Tag Archives: depression

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 #078 Iyar 25, 5775 May 14, 15

Its not the circumstances

 Reflecting on the common physical causes for insomnia which I encounter with my clients, they all share one common root: disregard for connection between mind and body. It seems that we all live without regard to the body which so cares for us.

So for instance, the amount of artificial light which we fill our living spaces can have cumulative devastating impact on our health (this was brought home to me by some frightening data about breast cancer and light pollution which you can read about here). Yet as much as we read about how important it is to ease the body towards sleep by decreasing exposure to light, we keep the lights on and use our phones, computers, and tablets to stimulate ourselves late into the night. 

I mention this disconnection here because for most of our clients, insomnia is another manifestation of their negative relationship with their bodies. While deeply delving into this relationship is not always required, it’s important to at least raise the issue. 

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 #072 Iyar 16, 5775 5 May, 15

A terribly tortured client complained about her feelings. Not a specific feeling. She simply hated the whole idea of feelings; they were inconvenient; bothersome. Not surprisingly, she was suicidally depressed, full of self hatred, and utterly confused by why she was so miserable.

There’s good news. She’s doing great now; cognitive therapy has helped her far more than all of the hospitalizations and medications. She’s come to understand that feelings are wonderful teachers and friends. Instead of repressing them she lives her life joyfully by respecting the wisdom they offer.

Her story comes to mind as I reflect on my trip (told in a previous post) to Meron. Instead of taking our car, I decided on public transportation (it was actually really nice!!). One major difference between going in a private car and public bus is that on a bus there are no bathroom breaks. Otherwise, the driver would be forced to pull over every second; tachlis, a three hour trip would take three days. So instead we must all ‘hold it in’, cutting ourselves from our the messages that our bodies tell us.

The same is true of the family which my client comes from. Many children. Harried parents. A culture which indoctrinates towards sameness and ostracizes difference. In a world like that who has time for feelings? Who has time for inconvenient truths spoken by the heart. ‘Onward!!’, she was told again. Onward towards where? To a place whose entry fee was the cruelest kind of amputation: the person from herself.

Cognitive Pearl #070 Iyar 12, 5775 1 May, 15

We rise by lifting others




In considering the depth of cognitive treatment I take the approach that above all, my efforts must ultimately lead to positive social reintegration. Humans are a social animal; we can do amazing things when we’re attached to others. From a cognitive therapy perspective, social connectedness forms the bridge that allows the transfer of new ideas between people. These are the ideas that save our lives. 

Consider depression. Or schizophrenia. Both share features in common: thought disturbance and  emotional disconnection are the most visible. When most of us think of schizophrenia, delusions and hallucinations come to mind. Or when we think of depression we think of the immobilizing heaviness of self hatred and despair. Yet in both cases, social disconnectness is the most important determinant of outcome. That connectedness provides the leverage to keep the client connected to reflection, reality testing, and the magic of community. 

So tachlis, as a cognitive therapist, my treatment plan and its length, intensity, and depth is designed around getting the client back in touch with others. 

After all, life is with people. 

More on this next week.

Shabbat Shalom!

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







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