New Tool for Depression – Focus on Positive Future Expectations

For years, I’ve been teaching clients simple frameworks to manage the emotional mind. These frameworks have to be accessible within 1/3rd of a second, before the emotional mind hijacks the rational mind.

A powerful example of this is the framework developed by Phillip Zimbardo at Stanford regarding time perspectives and valence, which is a fancy way of saying that our attention can take you certain places – internal (e.g., monitoring your heart rate, your thoughts) or external (e.g., the room you are in, the people you are with); past, present or future; and/or positive or negative emphasis.

From Ken Pope’s excellent newsletter…

*CNS Neuroscience & Therapeutics* has scheduled an article for publication in a future issue: “Treating Major Depression by Creating Positive Expectations for the Future: A Pilot Study for the Effectiveness of Future-Directed Therapy (FDT) on Symptom Severity and Quality of Life.”

The authors are Jennice S. Vilhauer, Sabrina Young, Chanel Kealoha, Josefine Borrmann, Waguih W. IsHak, Mark H. Rapaport, Narineh Hartoonian, & Jim Mirocha.

Here’s the abstract:

[begin excerpt]

Introduction: This nonrandomized pilot study assesses the efficacy of a new future-oriented form of therapy, known as future-directed therapy (FDT), as a treatment for patients with Major Depressive Disorder (MDD) in a naturalistic hospital-based outpatient psychiatry clinic. The study measured symptom severity of depression and anxiety, in addition to quality of life pre- and posttreatment.

Aims: The study examined a new manualized treatment designed to help people anticipate a more positive future. The intervention consists of twenty 90-min group sessions administered twice a week over 10 weeks. The intervention was compared to depressed patients in the same clinic who enrolled in traditional cognitive-based group psychotherapy. Sixteen patients with MDD completed the FDT intervention as part of their outpatient treatment for depression. Seventeen patients with MDD participated in treatment as usual (TAU) cognitive-based group therapy. The Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality-of-Life Enjoyment and Satisfaction Questionnaire short form, self-report instruments were administered prior to and immediately after the completion of therapy.

Results: Patients treated with FDT demonstrated significant improvements in depression (P= 0.001), anxiety (P= 0.021) and quality of life (P= 0.035), and also reported high satisfaction with the therapy. Compared to the TAU group, patients treated with FDT showed greater improvements in depressive symptoms (P= 0.049).

Conclusions: FDT may have the potential of becoming an additional treatment option for patients with MDD.

[end excerpt]

On the Cedars-Sinai (where the research was conducted) web site there was the following additional information:

[begin Cedars-Sinai info]

Patients with major depression do better by learning to create a more positive outlook about the future, rather than by focusing on negative thoughts about their past experiences, researchers at Cedars-Sinai say after developing a new treatment that helps patients do this.

While Major Depressive Disorder patients traditionally undergo cognitive-behavior therapy care that seeks to alter their irrational, negative thoughts about past experiences, patients who were treated with the newly-developed Future-Directed Therapy(TM) demonstrated significant improvement in depression and anxiety, as well as improvement in overall reported quality of life, the researchers found.

Results were published recently in the peer-reviewed journal CNS Neuroscience & Therapeutics.

“Recent imaging studies show that depressed patients have reduced functioning in the regions of the brain responsible for optimism,” said Jennice Vilhauer, PhD, study author and clinical director of Adult Outpatient Programs for the Cedars-Sinai Department of Psychiatry and Behavioral Neurosciences. “Also, people with depression tend to have fewer skills to help them develop a better future. They have less ability to set goals, problem solve or plan for future events.”

According to the U.S. Centers for Disease Control and Prevention, an estimated one in 10 American adults meet the diagnostic criteria for depression.

Anand Pandya, MD, interim chair of Cedars-Sinai’s Department of Psychiatry and Behavioral Neurosciences, said, “Future-Directed Therapy is designed to reduce depression by teaching people the skills they need to think more positively about the future and take the action required to create positive future experiences.  This is the first study that demonstrates this intervention intended to increase positive expectations about the future can reduce symptoms of Major Depressive Disorder.”

