Our not so realistic reality

Not so real reality

Not so real reality

The basis of any anxiety or panic problem is a personal belief about something that in reality is not true. Whatever your individual fear may be, the chances are that it is completely illogical and not at all rooted in real facts. Living a life based entirely on thoughts and feelings which we know don’t reflect reality is one of the strangest experiences a person can have, and yet so many of us live this way every day, sometimes without even realizing they’re wrong.

Myself, I could say with total conviction that I know my anxious thoughts are incorrect. My logical brain is well aware that a panic attack will do me no harm; I’ve had more than enough to factually confirm that. However, there is still that thought, a voice so to speak, which convinces me to avoid any situation that could cause a panic attack because there is always a “what if?”. This makes my anxiety very difficult to explain to others, and I know I’m not alone. People will say “there’s nothing to worry about, you’ll be fine” and you can’t help but answer “I know I will”. They ask why you’re so scared if you know you’re going to be safe, and unfortunately you’re left with no real answer. It is simply a feeling which guides you through your day, and although this may only make up 1% of your thoughts, that 1% is stronger than all of your logical thoughts combined.

It seems mad, on paper, to allow something you know is wrong to dictate everything you do. From what you eat, to where you go, to who you go there with, this one small sensation, which tells you that maybe this time will be so much worse than all the others, is in control of your life. It doesn’t take long to collect a full repertoire of symptoms and side effects of anxiety, from heart palpitations to nausea and full panic attacks. You become familiar with each one, you’ve experienced them all at their very worst and still survived to tell the tales, but still you continue to avoid and fear situations which may cause them again, all because of one tiny voice.

Imagine a world where this voice, this feeling, is the minority. Where you consider that maybe there is a risk, a small “what if?”, but you don’t allow it to control you because you truly do believe that those anxious thoughts are nothing but lies. Simply knowing that your paranoid brain is wrong is just step one, and while it’s an excellent step, it doesn’t change the fact that there is still a part of you which refuses to commit to the belief entirely. There is so much more freedom and liberation which comes with fully accepting and internalising the idea that these thoughts you have are only there to hold you back, and in no way reflect what life is really like. You first have to realise that you’ve seen it all before, you have the wisdom and benefit that comes with experience. You have been through the worst of it and you are still standing, and that should suggest that maybe, just maybe, some part of your way of thinking is very, very wrong.

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To see ourselves as others see us

I don’t know about you but there have been times in my life when I have been acutely sensitive to the gaze of others. I am not immune even now, although I am better at managing how it makes me feel.
Which is why I found this video interesting and I thought you might also. It shows how different our own impression of ourselves can be to that of others.
It is like having a window into the subtle ways we see ourselves (not the good ways) and how that can distort everything else we feel.

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After Paris does the world feel more dangerous and do you feel more anxious?

Terrible things do happen.

Terrible things that happen without warning can make you feel more vulnerable and anxious. The media play and replay their footage, with comment and analysis. All of this can have the the effect of making the terrible event seem more likely to happen to you or the people you love. Your brain is genetically tuned to detect threats to you. Indeed it is highly sensitive to any situation that may even turn threatening. So when a threat is perceived but there is no obvious focus for the threat your brain often goes into a worry loop.

If you find that the terrible events in Paris have caused you to be more anxious but you’re not sure why then watch my video. I will explain how worry gets started and why anxiety goes up.

Are you anxious?

 

The link to the next film

About Dr David Purves

Dr David Purves is a Reading based psychologist providing private CBT in Reading, Berkshire. Dr Purves is the clinical Director of The Berkshire psychology service and former Consultant Psychologist and Head of the NHS Berkshire Traumatic Stress Service. He treats trauma and PTSD at his clinic and writes and speaks internationally on matters of terrorist related trauma.

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Depression Treatment and Symptoms

Why mental defeat creeps up on you

When you’re thinking about depression treatment and symptoms you’ll recognise that sometimes you feel like giving up and letting everything just drop. This is a normal reaction when things feel overwhelming. But sometimes when we are faced with circumstances that feel beyond our control this need to let go of everything can get out of control and turn into mental defeat.

