Category: cbt

Depression: How To Feel Like A Loser

Published on by Scott Williams26 Comments

I hate walking. We have a corner store at the end of our block (seven houses away) and I have, on occasion, driven there for licorice. This made the advice from the counselor even more problematic. I was depressed and the thought of walking it off was a million miles away. If I didn’t want to walk when I was healthy, why would I consider it now?

They sit across from me, and tell me a story. They have been to see counselors for depression and were given what seemed to be helpful advice, “Do something”. Take a walk, get out of the house, socialize, join a group, go to church, or join a gym.

Seriously? Anyone who has had serious depression can tell you that this is terrible advice. If someone is having difficulty getting out of bed, is feeling despondent, is wondering if life is worth it, is too exhausted to have a shower; what is the chance they will go for a walk tomorrow morning?

There is no way you could do the things he/she asked you to do. When you went to the psychologist you had depression. Now you have depression and you feel like a failure.

Thanks for nothing.

I would like to suggest that It is a serious error for clinicians to give such counsel to a patient who is seriously depressed and has had difficulty coping and functioning on the most basic level. It is perhaps the most misused advice about depression that I have encountered. People who are struggling with intense depression cannot ‘do’ much of anything. It is a miracle that they made it to their appointment for counseling.

In therapy I often tell patients that dealing with depression begins with what is easiest. So what can they ‘do’ that has huge gains for little effort? Dealing with depression correctly starts with changing the way we think about what is going on. I tell the patient, “Change your mind and your ass will follow”. It is almost impossible to change your circumstances when you are starting out. Getting out of bed is a major chore; going for a daily walk is laughable. Most people cannot, or will not, engage in regular physical activity when they are clinically depressed.

The second mistake is trying to start by changing how you feel. Emotions are the least reliable and most difficult thing to change. Some nights I feel like working out so I think to myself, “I should get up really early tomorrow and do some martial arts, maybe write a few blog posts, and make a big breakfast for the family!”

That all sounds completely doable in the evening. When the alarm goes off at some ungodly hour the next morning, however, I rarely ‘feel’ like getting up. What was I thinking? What a ridiculous idea! It seemed like such a smashing idea the night before; when I was already awake. A great idea, in fact, in theory.

I am learning that doing something only when I feel like it, especially something that requires discipline or commitment, is a horrible way to live one’s life. I never ‘feel’ like going to the dentist, or taking an eight-hour martial arts test, or paying my taxes. Unfortunately the tax department ‘feels’ like making me pay anyway.

So what can you talk about in counseling for depression then? When patients come to see me I tell them that most likely nothing significant will change in the first month. All I’m going to ask them to do is talk; about their situation, their past, their attitude; their coping mechanisms. In turn I will talk to them about our propensity to employ cognitive distortions, how to stop their mind from ‘going there’, mindfulness, radical acceptance. We will look at the ‘why’ questions, find out if there has been trauma, and help them address their dysfunctional thoughts, feelings, and actions.

The interesting thing is, about a month or two into therapy the patient will come to a session and report that they are starting to see improvement and change. If I ask them why they will often say that they are not sure. Things just ‘happened’. This is because they have begun to view life through a different lens and cope in different and functional ways. There are many counselors who will tell you that this strategy works, even if it doesn’t seem to initially make sense. For some reason talking to a good counselor can change your life. If you’re like me, and I know I am, you will probably never get enough counseling to like going for walks though.

I’m not a miracle worker…

p.s. – if you are a counselor/therapist why not consider writing a guest blog about your unique perspective, an interesting experience, or what you are learning. I have learned so much from others who have shared their heart and skills with me and would appreciate any input you might have.

Related articles

Guest Blogger – “Living With A Narcissist”

Published on by Scott Williams5 Comments

Oil on canvas*this article originally aired for approximately one hour until the writer was worried about being found out…

Wednesdays I host a guest blogger – professionals, clients, friends, strangers; stories of success and failure, people who are suffering, some who are opinionated, all of whom are a work in progress. These are struggles about real life issues. If you are interested in telling your story email me at info@scott-williams.ca.

Back a few years ago, narcissist was a word I was only vaguely familiar with.  A word in a book title, a word describing someone in someone else’s life,  a word I had trouble spelling.  Two years and hundreds of hours of counseling and self work later, narcissism is something I think about everyday.  I don’t want to, mind you, but when you wake up beside a narcissist every morning, you better know what you’re dealing with.

