Tag Archives: Depression

Listening Effectively to Strong Emotions

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Listening effectively is hard. Especially when the other person has strong negative emotions. We usually and intuitively do the wrong things.

Let me give you a quick test.

Which of the following is a better response?

Speaker: I’m so depressed about being passed over for a promotion at work. I’m worried that I’m going to be fired, or just that I’ll never get another promotion.

Listener:

  1. Cheer up, it’s not that bad. You still have a job and I’m sure eventually you’ll get promoted.
  2. Wow, that sounds really upsetting. It makes sense that you’re feeling down. Being passed over is a huge disappointment. And it also sounds like you’re worried about the future and your job. Tell me more.

Which do you think is a better response? If you picked a) then you are in good company. Most people think that that’s a better response. It’s a response that attempts to change the person’s emotion to a positive one. What’s wrong with this?

What’s wrong with it is that it is based on what I call the switch-on-the-forehead model of human emotion. In this model, we imagine that there’s a switch panel on our forehead that controls all of our negative emotions. If you feel depressed,  just reach up and flip the depressed switch to the off position. If you feel anxious, do the same with the anxiety switch. I’ve written quite a bit about depression and anxiety in previous posts, and this model of negative emotion doesn’t really work. 

Emotional Toggle Switches

Too bad we don’t have one of these on our forehead! Instead, we need to listen effectively to strong emotions.

Unfortunately, human beings don’t actually have an emotional switch panel. In reality, we are really bad at changing our feelings quickly. When someone we are talking to implies we should be able to switch off our negative emotion we end up feeling the original painful negative emotion as well as an additional layer of shame that we can’t control.

We say things like “I feel so weak that I can’t overcome my depression.” “I’m such a loser to get so anxious about a job interview.” “I should not get so angry.” Notice that all of these statements are trying to negate a strong emotion and shame comes with failing to do so.

It gets worse. There’s actually quite a bit of research on thought suppression and what this research has found is what I call the pink elephant effect. The more you try not to think or feel something the stronger those thoughts and feelings become. Try not to think of a pink elephant and if you try hard enough that will be all you can think about. This is also true of anxiety, anger, sadness, and virtually all negative emotions. Thus when we try to “cheer up” someone who is upset, it usually backfires.

Why do people use invalidating listening responses instead of listening effectively? It’s not out of malevolence. We all want to help. But these attempts to “cheer up” people are usually doomed to failure. People typically push back against the “cheer up” message. If you tell a depressed person to look at the positives in their life, they will push back and tell you about all the negatives, or they will negate the positives. Tell an anxious person that their fears are overblown and they will tell you why their fears are realistic. As they push back, they feel more depressed and more anxious.

What Not to Do When Listening to Emotions

What are the most common “try not to think of the pink elephant” invalidating listening responses?  Why are they unhelpful?

1. Simple negation statements: “Don’t feel sad, don’t feel anxious, don’t feel angry.” These are statements that simply instruct the person to stop feeling the negative emotion. Another version of a negation statement is “cheer up”, “don’t worry”, or “chill out.” Or perhaps the worst of all, “Get over it!”

These are unhelpful because we don’t have that switch panel on her forehead that allows us to simply turn off negative emotions. In fact, because throughout human history negative emotions had more survival value than positive emotions, the brain overweighs negative emotions. On the ancient savanna, fear of being eaten by a lion when you hear rustling in the brush is a survival mechanism. Dismissing this fear could lead to disaster.

2. Problem-solving suggestions: “Maybe you should look for a different job.” “Have you considered ending your marriage or relationship?”

The problem with these kinds of suggestions is that they implicitly dismiss the person’s right to have negative emotions. They suggest a simple solution that will remove the negative emotions. But they are disrespectful because most people have already thought through all of these simple solutions and either they’re not simple, or they’re not solutions that they are willing to take.

Sometimes problem-solving is reasonable, but is best done after lengthy supportive listening. And usually, it’s best to avoid problem-solving and advice-giving entirely. 

3. Look-on-the-bright-side statements: “It’s not that bad, at least you have your health (money, relationship, kids, etc.)” or my favorite one, “At least it’s not cancer.”

These kinds of statements are not helpful because typically they are experienced as dismissive of our right to have these negative feelings. And we often push back and point out that there is no bright side, which can end up in a struggle between ourselves and the listener. This struggle is frustrating for both.