Depression treatment and symptoms

Depression treatment and symptoms: Mental defeat

Mental defeat is often seen in clinical cases of post traumatic stress disorder (PTSD) where it is a whole body response to overwhelming fear, and the threat of death. The survivor often cannot shake off the belief that there is nothing they can do to protect themselves. This leaves them with an ever present sense of vulnerability and threat. Mental defeat is not limited to PTSD however, a recent study into chronic pain revealed that mental defeat is correlated with how distressing chronic pain is felt to be.

Depression treatment and symptoms: Psychological coping

One of the core elements of psychological coping is the belief that you have the necessary means to get through your present troubles with your identity intact. However when mental defeat creeps up on you it attacks your sense of self; leaving you wondering if you can truly manage, while suspecting you cannot. This delicate balance on the edge of coping is both distressing and debilitating. Chronic pain can often leave sufferers with an intense psychological reaction to pain feeling like it has taken away their autonomy and identity.

Depression treatment and symptoms - On the edge

Depression treatment and symptoms: The study of mental defeat in chronic pain

Mental defeat was measured by agreement or otherwise with statements like these:

because of the pain I felt destroyed as a person’

‘I felt humiliated and that I was losing my sense of inner dignity’.

The study used questionnaires to assess mental defeat, pain, distress, and disability in a sample of Hong Kong Chinese. The results are also considered to be relevant to European chronic pain sufferers. Three groups of chronic pain sufferers were compared. When the pain levels of the groups was statistically controlled for the results showed that those volunteers who also scored higher on measures of mental defeat showed more poor functioning and distress, over and above the effects of pain severity.

Depression treatment and symptoms: Mental defeat is linked to depression and anxiety

Those volunteers who scored higher in mental defeat also scored higher on measures of depression and anxiety. They were also much more likely to seek specialist treatment for chronic pain.

Mental defeat is pernicious and can creep up on anyone. It has long been recognised that depression elevates the impact of pain and causes the feeling of mental defeat to be stronger and more persistent.

Chronic pain is a real problem in our modern society, with some estimates putting the incidence of chronic pain in the community as high as 46.5%. So there is a real need to provide psychological interventions and treatment strategies that help defuse the mental defeat that creeps in with chronic pain.

Depression treatment and symptoms: My CBT therapy tools for tackling mental defeat

Depression Treatment and Symptoms - Tools to tackle it

  1. To see the pain as an enemy is to open the path to victimisation. If you give the pain control over your identity then you are in a struggle you cannot win. The pain is not your enemy it is simply an experience you are having. Therefore accept the pain and don’t think of it as an intruder, an enemy or a life spoiler.
  2. Don’t fight pain with rejection or avoidance. Of course you must minimise the effects of pain by careful management but don’t refuse to accept its existence. This only places you in an oppositional place where you cannot win. I have had many clients who started out saying things like:

‘I can’t accept the pain’ I didn’t ask for it, it has robbed me of my life I won’t let it defeat me.

These are understandable sentiments but they are not usually conducive to a good outcome. Don’t fight the existence of the pain but do manage it as well as you are able.

  1. Do allow the pain to flow and ebb. Accept that it is there and is a part of you right now. Although intend that it will diminish as your engagement with it diminishes.  Pain feeds off your attention, anger, avoidance and disability. When you stop feeding pain it loses strength. Stop feeding it your negative emotions.
  2. Depression increases the burden of pain by as much as 15%. Imagine if you could have 15% less pain by changing your mental attitude. This is the goal, as you turn mental defeat, depression, anxiety and the feelings of helplessness that accompany mental defeat away you reduce your burden of pain. This in turn helps empower you to accept the pain you have; reducing further your anger over it. This further decreases your burden of pain and you become someone who has pain but is not defeated by pain.
  3. In the end mental defeat is a forlorn attempt to fight yourself. It just never works. Use a different strategy and you will get a different outcome. And along the way you will become empowered once again.

Reference

Mental Defeat Predicts Distress and Disability in Hong Kong Chinese with Chronic Pain (2013) Tang NKShum SHLeung PWChen PPSalkovskis PM.

http://www.ncbi.nlm.nih.gov/pubmed

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Seeking an alternative depression treatment?

