Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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COVID-Fatigue or Depression: How Can You Tell?

By Lynne Gots, posted on February 9th, 2021.

In the last week, everyone I’ve seen virtually for therapy has voiced increasingly familiar complaints. They are bored; they cannot get motivated to work or study; they have no appetite or have put on pounds from mindless snacking; they cannot practice healthy sleep habits even though they know too much screen time before bed and staying up past midnight will make it harder to function at peak efficiency the next day.

A lack of interest and motivation, along with appetite and sleep changes, can signal depression. And, certainly, we all are experiencing what feels like a collective state of depression after nearly a year of living with the drastic changes raised by a global pandemic, a situation that appears endless to many of us.

So, if your mood is low and you are having trouble concentrating, take heart. You are not alone.

As we know from a large body of research on mindful self-compassion, acknowledging the struggle, rather than beating yourself up for going through a hard time, can help, especially when you can connect with a common humanity (“Life is different for all of us right now.”) Treat yourself with the same kindness you would offer a close friend or family member to ease the unpleasant feelings. 

Other coping strategies include seeking out social interactions, even if they might be less satisfying through a virtual platform, and breaking out of the daily routine by creating some novelty. Try learning a language, experimenting with new recipes, or practicing a different exercise routine. If you have trouble pushing yourself to do anything right now, keep in mind a lesson psychologists have learned from behavioral activation for depression: just doing something – anything, in fact –can pull you out of the doldrums, even if nothing sparks your immediate interest. 

That said, although your current feelings of ennui may be nearly universal, they still could signal the onset of depression. If you have had a history of depression, you may be more vulnerable than someone with no previous episodes. Be on the alert for warning signs: constant rumination, feelings of hopelessness, extreme changes in sleep and appetite, and persistent thoughts of self-harm or suicide. Please seek help if those symptoms persist or worsen. 

If you are just weary from the daily dreariness and not clinically depressed, you might try observing your emotions through the lens of mindfulness. A common approach in meditation is to view your thoughts and feelings as transient, like clouds in the sky or a stormy weather pattern: they change from moment to moment.

I had the opportunity to practice observing my response to an actual meteorological event recently when I woke to a heavy snowfall. My first reaction was irritation at the inconvenience of it. “I won’t be able to walk the dogs without worrying about being pulled over on the ice.” “We’ll have to dig out the cars.” “It’s so annoying.”

But instead of continuing to wish it were different and getting upset about a situation I had no power to change, I decided instead to work on accepting the state of affairs. While I drank my coffee, I gazed out the window at the wooded path behind my house and noticed how peaceful it looked. I bundled up, took the dogs for a walk, and let them enjoy sniffing and digging in the soft mounds of snow. I laughed out loud watching Roland drag a shovel down the stairs and across the yard like a prized game specimen. I stopped my internal grumbling, and my mood lifted.

And, then, much to my surprise, the sun came out, it warmed up, and the snow melted. Of course, the puddles will freeze tonight when the temperature drops. And tomorrow, we will begin, again.

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Posted in Acceptance and Mindfulness, Cognitive-behavior Therapy, COVID-19 Mental Health, Depression, mindfulness |

COVID and Holiday Stress

By Lynne Gots, posted on November 21st, 2020.

Thanksgiving is just a few days away.  The approach of the holidays this year has trapped many of us between the proverbial rock and hard place. How should we celebrate? Is it OK to let down our guard and see family if we’re all being careful? Should we get on a plane? Is it worth risking putting our older relatives in danger of infection in order to be together? 

If we were going strictly by the book, nobody would host or attend a Thanksgiving dinner. The CDC has advised us to avoid travel and not to spend time indoors with people outside our immediate household.  Even so, most families are deciding how closely to follow the guidelines, calculating—and perhaps underestimating—the risks involved. . 

We all want to hold onto cherished traditions and see the loved ones we’ve been separated from during these endless months of COVID.  And, yet…

There is no right answer. 

