cognitive disorders

Depression or Sadness

In beginning a new month, I thought we would begin a new topical series on psychological disorders beginning with the one that affects more North Americans than the others…Depression.

In my professional opinion depression is a term over-used and over-diagnosed in numerous cases where it is clearly not applicable. We have become a society whereby sadness is often stated to be depression, which prevents some from a normal life experience. Experiencing sadness is not a bad thing; it should be part of every human beings emotional repertoire. Without sadness, we cannot fully comprehend joy. As psychologists and psychiatrists, I believe we have over-diagnosed normality of experience at times. There are numerous events in life that will create the emotion of sadness—these events do not require psychotherapeutic interventions, medications, and/or disability leaves from the workplace.

These sorrowful events require…

  • good support from family and friends,
  • our willingness to not always feel good,
  • and our initiatives to experience, press beyond, and come out the other side having conquered and overcome.

Similar to the use of the word “stressed” in the 80’s we are now a society that is “depressed”. Through the 80’s and 90’s everyone was “stressed” and needing a break. Many used this term to take weeks if not months off from work. What became evident through research was that stress is not a bad thing; we all need some degree of stress in our lives to function at optimal levels—we simply need to know how to manage stressful events and situations to ensure this does not become a greater concern. Additionally, insurance carriers and others stopped accepting the term “stress” as a rationale for a leave from work, which initiated the diagnosis of depression as this, is a qualified diagnostic that allows for a leave from work. The problem with this…it filtered beyond the medical and psychological offices into day-to-day linguistics and has become the new “stressed”.

Depression is a reality for many…I clearly believe that this disorder exists and it is devastating for those experiencing it and for their friends and family members. However, it needs to be properly diagnosed and properly treated through either psychopharmaceuticals and/or psychotherapeutic interventions. However, the rate of depressive diagnostics has skyrocketed over the past 15 years and albeit that there are some rationales for an increase in the number of cases this does not account for the numbers we are seeing as a society.

This week we will explore the many faucets of depression from what it “really” is, how it is diagnosed, what are the different treatment options (including specific methods and suggestions for healing oneself), to when should you seek professional supports.

Before I end today’s blog, I will describe one of my favorite “stress/depression” episodes. An individual came to see me to provide me with a medical note indicating a leave from work for “stress/depressive” symptomologies. Everything about this looked to be normal for this type of case except that there was no treatment plan whatsoever which in and of itself is not that unusual either (unfortunately) but this person seemed “scripted” in their description of symptoms. In any event, they were also surprised and actually appalled that I was going to be giving them a prescribed course of psychotherapy. Most individuals that are depressed are happy to finally be shown a light at the end of the tunnel; this person saw it only as a train getting in their way. At the time, I was proving EAP services to organizations, which meant that I worked with all the employees of specific companies… so if colleagues needed supports they would come to me too. Well in short order another employee from this same company came to see me with the same set of symptoms (almost the same script) and the same disdain for the prescribed course of treatment. Then another came into my offices. This was beginning to look very unusual to the point that I was curious as to the working environment these individuals were being exposed to that all would have the same symptoms of stresses. I then received a call from the insurance carrier that was handling all of these “disability” claims to discover that the notes were also all written from the same physician. The insurance carrier decided to investigate only to find that these individuals were all looking to take extra time off as a means of having extended vacations. Apparently, they even spoke to their co-workers about this new found scam and all of them ended up getting sort of what they wanted—unlimited time off from work; for them it was no longer disability though, it was termination.

TODAY HAS STARTED—HAVE A GREAT ONE!

Anxiety: Then and Now

This week we will look at the other side of the spectrum to a depressive disorder and explore anxiety disorders.

Once again, these are something that are experienced at exponential rates and can often be contributed to poor stress coping mechanisms and living in a high demand society. If you stop for even a minute and look at your life you will notice a dramatic difference from what it looks like now and what a person’s life looked like a mere 40 years ago. The “electronic age” has typically not made a person’s life easier; the way it was intended—it has made it more stressful and when combined with poor coping skills it is not difficult to understand how people on mass can become overwhelmed at a much higher rate. The “electronic age” was supposed to change the world whereby work would be easier, more automated, and safer. Some of these things have happened, but it has also brought a constant learning curve, an increase in work hours for many due to connectivity features, and a population that experiences higher than usual anxiety states.