What is an alternative depression treatment? Well in this case we’re looking at options that aren’t medication. Usually antidepressant meds are the first treatment plan people consider after finding out that they are suffering with depression.

alternative depression treatment running
Antidepressants have their place but with them come side effects. And if you only use antidepressants to treat your depression when you stop taking them you have a 60% chance of relapsing.

So what can you do? Consider alternative depression treatments as part of your assault on depression.

Alternative depression treatment: Lifestyle changes

For some, looking for alternative treatments for depression, lifestyle changes are all that’s required but they can also be an important part of an overall treatment program if your depression is more severe.

Stress

Spend a few minutes looking at your life and identifying causes of stress and consider how you might reduce this.

Mark’s depression became substantially worse after he took a new job. His manager seemed to dislike him immediately and bullied him almost from day one. Mark realised this was adding to his stress and depression so made a complaint to HR. They worked with Mark to try to improve the situation but he didn’t feel it was enough. Mark was lucky enough to find a new job where he worked with much nicer people who recognised his ability and were very supportive. By reducing stress in this area he found that his depression eased considerably and very quickly.

Sleep

How well are you sleeping? Try to make sure that you are getting enough rest. You will find your symptoms are worse if you are trying to get by on less than 7 hours sleep a night.

alternative depression treatment sleeping
Diet

What is your diet like? In my experience people suffering with depression either comfort eat or don’t eat enough. Whilst fast food, chocolate and desserts may be really attractive try to ensure that you eat a balanced diet with plenty for fresh fruit and vegetables. And eat regularly. This will ensure that your sugar levels don’t dip and help to stabilise your mood.

Exercise

Regular exercise is an important weapon in the fight against depression.  It’s a great alternative depression treatment because when you exercise it releases endorphins and boosts serotonin which make you feel happy. If you’re not used to exercise start with walking as walking is a great stress buster. Just 30 minutes a day is enough to make a difference to how you feel.

Brandon had started taking antidepressant meds when his father died. It coincided with a very stressful time in his life as Brandon was also studying for his law degree finals. His GP prescribed antidepressants for depression with the idea of helping Brandon to get through the exams. After his exams Brandon started seeing a psychologist. After a few months Brandon was keen to come off the antidepressant meds. He joined a gym and went five times a week really focusing on cardio. Brandon came to really enjoy running especially and when his 30 minutes were up he often kept going  for another 15-30 minutes. Under his doctor’s supervision Brandon was able to reduce and finally come off the antidepressants  without feeling his mood dip. Exercise continues to be a constant part of Brandon’s life and his depression has never returned.

Alternative Depression Treatment: Supplements

In addition to alternative depression treatments there are some natural treatments for depression which you can try. As far as supplements go St John’s Wort is probably the most well known. You can learn more in my natural treatments for depression article.

clinical-depression-treatments-antidepressant-meds

Alternative Depression Treatment: Complementary Therapies

If you’re seeking an alternative treatment for depression then complementary therapies such as homeopathy and acupuncture can also be helpful.

The way homeopathy works is to treat the whole person. Before prescribing a remedy a homeopath would consider your mental and bodily types along with your symptoms. There isn’t a one size fits all in homeopathy. One person with depression could get a different remedy  from another.

If you are taking antidepressants homeopathy had still be used in addition.

With acupuncture very fine needles are inserted in to the skin at specific points to unblock stagnant energy in the body. It’s a practice that has been used for many years in the East. Among other things Acupuncture can lift your mood and reduce stress.

Alternative Depression Treatment: Therapy

Those who seek therapy for depression have  around a 30% chance of relapsing within two years . If you only take antidepressant medication than your chance of relapsing within two years is around 60%. So I think you’ll agree that it’s worth exploring  therapy.

self-help-depression-man
Why is this the case? Well, therapy helps you get to the root of your depression. Through therapy you can uncover the underlying cause.

