Tag Archives: anxiety

Cognitive Pearl #098 Suicide & Hope

Einstein It's A Miracle

 

 

 

 

 

 

 

 

 

 

 

A client asked me if I was worried that he might commit suicide.

Wow. That’s a question that I don’t get asked everyday. As loaded as the question was however I felt it was important to give the answer. Not ‘an’ answer.

The answer.

‘Actually, I am a bit worried that you might suicide but I’m more worried that you’ll miss an opportunity which lays before you.’

Now it was his turn to be caught off-guard.

So I explained that as I saw it, he was dealing with some terrifying issues. These were issues (relating to family obligations) that he was finally taking on in a manner that offered the best chance of his coming out the other side. The size of the prize makes the journey fraught with danger, suicide being a small risk compared with the bigger risk of bailing out of the process. In the meantime we would continue to work the process and in the vernacular of my youth, let the chips fall where they may.

Content with my explanation he left a few minutes later when our session was over. The after-image as he left: determination and confidence.

Suicidality has fascinated me since entering the profession. It’s struck me that overall, all of the holy trinity of professions (psychiatry, social work, and psychology) seem to be quite confused by the whole topic. Whether it’s predicting suicidality or what to do to prevent it, professional consensus remains elusive. Societal expectation that somehow we soothsayers of the human mind should ‘know’ who kills himself and who doesn’t even more ironic.

For me however suicidality goes to the heart of my approach to cognitive therapy. And that’s the topic I’ll be fleshing out in the coming posts.

Cognitive Pearl #096 Time & Mother Earth

Don't Look At The Jug

 

 

 

 

 

 

 

 

In my previous post, I introduced two ways to help reorient clients to the present moment. Here’s one more:

3. Strengthening their executive functions. Our minds are complex chaotic systems within systems. Yet, somehow our minds sustain us physically, emotionally, and so forth. This is all due to the blessing of our executive functions. You can read more about them here. Anxiety, depression, psychosis, as well as psychosis and many other states (including bereavement) levy a heavy price on these functions. Here are some of the things that I do with my clients to strengthen them, 

Get them writing. Shopping lists, budgets, schedules, reminders, sudoko games, and journaling help organize frenzied minds. Whether it’s with paper and pencil or using an app on a phone, the physical act of writing grounds and organizes. Grounding reduces cognitive stress so they can more easily focus on the challenges and opportunities of the moment. 

Get them physical. Anxiety, depression, psychosis, you name it, are states that remind me of a scene in the movie 2001: A Space Odyssey when one of the astronauts has been severed from the tether that connects him with the space ship. We see him horribly and helplessly floating away. My clients always relate to that image. My answer is to get them reconnected with Earth. They do this through bathing, cooking, cleaning, walking, peeling potatoes, dancing in their living rooms, or tossing a ball from hand to hand. Anything that gets them out of their ‘lost in space’ mind set and back to Earth will help them reorient to the now. 

Use Prostheses. Without getting into the spiritual and psychological downsides of smart phones, tablets, and all the rest, technology can really help our clients. Calendar apps, To Do List, apps, Journaling apps, and even Cognitive Therapy apps (here’s a good one). And let’s not forget how the convenience of music, lectures, and guided imagery meditation in the palm of the hand. This technology is no different than the prosthetic arms and legs and eyes that we use to the limited live again. And living brings people back to the now. 

To be continued!

Shabbat Shalom!

Cognitive Pearl #095 The Moment & It’s Loving Embrace

Jerusalem cats tale

 

 

 

 

 

In my previous post, I suggested that a function of the sensation of the passage of time is part of our pattern recognition abilities. The sensation of time provides a background standard to organize the contents of our lives. We categorize, prioritize, plan, and respond based on the sensed temporal immediacy.

In our work, ‘sensed’ or ‘felt’ time has great relevance. The anxious, overwhelmed client not only experiences a swarm of threats; all of those threats are bearing down on him NOW. For the anxious there is no reprieve of ‘later’. As one of my clients described it, ‘I’ve gotta do everything right the hell now!!’

Similarly, the depressed client, especially when in a dysphoric mood state, is immobilized by regrets anchored in the temporal space of NOW. While clients may describe events in the past tense, their affect and cognition are temporally centered in the present and in the future. A client described his misery as watching ‘reruns of past failures scheduled for the next hundred years’.

In order to feel better our clients must do things that give them pleasure and mastery. Because of its enormous influence on their abilities to plan and do things, our clients’ temporal orientation is vitally important. The good news is that temporal reorientation in the vast majority of circumstances is accomplished easily. Here’s some of the ways which I’ve noticed and which I’ve developed further:

1. The imposition of temporal order through activity scheduling. The mere establishing of appointments has a reorienting effect. Cognitive therapists have long used activity scheduling to extend our efforts to bring the client back to the unpolluted now.