Depression in Men depressed guys

When people talk only about the negative aspects of their lives, it causes them to focus more attention on what makes them unhappy, Vilhauer said.

“Talking about what makes you unhappy in life doesn’t generate the necessary thinking patterns or action needed to promote a state of thriving and create a more positive future,” Vilhauer said.  “Future-Directed Therapy helps people shift their attention constructing visions of what they want more of in the future and it helps them develop the skills that they will need to eventually get there.”

In the study conducted at Cedars-Sinai, 16 adult patients diagnosed with Major Depressive Disorder attended future-directed group therapy sessions led by a licensed psychologist twice a week for 10 weeks.  Each week, patients read a chapter from a Future-Directed Therapy manual and completed worksheets aimed at improving certain skills, such as goal-setting.  Another group of 17 patients diagnosed with depression underwent standard cognitive group therapy. The study team measured the severity of depression and anxiety symptoms, and quality of life before and after treatment, using the Quick Inventory of Depressive Symptoms, the Beck Anxiety Inventory, and the Quality-of-Life Enjoyment and Satisfaction Questionnaire short form.

Results include:

Patients in the Future-Directed Therapy group experienced on average a 5.4 point reduction in their depressive symptoms on the Quick Inventory of Depressive Symptoms scale, compared to a two point reduction in the cognitive therapy group.

Patients in the Future-Directed Therapy group on average reported a 5.4 point reduction in anxiety symptoms on the Beck Anxiety Inventory, compared to a reduction of 1.7 points in the cognitive therapy group.

Patients in the Future-Directed Therapy group reported on average an 8.4 point improvement in their self-reported quality of life on the Quality of Life Enjoyment and Satisfaction scale, compared to a 1.2 point improvement in the cognitive therapy group.

[end Cedars-Sinai info]

The author note provides the following contact information: Jennice Vilhauer, Ph.D., Cedars-Sinai Medical Center, Department of Psychiatry and Behavioral Neurosciences, 8730 W. Alden Drive, Thalians W-101, Los Angeles, CA, USA. Tel.: +(310) 423-2620; Fax: +(310) 423-0114; E-mail:

<vilhauerj@cshs.org>.

Are You Rational When It Comes to Money?

I just read a great blog post by Ben Hayden on Psychology Today. I tried leaving a comment but was enable to due to website difficulties. Instead I’ve reprinted the post here with my comment below. Click on the article title below to go to the original blog post on Psychology Today…

The Decision Tree

Decision-making from all perspectives.

by Ben Hayden, Ph.D., is an Assistant Professor of Brain and Cognitive Sciences at the University of Rochester.

Are you rational?

What do economists mean by rational and irrational?

Published on June 26, 2011 by Ben Y. Hayden, Ph.D. in The Decision Tree

My last post raised a lot of questions about rationality. Rather than reply to them individually, I decided to devote this column to the topic.

I talk to the public a lot about economic discoveries that violate assumptions of rationality. And one thing that always surprises me is just how pleased people are to hear about these violations of rationality. Gleeful even. Relieved to not be the only dummy out there.

It’s surprising that people are so excited because, when it comes to economics, violations of rationality are pretty darn recondite.

An economically rational individual is someone whose preferences obey certain formal rules that insulate them from economists’ bugbear: intransitive preferences. Intransitive preferences means I prefer an apple to an orange, an orange to a pear, and a pear to an apple. This pattern of preferences is distressing to economists because some opportunistic evildoer could come along and offer to trade me an apple for my orange plus a small fee, and then offer me a pear for that same apple plus an additional fee, and then offer me an orange for the pear plus another small fee. Then that evildoer winds up with a free lunch from me. And there’s nothing economists hate more than a free lunch. (Economists would say that this evildoer has turned me into a ‘money pump’).

