Search This Blog

Monday, April 15, 2013

State of Mind: Observing Mind

The ability to observe ourselves is a distinctly human ability (as far as we know) and is associated with the frontal lobes of the brains.  It is one of the executive functions.

As far as we know, we are the only animal capable of observing ourselves and contemplating what is going on within us, and also about how we are affecting others by our actions.

This ability can keep us out of trouble by warning us about how we are coming across to others before we go too far and damage relationships. It therefore can help us to know what not to do.

The ability to observe outselves dispassionately gives us a means of coping.  It means that we don't always have to be fully immersed in our emotions.  We don't always have to participate in situations from a self-centered, me, me, me point of view.  We are not our emotions.  There is a person, an "I" or a soul, behind my emotions. 

We use observing mind in cognitive therapy.  There are two major steps in cognitive therapy: thought distancing and thought evaluation.  Observing mind is used in the thought distancing step.  We realize that we are having thoughts.  More than that, we can realize that these thoughts are not necessarily the same thing as reality.

I would also include here the concept of what I might refer to as "transcendent mind."  The transcendent, observing mind is capable of looking at ourselves and at our situation philosophically.  Philosophers call this "sub specie aeternitatis."  For a better understanding of this concept, see in Wikipedia.  We have the ability, as it were, not only to stand aside and look ourselves from the ceiling in the present moment, but we also have the capacity to imagine how out situation and behavior might look from a vantage point decades later or even centuries hence.  And the result is that we begin to see our problems, our needs, and our behavior in a different light.  In transcendent mind, our problems might seem quite small, just as looking through the wrong end of a telescope.  Instead of things looking exceptionally large, as when we look through the eyepiece of a telescope, they can look smaller when considered from the vantage point of eternity.  Emotional mind tends to make problems look larger than they might otherwise seem; transcendent mind tends to make them look smaller.

Tuesday, March 19, 2013

Sensing Mind

(Part of an ongoing series on mindfulness.)

Sensing mind is the part of us which is pure experiencing.  We see, we hear, we feel, but we don't judge.  At the moment that we are in sensing mind, we are not judging.  We are probably not worrying.  We are probably not feeling despair.  We are just in touch with our senses.

Sometimes with patients, as I am trying to get them to focus on the present, I will ask them, "How does that chair feel?"  (I have two green wingback chairs in my office.)  Usually, the client will say that it feels soft and comfortable.  I then go on to ask them to notice other sensory stimuli in the room at that moment--the lighting, the air temperature, and so on.  When focusing on these, we are not focused on whether we will be able to pay the taxes six months from now.  We are not focused on what our lab tests will show next Friday.  We are just sensing.

I want to oversimplify a little here.  Pure sensing is direct and bypasses the emotional centers of the brain.  It is in someway a focussing process based on the occipital cortex, the auditory cortex, and the sensory motor strip of the brain.  It is not focussed on the limbic system.

What are some of the things which I might sense directly?
Blue sky
Green grass
The color red on a car or anywhere else
Yellow traffic lines
The colors of flowers
The color of my wife's eyes
The smell of roses, or of food
The taste of food or drink
The soft feeling of a chair
The feeling of acceleration in a fast car.
A cool breeze.
And so on.

Mindfulness therapy teaches people to do things, sense things, see things, etc. in a deliberate way.  All too often we lives our lives on autopilot.  We don't slow down to really taste our food or to really see our environment.

The value of sensing mind is in part how it can distract us from painful emotions.  In addition, it produces pleasure.  There is pleasure in sound, in light, in color, in contrast, in texture, in smell, in taste, and so on.  Our autopilot selves know little of this.  Our autopilot selves live in an abstract world: turn left, take care of that letter to insurance, see 9 AM patient, return telephone call, and so on, as we tick off a list of things to do.  I'm not saying that such a list may not necessary or helpful; it just produces little pleasure.  Yesterday, as I walked my dog, I saw one of the most beautiful sunsets I have seen in a long time.  It looked like the sky above the horizon was on fire.  I tried to take it all in.  I just focused on the color, and the variations of colors.  It was quite enjoyable.

