Speaker 1: Before we get started, I want to give a big
Speaker 1: shout out to our newest Patreon members Cynthia B, Cynthia G,
Speaker 1: Nicole G, Tara Are, Duane P. And Stephanie B. Thanks
Speaker 1: so much to all of you, and thanks so much
Speaker 1: to all of our Patreon members. If you'd like to
Speaker 1: experience being a Patreon member and all the benefits that
Speaker 1: come with it, go to One You Feed dot net
Speaker 1: slash join. The trap of depression is the person often
Speaker 1: thinks they'll act once they feel better. It's actually the
Speaker 1: other way around. They'll feel better once they act. Welcome
Speaker 1: to the one you feed. Throughout time, great thinkers have
Speaker 1: recognized the importance of the thoughts we have. Quotes like
Speaker 1: garbage in, garbage out, or you are what you think
Speaker 1: ring true, and yet for many of us, our thoughts
Speaker 1: don't strengthen or empower us. We tend toward negativity, self pity, jealousy,
Speaker 1: or fear. We see what we don't have instead of
Speaker 1: what we do. We think things that hold us back
Speaker 1: and dampen our spirit. But it's not just about thinking.
Speaker 1: Our actions matter. It takes conscious, consistent, and creative effort
Speaker 1: to make a life worth living. This podcast is about
Speaker 1: how other people keep themselves moving in the right direction,
Speaker 1: how they feed their good wolf. Thanks for joining us.
Speaker 1: Our guest on this episode is Dr Stewart Eisendraft, the
Speaker 1: founding director of the University of California, San Francisco Depression Center,
Speaker 1: where he served as the Professor of Psychiatry. His newest
Speaker 1: book is When Antidepressants Aren't Enough Harnessing the Power of
Speaker 1: Mindfulness to a lad be a depression. The book aims
Speaker 1: to take the reader through steps they can utilize to
Speaker 1: gain relief from depression and anxiety. Hi Stewart, Welcome to
Speaker 1: the show. Hi, thanks for having me. It's a real
Speaker 1: pleasure to have you on. We're going to be discussing
Speaker 1: your book, When Antidepressants Aren't Enough Harnessing the Power of
Speaker 1: Mindfulness to alleviate depression. And depression is a common topic
Speaker 1: on this show, so I am really excited to talk
Speaker 1: with you about it. But let's start like we always
Speaker 1: do with the parable. There is a grandfather who's talking
Speaker 1: with his granddaughter and he says, in life, we have
Speaker 1: two wolves inside of us that are always at battle.
Speaker 1: One is a good wolf, which represents things like kindness
Speaker 1: and bravery and love and the other is a bad wolf,
Speaker 1: which represents things like greed and hatred and fear. And
Speaker 1: the granddaughter stops and she thinks about it for a second.
Speaker 1: She looks up at her grandfather and she said, well, grandfather,
Speaker 1: which one wins? And the grandfather says, the one you feed.
Speaker 1: So I'd like to start off by asking you what
Speaker 1: that parable means to you in your life and in
Speaker 1: the work that you do. My life, I would say
Speaker 1: that that parable gives a good perspective on the topic
Speaker 1: of my book, and that is your emotions and whether
Speaker 1: you're going to be ruled by your emotions or whether
Speaker 1: you're going to be able to look at your emotions
Speaker 1: with some perspective. If you're ruled by your emotions, you're
Speaker 1: kind of battered around by the changing winds wherever they are.
Speaker 1: If you're able to look at your emotions, you can
Speaker 1: have much more equanimity in your life and be able
Speaker 1: to have a different stance towards them. Yeah, absolutely, I agree.
Speaker 1: So much of this is about how do we deal
Speaker 1: with our emotions skillfully enough that they can be there,
Speaker 1: but then we can live according to our values exactly.
Speaker 1: I love the title of your book when antidepressants aren't
Speaker 1: enough because it doesn't imply that there's a problem with
Speaker 1: antidepressants or you shouldn't take antidepressants. It just says that oftentimes,
Speaker 1: and I would argue, in a lot of cases, we
Speaker 1: need more than just a pill. Write a pill can
Speaker 1: be a lifeline to a lot of people. It has
Speaker 1: been for me for sure, and I've needed all sorts
Speaker 1: of other techniques and tools and perspectives and resources to
Speaker 1: deal with it. And so I really love the title
Speaker 1: because I think it sets us off on the right
Speaker 1: foot that like, Okay, if you need antidepressants, great, and
Speaker 1: there's probably more you can and should be doing. That's
Speaker 1: completely correct. I'm not anti antidepressants, uh as you say
Speaker 1: they can be invaluable, but what we find with antidepressants
Speaker 1: are that they usually, at least in half the cases,
Speaker 1: don't get the person back to full recovery from a
Speaker 1: depressive episode. So we really developed this approach as a
Speaker 1: way to help people improve upon any recovery that they
Speaker 1: have made with antidepressants and go to be a more
Speaker 1: complete recovery. You say very early on in the book
Speaker 1: that many treatments for depression try to suppress symptoms, which
Speaker 1: is often difficult to achieve. This book's approach is different.
Speaker 1: It aims at changing your relationship to depression without focusing
Speaker 1: on a decrease of its symptoms. Say a little bit
Speaker 1: more about that, it's hard for people who have been
Speaker 1: depressed for a long time to stop having depressive thoughts.
