How people change: by doing nothing

People will change whether they want to or not. From babies into children, from children into teenagers, from teenagers into adults. During the course of the average lifetime, they will become students, friends, lovers, parents, workers (with several job changes), good guys, bad guys, wonder guys.

Here are some other factors about change:

Every day you will have an average of 60,000 thoughts and thousands of accompanying feelings, emotions and moods.

Each time your brain retrieves a memory, it re-edits it.

Every week each person will acquire 238 Gb of new information (the average laptop stores 256 Gb in total)

Every month you will meet an average of 10 new people

Each human being experiences at least one major life event every 15 months.

Over 10 years every single cell in your body is replaced.

Over the course of a lifetime your personality traits change, as measured in standard personality tests.

What these, and other facts show is that personal change is inevitable and, indeed, miraculous. At the level of thought, emotion and action we undergo hundreds of (minor and major) changes each day.

Spontaneous change also occurs frequently in mental health problems such as trauma, anxiety, depression and addiction. For example, a 2013 study estimated that 53% of cases of clinical depression cleared up within 12 months, without medical or therapeutic assistance. Within two years, around 80% will clear. We all know of alcohol and drug users who stopped drinking and using as a result of a decision. Likewise many people have overcome adversity and trauma in their lives through habits of resilience.

Joe was an 18-year old with anxiety and low-level depression. He disliked sixth form college, finding it too much like school, where he never fitted it. He was also unhappy at home where his father was irritated by his unhappiness and kept telling him to ‘grow up’. Meanwhile, his mother was having an affair with a neighbour, and took no interest in Joe. It seemed to him that he didn’t fit in anywhere, and was plagued with self-doubt and worries about what life might have in store for him. We worked together on his self-judgments, his worries about the future, and on obtaining more independence from his parents, but while his anxiety decreased his mood remained low. A few months later he moved to a northern university to read for a science degree and I did not see him again until the Xmas holiday. The change in him was remarkable. He was relaxed and smiling, telling me stories about his new life at the university: the stimulating lectures, the friends he had made, the rugby team for which he played, and the long hikes he took in the hills.

To understand what happened to Joe it is important to keep in mind that depression, like anxiety is always about something. To be sure, it is created in thought, and could be solved with new thoughts. Equally so, the problem will dissolve when external facts change. In Joe’s case his unhappiness related to alienation from school and home, parental neglect, and a lack of reward in the form of stimulating work and relationships. Moving to the university changed the environment in which anxious thoughts and a depressed mood was the likely response (for want of other directions), to one in which hope, engagement and renewed agency were more likely.

After this catch-up session I did not see Joe again, but heard a few years later that he had left home for good and taken a laboratory job in Sheffield. That he was settled there, and planning to take a post-graduate degree.

Given our natural power to make changes to thought action – and in many cases to our environment, how is it that so many of us remain stuck in anxiety, depression and other mental health problems? The answer (disregarding environmental factors for a moment) can be given in one word: thought.

Here are the most common types of thought that can keep us trapped.

Thoughts about Self. In which we think of ourselves as ‘always depressed/anxious/disturbed’. Helpless to do anything to change. As ‘failures’ or ‘hopeless cases.’

Thoughts about life. That life is too much for us and we are powerless to intervene. That life problems are the cause of our unhappy state, when in fact it is our thoughts about those problems that create it. This often leaves people feeling like victims.

Thoughts about the problem. That it is ‘over-powering’, ‘frightening’ and the sign of a much deeper disturbance, linked to our defective personalities.

Thoughts that exclude possibility. As a result of all the above, we think that nothing can change, and our negative filters focus exclusively on the things that keep us stuck. In fact there are all kinds of changes and possibilities that present to us every day, but we cease to notice, or capitalise on them. Joe, as an 18-year old was perhaps more open to these than an older client might have been. In such cases the therapist must be alert both to internal (mind) possibilities, and to externals (environment).

In relation to thought defusion techniques are required to uncouple from them, as I have written elsewhere.

How people change: normalising problems

One of the most frightening things about having a mental health problem is how crazy it can all seem. Panic attacks in which your body seizes up; depressed moods that make the world look like a place of devastation; obsessions that keep you doing the same damned thing hour after hour. Too often, the client ends up worrying about where it is all going to end. The anxiety that results creates a spiral of worry that compounds the original issue. The burning question many clients have is: what the hell is happening to me? Why this? Why now? Clients naturally seek answers, and failure to address this may block people from taking that first step towards resolution.

