Improving Your Mood

Lawyers Assistance Program

Facilitated by Robert Bircher

Introduction

• In this course we will be using a workbook-”Your Depression Map” it is designed to be interactive-of course to be useful, the readings and projects each week must be completed

• “In order to change your life you need to change your life” this is a therapists maxim and relates to the fact that although most people want change; much of therapy is about overcoming peoples resistance to change

• About 50% of happiness is genetic,10% is circumstantial and 40% is due to intentional behavior

Introduction

• We are working on the 50% that can be changed, that is the way you live your life and the interpretations you put on them

• “Insanity is doing the same thing over and over and expecting a different result”

• The philosophy we have here is that you have the power to make a substantial difference in your moods-in one sense it is easy-what works is well known-in another sense it is not easy-changing thinking and behavior habits is difficult for everybody

Measurement

• Improving your mood is about changing your experience of your reality-after basic needs have been met it is difficult to imagine anything more important

• Measurement is important-we must track our progress quantitatively –we will use the Burns depression and anxiety inventories and the measurement scale on p.7 of the workbook

• Lets start by completing the exercise on p.6-what have you been missing due to low moods?

Measurement

• Another measurement is how you spend your time-start today with this-also rate how enjoyable is this activity?-if you spend most of your free time watching TV and it rates a 4/10-this is useful to know

• We will do about 2 chapters a week and will be going over your exercises in each class-the reading and exercises are 60% of the value of this course

Chapter One

• Chapter one deals with the various types of depression-most people we deal with have minor depression or a substance induced mood disorder-more serious cases are referred to a psychiatrist and medication is part of treatment

• Depression occurs about twice as often in lawyers as in the general population-sadly, mild or even moderate depression is very common in legal culture-a surprisingly large percentage of people in any given law office are on antidepressants

Chapter One

• In addition we have the cultural causes mentioned on p 22

• Depression may arise as a “nervous breakdown” which means the amount of stressors quickly exceeds ones ability to cope-or it can be a gradual wearing down until life becomes almost grey and dull

• Complete P27 –your depression history

Mythology

• Of all diseases depression probably has the most false information about it-even well educated lawyers or legal staff are often mislead by these myths

• The danger of these myths is that they delay or prevent people from doing what works

• In lawyers the most dangerous are “I just can’t cut it" (myth #6 and #7)“It is biochemical” (myth #2) “Its because of past traumas" (myth #7)

Mythology

• Another common idea is that it is entirely due to law or their legal career-although this can be partly true since law has great potential for triggering stress-many of these same people would also be stressed if they became parking lot attendants!!-only the stories would be different-some (or all) of your depression and anxiety has little or nothing to do with law or your legal career

• Fortunately law is a vast field with many potential careers of varying degrees of stress

• Exercise: Which myths are impacting you now??-Out yourself on page 37

Chapter 4-Depression is Multifaceted

• Depression is not just an emotional issue but involves thoughts, behavior and physiology

• Exercise P41-how do you make your own depression worse?

• What secondary gains are there for you in depression?

• Snowball effects:• Sleep disruption, poor diet, social

isolation, lack of exercise, inactivity-all make depression worse

Floating Diamond

• Your individual situation is unique• Behavior: How much of your day/week

/life is spent in compassionate or enjoyable experiences

• Thoughts: Is your stream of consciousness largely negative-“the sad story of me”

• Emotions: Are a result of the stories you tell yourself-accurate stories will result in healthy emotions

• Physiology: How does your body react to depression?

Floating Diamond

• History: Your upbringing and past contribute to the stories you tell yourself-you can’t change what has happened but you have absolute control over your own interpretation of it-for most people revising their history is essential for there own happiness

• Biology: You can’t change your age, gender or genetics but you can be aware of how these impact your life

Floating Diamond

• Situation: We are all part of an interconnected community-we can, however, control how much and how often we are exposed to psychotoxic people, environments and circumstances-although none of these create our depression they can make it very difficult to deal with

• Social: A good social environment is critical to happiness-also a healthy and loving primary relationship has a profound positive impact-a bad relationship has the opposite effect

• Meaning: The spiritual side-creation of meaning is critical

Your Situation

• Complete page 52-what are the top 5 precipitating events that create your present mood?

