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How Do I Want to Feel?

This is an important question to get into the habit of asking because by asking it we learn that we can actively change how we feel. Yet it’s a question most people often don’t consider because of the idea that feelings aren’t really under our control. In some ways, that’s correct since the activation of feelings happens automatically: When something angers us, we feel angry; when something saddens us, we feel sad, etc. Emotions are biological experiences that just happen.

However, the cognitive model, on which cognitive behaviour therapy is based, proposes that thoughts, feelings and behaviours are all linked, each one able to influence the others.

 From this perspective, we have the ability to change how we feel by changing our thinking or our behaviour. A concrete example will illustrate the process:

A man is feeling stressed one morning about a presentation he has to give at work that afternoon. He realizes that he’s walking around his house with a furrowed brow, sighing heavily and utterly preoccupied with how challenging his presentation might be. Aware that there are several hours between that moment and when his presentation is scheduled to begin, he asks himself the question ‘How do I want to feel?’ and decides he wants to feel calm instead. With that as his goal, the man begins the process of changing his behaviours to ones that are more consistent with feeling calm. He relaxes his face and other tense muscles, he takes note of his breathing and tries to breathe more calmly, and he slows himself down so he isn’t stressing himself further by rushing. He also changes what he is thinking about to better reflect the state of calm he is looking for. Instead of continuing to imagine all the terrible futures he might encounter, he focuses on the things around him in that moment; he also thinks about a recent time in his life when he felt happy. Because he knows where he wants to end up, the man is able to change his course and get himself there. It isn’t easy, though. When he stops focusing on calmness, his body occasionally drifts back into the stress. But knowing about the cognitive model, he is able to return to that state of calm as many times as he needs to.

Decide for yourself how you want to feel then take the time to change your thinking and your behaviour to bring about that desired state of feeling. We can all do this.

Understanding Depression

Almost everyone uses the words “I’m depressed” to describe how they are feeling from time to time. However, used in this way what it means is often unclear, referring to anything from feeling down or ‘blue’ to being stressed or run down. It is often the way people describe their feelings when they are not even sure what it is they are feeling (e.g., “I’m just not feeling like my usual self. Maybe I’m depressed?”). Everyday feelings of depressed mood become problematic when they interfere with normal functioning and last for at least two weeks. Clinical depression can affect both the body and mind, changing how a person thinks and behaves, and how his/her body functions. It can disrupt some of the body’s most basic systems, making the person feel unwell.

Signs and Symptoms of Depression:

  • Feeling worthless, helpless or hopeless
  • Overwhelming feelings of sadness or grief
  • Sleeping more or less than usual
  • Increased alcohol and drug use
  • Staying home from work or school
  • Eating more or less than usual
  • Difficulty concentrating or making decisions
  • Loss of interest in usual activities
  • Decreased sex drive
  • Thoughts of death or suicide.

Causes of Depression

There is no single cause of depression. Rather, a number of factors make some people more prone to it than others. These include upsetting life events, a genetic or family predisposition and psychological factors, like a negative or pessimistic view of life.  Depression tends to recur. Between 50% and 85% of people who have had one episode of depression will experience others in their lifetime.

Effects of Untreated Depression

People who are depressed cannot simply “pull themselves together” and feel better. They often delay seeking treatment because of concerns that having those feelings means they are giving up or are weak. These beliefs are untrue. In fact, more than 17% of American adults will experience depression at least once in their lifetime1 and the World Health Organization lists depression as the 4th leading cause of disability worldwide2. Untreated, depression can interfere with relationships and one’s ability to function at work, and can increase the chances of drug or alcohol addiction. In severe cases it can also result in suicide. Without treatment clinical depression can last for months or years.