There are different types of therapy you can try but Cognitive Behavioural Therapy or CBT therapy is put forward by the National Institute for Health and Clinical Excellence (NICE) as the psychological treatment of choice for mental disorders such as anxiety and depression.

CBT therapy is a talking therapy that can help you challenge negative thoughts, feelings and behaviours.

I favour CBT therapy because it gives you, the patient, a greater knowledge and sense of control over the whole process.

Our feelings are not a good guide to reality in a lot of circumstances and in particularly when we have very negative beliefs and feelings about ourselves. If we don’t challenge these beliefs and feelings and change them they will continue to exert a powerful influence over us and they will distort and eventually ruin the course of our lives causing depression, for example.

CBT therapy is a good way to go about changing your thoughts and feelings.

Alternative Depression Treatment: Finding a therapist

Your GP should be able to refer to a good therapist or you can ask around and see if anyone has a therapist they recommend.

Sometimes you can’t access therapy as quickly or cheaply as you’d like. If you find that’s the case there are some online courses such as Mood Control which you can begin immediately.

There are also free CBT exercises on the internet which you can use to get you started.

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You can walk away stress

We have all known it for ages but now science is catching up with the evidence that exercise is stress-busting. The Daily Mail reported that walking briskly or jogging really does calm you down by sparking nerve cells in the brain that relax the senses.

exercise can beat stress

You can walk away stress

Exercise has long been thought to be effective for anxiety and depression, but the brain mechanism behind the phenomenon has remained a mystery. Now tests on mice show when they are active, soothing neurons in the brain are triggered. Then when they are then exposed stress they are more calm. You can read the original article by following the link.

Read more: http://www.dailymail.co.uk/health/article-2356004/You-CAN-walk-away-stress-Scientists-discover-stroll-soothe-brain.html#ixzz2YY52ZK84

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Clinical depression treatments: Your soul has a cold (Kokoro no Kaze)

Clinical depression treatments vary tremendously depending on where you live. This comes from the fact that attitudes to depression can be very different across the globe.

Japan traditionally suffered twice the suicide rate of the USA. However, talking about depression in Japan had always been a very different matter from talking about it in Western countries. In our language, the word for depression is interchangeable with dips in landscape, economy or mood. But in Japanese the word for depression (utsubyo) was used only to describe major depressive disorders and/or mania. Indeed it was seldom heard outside psychiatric circles.

clinical-depression-treatments-in-Japan
In Japan, to talk about or express feelings, people relied on the word ki or ”vital energy.” When describing low mood people might use the word ‘Ki’ and couple it with expressions of sadness because their Ki was sluggish, blocked or leaking.

Moreover there had always been a keep it to yourself (KITY) social norm in Japan where there was merit in not burdening others with your problems. And for both cultural and religious reasons people with mental health problems like depression were likely to suffer stigmatization, in addition, to the burden of their psychological problem.

Traditionally the major pharmaceutical companies had bypassed Japan when marketing anti depressants because there was not a disorder of depression recognized in Japan to treat and therefore no market for antidepressants. Until that is a new phrase was coined that linked the traditional Japanese notion of Ki and low mood. Kokoro no kaze (your soul has a cold)

Clinical depression treatments: Your soul has a cold

The effect of this clever combination of traditional word and understanding coupled with the new way to talking about something that was an unspoken problem for Japanese society started slowly but with gathering pace to change the status of depression. Depression became defined as a ‘real’ problem. And real problems have real solutions!

clinical-depression-treatments-soul-has-cold
Clinical depression treatments: Antidepressant meds

So far so good. The problem I have with this story is not that depression in Japan was under reported and under treated, I think that is self evident.  And clearly the changing force needed to bring this problem into awareness against a strong and established cultural norm was very substantial. All of that I believe was to the common good. No, the problem I have with this overall approach is that in Japan depression has been characterized as an entirely biological problem that is therefore can only be solved by the use of antidepressant drugs.

Clinical depression treatments:  How the Japanese viewed low mood

To put the problem into an historical context the traditional way of thinking about suffering in Japan may shed some light on why depression was never considered a disease. ‘Melancholia, sensitivity, fragility were not considered to be negative experiences for Japanese hence they were not considered to be problems in need to a solution. They were not considered bad in and of themselves.

