December 11, 2012

Don't Believe the Hype

Although most of us would agree that worry, anxiety, and depression are unpleasant, these experiences are sometimes associated with positive beliefs. This is problematic because such positive beliefs make these mental health scourges resistant to change.

Example: Generalized Anxiety Disorder (GAD) is a disorder characterized by chronic worry and subsequent anxiety and physiological symptoms (e.g., muscle tension, headaches). People with GAD habitually create worry chains of worst-case scenarios, often starting with "what if" (e.g., My boss asked to see me, what if I made some kind of serious mistake, what if I get fired, how will we pay our bills? or My head hurts, what if it's something serious, what if it's fatal, who will take care of my kids?).

Although most GAD patients say they're sick of worrying and wish they could stop, it's well established that most people with this disorder have positive beliefs about worry. Among other things, they believe that worrying offers protection from feared outcomes (e.g., if I worry about my son being in a car crash, it's less likely to happen), that worrying is a positive personality trait (e.g., I'm the family worrier, it's how I show my love), or that worrying shelters them from potential future negative emotions (e.g., if I worry about losing my job, it won't hurt as much if I actually do).

Positive beliefs about unpleasant psychological symptoms aren't limited to GAD. A depressed patient told me that during her childhood, she and her siblings and their divorced parents scoffed at happy-seeming nuclear families, assuming that the happy families were either faking or stupid or both.  As an adult, my patient still believed that being happy was synonymous with being phony and dumb and that being depressed meant that she was smart and authentic. I had a patient with an eating disorder who believed that her bulimia made her dramatic and interesting. Whenever she attended a social function involving food, she would refer to her "serious eating issues," generating instant curiosity and solicitousness. She believed that recovering from her eating disorder would make her boring and pedestrian. Finally, I used to believe that anxiety made me productive. I spent years resisting mindfulness and other enormously helpful relaxation techniques, believing that I'd never accomplish anything if I weren't anxious.

In such cases, the best strategy is not to simply tell people that their beliefs are wrong, but to get them to test the beliefs. My depressed patient took inventory of the people she knew who seemed happy. She found that many of them were both intelligent and genuine, demonstrating that her belief wasn't altogether accurate. My GAD patient practiced not worrying when his son made the five-hour drive to visit; he noticed that not only did his son arrive safely, but he enjoyed their visit more because he wasn't a worried wreck by the time his son arrived. My bulimic patient made a list of people she found interesting and noticed that none of them had eating disorders--and that two of her friends who also suffered from eating issues hadn't made the list. She also made a list of the qualities that she admired in herself, and identified a number of interesting and enviable traits that weren't related to her eating issues. For myself, I took a closer look at whether or not I was actually more productive when I was feeling anxious. I noticed that while anxiety occasionally propelled me into action, it more often drove me to produce unrealistic to-do lists that raised my stress level and stifled productivity. I also observed that on days when I was more relaxed, I was happily productive.

It's counterintuitive that we want to hold on to being anxious, worried, eating disordered, and depressed, and it can be frustrating for friends, family members, and therapists who want to help us make change. In such cases, exploring beliefs about symptoms helps. Worked for me!

December 04, 2012

The Pleasure Principle

In the upcoming season of excess, what can we do when faced with temptation? When tempted to eat a third piece of pie, drink a fourth glass of wine, or buy a fifth adorable gift for our adorable niece, how can we exercise restraint? If you're wondering how to face the overeating, overdrinking, overspending, and other overs that run rampant in December, here are some ideas:

One way to handle situations that require will power is to have a predetermined rule. As discussed in an earlier post, using a rule means not having to make decisions, thereby avoiding poor choices borne of decision fatigue and ego depletion. For example, if you have a non-negotiable rule that you go to the gym before work every Monday and Wednesday, you don't have to make a decision when your alarm goes off in the morning, you just hop out of bed. If you have a non-negotiable rule that you don't drink coffee after 2pm, there's no will power involved in turning down your colleague's offer to pick you up a latte, because afternoon coffee is simply not something you do. 

Rules are rigid, though, and it takes time for them to be integrated to the point that no will power is required. I have a friend who has a novel approach: My friend pretty much never eats dessert. When others are impressed by her will power or accuse her of denying herself pleasure, she replies that rather than denying pleasure, she's giving herself a different kind of pleasure--i.e., the gratification of feeling fit and liking how her body looks. This is a new angle and one that applies equally well to saving money, avoiding sweets, exercising, and other generally positive behaviours.

I like to call this the Pleasure Principle and I've adopted it for my own use in situations involving, for example, spending versus saving money and going to bed at a reasonable hour versus staying up late reading or playing around on social media. I could enjoy new boots or I could enjoy feeling confident about paying my bills at the end of the month. I could enjoy sending one more message or I could enjoy being pleasant and well rested tomorrow. If I decide to save my money or decide to turn off the computer and get in bed, I'm not denying myself the pleasures of new boots or Facebook--rather, I'm benefiting from an alternative pleasure.

How is the pleasure principle different from rules, will power, and doing your future self a favour? Rules imply rigidity, will power implies self-denial, and doing a favour for your future self implies doing something grudgingly, but for a greater or future good. The pleasure principle removes all of the negative implications, leaving you with pure pleasure--it's win/win.

This holiday season, keep the pleasure principle in mind when you're trying to resist the third piece of pie, fourth glass of wine, and fifth perfect gift for your niece. Let me know if it helps!