But psychodynamic is directionless and in a way that never seems to help either, and hides behind the lack of measurement. It could be amazing with a wise Irvin Yalom figure, but 99% of us aren't interacting with somebody that thoughtful.
How well, generally, do you think therapy works?
What works best?
> Dardaris had entrusted her pooches to the care of a dog-sitter, who was Tang’s then-girlfriend, in the fall of 2019 while she acted in a play in South Carolina, she previously told The Post.
> Tang snuck into his girlfriend’s apartment when she wasn’t home and viciously tortured Dardaris’s white-furred companions Oct. 24, 2019.
> After fatally beating Alex, Tang was accused of taking Frankie to the building’s rooftop and punching, throwing and kicking him.
And he served no jail time and just got a slap on the wrist. Completely insane behavior, who does that?
Completely true, but comparable with lots of other coffee drinkers habits. I make mine half chai concentrate from a local restaurant and half 2% milk in small portion sizes of about 120 calories, so I don't feel _too_ bad about it.
I might have slightly more sugar than is strictly recommended DV, but not by much.
I worked remotely from Tenerife last year. I was there two months, at first it was great, everything new and novel. But it wears off and towards the end of my stay I longed for home, community and my usual routine.
The best balance is occaisonal "pattern interrupts" like travel abroad (or within your own country). You do not necessarily need big sweeping vacations or "experiences". A bike ride in a forest for a few days with a friend you have not seen for months can give you that mental refreshment.
I appreciate Derek Sivers. (And he is active on HN, so - hi)
Derek does though tend to act in, or advocate for, the absolute extreme.
I remember an old story where Derek micromanaged CDBaby knowing how to do every thing including write all the code in Rails. Burning out, he then trusted his employees to run his company completely without him. Derek became painfully disillusioned when his employees betrayed him under zero oversight, and sold the company. My thinking reading this years ago was the wise path was probably more reasonable delegation with reasonable oversight.
It is ok to reject the shiny extreme. Moderation is beautiful.
I also appreciate Derek and his writing. But his style is like catnip to the 20-something-single-guy part of my lizard brain: sometimes he's missing a degree of duty, responsibility and community consciousness as he approaches situations. You've got to read his stuff with a critical eye, because a lot of it ignores the responsibilities that a mature grown person has.
When I was younger, it was common to add starch to make the cotton easier to iron etc - that would definitely make it stiff. Thankfully we don't do that anymore. Comfortwise, Cotton beats practically any other fabric + it gets softer the longer you use it so in a way it actually incentivizes reuse.
There are many possibilities around the candidate's behavior. They could be going through a manic episode, or autistic, or just a jerk, or scammer.
OP handled it well, but two things I would do differently in responding.
1. "Sorry you feel that way". I never apologize for other people's feelings, only my own actions, when am am sincerely sorry. "Not-really-apologies" are, IMO, always in bad taste.
2. Not sign emails using "best". Best what? Obviously this is up for interpretation but a dangling best is (IMO) corny and exudes "I am writing unnaturally and I think this is how professional people write"
“Your emotions result entirely from the way you look at things.”
I wholly disagree with this foundational principle of CBT. Feelings of, say, anxiety or depression can completely bypass rational thought. For me this is easily testable by having a cup of coffee. After that drink I will (often) feel less depressed and (sometimes) be more anxious. I may have thoughts that stem from these sensations. Just as sometimes I may have sensations that stem from thoughts. The system to me seems more complex than thoughts > emotions.
IANAE but the way CBT was explained to was that thought, emotions, and actions exist in a fully connected, bidirectional causal graph; not that any one particular node was primary over the others. The intention (I thought) was to try and take the "thought <> emotions" edge and apply some filtering to the "thoughts < emotions" flow, so that the relationship was less reactive and didn't lead to spiraling, ie. replacing:
>>> “Your emotions result entirely from the way you look at things.”
>> I wholly disagree with this foundational principle of CBT. Feelings of, say, anxiety or depression can completely bypass rational thought.
Why? It's a circular thing, the reason anxiety or depression can bypass rational thought is that they're drawing your focus to a particular train of thought. There are many thoughts going on in our heads at one time, and emotions can shift our focus to ones of greater emotional impact. IMHO the really strong emotions are often due to unresolved issues or unprocessed past trauma. Once you get those taken care of (no easy task), it's easier to choose a way to look at something that causes you the least distress. Sure, it may not be the ground truth but when it comes to interactions with humans there often isn't an underlying "correct" interpretation of things, so you may as well adopt a view that doesn't bother you and get on with your day.
The road (train of thought) is different from the pathfinding (emotional weight of thoughts), and an error in pathfinding does not indicate anything (error/traumatic/important/wrong) in a train of thought.