Clinical depression treatments: The medical model of depression

In contrast the medical model of depression categorizes suffering as pathological and a problem that requires an intervention. Normally this is a pill. It is the case that the treatment of diseases in more easily understood and funded by health insurance companies and national health agencies and of course the classification of something as a disease helps remove some of the potential for stigmatization. But it also creates a market for the solution where previously none existed. Some critics of this approach have argued that it leads to the pathologisation of normal emotion; the tipping point where moods become medical problems and as such it turns normal human experiences into commodities to be managed.

clinical-depression-treatments-antidepressant-meds
Clinical depression treatments: A Little history

Eli Lilly had decided in the late 1980s against selling Prozac into Japan as there was virtually no demand for antidepressant meds. Even though throughout the western world Prozac and other selective serotonin reuptake inhibitors, or SSRI’s were becoming a virtual cultural phenomena – the antidepressant era!

In 1999, Meiji Seika Kaisha a Japanese company began selling the SSR Depromel. Meiji was among the first users of the phrase kokoro no kaze.

The following year, GlaxoSmithKline (GSK) the maker of the antidepressant Paxil joined Meiji by entering the Japanese market.  At this point people did not realize they were suffering from a disease and so GSK put substantial effort into the re-education of the normal Japanese doctor. GSK created a simply message: ”Depression is a disease that anyone can get. It can be cured by medicine. Early detection is important.”

In the early 2000s GSK sent 1,350 Paxil-promoting representatives to visit doctors on average of twice a week. With additional campaigns to teach GPs and their patients about the symptoms of depression: ”head feels heavy, cannot sleep, stiff shoulders, backache, tired and lazy, no appetite, not intrigued, feel depressed.”

Clinical depression treatments: Recognition of depression is useful

I have to acknowledge that recognition of depression is better than not recognising it. Depression is a problem that causes untold misery. Even today in Japan data suggest that 6.6% of Japanese have depression.

clinical-depression-treatments-low-mood
Clinical depression treatments: Depression is a psychological problem

To promote depression as a solely biological problem is to tell an incomplete story. As a psychologist I am not a dispassionate observer of the capture of  depression by the medical establishment. I treat depression every working day and most of the time my clients never use antidepressant meds. Therefore my experience of clinical depression treatments shows me that depression is more than adequately treated by psychological therapy and probably best by CBT Therapy.  Nevertheless most psychological therapies are likely to have value as depression treatments.

I cannot blame the pharmaceutical companies for doing what they do which is to sell pharmaceuticals. And I know it is a common meme to bash the multi national drug companies. I can see they do a lot of good in many areas. If you have malaria you should take an anti malarial medication. But if you have a psychological problem that is better treated by a psychological therapy than a drug treatment then I have an issue with the bias in the message. That’s all.

The moral question is this: are we only consumers or human beings who can also consume? To assert and promote that depression is only a biological problem without also stating that it is a psychological problem is obviously good business for pharmaceutical companies but it is ultimately misleading and I think in the end immoral. If there are better depression treatments even though they cannot be packaged and sold by pharmaceutical companies they have an obligation to inform the public because that is a morally good act. I don’t observe this happening right now. How have we sleep walked to this place in the world where the pursuit of commercial advantage and money takes precedence over honesty, integrity and the common good?

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Attacking anxiety and depression: Correcting faulty thinking part 3

The consequences of faulty thinking

So far in the attacking anxiety and depression: correcting faulty thinking series we’ve looked at how the brain works and thinking develops and how and why your brain makes errors. In part three I’d like to focus on the consequences of faulty thinking – how this affects you.

attacking-anxiety-and-depression-yellow-light-bulb

Attacking anxiety and depression:  What are the consequences of faulty thinking?

When the short cuts your brain makes go wrong, you are left with the wrong interpretation or understanding of something. Imagine the experience of seeing someone from behind, being convinced it is someone you know.