Speaker 1: For example, in our research, when we studied people who
Speaker 1: had taken two or more antidepressants, their average time in
Speaker 1: a depressive episode was seven years. So those people have
Speaker 1: been having depressive thoughts for a long time, and it's
Speaker 1: very challenging to have them stop having depressive thoughts. Instead,
Speaker 1: we want them to change their relationship to those thoughts
Speaker 1: so they're no longer ruled by them. So they may
Speaker 1: still have them, but instead of being in a sense
Speaker 1: dominated by those thoughts, they can start to have a
Speaker 1: different relationship. And the relationship we're describing here is one
Speaker 1: of almost peaceful coexistence. Right, It's okay, these thoughts are
Speaker 1: here in my brain, and I'm going to go okay,
Speaker 1: they keep coming up because thoughts just tend to do that.
Speaker 1: They just arrive without any help from us. Here they are,
Speaker 1: but my relationship to them is going to be one
Speaker 1: of like, all right, I can let you be there,
Speaker 1: but I don't have to believe you, and I don't
Speaker 1: have to act on what you tell me to do.
Speaker 1: Is that the essence of it. That's the essence of it.
Speaker 1: Right there. You you nailed it. I'll give you an
Speaker 1: example from my own experience. As you mentioned, we all
Speaker 1: have our own experiences with these things. But I have
Speaker 1: migraine headaches, and I was having a very severe headache
Speaker 1: and I felt like somebody was putting this vice on
Speaker 1: my head and tightening it up, and I felt completely miserable.
Speaker 1: Then I started to say, well, wait a minute, what's
Speaker 1: going on here. Actually, I'm having the thought somebody is
Speaker 1: putting advice on my head and it was getting away
Speaker 1: for them sensation I was having and putting that interpretation
Speaker 1: on it, And if I was operating from those thoughts,
Speaker 1: it's no wonder I was feeling miserable. But as I said, well,
Speaker 1: wait a minute, that is an interpretation. Those thoughts that
Speaker 1: I'm having a vice on my head by somebody's putting
Speaker 1: it there is just a thought. I may still have
Speaker 1: the painful sensations, but my interpretation of them varies tremendously.
Speaker 1: If I'm able to step outside of myself and just
Speaker 1: what we call dissenter from those thoughts and have another viewpoint.
Speaker 1: So when I have the thought that somebody's putting advice
Speaker 1: on my head, instead of being condemned to believe that,
Speaker 1: I could say, oh, that's a thought, I can let
Speaker 1: it go. I do this often, my back will start
Speaker 1: hurting and I'll find my brain saying my back is
Speaker 1: killing me. You just do that, and I'll sort of
Speaker 1: go along like my back is killing me. But if
Speaker 1: I get enough awareness that I stop and I go,
Speaker 1: hang on a second, let's really check in with the
Speaker 1: back here, And I go, no, it's not killing me. Yeah,
Speaker 1: there's some sensations of pain back there. But I have
Speaker 1: definitely overblown the situation. My brain has taken sort of
Speaker 1: some cognitive shortcut where it has suddenly given this extreme
Speaker 1: language to it. And I think physical pain is a
Speaker 1: great way to look at because when we look at
Speaker 1: physical pain, there's the sensation component of it, but then
Speaker 1: there's also our interpretation of it and the stories we
Speaker 1: tell ourselves about it and our resistance to it. All
Speaker 1: of those things sort of come together to create the
Speaker 1: experience we call pain exactly, They actually create the experience
Speaker 1: we call suffering. Yes, yes, so we go through And
Speaker 1: the same applies for mental problems as much as for
Speaker 1: physical pain, because what we've found with people who are
Speaker 1: experiencing depression, they have depression, they have pain full emotional states,
Speaker 1: but they often add to it and amplify those states
Speaker 1: by saying, well, I'm a rotten person for feeling this way,
Speaker 1: or I'll never get over this, or I'm condemned to
Speaker 1: this for the rest of my life, or what's the
Speaker 1: use in going on because I'm just going to have
Speaker 1: more of the same. And all that does is move
Speaker 1: the person away from what is the painful experience actually like,
Speaker 1: and can they shift in their attitude about it and
Speaker 1: let those thoughts such as I'm a bad person or
Speaker 1: I'm a rotten person drop away and just be there
Speaker 1: with the painful sensation. It's not to say it's not painful,
Speaker 1: but once you let those things drop away, you're suffering
Speaker 1: may diminish quite a bit. That's one of those things
Speaker 1: that is relatively easy for us to say and pretty
Speaker 1: hard to do, which is to just let those thoughts
Speaker 1: go because they tend to be somewhat As you said,
Speaker 1: somebody's had these depressive thoughts for a long time. What
Speaker 1: would you say to somebody to do if they Okay,
Speaker 1: we're in this moment. I realize that I'm having these
Speaker 1: thoughts and I'm having the painful emotions. I'm having that
Speaker 1: thought that I'm a terrible person. I'm having the thought
Speaker 1: this is never going to go away. How do I
Speaker 1: start to reorient? Well, there's several possibilities for that situation.
Speaker 1: One is if you take the person in depression. It's
Speaker 1: common for a person to be very self critical, like
Speaker 1: I'm a bad person, or I'm a rotten person, or
Speaker 1: I'm guilty of various crimes that I can accuse myself of.
Speaker 1: And one way is to help the person decenter from
Speaker 1: those thoughts, realize those thoughts are actually not a realistic assessment.
Speaker 1: They're part of depression. So a person who has a
Speaker 1: depressive state and says I'm a bad person, if you
Speaker 1: can help them say, well, actually, the thought I'm a
Speaker 1: bad person is part of your depression. Just like if
Speaker 1: you had pneumonia, your fever would be part of the pneumonia.