Systems Affected by Depression:

  • Sleep-wake cycle
  • Hormonal system
  • Stress response system
  • Immune system
  • Gastrointestinal system

Notes:
1 Blazer, DG, Kessler, RC, McGonagle, KA, & Swartz, MS. (1994). The prevalence and distribution of major depression in a national community sample: The national comorbidity survey. The American Journal of Psychiatry, 151, 979-986.
2 Depression. Retrieved June 26, 2008, from www.who.int/mental_health/management/ depression/definition/en/

The Trouble With Automatic Thoughts

When we begin working with new clients, the psychologists at Shift Cognitive Therapy focus first on identifying why problems are occurring. A significant component of this process involves teaching clients to appreciate their patterns of automatic thinking. We have some control over our thoughts (if you want proof, go ahead and think of something, then change your focus and think of something else) and we use that to harness our brainpower every day. But there is another part of our thinking that we can’t influence quite as directly. An example of this can be drawn from the everyday process that our brain uses to categorize things.

If you saw a person walking a teacup poodle down the street your brain would instantly match that animal with others you have encountered before and let you know that what you were seeing was a ‘dog.’ It would do the same thing if you saw a much larger animal, like a Great Dane because the brain possesses a mental model for ‘dogs’ that is broad enough to include both breeds. The brain consults this model all by itself, without any need for conscious thinking (this process is automatic because it’s part of the life support system we call the Fight Flight Reaction). The brain is continually taking in new information, sorting and collating it, and learning new things along the way. It is also using that same information to confirm what it already believes to be true.

Automatic thinking can be dysfunctional when it’s based on old or incorrect information. For example, a lesson learned in childhood that one is weak might no longer apply once the person grows into an adult and learns how to ask for what they need. However, the brain might be so accustomed to believing that lesson is true that it no longer questions it and continues to act as if it is true. Such thoughts can influence behaviour in negative ways, resulting in life problems that appear to reinforce the incorrect belief and contribute to further challenges.

Once our psychologists understand the specific nature of each client’s automatic thinking patterns, we can begin the process of teaching skills to challenge such thoughts and develop more adaptive ways of living.

What Psychologists Do

Psychologists are highly trained mental health specialists who focus largely on behaviour, on understanding its causes and how to change it. While people are usually aware of much of what they do, a lot of behaviour occurs on the fringes of awareness and it is there, that it can contribute to problems. For example, arguing in relationships, eating or drinking when stressed, procrastinating, worrying and avoiding are all behaviours that can happen without full awareness. We can change those behaviours, but only by becoming aware of them and understanding why they occur.

Some psychologists do this by providing a supportive ear, listening without judging and asking questions that promote a different way of thinking. Others add a practical component, teaching skills and techniques the clients can use to feel better and function more effectively in life. Still others focus on formal assessments to identify and diagnose emotional, academic and neuropsychological conditions. Generally speaking, all psychologists try to understand the needs of the person seeking their services and tailor an intervention to meet those needs.

People consult the psychologists at Shift Cognitive Therapy in Oakville because of work/life stress, anxiety, phobias, excessive worry, depression, trauma, unexplained medical symptoms, medical issues with strong behavioural components (e.g., diabetes, drinking, obesity, pain), relationship issues and family issues, Attention-Deficit/Hyperactivity Disorder, child behaviour problems and learning issues.

Growing bodies of evidence show that psychological interventions are often less expensive than medication and are as or more effective than medication for conditions like anxiety and depression. This is because psychological interventions teach people to manage their symptoms, instead of masking them. When people feel more confident coping with their own issues they use the health care system less.

What Are Psychologists?

Many people are unsure about what psychologists are and what they do. This was illustrated in a 2011 survey of Canadian attitudes about psychologists and psychological services. Most of the almost 3000 Canadians asked believed that family doctors were the specialists to consult when it came to dealing with issues like anxiety and depression, addictions, dementia and coping with serious illnesses like cancer. Relatively few were aware that psychologists can be helpful with all of those issues. At the same time, 26% of respondents said they felt most confident in psychologists’ abilities to help with mental health problems, compared to only 18% who stated having greatest confidence in their family doctor. These results suggest some confusion about what psychologists do and when it’s appropriate to consult them.