Let’s explore the typical person’s life that is married with two kids and a white-collar job.

If we go back 40 years they likely lived reasonably close to their place of employment or lived in a smaller city then they do now and thus the commute was not an hour of bumper-to-bumper traffic with everyone else “rushing” to get into their office. On the way to and from the office people had time to think, to read (and not text messages or email), and to visit…basically not to work. Once at the office most were not faced with their own desktop computer or the hugely expensive “personal laptop” that they could take home at night in order to keep working. There was an “off switch” to the world of work. Once you got home from work, relaxed for a few minutes, you could take your kids to their respective activities often within your community or a community one over and have time to talk and visit with neighbours while your kids engaged in some form of play or entertainment.

Today people often commute one to two hours into their office and almost everyone has a cell phone, which is attached to his or her ear 24-7, and being on-call has been taken to a completely new level. Today most kids are in numerous activities (not just one or two) and the drop off and pick up times have extended dramatically. We have come to normalize the limited amounts of time that families spend together just interacting with each other; as the drive to and from these events are often accompanied by MP3 players, cell phones (with parents talking to someone and kids texting until their fingers are blue), and IPods. Once at home again, there is homework, office work, and house chores.

It is not surprising why people are more anxious—they work more, they interact (meaningfully) less, they are required to know more and continually upgrade this learning (just explore a new TV, cell phone, or computer), and most do not have well constructed boundaries or are trained in methods to manage stress. I know this is an over-simplified look into society but for many this is what has contributed to their response to “How are you?” to have become “Anxious!”

This week we will look at what a diagnosed anxiety disorder is, what managed stress looks like, and how to set and keep healthy boundaries in your world.

TODAY HAS STARTED—HAVE A GREAT ONE!

Anxiety versus Worry

The vast majority of people that experience anxiety symptoms (not a full anxiety disorder), do so from WORRY. As such, before we look at what anxiety disorders are we will explore the condition that affects a vast majority of the population. What is worry? By definition worry is a position or state where an individual torments oneself with or suffers from disturbing thoughts. Worry is also a habituated behaviour, which is a good thing—because behaviours can become alterable simply through replacement and practice.

So let’s explore worry at a deeper level; we’ll start with what worry is not…

  • It’s not simply thinking about future possibilities and the actions one would take if these occurred
  • It’s not becoming anxious because your current life situation is realistically in difficulty and you are finding it problematic to see a way out
  • It’s not looking at all the options in front of you when faced with a major life change
  • It’s not productive in any manner

So what is worry…

  • It’s obsessing about past and/or future events that may never happen or cannot be altered, to the degree that this causes feelings of anxiousness
  • It’s about not being able to remain present for lengthy periods of time because ones mind wanders off to think about events outside of their current experience
  • It’s evaluating past events or attempting to foresee future events from a current frame of focus that is inappropriate for either event; as current knowledge and stances may have altered past activities and will change by the time one reaches the future
  • It’s a time waster as most future events that are worried about never happen
  • It’s often accompanied by what are commonly known as “cognitive distortions” or distorted ways that people look at events

Here is the good news; if you are a worrier this is not a complex behaviour to alter. Below are some direct suggestions for stopping worry before it takes hold.

Go buy yourself a notebook or a journal and for everything that you worry about write this in the book. From there you could follow the below options.

If it is past events ask yourself the following question…”Is there anything I can presently do about this event”? If the answer is yes, take action and stop worrying about this. If the answer is no, write out what you would do if this same event were to occur over the next few months (you don’t want to apply this beyond a few months as you will know more as time goes on and you may develop better ways to handle this same event). If this is unalterable, then forgive yourself or others related to the features that are tormenting or problematic and allow yourself permission to move forward in life.

If what you are writing is about future events then ask yourself the following question…”What is the true likelihood of this event actually happening”? If the percentage is below 80% then do thought stopping (see below) to change this activity. If the percentage is above 80% then rather than worry take action! Write out all of the options you can take to address and influence this high potential activity and then act upon these directives rather than simply worry about the outcomes.

Thought Stopping: when you realize you are worrying about something internally YELL STOP and re-focus your attention to the current moment by focusing on the concrete features to where you are—sight, sounds, taste, touch, and smell. You can yell this in your outside voice, but this may be met with interesting responses by those around you.
TODAY HAS STARTED—HAVE A GREAT ONE!

