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Saturday, October 29, 2005

Stress and Anger as Psychological "Luxuries" We Can't Afford

Most people think of stress and anger as simply part of life. We have to put up with them because they come with the territory of living. However, research increasingly indicates that both of these take a negative toll on our minds, bodies, and relationships.

Certainly, they are not totally avoidable. Some degree of stress is healthy for the body and mind. It actually strengthens us. But the old saying of Nietzche is not true--"Whatever does not kill me makes me stronger." In fact, what does not kill us may kill off brain cells and add fat to our waist. Excessive stress has been shown to harm cells in the hippocampus, which is a part of the brain central to storing memories. It has also been shown to lower the immune system's ability to fight off infection. Depression and anxiety can be triggered by stress in some individuals. For others, stress may lead to unhealthy use of alcohol and other substances.

The goal of the healthy individual need not be to eliminate stress altogether but to avoid very high, unusual levels of stress if possible. How can this be done? Many people believe that the stress they experience is totally beyond their control. But it is not. Here are some things which can be done to diminish stress.

First, live a healthy lifestyle. Do the obvious. That is, don't take excessive risks financially. Nurture and nourish relationships. Build for the future in both finances and social support.

Secondly, work on any excessive negative thinking. My web site has several handouts on how to do this ( Very often 50% or more of the stress we experience is of our own making from excessive negative thinking.

Deal with problems slowly, methodically, one at a time. Don't avoid problems. They will just pile up. And don't try to take on all problems at once. That will just overwhelm you.
Most of my clients have one of two different problems: either excessive negative thinking or avoiding problems. Working these two areas can do wonders for a person's stress level.

Next week: the "luxury" of anger.

Wednesday, October 19, 2005

Is There a Type D Personality and Does it Matter?

In the past, it was thought that the hard driving, time pressed Type A personality led to more heart attacks than the easy going Type B personality. Unfortunately, that research lead did not prove to be true. But wait, now there is research on a Type D personality, and it remains to be seen whether the Type D personality predicts heart problems any better than the old theories. However, some research suggests that it does.

Johan Denollet, a psychologist in the Netherlands at Tilburg University found a personality type likely to build up chronic stress. They have both negative emotions and an inability to talk with others about those emotions. They tend to overreact to situations with negative emotions but then can't express these emotions and get them out of their systems, so to speak.

Persons high in Type D characteristics tend to have more heart disease, hypertension. They also tend to respond less well to treatment, have a poorer quality of life and to die prematurely. Among heart patients, they are four times as likely of getting another heart attack or dying too soon.

If you are interested in looking at the Type D questionnaire, you can go to

Tuesday, October 18, 2005

Sometimes the Closet Overflows

One of the analogies I use with my clients is that of the stuffed closet.

Imagine that as a child, a person learns to clean up the items in their room by throwing them in their closet. And then, as they grow older, everytime they need to clean their room, they simply open the door and throw more things in. This works for years, say, and then there is just too much in the closet. Nothing else can be thrown in. And so the person doesn't know how to deal with the odds and ends they have lying around. If they open the closet, everything comes tumbling out. And if they don't open the closet, they don't know what else to do with their problems.

This is just the problem that many of my clients face. As a child, they learned to deal with problem feelings and thoughts by stuffing them deep down, out of awareness. This worked, more or less, for years and years. But finally, there is just too much stuffed down. In psychology, we call this repression.

Eventually, it starts to come out as depression, anxiety, anger, flashbacks, physical symptoms, etc. Now they have a dilemma. Their only mode of coping is to stuff things. But there simply is no more room for things to be repressed. And if they try to sort through the things in the closet, they feel overwhelmed.

This is where the therapist comes in. At this point, there really is no choice but to start sorting through the years of accumulated issues which were not dealt with. Perhaps not every one of them has to be looked at, but the big ones at least. The therapist can help guide the client through this sometimes rather arduous process. But in the end, the closet is cleaned out. The symptoms are reduced. And the client is no longer hiding from their own thoughts and feelings.

Thursday, October 13, 2005

Therapy As a Rapid Process

Perhaps this will sound confusing after my last post, but therapy can sometimes be a rapid process. How can that be after pointing out just how long it can take to get to the bottom of things in my last post?

The fact is that not everyone comes to therapy with the same expectation. Some people are coming for an overhaul and others for a tune up. And others are coming to get their engines jump started. In fact some psychotherapy theorists have argued that all we should really be doing as therapists is helping people to get "unstuck." The idea here is that people are generally coming up against one problem after another, and that is a normal situation. However, sometimes they come up against situations which they can't solve. They are not thinking creatively or "outside the box." With help, however, they can solve their dilemma and continue to go on with their lives.

Another way of looking at therapy as a rapid process is to consider mild to moderate depression. The client comes in in a demoralized state. They have started thinking negatively. They have quit being assertive. They have pulled away from friends. They have quit eating and sleeping in their normal patterns. All of these problems tend to pile on top of each other and compound each other. Very often, as the therapist helps the client to improve one area, there is a positive spreading of effect so that the other areas start to improve. Instead of a negative chain reaction, there is a positive chain reaction.