Speaker 1: It doesn't mean your metabolic state has actually changed. It
Speaker 1: means you're having a syndrome, which includes a fever or
Speaker 1: in depression includes having negative thoughts. In depression, we notice
Speaker 1: people tend to ruminate quite a bit, where they keep
Speaker 1: going over things, and what we try to do is
Speaker 1: help the person realize they're ruminating, because when they're in
Speaker 1: the middle of it, they're just stuck in this downward
Speaker 1: spiral that leads to more depression. And if they can
Speaker 1: catch themselves and say, wait a minute, I'm ruminating. I mean,
Speaker 1: it sounds simple, and to some extent it is, because
Speaker 1: it's shifting out of what we normally do. One way
Speaker 1: I have tried to help people realize this is that
Speaker 1: some simple meditation techniques. For example, if you count your breath,
Speaker 1: if you sit still and just try counting each breath
Speaker 1: starting from zero and going up to ten, one breath
Speaker 1: to breath, three breaths, and every time your mind wanders,
Speaker 1: you go back down to zero and start again. And
Speaker 1: what we find is that many people, when they get
Speaker 1: started doing this, they can get up to about two
Speaker 1: or three. That's as far as they go before their
Speaker 1: mind wanders. And what you start to notice, what is
Speaker 1: my mind wandering. Wow, I'm having a lot of thoughts
Speaker 1: that I wasn't even aware of. Myself having, and those
Speaker 1: thoughts are often the drivers of depression. So it's very
Speaker 1: important to start to notice. Ah, there is I mean
Speaker 1: one woman, for example, in doing this exercises, you know,
Speaker 1: I'm having all these thoughts that I'm a bad person,
Speaker 1: that I'm a fat person, that my thighs are too fat,
Speaker 1: and then after doing the exercise, she says, Wow, I
Speaker 1: realized I'm having a public relations campaign against myself. It's
Speaker 1: exactly it. I was interviewing somebody else recently. We were
Speaker 1: talking about this, and we're talking about that inner critic,
Speaker 1: and you know, he was like, we have a tendency
Speaker 1: to do one of two things with it. Either we
Speaker 1: argue with it or we just accept it. It's like
Speaker 1: you're an awful person. You're you know, like you said,
Speaker 1: you're fat, you're ugly, you're terrible, and we just go, yeah,
Speaker 1: you're right. When you look at it in that light,
Speaker 1: you're like, well, that's kind of insane. Like if somebody
Speaker 1: else came up to me and said that, I'd be like, well,
Speaker 1: hold on a second, fellow, you know, I'm not going
Speaker 1: to take that. But from ourselves we just go, oh,
Speaker 1: it must be true. And you and I had this
Speaker 1: conversation before, and we had some sound issues, so we're
Speaker 1: doing it again. And one of the things that you
Speaker 1: said to me that has stuck with me ever since
Speaker 1: was I was saying to you, what do we do
Speaker 1: when we're in one of these sort of emotional storms? Right,
Speaker 1: Sometimes it's easy to dissenter from our thoughts it's not
Speaker 1: too stormy, but sometimes it's really stormy. And you said
Speaker 1: something along the lines of the very fact that the
Speaker 1: thoughts are causing that much of a storm is a
Speaker 1: clue to not believe them. And I thought that was
Speaker 1: really wise, because I think we tend to do the opposite.
Speaker 1: We tend to think the harder I'm thinking it, the
Speaker 1: more true it must be. But actually that's not the case.
Speaker 1: That's right, Those kinds of thoughts, UH, that have a
Speaker 1: great deal of passion are often incorrect. And the trouble
Speaker 1: is we tend to operate from those thoughts. And what
Speaker 1: we're trying to learn in this approach is, instead of
Speaker 1: operating from those thoughts, were actually trying to look at
Speaker 1: those thoughts and see them quite differently. And so the
Speaker 1: thoughts that are most powerful often are really ideas that
Speaker 1: we are laying onto the situation, and they're often based
Speaker 1: on experiences we've had in the past or issues that
Speaker 1: have come up for us, but we're applying them in
Speaker 1: the present, and so we're trying to help people shift
Speaker 1: in their attitude about those thoughts. You say that one
Speaker 1: step in coping with these thoughts is trying to decide
Speaker 1: if they are facts or just thoughts. Say a little
Speaker 1: bit more about how he would tell a difference between
Speaker 1: a fact and the thought. Well, there's a saying that
Speaker 1: often in depression, there's false evidence that appears real, and
Speaker 1: the person tends to say, for example, a young woman said,
Speaker 1: I was out for dinner with the new fellow and
Speaker 1: he was looking down at his phone that was on
Speaker 1: the table, and I thought he must be bored with me.
Speaker 1: And as we explored it, there were plenty of other
Speaker 1: alternatives about that situation. Then he's bored with me. If
Speaker 1: you operate from that idea, he's bored with me and
Speaker 1: generates all kinds of feelings I'm depressed, I have been rejected,
Speaker 1: or I'm angry with him for being bored with me.
Speaker 1: All kinds of things would really are what we would
Speaker 1: call false evidence. Various things can be done in this
Speaker 1: situation like that is one is try to gather more information. Well,
Speaker 1: does he sit there focused on his phone all night
Speaker 1: and completely ignoring you. That's different than if he glances
Speaker 1: down at his phone, or if the phone dinged and
Speaker 1: he got a message, or if he was waiting for
Speaker 1: a certain callback or something like that. It's getting more
Speaker 1: evidence and seeing whether the evidence that you were operating
Speaker 1: from is actually valid or not. And also this is
Speaker 1: why mindfulness based cognitive therapy, which is the technique that
Speaker 1: we've used, borrows from some cognitive therapy elements and saying
Speaker 1: are there other explanations? Are there other potential explanations that
Speaker 1: might explain what I'm seeing and what I'm observing in
Speaker 1: this particular situation, and hence the feelings that I'm having. Yeah,
Speaker 1: I love both. Those one of the best descriptions I
Speaker 1: ever heard of this. It was a book about communication,
Speaker 1: so it was something slightly different, but it was basically like,
Speaker 1: the fact is what could be observed with a camera.