2. Helping the client establish a renewed sense of time through dialogue. The client centered psychotherapies in general, and cognitive therapy in particular, have always advocated ushering the client into the moment. We do this with dysfunctional thought records and with all of the homework assignments that we prescribe.

Most importantly it is our reassuring insistence which compels both client and therapist into the present. Instead of preoccupation in the past, we focus on present symptoms and ways to feel better now. While I acknowledge that past experiences and future risks are part of our work, I often explain to my clients that the best way to heal their lives and help them blossom, is to be rooted in the loving embrace of the present moment. From that secure position they can go back or forward in time and process anew the traumas of the past and fears of the future. 

To be continued!

Cognitive Pearl #080 Sivan 2, 5775 May 20, 15

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As a cognitive therapist, helping relieve insomnia requires getting into the thoughts and beliefs that otherwise make sleep impossible. Mind and body are connected; what the mind thinks it ‘translates’ into physical reactions. The body is a captive eavesdropper on the thoughts, worries, regrets, and impulses that criss-cross the mind.

An example:

Last week a client made an important decision which would have great influence on her future. Without going into the details if this decision fell in between ‘what-to-order-for-dessert’ (trivial) and ‘who-to-marry’ (super not trivial), this particular decision would fall closer to the who to marry direction. Not surprisingly she complained of sleep difficulties. In this specific case, she was able to fall asleep literally when her head hit the pillow but awakened two hours later and then not be able to fall asleep again.

It didn’t take a rocket scientist or advanced, experienced cognitive therapist to understand why this was: her mind, after a two hour nap, began percolating with activity. The body, ever ready to help out, heard the mind, and threw some coals on the fire. By coals on the fire, I mean acetylcholine, the neurotransmitter of physical activity. It also stopped dumping adenosine, the neurotransmitter of sleepiness, into the blood stream. The result was a body ready to go and buy a dress (oops! I’ve said too much already!). 

What we did about however was pretty cool. More on that later. 

Cognitive Pearl #076 Iyar 23, 5775 May 12, 15

Between Stimulous & Response

 

 

 

 

 

 

 

 

 

The integration of cognitive behavior therapy into the treatment of insomnia has received lots of coverage in the general press as well as in the professional literature. The results reported have been positive regardless if the client was suffering from comorbid depression, anxiety, or addictive disorder or if sleep medication was also used.

The model that I’ll be sharing in coming posts is taken from the protocol developed by the United States Department Of Veterans Affairs. They have an immense amount of experience treating veterans, their families, and their communities for a variety of comorbid disorders. 

The protocol has three components. They are:

Psychoeducation about sleep, insomnia, and the conditions that interfere with sleep.

Treatment of environmental, psychological, and physical factors that get in the way of sleep.

Monitoring and follow up of those in treatment.

In following posts, we’ll briefly review what you need to know about sleep (psychoeducation). Then we’ll get into stimulus control, quieting the mind, and relaxation techniques. 
 

 

Cognitive Pearl #066 Iyar 8, 5775 April 27, 15

The words You Speak Become The House You Live In

Most of us think of cognitive therapy as a way of understanding and relieving depression, anxiety, and whatever else we use it for by focusing on the thoughts that underlie the disorders.

That is all true.

Yet, for me at least, cognitive therapy is about approaching the processing system that is the human mind. Whether it’s depression, joy, psychosis, impulsivity, concentration, love, pain, and all the rest, (and there’s a whole lot more!) the mind takes in information, processes it, and then uses those processes to guide how it navigates its existence. Cognitive therapy seeks to alter cognitive processes by illuminating them and by upgrading them.

The end result is a better life. 

While some mistakenly claim that cognitive therapy is superficial, it isn’t at all. It’s just that we cognitive therapists have found that not every single cognitive process needs to be illuminated and upgraded to make things better. Generally speaking, chronicity and severity are the best guides to how much we need on the table. 

More on that in the next post. 

 

Welcome & Shalom

 picjosh

 

 

 

 

 

Are you or someone you know in need of effective psychotherapy?

Are you going through an especially difficult passage?

Do you want the assistance of a qualified and compassionate psychotherapist?

Do you suffer from depression, anxiety, eating disorders, addictions, insomnia, medical problems, or post traumatic stress disorder?

Are you and your spouse or child in conflict? Do you want your relationship to get back on track?

Have you heard about cognitive therapy and its ability to bring bliss and joy to life?

Do you want practical ways and tools to integrate the ideas of mindfulness and cognitive therapy into your life, marriage, and family?

Are you looking for a qualified and licensed professional who speaks your language and shares your values?

 My name is Rabbi Dr. Joshua Mark, PhD. I’m a psychotherapist and teacher.

 And I am here to help.

 

 

Located In Jerusalem