You tap them on the shoulder and it turns out to be a stranger. That is an example of a short cut error that could be called faulty thinking. In this example you jumped to a conclusion without enough information to be fully sure you knew the person. If this has happened to you there is not likely any harm done, it was a mistake.

Sadly, many human error disasters and accidents can be wholly attributed to short cut errors. The human brain often misjudges the distances between things, miscalculates the speed of something, hears what it expects to hear and interprets something in an habitual way.

In fact it jumps to conclusions,  it sees what it expects to see, it hears what it expects to hear and is imagines things that have not happened. All of these are based on scanty information and the application of rules that are no longer valid.

Sometimes faulty thinking can have catastrophic effects. And the same principles that underlie the faulty thinking in disaster or accident situations also happen in everyday life and can lead to very serious problems;  leaving you dealing with depression and anxiety.

Attacking anxiety and depression:  How faulty thinking creates psychological problems

You are equipped with the ability to be self-critical. Depending upon your life experiences up to this point, your ability to be self critical will be more or less developed. For many people it will be highly developed. But be under no illusion, everyone is critical about themselves to some degree.

If you experience times in your life when you are overloaded, stressed, burdened, confused, tired, unsure or unstable, then your self critical capacity is increased. At the same time your brain is probably working hard to manage the problems you perceive in your life. This is when short cut errors become highly dangerous.

attacking-anxiety-and-depression-danger

When your brain makes a shortcut error and the outcome is negative, self destructive, depressing or fear inducing, you may not recognize it as a short cut error. You may accept it as a fact. This increases unpleasant negative emotions and depresses your mood further. Remember: if an error has happened once it is more likely to happen again. The next time your brain makes a short cut error you again accept it as fact. And so this continues until the shortcut error is automatic. You no longer question it.

The process can repeat itself many times with many forms of shortcut error. Your job now is to recognize short cut errors and bring them once again under conscious control; because only by bringing them under conscious control can you rectify them.

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Attacking anxiety and depression: Correcting faulty thinking:

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Attacking anxiety and depression: Correcting faulty thinking part 2

Brain Processing Errors

In part one of attacking anxiety and depression: correcting faulty thinking I talked to you a little about how your brain works so that you could understand how thinking develops. In part two I’d like to tell about how and why your brain makes errors and what that means for your mental health.

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Attacking anxiety and depression: How your brain works

Firstly, I should point out that your brain works very well indeed. However, in any system that has to manage the vast amounts of data your brain does, there will always be the possibility of error. The study of brain processing errors is a whole field of research that helps us better understand how the brain works. Many common errors seem to be the result of the brain using an inappropriate short cut. Which means the brain applies a strategy or rules it has used before thereby not having to fully process something. This leads to what we have called shortcut errors.

Attacking anxiety and depression: Brain short cut errors

The real problem with these errors is not so much that errors exist, but that you do not recognise them as errors.
Remember the effect of learning and repetition which we talked about in part one? Well, if an error occurs and it is not recognised it becomes easier to make the same error again; and after 50 errors it is automatic.

Sometimes this really does not matter very much. Suppose you acquired the habit of never eating green vegetables as a child because you mistakenly believed they were poisonous. It is now automatic. You never eat them. It is probably not going to hurt you much.

But suppose you acquired the habit of thinking of yourself as stupid. If you have thought it 50 times or more it is likely to be automatic. Lack of green vegetables will not stop you from achieving your life goals; thinking of yourself as stupid probably will. Both are examples of shortcut errors we have called faulty thinking.

Attacking anxiety and depression: The Muller Lyer Illusion

muller lyer illusion
Look at this picture. It is called a Muller Lyer illusion. Can you decide which of the horizontal lines is the longer, the one on the left or the one on the right?

This illusion is one of many tools that is used to study brain shortcut errors. Actually the horizontal lines are both the same length. But the way the diagonal lines are arranged fools your brain into thinking that the line on the right is shorter and the line on the left is longer. Feel free to measure them with a ruler is you feel the need.

The fact that your brain can make short cut errors may seem strange to you; if so, you can now see why you may have never corrected the errors. The fact is you would not recognise any thought or belief as an error unless you were shown how to see it in the first place. This is what we will do in part three.

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