Psychologists are experienced, highly trained mental health professionals who help people resolve all kinds of problems in their lives, including clinical issues, like anxiety and depression, and everyday concerns, like managing stress and parenting. Psychologists study and train in therapy skills, assessment and diagnosis for many years before being licensed to practice. In Ontario, all psychologists have a Doctor of Philosophy (PhD) degree, or the equivalent and attend university for about 10 years. Approximately 3,000 hours (or more) of their work is supervised during and after that period. By comparison, psychiatrists train for about 10 years and family physicians for about 6, but the amount of therapy training those clinicians receive varies widely. Psychologists are called “Doctor” and only psychologists can use the term “psychological” to describe the services they provide.

Follow these links for more information on psychology:

Ontario Psychological Association

Canadian Psychological Association

You Don’t Have to Believe in Order to Change

Changing something we don’t like about ourselves isn’t easy. In fact, it can be quite difficult because there’s nothing simpler than continuing to do what we’re already doing.

A common pitfall that interferes with successful change occurs when we either give up too soon or fail to even start making change because we think we lack the qualities required to be different. A person who tells himself, “I’ll be more confident after I’ve lost this weight” might conclude it’s pointless to even start an exercise regimen. In the same way, an anxious person who is afraid to try something new might continue to feel stuck if she believes that she can’t do it until her fear goes away. It’s easy to lose hope, stop trying new things, and conclude that change is impossible when those future, better versions of ourselves fail to appear.

Change is a process that occurs in steps and it begins exactly where you are right now. A great example of this appeared in a Fibre One cereal commercial a few years ago. The TV spot opened with a scene of an expert surfer riding the biggest wave you can imagine. The words “Step 10,436” gradually appeared in the top corner of the screen. The next scene was of a bright, suburban kitchen, featuring a breakfast table set with a bowl of Fibre One cereal, milk, juice, toast, etc., and the words “Step One.”

Making changes in our lives doesn’t require a belief that we can do it; it just requires that we take action, one single step. From there, we can take another and then another, and before you know it, you’ve gotten somewhere.

Wherever you are right now is just fine because it’s only from there that can get anywhere else.

Making Change by Thinking Realistically

It’s no secret that many physical issues, like obesity, heart disease and diabetes are strongly influenced by lifestyle and behaviour. Behavioural choices also contribute to emotional issues, like anxiety, stress and depression. Often, we know exactly how to reduce the severity of problems or even avoid them outright simply by changing our habits. But it’s so easy to continue doing the same things over and over, even when that leads to the very issues we’re looking to overcome. The good news is that every person can change. Some approaches just work better than others.

Change is hard. It’s even harder when we set ourselves up to fail by downplaying that fact and viewing our options too simplistically or in moralistic terms. When we categorize some activities, like exercising or facing our fears as “good” and others, like smoking or procrastinating as “bad.” Labels interfere with successful change when we mistakenly extend them to ourselves as well, describing our very character as similarly “good” or “bad” depending on the activity we choose. Concluding that “I’m weak because I didn’t stick to my exercise plan” focuses only on the outcome and ignores important context, like whether you were struggling through other issues or hit your goals according to schedule more often than not.

Making change is a process that happens over time, and part of that process involves learning to look at ourselves realistically, acknowledging both our successes and our failures. Doing so provides a sense of context, enabling us to see our struggles as single parts of the bigger picture. Few people judge an actor’s or a writer’s entire career based on the success (or lack thereof) of a single piece of their work, yet we so often make things harder on ourselves by concluding that we are entirely lacking or hopeless simply because we’ve hit a snag along the way.

Reacting AND Responding

Human survival has always depended on our ability to react to quickly. Acting on instinct, without thought was rewarded by the opportunity to continue living, so our bodies became exceptionally good at it. We’ve never lost that ability.

Whenever we perceive some thing or event, that is, when we see it, hear it, smell it, taste it or feel it, the body activates positive or negative emotions and gets ready for action. This system is so much a part of our basic life support that these reactions occur even in the absence of any actual threats! All we have to do is have a thought about something frightening or come into contact with something that we viewed as dangerous or scary in the past, and the body can instantly go from rest to full-throttled arousal, complete with sweat, a pounding heart, shortness of breath, wobbly knees and dizziness. We often call this “panic.”

