New research has found a powerful connection between a tough childhood and adult onset depression and anxiety. Read the News
With the return of the sun, the warmth, flowers and frisbees, how could anyone be depressed? Read the Blog
A new study by Michigan State University found that using multiple forms of media at the same time is linked to symptoms of anxiety and depression. Read the Story
Frank walked into my office and said, “I was in therapy for 15 years, know my ‘issues’ inside and out, but I’m still taking an anti-depressant and an anti-anxiety med when I have to do any major presentation at the firm. It’s like my baseline is off. It’s great for being a lawyer. I’m always hyper-vigilant—looking out for the next danger, working very hard to stay on top of everything. But when I get into bed at night, my mind is racing and I feel this sinking feeling. Still, after all this therapy. What can you do for me?”
Frank doesn’t have a motivation problem, or a lack of insight problem. Frank has a brain problem.
Frank had come into my office after having done research into the benefits of neurofeedback for depression and anxiety. I see clients like Frank everyday and I call them my “Worrier Warriors”. Their nervous systems are in a state of ‘activation’ where the flight/fight/freeze brain is always in go-mode. And he’s right—it serves a law firm well. These brains are habitually trained to be on the watch for danger. Add a good analytic mind to that mix and you’ll have a highly successful lawyer who protects his or her clients well, but at a high cost of health and happiness.
We’ve come a long way in our understanding of the brain and brain functioning in producing the symptoms we call anxiety and depression. In the mental health field we used to think of them as ‘mind’ problems, but now we’ve come to understand that they are also brain problems.
We all know we are ‘creatures of habit’ but what that really means is that the brain is prone to habituated rather than fresh responses. The brain functions to be most efficient and effective in use of its energy to protect and maintain the body. The flaw in this system design is that the brain becomes efficient by using cues to approximate the present situation and then uses an old response pattern, which leads to misperceptions of the present moment and less than appropriate responses. We’ve all seen someone “lose it” and respond with an angry outburst when the situation warranted concern or a firm voice.
A dramatic and sad illustration of this principle is the war vet who comes home with Post Traumatic Stress Disorder (PTSD) from his years of service. As a soldier he has been trained to respond to danger with ‘fight’ response. But now he is home from the war and is walking down his hometown street when a car backfires. The brain is habituated to “loud sound equals danger” and the vet’s brain goes into fight mode—yelling, pushes someone or becomes highly irritable and later starts a fight with a loved one.
An important piece of information to know about the part of the brain that operates the fight/flight response: it does not take orders from anyone. It is a part of the brain that needs to be able to respond in milliseconds, so it doesn’t take in information from other, more rational and analytic parts of the brain. As a result you could say to yourself, “I really shouldn’t get angry and fly off the handle.” But the part of the brain that decides that action, acts without input from our rational, willful self. It takes in sensory input and then makes a snap decision.
Why are lawyers so prone to anxiety, depression and anger outbursts? Their brains are habituated to the flight/flight/freeze response (anger/anxiety/depression) response. For whatever reason, and their could be many, they experienced a threat or threats at some point in their lives that were significant enough to habituate the brain to being in this activation mode. A quick way to find out if you are is to ask yourself this question, and answer quickly without thinking: Is the world a safe place? If the answer is ‘no’ then chances are your brain is habituated to thinking that you are in danger when you aren’t. It makes you a perfect candidate to become a lawyer where you always have to be thinking about what the risks are in any situation. Or to be an ENT or an emergency room doctor. Your brain is habituated to perceive risk.
Now what to do about this habituated brain? Here are some tips:
- Breath. Seriously. The breath, slow and deep breathing are ways we can “tell” the brain that we are safe and it can go into a state of relaxation and regulation. Slow deep breathing for 5 minutes where you work your way up to counting to 5 on the inhalation and 5 on the exhalation will do wonders to communicate to the brain to come out of flight/flight and into calm awareness (the state of a regulated and balanced brain.)
- Understand: Help yourself by having a good and clear conceptual understanding that your anxiety and depression and anger outbursts are a brain over-reacting, not an accurate assessment of the present moment’s situation. Your brain is reading a newspaper that’s 20 years old and acting as if it’s the here-and-now news.
- Get exercise: I recently had a neurologist tell me that if the positive effects of exercise (increased heart rate 30 mins 5 times a week) were a drug, it would be considered a “miracle drug” and would generate billions of dollars a year in revenue.
- Get enough sleep. Studies are now coming out showing the detrimental effects of chronic sleep deprivation—5 hours a night or less—on the development of chronic conditions.
- Train the brain with neurofeedback. Neurofeedback trains the brain to optimize its functioning through allowing the brain to ‘see’ its unhelpful response patterns. And the brain learns to use the present moment to decide it’s next action rather than using those old habitual response patterns. As a result the trained brain sleeps better, is calmer, is better able to focus, and is more cheerful. And as one client said, “I have the same problems, they just don’t get to me anymore.”
Natalie Baker, MA LMHC, works as a psychotherapist and neurofeedback trainer in private practice in New York City. http://www.neurofeedbackny.com
From The New York Times, a great meditation on what anxiety means at middle age. Read the Blog
Reactions to a stressful situation now can predict your health problems for 10 years down the road, regardless of your present health and stressors. Read the Story
Interview with novelist about his recovery from anxiety and depression. Read the Interview
Worry, anxiety, stress and panic reflect emotional expressions of catastrophic thinking. Technically, catastrophizing is an exaggerating, irrational, style of dwelling on real or imagined disasters. This is popularly known as painfully blowing things out of proportion. Fortunately, catastrophic thinking is correctable. I’ll emphasize how to do this.