Related to Sensing Mind is what I would refer to as "Aesthetic Mind." There is a major difference between just seeing colors and seeing a Renaissance Botticelli of a Madonna and Child. Much more is coming into play in the mind besides color or even color and form.  When we see or listen to something which is complex, then a whole new level of beauty is added.

Music can range from the relatively simple delights of the sensing mind (the sound of birds, or a simple but pleasant childrens' song) to something quite complex and aesthetic.  I would suggest for example, listening to Barber's Adagio for Strings as an example.  Experiencing such a piece of music goes beyond pure sensing to something more, something transcendent.  And again, there is pleasure, and there is distraction from unpleasant emotions.

Note: In addition to seeing, hearing, touching, smelling, and tasting, there are internal sense states--proprioceptive and kinesthetic sense states. I want to acknowledge that there are some situations where paying attention to stimuli, particularly internal stimuli, might actually make things worse. For example, being aware of our internal sensations (such as heart racing, stomach churning, heavy breathing) can actually heighten anxiety during panic attacks. Being aware of some external stimuli (e.g., hearing people talking) might heighten anxiety or paranoia. I will deal with this problem a little later on in a different blog.

Sunday, March 10, 2013

State of Mind: Emotional Mind

I'm going to start by talking about emotional mind.  Why?  Because that is the place where many of my patients start.  They are wrestling with depression, anxiety, or anger.

In emotional mind we are taken hostage by our limbic systems and midbrain.  We ARE our anger; we ARE our anxiety, our depression, and so on.  It has taken us over lock, stock, and barrel.  We are now thinking through a primitive part of our brain.  We can be taken hostage by our anger, by our depression, by our fear, and so on.  These are all built into us for good reason.  But many of the original primal situations from "cave man" days, which required these feeling states, are rarely present.

Emotional reasoning is not advanced.  It is very instinctual and primitive.  It does not think rationally.  It may generate thoughts, e.g., "I'm going to fail this test," but the thoughts are not being generated logically.  The thoughts are being generated by the emotion, or more accurately, the thoughts are being generated by the emotional part of the brain.  They are thoughts in bondage to emotion, rather than emotions being subservient to logical thinking.

The experience of strong emotion is somewhat like a spasm.  Indeed, panic attacks have been likened to an anxiety spasm.  When we become enraged, we don't want to be calmed down.  In fact, telling someone who is enraged to calm down may be a sure way to make them angrier.  They don't want to calm down.  They often want to take out their rage on someone or on something. 

When we are in a panic state, we may not want to stay in a panic state, but we may feel absolutely frozen and stuck in it.

When we are mired in depression, we may want to get out of it, but we can be constantly bombarded by more and more negative thoughts which seem to prevent escape.  Even the thought of getting help may be batted down with a negative thought that "getting treatment won't help; my case is hopeless."

Emotions lead to negative thoughts, which lead to more painful emotions, which lead to more negative thoughts, and so on.  In negative emotional states, it is easier to remember incidences of shame and failure from our past.  It is harder to remember positive events from our past when we are depressed, and it is harder to anticipate positive events in our future.

When we are engaged in emotional mind, we believe that we are being realistic.  There is a feeling of certainty which comes from our emotions.   If we are angry, we believe that we are justified in our anger.  If we are panicked, we are sure that there is catastrophic danger.  If we are depressed, we believe that we are only being realistic.  Emotional mind does not want to "yield the floor" to other aspects of mind.  It does not want to admit to other possible ways of looking at situations.

Of course, not all emotions are negative.  There are very positive emotions, and joy is a positive aspect of mental health.  Joy does not coexist well with anger, depression, or anxiety.  Enhancing joy in our lives is one way of dealing with our negative emotions.  I have not included a mental state of "joyful mind,"  although that would certainly make sense.  It would make sense because we know that it exists.  We know that it is distinct from our negative emotions.  It is also relativelydistinct from our logical mind state and our observing mind state, although I would tend to associate it somewhat with sensing mind.  I will write more about joy in the blog on sensing mind.