This anxiety does not have to reflex reality at all (consider my father and his dementia). The stimuli is inconsequential for a rational observer, but latched onto by the anxious. 'Fixing/dealing' the thought causing the anxiety does nothing to alleviate his anxiety - as there will always be something to be anxious about.
It's not that trains of thoughts are causing his anxiety: it is very clearly his anxiety searching the tracks until it can get on the most disturbing it can find...
I think a useful way to look at this is in a less immediate sense, and more long term. How you choose to interpret your experiences will shape your emotional stats more and more over time. If you decide something is bad, you ruminate over it, you express sadness about it to others, etc. then eventually your emotional response to it happening will be more and more negative. Most likely at least.
By applying some form of mindfulness like CBT, you can avoid these cognitive distortions that are likely to lead you down unnecessarily negative thought paths. These patterns typically compromise us. They are more likely to lead us to negative thoughts about our experiences. By avoiding them, over time we may find ourselves feeling better as a result.
I don’t believe in free will in a very immediate sense. It seems our greatest form of control is in choosing how we react internally to what occurs in the world, or what “bubbles up”. By choosing wisely we can gradually steer the ship in better directions. Yet we never seem to have full control over it, by any means.
Sometimes I feel like a passenger rather than a driver, and I’m constantly telling the driver how to operate the vehicle. Over time, the driver will hopefully become a bit more conscientious, skilled, and capable of avoiding accidents. In the immediate sense, I just have to relax and be prepared for fender benders and other nonsense and deal with it when it happens.
For instance, anxiety therapy requires both the cognitive part where you work on your thought and the behavioral part, exposure, where you physically expose yourself to your fears (assuming it's something in the real world).
As for depression and anxiety levels changing through caffeine intake, it's in the same ballpark as alcohol--you affect your internal chemistry, so different processes start to work differently, and so a given train of thought can be temporarily boosted or silenced. But because you still have the same core beliefs, as soon as you return to your baseline, you'll get back to the same psychical state as before.
Strongly agreed. Thoughts certainly can dictate emotions, but I've often observed that general emotions are floating around in my head. I can take the effort articulate these emotions into thoughts, and those thoughts may perhaps be negative / harmful. But in many, many cases it's clear the emotions preceded the thoughts.
> I can take the effort articulate these emotions into thoughts, and those thoughts may perhaps be negative / harmful
But those thoughts are ultimately interpretations of the emotion, and those interpretations are built on a foundation of past experience and external factors. The feeling of anxiety and the feeling of excitement are remarkably similar, and "I'm anxious about this upcoming event" and "I'm excited about this upcoming event" are two potential interpretations of the same feeling.
> But in many, many cases it's clear the emotions preceded the thoughts.
The question is: what preceded the emotions that preceded those thoughts? I think that in many cases, it's hard to trace this all the way back. There are times when thoughts (e.g. incessant rumination) directly lead to the negative emotions, which then lead to thoughts, but now there's a feedback loop and it's hard to tell where it started.
There's a certain kind of co-emergence that seems to happen, and the interpretive layer has a lot to do with how it plays out. And as interpretations change, so do the resulting chains of thoughts/emotions.
I think that's a fair interpretation, however I'd strongly argue two points:
- Sometimes, emotions precede (and at least set the stage) for thoughts.
- The reality is not so clear cut as the CBTs state. ie, they say that "Thoughts [always] dictate emotions."
That said, CBT is still very effective, and will yield improvements for most people. It's just that their core tenant seems to be an oversimplification.
I think that's fair as well with the "sometimes", and I fully agree re: the oversimplification. I think CBT is ultimately labeling the most recognizable stages of certain mental phenomena and providing a framework for interacting with and guiding that phenomena. But as a discipline I think CBT knows very little (relatively speaking) about the machinery involved, and at best we have a low resolution understanding that is surely incomplete.
But yeah, my belief in CBT is mostly for its utility.
As a side note, I've found some of Lisa Feldman Barrett's work on emotions to be pretty interesting. It dives into newer research behind how emotions are intrinsically connected to other bodily processes, and explores some of ways that the emergence of emotional states doesn't match our intuitions.
Not far afield at all. That’s another rabbit hole I’ve gone down pretty deeply, and I’ve found it an incredibly useful set of ideas for thinking (or not thinking) about the world. It cuts through a lot of the stuff we tend to get stuck in our heads about.
On this tangent, I’ve found mindfulness meditation to be one of the most useful tools when navigating the harder feelings. In that mode of observation, you start to notice these things just unfolding in the space of consciousness.