Even though we cannot control when our reaction systems will activate and can do nothing to stop them once they start, we always retain some ability to control how we RESPOND to them afterwards. Responses are choices, thoughtful decisions about how we want to manage with something. Recognizing the difference between responses and reactions is important for coping because it gives us the chance to come back to the present moment and reconnect with our goals and values. It gives us back a sense of control. When I catch myself feeling anxious, angry, stressed, or depressed I can always ask ‘How do I want to feel in this moment?’ and then change my focus and my behaviour to start the process of bringing that change about.

The video below is a fun example of this. Passengers forced to wait on a delayed Air Canada flight were serenaded by a Klezmer band traveling on the same plane. Every passenger made their own choice about how to cope with the wait: to enjoy the music and the fun of such an unusual experience, to remain angry and frustrated at the inconvenience, to worry about whether they’ll make their connecting flights. We always have the choice. The trick is just to remember that.

The Anxiety Feedback Loop

The human body values survival so highly that it devotes a large portion of its energy resources to watching for and reacting to potential dangers. The ‘fight-flight reaction system’ is our built-in mechanism to focus attention and help us manage with trouble. It works automatically, sounding alarms without the need for conscious control because waiting for us to guess what some noise, smell, unknown animal, etc. might be takes too long and could put our safety at risk. Instead, the five senses enjoy a direct link into the oldest parts of the brain, where decisions are made instantly about whether things are ‘safe’ or ‘dangerous’ and the heart, lungs, muscles, nerves and emotions activate to prepare us for immediate action.

“Anxiety” occurs when our bodily defenses turn on and the resulting arousal is perceived as a frightening threat. Consider, for example, a situation where you’re at home and a thought about a presentation you’re to give next week at work suddenly leaves you feeling tense and anxious. This is totally normal, as human brains don’t care that threats like this one exist solely within the imagination; they act as they would if the threat was present right then and there, and trigger the body’s resources anyway. In the absence of an identifiable threat, many mistakenly believe that the their body is ill or malfunctioning, which further activates the alarm system and can result in even greater arousal. Not surprisingly, people with clinical anxiety are more likely than those without to: use medical services and use them more often, have more emergency room visits and hospital stays, have higher outpatient and prescription drug costs, and are more likely to be absent from work.*

Cognitive behaviour therapy is an effective treatment to break free from the anxiety loop.

*Marcinak, M, Lage, MJ, et al. (2004). Medical and productivity costs of anxiety disorders: Case control study. Depression and Anxiety, 19, pp. 112-120.

Set An Intention and Do It

Thanks to P. Jobling for the photo.

Standing at the finish of the Sporting Life 10K this morning, watching several thousand of the estimated 23,000 runners cross the line, it was hard not to notice the differences among them. Some crossed the line in focused sprints, putting all of their remaining energy toward the goal of finishing with their best time, while others slowed and even ran backwards to smile and wave to friends, family and video cameras. Several ran in costume, dressed like Bay Street bankers, Smurfs and even as a banana, but most wore workout clothes of every colour imaginable. One woman pumped her arms so intensely that it looked as though that action was what powered her legs. Some people bounced with every stride, some loped and some plodded, but all ran and all looked satisfied with themselves just for finishing, especially wearing the medals they received after crossing the line.

Watching all of those different people accomplish their goal of running 10 km was inspiring and highlighted the realization that we can all do almost anything, but only when we set our intention.  The strength and the power to achieve our goals exists within us. They are qualities innate to every human being, and we can access them at any time. However, fears, doubts, and painful life histories can all interfere by convincing us that we are weak, that we will fail, and that we shouldn’t even bother trying. Setting an intention to do something difficult doesn’t mean putting on rose coloured glasses and thinking only positive thoughts. Instead, it emphasizes thinking realistically, accepting that yes, we will face difficult challenges along the way, and yes, we will fail at those challenges some of the time; but if we believe that maybe we can do it and we keep working at it, then we can tap into those internal resources and get where we want to be in life.

Congratulations to all who ran today and to everyone who tried something difficult even when they weren’t certain they would succeed at it in the end.

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