If you go ahead with your plans and get together with family for Thanksgiving dinner, you may feel guilty about ignoring the various governmental recommendations. And, even worse, you might have to live with the consequences if one of your parents or grandparents or aunts or uncles gets sick.

If you exercise the recommended caution and stay home alone or just with your immediate household, you will feel sad and lonely, and you may regret playing it safe when friends are posting pictures of their family get-togethers on social media.

Either way, you can’ t win.

Several of my patients with OCD have told me, “Now maybe people will understand how hard it is to live with OCD.”  The back-and-forth, the doubt, and the emotional distress many of us are going through right now as we try to decide how to spend the holidays mimic what those with OCD struggle with on a daily basis.

So how do we cope? Approaching an upsetting situation with an attitude of mindful self-compassion can make it more bearable. First, acknowledge that this turmoil is really hard. Then, connect with the “common humanity”: millions of people are sharing the same, challenging experience. Finally, treat yourself with kindness. Accept your decision, whatever it is, and remind yourself, “You’re doing the best you can.”

And think about next year when, with luck and the possibility of a vaccine, we all will be able to bring back our old traditions and appreciate them, perhaps even more than ever.

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Posted in Acceptance and Mindfulness, COVID-19 Mental Health |

Quarantine-Induced Agoraphobia and Other Anxieties

By Lynne Gots, posted on July 27th, 2020.

As states have been opening up, life has become more complicated. Many people found shelter-in-place mandates easier to navigate because they didn’t have to make decisions about whether to go out. But now, we have to consider the personal importance, and relative risks, of various activities, such as attending a protest, meeting friends for drinks at an outdoor patio, eating a meal at a restaurant, or getting a haircut. Having more choices leads to more uncertainty and, often, more anxiety.

Leaving the safety of home and feeling anxious, perhaps even panicky, about venturing into the world mimics the condition of agoraphobia, which means, literally, “fear of the market place, or place of assembly.” Agoraphobia is classified as a panic disorder because panic attacks typically occur in crowds or on public transportation, where escape is difficult. Subsequence avoidance of situations where a panic attack has occurred often leads to a narrowing of safety zones. People with agoraphobia may, if untreated, become completely housebound.

After several months of quarantining at home, going out can feel very strange. If you’ve been staying inside since March, not even taking a walk around the block, you may find yourself feeling nervous and jittery the first time you leave your apartment or house. The best approach is to start with just a short outing, gradually increasing the time and distance away from home to build tolerance. 

Another consequence of the quarantine may be heightened social anxiety, which often takes the form of excessive concerns about being evaluated negatively and judged by others. For example, someone with social anxiety might worry about being seen as irresponsible for not wearing a facemask when walking in a park (and social media only adds to the confusion, with accounts of assaults on both masked and unmasked people.) If you’re uncomfortable meeting others for a socially distant get together, then don’t. Everyone has a different tolerance for risk, and you shouldn’t feel pressured into accepting someone else’s decision about what is safe or embarrassed by your greater need for caution.

Setting limits with friends and family about safety practices can also be difficult for someone who worries about disappointing others. Should you let your parents, who are more casual about taking precautions than you, fly to visit you? Should you agree to meet your friends for an indoor meal at a restaurant because they are pleading with you to join them? Should you allow a lonely friend to join your quarantine pod?

In these unprecedented times, we cannot rely on social convention to help us decide what choices to make. And we can’t expect friends or family to help because they may have vastly different interpretations of risk. So we need to decide what feels right for us.

But if you are so fearful that you have become housebound, you will want to begin returning to the world, using reliable scientific sources, and not anxiety, to guide your decisions about what activities are reasonably safe. Both sunlight and exercise can ease stress and strengthen the immune system. So take those first steps and go outside for a walk.

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Posted in Anxiety, COVID-19 Mental Health |

This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.

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© 2008-2022 Lynne S. Gots, PhD. Photographs by Steven Marks Photography.