Cognitive Behavioral Strategies

Lynne S. Gots, Ph.D.
Licensed Psychologist

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Coping with Loneliness during the Holidays

By Lynne Gots, posted on December 23rd, 2015.

For many people, the holiday season, filled with greeting-card images of family gatherings and communal good cheer, can heighten feelings of loneliness. Those who are grieving the loss of loved ones may miss them especially keenly during this time of year. Memories of happier times can cause the pain of past relationships ended through divorce, a break up, or estrangement to surface unexpectedly. And for those who lack any intimate relationships, overhearing discussions of colleagues’ vacation plans or seeing constant reminders on social media and in seasonal advertising of others’ connections can intensify an already pervasive sense of social isolation.

A study described in a recent NY Times Magazine article  found that people who perceived themselves as lacking close connections (the “lonely” experimental group) were much more reactive than the socially well-integrated comparison group (as measured by electrical activity in the brain) to words suggestive of social isolation, such as “excluded,” “foe,” and “detached”. The researchers concluded that lonely people selectively attend to negative social information. This hypervigilance to perceived threats paradoxically heightens their loneliness and social withdrawal by making them “act in a more defensive, hostile way toward the others with whom they would like to connect.”

So if you’re feeling lonely this holiday season—regardless of whether your loneliness is acute or chronic—be aware of the temptation to compare yourself to others whose holidays seem brighter than yours. Focusing on the negative aspects of your situation may make you withdraw even more and sharpen the pangs of loneliness.

Instead, try reaching out. Accept invitations even if you feel you’re only being included because “they feel sorry for me.” If no invitations are forthcoming, consider extending one to an acquaintance who also is alone. Or volunteer to serve turkey dinner at a homeless shelter or distribute presents at a children’s hospital.

Connection comes in many forms. The Norman Rockwell version of the family holiday table is only one of them.

 




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Posted in Cognitive-behavior Therapy, Self-help |

“Do I Need Medication?”

By Lynne Gots, posted on February 18th, 2015.

 

I discuss this question so often in my practice—and have so frequently considered blogging about it—I had to scroll through my archives to see if I’d already written a post on the topic. But, apparently, it only existed in my mind.

I’m prompted finally to address the issue of medication because I attended an interesting discussion the other day about a book titled Does My Dog Need Prozac? Everyone in the group, including me, has a fearful dog (my Australian Shepherd Freddie, as I’ve mentioned before, is tightly wound and “reactive” to other dogs, people unknown to him, and the television). We talked about how to help our sensitive pets be more comfortable in the world while at the same time learning to accept them as they are rather than being disappointed when they don’t behave like TV dogs. Come to think of it, this attitude of acceptance would make it a lot easier to be content with children, spouses, friends, and colleagues who don’t quite meet our expectations, either.

Given the title of the book, the conversation eventually turned to the use of medication to help ease reactive animals’ fears. According to the animal behaviorist who moderated the discussion, people are as reluctant to medicate their anxious canines as they are to consider pharmacological treatments for themselves—although she encounters, as I do, less resistance to so-called “natural” remedies, such as herbal compounds and vitamin supplements. (I’m always puzzled when someone who is adamant about not taking medication will ingest an uncontrolled, unregulated substance, however natural it may be. After all, poisonous mushrooms and hemlock are natural, too. But lethal.)

My position on medication is flexible. I’m more than happy to try a course of CBT sans meds if someone comes to me with that preference. The research suggests that CBT alone can be as effective as a combination of medication and CBT together in treating anxiety. and I’ve certainly seen many people benefit from CBT interventions without the help of a prescription. Medication alone, on the other hand, is not as effective. It may lessen discomfort, but it won’t resolve the patterns of avoidance people develop—and often become consumed by– to cope with their distress.

Here’s the rub. If anxiety is off the charts, a person (or dog) won’t be able to think clearly enough or stay in a triggering situation long enough for tolerance and habituation to take place. So medication can be very helpful in dialing down the arousal enough to facilitate the behavioral practice crucial for success.

I doubt animals feel stigmatized if they need to take Prozac (though their owners certainly might). But many humans I’ve worked with are ashamed, or see themselves as weak, if they can’t white-knuckle it through without the aid of a pill. Despite advances in modern neuroscience, culturally we’re still stuck in the last century when it comes to psychiatry, seeing mental disorders as failures of will or character flaws rather than disturbances of brain chemistry.

I personally have nothing to gain from recommending a course of medication. I can’t even prescribe it. But I believe in doing what works best—for people and for pets. And sometimes that means using all the tools we have at our disposal, including pharmacology, to make the process of coping more manageable.

[For the record, we did try Prozac with my late Golden Retriever Calvin, who suffered from separation anxiety and compulsive licking. Freddie hasn’t been on any medication because we’ve taken great pains to work with him behaviorally, and he’s responded to the training. In the interest of full disclosure, I confess to having been one of those owners who gravitated towards holistic remedies, such as DAP (dog-appeasing pheromone) and lavender spray. Sadly, none of them worked, so we’re back to plain old desensitization. And lots of dog treats.]

 

 

 

 

 

 

 

 

 

 

 

 




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Posted in Anxiety, Cognitive-behavior Therapy, Dogs |

News You Can Use: Small Actions Can Boost Your Mood

By Lynne Gots, posted on January 10th, 2015.

If winter is getting you down, consider putting a spring in your step—literally—to feel more energetic and happier.

It’s not hard to recognize people who are sad or depressed from the way they carry themselves: slumped shoulders, lowered gaze, downturned mouth, and shuffling gait. Happy people, in contrast, stand up straighter, make eye contact, smile, swing their arms, and bounce along at a brisk pace.

Short days and post-holiday doldrums can take their emotional toll; temperatures in the single digits may worsen the seasonal blues by limiting our exposure to sunlight and causing us, when we do brave the elements and venture outside, to bow our heads, hunker down against the cold, and pull our arms in tightly against our chests.

Posture, it turns out, can affect mood. The results of some recent research point to a connection between how we walk and how we feel.

In one study, undergraduates (who, due to their ready availability and incentives to participate, are the most commonly tested subjects in psychology experiments) were told to attempt to move a gauge as they walked on a treadmill. For one group, the gauge moved when they bounced along at a fast, “happy” clip; for the other, the gauge responded to a slowed, “depressed” pace.”

After being given a list of 40 words—half negative, such as “ugly” and half positive, such as “happy”—the subjects in the depressed group recalled more of the negative words. Another study by the same research team, which used people actually suffering from depression rather than randomly selected undergraduates, produced similar results when half the participants were told to slump. Subjects instructed to sit upright recalled fewer negative words.

Although more research with larger samples (each of the above studies tested fewer than 40 subjects) would be required to draw any broad conclusions, the results make intuitive sense. They also lend support to the framework underlying cognitive-behavioral therapy: making even small changes in behavior can help alter moods.

If walking isn’t an option–say you’re sitting at your desk and feeling in a funk with a deadline looming–try smiling.  The act of putting on a happy face can activate neural pathways to boost serotonin and dopamine, two of the neurotransmitters targeted by most antidepressant medications.

To be clear, none of these microphysical adjustments will cure a serious case of depression. If you suffer from more severe, intractable mood problems, please seek professional intervention. But for the garden variety blahs so common this time of year, why not try walking happy? It just might help.

 

 

 

 

 

 

 

 

 

 

 




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Posted in Cognitive-behavior Therapy, Depression, Techniques |

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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