Avoid hidden "Forks in the Road" to anxiety and depression

[David Baxter PhD]

Avoid hidden "Forks in the Road" to anxiety, depression
January 6, 2007
By A. B. Curtiss

We don't think of a "fork in the road" as an integral part of daily life. Usually it indicates some defining moment of change ? the end of a marriage or the beginning of a new career. A recent news headline declared "Nuclear talks reach 'fork in the road' " ? one fork leading to armed force, another to negotiation.

The accepted thing about forks in the road is that they are obvious to everyone ? if not before, at least after the fact. The Enron scandal gave everybody a hindsight look at those executives who, when they came to their ethical fork in the road, obviously took the wrong one.

As a psychotherapist, I see the damage that happens when people take a wrong emotional fork in the road. They do it because these forks are not so obvious. They are hidden in habit. They don't appear to be forks in the road. They appear to be momentary, sad musings or random thoughts of loss, failure, guilt or unworthiness. Actually, these transient thoughts are the very important wrong forks in the road that lead to depression and keep you in it.

Since these forks are hidden, when you find yourself stuck in depression, you don't see any fork in the road to take you out of your pain. Yet depression is cyclical, meaning it always ends before the next cycle can begin. A fork in the thinking road does occur naturally, sooner or later, even in the most serious cases of depression, and people gratefully notice that suddenly they are in a different and better place.

In a nutshell, my job as a therapist is to help people get to this place of okayness sooner rather than later.

People can learn to spot formerly ignored small forks in the road so they no longer take them. Most important, they can learn to make a fork in their thinking road that can take them out of depression, anxiety or any other kind of emotional suffering.

Forks in our emotional road are the stuff of our continual daily existence. Another word for them is options. If you don't see the forks in your road, you won't see what your options are. Therefore, you might believe you are emotionally powerless and helpless to do anything but go along with the pain and torture your moodswings lead you to.

This is not necessary. You are not really helpless, you just feel helpless.

You always have the power to take a different fork in whatever emotional road you are stuck on. Suppose you wake up in the morning feeling lonely, empty, depressed. You can continue on this same road or you can make a fork in your thinking and get the heck out of there. Depression is like living in a room of pain. You can learn how to leave the room.

One symptom of depression is to stagnate ? hunkering down in bed or on the couch, thinking about your pain. You can make an action fork in the road of your hurt. You make a new fork in the road by actively thinking or doing something different. If you're depressed, get yourself up, up, up and do something physical. Jog if you can. Do a crazy dance and jiggle yourself alive again. Physical activity is a fork in the road out of depression.

Another symptom of depression is the sense of helplessness and the isolation of self-focus. You must make a community for yourself. Self-focus, thinking about yourself is the road to Hell. What can you do? Quickly make a community fork in the road by thinking about someone else, your dog even. Send a prayer to someone, or imaginary medicine to help a sick friend. Visualize a loved one finding that house or landing that job. Suddenly you are not alone and trapped in yourself. And in your effort on behalf of others, you are not quite so helpless. You have powered up.

Feeling sad and blue? Many people have wandered down this emotional fork to full-fledged depression. Not to worry. Make a fork in the road called "Do some silly exercise right now!" Sing a dumb song in your mind to replace the thought, "I am depressed." I know what you're thinking: "This is ridiculous." It is. It is also extremely effective. The only problem is actually singing the song. Actually doing something else other than thinking about your depression is how you make a fork in the road out of it.

True, you don't know for sure where any new fork will take you. But your experience tells you where the old fork is going, and you know you don't want to go there. Your road of life is prescribed by the emotional forks you take. It's okay to stumble and bumble and feel down and out. You can always make a new fork in that downer road. And get yourself up, up, up to a better place.

A. B. Curtiss is board-certified cognitive behavioral therapist and author of "Brainswitch Out of Depression".

 

[Into The Light]

great article, i really liked it. thanks david

 

[Halo]

I thought this part was really interesting:

You make a new fork in the road by actively thinking or doing something different. If you're depressed, get yourself up, up, up and do something physical. Jog if you can. Do a crazy dance and jiggle yourself alive again. Physical activity is a fork in the road out of depression.

