Helpful Repetitive Thinking in Depression

In a previous blog, I noted that rumination – repeated dwelling on feelings, problems, and difficulties – is an important process maintaining depression. I also discussed the finding that repetitive thinking about upsetting events and unresolved problems is a normal and natural response – and that sometimes it can be helpful. For example, focusing on our difficulties can help us to come to terms with them and to solve problems. These contrasting effects of repetitive thinking led to the key questions of what factors determine whether repetitive thinking is helpful or unhelpful, and how does such thinking go wrong in depression?

These questions have been the primary focus of my research over the last 15 years and we are beginning to get some preliminary answers. This research is summarized in a research paper I published in Psychological Bulletin (2008).

First, it appears that the content and focus of the repetitive thinking is important. If you keep thinking about something positive, it is likely to make you feel better, whereas if you keep dwelling on something negative it will make you feel worse. In a nice meta-analysis of the field, Mor and Winquist (2002) found that attention to negative aspects of the self was strongly related to increased levels of negative mood, whereas attention to positive aspects of the self was related to lower levels of negative mood. The act of repetitively thinking about anything acts as a form of mental rehearsal for the content of inner speech, strengthening and elaborating the mental representations, making them easier to come to mind in future. It also tends to polarize and exaggerate thinking, making it more extreme. So, repetitive focus tends to exacerbate the current state and mood – if you are in a sad mood with negative thoughts, and you dwell on them, the mood will get worse, and the thinking will get more negative. Thus, repetitive thought acts as an amplifier of thoughts and feelings.

Second, the style of the repetitive thinking is equally important. It is possible to focus on negative information in helpful or unhelpful ways.

Imagine that you are faced with an upsetting and saddening event such as the unwanted end of an intimate relationship. The break-down of a relationship will be experienced as negative by nearly everyone and will likely lead one to dwell on its demise. However, there are quite distinct ways of dwelling on it.

One understandable way to dwell on this split is to think about why it happened, what it means, what caused it, and its implications for the future. In this style of processing the break-up, you would be focused on the causes, meanings, and implications of what happened. This way of thinking tends to move away from the specific details and contexts of what happened and to more general abstractions, which capture the key gist of the event and what this event might share with past events and with other situations in the future. Hence, this style of thinking is called abstract processing. Typical questions might include “Why did this happen? What does it mean about me? What does it mean about the future?” An extensive social psychology literature indicates that such “why?” questions tend to make thinking more abstract and to distance individuals from the specifics of situations.

This abstract style of processing negative events is typical of depressive rumination and anxious worry. You can see how if you are feeling down and have low self-esteem, focusing on yourself and thinking about a break-up in this abstract way could be unhelpful, because asking these questions about causes, meanings, and implications is likely to lead to negative self-blaming conclusions, e.g., “It is my fault”. Moreover, because abstract processing tends to broaden out across situations, such thinking will pull in past memories of rejection and loss (e.g., “This keeps happening to me”), and may lead to general conclusions about the future, such as “I will never have a lasting relationship”, all of which worsen mood and exacerbate depression.

In contrast, you could repetitively reflect on the break-up by focusing on exactly how it happened, replaying in detail the events that led up to the split and the final few meetings and conversations with your ex, noting in detail what happened. In this style of processing the break-up, you would be focused on the specific details, the sequence and the circumstance of how the relationship came to an end. This way of thinking focuses on the context (when, where, how, what, who) of what happened and how it happened and stays close to your actual concrete experience of the end of the relationship, rather than thinking about its meaning. Hence, this style of thinking is called concrete processing. Typical questions might include “How did this happen? What did I do? What did my ex do? How did I feel? How did this unfold over time?”

A series of experiments in my lab, replicated in other labs, have found that, when faced with problems or upsetting events, adopting a concrete style of processing is more helpful than an abstract style of processing. For example, when asked to generate solutions to interpersonal difficulties such as an argument with a partner or a disagreement with your boss, we found that prompting currently depressed patients, formerly depressed patients and never depressed controls with either no questions, abstract “Why?” questions, or concrete “How?” questions, influenced the quality of solutions generated. Replicating other findings, patients with depression were worse at solving social problems than recovered depressed patients and non-depressed individuals when left to their own devices. However, when prompted to ask concrete questions, patients with depression were as good at solving problems as the other two groups, suggesting that these “How?” questions ameliorated this difficulty. Further, asking abstract “Why?” questions worsened problem-solving in people who were formerly depressed, suggesting that these questions activated their previous difficulties. We believe that concrete processing is more helpful for problem-solving because it makes an individual aware of the specific circumstances and behaviors that occurred in a situation, suggesting possible alternatives to resolve the situation.