• Taking stock: chapter 4(pages 54-65) is critical-this is self diagnosis-you must complete this section to proceed with this course

• P 65 identify your top 5 symptoms• The remedies are named after the

symptom ie if inactivity is a problem the solutions are discussed in 9-1(chapter 9 first strategy)

• Homework: Identify your solutions for your top 5 symptoms

• P 66 Identify what already works

Chapter 5

• How did I wind up depressed?• Vulnerability factors-trauma from the

past-age-gender-genetics-some of these can be minimized through therapy, some cannot be changed

• For the unchangeables having a depression resistant lifestyle is the best defense-keeping fit, making fun a high priority-and avoiding high pressured occupations

• For some lawyers this means doing a low stress type of law or going into quasi-legal types of jobs (policy analyst)

Depression Triggers

• Often a depression will be kicked off by negative life event-a divorce or relationship breakdown, serious work problems like getting fired or problems with the law society, death of a person or pet, serious illness in yourself or a partner, addictions etc.

• Page 52 has a list and your particulars triggers will show up there

Maintaining Factors

• Once started a depression takes on a life of its own-ie the lack of interest in doing things, keeping fit, avoiding fun events, being reclusive, bad sleep hygiene etc.

• Anti-depressogenic factors include-good childhood, lots of social support, reducing stressors in your life (which can include a job change or changes in relationships such as eliminating depressogenic people in your life)

• Bullet proof self care includes good diet, regular supportive social contact, bright light, exercise (any body movement at all is good-you don’t need to do a marathon or hire a personal trainer)-doing meditation or having a spiritual practice of some kind

• Do the exercise on p72-your risk factors

Chapter 6

• Physiological causes of depression• Having a serious medical problem often has

depression associated with it• Prescription drugs can have a side effect of

depression• Alcohol is a depressogenic substance

combined with the fact that abuse of it creates many depression triggers-even ordinary use of alcohol enhances depression due to sleep disturbances, isolation weight gain, promotion of inactivity etc

• Self medication with alcohol to deal with depression is like pouring gas on a fire you are trying to put out

• Illegal drugs are also depressogenic and create depression-rather than the other way around

Physiology

• If you depressed or prone to depression alcohol and many drugs will make the problem worse-notwithstanding the popular belief that these are a symptom of depression

• Caffeine can be a problem for people that are prone to anxiety-some lawyers are hard core caffeine addicts which increases anxiety or causes sleep disruption

• If you want to quit any drug but can’t-you know what to do –call the LAP!!! we have excellent addiction counselors

Sleep Disruption

• Poor sleeping habits are a major cause or a factor in maintenance of mood problems and are often underestimated-studies show that symptoms of depression or anxiety or even insanity can be easily and quickly created with sleep deprivation alone!!

• With lawyers it can be due to poor sleep hygiene-drinking or smoking before bed, watching negative newscasts etc-see p167 for good sleep hygiene-some problems are easy to fix (not drinking coffee before bed- others are more difficult-ie obsessing or worrying)

• What are your physiological depression factors?

Goal Setting That Works! C-9

• Depression is the universe asking you to make changes in your life

• These changes are unique to each person, although some are so common they are almost universal-exercise

• It is not what you are able to do-it is what you are willing to do

• Changes must be relevant, easy and behavioral

Basic Goal Setting

• There are ultimate goals-I want to be able to run a marathon and immediate goals-I will start by walking around the block

• You are far better to focus on small achievable steps rather than focusing on the ultimate goal-in this way you set things up to win

• Being overly optimistic is a mistake-goals should be tangible, measurable and easily achievable

“Your reach should exceed your grasp”

• This is a disastrous belief-it almost guarantees failure

• For lawyers trying too hard is usually the problem-when combined with perfectionism nothing ever gets started

• Another common mistake is waiting until desire returns-when you are depressed it wont!-you must act first then desire will return

“If you want to change you life you need to change your

life”• The challenge of every therapist is

not finding a solution to peoples problems-that is usually very easy-it is convincing people they can change their life

• Most people use 98% of their energy in proving to themselves (and anyone who will listen) no change is possible or desirable

• P-129-what changes could you make?

Problem Solving

• Take a problem and make a goal out of it- “I would like to go out with friends twice a week”

• Subdivide this into components• Create options • Pick one option you are likely to

follow through on• Test; Is it easy? Does it help solve

the problem? Is it tangible and measurable?