For years, I had no idea what I was dealing with. My life looked good from the outside and I couldn’t pin down the reasons for my constant turmoil and distress.  My spouse was the very picture of perfect, everyone told me so.  Much of the time, I even believed it myself.   But belaying his sugar-coated exterior was a cavalier disregard for precise truth, concealed agendas, subtle manipulation and veiled devaluation that I experienced on a daily basis; all in the name of a higher good.   I’d become so accustomed to this, I took it as normal.  My sense of normal was skewed, to say the least.

Over the course of my marriage, I slowly lost my self-worth, faith, hope and ability to cope. I was convinced I was the problem, and so were many others. I second guessed all my perceptions and my internal world became so distorted, I wasn’t even sure what was real anymore.  Was I crazy, lazy, fallen, and below par as my spouse so subtly and repeatedly implied, or was he not who he appeared to be?

It’s taken me a long time to wrap my head around what narcissism really is.  Imagine slowly discovering everything you thought about your spouse was dead-ass wrong.  That all the admirable qualities you’d attributed to them, all the good intentions you thought they had, all the motivations you thought stemmed from love actually came from their need for self-aggrandizement.  Then imagine discovering your spouse isn’t really capable of intimacy, true empathy, honesty or truly loving you or your kids.  Is it any wonder it takes so long to wrap your head around such a thing?

And what in the world do you do when that brutal realization finally makes its way in?

Well I’m still learning and I imagine it’ll be awhile yet.  But here’s a tip I wish I’d paid attention to earlier.  When something doesn’t feel right in your life, find yourself a good counselor.  Then tell the truth and deal with yourself.  It took me 22 years of denial, doubt, and second guessing to hit breaking point. Don’t wait that long.

And then educate yourself about narcissism and it’s effects.   I’m learning to question all my assumptions, look for secondary motivations,  trust my gut instincts, have no expectations of a normal marriage; and trying to be patient with how damn long it takes to begin to feel whole again.

This is an unfinished story for me still.  One of learning to understand myself, my circumstances and live at peace in spite of.  It’s easy to become overwhelmed and lose sight of personal change.  But I think it’s coming, in slow painstaking millimeters, and with it hopefully better days.

The Lies We Tell Ourselves – ‘Everything Happens For A Reason’

Published on by Scott Williams11 Comments

How It Shakes Out – All this suffering is part of a cosmic divine plan.

Why I Hate It –  For some reason almost everyone seems to believe this bizarre statement. We say to hurting families at funerals that this must be part of a bigger plan. This cliche is often used when someone gets a terminal illness or when bad things happen to good people.

Please stop. It isn’t helping.

I remember that day like it was yesterday. A friend and I were called to Kevin’s house, no one had heard from him for days. As we entered his house I knew what had happened, I could smell it. Death has its own fragrance. We found Kevin sitting alone, in front of his television, dead from an overdose called ‘speedballing‘. Another wasted life.

I spoke at his funeral a few days later. I remember too well my half-baked attempt to make sense of something that should never have been. I will also never forget the lady who came to me after the funeral and accused me of “putting a negative spin” on the situation. She concluded with, “I know this will change a lot of lives and you should have spoken of that.”

I host a group for people who have lost loved ones and are struggling to cope. They are broken and confused, damaged goods. Inevitably in the group someone will share how, at the funeral of their child, an aunt or a well-meaning pastor came to them and said, “I guess God needed another child in heaven.”

The God they believe in must be a bastard. Apparently they believe that God needed another pre-adolescent to fill the roles so he killed yours. In counseling we call this a ‘cognitive distortion’. We also call it asinine.

Only slightly less damaging is the statement, ‘everything happens for a reason’. People who believe this think it is a very loose translation of a bible verse, “all things work together for good”. It’s not, and any decent theologian will tell you the bible verse does not mean that everything works to promote what you think is good.