Related to these questions is another concern: will this psychotherapist be able to help me? Does he know what he is doing? Can I trust him? This concern is especially salient if the visitor has never been inside a consultation room before. It’s even more pressing if she has and been turned off by the vague, or disturbing, answers so far received from other professionals.

In framing the answer the therapist is not simply offering re-assurance. She is also providing a route map. One that takes in the reasons for the problem, and indicates what the solution might be. Along the way, she normalises the predicament the client is in.

Normalising is the art of reframing the problem from ‘weird’ and ‘alarming’ to ‘expectable’ and ‘soluble’. Expectable in terms of the cognitive and emotional characteristics of the client, the life problems that triggered the disorder, and the physical result (the anxious state). Soluble in terms of addressing, one by one, his thoughts and emotional judgments, his physical state, and his difficulties in life.

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How people change (New series)

I have been a student of personal change ever since I was a depressed teenager reading Dale Carnegie’s How to Stop Worrying and Start Living (although that book never worked for me, as I never could work out where to start living). Before and after I trained as a psychotherapist I studied the Upanishads, Gurdjieff, Zen Buddhism, Taoism, Stoicism, Psychoanalysis, Transactional Analysis, Hypnosis, Ericksonian therapy, Cognitive-Behaviour therapy, NLP, EST, Brief Solution-focused therapy, and Acceptance & Commitment therapy. All of which later on filtered through the lens of working with my clients over the past 32 years.

This series of articles summarises my conclusions of what works best in therapy, as well as what doesn’t. And I aim to share these insights with you over the coming months.

Here is the planned list of articles (the list may change as the series unfolds)

Normalising problems

Change through doing nothing at all

Changing consciousness

Accepting what is (and what is not)

Downsizing the ego

Changing expectations

Changing thought

Breaking the rules

Changing the pictures in your head

The Crystal ball method

Focusing on possibilities rather than problems

Separating intentions from outcomes

Replacing bad habits with new ones

Taking one (small) change at a time

Changing feelings and internal states

Exposing to scary environments

Changing personal strategies

Pursuing your passion

Changing behaviour

Building resilience

Please do let me have your suggestions or requests for further articles in this series. As well as your own stories about personal change.

Keeping Brief therapy brief

In a study by the psychologist, Moshe Talmon, in the 1980s it was revealed that the most common number of psychotherapy sessions (the modal number) was one. That’s right – a single session was the most common in the largest group of clients. It had been thought that the reason one was the most common number was that clients were ‘shopping’ or ‘dropping out’. But a follow up study on clients who elected for single session therapy revealed that this wasn’t the complete story. And that many such clients were perfectly happy with their visit, stating that they found some of the answers they were looking for.

A famous example of single session therapy took place in August 1910, when the composer Gustav Mahler visited Sigmund Freud. Freud, who was on holiday in the Netherlands, took Mahler for a walk around the town of Leiden as they discussed the reduction in Mahler’s sex drive. We don’t know precisely what was said, but we do know that Mahler was happy with the advice Freud gave him, and that his marriage improved as a result.

Practitioners in Brief Therapy like me work on the assumption that every session – including the first – could be the last. Therefore every session focuses on helping the client change. Either what they want to change (for example, their anxiety), or how they can change (for example, moving away from the thoughts that create anxiety). Sometimes we might have a conversation about why change is necessary (for example, because doing so will improve their relationships). ‘Why’ conversations can be helpful, insofar as they connect clients to their values in life, and push them towards further changes.

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Defusing from Anxiety

In my last article I wrote about defusing from Anxious thoughts. In this article I describe how to exit from unwanted states. For example, a panic attack.

To remind you: defusion is the art of extracting yourself from an unwanted thought, a feeling, a memory, or a hallucination about some future event. Not resisting, resenting or running away from any of them. For if you do any of those things you give power to the gremlins. Instead, you acknowledge their presence, accept the gremlins are at work in your head, then smilingly turn your attention to a something worthwhile.

Distorted thoughts trigger bad feelings. A worry triggers anxiety. A helpless thought triggers depression. A craven thought triggers an addictive urge. In our example, let us say that you have thoughts related to social anxiety. Your mind is telling you that the party you are about to join will be a disaster. That you will have nothing to say. That others will conclude you are pathetic. That you will break down and will have to leave. For some reason, you fail to defuse from these thoughts in time. A few seconds later you experience a panic attack.

At this point you will most likely have another bad thought: that the panic is so awful you cannot possibly enter the room. And that thought seems like the clincher: you really have no choice but to go home.