Speaker 1: So using your scenario, if there was a camera watching
Speaker 1: the couple at dinner, the camera would record that the
Speaker 1: man glanced at his phone a few times. That would
Speaker 1: be the fact. Everything else is interpretation. Everything else about
Speaker 1: why he did that and what he meant by that
Speaker 1: and how he feels about her. That's all the interpretation,
Speaker 1: that's all the meaning making, which is what we as
Speaker 1: humans are always doing. We're always taking a fact and
Speaker 1: trying to go what does it mean? Right? But we
Speaker 1: lose the delineating line, We lose the line between fact
Speaker 1: and interpretation, and they merge and it all feels like
Speaker 1: the same. But I just thought that example of what
Speaker 1: would a camera see as a really helpful way of
Speaker 1: honing in on what's a fact and what's an interpretation
Speaker 1: or a thought very good point. I mean the old
Speaker 1: show Greg Net, which I don't know how many of
Speaker 1: your listeners still remember, but you know it was really
Speaker 1: a detective series, and the detective always asked his witnesses
Speaker 1: just the facts, ma'am, just the facts, without the interpretation,
Speaker 1: as you say, being put on it. The same thing
Speaker 1: really applied to me with with that headache example that
Speaker 1: I mentioned, because when I let go of the idea
Speaker 1: that somebody was putting advice on my head, I still
Speaker 1: had unusual sensations, but actually they stopped being so painful.
Speaker 1: They are more like a buzzing sensation that I had
Speaker 1: been putting onto them. This is a vice being put
Speaker 1: on my head versus well, tingling, numbness, buzzing. But I
Speaker 1: don't have to put on somebody's putting a screwge to
Speaker 1: my head. Another thing that you say in the book,
Speaker 1: we sort of reference this a little bit. Is Another
Speaker 1: way of assessing a thought is to ask yourself how
Speaker 1: you feel in thinking it. If you feel more depressed,
Speaker 1: there's a very good chance that the thought is being
Speaker 1: driven by depression. That's right, That's completely right. That's why
Speaker 1: if a person is ruminating quite a bit, we say
Speaker 1: to them, first of all, notice you're ruminating. Now, when
Speaker 1: people start to ruminate, they say, oh, if you ask them,
Speaker 1: what are you doing when you're ruminating, Well, I'm trying
Speaker 1: to solve a problem. Well, is it leading to a solution.
Speaker 1: If so, then your problem solving. The trouble is with
Speaker 1: most ruminative thoughts you're not solving a problem. And in fact,
Speaker 1: try ruminating for ten minutes and see how you feel.
Speaker 1: Usually you'll feel much more depressed. And rumination is a
Speaker 1: driver of depression. So you can do these experiments like
Speaker 1: how do you feel in doing this? How do you
Speaker 1: feel in having a certain thought, and if having the
Speaker 1: thought that you have fat thiyes makes you feel worse,
Speaker 1: chances are the idea you have fat eyes as par
Speaker 1: out of your depressive state. One of the things that
Speaker 1: happens when somebody has depression is often they start not
Speaker 1: taking actions that they need to take in their life.
Speaker 1: And as that happens, it basically provides evidence. You talked
Speaker 1: a minute ago about false evidence appearing real. So false
Speaker 1: evidence I'm going to be a failure, right, But then
Speaker 1: all of a sudden, I get depressed and I start
Speaker 1: being less able to do the things that I know
Speaker 1: are important for me, to say, do well at work.
Speaker 1: So all of a sudden, now I'm doing less well
Speaker 1: at work because of my depression, and my brain is
Speaker 1: going to see you're doing less well at work at depression.
Speaker 1: It's just going to keep happening. So some of the
Speaker 1: evidence is not necessarily false in that case, it's actually
Speaker 1: starting to become a self fulfilling prophecy to a certain extent.
Speaker 1: How to break out of that cycle because I think
Speaker 1: a lot of times the thoughts, albeit distorted, might contain
Speaker 1: a truth in them about how we're living. What you're
Speaker 1: getting at is the trap of depression where the person
Speaker 1: feels like, you know, I can't do anything, and they
Speaker 1: adapt a rather passive stance. I can't do anything. What's
Speaker 1: the point of going to the dance tonight because I'll
Speaker 1: just be rejected And you could apply that same approach
Speaker 1: that you just mentioned. Well, does that make you feel
Speaker 1: better or worse? How does that affect your mood? Well,
Speaker 1: it makes me feel worse because I'm just stuck at home,
Speaker 1: never having any social life. Well, the trap of depression
Speaker 1: is the person often thinks they'll act once they feel better.
Speaker 1: It's actually the other way around. They'll feel better once
Speaker 1: they act, and you don't have to feel like you
Speaker 1: want to do it in order to do it, Like
Speaker 1: should I go to the dance tonight or am I
Speaker 1: going to get rejected? Well, I don't have to feel
Speaker 1: like I want to go. I just go. And that's
Speaker 1: where depression has a tendency to paralyze you. And the
Speaker 1: way out of it is to start to act and
Speaker 1: take some steps towards doing something and not just giving in.
Speaker 1: The same thing happens with depression and sleep or rest.
Speaker 1: I mean, if you're depressed, you have a tendency to
Speaker 1: want to stay in bed, for example, all the time,
Speaker 1: pull the covers over your head. But actually that doesn't
Speaker 1: lead to a feeling of being refreshed in any way.