Daniel Wallace explains – You’ve heard it thousands of times: “Don’t worry; everything will work out just fine.” It’s the eternal optimism that is born not in the crucible of reality but in the wishful thinking of the American dream, of Hollywood make-believe, or of a nave Pollyanna outlook. All of us know it isn’t completely true—we know of children who were cut down by cancer or drunk drivers, of drug addicts who came from good homes, of family men who lost their jobs, of soldiers who returned from battle with one less limb. We know of countless tragedies and needless suffering, yet we repeat the myth to our children without blinking an eye: “Don’t worry; everything will work out just fine.”

The fact remains that most people in my part of the globe still believe this to be an important truth. The painful truth is, however, that the grieving widow given this advice often wonders how such a tragedy could possibly be a good thing. As a result many who suffer wonder if this situation is somehow the will of God, or it is because they are not spiritual enough. They become confused, hurt, and often shunted in their grieving process.

This phase is indeed problematic on several levels. The speaker gives the impression that they believe that he or she has some inside track to the motivation of God or Karma or whatever mystical unseen hand is in control of our universe. They are saying that there is a power that decided that there was a good reason to inflict their newborn with cancer or have a woman raped. There must be some reason why some sixty million people perished in World War 2 including millions upon millions of innocents. Apparently we are supposed to learn a lesson which required 2.5% of the world’s population to die and over 6 million Jews, 2.5 million Poles and countless others to be murdered.

And given the existence of this holy force, which acts on our behalf, who am I to question why a child was molested or my friend Duke died of lung cancer at nineteen.

Even if you cannot see the fairy tale ending then your pain was part of a greater plan that helped someone else, surely? Don’t be upset that you were paralyzed by a drunk driver, think about the lesson you’ve taught others about drinking and driving!

As a person of faith I am not suggesting that all pain and suffering is pointless, or that nothing good can come out of a good situation, but the belief that everything happens for a reason is not only untrue, it is also a naive and potentially damaging way to look at life. Kevin’s death was a tragedy and I realize more and more that it is not necessary to rationalize or justify. Stuff happens. Bad things do happen to good people. Sometimes the rich do get richer and the poor do get poorer. Sometimes life isn’t fair (another lie we want to believe). Sometimes addicts die, in spite of our best efforts. I no longer blame God for things I cannot accept without a fairytale ending.

It’s only when we open our eyes and accept life on life’s terms that healing and hope begins. Pretending we are not angry, or frustrated, or confused, only keeps us sick and makes us bitter. No more lies.

Silence The Inner Voice That’s Stressing You Out

Published on by Scott Williams1 Comment

From Psychology Today

Millions of people struggle with unhealthy levels of stress. Stress isn’t just destructive to our mental health but to our physical health as well. It weakens our immune systems and contributes to heart disease, high blood pressure, strokes, and other illnesses.  These facts are important, but reading about  them, or even relaying them,  admittedly makes me feel a little, well… stressed. Too often reflecting on our stress just makes us feel worse. So rather than scare you straight when it comes to stress, I thought I would offer a real solution to those nagging (at times terrorizing) thoughts that lead to stress.

The mere mention of the word stress is enough to make our heads spin with thoughts of to-do lists, meetings, schedules, social calendars, kids, work, money. Whatever the trigger mechanism is, it’s always there to distract us from any potential sense of calm. When we allow our negative thoughts to take over, we spend precious energy handling the symptoms of stress instead of solving the problem or dealing with what’s really making us feel such pressure or worry.

These negative thoughts tell us when to worry and what to worry about, but never do they offer us a real solution to our problems. If we were to challenge these negative thoughts, we would soon realize that not only is this destructive thought process amplifying our stress levels but it is actually causing us much of our anxiety in the first place.

For example, many of us feel concern when we have more things we need to do or want to do than we believe we can get done. Very often, however, we are placing too much pressure on ourselves and setting our expectations too high. In effect we are setting ourselves up, and literally scheduling ourselves out, to get stressed. When we set our standards too high, we often set ourselves up to later become a target for our critical inner voice. We start to have self-critical thoughts like: What is wrong with you? You never give 100 percent to anything. Can’t you just get one thing right? You’re such a failure!

Even when times are tough or the pressure being placed on us is external, we can seek out an inner sense of calm by quieting those inner voices that exacerbate the problem. This is not meant to undermine the fact we all have real concerns about our lives. We all struggle at some point with our careers, our families and our futures. Every one of us has concerns at one time or another about keeping a job, falling in love or raising our kids. However, what we actually feel about these things is usually never as bad as what our critical inner voice is telling us to feel about these things.