4. Changing the topic entirely: “Let’s not talk about your depression, what are you doing the rest of the week?”

Again, this is usually experienced as dismissive and unsupportive. It’s like saying to the person, “Shut up and stop talking about your suffering.”

5. Get therapy or go on medication suggestions. This is when your friend or family member suggests you may need therapy or medication to deal with your negative emotions. Again, this comes from a helpful place but is often experienced as dismissive. It’s like saying, “I can’t deal with your negative vibe, so please talk to somebody else.”

There are certainly times when it’s appropriate to recommend therapy, but this is best done after using positive listening approaches. Doing it at the front end is another way of invalidating the person’s feelings.

How to Listen Effectively to Strong Emotions

If these are all examples of what not to do, what should we do when someone expresses strong emotions to us?  How should we respond? What skills can we use to listen effectively? 

1. The first step is to listen empathically. What that means is to reflect back to the person what you hear them saying particularly the emotion. This skill is called a reflection of feelings. You basically just paraphrase their emotions, making an effort to be accurate as to the intensity. If someone says I am massively depressed, you don’t reflect back “You’re feeling a little bit down.” Instead, you reflect, “You’re really feeling overwhelmingly down.”

If you accurately reflect feelings,  then the person will elaborate on what they are feeling and you reflect again. Or you ask open-ended questions like, “How did that make you feel?” or “What did you feel then?” This will also expand the responses to their emotions.

Another good option is to reflect back the emotion and then ask the person to tell you more. “Sounds like you’re really mad at your wife about her spending. Tell me more.”

Of course, basic listening guidelines apply. Make good eye contact, use head nodding and nonverbal encouragers like “mmmm”, and “go on.” And of course, turn off your phone or mute it so you can listen fully.

2. Try to avoid the temptation to problem-solve or give advice. Especially try to avoid what I call the narcissistic shift. The narcissistic shift is when you shift to your own experience instead of staying with the other person’s experience. Many people mistakenly believe that these kinds of shifts are actually empathic but they are not. Here’s an example of the narcissistic shift:

Speaker: “Ever since I went off my antidepressants I’m feeling very depressed.”

Listener: “Yes, that happened to me a few years ago. I ended up having to go back on them. That’s probably what you should do.”

Even though it may be true that the listener had a similar experience it is invalidating because typically the exact experience was quite different. Also, the message becomes, “Let’s  not talk about you, let’s talk about me.”

It is like my favorite narcissist joke. The narcissist says, “Let’s not talk about me, let’s talk about you. What do you think of me?”

3. Normalize the speaker’s emotions. Statements like, “Of course you are feeling overwhelmed, so much has been going on lately.” Or, “Of course you are feeling depressed, you lost a job you loved. It makes perfect sense.”

The benefit of normalizing emotions is that it takes away the shame. Just try not to do the narcissistic shift as part of this. Avoid saying, “when I lost my job I got depressed also.” Just remember good listening is not about you, it’s about the other person.

4. Ask questions. Open-ended questions or encouragement to talk more are the best. Examples of open-ended questions are: “What are you feeling?” “How did that affect you?” Try to avoid asking why questions as they often come across as attacking. Example: “Why are you so sad?”

John Gottman, the well-known marriage therapist, suggests some of these questions:

  • Tell me what happened.
  • Tell me everything that’s bothering/worrying you.
  • Tell me all of your concerns.
  • Tell me everything that’s led up to this.
  • Help me understand more about what you’re feeling.
  • What set off these feelings?
  • What’s the thing that’s worrying you the most?
  • What’s the worst that could happen?

Notice that all of these encourage the person to feel safe venting and talking about their most painful emotions.

Some final thoughts on Listening Effectively  

Listening effectively is simple but very hard. Most of us will have a strong temptation to do all of the wrong things when confronted with strong emotion in another person. Fundamentally, we are all uncomfortable with strong negative emotions both in ourselves and in other people. It is a hard practice to learn to accept and tolerate negative emotions in others and in ourselves.

Now you’re probably thinking about a friend or family member who tends to ruminate about things and wondering if this approach would actually be counterproductive with them. I tend to think that much rumination is actually an interpersonal phenomenon that is based on unsupportive listening. A good analogy, although somewhat gross, is training an abscess or boil. When it’s fully drained, a painful process, healing begins. If you just put a Band-Aid over it, it only worsens. Unsupportive listening forces the speaker into pushing back by staying stuck with their emotions rather than fully expressing them.