Speaker 1: It leads to more feelings of lethargy. The way out
Speaker 1: of it is to say, even though I don't feel
Speaker 1: like exercising, I'm going to do it. You don't have
Speaker 1: to feel like exercising to actually do it. And what
Speaker 1: we find is once the person does it, they generally
Speaker 1: feel quite a bit better. Yep, you brought up to
Speaker 1: my favorite phrases that we've used on this show countless times.
Speaker 1: The first is, sometimes you can't think your way into
Speaker 1: right action. You have to act your way into right thinking,
Speaker 1: you know, which is just this exact point you're making.
Speaker 1: There's just times of the brain isn't going to make
Speaker 1: the right decision, but you you, you can do the
Speaker 1: action and oftentimes the feelings will follow. And then the
Speaker 1: other one for me with depression is depression hates a
Speaker 1: moving target. You know, when I get depressed, my goal
Speaker 1: is just to be in motion to some degree, some
Speaker 1: sort of positive movement. I don't just mean exercise, although
Speaker 1: that's a key part of it, but get outside, take
Speaker 1: a walk, read a book. I mean, just move. Go
Speaker 1: from the bedroom to the couch, go from the couch
Speaker 1: to the shower. Move. I agree with that completely, and
Speaker 1: you can apply modest expectations to it. You don't have
Speaker 1: to go run a marathon. Just going for a walk
Speaker 1: may be sufficient to get you moving and get you
Speaker 1: out of a depressive state. And some of the studies.
Speaker 1: There's a large study that looked at people, it's called
Speaker 1: the Heart and Soul Study, and found that probably the
Speaker 1: most important thing was a person being active and exercising
Speaker 1: whenever possible, more so than almost any other factor that
Speaker 1: they could put their finger on. So for people who
Speaker 1: have especially who had medical problems, this was a very
Speaker 1: useful finding. Yeah, it's so boring to recommend exercise. I
Speaker 1: always wish I had something better, something more exciting, something,
Speaker 1: But it's just crazy easy. The number of conditions that
Speaker 1: go if you just exercise, it will get better. I'm like, well,
Speaker 1: pretty much, name your condition and exercise helps with it.
Speaker 1: It really is a wonder drug exactly. I often tell
Speaker 1: people that as a drug, I mean, I tell him
Speaker 1: this is like medicine. You need to do what you
Speaker 1: need to build it into your life. So that it's
Speaker 1: something you can do every day or six days of
Speaker 1: the week at least. Yeah, if I could only have
Speaker 1: one intervention for depression, that's the one I think I
Speaker 1: would pick. If I was forced to just say, you
Speaker 1: only get one. I like having twenty of them, right.
Speaker 1: I like to throw, as I say, sometimes I throw
Speaker 1: the kitchen sink at it, you know, just everything I've got,
Speaker 1: But exercise would be the one I would keep. I
Speaker 1: want to ask you a little bit about the role
Speaker 1: of obsessive compulsive disorder and depression, and not so much
Speaker 1: the type of o c D that we see where
Speaker 1: it's like outward behavior, but the obsessiveness of thoughts that's
Speaker 1: kind of like a rumination. Is the approach still the same, Yes,
Speaker 1: In the essence, you're trying to help people start to
Speaker 1: notice their thoughts and change the relationship. So if I'm
Speaker 1: having obsessive thoughts about a certain situation or about certain
Speaker 1: ideas that I have, start to notice, Oh there it
Speaker 1: is again. There I'm having the thought. I'm having the thought,
Speaker 1: as one follow saw said, I'm having the thought I
Speaker 1: probably have cancer and I need to check myself all
Speaker 1: the time because I think I'm having another cancer develop
Speaker 1: Changing the relationship to that means instead of acting on
Speaker 1: that thought, like having to check myself literally saying, ah,
Speaker 1: there's the cancer thought again. There it is, And instead
Speaker 1: of having to be terrified, I can notice there it is.
Speaker 1: I've had it ten times today. And that's what I do.
Speaker 1: I have cancer thoughts or maybe I have cancer thoughts
Speaker 1: in relationship to stress or is in my life. But
Speaker 1: it doesn't mean I have cancer. It means I'm having
Speaker 1: an obsessive thought. Yeah. And this stuff is again kind
Speaker 1: of easy to say, and when you're really deep in it,
Speaker 1: it's hard. It's really hard to find a way through,
Speaker 1: you know. Like you said, sometimes finding a minimum effective
Speaker 1: dose can be really important, like with with exercise, like
Speaker 1: if we try and do too much, we get overwhelmed
Speaker 1: by it. That's right. We don't want to overwhelm people
Speaker 1: and don't want to have expectations that are too high.
Speaker 1: One of the problems with depression is individuals often have
Speaker 1: very high expectations of themselves and then in the sense
Speaker 1: what that means is they're very critical of themselves. And
Speaker 1: to help people get an idea of this is the
Speaker 1: equation where happiness is equal to achievement divided by expectation,
Speaker 1: and in depression, what happens is that expectation is very
Speaker 1: high and a denominator and the achievement is diminished. So
Speaker 1: the person doesn't think they've done much in their life,
Speaker 1: and they have very high expectations, and so no matter
Speaker 1: what they actually achieved, they end up feeling pretty miserable.
Speaker 1: And what we have to help them do is realize
Speaker 1: what they've achieved is reasonable, and let's get those expectations
Speaker 1: into alignment. I agree. I love that concept that happiness
Speaker 1: is equal to achievements divided by expectations, and when I
Speaker 1: do coaching work with people, we're working on both of those.