Monday, March 04, 2013

Mindfulness: Wise Mind and Monkey Mind

Traditional mindfulness concepts include about "monkey mind" and "wise mind."  I cannot pretend to understand all that is meant by these two terms because my training is in cognitive therapy and not mindfulness therapy.

However, I believe that "monkey mind" involves much of the ceaseless, annoying chatter which can bubble up in our brains when we try to achieve calm, deliberative silence.  (Think of the jabber of monkeys in the trees.)  Wise mind is a compassionate, observing mind which can learn to ignore monkey mind.  There.  That ends my knowledge about the concepts.

However, in my work with clients I have come to understand that there are at more important states of mind that my clients need to understand--probably several more.  But let's start with the most important four.

First of all, there is emotional mind.  This state of mind occurs when we are dominated by our emotions: sadness, anger, grief, fear, panic, anxiety, jealousy, envy, and so on.  It is not all bad.  Grief is normal.  In fact, most emotions have some important place in life.  However, many patients consult with me because they are overwhelmed by their emotions and they need some new way of coping with them.  They want an alternative to emotional mind.

Emotional mind is probably associated most with the limbic system.  This is the midbrain, sometimes called reptilian brain.

What are the other three types of mind which can compete with "emotional mind?" They are observing mind, logical mind, and sensing mind.  Each of these provides an alternative to being submerged in our emotions.

Let's start here with observing mind.  This would most likely be associated with the pre-frontal cortex.  It is associated with the executive function of self-awareness.  When we are in the state of observing mind, we are aware of what is going on within us.  We can observe, in a somewhat detached way.  We can become aware that our anger is rising, or that we are feeling panicky.  We can be aware of our negative thinking, and we can watch it come and go.  We can see how our negative thinking is producing painful feelings, and vic versa.  We can also detach ourselves from our emotions.  When we are observing them, they do not have to stick to us.  They are simply clouds passing in the sky.  They come, and they go. 

Then there is logical mind.  This is the part of the mind which is trained the most by cognitive therapy.  If I fear that I am going to lose my job because the boss has been in a bad mood recently, my logical mind can realize that I am personalizing my boss's behavior and seeing it as aimed toward me.  Logical mind can realize that there is a very low rate of people being let go.  Logical mind can think about all of the written counseling procedures and safeguards which have to be accomplished before someone can be let go.

Finally, there is sensing mind.  No matter what I think may happen tomorrow, I am currently sitting at my computer.  I can feel the chair beneath me.  This morning, from where I was sitting, I could look up and see the colored spot lights.  Then later, I noticed the blue sky, and even the yellow stripes on the road.  My center shifted from logic and from emotions to heightening my awareness of what was coming in through my senses.  I became aware that I was hardly aware of the colors around me and that it was actually quite enjoyable to look at the colors of the world, even the man made world.

When we are submerged in emotional mind, these other three states of mind offer us alternatives.  We can observe the coming and going of our thoughts and feelings.  We can logically challenge any irrational negative thoughts which lead to the negative feelings.  Or we can simply focus on our senses and enjoy the world around us.

Friday, March 01, 2013

Mindfulness Concept #4: Detachment and Acceptance

This is a hard concept for people in the Western world.  We are very attached to our things.  We are attached to our goals.  We want what we want.  To be detached might be seen as some as apathetic, or even lazy or against progress. 

Detachment need not be any of these things.  Instead, it can be an acceptance of what is, coupled with a deliberate use of our wills to change what is into something more acceptable.

One problem is that often we assume that anything that isn't the way we want it, it needs to be changed.  This creates a lot of "targets" for change. 

Another problem when we don't detach is that we become burdened by many negative feelings during the day.