If you really believe that someone you care about is stuck in rumination, then do an experiment. Listen effectively and fully for an hour. Let them cry, scream, quiver, whatever they need. In most cases, they will feel better and be less stuck in rumination. And you will have given them an amazing gift of love and kindness. Try it sometime, you will be amazed at the results.

How Your Smartphone Is Making You and Your Teenager Dumb and Depressed!

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smartphone making you dumber

Your smartphone. Smartphones are very cool devices. You can text, Snapchat, or email from anywhere. You can find your way through traffic using Google Maps or Waze. Find a good restaurant with Tripadvisor or Yelp. Take pictures and send them to all of your friends and family instantly. Nothing but upside right?

Wrong! Multiple research studies show that our smartphones are actually making us dumber, and maybe more depressed as well. Let’s look at some interesting facts. I’ve written previously about smartphone use and happiness but wanted to revisit the subject with more data.

Fact One: The average smartphone user looks at their phone 80 times a day, according to Apple.

Other reports suggest that people look at their phone 130 times a day. That means 30,000 to 47,000 times a year! Each of those glances distracts you from your current circumstances, and if you are trying to do something complex, or learn something, you are getting dumber 30,000 to 47,000 times a year! That’s a lot of time to lose. And since studies show it takes 25 minutes and 15 seconds to recover from distraction, that means you are losing 526 days a year, which is more than a year, which means that you are basically distracted and dumber all the time.

Fact Two: The closer your phone is to you, the dumber you get.

The University of California, San Diego conducted a study of 520 undergraduate students. The students took two tests of intellectual functioning.  The main variable in the study was where student put their phones. Some students put the phones in front of them on the desk, others put the phone in their pockets or purses, and others left their phones in an adjoining room.

The results: the closer the phone was, the dumber the person based on the test results. Phone in front of you, bad, phone in your pocket or purse, a little better, and phone in the next room, best results. And remember, this was with participants never checking their phones!

Fact Three: We don’t realize how much our phones impair our performance.

All of the participants in the UC study later said their phone was not a distraction, and that they never thought about their phones during the experiment. This shows we don’t even recognize the damage our phones are doing to our minds.

Fact Four: Smartphones bring down college grades by one whole letter grade when brought to class!

Researchers at the University of Arkansas found that those students who left their phones at home scored a full grade higher on material presented in the classroom than those who had their phones in class. It did not matter whether the students used their phones or not. In another study from the U.K. found that when schools ban smartphones, test scores go up a lot, with the worst students benefiting the most.

Fact Five: Your smartphone makes you worse at relationships as well.

Another study from the U.K. had 142 people divided into pairs and asked to talk in private. Half had a phone in the room, while the other half had no phone. The pairs then rated each other for affinity, trust, and empathy. “The mere presence of mobile phones,” the researchers reported in 2013 in the Journal of Social and Personal Relationships, “inhibited the development of interpersonal closeness and trust” and diminished “the extent to which individuals felt empathy and understanding from their partners.”

Fact Six: It Is Worse For Teenagers

According to Neilson, teenagers send and receive 3,339  texts per month, which is about 7 texts per hour, or one text every 8.5 minutes. Actually, it is worse. Let’s assume that most teens don’t text during classes. That means outside of class, they are texting about 12 times an hour, or once every 6 minutes.

iphone woman

This can’t be good for learning or memory.  Imagine you are trying to learn something hard, and every 6 minutes someone asks you a question and you have to respond. How’s your performance? And since we know that distraction lasts 25 minutes, that basically means that all teenagers are distracted every minute that they are awake and not in class.

What’s even worse is that smartphone usage also affects happiness. The Monitoring The Future Survey, which is funded by the National Institute on Drug Abuse, has collected data on 10th graders and 12th graders for decades. They asked teens how happy they are and how much time they spend on various activities including non-screen activities like socializing and exercise, and screen activities such as social media, browsing the web, or texting.

The results? All screen activities are linked to less happiness, and all non-screen activities are linked to more happiness! Eighth graders who spent 10 or more hours a week on social media were 56% more likely to say they’re unhappy. Even those who spent six hours a week on social media were still 47% more likely to say that they were unhappy. And even more ominously, the more time that teenagers spent looking at screens the more likely they were to report symptoms of depression. Teens who spent three hours a day or more on electronic devices were 35% more likely to have at least one risk factor for suicide.