Speaker 1: Let's bring the expectations down, and then let's bring the
Speaker 1: achievements up, even if it's just a little bit, right,
Speaker 1: and then let's really work to feel good about those
Speaker 1: small victories, because feeling good about the small victory leads
Speaker 1: you to the next one, to the next one, to
Speaker 1: the next one, and before long, your ability to function
Speaker 1: is going up and up and up. But if we
Speaker 1: can't feel good about the small winds, it's hard for
Speaker 1: them to gain a lot of momentum. Yes, that's exactly right.
Speaker 1: Depression tends to make it very challenging to work with
Speaker 1: those things because there's a distortion that takes place. When
Speaker 1: you talk to people who have depressed, they're invariably very
Speaker 1: harsh and self critical. And part of what we've learned
Speaker 1: with mindfulness is that the person learns to become more
Speaker 1: self compassionate, start to change their relationship to themselves. So
Speaker 1: instead of being critical, say, okay, you know, uh, I
Speaker 1: didn't run the marathon today, but I did walk around
Speaker 1: the block. So doing things in small bites is an
Speaker 1: important way of doing it right because it can be
Speaker 1: really helpful to say I'm going to walk around the
Speaker 1: block today, and then if we do it. I often
Speaker 1: refer to it as an inner coherence between what we
Speaker 1: said we were going to do and what we did,
Speaker 1: and that feels good. It's back to that idea of
Speaker 1: let's get our expectations kind of in line here here's
Speaker 1: where I'm at. Let me set a goal that's one
Speaker 1: step ahead of me, and then when I hit that
Speaker 1: one step goal, I go, Okay, good, I did what
Speaker 1: I said I was gonna do. Wonderful. That feels good.
Speaker 1: It's an upward spiral. You mentioned the trap of depression.
Speaker 1: The trap of depression is that downward spiral. Right, I
Speaker 1: feel bad about myself, so I don't do much. And
Speaker 1: since I didn't do much, I now feel worse about myself.
Speaker 1: And since I feel worse about myself, I don't do much,
Speaker 1: and down it goes. And the upward spiral is just
Speaker 1: the opposite direction. Pick something small, do it, feel good
Speaker 1: about it. Oh, I feel good about it, so that
Speaker 1: gives me a little bit more energy to do the
Speaker 1: next thing. Exactly. One way we try to help people
Speaker 1: understand the concept of making small victories is to if
Speaker 1: you think about all the food you have to eat
Speaker 1: and the the rest of your life, and you were to
Speaker 1: put it in a room, it would be overwhelming. Yeah,
Speaker 1: if you say, well, actually I need to eat it
Speaker 1: one meal at a time, you know, it changes your
Speaker 1: perspective and you can feel good about, Okay, one healthy
Speaker 1: meal and I don't have to eat the whole aisle.
Speaker 1: And it's the same way in depressive states to say, okay,
Speaker 1: what is one thing? What is one kind of exercise
Speaker 1: you can do? What is one accomplishment? What is one
Speaker 1: confronting your passivity? It may be going to one dance,
Speaker 1: doing one thing along the path of accomplishment. I am.
Speaker 1: Let's talk about another thing, though, which is that one
Speaker 1: very common feature of depression is should in ourselves, right,
Speaker 1: I should, I should? I should I should? And so
Speaker 1: how do we find that ability to take sort of
Speaker 1: the next step forward without then layering too many shoods
Speaker 1: on ourselves. Well, I always try to urge people to
Speaker 1: replace should with the phrase it would be nice if
Speaker 1: and it helps the individual to gain a little bit
Speaker 1: less absolute view of themselves instead of I should be
Speaker 1: more accomplished, it would be nice if I was more accomplished.
Speaker 1: And my son has picked up this concept quite well,
Speaker 1: because because when I say to him something like you
Speaker 1: should be doing this or that, he says, you mean, Dad,
Speaker 1: it would be nice if I was doing this, or
Speaker 1: the good for him? Good him. Albert Ellis coined the
Speaker 1: term musturbation, which is a variation on this right. It
Speaker 1: was the I must I should, you know, and it
Speaker 1: was really that idea of change your requirement it must
Speaker 1: be this way to a preference. I really like that.
Speaker 1: As we start to think about Albert Ellis and some
Speaker 1: of those people, there's cognitive behavioral therapy, and then there's
Speaker 1: more mindfulness based therapies, and you're describing something called mindfulness
Speaker 1: based cognitive therapy, which brings elements of both. And one
Speaker 1: of the questions that I often find interesting to try
Speaker 1: and sort out, and as I look at all this,
Speaker 1: I sometimes get muddled on and I try them in
Speaker 1: my own life is on one hand, cognitive behavioral therapy says, hey,
Speaker 1: the reason you feel bad is because you're believing thoughts
Speaker 1: that are are negative or aren't true. So if you
Speaker 1: just change those, if you see through those, if you
Speaker 1: see the truth, that will go away. Acceptance based therapies
Speaker 1: are mindfulness based therapies tend to be a little bit
Speaker 1: more on. Hey, let's not wade into the muck with
Speaker 1: the thoughts and wrestle with them. Let's just see them
Speaker 1: as thoughts and give ourselves a little bit of distance
Speaker 1: from them. How do you know which of those styles
Speaker 1: he's going to be more effective? Or is it really both?