Bottom of Form

But the real reason this bothers economists goes much deeper than their annoying perennial reminders about free lunches. In the early 20th century, economics struggled to establish itself as a formal and rigorous science. Economists craved respect. (Anyone who has heard economics called the dismal science knows it’s been an uphill battle). Many brilliant economists built the field a solid foundation that was axiomatic – based on a few simple and obvious rules – the same way Euclid did with geometry and Peano did with arithmetic. And to make these axioms, economists had to come up with an economist’s equivalent of mathematically true and false. And they chose the terms rational and irrational.

Aristotle and Plato

Aristotle and Plato Discussing Reason and Emotion

These words were not intended to describe what people do. Humans are not robots; most (but not all) economists know that. Even if we were, our brains are finite. We have to take mental shortcuts. We are approximately rational and even that only sometimes. We economic psychologists love the phase ‘bounded rationality’.

Economics 101 is one of the most popular undergraduate courses in the United States, and it often gives rationality a central place. But we all have money anxieties, so we are predisposed to hear personal judgment coming from our economics professors. Every year, a new crop of students thinks their teachers are criticizing them about how they manage their personal finances.

But that’s not it at all.

Violations of rationality are nothing to be ashamed of. They are like optical illusions in vision: they are universal and they provide clues to how the visual system works. We study irrationality because it gives us essential clues to help us learn how the brain makes economic decisions. And we do that because it leads us to solutions for the real irrationalities: depression, addiction, schizophrenia, and so on.

Invite your local economists to the bar, buy them a round of beer and ask them about it. They’ll admit (in my experience, cheerfully) that when they go to the store, they make the exact same mistakes as the rest of us do. Because we are all human. We are all irrational.

          Ben

 ——————————————————-

Dear Ben:

Thanks for the insightful blog post! I have this difficulty with clients frequently – they want to believe the illusion that they are primarily, if not solely, rational individuals. This would be great if it were so, but as you point out, it’s not the case. And I find individuals vary on a spectrum as to how much of the time they spend being rational vs. emotional. My challenge, for years, has been to decipher how to become aware of and train the emotional mind.

 

Different emotions can increase or decrease our rationality, reasoning and focus. Anger, for example, makes us more focused and rational – to a point. Think of anger on a 1 through 10 scale with 1 being calm and 10 be enraged.  Anger can  be useful below a 5. Once you go above a 5, the emotional mind is in charge, rationality goes out the window and we become atavistic and primal.

 

Thank you for pointing out our ubiquitous illusion of rationality.

Best regards,

John L. Schinnerer, Ph.D.

Founder Guide to Self

Award-winning author, blogger and anger management coach

For a free copy of John’s award-winning book on reason and emotion, visit GuideToSelf.com, click on the yellow book icon and enter your name and email.

The Battle Going on In Your Mind – Automatic Vs. Conscious Minds

There is a battle going on in your mind. There are two factions in your mind. Sometimes these two get along and sometimes they are in conflict. At times, the two cooperate. At times, they act in direct opposition to one another.

The two factions are your rational, thinking mind and your automatic, emotional, subconscious mind. Here is the latest study to examine the differences between the two sides…

ScienceDaily (Nov. 8, 2010) — Expert typists are able to zoom across the keyboard without ever thinking about which fingers are pressing the keys. New research from Vanderbilt University reveals that this skill is managed by an autopilot, one that is able to catch errors that can fool our conscious brain.

The research was published in the Oct. 29 issue of Science.

“We all know we do some things on autopilot, from walking to doing familiar tasks like making coffee and, in this study, typing. What we don’t know as scientists is how people are able to control their autopilots,” Gordon Logan, Centennial Professor of Psychology and lead author of the new research, said. “The remarkable thing we found is that these processes are disassociated. The hands know when the hands make an error, even when the mind does not.”

