow you anesthesia for open heart surgery. Fortunately, the genius of the Twelve Traditions & the Twelve Concepts (the latter extremely little known) which structure the larger movement, it’s essentially impossible for one group to hijack the movement and impose a monolithic party line.

Fortunately, times are changing. I remember taking an adolescent client with a substance use disorder to an AA meeting where one of the members got up and gave a rambling, disjointed monologue. The person next to me leaned over and whispered, “He’s bipolar but doesn’t want to take the medication.” However, it was said with a tolerant smile, and the person was a regular. Another time, at the same meeting, a member apologized for coming late because they were at a psychiatry appointment getting a medication adjustment.  That person, too, was fully accepted by the group.

My greater concern is that across the nation there are many places which bill themselves as substance abuse treatment, some of them very expensive,  which do little more than take people to 12-step meetings and do structured step-working groups.  Some of them are contractors to local governments. (Just as an aside, the 9th U.S Circuit Court of Appeals ruled some years ago that people convicted of DUI can’t be forced to go to AA meetings by the courts because a Higher Power looks too much like God) As a taxpayer, I don’t like the idea of my tax dollars going to pay for people working 12 steps when they can do that for free.

Don’t get me wrong– I support 12 step groups. There is a body of research that shows people who connect with AA (the 400 pound gorilla of 12 step groups; others are much smaller) are more likely to have better treatment outcomes.  I just don’t feel comfortable with it as a treatment modality that people have to pay money for. the AA literature itself emphasizes that it should be voluntary and that AA should be independent of other institutions to work.

This post is becoming rather rambling, and I don’t have a clear destination. But I guess the main thing that moved me to write after having seen the article quoted at the top is that after all these years, it’s still so hard to get treatment, and that stigma is not only hanging on, but being used as a tool to make money by a manufacturer of what is represented as a treatment tool. The tool itself is not that great, in my clinical experience, but if they want greater sales, they should encourage more treatment of all kinds for all kinds of substance use disorders, not disparage other providers of other tools. After all, the disease has overtaken car crashes as a cause of death. If you’re really trying to help, don’t be so greedy.

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Turning the Mind, Fighting Worries

Sometimes I forget to put things here because they seem very basic to me, but then I go over them with a client and I realize that while they may be very basic and simple to learn, they are not inherently obvious to people.  So if you have, for example, been taught all about turning the mind through DBT (Dialectical Behavior Therapy) or other channels, you already know all about this. It is a skill that we all have, fortunately, and can also be key in dealing with anxiety or worries.

The most obvious way to explain turning the mind would be, for example, to look at something, then to turn your head and look at something else. You are turning, in this case, your eyes from one physical thing to another. If you don’t feel this qualifies as turning the mind, do it this way: look at something closely, as though you will be asked to describe it. Then look at another object or scene in the same way. Now, close your eyes and recall the first scene, then replace it by the memory of the second. You have the ability to turn  your mind from one thought to another thought. It’s essentially that. When I choose to think about something like the salad I just had for lunch, then remember the doughnut I ate after lunch (happy National Doughnut Day), that is also turning the mind.

Now, about dealing with worries or anxiety. Here’s a basic procedure:

  1. Ask yourself, “What am I worried/anxious about? Be specific.
  2. Look at the specific worry and identify an action step that you can take, right now, to deal with the worry.
  3. Do the action step.
  4. Turn the mind to something else.

Example: I feel anxious. when I think about it I realize, I’m worried that my phone might get turned off.  I check my account status right now and realize that I missed paying the bill last week. I check my checking account right now and find that I have the money. I authorize payment right now. Then I turn my mind to something else.

Suppose, on turning the mind, that I now start worrying that I will be killed by an asteroid hitting the Earth.  I then go to https://cneos.jpl.nasa.gov/ to see if there are any asteroids scheduled to hit the Earth. When I discover that there are none, I have no action item, so I turn the mind to something else.

There can be more to this, of course, but I’ve known folks facing complex medical issues with life-threatening consequences to maintain happiness in the moment by acknowledging that they’ve done every action item they can, up to and including estate planning, and now have no more action items. Note that I’ve used words like simple and basic but not the word easy. It may or may not be easy for you, but it certainly can be done.

Alfred E. Neuman from https://comicvine.gamespot.com/alfred-e-neuman/4005-12578/images/

 

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