Here are a few somewhat radical suggestions:

  1. This one teenagers will really hate. What if parents took away smartphones from their kids, and gave them flip phones, for phone calls only? Turned off texting on the phone. I suspect the average teenager’s grades would go up a grade. Not to mention better learning and memory. Flip phones would allow teenagers to call their parents for a ride, thus having much of the convenience factor without any of the negative smartphone factors.
  2. If this is not practical then I would recommend that parents take smartphones from their children when they arrive home from school, put them in a locked drawer, and only give them back the next morning. Certainly, there should be no access to smartphones while studying or doing homework. When children have finished their homework and are in relaxation mode, they can have limited access to their smartphone, but only until a reasonable hour because the use of smartphones before bedtime is very disruptive to sleep.
  3. For adults, leave your phone in your car trunk when having dinner out. You’ll connect with your dinner partner much better.
  4. For families, all smartphones, tablets, laptop computers go away before every family meal. Unless you are a physician on call, nothing is so important that you can’t put away your smartphone and have a nice family dinner.
  5. Finally, consider a digital device Sabbath. Orthodox Jews do not use any digital devices during Sabbath, which starts Friday night and ends Saturday night. All of us should emulate this, and pick a day on the weekend which is a digital-free day.

I am reminded of the first time I met my friend Fred Luskin, a psychologist who studies stress and forgiveness. I was attending a workshop he led. At the beginning, he asked everyone to take out their smartphones and turn them off. Not “turn off the ringer” or “set to vibrate” but actually power down the phones. Participants were shocked and resistant. It took a few minutes for him to get people to actually turn off their phones. At the time I wondered about this, but now I can see that it makes a big difference. When your phone is powered down, you are not anticipating anything from it, so that little bit of attention that is always focused on the phone is freed up for other purposes.

Now I’m going to turn off my computer and my phone, go outside, and take a walk…

Depression Often Misdiagnosed, and Untreated

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The New York Times had an interesting article about how depression is often misdiagnosed in the US, and how most people who actually have depression don’t get treatment.  They reference a research study just published in the JAMA Internal Medicine.Depression

This research study performed by Mark Olfson, Carlos Blanco, and Steven C. Marcus, looked at responses from 46,417 people on the Patient Health Questionnaire-2 (PHQ-2) which is a brief screening tool for depression. A score of over 3 indicates depression on this scale.

What did they find? They found that approximately 8.4% of all adults studied had depression, but only 28.7% had received any depression treatment in the previous year! That means 71.3% of the people who suffer depression got no treatment for this depression.

Of those who were being treated for depression, about 30% actually had depression based on the screening, and another 22% had serious psychological distress. That means that of the people in the study who were being treated for depression roughly 48% neither suffered depression nor did they suffer serious psychological distress, indicating inaccurate diagnoses by the treating professionals.

There were some interesting correlates of depression. About eighteen percent of those in the lowest income group suffered depression, while only 3.7% of those in the highest income group suffered depression. It pays to be rich!

Depression was more common in those who were separated, divorced, widowed, or who had less than a high school education. None of this is terribly surprising.

How did depression sort out by age?

In the 18 to 34-year-old group 6.6% suffered depression. In the 35 to 49-year-old group 8.8% suffered depression. Ten percent of the 50 to 64-year-old group suffered depression. Of those over 65, only 8.3% suffered depression. So at least in this sample the 50 to 64-year-old group was slightly more likely to suffer depression, and contrary to what many people think, the youngest adults were somewhat less likely to suffer depression.

Of those who were married only 6.3% suffered depression. Of those who were separated, divorced, or widowed, 13.3% suffered depression. Divorce is bad for mental health, with almost a doubling of rates of depression.

Most of the patients who were treated for depression were treated by general practitioners (73%), with roughly 24% receiving treatment by psychiatrists and 13% receiving treatment by other mental health specialists. (There was some overlap, that’s why the numbers add up to more than 100%.)  This may explain the rather poor diagnosis and treatment of depression because general practitioners although competent and intelligent, are very busy and typically only have a few minutes to spend with each patient, not enough to do a good job diagnosing and treating depression.

CONCLUSIONS ABOUT DEPRESSION FINDINGS

What can we conclude from this research?