In another study, we found that training students to think about the meanings and implications of emotional events for 30 minutes caused them to feel worse to a subsequent stressful anagram task than students who practiced thinking about the concrete details of emotional events. Thus, relative to concrete processing abstract processing increases the negative emotional response to difficulties. Similar effects have been found when studying how quickly people recover from previous upsetting events, with a concrete style of thinking about past sad or traumatic events proving to be more helpful.

Taken together, this research suggests that repetitive thinking about the self, negative feelings and problems in an abstract style will be particularly problematic, driving depression and anxiety. Further, it suggests that shifting to a more concrete way of thinking about difficulties could be helpful for people with depression. Building on this hypothesis, we have investigated whether training people with depression to become more concrete and specific can itself help to reduce depression. This will be the subject of another blog.

Ed Watkins, Ph.D. is a clinical psychologist.

 

How Lawyers Can Choose the Right Treatment for Depression

Dr. Irving Kirsch, a professor at The University of Hull, has caused a stir lately with a body of research suggesting that SSRIs, the most common class of antidepressant, are no better than placebos. (Here is a 60-Minutes story about his findings.) Of course, for every SSRI skeptic there are any number of evangelists who swear by the drugs.

Personally, I’m undecided. I’ve seen SSRIs aggravate depression by muting happy emotions and adding unpleasant side-effects, while offering no measurable antidepressant effect. But I have also seen them help. In rare cases, they have been a godsend.

For anyone considering antidepressants, I would humbly suggest that the question, do antidepressants work, is the wrong question. The more relevant and pragmatic question is this: might antidepressants be helpful in my particular case? 

The SSRI debate is useful in general, but it is mostly irrelevant to individual cases. It’s a bit like debating the effectiveness of transmission replacements for cars. Sometimes a new transmission fixes a car, sometimes it doesn’t. It depends on the problem.

If I found a mechanic who insisted on rebuilding every transmission (or who reflexively opposed it) I would find a new mechanic, pronto. I wouldn’t settle for one who failed to define the problem before tearing into my car. Yet that is often what is expected of patients who seek treatment for depression. Describe your symptoms – quickly! – and don’t question my treatment.

It seems to me that our central nervous systems should get at least as much respect as our cars. Of the many times that I have witnessed the failure of an antidepressant, there has been a corresponding misapplication of the drug. The correlation is difficult to ignore.

But don’t take my word for it. There is compelling research suggesting that antidepressants are routinely misused in Western countries. In a rather conservative study, Jureidini and Tonkin (2006) found that many prescriptions (one third or more, depending on the measure and the population) fell outside clinical indications, were given in excessive doses, or were prescribed for far longer than they should have been.

According to another study, only about one-third of patients experience relief after taking an antidepressant for a sufficient period of time (Cascade, Kalali, and Blier, 2007). That’s an exceptionally low number, and I suspect that has more to do with poor diagnosis than the effectiveness of the medication.

Antidepressants may be the first and best option in cases of severe depression. But in mild or moderate cases – which are the vast majority – behavioral interventions work better. Addressing the problems that lie behind depression is often more effective and longer lasting than medication (Dobson et al. 2008).

(Ironically, Jureidini and Tonkin also found that antidepressants are under-prescribed among the seriously depressed who could most benefit from them. They noted that fewer than 25 percent of US, Canadian, and European patients meeting criteria for major depression receive proper medication management.)

Antidepressants appear to be helpful in severe cases but they are probably useless and potentially harmful when they are incorrectly prescribed in less severe cases. I believe that anyone considering SSRIs should first answer these four questions, with the help of a qualified clinician:

  1. How severe is the depression? There are a number of depression inventories to help answer this question. If the symptoms are in the mild to moderate range, SSRIs are probably an inappropriate intervention.
  2. Is the depression most likely a result of circumstances or lifestyle choices that will remain unaffected by medication? If so, pills may blunt moods but they won’t fix the problem.
  3. Have physical problems been ruled out? Depression can be secondary to thyroid problems, low testosterone levels, nutritional deficiencies, sleep difficulties, and other physical problems. SSRIs fix none of these.
  4. Have healthier interventions failed? Making tough decisions about exercise, diet, sleep, alcohol use, and other lifestyle choices should be the first order of business in cases of mild to moderate depression. Physical exercise alone is as effective as any antidepressant in most cases (it is the benign cure-all that SSRIs wish they could be), and cognitive behavioral therapy is an excellent response to circumstances or lifestyle choices that contribute to depression.