While I understand her "fork in the road" theory and doing something different to get out of the depressed feeling, I don't think she has ever really suffered from depression or felt that extreme sadness or she wouldn't be suggesting that someone who is depressed just jump up out of bed and dance, jog and jiggle themselves alive. Is she serious? I can say that on a good day it takes most of my energy just to actually get out of bed and put my feet on the floor in the morning and to get through my day let alone trying to think of doing something physical.

Again, I understand what she is trying to say but I interpreted the article to imply what many others in this world suggest which is to just snap out of it and think yourself better.

Sorry, just my personal rant

 

[David Baxter PhD]

While I understand her "fork in the road" theory and doing something different to get out of the depressed feeling, I don't think she has ever really suffered from depression or felt that extreme sadness or she wouldn't be suggesting that someone who is depressed just jump up out of bed and dance, jog and jiggle themselves alive. Is she serious? I can say that on a good day it takes most of my energy just to actually get out of bed and put my feet on the floor in the morning and to get through my day let alone trying to think of doing something physical.

Very good point.

If you are sad, down, having a bad, day, etc., that's great advice.

If you are suffering from a major depressive episode, going to the bathroom and brushing your teeth might be a major accomplishment for that day. "Dancing a happy dance" is just not going to happen.

 

[Into The Light]

i hadn't thought of it that way, good point nancy. the way i interpreted the article was that it said to try and do something about it, no matter how hopeless or awful you feel. you can make decisions to help yourself. that's where cbt comes in where instead of letting your thoughts drag you down, you make a conscious effort to change those distorted thoughts. you have to work at it, and it's difficult and takes time and patience, but it can be done.

 

[just mary]

While I understand her "fork in the road" theory and doing something different to get out of the depressed feeling, I don't think she has ever really suffered from depression or felt that extreme sadness or she wouldn't be suggesting that someone who is depressed just jump up out of bed and dance, jog and jiggle themselves alive. Is she serious? I can say that on a good day it takes most of my energy just to actually get out of bed and put my feet on the floor in the morning and to get through my day let alone trying to think of doing something physical.

The exact same thing went through my head Nancy. It all seemed so simplistic.

jm

 

[Into The Light]

this article says depression is cyclical, and i have read that more than once in different places. what exactly is meant by this? that it will always come back even when you seem to have recovered? or do they mean it has its "ups" and downs when you are suffering from it? (ie, some days the depression is worse than others)

 

[David Baxter PhD]

I don't think the gerneral advice given in the article is bad - perhaps a little exaggeration for effect to illustrate how CBT can help.

Ladybug, depression can be recurrent or cyclical for some people but that is not necessarily the case for everyone.

 

[Halo]

All I can say is that I am glad that she is not my therapist telling me to do a "happy dance" when I am in one of my depressed cycles The most physical she would see would be me dancing my way out of her office.

 

[Misha]

It's true that the article has some level of value, but takes it a bit too far. In that, it's really no different from any c-b stuff written before it.

I agree with Nancy that a "happy dance" is not going to happen in a Major Depressive state (I rarely even brush my teeth on those days)....

I think that there are ways that I already apply this kind of thing to my depression. But for me it has to happen while I'm "going down" and not when I'm already down. If I take care of myself and apply these types of strategies on the way down, I will still end up down but I think it is for a shorter period. But again it is not a happy dance but rather self-care choices like nutrition and med compliance and exercise.

 

[Cat Dancer]

I was looking at the author's website and it looks like he suffers from bipolar disorder? But it also looks like he advocates treating depression without medication.

I like this part:

Another symptom of depression is the sense of helplessness and the isolation of self-focus. You must make a community for yourself. Self-focus, thinking about yourself is the road to Hell. What can you do? Quickly make a community fork in the road by thinking about someone else, your dog even. Send a prayer to someone, or imaginary medicine to help a sick friend. Visualize a loved one finding that house or landing that job. Suddenly you are not alone and trapped in yourself. And in your effort on behalf of others, you are not quite so helpless. You have powered up.

That is so true for me. I get so self-focused when I'm depressed and that is the worst thing for me.

 

[David Baxter PhD]

I can't disagree with any of the comments about the article. There are certain things that CBT can do - and it does those things very well. But you cannot base your therapy solely on CBT and expect it to accomplish for you all you want to accomplish.