For example, when we lose a job, we may have thoughts like: What are you going to do now? You can’t do anything. How humiliating!

When we go through a break up with a partner, we may hear voices such as: See? No one could ever love you. You’re going to wind up alone.

Even an event as simple as forgetting to mail a letter can get our self-attacks going: You’re so irresponsible. How are you ever going to get anything done?

These thoughts impair us in our actions and lead us to feel demoralized and even more stressed out.  We can interrupt this cycle by becoming more aware of the thoughts that are propelling our feelings of worry. For example, a friend of mine noticed she was waking up in a bad mood every morning. Feeling overwhelmed and rushed, her morning mood was slowly infiltrating her whole day. Snapping at people, overdosing on caffeine and rubbing her head to the point of almost literally tearing her hair out, she knew something had to change.

To understand her 7 a.m. stress, I suggested my friend write down all the thoughts she was having before she went to bed. When my friend did this, she noticed her head was full of vicious self-attacks. Her negative thoughts surfaced every night when she finally took a rest from pushing herself through her day. My friend recounted her thoughts to me: What did you actually accomplish today? You’re no closer to your goals then you were yesterday. Everyone hates you. You snap at everybody. Are you even doing a good job? What’s so important about what you do anyway. You never make time for anyone. You’re so selfish. You’d better work harder tomorrow.

When my friend told me her attacks, I was appalled. “No wonder you’ve been feeling under pressure in the morning. You’re tearing yourself apart right before you go to bed.” As soon as my friend realized this pattern, she started to feel compassion for herself and noticed herself feeling relieved of her morning anxiety.

To fully rid oneself of the critical inner voice, one must not only identify the negative thoughts but stand up to them. Putting our voices in the second person can help us make this initial separation. Try to write down your critical thoughts, first as “I” statements, then as “you” statements. If you have thoughts of feeling stupid, write down “You are so stupid.” Next, stand up to this internal enemy by writing down responses to your critical thoughts with the more realistic perspective of a compassionate friend. For example, you could write, “I am not stupid. Anyone can make a mistake. I have a lot of areas in which I am intelligent and confident.” The intention here is not to build yourself up, but to gain a more realistic view of yourself.

Finally, think about what the actions are that could counter your critical inner voices. When my friend had an attack that she was snapping at people, it didn’t help that she was acting on her self-critical thoughts by getting moody and lashing out at co-workers. Avoid actions that will lead you to feel worse. If eating three slices of pizza relieves you after a stressful day only to leave you later stressing over your weight, it’s best not to use that behavior as a coping mechanism. Remember the critical inner voice is tricky and can sound soothing or friendly as it lures you into self-destructive behaviors. Have that second glass of wine. Just stay home and relax on your own. Later on that voice will punish you with thoughts like: There you go having another drink. You can’t stick to anything. What a loner. You’ll never meet anyone.

The voice can also tell us that we are being victimized. When we have thoughts like, Why is everyone walking all over you? No one else does anything around here, we put ourselves in a powerless position and blame others for the pressure we’ve put ourselves under.

Dealing with stress means taking our own side without feeling like a victim. It means empowering ourselves against our inner critic and not allowing that critic to dictate our lifestyle. That critic will put up a fuss when we act against it and cause us anxiety over the changes we make in our lives. However, the more we persevere and the longer these negative voices in our heads are quieted, the better able we are to live in the moment without worrying about the past or the future. We can then deal with everything in our lives one moment, one step, one deep breath and one thought at a time.

Beating Anxiety And Depression Is Possible, But It May Be More Work Than You Are Prepared To Do

Published on by Scott Williams18 Comments

Anxiety and depression are plaguing 21st Century culture. It’s an epidemic.

We have never had better medications to provide relief, never had better therapies available. Health care, thorough physicians, EAP programs for free counseling, nurses, and other professionals has never been as accessible.There is no world war, most of us do not have a terminal illness. Employment is at an all time low. So what is the problem? Is there any hope?