SSRIs should only be taken with considerable deliberation and a solid understanding of the problem at hand. Despite their benign image, they are the furthest thing from harmless happy pills. They come with side effects, and there is evidence that they can have serious, long-term effects on the central nervous system. If SSRI’s are the right answer for you, then by all means, use them. But please take the time to properly define the problem first.

I realize that it is an investment of time and money, and I know that depression deprives a person of gung-ho initiative. It might be simpler to skip the process and take the pills, but we only get one brain each. Taking time to define the problem could prevent years of wasted effort and needless suffering.

Dr. Shawn Smith is a psychologist in Denver and the author of The User’s Guide to the Human Mind: Why Our Brains Make Us Unhappy, Anxious, and Neurotic and What We Can Do about It.

 

 

An Interview with Dr. Andrew Weil about Depression

One reason Andrew Weil, M.D., the “father of integrative medicine,” wrote his new book, Spontaneous Happiness, is that the most searched-for term on DrWeil.com is “depression.”

It’s the common cold of modern emotional life. And he thinks we’re thinking about it all wrong. Yes, an imbalance of brain chemicals can trigger depression, but it goes the other way, too: An imbalance of thoughts and habits can change your brain to make depression more likely – – or less likely.

Dr. Weil believes an approach that integrates healthy habits of the body, mind and spirit can play a key role in preventing and alleviating mild to moderate depression. It can foster emotional well-being — and happiness.

Like all of his books, Spontaneous Happiness is a refreshing combination of clarity, science and practical wisdom. But it’s also warm and, indeed, personal: Dr. Weil includes not only anecdotes from people who’ve written to him over the years, but also his own experience in battling mild depression.

What is spontaneous happiness?

I use spontaneous happiness to call attention to the fact that happiness is something that comes from inside. It doesn’t come from getting something you don’t have. You can’t expect to be happy all the time, but you can open yourself up to the possibility of happiness.

A better goal than happiness, actually, is contentment. Contentment is an inner feeling, and it is something that can be cultivated.

Is depression always bad?

I don’t think depression is all bad. Our moods are supposed to vary. We’re supposed to have positive and negative moods. I’m not talking about incapacitating depression. But mild or moderate depression can lead to an inward focus and rumination that may help you solve problems. That’s why depression is often associated with creativity.

Is depression on the rise?

We are witnessing an unprecedented epidemic of depression in this country, mostly mild or moderate. Some may be due to the pharmaceutical industry influence, but maybe only a quarter or so. There’s still a lot of depression to be accounted for. There are many factors: increasing social isolation, disconnection from nature, information overload.

You can’t find cases of severe depression in hunter-gatherer societies. What’s different about them? Almost everything! They eat differently, connect to nature every day and have strong tribal social support. Discontent correlates with affluence — the more people have, the more they are discontent.

Are women more prone to depression than men?

Hormones do play a role. Before puberty, the rate of depression in boys and girls is the same. After puberty, the rates rise [for females]. So, women are more susceptible to depression. That means they should be especially vigilant about their moods, and take this information and put it into practice.

Why is the idea that the mind can affect the body such an important concept?

Changing the way you think and perceive can change the structure and function of the brain. Not to deny brain chemistry, but it’s only one of many factors in depression. Most of psychiatry today only looks at brain chemistry, and so the only solution is drugs. And the drugs don’t even work that well. Physical activity and supplemental fish oil work as well as antidepressant medications.
There are other things you can do, and some are so simple. I was amazed in researching this book how much scientific evidence there is for the power of feeling and expressing gratitude to create lasting changes in mood.

What do you wish primary care physicians would do when someone comes in with mild or moderate depression?

Before reflexively prescribing a drug, I’d like them to look at the person’s lifestyle. Look at all the factors before resorting to medication. Severe depression can be life threatening, and requires medical management, and maybe medication. But even here, I’d like it to be limited to a year, and then [the doctor] should work with the patient to get off the medication and substitute other measures.

You recommend mindfulness for emotional well-being. What is mindfulness?

