Can self help (cognitive-behavioral work and strategies for positive thinking) actually impede the process to recovery?

On Fridays I will address a question related to depression and find the answer from an expert. If you have a question you want answered, please ask it on the combox of this post, and I'll try my best to do some research and feature it in an upcoming Friday post.

I have long been a fan of Dr. Tamar E. Chansky's work. We worked with the same editor for awhile at Broadway Books, and that editor handed me Chansky's book, "Freeing Your Child from Anxiety," when I had lunch with her one day. "Something tells me you'd benefit from this book," she said.

I've quoted Dr. Tamar often on Beyond Blue, and excerpted from her book in my "11 Red Flags" post.

So I was delighted to see her post a comment on the combox of my "12 Ways to Overcome Envy and Jealousy" post, and when she mentioned she had a new book out, "Freeing Your Child from Negative Thinking," I begged her to send it to me ASAP so that I could delve into it and share her wisdom with you all.

You may read child psychology books for the same reason I do: it's much easier to focus on changing someone else's thinking pattern than it is your own. Plus, if you're caught with this book in your hands it's less embarrassing, than holding a copy of "Freeing Myself from Negative Thinking Again and Again and Again." Needless to say, I read this book more for myself than for David. And because the writing was so clear and simple--in language you could translate to your seven-year-old--I understood it! Just like the CliffsNotes I read back in college.

So I'm going to excerpt sections of her book here, but I urge you all to get a copy of "Freeing Your Child from Negative Thinking" (for yourselves, not your kids) because there are several brilliant illustrations and concepts in that book that are too complicated to reproduce here.

Since it is Friday, I wanted to ask Dr. Tamar a question I often struggle with: Can self help actually impede the process to recovery? At what point in a severe depression does cognitive-behavioral therapy becoming not only unhelpful, but dangerous? When do you know it's time to rest from reframing your thoughts?

Let me back up by presenting information from her introduction. Positive psychology, based on the studies of Martin Seligman and colleagues, has found that you can protect vulnerable children (and adults) from developing depression by teaching them the skills to find a positive way of thinking, and that children who have learned these skills had half the rate of depression of the children who hadn't learned the skills, per a study by Seligman published in the journal "Psychological Science."

Furthermore, Dr. Tamar shares the research of Sonja Lyubormirsky and David Schkade, who quantify the relationship between three elements of happiness (genetics, circumstances, and voluntary control) as follows: Our happiness is 40 percent under our voluntary control, 10 percent due to our circumstances, and 50 percent due to our set point, or genetic make-up.

I have read these statistics before and can appreciate the theory that we can change our brain by tapping different neural circuits. I am fascinated and empowered by what Dr. Tamar writes in her book:

A journey of a thousand neurons begins with a single rewire. Knowing that there is another destination greatly increases the chances that you will head in that new direction. The neural relandscaping is happening in the form of healthy growth of new circuits in the prefrontal cortex that transport your child from right-brain negative thinking to left-brain possible thinking. Over time, these new circuits will develop into brightly lit pathways flashing the clear message: "Right this say; this you can manage."

However, I have always maintained that you have to be halfway to recovery before you can start to practice this kind of cognitive-behavioral therapy, because if you attempt to do this in a severely depressed state, it could cause further damage. To illustrate my point, I highlight one research study at the University of Wisconsin-Madison, in particular, that used high-definition brain imaging to reveal a breakdown in the emotional processing that impairs the depressive's ability to suppress negative emotions. In fact, the more effort that depressives put into reframing thoughts--the harder they tried to think positive--the more activation there was in the amygdala, regarded by neurobiologists as a person's "fear center." Says Tom Johnstone, Ph.D. the lead study author at the University of Wisconsin:

Healthy individuals putting more cognitive effort into [reframing the content] get a bigger payoff in terms of decreasing activity in the brain's emotional response centers. In the depressed individuals, you find the exact opposite.

I found this to be the case with me. When I was suicidal, very severely depressed, the methods that I use now--that are extremely helpful in pulling me out of destructive thinking--only backfired at that time, because the more I failed at redirecting my thoughts, the more I hated myself.

My question to Dr. Tamar, then, is: When do you know that cognitive-behavioral therapy can relieve you of depressive symptoms, and when do you have to stop the reframing in order to get to a better place?

Here she is with her answer!

Dr. Chansky:

You ask a very important question, but a complex one. I will try to simplify my own ideas about this by starting with the idea that positive thinking is not the goal. Anything but negative thinking is the goal. When I was in graduate school, my advisor, Dr. Phil Kendall published a study whose title gives away the punch line: The Power of Non-Negative Thinking. Essentially what they found is that mental health is not built on the presence of positive thoughts, but more the absence of negative thoughts. Let's put that idea on hold for a second and bring in another idea... that of Seligman's intelligent optimism: attributing negative events and feelings to temporary, specific and non-personal sources (as opposed to the permanent, pervasive and personal explanations that are automatically generated in depression). A third idea is that thoughts that are the most comforting need to be accurate but also reflect what is real to us in the moment. So taking all three of these points now, I would answer your question in the following way. When someone is depressed, it is very important that they "hear" what they are saying to themselves so that rather than just those thoughts staying protected in their head (where they sound soooo true, even when they're not), they can hear them and see if there is some editing they can do to make the thoughts more accurate, tolerable, and perhaps hopeful. For example:

"I hate my life" Becomes: "I am feeling really bad right now and just feel now that nothing is working in my life, I don't know when this feeling will pass, but I know it is temporary and it's coming from my depression.

"I can't do anything right!" Becomes: "I am depressed right now, this is not a time to assess what I can do because everything looks bleak right now." "I don't have to prove it wrong, but I'm not going to argue with my depression right now."

In these two examples we see that there is no "cheering yourself up" strategies, which take a lot of effort, and as you point out make you feel more depressed when they don't work. Rather, it is just trying to put the thoughts and feelings in an accurate context and perspective. Maybe by doing this, a person is able to determine if there is something else at the moment that is bothering them that they can attempt to address, but as we know, when depression circuits light up, often there is no apparent cause or trigger, it's just the groove that the brain has gotten used to following.

Overtime, when people don't just take their depressive thoughts as having the ultimate authority in their lives, but instead see their role as being able to shape their own running commentary of what is going on in their lives, they begin to feel more empowered and slowly, slowly move their way out of depression. So I wouldn't say that cognitive therapy (CT) is counterproductive at all, but that perhaps there is an understanding of what CT consists of which is creating unnecessary frustration for folks. It may be that this misunderstanding has come directly from something they've read or even their therapist, but if this is the case, they may want to clarify--- it's not about being positive, it's about not being stuck with the negative.