  1. Almost 10% of the adult population suffers from depression. Of those people who have depression less than 30% of them will get any treatment for depression.
  1. You are more likely to suffer depression if you are in the lowest income group, divorced, separated or widowed, or have no high school education. If you are married you have half the probability of being depressed.
  1. Many adults receive depression treatment even though they don’t really meet the criteria for depression. In this study, almost half of the people receiving treatment for depression were neither depressed nor were they even particularly distressed.
  1. Rates of depression by age groups were relatively equal, with the youngest age group having the least depression and the middle-aged group (50 to 64) suffering somewhat more depression. Married people are suffer half as much depression as divorced, separated, or widowed people.
  1. Most people received depression treatment from their general practitioner or internal medicine doctor, with a smaller number receiving treatment from a psychiatrist, and even a smaller number receiving treatment from psychologists. This also meant that most people who receive depression treatment were treated using medication, and very few people received psychotherapy, even though most studies comparing medication to cognitive behavioral therapy for depression have shown that therapy performs at least as well as medication and probably better over the long term, with less relapse.

Reading between the lines of this study, it suggests that many people who feel depressed would benefit from receiving an accurate diagnosis from a clinical psychologist, and might very well also benefit from receiving cognitive behavioral therapy for depression rather than medication. Even if medication is indicated, a psychologist could recommend it to the patient’s general practitioner, and then monitor more closely the results.

The study also suggests that many people receive antidepressant medication who actually are not depressed, which needlessly exposes them to side effects and also fails to provide the correct treatment for what troubles them.

And finally, since only about 30% of those who suffer depression received any treatment for it, if you feel depressed, be sure to pursue treatment for depression. Get an accurate diagnosis and then get treatment, ideally with a psychologist or therapist who practices cognitive behavioral therapy. If you want more information about depression, I’ve written extensively about it with a complete list of depression articles.

Gallup Survey Shows Stay-At-Home Moms Suffer More Depression

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Are stay-at-home moms more depressed than working mothers? In a Gallup poll released last week, stay-at-home moms showed a 28% depression rate compared to 17% of working mothers and 17% of working women without children.

Stay-at-home mothers reported more anger, stress, sadness, and worry. They were more likely to report themselves as struggling and suffering!

This is very important data. According to Gallup, stay-at-home moms make up 37% of mothers with kids living at home.

So who are these stay-at-home moms? Contrary to the mythical model of the rich stay-at-home mom who bounces between yoga class, tennis, pilates, and home to the nanny, the reality of stay-at-home moms is much grimmer. They tend to be poorer on average, younger, Latina, less likely to have graduated from high school or college, and more likely to have been foreign-born.

Here’s some more data directly from the Gallup report, which explored the well-being of 60,000 U.S. women in 2012.

In terms of worry 41% of stay-at-home moms reported worry, compared to 34% of employed moms and 31% of employed women without children.

In terms of sadness 26% of the stay-at-home moms reported it, compared to 16% of employed moms and 16% of employed women without children.

In terms of depression, almost a third of the stay-at-home moms (28%) reported depression, while only 17% of employed moms and 17% of employed women without children reported depression.

The only negative emotion that didn’t vary very much was stress. 50% of stay-at-home moms reported stress, but 48% of employed moms and 45% of employed women without children also reported stress. So apparently stress is pretty much the same across the board for women.

In terms of anger, 19% of stay-at-home moms reported it, while 14% of employed moms and only 12% of employed women without children reported anger.

What about positive emotions? Even though Gallup makes much of the lower ratings of positive emotions for stay-at-home moms, the numbers don’t reflect very large differences. 42% of stay-at-home moms reported themselves as struggling, while 36% of employed moms and 38% of employed women without children reported themselves as struggling. Not a very large difference and probably not statistically significant. What’s interesting about this data is that so many women, regardless of their parenting status, report themselves as struggling. This is quite troubling. I’d be very curious to see comparative data on men.

This is interesting research and completely consistent with some other research that was conducted by Daniel Kahneman and associates on women’s experienced happiness performing various activities. He looked at the percentage of time that women spent in unhappy mood states. Parenting activities showed a 24% on happiness ratio as compared to 18% for housework, 12% for socializing, 12% for TV watching, and 5% for sex! Even though children are delightful, parenting is hard work, and there are many negative emotions associated with it. Working outside the home has negative emotions also, with a 27% unhappy emotion ratio, but it also has rewards and recognition that the lonely job of parenting does not have.

So what should we make of all this research? What wasn’t investigated by Gallup is the relative advantages versus disadvantages for the children of stay-at-home moms versus working moms. So we don’t know if there are significant benefits to the children, which might compensate for the higher levels of suffering reported by stay-at-home moms. I may come back to this issue in a future blog post.