Mindfulness is the practice of bringing full attention to the present moment. Mindful eating, for example, means eating not in front of the TV or in your car. It means putting the food in your mouth and tasting it. One reason we have an epidemic of obesity is that so much eating is unconscious.

Can mindfulness training be part of the treatment of depression?

Mindfulness is movement that started with the Dalai Lama and collaborations with neuroscientists and Buddhist monks and teachers. They’ve shown that practices like meditation and forgiveness change brain function — and that these practices can be taught.
Mindfulness is now being integrated into cognitive behavioral therapy (CBT). This is very effective for the treatment of depression. It is also very cost efficient and time efficient.

What is the emotional benefit of a “media holiday”?

Addictive listening to and watching news often makes people feel angry, anxious and powerless. It’s not necessary — you can stay informed without it. You can have control over how much you let into your life. Many people tell me that just reducing that input has had major positive benefits on their emotional well-being.

Can silence improve emotional well-being?

Many people aren’t aware how powerful an influence noise is on the nervous system. It really works to cultivate silence.

What do you do every day to foster emotional well-being?
Every day, I try to get physical activity, spend time in nature and get enough good-quality sleep. I follow an anti-inflammatory diet and take fish oil. I meditate and do breathing exercises. And since writing this book, I make notes of things to be grateful for and remember. I also seek out the company of people who are positive. There is very strong evidence that depression is contagious, and so is happiness.

Watch this T.V. Interview where Dr. Weil talks about depression

watch?v=ps3M5DQ-DAY&feature=results_main&playnext=1&list=PL84C5CB591BB45E5F

 


Good Ways To Treat Depression: And Why People Don’t Do Them or Give Up Trying

Depression sufferers are often told to embrace what I call the three “G”’ Trifecta: Get therapy, Get on antidepressants and Get some exercise.

Each of these tactics has empirical support. So there’s a lot to recommend about them. But as I will discuss later, lots of people have a hard time embracing these approaches or sticking with them. First, let’s take a peek at what’s good and promising about these three treatment routes.

Why these approaches are Effective

-Therapy

Many studies show that ‘talk therapy” helps folks with depression. In particular, cognitive behavioral therapy; a form of counseling in which a psychologist compassionately confronts a depressive’s pessimistic thinking and tries to teach him or her more optimistic an productive ways of thinking about their. Research has shown that there’s a powerful connection between pessimism and depression: the more negative your thoughts, the more likely you are to get sucked down into the well of depression. Other studies show that lawyers are much more pessimistic than the general population. As such, CBT is a very good treatment option for many in the legal profession.

-Medication

Antidepressant medications are often an effective way to treat depression for lots of people. It seems to alleviate the brutal physical symptoms – – loss of appetite, inability to sleep and chronic fatigue – – so that one can benefit from therapy. It’s tough to get much insight from therapy when you’re feeling so crappy.

However, recent research has discovered that it often takes two or three attempts before the right medication is found that will relieve a person’s particular depression.

-Exercise

Sweating it out has been proven to lift not only one’s general mood, but alleviate depression. Probably the best book I’ve read on the topic is Spark by Harvard physician, John Ratey, M.D. who writes:

“Antidepressants are curious because we think we’re changing brain chemistry when we take them. The science shows us that exercise does the same thing. By exercising, we’re improving the brain’s plasticity. And while it’s hard to get depressed people to get up and move because, well, they’re depressed, you have to sell them on the value of it. Once they get it, they go with it.”

Why People Don’t Do These Things, or Don’t Stick With Them

If these remedies are so effective for so many, why don’t more people who struggle with depression do them, do them more often or stick with them?

– I Don’t Want to Talk About It.

There are lots of reasons why educated and intelligent people don’t go to therapy.  Here are a few of them:

People (lots of them men) don’t go because they just don’t want to talk about what ails them. Culturally, men are often not given permission to be vulnerable and emotive. There’s a limited range of feelings that the culture says are okay for men to vent: anger, irritability and humor. –

Sufferers sometimes can’t find the right therapist and give up.

Those around them do not believe in therapy. I know a lawyer with depression whose wife thinks therapy is a bunch of hand-holding baloney and a rip-off at $125 per hour (Buffalo rates, mind you). As such, he feels discouraged, doesn’t want to hear his wife complain about the cost and doesn’t go.