When I meet a new client who is in crisis (which of course is often the case to a greater or lesser extent when someone begins therapy), I approach therapy as three stages:

1. crisis management: try to address the immediate crisis and help the client to cope with the fallout of that crisis, a big part of which is to reassure the client that resolving the crisis is indeed possible - CBT may play a role here but is probably not the primary tool;
2. symptom management: help the client to gain some control over the symptoms of depression, anxiety, panic, etc. - this is primarily where CBT and often medication comes in; and
3. address the underlying issues and trends in the individual's life that brought him or her to this point.

Conceived in this way, CBT is a valuable component of the overall strategy but it plays a primary role only in one phase.

 

[Halo]

While I understand the overall concept of what the article is saying and I don't disagree with the "fork in the road" concept and cbt techniques described, I do have to wonder about the author thought. I, like Janet realized that the author is a big supporter of treating depression without medication. She has even authored a book called "Depression is a Choice: Winning the Fight Without Drugs". Now it makes sense to me as to why she would suggest for depressed people to just get up and do a "happy dance"

Hasn't it been proven that medication together with CBT works better for depressed patients than medication or CBT by themselves?

 

[David Baxter PhD]

Hasn't it been proven that medication together with CBT works better for depressed patients than medication or CBT by themselves?

Yes. Absolutely. Definitely. Repeatedly. This has been clearly demonstrated in every study that ever looked at the question.

 

[Halo]

That's what I thought and was thinking to myself just how she expects to support whatever she claims in her book (based on the title of Winning the Fight Without Drugs) if based on all the research that shows that medication and cbt work better together.

On second thought, maybe she is talking about people that are only mildly depressed and not suffering from major depression. I guess that is possible.

Sorry, just thinking out loud again

 

[David Baxter PhD]

You may well be right. In this particular post, though, at least some of the comments would apply not only to mild depression or sythymia but also to an approaching recurrent major depression, where if one is skilled in CBT one might be able to minimize the depths of the depression or shorten its duration by applying the CBNT techniques previously learned and practiced.

For example:

Forks in our emotional road are the stuff of our continual daily existence. Another word for them is options. If you don't see the forks in your road, you won't see what your options are. Therefore, you might believe you are emotionally powerless and helpless to do anything but go along with the pain and torture your moodswings lead you to.

Applying cognitive counters to those beliefs about helplessness and powerlessness may assist you in doing what you can to reduce the pain and distress the author describes.

 

[Halo]

I see your point and actually agree that CBT can help to counter those beliefs about helplessness and powerlessness and may reduce the pain and distress however I guess depending on the person and the intensity/severity of the depression will CBT work without the need for medication.

Again, I am not diagreeing with the author's article here in its entirety but more the get up and do a "happy dance" to make yourself better portion and more specifically the title of her book "Depression is a Choice: Winning the Fight Without Drugs" which just makes depression sound like it is something that a person decides whether they want it or not and when they want to get rid of it and can make it go away on their own with no medication. So not true

Okay, sorry rant over

 

[David Baxter PhD]

depending on the person and the intensity/severity of the depression will CBT work without the need for medication

Short answer: No. Not for everyone. Not for most people with recurrent major depression.

 

[Halo]

Thanks, I didn't think so

 

[Misha]

In my own experience there is a lot of pressure from certain therapies that have reputations to uphold, and cbt is one of them. I recently passed up the opportunity to do DBT (dialectical behavioural therapy), a form of cbt for borderline personality disorder. With the exeption of my current therapist, I was met with disapproval about my choice... as though this was the only therapy that could ever help me.
Tying this into the thread now... one of the reasons i chose not to do DBT is the fact that it does not integrate medication into the therapy. I have many other "issues" with the philosophy and behavioural strategy of dbt which i will gladly rant about upon request.... Anyways, I would be free to see an "outside" therapist but only to get refills on my meds. No discussion or support allowed, as this is considred therapy interfering behaviour. Somehow I don't think that seeing a second therapist who has no idea what's going on in my life for meds while doing a cbt type therapy that has no connection with this...well, it doesn't sound quite right.
Medication is not only a necessary part of therapy, but it needs to be a fully integrated part of therapy as well.