Speaker 1: Or how do you work through that? And am I
Speaker 1: making a distinction that's not even real? There? Well, I
Speaker 1: think you're right on the money that cognitive behavior therapy
Speaker 1: tries to help a person identify distortions that they're having
Speaker 1: and come up with alternatives. The difficulty with that is
Speaker 1: in my experience, and I actually I ran cognitive therapy
Speaker 1: groups for a long time, is that people who have
Speaker 1: been depressed for quite some time are really stuck. And
Speaker 1: I felt like I was a lawyer trying to prove
Speaker 1: a case with you. You know, if they said, well,
Speaker 1: I'll be rejected at this party, I'll never be able
Speaker 1: to have a social life or whatever. And then you
Speaker 1: try to say, well, that's a distortion. Maybe you know
Speaker 1: you could have an alternative thought. Well, they'll they'll argue
Speaker 1: against it, and that's one of the challenges. If pointing
Speaker 1: out the distortion works, that can be very helpful. But again,
Speaker 1: if it doesn't work, an acceptance or mindful approach is
Speaker 1: a very good alternative because they don't have to argue
Speaker 1: against it. They can say, okay, there's the thought, and
Speaker 1: instead of trying to come up with an alternative thought,
Speaker 1: they could say, that's just a thought. I'm having the
Speaker 1: thought that somebody's putting advice on my head. That's just
Speaker 1: a thought. It's a passing mental event and I don't
Speaker 1: have to change it. I just notice it. And once
Speaker 1: you start to notice it, it has much less power
Speaker 1: in your life. I love that idea of you end
Speaker 1: up becoming like a trial lawyer. I have an example
Speaker 1: of this in my own life. It's slightly different, but
Speaker 1: my partner's mom has Alzheimer's and she'll occasionally get really
Speaker 1: afraid of something. I don't do this anymore. I've learned
Speaker 1: my lesson, but I would try and aid in with logic.
Speaker 1: I'd be like, well, hey, you know, she'd be like,
Speaker 1: I'm gonna starve to death and die alone this winter,
Speaker 1: and I'm like, well, now hold on, like that's not
Speaker 1: gonna happen. Here's why. And I start to list the reasons,
Speaker 1: and she just keeps coming up with increasingly bizarre scenarios
Speaker 1: to counter every possible reason I have. You know, before
Speaker 1: long we are in the zombie apocalypse, you know, like
Speaker 1: that's where we are. Because I'm giving her a fact
Speaker 1: and she's going, no, here's why, you're not right, and
Speaker 1: I finally just realized, like that approach is not working.
Speaker 1: It's a little bit different, but then with her it's
Speaker 1: just sort of like that sounds really scary, and boom,
Speaker 1: We've just diffused the whole thing to some extent. But
Speaker 1: I think we can all look in our own lives
Speaker 1: at the way we argue with ourselves back and forth.
Speaker 1: You know. The mindfulness approach seems to be the middle
Speaker 1: ground between arguing with my thought or completely believe in it.
Speaker 1: Like you said, it's just a thought, it's not necessarily real.
Speaker 1: And the other thing I think so fascinating about meditation
Speaker 1: is it's such a learning experience if we take it
Speaker 1: that way, which is just these thoughts just pop up.
Speaker 1: I'm not doing it. Our minds are like popcorn poppers.
Speaker 1: They generate thoughts, and it's just like sensations in the
Speaker 1: body that we feel all the time that our our
Speaker 1: minds generate thoughts. And unfortunately, if you are prone towards depression,
Speaker 1: those thoughts are going to be negative ones, or if
Speaker 1: you're prone towards anxiety, they're going to be negative ones
Speaker 1: about the future. So that's why in mindfulness we're focused
Speaker 1: on the present moment, because in depressive states, the person
Speaker 1: feels as if they've undergone a significant loss, whereas in
Speaker 1: anxiety states, they feel as if they're going to experience
Speaker 1: a loss, so they're either in the past or in
Speaker 1: the future. By having a mindfulness approach, you're helping them
Speaker 1: focus on the present moment, and in the present moment,
Speaker 1: there's no loss in the past or the future. They're
Speaker 1: just focusing on their breath, for example, or on their
Speaker 1: body sensations right now in this moment. So it has
Speaker 1: a natural antidepressant and anti anxiety effect. When you bring
Speaker 1: your attention to the present moment, which when you have
Speaker 1: ruminating thoughts is kind of hard to do because you
Speaker 1: come and it just keeps dragging you away. But it's
Speaker 1: the exercise of doing it. You have an exercise in
Speaker 1: the book I really liked, which is basically, you close
Speaker 1: your eyes and you put your finger up in front
Speaker 1: of you. Well, why don't you describe it? You use
Speaker 1: your finger as the indicator, close your eyes and focused
Speaker 1: on moving your finger to the left with each thought
Speaker 1: about the past that comes into your consciousness, or to
Speaker 1: the right with each thought about the future that comes
Speaker 1: into your consciousness and leaving its center. When you're just
Speaker 1: focused on the present moment, and you can begin to
Speaker 1: notice how much your finger moves towards the past or
Speaker 1: towards the future and stays out of that present focus,
Speaker 1: just becoming aware of Wow, I spend a lot of
Speaker 1: time focused on the past or I spent a lot
Speaker 1: of time worrying about what's going to happen in the future,
Speaker 1: and the idea is not to stop that, but just
Speaker 1: to bring your attention to noticing that. Like one woman
Speaker 1: who came into one of our mindfulness groups. By the
Speaker 1: end of it, she says, you know, when I came
Speaker 1: into the group, I was expecting I would get rid
Speaker 1: of all my anxious thoughts. She had a lot of
Speaker 1: anxiety coming in. She had three children. She worried about,
Speaker 1: you know, some disaster going to happen to them, Are
Speaker 1: they going to be abducted, were they going to go
Speaker 1: out driving and being an accident, or you know, some
Speaker 1: other kind of disaster. At the end of the eight
Speaker 1: weeks of the mindfulness training, she realized she was going
Speaker 1: to have just as many thoughts like that, but she
Speaker 1: didn't have to react to them so powerfully. She could
Speaker 1: really respond to them more skillfully. So, yes, it's not
Speaker 1: you're going to stamp out those thoughts. The thoughts emerge,
Speaker 1: but if you're able to say, ah, okay, there's a
Speaker 1: disaster thought again, you start to change your relationship to it.