In any case, it suggests that stay-at-home moms need much better support systems from our society, and that we also need to develop better ways for women split time at home and work. Currently there are few options for women who wish to work part-time at satisfying jobs. Because child care in the United States is so expensive, it is difficult for poorer women to stay in the workforce. This may lead to higher levels of depression and suffering in women.

From a clinical perspective, psychotherapists need to be alerted to be extra careful to screen stay-at-home moms for depression and anxiety disorders. I have a quick depression screening test on my website which stay-at-home moms can use to identify if they are suffering depression. If so, call someone for help. Don’t suffer in silence.

Changing Thoughts May Be Better Than Changing Behavior in the Early Stage of Psychotherapy for Severe Depression

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A recent study took a close look at what predicts improvement in depression in the first five sessions of cognitive behavioral therapy. They looked at the degree to which the therapists used either cognitive therapy methods, practiced structuring the sessions clearly, and how much they used behavioral methods/homework. They also examined whether the patients cooperated with these parts of cognitive behavioral therapy. They also measured the strength of the therapeutic alliance.

Sixty patients with major depression participated in the study. Their sessions were videotaped and trained raters rated how much the therapists used cognitive versus behavioral methods.

What they found was only two aspects of therapist behavior predicted improvement between sessions. Depression was measured after every session, and these measurements showed that patients felt better when therapists used cognitive techniques, but didn’t improve when the therapists focused on behavioral techniques.

Patients also showed greater improvement when they adhered to suggestions made by the therapist, which is not surprising.

The behavioral methods used were techniques such as having patients schedule their activities to become more active, and tracking how they actually spent their time. This is called behavioral activation, and previous studies have suggested it is an effective approach to treating depression. The behavioral activation model is that depressed patients tend to do very little, and this leads to further depression. Patients are encouraged to schedule activities that are fun, or activities that provide a sense of mastery or success. This leads to a lessening of depressive feelings.

The cognitive methods were techniques such as writing down what your thoughts are, and using cognitive therapy to challenge or modify distorted thinking.

So how to interpret the results of this study?

It’s only one small study and I would be cautious about taking too much from it. It does suggest that at least in the early sessions of therapy, cognitive methods may be superior to behavioral methods. This makes sense to me because early in therapy depressed patients feel a lot of pain and lethargy, and getting them to suddenly increase their activity can be very challenging and perhaps too difficult. This may lead to a sense of failure which increases depression rather than reducing it. On the other hand, using cognitive methods may lead to more immediate sense of control and relief, which would tend to reduce depression levels.

My sense is that later in therapy behavioral activation techniques are very useful. But typically in order to get patients to cooperate with these techniques there needs to be a strong alliance with the therapist. This takes some time to build.

It would have been interesting if they had continued the study beyond the first five sessions, and looked at whether over time the relative importance of the cognitive versus behavioral techniques would have shifted.

The study shows that therapist behavior in sessions does matter. This is one of my pet peeves. Many psychotherapists claim to use cognitive behavioral therapy, yet fail to actually use any cognitive behavioral techniques on a regular basis in sessions. This study shows that therapist adherence to structuring sessions and using cognitive techniques matters.

So from a consumer point of view there are a few take-home lessons.

1. If you are seeking cognitive behavioral therapy, make sure your therapist actually does cognitive behavioral therapy during sessions. This means they should structure the sessions clearly, as opposed to simply letting you talk about whatever is on your mind. It also means they should be asking you to track your self talk in written form, during sessions go over those thoughts, helping you learn to identify and correct distortions in the thoughts. If they don’t do these behaviors, and therapy feels free-form, then you’re probably not getting cognitive behavioral therapy, and you might want to look elsewhere. If you don’t regularly get homework to do between tasks, you aren’t receiving cognitive behavioral therapy.

2. At least in the early part of therapy pure cognitive therapy techniques may be more effective than behavioral techniques. You may want to focus your own homework more on identifying and changing your inner thoughts, rather than trying to increase positive behaviors. This probably will yield more relief of depression.

3. The study also confirmed that when clients cooperate and are more involved using cognitive therapy techniques, they improve faster. So even if you’re feeling skeptical, try to fully participate during sessions and in between sessions, as that provides you the best chance of more rapid relief.

Your off to analyze his thoughts psychologist,

Andrew Gottlieb, Ph.D.

Copyright © 2010 Andrew Gottlieb, Ph.D. /The Psychology Lounge/TPL Productions