Albert Ellis wrote about this issue from a cognitive therapy point of view in his book, Reason and Emotion in Psychotherapy:

Irrational Idea No. 5: The idea that human happiness is externally caused and that people have little or no ability to control their sorrows or disturbances. In contrast to this, Ellis argues the following:
  • Unless we are being physically or economically assaulted, other people actually have little power over us unless we tell ourselves that they do.
  • If we tell ourselves that we can't stand a situation, that is nonsense.  Unless we are being assaulted or deprivied of a necessity, then we can stand it.
  • It is difficult in our society for people to believe that they can actually change their emotional reactions to situations mainly because they rarely choose to do so and thus have little practice at it.
  • We may go from believing that something might reasonably be upsetting to believing that it should be upsetting, which would probably guarantee that it would be upsetting.
Detachment does not have to mean not caring.  It can mean instead an awareness that just because something is not the way we would very much want it to be, does not have to create a causal link, (imagine an iron chain of links, from the external event to our internal emotions).  We can choose to unlink the chain.  We can detach strong feelings from it.

The image of the teflon frying pan has been used by one teacher of mindfulness.  Someone can throw something at us, or life can throw something at us, and we can imagine holding up the teflon frying pan, almost like a suit of armor.  The messy substance being thrown hits the pan but does not stick to it.  It slides off.  In the same way, we can detach from unpleasant circumstances to a degree.  We can imagine holding up the frying pan and letting the "yuck" slide off onto the ground, leaving us unharmed.  It doesn't stick to us.  We are thus detached in a way, just like the teflon stays detached from the grime.  We can go on with the rest of the day with the same new feeling that hopefully we woke up with.  The ability to detach can give us some peace.

The opposite is to imagine an old worn out frying pan.  Everything sticks to it.  Perhaps overnight it was in the dishwasher, and it is clean.  But then each hour, or maybe even every minute, something gets thrown at us, and part of those situations stick to the frying pan, so that we quickly are carrying quite a bit of messy feelings with us throughout the day.

Monday, February 25, 2013

Mindfulness Concept #3: Awareness of the Sensory World Around You

As I work with clients to get them out of their (sometimes seemingly endless) rumination about the past and the future, I sometimes ask them, "How soft is your chair?"  My chairs in my office are reasonable comfortable and soft, albeit somewhat worn from years and years of patients sitting in them.  The answer is invariably something like, "It's fine."  I then follow up with, "How's the room temperature?"  And again, the answer is usually something like, "It's okay."  And so on.  "Are you hungry, or are you satisfied right now?" I may ask.  Sometimes my patient is aware of hunger, sometimes not.

Why do I do this?  To point out that in the instant they are assessing the softness of the chair, the warmth or coolness of the room, and the state of hunger or satiety, they are no imaginary monsters stalking them.  There is no monster from the past making them feel guilty for what they have done or not done ("should statements" or reverse fortune telling).  There is no monster from the future about what might happen (catastrophizing).  There are only the awareness of the present. 

This is sometimes referred to as "getting off of autopilot."  Sometimes, a mindfulness approach by Dr. Jon Kabat Zinn is just to help someone eat one raisin with full awareness--without being on autopilot.

I had mentioned in a previous blog one of the techniques I use to heighten my sensory awareness.  I ask myself, what would I paint in the scene before me?  As I look around my study right now, I can ask myself that question.  Is it the cluttered stack of mail in front of me?  Probably not.  I look at the Poinsettia slightly past its prime.  Would I paint it?  Not in the state that it is in, but then I notice the lovely redness in some of the leaves.  I had totally overlooked that when I walked in the room and when I started typing!  At the moment, I find no clear subject, but I also realize that with just a little rearranging, there are actually many possible subjects.  I am also aware of the many little pieces of art, none of which are expensive, but all of which have some interest in them.  With just a slight rotation of the Poinsettia and a leaf fallen on the desk below it, maybe it would made a good painting after all.

Why is this important?  Because there is a tendency for us to go on autopilot.  We have so many things.  We work hard for a life of many things, and then we ignore them.   We continue striving.  And striving is good in some ways.  But I do not believe that it is good for us when we only strive to have more, but cannot take the time to appreciate what we then have. 

Our senses are a way out of our mindless striving.  Why do I refer to it as "mindless" striving?  It is mindless because we are often on autopilot.  And it is mindless to acquire things just so that we can ignore them.  It is mindless to strive without having a good reason to strive.  It is mindless to strive but then not enjoy the fruits of our labors.