Day after day people tell me in counseling that they have been dealing with anxiety and depression for years, even decades. They have been on antidepressants literally for generations. They believe that they have a biological issue, some sort of genetic flaw, though no one can identify when or how they were tested to confirm the neurochemical prognosis. Many people, at least in my part of the world have seen a psychiatrist who, after ten or twenty minutes, has diagnosed them (without any evidence-based analysis) as having a depressive or anxiety disorder. I have asked these individual what tests were run, what scale was used; did you even fill out a Burns Depression Questionnaire, or a PHQ-9, or a HAM-A/D, a GAD-7? Anything? Did you share the story of your past few years, describe the emotional and psychological stressors?

Twenty minutes every month and a prescription for an antidepressant, a benzodiazepine, and a sleeping medication. Many, many of my patients have been taking these same medications for a decade or more and have no idea if they do anything substantive.

The hard truth is that taking medication for a generalized anxiety or depressive disorder is only a small part of the solution (though perhaps necessary); and by themselves do little to address the important questions. Dealing with anxiety and depression requires actually dealing with the key causes, issues and effects, and takes a tremendous amount of learning, transition, and vigilance.

I tell patients that the tools they need to address these issues are incredibly simple to learn and very very difficult to master. This requires a level of humility and dedication most people are not willing to give. If you have a major issue with anxiety or depression it is going to take major work. But with the right tools, a counselor that doesn’t suck, and a dedication to do ‘whatever it takes’, you can experience significant change in just a few months.

But you need the right tools. If you go to a counselor and they tell you that you need to begin by changing your lifestyle (like the doctor who tells you to fight depression by going for a long walk every morning) then fire that therapist. Real change begins with changing your mind, not your activities or emotions. A counselor who knows what they are doing will challenge you to deal with your thoughts, show you how to practice taking back control of your impulses, and help you learn to address your dysfunctional coping skills and cognitive distortions.

With depression, for example, if you could go for a long walk every morning you probably wouldn’t be talking to your doctor. A person who is seriously depressed is usually unable to find the energy or motivation to open the curtains, let alone go for long hikes. So once again you are a failure, only further entrenching your despondency. A good counselor will help you find hope, not set you up for more failure.

Depressed people can get better. Every day I teach people the tools they need to find hope. The problem is that not everyone is prepared for the relentless battle that is necessary to drag your emotions and garbage, kicking and screaming, back into your control. You will have to fight your own dysfunctional thinking and learn to get control of your mind, battle your obsessions, say no to your desires, and question your own beliefs. This is a great deal of work and pain but the reward is sanity, hope, and a shot at a happy life.

I love what Tony Campolo once said, “As children we were taught to pray the prayer, ‘If I should die before I wake’. Most of us should be praying, ‘If I should wake before I die’.” Many of us have been walking around most of our lives half asleep, half alive. Isn’t it time we woke up? Anxiety is not a terminal illness. Panic attacks can be beaten. Depressed people find hope.

Don’t give up, you’re worth it.

Related articles

Lowering Your Expectations

Published on by Scott Williams6 Comments

Do you want to be happy in life and with your relationships? Lower your expectations!

Most of us grow up believing we are going to be rich, or famous, or at least happy. It seems, however, that the real world rarely lives up to our expectations.

Jerry Seinfeld (character)I love how Jerry Seinfeld sums up the problem with the real world: “The bad thing about television is that everybody you see on television is doing something better than what you’re doing. Did you ever see anybody on TV like just sliding off the front of the sofa with potato chip crumbs on their face? Some people have a little too much fun on television: the soda commercial people – where do they summon this enthusiasm? Have you seen them? 

“We have soda, we have soda, we have soda”, jumping, laughing, flying through the air – it’s a can of soda. Have you ever been standing there and you’re watching TV and you’re drinking the exact same product that they’re advertising right there on TV, and it’s like, you know, they’re spiking volleyballs, jetskiing, girls in bikinis and I’m standing there – “Maybe I’m putting too much ice in mine?”

Though many people in the addictions field don’t speak about boredom and the real world, it remains one of the main reasons recovering addicts relapse. They have lived in a world of adventure and the real world moves very slow. In short, it’s boring. The typical day used to start with cravings and emotionalism, they would spend time looking for a means to buy drugs, go to the deal, do the deal, take the drugs, zone out for a period of time, come down, clean up, and go to bed. Compare that to the heroine addict who goes on a Methadone program. He or she gets up, goes to the pharmacy, gets a Dixie cup of methadone, drinks it… now what? It’s 8:30 in the morning and your schedule is done.