• Make a plan-P 135

Goal Setting Traps

• Trying to do too much• Discouragement after a few steps• Not acknowledging small successes• Perfectionistic goal setting• Good slogans- “If it ain’t easy its

impossible”• Set yourself up to win at every turn-a good

definition of success is “Being in the process of doing that which is most important to me” this means you are winning in life any time you are taking a step towards your goals

• See page 137 –the best metaphor is a staircase-you climb Mount Everest one step at a time-each step is a win-not just when you reach the top

Hiring HelpC-10

• You don’t need to face depression alone-you can create a team

• In most cases help means someone you are paying to see-not friends or relatives

• Well intentioned friends or relatives may or may not be helpful-some may make things worse “ just look at the bright side of things” “ you think you have it bad –let me tell you….” “all you need is a positive outlook” this is useless or worse than useless advice

Helping Teams

• These teams may include your GP, the LAP counselors, psychologists, psychiatrists therapists, career counselors etc

• Self help groups can be useful• Self help books work for some

people• Exercise-design a helping team of

people that are already helping or could be helpers

Psychotherapy and Depression

• CBT-Cognitive Behavioral Therapy-well researched and very effective-we use this a lot at the LAP

• This involves changing the internal stories you tell yourself about your life

• This form of therapy has been shown to be at least as effective as drugs-both can be used at the same time and can be even more effective than either alone

Types of Therapies

• Trauma based therapy-many people who are depressed have a history of trauma

• This therapy is designed to reduce the impact of past trauma (ie sexual abuse) and can be effective if the internal narrative of the story is minimized as an impact on your life

• It can be dangerous in some cases ie telling of past trauma over and over can make it worse, also it can be used as an excuse for not making necessary behavior changes- “I can’t be successful now because I was abused and traumatized as a child”

Types of Therapies

• History based (psychodynamic and Freudian approaches)

• Based on the idea our past contributes to our present situation-understanding the past may help to deal with the present-understanding old family rules is useful (always like your relatives) as is restructuring internal narratives

• Problems are that research shows limited effectiveness and they can be time consuming and expensive-insight alone is of little use

Types of Therapies

• Couples therapy-most couples can use this from time to time or on a regular bases-the chances of a poor relationship curing itself without outside help is remote-a bad relationship is a major stressor

• Problems are that many couples wait until it is too late to save the relationship and it becomes separation counseling

Types of Therapies

• Creative Therapies art therapy, dance therapy, music therapy etc can be useful. They tend to be non cognitive- which is very useful for “over thinkers” you can’t figure them out which is useful

• Should not be the only therapy you use-best as an adjunct

• I would include body work type therapies and acupuncture here as well-very effective for highly educated (in your head) type people

Psychotherapy

• Interpersonal Psychotherapy-this is about managing relationship situations in a positive way

• This involves dealing with bereavement, conflicts, role changes and problems establishing or maintaining relationships

Changing BehaviorsC 12

• In order to change your life you need to make changes-this is so simple it is often forgotten

• Many people come to therapy in order to make changes but most of the therapy is about overcoming resistance to making the very changes that would actually make a difference in their lives

• All of the changes in C12 are easy and simple-if they are applied

Healthy Diet

• One of the first things to go in depression is diet-some people overeat comfort foods, others starve themselves

• Changing your diet is simple and effective-if you are overweight the positive effects will be immediate if you lose weight

• Getting help-joining a group ie weight watchers is often helpful-the emphasis is on what works for you

Physical Exercise

• A huge body of research confirms that moving your body helps your mood- a lot-in some cases as much or more than any antidepressant drugs

• I say to people who tend to become anxious “exercise for most people is a good idea-for you, however it is a necessity”

• I recommend 1 hour a day, and for lawyers breaking up the day at noon for a workout, run or yoga is perfect

Move your Body

• Do whatever you like to do-anything that involves manufacturing discipline won’t work for long

• I find non competitive, restorative exercise is the easiest to do ie dancing, swimming, running etc.-I quit golf because it triggered self criticism and fostered competitiveness among friends

Sleep on It

• One of the most overlooked causes of stress and depression is poor sleep habits

• Sleep deprivation has very serious consequences and is severely impairs cognition

• Practice good sleep hygiene-see p 167-alcohol and pot and many sleeping medications create short term relaxation but impair depth of sleep

• Many people don’t sleep well simply because they aren’t physically active during the day

Light and Caffeine

• Lots of lawyers are caffeine over users and this increases anxiety and disrupts sleep-2 cups a day are my max

• Some people are strongly affected by darkness in the winter especially here in Vancouver-SADS is quite common here

• Light therapy is sometimes effective, some people need to take holidays to a sunny place in the winter

Drugs and Alcohol

• Short term gain for long term dire straights

• Any problems you have will be made worse by drugs and alcohol-alcohol is depressogenic agent-not what you need if you are depressed

• LAP has some of the best drug and alcohol counselors in BC-if this is a problem contact them

Having Fun

• Paradoxically the most serious error you can make around depression is avoiding fun!!