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Defusing from Thoughts

In my last post I referred to the flaw in our minds through which we become entangled in anxious, depressing, obsessional thoughts. In this post I explore ways we can disentangle from them.

The time-honoured approach is that of Cognitive-Behavioural Therapy, in which we identify the thought, write it down and hammer it with facts, logic and counter-evidence. Exposing it for the nonsense that it is. A simpler, but similar approach is The Work, developed by Byron Katie in which you go beyond the thought by addressing four questions to it:

Is that thought true?

Can you absolutely know that it is true?

What happens to you when you hold that thought?

Who will you be without that thought?

Both these approaches work well for the majority of people, as I can testify from years of using both.

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The Flaw in our Minds

The more I work with depression, anxiety and obsessional disorders, the more they display a mystery about the human mind. How is it we are so easily hijacked by depressing thoughts, anxious thoughts, obsessional thoughts? On average, each human being has at least 50,000 thoughts per day. Some are trivial, some constructive, some are funny. 6,000 of them are repetitive thought chains, focusing on the same issue. Yet the anxious person will keep coming back to the same twenty or thirty negative thoughts. Every hour, every day. That tiny group of worries, self-judgments and catastrophic predictions creates her mental health problem.

What is it about the human mind that makes it so easy for us to be taken in by thoughts?

The answer lies in how consciousness works.

From a few weeks after birth to the moment of death, consciousness runs on like a continuous cinema reel, recording every event, every sensory experience, every thought, and every emotion. To which we add our ever-changing story. 

In consciousness, we also connect to the outer world: people (and the things they say), rooms, food, drink, atmospheres and (if outside) woods, trees, lakes and skies. Also, recording the inner world of thoughts, emotions, sensations, and reactions.

And here lies the flaw: that consciousness gives the same reality to thoughts as it does to experience, and on (factual) written or spoken words. We come to believe that what thoughts tell us are as real as the instructions in a manual. When in fact many thoughts have no referent.

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9 Habits of Resilient People (No. 9)

This is the concluding piece in a series of articles on resilience.

The ninth habit is: Resilient people are (mostly) spiritual people.

This is one of the few habits which has been studied scientifically. Numerous surveys show that people with spiritual beliefs live longer (on average) and manage stress better. They also cope with potentially terminal illnesses more effectively.

By ‘spiritual’ I mean those beliefs through which we live by a higher purpose in (or beyond) this life. A purpose which gives meaning and direction to existence. This could be based on formal religious belief but for many it does not. While some people have a deep sense of the divine at work in themselves and in others, some find this hard to understand. For many people it is enough for them to appreciate the beauty and intelligence in nature and its species; or in the revelations of art, science, mathematics and philosophy. For others still it is enough to know that they are giving service: for the family, for the community, or for future generations.

One reason spiritual beliefs and values aid resilience is that they provide us with a refuge in times of crisis: in tragedy, illness and death. They enable us to keep going even when we feel like giving up. They give us the strength to support others who are in despair. And despair is the enemy of resilience.

A deeper reason relates to personal fulfilment. To know that you are part of something bigger than you are, and that the service you give to others is important, provides you with an inner strength and a will to live that is inspiring to others and fulfilling to you. And, generally speaking, a fulfilled life is not only a happier life but a healthier one too.

9 Habits of Resilient People (No. 8)

This is the eighth in a series of articles on resilience.

The eighth habit is: Resilient people take ownership.

What this means is that resilient people take total responsibility for what happens to them. Another way of putting this is that resilient people do not become victims or succumb to self-pity.

This does not mean that ownership for what happens means that you are always the cause of what happened. It may be (partly) your fault if you lost your job, or your relationship, or got into debt. But you aren’t the reason for an airplane crash, a terroristic attack, or the cancer that killed your mother. But in either case you can decide how you are going to respond.

Let us also make a distinction between a reaction and a response. A reaction is usually automatic and predictable and woeful. A response is something that is planned, thoughtful and focused. Reactions may take any of the following courses:

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9 Habits of Resilient People (No. 7)

This is the seventh in a series of articles on resilience.

The seventh habit is: Resilient people spend time with resilient people

In article No. 4 in this series I mentioned that resilient people actively ask for help when they need it. The people they ask will most likely be people who are as resilient as themselves. For who better to ask than someone who knows how to deal with a crisis? For that reason resilient people will notice resilience in other people and will recruit them to their network of friends and supporters.

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