People are just too fearful of what the consequences would be if they admitted they had depression: “Will I lose my job?” As such, they often deny to themselves or others that something is wrong. – Procrastination: “Maybe it will go away”.

Shame: people feel they will be labeled “defective”, “weak” or “mentally ill.”

Or, for many, they just don’t know any better. The misery they endure is their “normal”. They can’t see how their maladaptive, pessimistic thoughts about life could be anything other than reality – – “That’s just the way life is.” They may even feel bitter when they see others having fun or being happy. They feel cheated. Why can’t I have more happiness in my life? They may feel that happiness is something doled out by the unseen hand of God or lady luck. However it is dished out, they’ve feel they’ve been given a pittance. Not surprisingly, they have no confidence that they have the capacity to create happiness within themselves. “No”, they think when they imagine to themselves that they have good things to look forward to, “That’s not how my life seems to turn out’. This disempowered state is a vicious circle that can only lead to more depression.

 -Antidepressants: The Flip of the Coin?

There’s a billion dollar debate going on whether antidepressants work or not. On one side of the aisle are the folks in lab coats – the bespectacled researchers who look at brain tissue through microscopes; pharmaceutical executives in blue suits who smoke big-ass cigars; and the psychiatrists – the high priests of all that ails the depressed mind – – who advocate taking medication to treat clinical depression.

On the other side are patients who swear that the meds did nothing to help their depression and just screwed them up and made them feel like zombies. On the other are holistic practitioners who believe depression isn’t caused by a chemical imbalance in the brain, but by lack of proper nutrition, diet and balance (check out Dr. Andrew Weil) and my psychiatrists who believe that medications, while useful, are over-prescribed.

There currently are no tests, other than trial-and-error, to determine what type or types of medication will prove effective for a particular person. It’s really trial or error. Our family owns a big fat rodent. Did I say he was really fat? Anyway, he is black and white and lives in a large cage in a back room of our house. The colors make him look like a magician in a tuxedo. Hence, his majestic name – – Houdini. I felt like Houdini when my psychiatrist tried different medications on me in a quest to get the right one – a lab animal in which he tried this and then that. Some were real duds; some outright blunders. But I stuck with it. And I’m glad I did because the “right meds” were eventually found for me.

People won’t take medication because of the stigma attached to it. Or, they give up on it before the right medication, dosage or combination is found. Even when the right one is found, folks often stop talking it because of the side effects. I know depressed lawyers who would rather drink or drug rather than take antidepressants.

-Why We Won’t Get Moving

People find it hard to exercise because depression screws up their ability to sleep leaving them unmotivated and just too tired to get to the gym. Years ago, when I first was diagnosed with depression, I recall being bone-tired at the end of a work day and falling asleep a 9 p.m., sleeping on and off throughout the night, getting up at 3 or 4 a.m., shaving, getting dressed and driving to an all-night coffee shop to slurp coffee, get ready for work and wonder “Just what the hell is wrong with me?” But I didn’t have any answers back then. In retrospect, truthfully, the only thing that helped me survive it was to keep walking.

Three Quick Things to get you on the Right Track

1.    If you’ve never been to a competent psychiatrist, remind yourself that you can just go for a consultation and hear what they have to say. Whatever their recommendation, you don’t have to agree with it or follow it. But why not get an opinion from someone who has treated hundreds of people with depression and could tell you whether or not you have it and what your options are? You can also get a second opinion. There are “Depression Centers” around the country where you can go for such a consultation and then return to your treating psychiatrist who can prescribe the recommended medication and monitor you. Bring a friend or family member to the appointment. Sometimes, when we’re depressed, we might not truly hear when the psychiatrist has to say. What does your loved one or friend think the doctor said?

2.   If you don’t want to go to a therapist, you really have to ask yourself why not. I usually recommend that people call friends to ask for recommendations for a couple of therapists. Go visit a few for a 1 hour consultation to see if you click with that person. Remember, if you give into your depression, you will tend to isolate yourself and “suck it up.” What you really need to do is talk to a therapist who has treated hundreds of folks with depression who can give you some ideas about whether you can benefit from therapy. A good friend can listen and give you their love and compassion. But, they can’t do what a good therapist can do.

3.   Make it easier to exercise. Here are three quick ideas. First, always keep your gym bag in your car – EVERY DAY. I’ve found that I’m much more likely to exercise at the gym, if only for 20 minutes, if it’s in the car. Second, don’t shave or shower when you get out of bed. Get dressed like you normally do for work and go get a coffee if you like. I find that I have to work out because I now HAVE TO GO to the gym if I want to get a shower and shave – it’s too late to go home now!