For  a free PDF copy of the award-winning book Guide To Self: The Beginner’s Guide to  Managing Emotion and Thought, visit http://www.GuideToSelf.com and enter your name and email address. This book outlines the latest proven tools for optimal human functioning – tools to manage your negative emotions (anger, anxiety, sadness and stress) and turn up the volume on your positive emotions (gratitude, curiosity, awe, love,  joy, pride, hope, happiness and passion). It also helps you become more aware of your automatic mind and the shortcuts it takes without your consent.

To determine the relationship between the autopilot and the conscious brain, or pilot, and the role of each in detecting errors, Logan and co-author Matthew Crump designed a series of experiments to break the normal connection between what we see on the screen and what our fingers feel as they type.

In the first experiment, Logan and Crump had skilled typists type in words that appeared on the screen and then report whether or not they had made any errors. Using a computer program they created, the researchers either randomly inserted errors that the user had not made or corrected errors the user had made. They also timed the typists’ typing speed, looking for the slowdown that is known to occur when one hits the wrong key. They then asked the typists to evaluate their overall performance.

The researchers found the typists generally took the blame for the errors the program had inserted and took the credit for mistakes the computer had corrected. They were fooled by the program. However, their fingers, as managed by the autopilot, were not — the typists slowed down when they actually made an error, as expected, and did not slow down when a false error appeared on the screen.

In two additional experiments, the researchers set out to probe awareness more deeply. In the second experiment, they had the typists immediately judge their performance after typing each word. In the third, they told typists that the computer might insert or correct errors and again asked them to report on their performance.

The typists still took credit for corrected errors and blame for false errors in the second experiment, and still slowed down after real errors but not after false ones. In the third experiment, the typists were fairly accurate in detecting when the computer inserted an error, but still tended to take credit for corrections the computer had made. As with the other two experiments, the typists slowed down after real but not after false errors.

The research is the first to offer evidence of the different and separate roles of conscious and unconscious processing in detecting errors.

“This suggests that error detection can occur on a voluntary and involuntary basis,” Crump, a postdoctoral fellow in psychology, said. “An important feature of our research is to show that people can compensate for their mistakes even when they are not aware of their errors. And, we have developed a new research tool that allows us to separately investigate the role of awareness in error detection, and the role of more automatic processes involved in error detection. The tool will also allow a better understanding of how these different processes work together.”

The research was supported with funding from the National Science Foundation.

1. Gordon D. Logan, and Matthew J. C. Crump. Cognitive Illusions of Authorship Reveal Hierarchical Error Detection in Skilled Typists. Science, 29 October 2010: Vol. 330. no. 6004, pp. 683 – 686 DOI: 10.1126/science.1190483

To life, love and laughter,

John Schinnerer Ph.D.

Founder Guide to Self, Inc.

http://www.GuideToSelf.com

FREE Copy of the Best Self Help Book of the Year!

I’m kicking off the launch of my new video blog at drjohnsblog.wordpress.com. And to make the announcement fun for all, I thought I’d offer a FREE copy of my book Guide To Self: The Beginner’s Guide To Managing Emotion and Thought.

It’s all about how to quiet the voices in your head, turn down the volume on negative emotions and turn up the volume on positive emotions, click here for instant access!

So if you want a free PDF version of some of the latest proven tools to manage your mind, the latest methods to increase your happiness via positive psychology, the greatest tips to manage your anger, check it out! Click here for a fantastic freebie!

Enjoy!

John

Top 14 Ways to De-escalate Anger in the Workplace

John Schinnerer, Ph.D.

Guide To Self, Inc.

‘Excuse me’, I said in my kindest voice, ‘there is a mistake in this report.’ My coworker, a woman twenty years my elder, reacted with fury, ‘And I assume you’re perfect?! My reports don’t have mistakes in them. Why don’t you take that report and shove it up your a..!’ She continued with her tirade while I did a quick visual scan for any nearby sharp objects she might use on me. After what seemed like ten minutes, she snatched the pages from my hand and stormed away.