Speaker 1: Instead of believing it to be true and feeling quite
Speaker 1: miserable you can say, oh, there is again. It's like
Speaker 1: the radio playing in the background. I have a radio
Speaker 1: that's tuned to one station. It's a disaster station, but
Speaker 1: I don't have to let it rule my wife. Yeah,
Speaker 1: it is helpful sometimes to think of it as a
Speaker 1: radio and put that voice in a funny announcer voice.
Speaker 1: Let's talk briefly about the role of resisting in our depression.
Speaker 1: You know, to what extent is resistance a problem and
Speaker 1: how do we work with that. Resistance can amplify the
Speaker 1: emotional pain that a person is having. In that sense,
Speaker 1: it increases the suffering. Because here's another equation that we have,
Speaker 1: and this is not a unique one that has been
Speaker 1: followed in Buddhist philosophy for many years. But pain times
Speaker 1: resistance equal suffering. So you may have a painful stimuli,
Speaker 1: but the amount of resistance you have can amplify or
Speaker 1: diminish the amount of suffering that takes place. So, for example,
Speaker 1: if you have a bear that walks in the woods
Speaker 1: and steps on a thorn and has painful stimuli in
Speaker 1: its paw, how does the bear respond to it. Well,
Speaker 1: it maybe responds quite differently than somebody who's in the
Speaker 1: middle of depression. The bear doesn't think, oh, how did
Speaker 1: this manifest itself in relationship to my mother? Why did?
Speaker 1: Why did I have this happen to me? I must
Speaker 1: be a bad bear to have this happen. You know,
Speaker 1: there's all kinds of things that a bear, as far
Speaker 1: as we know, wouldn't get into, whereas with humans we
Speaker 1: tend to add a lot of overlay to the situation.
Speaker 1: And with depression it's like if I was a better person,
Speaker 1: I wouldn't have this, or this means I'm a bad person,
Speaker 1: or some other kind of resistance to the idea, Well,
Speaker 1: I have some painful emotions today, but I don't have
Speaker 1: to resist them. I can just experience in them. It
Speaker 1: sounds a little odd because who wants to experience painful emotions?
Speaker 1: But oddly enough, if you stop resisting it, you may
Speaker 1: suffer quite a bit less. I like to think of
Speaker 1: depression as being like the weather. I think we may
Speaker 1: be talked about this before and use the word instead
Speaker 1: of depression, like I'm experiencing depression. I'd like to think
Speaker 1: of it as it's depressing out today. So like if
Speaker 1: you wake up and it's depressing out, may not be
Speaker 1: that pleasant. A situation, but just like it's raining out. Well,
Speaker 1: if I wanted to go on a picnic today and
Speaker 1: it's raining out, I can't do it. But if I
Speaker 1: respond skillfully, I can do other things. I can go
Speaker 1: to a museum, I can go bowling, I could do
Speaker 1: a lot of other things that don't involve being out
Speaker 1: in the rain. So it's responding to that situation. And
Speaker 1: the same thing. If you have a depressive state, you
Speaker 1: wake up when you're feeling depressed. If you start going
Speaker 1: into it like I'm a terrible person because I'm feeling
Speaker 1: depressed today, that's different than saying noticing I'm depressed today
Speaker 1: and it's like it's depressing out And instead of be
Speaker 1: rating myself, I could say, Okay, I have to take
Speaker 1: care of myself because I'm having depression today. But it
Speaker 1: doesn't mean I'm going to be depressed tomorrow. It doesn't
Speaker 1: mean it's going to be raining tomorrow. So I can
Speaker 1: have a different attitude about the depressive state. Yeah, I
Speaker 1: love that. I think that's such a good analogy. And
Speaker 1: I think there are two things, And then he said
Speaker 1: one was sort of the permanence piece. By realizing like
Speaker 1: this is not necessarily always going to be this way,
Speaker 1: you know. And I think that skillful response is so important.
Speaker 1: I often say to people, I just think one of
Speaker 1: the things that's happened to me over the years is
Speaker 1: I've gotten better at being depressed, which doesn't sound extremely hopeful,
Speaker 1: but it really is because my resp wants to it
Speaker 1: is so much more skillful that it really does minimize it,
Speaker 1: almost to the point of like what a rainy day is, like,
Speaker 1: oh it's a rainy day, Okay, not the end of
Speaker 1: the world. Like Okay, here's what I'm gonna do. Here's
Speaker 1: how I'm gonna adapt. It's such a different response versus
Speaker 1: oh my god, I'm depressed. What's the matter, everything's bad?
Speaker 1: You know. It's just a lot more like, Okay, here
Speaker 1: we are again, and I do what I know helps,
Speaker 1: and I take the preventative measures and the helpful measures,
Speaker 1: and then I relax. That's right. Instead of having it
Speaker 1: be a catastrophe, you can say, Okay, there it is again.
Speaker 1: You know, I'm gonna just ride with it. I'm going
Speaker 1: to ride on the surface of its surf the emotions,
Speaker 1: as they say, and uh not expect that it's going
Speaker 1: to be a forever thing. All of a sudden yep yep. Well,
Speaker 1: thank you so much Stewart for taking the time to
Speaker 1: come back on the show. I found this to be
Speaker 1: a really helpful discussion, and I think our listeners will too,
Speaker 1: So thank you so much for your time. Okay, thanks
Speaker 1: for having me. I appreciate it. Yeah, it's been a
Speaker 1: real pleasure. If what you just heard was helpful to you,
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