Dear Dr. Yael:
I am a man in my 50s who, Baruch Hashem, has had a good life. I am married with children and grandchildren and was always a happy-go-lucky person, thankful for all the berachot bestowed on me.
This year, though, has been very difficult for me, with many family and personal problems. I have begun to experience something that I have never really had before: depression. Out of nowhere I begin to feel upset and anxious, and I do not know what to do to get rid of these feelings. I have never been a negative or sad person and I don’t know how to return to my old self. I try to think more positively but my mind always starts to find the negative aspects, and it often snowballs and makes me feel more and more depressed. I do not know how to get out of this cycle or how to be more upbeat. I do not want to feel this way, yet find myself returning to depressing thoughts more and more. Please help!
Without having a chance to sit and meet with you, it is hard to say exactly what your issue is. However, it is possible that you are experiencing either an adjustment disorder with depressed and anxious mood or feeling some dysphoria. Both of these disorders can be similarly treated. Your thoughts seem to negatively impact the way you feel and this in turn makes you think more negatively – and subsequently you feel worse. As you noted, it is a difficult cycle to end. The most important thing to do now is to go for professional help before you get worse. Here are some ideas I believe will be helpful:
One helpful Cognitive-Behavioral Strategy is to restructure your thoughts. In order to do this, you must ask yourself questions. For example, what’s the argument for and against a particular thought? What would I tell a friend in the same situation? Is there any way to look at this positively? Is thinking about this helping me or making the situation worse?
Try to rationally think about the truth. Chances are that you are having cognitive distortions that make you overgeneralize, thus painting a limited occurrence with a broad brush (e.g., believing that if just one problem arises, your life then becomes problematic or terrible). You might also be personalizing things, like when someone ascribes an external event to himself when there is, in reality, no connection between the person and the event. (An example of this is when a stranger or aquaintance is rude to you and you incorrectly conclude that you must have done something to cause the person’s rudeness.)
Another possibility is that you are making arbitrary inferences, creating – with no supporting information – a not necessarily correct conclusion (not necessarily the right one) in a certain situation. An example of this is when – despite no actual information to support his or her belief – a person believes that someone either does not like him or her or that the person believes him or her to be a horrible person. All of these cognitive distortions are untrue and unhealthy because it causes the one with this condition to have a negative self-view.
In therapy the first thing a client will learn is how to identify these problematic thoughts which in addition to increasing depression and anxiety, also reduce a person’s ability to cope with his or her environment. If you are theoretically able to identify when you are doing this and are then able to replace these thoughts with a more realistic view, you will begin to feel better.
The next step is for you to practice replacing these negative thoughts. Some therapists ask their clients to write down specific thoughts, when they took place and how he or she felt at that time. Then they are asked to think of a replacement thought that is more realistic to the situation and to rate how that thought would make them feel. It starts out as an exercise, but hopefully over time you will begin second-guessing these negative distortions and replacing them with more positive, realistic thoughts that engender more positive feelings. It is never helpful for anyone to think negatively, even if a situation is not a positive one.
Human beings need to find the best part of each situation and turn whatever negatives there may be into a positive. Then join the former negative with the best part of the situation. For instance a negative, distorted thought would be, “I yelled at my wife yesterday, making me a horrible husband. Now, she may want to divorce me and I will never be happy again.” A replacement thought would be, “I made a mistake yesterday, but everyone sometimes does that. I do not usually yell at my wife and I try to speak nicely. I will apologize and try to control my anger next time. My wife loves me and will not leave me because I got angry and yelled at her.”
Regarding your anxiety, you can try using the aforementioned skills while adding some relaxation techniques to the mix. Deeply breathe in through your nose, hold it for a few seconds, and then release your breath slowly through your mouth. You will immediately feel less tense. Using relaxation imagery (imagining yourself in a calm place or situation) and muscle relaxation (calmly telling each of your body parts to relax) are also very helpful.
Having a safe place where you can express your feelings and experiences will help you get through this trying period. If you are still unhappy with the first therapist you go to, please do not give up on the idea of therapy. After all, you must feel comfortable and safe with your therapist because he or she will ask you to do things that make you feel uncomfortable, namely thinking about your negative/anxiety thoughts and replacing them with positive, calming thoughts. You need to fully trust your therapist in order to accomplish your ultimate goals of calmness and happiness. So please remember that if the initial professional does not work for you, find someone who is a better fit for your needs.
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