 While this took place nearly twenty years ago, I remember it vividly as it was an early lesson that the anger of coworkers is not always directed at the right person, to the proper degree and in the best manner. More often, the anger of coworkers, customers and supervisors is misdirected at people who had no involvement in creating the anger in the first place.   

So how do you handle it when someone else’s anger begins to escalate in the workplace?

The ability to de-escalate the anger of others is a critical political and emotional ability necessary for long-term success. As an executive coach and speaker, I have seen and heard about anger taking on a life of its own, destroying relationships and derailing careers. While we do our best to act the part of rational, reasonable business people, the truth is that we are also emotional beings.

The emotional brain (primarily the limbic system) has been in existence in human beings for 3 to 10 million years. On the other hand, the rational brain (the cortex) has only been around for roughly 50,000 to 1 million years.

The emotional brain has been through countless revisions and is nearly perfect in its ability to keep humans safe and act as a general guidance system (approach vs. avoidance). The emotional brain has the ability to take over the rational brain when someone comes between you and your goal (leading to anger) or when danger is sensed (leading to fear).

The rational brain is still in the earliest stages of revision on an evolutionary scale. It is prone to mistakes in thinking, and can be overpowered by the emotional brain in a matter of .33 seconds.

All of us are simultaneously rational and emotional. So anger is inevitable when you have groups of people who care passionately about their companies, their jobs and a wide assortment of individual, team and corporate goals. As goals come into conflict with others, anger is bound to result.

Anger exists on a spectrum. Think of the intensity of anger along a 1 – 10 scale where 1 is calm and 10 is enraged.

1.      The first step to take when someone is angry with you is to do a body scan. This is simply a mental scan of your body to monitor your own anger level. If your anger gets above a 5 on the anger scale, tell the person that you are getting upset and ask them to continue the conversation later (after you’ve calmed down). In my work helping executives with anger, I’ve found that anytime you get above a 5 on the anger scale, hurtful words are spoken and destructive acts are committed. It becomes highly difficult to manage yourself when your anger level is above a 5. And it becomes nearly impossible to help another person manage his or her anger if your anger spikes.

2.      Be aware that anger is one strategy that people use to get their own needs met. I call the use of destructive emotions to get what one wants ‘emotional bullying.’ Keep that phrase in your mind and see if emotional bullying is taking place in your situation. If so, calmly state to the other person that they cannot use emotions to get what they want.  Or you can choose to tell them that you are happy to speak about the situation further when they have calmed down.

3.      Take a deep breath. Studies show that focused breathing reduces the intensity of negative emotions such as anger, anxiety and resentment. Negative emotions lock the body into certain patterns of movement and thinking. For instance, anger locks you into shallow breathing, tightened muscles, and thoughts which reinforce the anger. Deep breathing into your belly is the most important step in unlocking anger.

4.      Avoid criticizing or blaming the angry person. Criticism, blame and judgment are highly likely to heighten the intensity of the anger.

5.      Look for common ground between your experiences and the focus of their anger. There is usually a kernel of truth in angry statements, even if it is a tiny kernel. Your job is to seek out that truth and magnify it. If you can relate to their experience, let them know, ‘If I put myself in your shoes, I’d be angry too. Let me see what I can do to help you make this situation better.’

6.      Tune in to the early warning signs. These can tip you off that a coworker is getting progressively angry. It’s powerful to know someone is ready to blow their top before they actually lose their temper.  There are physiological indicators of anger for which you can be on the lookout. These include clenched jaw, furrowed brow, upper lip curled up on one side (disgust), muscle tension, narrowed eyes and shallow breathing. Beyond that, you can look for deviations from typical behavior patterns. For instance, when a coworker who is usually boisterous and outgoing turns silent and withdraws, it may be a red flag for anger. When you notice such changes in people, simply call attention to them gently to diffuse them before they erupt. For instance, ‘Hey Jan, I notice you have become quiet all of a sudden. What’s going on for you?’ or ‘Bob, you seem to have an irritated look on your face. Is there anything we may have missed?’