• The Puritan work ethic is highly prized among lawyers-this usually means fun is a very low priority-only after all conceivable work of every nature and kind is done-then I will have time to play

• Putting things you enjoy doing as priority 1 when you are down is a great plan

Having Fun

• Problem is that when you are depressed you don’t feel like doing much-do it then feel like it is a mantra to follow

• You can create depression in the most mentally healthy person by doing what depressed people do (do very little, cut out social contact, give up fun etc)

• Fun needs to be priority one!!

Medications

• This an area of great controversy and everyone seems to have a strong point of view about it

• Few people want to rely on drugs and more people seem to resist them rather than embrace them

• Page 182 recent research indicates that the high rate of ineffectiveness can be improved by changing doses or anti-depressant meds

Medications

• My experience is that they can be very effective for some people-also they may be necessary for some people to buy time and energy to make changes

• The biggest problems I see are people who rely on the meds to cure their depression without making other critically important changes in their life-the other problem are those where it doesn’t work but they don’t change their dose or type of med-they stay on them out of fear it would get worse if they stopped

• Putting a pillow over the fire alarm is never very effective-(but it beats facing a major life change like a major career shift or relationship change)

Changing “Reality”C-14

• This chapter is about changing your internal story of the world

• None of us live in “reality” we live in a world created by our mental construction of it, which, depending on our life history, can be somewhat accurate in some areas and totally inaccurate in other areas

• Our opinions and judgments about the world can be extremely inaccurate whem we are depressed

Don’t like your reality?Think of a new one!!

• CBT Cognitive Behavioral Therapy has been shown to reduce depression and prevent relapse

• Depressed people create a nightmare world that often bears little relationship to reality

• A friend fails to show up for a scheduled lunch-you will likely go into many explanations in your mind before the actual reason is known-she may have forgotten (I am obviously not very important to her) or (she is such a scatterbrain)

“Changing Life Stories”

• Thinking is an endless dialogue or monologue in our minds-a narrative or story about the world-it seems real but it is more useful to think of it as a fiction with a basis in reality (we are not speaking of factual thinking-today is Wednesday is a fact and it is useful to believe it)

• Depressing stories are filled with automatic thoughts-see page 193 downward spiraling thinking

• Interpretation changing-take an event in your life and spin the story in several ways-as a Walt Disney script “X happened which was bad but I got a valuable lesson out of it” or as a mystery “X happened which was bad but it set a chain of events that had a positive outcome”

Common beliefs that are deadly

• See page 195-these are commonly held beliefs that cause more problems than they solve

• Common one for lawyers- “in order for something to be good or valuable it must be difficult or hard”-if you follow this you will end up with a joyless difficult life-you will avoid what is easy or natural

• “My image is critically important”-your image is a fantasy in your mind as it is in others-you will live your life worrying about what everyone thinks about you-this is insane -no one is thinking about you!!

General Distortions

• See p -197-what are your core distortions

• P-198 –the most common cognitive distortions-lets try a mood log with a recurring negative belief “I lost my job and can’t find another, therefore I am a loser”

• Many people are great at catastrophizing -getting frustrated solving non existent future problems

Two Worlds

• Broadly speaking your “reality” can be in one of two worlds the world of “what is” and the “world of what should be”

• In the world of what should be I should have a full head of hair-in the world of what is I don’t-I can choose to make a problem about that if I want or I can accept what is-accepting doesn't mean I can’t or won’t do anything about it –it just means I start with what is in a non judgmental way

“Should-A dirty word

• One of the counselors here has young children and has a “should” jar-if you say “should” you have to put a dollar in it-to teach his children this concept

• Shoulds are very destructive to self esteem

• When directed towards ourselves they cause guilt and pressure, towards others they cause anger and resentment and generally create misery wherever they appear

• “It should be sunny today”

Dealing with Shoulds

• Replace with I chose to or I chose not to

• Release others from your shoulds-assume nothing or be assertive “ my girlfriend should know I like my coffee with sugar”

• Perfectionism is a deadly life denying neurosis- not an attribute!!