Anxiety and Cognitive Disorders

For many people anxiety is the culmination and/or overuse of any one of the below listed common 10 Cognitive Distortions. Cognitive distortions are simply distorted ways that people interpret everyday events. We all do these things, the difference between normal use of cognitive distortions and problematic use of cognitive distortions is related to the frequency of their usage. If you are using any one or more than one of these distortions on a regular basis, it will create any number of difficulties including anxiety for some.

If you want to know if you are using these distortions keep track for two-weeks by keeping a checklist three times a day by simply asking, “Did I do any of these, if so which ones and how often since you last checked”? At the end of the two-weeks, simply total the number and see which one(s) you are using most frequently. Come back later for answers on how to alter these patterns.

All-or-Nothing Thinking: A work project fell short of perfect and so now you think it is a total failure.

Overgeneralization: You did not get that promotion so now you believe your career will never amount to anything.

Mental Filter: You handed in an exceptional project at work yet one of your co-workers wonders if you could have used a different folder; you focus exclusively on the folder versus the exceptional project.

Disqualifying the Positive: You did a great job on that project yet you attribute this to “just being your job” and re-focus your attention elsewhere.

Jumping to Conclusions: You see the world negatively even though there are no facts to support this either through mind-reading (thinking you know what other believe without proof of this) or fortune telling (you automatically believe something negative will happen without any reason as to why this might be).

Magnification and Minimization: You highlight and focus on your problems or defects and minimize your good qualities as unimportant.

Emotional Reasoning: You assume that if you see something as negative it must be that way even though others are likely to see it differently; you are unwilling to see things through the “eyes of the world”.

Should Statements: You frequently use the words should, have to, must in your language that sets you in a position of never doing things right.

Labelling and Mislabelling: You take one event and apply it to your whole life; you see a mistake as meaning you are stupid.

Personalization: A situation that you were not involved with goes poorly and because you have some association to the project, you blame yourself completely for the result even though it was not your work even.

TODAY HAS STARTED—HAVE A GREAT DAY!

Correcting Negative Thinking

In a previous blog (Anxiety & Cognitive Distortions) I had mentioned that I would go through the methods for resolving the common Cognitive Distortions—then I went on holidays! Well it has been brought to my attention that this area still requires attention, so here it is.

To re-cap there are 10 Common Cognitive Distortions—
1. All-or-Nothing Thinking: A work project fell short of perfect and now you think it is a total failure.
2. Overgeneralization: You did not get that promotion so now you believe your career will never amount to anything.
3. Mental Filter: You handed in an exceptional project at work yet one of your co-workers wonders if you could have used a different folder; you focus exclusively on the folder versus the exceptional project.
4. Disqualifying the Positive: You did a great job on that project yet you attribute this to “just being your job” and re-focus your attention elsewhere.
5. Jumping to Conclusions: You see the world negatively even though there are no facts to support this either through mind-reading (thinking you know what other believe without proof of this) or fortune telling (you automatically believe something negative will happen without any reason as to why this might be).
6. Magnification and Minimization: You highlight and focus on your problems or defects and minimize your good qualities as unimportant.
7. Emotional Reasoning: You assume that if you see something as negative it must be that way even though others are likely to see it differently; you are unwilling to see things through the “eyes of the world”.
8. Should Statements: You frequently use the words should, have to, must in your language that sets you in a position of never doing things right.
9. Labelling and Mislabelling: You take one event and apply it to your whole life; you see a mistake as meaning you are stupid.
10. Personalization: A situation that you were not involved with goes poorly and because you have some association to the project, you blame yourself completely for the result even though it was not your work even.

It was suggested that you keep track of these internal thought patterns for two weeks simply by asking yourself twice a day, “which of these, if any, did I use and how many times”? Then record this number; at the end of two weeks if any one or more than one of these is being excessively used, you might want to look at what can you do different to change this pattern? For each distortion, there are multiple ways that you can alter this pattern.

Listed below are the common ways people change these thought processes; listed with them is the distortion it is best applied towards.