In a previous blog, I referred to the thin tropical island of the present.  In that world, our senses help us to get in touch with the physical reality around us.  When we are looking, we can really look at the present.  When we are listening, we can really hear the present.  When we touch something, we can really feel it.  Or taste it, or smell it.  And when we are doing that then are almost always in the present and out of the clutches of the real or imagined demons of the past and future.

Sunday, February 24, 2013

Mindfulness Concept #2: Self Compassion

Principle 2.  Self Compassion

Thias, again, can be thought of as the flip side of cognitive therapy.  In cognitive therapy we try to reduce or even get rid of should statements.  Shoulds are often directed towards the self in a very self-punitive way.  We might say to ourselves, "I should have done better," "I should have studied more," etc. 

Consider this quote from Karen Horney regarding the "tyranny of the shoulds."  She described the attitudes of someone whose thinking is dominated by such thoughts:

 “He should be the utmost of honesty, generosity, considerateness, justice, dignity, courage, unselfishness.  He should be the perfect lover, husband, teacher.  He should be able to endure everything, should like everybody, should love his parents, his wife, his country; or, he should not be attached to anything or anybody, nothing should matter to him, he should never feel hurt, and he should always be serene and unruffled.  He should always enjoy life; or, he should be above pleasure and enjoyment.  He should be spontaneous; he should always control his feelings.  He should know, understand, and foresee everything.  He should be able to solve every problem of his own, or of others, in no time.  He should be able to overcome every difficulty of his as soon as he sees it.  He should never be tired or fall ill.  He should always be able to find a job.  He should be able to do things in one hour which can only be done in two to three hours.”

I have worked with people for years to eliminate the unnessary "shoulds" from their lives because they are unnecessary and because they usually cause feelings of tension, guilt, or inadequacy.  I like the concept of self-compassion because it works on the same issue but phrases it in a positive way.  Getting rid of unnecessary shoulds can be a step in self-compassion.

Some people are able to be compassionate towards others but not towards themselves.  We all make mistakes.  Sometimes they are big mistakes.  Sometimes we can make amends for what we have done, and sometimes we can't.  Either way,  we need to learn self-compassion.  We all engage in negative mental behaviors, such as ruminating, focusing on faults, etc.  We need self-compassion for those behaviors, too.  For people who are good only at compassion toward others, it may seem odd, peculiar, or even immoral to have compassion toward oneself.  It need not be. 

I'm not talking about murder here.  I'm talking about the tendency to be harsh on ourselves for unhealthy behaviors.  It might even be for something our therapist asked us not to do.  For example, I may suggest that someone try to eliminate the word "should" from their vocabulary.  For many patients, the next step is that they are telling themselves that they "shouldn't" use the word "should."  See the vicious cycle?  There is no vicious cycle with self-compassion.

Some might argue that self-compassion means that we will tolerate negative behaviors in ourselves.  That need not be true.  If I am aware that I am procrastinating, I can work on new ways to overcome that without beating myself with shoulds.  I can accept that this is a problem that I have had--for whatever reason--and at the same time be determined to move forward into a more healthy behavior.

Sometimes in the past, I have demonstrated metaphorically an attitude of calm self-compassion with a black rock on my table next to my chair.  I pretend that the black rock is a negative thought or negative behavior.  I proceed to slap the rock, as one metaphor for how people beat themselves up for their undesirable thoughts and behaviors.  Then I demonstrate nonverbally another approach.  I pick up the rock (the negative behavior) with the least amount of force and energy possible, and gradually set it aside out of my sight.  Behaviors can be set aside without energizing them further with self-blame.  And self-blame often does energize our negative thoughts and behaviors and make them worse.

Tuesday, February 19, 2013

Mindfulness Concept #1: Living in the Present

In my last blog, I wrote about following up cognitive therapy coping with mindfulness techniques.  Mindfulness is actually a collection of concepts centered around one or two major ideas. 

I have come to see that mindfulness concepts are the opposite side of the coin from cognitive therapy.  In cognitive therapy, the point is to clear away negative concepts.  In mindfulness, there is an emphasis on the positive.  However, they are just flip sides of the same coin.