Many therapists today teach cognitive therapy, which is a set of skills designed to overcome irrational negative thoughts. This therapy was originally designed to be administered in 20 sessions. However, even that is a long time for many patients. The average number of sessions for a client to stay in therapy is 6 to 8 sessions.

There is no "right" length of time to stay in therapy. It is up to each patient/client to decide how much change they want to accomplish. It is also up to them to decide how much of their personal lives they want to disclose in order to accomplish that. The important thing is for the client to be up front with their therapist, explaining what they want to accomplish and how much time they are willing to invest in that. The therapist can then tell them if their expectations are realistic or not.

Tuesday, October 11, 2005

Therapy As a Slow Process

I will be writing another column on Therapy As A Rapid Process. Today, I want to address the opposite side of the issue. Sometimes it is a slow process. There are several reasons that it can be slow. One is that it takes time to trust the therapist. I used to think that it would be possible to derive a full treatment plan from an initial, thorough intake. Wrong. The fact is that sometimes the client does not trust the therapist enough to tell them what is bothering them until perhaps the tenth, twentieth, or thirtieth session.

Secondly, sometimes the client themselves does not know what is bothering them. Or perhaps they have a vague idea of the problem, but they have a hard time focusing in on it or articulating it.

Other times, therapy takes quite some time because there are years of habits. The habits can include negative thinking, fear, avoidance, and so on. These do not change overnight.

Fortunately for some patients, they have adequate insurance to allow them to stay in treatment and do the work they need to do. Unfortunately, others do not, and they are only able to take advantage of the "front end" of therapy. But that is much better than nothing.

Next time, how therapy can be a rapid process...

The Two Kinds of Problems

Most of my clients have one or both of two kinds of problems: they are either troubled with negative thoughts which make them feel angry, depressed, anxious, etc., or they avoid dealing with issues and problems.

Negative thinking is something I deal with a lot on my website ( However, I don't deal that much with avoidance on the web site. There are two ways that people avoid--externally and internally. Externally, people may avoid dealing with problems. As a result, the problems just keep getting bigger and bigger, causing more and more difficulties in the person's life.

The other type of avoidance is not facing their own internal thoughts and feelings. They try to stuff these internal issues into the closet so to speak. However, after a lifetime of closet stuffing, they often end up with a problem. They only way they know to deal with things is to throw them out of site in the closet. But every time they open the closet, there is so much in there, that it all starts to tumble out. In other words, a person can only repress and avoid thoughts and feelings so much before there is no way to stuff any more. The thoughts and feelings which they thought they had successfully managed to avoid are now coming out as symptoms and interpersonal problems. That is where a therapist can be helpful. Because when everything starts to tumble out, a therapist can help to sort it all out so that it is not overwhelming.

More on Unwanted Thoughts

Some unwanted thoughts are what we call "obsessive thoughts." These thoughts are generally of a violent, sexual, or religious nature and are just the opposite of what we truly believe and/or want. These thoughts can be in words or in pictures. Because they are the opposite of what we truly feel or think, they are very distressing. The technical name for this is "ego dystonic," i.e., they feel bad to our ego.

The way to deal with these thoughts is not to fight them but to see them for what they are. They are coming from some part of our brain but they are not really us. As such, there is no reason to fight them. They simply need to be set aside. Fighting them seems to energize them. Usually, the best course of action is to simply set them aside with as little mental energy as possible and go on to distract ourselves with something else.

Monday, October 10, 2005

Do I Have to Feel Guilty For Having Certain Thoughts?

One of the problems I encounter with my patients is that they have thoughts that make them feel guilty. Sometimes these are thoughts that are evaluating others. Sometimes, they are thoughts which are sexual in nature. Sometimes, they are simply unacceptable in other ways.

This is a very complicated subject, but let me begin by saying that one sure way to create psychological problems in ourselves is to try to reign in our thoughts too closely. This can sometimes lead to repression (thoughts being kept out of awareness through an unconscious process) or denial (when we emphatically deny at a conscious level what we are actually thinking or feeling).

The brain has a variety of structures within it, and they are not all equally under our control. The limbic system can generate emotions, impulses, and thoughts of a sexual, fearful, or hostile nature. It may take a few seconds before we realize what is happening and have a chance to begin to process these rationally. This is normal.

Another issue is the issue of evaluating others. Many people feel guilty because they believe they are judging others. This is partly a problem of words. Judging can be evaluating others (I don't think he looks good with orange hair), or condemning others (Only a worthless bum would have orange hair). Many religions warn against condemning others. However, a person would have to be brain dead in order not to evaluate situations. We evaluate because that's what our brain is built to do and trained to do. There is no sense in feeling guilty about that.

However, in judging people by condemning them in our minds as worthless, inferior, and so on, we are indeed putting ourselves in a very precarious position psychologically (and spiritually). Each person is who they are as a result of their genetics and personal experience as well as decisions they have made. When we judge others, we are in essence saying, "If I had had their genes and their family upbringing, I would be doing better than they." In fact, there is no way of knowing that. Perhaps we would be doing worse!

Judging as condemning can lead to excessive angry feelings. We can evaluate without it necessarily strengthening our anger. But to condemn is to be self righteous and almost always strengthens angry feelings.