When Is My Depression Going to End?

I find writing about depression for lawyers a delicate balancing act.  On one hand, I don’t want to pull any punches about just how awful depression is or how adversely it can affect your life and career.  On the other hand, I want to offer hope and encouragement to those who are in the trenches and deal with it every day.  I will try to do both today.

I have been encouraged by some to write only “positive” articles about dealing with depression. But I just can’t do that. To not deal with the more troubling aspects of depression seems to me a form of denial.  The other day, I was at my local bookstore checking out the Self-Help section for any new titles on depression.  Some of the titles seemed like they were being pitched by used car salesmen:  “Overcome Your Depression in 30 Days!”  This doesn’t help the conversation about depression because it sets up ludicrous expectations in the minds of those who suffer from it and their loved ones about the speed of recovery.  For many with depression, they’re in it for the long haul.

One of the hardest parts about dealing with depression on a daily basis is its seemingly unpredictable nature:  When is it going to start again and how long will it last?

Elizabeth Wurtzel, author of the best-selling book, Prozac Nation, gets it right when she wrote:

“That’s the thing about depression.  A human being can survive almost anything, as long as she sees the end in sight.  But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end.  The fog is like a cage without a key”.

Many, many lawyers go into a mode of survival waiting for a depression to end.  To me, the degree to which such a depression can create catastrophe in our lives as lawyers seems driven by the episode’s severity:  is it a tropical depression or a full blown hurricane?

If it a low to medium grade depression, tools like Cognitive Behavioral Therapy (“CBT”) are very helpful.  With CBT, we work in therapy to replace destructive, depressing, negative self-talk with positive, healthy and realistic self-talk.  The efficacy of this approach has been studied and documented using PET scans of the human brain.  Such scans show that an area in the frontal cortex (the thinking part of our brain) is hyperactive in depressives before CBT and then calmed down after successful CBT treatment.  This same area of the brain is activated when people do self-referencing [relating external events, particularly negative ones, to the self] and depressives do too much of this.  They spin around in a cycle of negative thoughts and try to use the cerebral cortex to snap out of their depression.  With CBT, they learn to decrease their self-reference to the things that are negative.  It’s a form of rehabilitation of the cortex where depressives learn to turn the volume down.

This is a critical skill for lawyers to develop.  According to psychologist, Martin Seligman, author of the best-selling book, “Authentic Happiness,”  lawyers are pessimists.  They develop thinking habits which see problems as permanent and intractable.  They also feel an overdeveloped sense of ownership or responsibility for such problems.  Optimists, on the contrary, see problems as temporary, solveable and not necessarily their “fault”.  The important point here is that optimism is a skill that can be developed and practiced. Read Seligman’s chapter, “Why Are Lawyers So Unhappy?”

If it is a deeper depressive episode, more like a trough of despair, CBT won’t work very well.  During such an episode, there is the sense that it’s never going to end.  Yet, this is the distorted voice of depression talking because for the majority of people with depression, IT DOES END.  The trick is to learn how best to weather the storm.

I find that when I am in a deeper depression, I need to go outside my mind and get into my body.  Consistently, the things that helped me the most were the following:

1.   It’s virtually impossible to feel depressed while exercising and even for a good period of time thereafter.  The problem, as most of us know, is getting to the gym or the park.  Behavioral prompts can help.  Always have your gym gear in your car.  Also, be realistic.  Remember that it takes at least 21 days to form a habit.  So, those first 21 days won’t be the easiest ones.  Tell your family and friends about the importance of exercise to you and have them support and remind you about this on a daily basis.

2.   Cut off any unnecessary negative input in your life during these times.  Don’t listen to any sad music, watch violent T.V. shows or read somber books.  This isn’t a forever type of deal.  Think of it more as a “timeout”.  Some people stop reading the newspaper during an episode as well.  Also, the time you’re not doing these activities gives you the time that you’ll need to exercise.

3.   See a massage therapist.  Touch has a powerful effect on the human body and is known to cause the release of endorphins (the feel-good chemicals).  It doesn’t involve any thinking on your part.  For busy lawyers, it’s a time to relax and receive something positive for the day.

Remember to be kind to yourself today.

 

 

 

 

 

 

 

 

 

 

 

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