Concept #1.  Living in the present.  Many of the people whom I work with are spending much of their mental energy living in the past or the future, and not in a positive way.  By living in the present, we are usually focusing on positive experiences, not negative ones.  Many of the negative thoughts we have are imagined, or even irrational.  This is something I have written about a lot.

There are some exceptions to this, and perhaps by exploring the exceptions I can clarify the importance of the being in the present.

My rule for myself is to spend most of my time right now, here in the current time.  But one exception I would make for myself would be to allow 1% of my time, or less, for worst case scenario thinking.  Why?  Well, if I am making a preflight inspection of the airplane which I rent, and there is a screw missing, it is really useful to imagine the worst that can happen.  If I decide that it is not a problem, then I fly.  However, if I can imagine any worst case scenario that would lead to a crash, then I check with a mechanic, or I don't fly.  If I am investing money, I think of the worst case scenario as well as what gains could come of it.   Perhaps, it would be good for people to imagine some worst case scenarios before going to Las Vegas.

However, it is usually a mistake to spend more than 1% of our lives thinking about the worst case scenario because (a) it usually doesn't come true, and (b) it can start us into an anxiety spiral.  By spiral, I mean a self-perpetuating cycle of negative thinking, leading to anxiety, which leads to more negative thinking, which leads to more anxiety, etc.  I am referring here to the the "anxiety spasm."

Usually, the present is a fairly good place to be.  Usually, we are in a relatively comfortable environment.  Usually,we are not too hungry.  Usually, there is no danger or threat to us.  By living in the present we are not subjecting ourselves to the bad feelings associated with past mistakes or with potential future catastrophes.

Another exception to thinking about the future is that there is a part of the future which I would label the "creative future."  This is thinking about the positive things we can do.  It involves a positive, creative aspect of our mental functioning.  While I suppose in excess it could lead to too much fantasy thinking, it is an important part of our lives to think about all of the wonderful things we could accomplish and created but which have not yet been done.

What about thinking about the past?  I would apply somewhat of the same rule.  There is some value in thinking over the past.  Could I have done something better?  Did I perhaps hurt someone's feelings unintentionally?  What can I learn from it?  But I would again probably apply the one percent rule here.  There is probably not much more "juice" that can be squeezed out of the past beyond 1% of our time.  I like to squeeze lemons into my water for an easy lemonade at a meal.  There is definitely only so much you can squeeze out of a slice of lemon.  After that you are wasting your time.  There is only so much usable "juice" one can get from mulling over the past.

So that leaves us in the present.  When I am working with a client on mindfulness techniques, I ask them to focus on the surroundings in my office.  Is the chair comfortable?  Is the temperature in the room comfortable?  Do they feel hungry or satisfied?  (They usually feel satisfied.)  The point is that in that place, at that time, in that situation, there is nothing to be upset about.  The only thing to be upset about is something outside of that room and place, which is something either in their past or in their future.  But this doesn't only apply to the psychologist's office, it is often true at home, too.  One statement which can be useful is the following, "At this time, in this place, there is nothing for me to worry about."

One image I have come up with is a thin strand of island about a hundred feet wide, in the middle of the ocean.  On that thin island is a hammock, coconut trees, sweet drinks, adequate shade, and so on.  On either side of the island, about a hundred feet into the water is a whirlpool (think anxiety spiral).  On the left side, is the whirlpool spiral of the past, which can suck a person down and cause them to drown.  This is the "shoulds" and reverse fortune telling about the past which lead to depression.  Thoughts in that whirlpool focus on the past and begin with "If only I had," or "I should have..." 

On the right side is the whirlpool spiral of fortune telling and catastrophizing about the future, which can also cause a person to drown.  This is worst case scenario thinking which is triggering anxiety, which in turn triggers more negative thinking, and so on.  Thoughts in this whirlpool usually begin with "What if...?"

But in the middle of the two, on the island, if we choose to lay in the hammock, and enjoy the shade, we can enjoy the "good life" of the present.