Believe what you want about substance use, it does fill up your day. Most recovering addicts complain that ‘normie land’ is boring, slow, and generally a let-down.

Let’s be honest, they are right. The real world is not like it is on television. Your job, no matter what that is, is usually a series of days you will probably not remember. That new car is exciting for a week or two then it’ just a car. Even relationships get stale after a while.

I’m trying to lower my expectations.

I was ADHD before it was cool. The world seemed to move at a snail’s pace. Even now, as a full grown adult I find most days are just… ok. It is tempting to become despondent and self-medicate, or give up, or get bitter. It is also tempting to feel that life is unfair, that things haven’t turned out the way they were supposed to in my childhood fairytale. I can rail and cry and take all the Cipralex I want, things may not turn into Game Of Thrones. There may be no more dragons to slay or maidens to rescue and somehow, some way, I need to learn to be ok with that.

I have come to believe that, at least for me, maturity and wisdom has something to do with learning to be content in spite of my outside world. I have seen firsthand how, when I lower the emotional impact of my expectations of my partner, my children, my work, and my world, that I am able to be more at peace. I am trying to get to that point in my marriage, for example, where I have no expectations of my wife. If she shows up I’m happy. She is crazy enough to love me and want to share life with me so what else can I ask? I’m not there yet but I have noticed that, as I endeavor to change my way of thinking, it is making a difference in my life.

Cognitive Therapy teaches us to realize that changing our mind may be better than trying to change our actions. If we can do this then our actions become more authentic and flow out of who we are, not how we feel. Change your mind and your ass will follow. As I begin to shift my focus from my unreasonable demands, as I learn to take care of myself before pushing my agenda on others, as I take the time to develop an attitude of gratitude and as Covey said, “Seek first to understand and then to be understood”; than slowly my world begins to change.

“Life is a journey not a destination”, they say. It is never too late to transform your life, if you are willing to put in the work.

The Panic Attack

Published on by Scott Williams2 Comments

I met Kate (not her real name) one morning during my turn at Intake. She came to me after having a panic attack in the local mall. She was walking by a kiosk and the next thing Kate knew she was on the ground in the fetal position. She asked her doctor what she should do and he gave her an anxiety medication, a sleeping med, something for depression, and a benzodiazepine for her panic attacks. She was medicated and ready to go.

But she kept having panic attacks.

She went to her psychiatrist who adjusted her medications (perhaps a stronger dosage would do the trick) and sent her on the way.

She came to see me – frustrated, despondent, defeated and deflated. A couple of weeks later she dumped most of the meds and surprise, she wasn’t having panic attacks anymore. So what happened?

I know I’m not that good. I am constantly surprised that people have amazing turnarounds after a few months of counseling. Nothing on the outside may have changed much, so why the turnaround?

When people get depressed or are battling anxiety they are usually told to go out and do a bunch of things – go for walks, work out, cut out caffeine, take medications, socialize more, etc. While these are good ideas and may eventually help, have you ever tried to ask a depressed person to go for a regular walk? They came into that office feeling depressed and a few days later, after being unable to get out of bed and go for the magical exercise routine, they are still depressed and now can point to yet another failure.

The secret is – it’s not just about what you do. It’s about changing your mind, not just your routine. The bible says -“As a person thinks, so they are” (I take truth wherever I find it). Cognitive Behavioural Therapy says it this way, ‘change your mind and your ass will follow‘ (ok, maybe it’s just me that says it that way).

It’s not about going for a walk, as good an idea as that may be. It’s about changing the way you think, addressing your own cognitive distortions about life (calling your own bullshit), and learning how take control of your thoughts and emotions.

So we talked about her panic attack. We figured out the “window of opportunity” for dealing with her oncoming attack. She learned what panic attacks were, and how her subconscious was directing her. We talked about a few options that seemed incredibly simple to learn. She practiced… and practiced. She documented her attacks and we talked again.

And things changed.

Panic attacks are not incurable. Neither is depression or anxiety. They just may take a great deal of work to conquer.

I’ll be dealing with this issue in further posts and with specifics for my email subscribers. Watch for my upcoming post, “Anxiety is curable, but it’s probably more work than you are prepared to do.”

And oh ya, hire a counselor that doesn’t suck… (I can also tell you how to find that person).