Beyond Blue

Over the weekend, I was reading Beyond Blue reader Cathy’s interesting blog, “Growing Curious.” She described her not-so-great Thanksgiving in a wonderful post called “This Is Your Brain on PTSD“:

I know I can be dramatic and all, but Thanksgiving was even worse than I imagined it might be.*
It was hell. Even though I love my family-of-origin and nothing “unpleasant” happened in the real world, I felt crazy, unsupported, crazy, insane, mad, impatient, sad, crazy, and in physical pain. My mother’s anxiety ruled the roost, and I tried hard to be helpful (kindness to her) without being an emotional vacuum-cleaner (kindness to me). I came home feeling so much pain in my body that it was like I’d been kicked and beaten.
[I want to be more forthcoming with details here. I would like specific feedback from people who have been in similar shoes. I also want to protect my family’s privacy so, you know… how can that happen?]
I understand why my PTSD is raging right now. When things got ugly in my family, they got really ugly. I come by this disorder honestly. How to say this… ugh… My dad almost died a couple of months ago and his health still teeters dangerously. Also, of course, I am a constant witness to the vulnerability of childhood. E is a wonder child, and she’s doing things that I used to do… before the awful things started. My mother chooses Thanksgiving as her most important holiday. No matter what is going on in the family, we all have to stop and observe according to her plan. She used to do it all, and it has been quite an effort to help her delegate some of the work.
Okay, so yes… it makes sense that I feel crazy right now. But the crazy I’m feeling is really big. Like I wish I was dead or something.

Although I felt bad for Cathy, it was refreshing to read something so honest, so real, so raw.
Like many persons (myself included) gripped by anxiety or depression, her thinking goes from “This is unpleasant …” to “I wish I were dead.” There’s not a whole lot of conversation in between those two conjectures. (This is not a criticism, of course, since her brain sounds a lot like my brain.)

That’s the way the depressed or anxious mind—and especially the one diagnosed with PTSD (post-traumatic stress disorder)–is programmed to think. Just as a body in motion stays in motion, a thought process born in stress and panic stays there.
Unless you teach your mind new tricks. Like Cathy’s doing. Like I’m trying to do.
The primary reason for the last eight years of my therapy is to train my mind to recognize an apple when I’m holding it my hands. To not mistake it for a pear, even though way back in my childhood I once ate an apple that tasted like a pear. And then maybe a few times in my adolescence. And, okay, I grew a pear tree in my backyard for two years after Katherine was born, during which time I picked its fruit and made apple pie.
Every week I learn exercises on how to distinguish an apple from a pear: how to study the shape, the color, the texture, and ultimately how to get the courage to take a bite, not that this has anything to do with the Garden of Eden and original sin. My therapist helps me develop the tools I need to convince my distressed brain that the reddish fruit in front of me really is, in fact, an apple.
In the book “Destructive Emotions,” a collaborative text between Buddhist scholars, Western psychologists, neuroscientists, and philosophers, narrator Daniel Goleman describes the results of the studies directed by Richard Davidson, a leading pioneer in the field of affective neuroscience:

We each have a characteristic ratio of right-to-left activation in the prefrontal areas that offers a barometer of the moods we are likely to feel day to day. That ratio represents what amounts to an emotional set point, the mean around which our daily mood swings. Each of us has the capacity to shift our moods, at least a bit, and thus change this ratio. The further to the left that ratio tilts, the better our frame of mind tends to be, and experiences that lift our mood cause such a leftward tilt, at least temporarily.

Now, to get there—to a right, left shift—requires a massive amount of hard work. It means getting yourself an axe in order to blaze a new trail of positive thinking in your mind. Because our brain is like field a wild grass. Our thoughts carve paths in our brain so that the more we follow a certain logic (even if it’s faulty logic), the smoother the path for other thoughts to trek down.
The year or so when I was suicidal, my therapist helped me pull apart my thought process, to help me recognize how many times I went from “this is unpleasant” to “I want to be dead,” or from “I don’t like this” to “I give up.”
It was an all-or-nothing thinking, one of David Burns’s ten forms of twisted thinking. The others I adopted (and still do) were: overgeneralization (viewing a negative event as a never-ending pattern of defeat), mental filter (coloring all of reality by one negative detail), magnification (exaggerating your shortcomings or problems), and labeling (attaching a negative label to yourself instead of separating yourself from the mistake).
I pulled out my copy of Burns’s “The Feeling Good Handbook” last night after reading Cathy’s post to see if I had made any progress in my thinking process. As I looked over the workbook, it was interesting to read how hearing about a friend’s good news was enough to trigger a snowball of negative thinking that ended in, of course, “I want to be dead.”
In order to adopt a new way of thinking, Burns recommends a four-step practice.
Step 1: Identifying the Upsetting Event
Here you name the specifics of a problem you are currently having, or describe a negative memory that is triggering a bad mood or depressive episode.
I wrote here: conversation with Sue (a colleague, who told me about my friend Ellen’s book—how well it was selling, and about her plans for a sequel).
Step 2: Record Your Negative Feelings
Write down your negative emotions and rate each on a scale from 1 to 100. Burns says to use words like “sad, frustrated, discouraged, angry, hurt, anxious, embarrassed, upset, or guilty.”
I wrote these six emotions: inferior (100), jealous (100), angry (100), defective (100), guilty (100), confused (100).
Step 3: The Triple-Column Technique
Here you are supposed to ask yourself what the negative thoughts are that are attached to your bad feelings. What types of things are you telling yourself?
In the first column, “Automatic Thoughts,” you record your negative thoughts and estimate your belief in each one (0 to 100). These are called “Automatic Thoughts” because they come automatically to mind when you feel bad. Burns says that recording these Automatic Thoughts is one of the most important exercises.
In the second column, “Distortions,” identify the distortions in each Automatic Thought. The distortions are the ten twisted ways of thinking:

1. All-or-nothing thinking,
2. Overgeneralization,
3. Mental filter,
4. Discounting the positives,
5. Jumping to conclusions,
6. Magnification or minimization,
7. Emotional reasoning,
8. “Should” statements,
9. Labeling, and
10. Personalization and blame.

In the third column, “Rational Responses,” substitute more realistic thoughts and estimate your belief in each one (0-100).
Here are a few things I wrote down in step three:
Automatic thoughts: “I will never be as successful as Ellen.” (100) “I’m a complete failure.” (100) “I suck at writing.” (100)
Distortions: Emotional reasoning, Magnification, Mental filter, Discounting the positives, All-or-nothing thinking.
Rational Responses:
“Maybe Ellen will be more successful than you. Who cares? Just do your best. Don’t compare.” (50)
“I’m good at some things. I don’t fail at everything. Accept yourself where you are.” (50)
“You’re not perfect, but that doesn’t mean you totally suck at writing. With some work you can get better.” (50)

Step 4: Outcome
Now re-rate your belief in your each of your original “Automatic Thoughts.” Cross out the original percent and put a new estimate.
My original thoughts—I will never be as successful as Ellen, I’m a complete failure, and I suck at writing—all went down from 100 percent to 50 percent.
Dr. Burns says that if you are still upset after doing this four-step practice that you may not have identified the disturbing event, you have something to gain by your negative feelings, you haven’t correctly identified your Automatic Thoughts, or your Rational Responses aren’t convincing enough. I’d add one more thing: you’re on the wrong medication. Because, as I’ve said in other places, all these exercises can only help a person who is stable and capable of cognitive work.
At any rate, with Cathy, I’ll be watching my path of thoughts this holiday season, and will be trying as hard as I can to blaze a new trail inside my mind toward mental and spiritual health.

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