  • Examine the Proof: show the evidence for your belief and also see if there is any possible other beliefs that might be relevant to the situation. (distortions 2-6)
  • Thinking in Neutral: rather than seeing the world in absolutes, create a range for thoughts and experiences…what is the range from 0 (no belief at all or small occurrence) to 100 (full belief in this and happens lots) (distortions 1 & 2)
  • Double Standard: ask yourself,”would I talk to others or treat others the way I am talking or treating myself right now”? (distortions 6, 7, 9, 10)
  • Perform a Survey: ask people you trust about their perceptions/ experiences with the thought and/or situation (distortions 4 & 7)
  • Explore Semantics: create substitute language; use neutral words or words that are more accurate to the situation (distortion 8)
  • Define your Words: if you are internally calling yourself negative things, define what those things are in their totality and see if you do in fact fit with that description or if you are identifying too much (distortion 9 & 10)
  • Pros & Cons List: do a full listing of the pros and cons to holding the belief that you have (distortion 4)

During the week I will provide detailed examples of both the distortions and ways to change these patterns.

TODAY HAS STARTED—HAVE A GREAT DAY!

Resolving Distortions – Part 1

1. All-or-Nothing Thinking: A good example of this is having a relationship fail and telling yourself “well I’ll never be in another relationship”. There are a number of things that will result from holding onto that thought; you will likely degrade your esteem by putting yourself down suggesting that you aren’t good enough for relationships, it may hinder your willingness to explore other relationships because you think the next one will simply be a failure too, or you might reduce or compromise your expectations of a partner believing this is the best you will get. There are likely a thousand other negative beliefs, but lets stick with these potentialities. To resolve All or Nothing Thinking you can begin by Examining the Proof— do you really want to be alone for the rest of your life? If the answer is yes then alter the thought to “I chose to be alone versus in a relationship” (by doing this, you are taking back control and a more positive internal stance). Alternatively, if the answer is no, then ask yourself what is the REAL likelihood of NEVER having another relationship—the answer infinitesimal…so change the message to “I will be in another relationship when the right person comes along and I have resolved my issues related to the past relationship”. Again, this places you back in a position of a truer reality and stops sending negative messages. 

2. Overgeneralization: You received a low grade in school or failed one course and now you believe your career is over. There are a number of things that will result from holding onto that thought; you may unconsciously self-sabotage your current position as a means of proving that belief, you might switch careers that you really belong in to offset the potential for failure, or you might not apply for that job you always s wanted for fear that it will not succeed. To resolve overgeneralizations you can begin by Examine the Proof (see above examples) or try Double Standard—talk to yourself the way you would talk to someone else experiencing the same reality. Would you tell someone else that his or her career is doomed? Would you suggest they seek other career or employment options because of one low or failed mark? Of course not (if you would you might want to examine your friendship skills). So talk to yourself in the same manner; rebuild your damaged esteem from the loss, grieve the process, and tell yourself the real story…this is one course and you cannot be good at everything nor are you required to be good at everything related to your career.

3. Mental Filter: You handed in an exceptional project at work yet one of your co-workers wonders if you could have used a different folder; you focus exclusively on the folder versus the exceptional project. In Mental Filter, people are filtering only parts of an event and typically the negative aspects. To reduce this thought tactic use the Double Standard technique (see above) or try Performing a Survey…see how others see the job that you did. By finding people you trust they are likely to provide a more realistic observation both positive and negative to an event that you experienced.

4. Disqualifying the Positive: You did a great job on that project yet you attribute this to “just being your job” and re-focus your attention elsewhere. To adjust this pattern of thinking use the Pros/Cons list where you examine all of the positives to having worked on the project and the negatives. Also, list what the positives and negatives are to holding this belief. In doing the exercise, you will likely find that it can be fulfilling to explore and appreciate the positive contributions that you made and you will be able to see the benefit to changing your belief stance.

5. Jumping to Conclusions: You see the world negatively even though there are no facts to support this either through mind-reading (thinking you know what other believe without proof of this) or fortune telling (you automatically believe something negative will happen without any reason as to why this might be). This is one of the most common distortions. To combat this pattern consistently employ the skill of Examine the Proof—you cannot know what others think beyond a guess; if you want to know the reality, ask them versus assuming you know. Secondly, believing something negative will happen often has people anxious and worried a good deal of their time—perform a Pros/Cons list to thinking this way; what benefit do you receive by assuming negative things will happen to you. Better yet, what is the cost to you by holding these beliefs? Just as easily that one can think negative things will happen, you can also think positive things will happen—either of these situations keep you from being present in the moment and thus you miss your life as it unfolds.

Next time we will explore Cognitive Distortions 6-10.

TODAY HAS STARTED—HAVE A GREAT ONE!