Now, I suspect that some readers would say, "If we only live in the present and enjoy it, we don't really accomplish anything." There is some truth to that. A little anxiety can motivate us. Creative thinking about the future can produce some excitement and tension about wanting to reach that future. However, if we live too much in the future, then even when we get there, we don't enjoy it. Thinking about "When I have children...", "When I get a job...", or "When I retire..." can all be legitimate events to look forward to. But if we can't enjoy the present NOW, we may not be able to enjoy the present THEN.

The island strand is only a metaphor. I am not trying to imply that we need to take it easy all of the time. Not at all. If the metaphor bothers you, think about there being a scientific laboratory just up the island a little ways, or an arts and crafts room, or a work out room. The point is that living in the strand of the present rather than the past or present usually makes us most productive.

Because one of my hobbies is oil painting, I have a technique which works for me that helps me to really appreciate the present.  I look around me, no matter where I am, and imagine how it could be made into an oil painting by a really excellent artist.  I have seen intriguing and/or attractive paintings of every type of scene imaginable, including broken down buildings and rusty signs.  By imagining the painting that could be produced from the scene I am looking at, I am able to enjoy my surroundings even more.  It helps me to not only be in the present, but also to enjoy the present.

Monday, February 11, 2013

After Cognitive Therapy--Then What? Mindfulness and Letting Go

Much of what I have published on my website (handouts, blog, and podcasts) has dealt with cognitive therapy.  From time to time, patients have asked me, "After the four column technique, what do I do then?"

That question has tended to puzzle me.  I would generally say something like, "Once you have challenged the negative thoughts, then most of the work has been done."

I think I understand my clients' questions better now, and I think I have a better answer than the one I used to give.

The key to handling stress is, I believe, a sequence of cognitive therapy, problem solving, and mindfulness.

1.  Cognitive therapy.  This involves hitting the most irrational thoughts head on.  When something negative has happened, we may tend to catastrophize.  Or we may gravitate towards another type of negative thinking, such as mind reading, all or nothing thinking, etc.  The first step is to use all the cognitive therapy techniques (and mainly the four column technique) to dismantle the irrational negative thoughts.

2.  Problem solving.  After the cognitive work is done, take time (about 30 minutes or so) to consider all your problem solving options.  What can be done about the problem?  Which of the available options do you want to try?  Consider page 20 in

3.  Put the problem on the shelf and let go.  Once you have chosen an option to try and fix the problem, then you may be able to implement it immediately.  Or you may have to wait until you have the opportunity to actually do something abou it.  You may have to wait until the next time you see your boss.  Or you may have to wait until the parent teacher conference.  Or you may be able to do something right now.  If so, you may want to do something immediately.  Either way, once you have done what you can do for that moment, let go.

There is no advantage to constant ruminating and worrying.  If you try to do the four column technique 24 hours a day, or if you try to problem solve 24 hours a day, what do you gain?  Probably very little.  If you ruminate about the problem 24 hours a day, what do you have to lose?  Probably a lot.  You will probably become more depressed and/or anxious.

I realize that putting a problem on the shelf is not always easy.  We want to ruminate.  Our mind wants to zoom in, laser like.  We want to fix things RIGHT NOW.  However, after we have taken action (or after we have decided how we are going to take action) there is no advantage in continuing to think about it.

How do we let go of the problem and our negative thoughts?  I will be writing another blog entry on that point.  The answer is in the techniques offered by mindfulness treatment of depression and anxiety.  These techniques help us to let go, rather than being embroiled by and consumed by our emotions.

To summarize, here is the technique in summary:

(For those of you who remember the four column technique)

Column 1:  The triggering event.
Column 2:  The automatic negative thought
Column 3:  The feeling generated by the ANT.
Column 4:  Challenging the ANT.
Column 5:  Identifying problem solving options available to us. 
Column 6:  This could be a blank column, because it can involve a nonverbal appreciation of the world rather than being stuck in a series of thoughts.  Or it could involve answering the question: "What are my senses experiencing right now?"  There is no way to explain this column here in this one blog.  That will have to come later after I have written several postings on mindfulness.  After that, I will take a stab at coming up with some specific steps or questions for Column 6.