7.      If you cannot prevent the angry party from exploding in rage, there are several approaches of which you will want to be practiced. This includes active listening, apologizing, acknowledging their feelings, and offering to make an attempt to rectify the situation.

8.      Active listening is the process of genuinely and sincerely attempting to truly hear what it is the angry party is trying to convey. It involves listening at several different levels simultaneously including

 a.     the text (interpreting the words they are speaking to you),

b.     the subtext (what is not being said yet is still part of the problem),

c.      the emotional (which emotions are involved in the anger such as resentment, disappointment, fear, sadness, contempt, disgust and more)

d.     the physical (the body language of the angry individual, how agitated are they, how tightly are they holding their hands, how contorted are their facial expressions, etc.).

9.      Attempt an apology if you feel one is warranted or appropriate. Apologies consist of five parts. First, you want to sincerely admit to the wrong doing (assuming you or your company made a mistake). ‘I know that I made an error when I filed the report with mistakes in it.’ Second, you want to apologize, ‘I apologize.’ Third, you want to ask what you can do to make things right. Ask them, ‘Do you have any constructive criticism for me?’ Fourth, let the other party know that you will behave differently next time. ‘Next time, I will make sure there are no errors in the report before I file it.’ Finally, ask for their forgiveness. ‘Will you forgive me for filing the report with errors?’

10.  Acknowledge their feelings. Help the angry party feel heard. Say something along the lines of ‘I think I understand how you feel. You are very upset. I hear you. Your anger makes complete sense to me. What can I do to help?’

11.  Attempts to reason with angry individuals are likely to fall on deaf ears. When anger gets intense, the emotional mind is firmly in control of the angry person and little if any information gets in. The exception to this is information that reinforces their anger. This sort of info will get in, will be focused on and will be magnified.

12.  Act with compassion. Compassion is empathy, the ability to put yourself in another’s shoes. The goal is to understand the situation from the perspective of the other person. The better you get at this learnable skill, the easier it is to unlock their anger.

13.  In some instances, these de-escalation skills will not be enough to defuse a rage. You always want to be aware when dealing with angry individuals that they may not be thinking completely rationally. As a result, you want to ensure your own safety. This means you must be mindful of an escape route should things take a turn for the worse and become violent or abusive. Make sure the angry party is not blocking your path to the door or a window.  Keep this in mind if the conversation escalates and slowly, calmly work your way towards a better escape route. If the situation escalates to a point where you feel it is out of control, do not hesitate to call the police to ensure your safety.

 14.  Learning proven methods to stay calm in emotionally charged situations is critical in business.  Meeting anger with anger is usually a recipe for turning irritation into a full blown rage.

If you are interested in coaching around anger issues or de-escalation skills for yourself or your staff, feel free to call Dr. John Schinnerer at 925-944-3440 or email him at Info@GuideToSelf.com or check out the website at http://www.GuideToSelf.com.

 About the AuthorDr. John Schinnerer is in private practice helping people learn anger management, stress management and the latest ways to deal with destructive negative emotions. He also helps clients discover optimal human functioning via positive psychology. His offices are in Danville, California. He graduated from U.C. Berkeley with a Ph.D. in psychology. Dr. Schinnerer has been an executive, speaker and psychologist for over 10 years. Dr. John Schinnerer is President and Founder of Guide To Self, a company that coaches executives to happiness and success using the latest in positive psychology. Dr. John Schinnerer hosted over 200 episodes of Guide To Self Radio, a daily prime time radio show, in the SF Bay Area.  Dr. Schinnerer’s areas of expertise range from positive psychology, to emotional awareness, to anger management, to executive coaching. Dr. Schinnerer wrote the award-winning, “Guide To Self: The Beginner’s Guide To Managing Emotion and Thought,” which is available at Amazon.com. His blog, Shrunken Mind, was recently recognized as one of the top 3 in positive psychology on the web (http://drjohnblog.guidetoself.com).