What are the signs of catastrophizing? You unintentionally make a bad situation worse, or create a crisis out of little to nothing. You may chain together worsening possibilities as you sink into a descending cycle of despair. When catastrophic thinking fuses with raw-nerve tension, you’ll have trouble concentrating. You’ll have trouble figuring out what to do. When ongoing, catastrophizing can be a prelude to depression. Combating this thinking helps prevent anxiety-linked depressions.
What does catastrophic thinking feel like? You receive a registered letter from the legal offices of Wiggins and Trust. Before you open it, you assume you are going to be the subject of a ruinous lawsuit and then you dwell on the horrors of the suit. You feel helpless, vulnerable, and overwhelmed. Feeling too tense to open and read the letter, you put it aside. After days of gut-wrenching dread, you can’t take the strain any longer. You open the envelope. You discover that a great aunt willed you her painting of the Grand Canyon.
Are you willing to make necessary changes to combat and neutralize catastrophizing in order to gain the advantage of greater command over yourself and over the controllable events that take place around you? If so, here are sample cognitive, emotive, and behavioral remedies.
First Things First
Let’s get rid of needless blame first. Let’s suppose you blame yourself or others for your emotional turmoil. Paradoxically, by accepting your catastrophizing as an automatic and unpleasant thinking habit, you can quickly shed blame about this whole sorry process. Compared to the blame alternative, tolerance for tension can feel comparatively good.
It’s not your fault that you catastrophize. Like everyone else, you’re wired to catastrophize; otherwise, you wouldn’t be able to learn to do this and then to involuntarily tyrannize yourself in this way. Nevertheless, if you want relief from this form of manufactured misery, it is your responsibility to change course.
Don’t Trip on the Molehills
When apprehension escalates to anxiety, go back to what you were telling yourself when you first started to catastrophize. Map the pattern. You may find a molehill that you made into a mountain. If so, use a flip technique where you turn panicked thinking into an active concern about doing and getting better. Here are four steps in this process:
1. As best you can, suspend judgment about both yourself and the real or presumed catastrophic event.
2. Accept that you, others, and the world are as they are, and no amount of complaining will change that. Nevertheless, you owe it to yourself to change your catastrophizing pattern.
3. Guide yourself, or seek expert help, about how to contain catastrophizing and advance your enlightened interests.
4. Engage in productive activities that can null your failure expectations.
Actively follow these four steps, and you are likely to experience the sort of resilience that springs from your concern to do better. Because you’ll have clearer options, you are less likely to view yourself as vulnerable and helpless. You’ll make better decisions.
We mostly think of catastrophizing as magnifying and dwelling on present problems and anticipating future disasters. However, you can anchor this thinking to a past, present, and future timeline.
1. You anguish over mistakes you made as if these selective recollections stamp the word failure on your forehead. As you extend this dread, you may panic over the possibility of others discovering, criticizing, and condemning you for past faults. However, you are mainly your own worst pain in the rump on this one. You’re better off focusing your attention on what you can do than what you may have done.
2. You look down and see that you are wearing different colored socks. You think that others think that you belong to the poor taste club. You make this event into the worst thing that can happen to you. You think that this error will haunt you forever. You feel mortified, fearful, and vulnerable. (Intentionally wearing off-color socks can help desensitize you to this type error.)
3. You anguish over the possibility of suffering from brain cancer. You feel fatigued. You think this is proof you have cancer. You get up fast from your chair and feel dizzy. You think this is proof you have cancer. You break into tears at the thought that because of this illness you’ll no longer be around to celebrate holidays and special occasions with your family and friends.
Let’s grant that you have made mistakes in the past, that the mismatched socks are a present-moment mistake, and that you have a tendency to jump to conclusions about future possibilities. So what!
The so what intervention helps put catastrophizing into a different perspective. However, you still haven’t put the catastrophizing issue to rest. There is more work to do, including expanding on your so what acceptance thinking. (Instead of exaggerating, you expand you coping capabilities.)
Expand your coping capabilities with a stop and reflect difference technique. For example, distinguish between concerns, calamities, and catastrophizing. Your house catches fire. That’s a calamity. When your reaction is one of concern, you care about what happened—perhaps deeply so. You accept—not like—the situation as it is. On the other hand, catastrophize and you figuratively throw gasoline on the flames. Extinguish these fires by imagining yourself infusing your actions with reasoned choices that propel productive purposes. Take the actions that you imagined.
Here are four examples of actions of acceptance to help you break a catastrophic thinking habit:
1. Acknowledge your tendency to create catastrophic fictions, and refuse to blame yourself for that.
2. Listen to your narrative. What is the story that you are telling yourself that feels so catastrophic? What are the facts and fictions in the story? Are you making a magical and illogical leap from what is possible to what is probable? For example, if you believe that you have an undiagnosed cancer, is this a fiction or a fact? How do you know?
3. Because you believe something catastrophic can happen, doesn’t mean that it will happen. The Mayan Calendar has the world ending on December 21, 2012. Many panic over this possibility. Were the ancient Mayans infallible prophets?
4. The catastrophizing reward system is where you experience a subliminal relief from distress that reinforces the stress that it relieves. When an expected catastrophic event doesn’t happen, or is not as bad as you thought, the relief you feel can reward your negative premonitions, making them more likely to come back. (A reward, such as relief or money, is a reinforcer only if it increases the frequency of the actions that it follows.) Make sure you reinforce your productive and not your dysfunctional reactions. Your awareness of rewards for worry or catastrophizing, can help snuff out these specious rewards.
By Dr Bill Knauss, author of The Cognitive Behavioral Workbook for Anxiety