• See my article on various forms of perfectionism

Repetitive Obsessing

• Worrying is spinning a negative story over and over-it is repetitive ,negative and useless-it achieves nothing yet is enormously energy consuming

• I find the most useful antidote is releasing your attachment to the idea the worrying is useful or meaningful-At some level you believe you can solve problems with worry-few decisions require more than a few seconds of thinking

Cognitive Impairment and Decision making

• When depressed your memory will be affected as will your decision making-see page 210 -211 for ideas – some Lawyers need to stop practicing since these are dangerous problems in a law practice

Your Social Network

• Social isolation is both a symptom and cause of depression

• Often people isolate themselves when they are depressed

• What is your social network?-lets do a written sociogram P-249

• This is your actual social network-what is your ideal one? This will be different for everybody, large volume is at the price of depth

• Shrinkage occurs all the time as people move or change jobs-depression itself often creates shrinkage

Social Networking as an Antidepressant

• Not everybody needs to be a close intimate friend-some contacts are destined to be narrow but still valuable-my dance friends

• Creating and maintaining friendships is an art, some people, especially men over 35 have great difficulty with it

• Regular contact is important for maintaining friendships

• Friendships that are healthy and nurturing are very valuable to mental health

Building your Social Network

• What could you do to improve your friendships? P-252 exercise

• Reviving old friendships is a good idea• Creating new friendships-joining

clubs ,groups and organizations that you enjoy will almost automatically increase friendships

• Avoid one way relationships-that is those that you do all the work and make all or initiate most of the contact

• Avoid “should” relationships ie certain relatives or business contacts

• Test 1- Do you feel bigger and better about yourself in their presence?

• Test 2-Do they light up when they see you and have no plans for your improvement?

Being Assertive

• Being assertive helps in enjoying life and building social networks

• Some people think to get away from being passive is to be aggressive-this actually makes it worse

• Both passive and aggressive people are afraid of intimacy and contact-they just defend themselves in different ways

Assertiveness

• Being assertive is the solution to going from one extreme to the other

• Do the exercises on p-269 where have you been too passive or too aggressive or assertive

Romance and Depression

• Depression usually creates havoc in primary relationships

• During depression it is wise to not attempt to initiate such relationships if you are single

• If you are in a primary relationship there is some great advice in this section-it doesn’t mean the relationship is doomed-it is a bad time to make long term decisions about the relationship

Meaning in Life

• In depression a lack of hope is common and usually improves, but a lack of a sense of meaning can be deadly-this is a sense of utter pointlessness-my life is irrelevant

• Another problem is that this can prevent any useful treatment or change-why set goals,diet,exercise,join clubs or groups-you say “what is the point?” And then you do nothing to help yourself-thus perpetuating the depression

Meaning Exercise

• What were your answers to the meaning inventory P 268

• Knowing your values is very helpful• Avoid the temptation to minimize what

seem to be unimportant goals in the eyes of the world-ie helping my grandmother or being a good dog owner-I call this the “Nobel Peace Prize” syndrome-My meaning is so trivial it is worthless in the eyes of the world

• Almost all crises contain a great learning, if you allow yourself to discover it and then move on

Growth Requires Suffering

• Cognitive learning you can do in school and is fairly easy

• Personal and spiritual growth requires life experiences and paradoxically, usually the more the suffering the better the lesson.

• Some people manage to learn nothing in exchange for all the suffering-a bad deal-this occurs when you blame others, your situation or the world for your problems and ignore your role in it-interestingly, blaming yourself is equally pontless

Say Yes to (productive) Suffering

• Suffering is necessary for growth but most suffering is unproductive-it is endless criticism or “coulda woulda shouda”

• In most situations the lessons are not complicated-ie in a divorce a few sessions with a good therapist are usually all you need to discover what your role was-hint- if you blame your spouse your are resisting the learning and prolonging the suffering

Spiritual Paths

• A healthy life philosophy is very helpful and if it works can end depression

• It doesn’t matter which form as long as it creates peace for you

• I like Zen and the Philosophy of Eckhart Tolle-these are eastern approaches and involve watching your mind rather than being a prisoner of it-very compatable with CBT

• Many people in recovery from addictions are transformed by the 12 step process-this is a western Christian approach

• Exercise on p 279 –imagine you are writing your own eulogy after your death –what will it say?

Depression Prevention

• Unfortunately, depression has a bad habit of paying another visit unless preventative measures are taken

• This a problem if the first depression was mild, some people just soldier on but don’t make substantial changes, they didn’t suffer enough

• Planning for excellent self care is the ultimate prevention-I sometimes say to clients “what would you do now if your mental health was priority one in your life?”

Depression Prevention

• Don’t take on too much-set boundaries around new stressors

• See other strategies on P 283• The big one is to make the

changes you need to make-changing jobs, changing relationships, changing lifestyle, changing life philosophies-in many cases the depression is a sign that you need to make changes in your life

Depression Prevention

• You can plan in advance what you need to do on P-289 if you have a relapse

• If you make changes and live a different life you will have a different result

• You can’t beat depression by thinking about it-the distorted thinking itself is the problem-changing any or all of the dimensions is the solution