It made a lot of the ideas I’d been introduced to in therapy actually become real experientially, e.g. the idea that I am not my thoughts sounds nice, but while meditating, I begin to experience this as thoughts come and go like waves, and eventually just stop. But I’m still aware. It was the first time I could really feel the difference between “me” and “a thought my brain is thinking right now”. Getting that separation makes dealing with the harder thoughts significantly easier.
To be clear, that is not a foundational principle of CBT, it is a quote from a book. Also, this article is certainly showing off distortions that CBT will teach, but is trying to apply it in ways that are different from CBT. CBT is focused on the idea that people recognize their emotions easier than their thoughts, so when they have emotions disrupt their lives, they can dig deeper to find the thoughts that brought those emotions up, recognize unhealthy patterns, and fix it.
CBT is just a tool. It works for some things. Not everything.
My understanding is that sensory inputs are going to literally physically reach your amygdala faster than your prefrontal cortex. Milliseconds, but what happens is you do have feelings of anxiety/depression/etc as a reaction before your conciousness is able to contextual the feelings.
Part of CBT is recognizing that so you can try to train yourself not to experience emotions as deeply and/or to be able to clamp down on these reactions before they spiral.
I've been around the block with CBT and some other forms of therapy. My anxiety/depression is rooted in complex PTSD from complex childhood trauma, and over the many years I've gotten very intimate with the relationship between thought/emotion and their interplay.
One of the biggest "aha" moments for me was the day that I realized that other people around me interpreted certain events in a way that was entirely unlike my own thought process. There were pessimistic defaults hammered into me from a young age, and my interpretation of circumstances always happened through that lens. I knew that everyone had their own experience of things, but it didn't really dawn on me how drastically different those experiences can be, and how much they're colored by past experience.
> Feelings of, say, anxiety or depression can completely bypass rational thought.
I think this is a matter of framing. I'd say that feelings of anxiety and depression co-exist with rational thought, but often surface as stronger signals. They're brain processes that manifest in the same space of conscious awareness as siblings to each other. They also seem to interact and modulate each other.
Now that I have tools to reframe/manage my depressive episodes, I can observe my depression and anxiety while also having a rational conversation with myself about the experience. I can both feel the anxiety and understand that the anxiety is an echo of past experience that has no current purpose. So as much as the anxiety is "overriding" rational thought, it's also possible to override the anxiety with rational thought. It just takes intentional work, which is where the "it's how you look at things" comes into play.
Very early in the process, I couldn't see past the anxiety/depression. Someone could point out the irrationality of it, and all I could conclude was "that's nice, but what about the depression?". At some point, it became clear that this was itself a kind of fallacy. A false dichotomy. The depression can exist alongside higher order thinking, and that higher order thinking modulates the depression over time. What I'd fallen into was a form of learned helplessness, where I had convinced myself that doing something wouldn't matter. The equivalent of drowning in 2 feet of water because I didn't believe that standing up would make a difference, because I didn't know that it could make a difference.
This is why external intervention can be very effective. Someone outside your currently compromised brain helps you start to reframe things and see them from another perspective. This jump starts new modes of thinking, and eventually builds the core tools to counteract the depressive thinking. At some point, it dawned on me that I could choose other modes of thought.
Once I realized this, I was off to the races. There was a point when I realized that my experience of a thing was modulated by my own brain, and to whatever degree I could get involved in that process, I could change my experience of things. This isn't to say it's easy or automatic - it has been anything but that - but it has also transformed my life.
I appreciate your detailed comment, I see myself partly in this although I only suspect I have CPTSD. But right now I feel like I know all this intellectually, and frequently I even believe that I can get up from those 2 feet of water, but if i do, there's just nothing there, no one there. I know it will pass and that I will have great days again, maybe even tomorrow, but during I just feel like I want to wallow in the water.
Or more accurately, it feels that the only things I want/need in those moments are unavailable, and anything else I just don't want to do.
I’m sorry you’re going through this, and what you’re describing sounds very much like me at some points in the process, and to be very honest, I’m still not immune; I still slip into depressive episodes.
But the more I focus on doing “the work”, the shorter they are, and there haven’t been as many. For me, that has meant: Weekly therapy, Get good sleep, Eat decent food, daily mindfulness meditation and Yoga, several long walks every week, daily if possible. Journaling to clear thoughts out of my head.
This would have sounded like an insurmountable list at one point, and in reality happened gradually. One thing built on the next.
If I could deliver a message to my former self when I was stuck in a much deeper and longer rut, it’d be:
0. I need to start loving myself, as strange as that feels. Especially when the love isn’t there from outside, find it from inside if I can (this was fucking hard at first but got easier)
1. The only person who can change me is me (but get external help)
2. I don’t actually like wallowing in it. I just have a deeply ingrained habit of wallowing in it and it feels “normal”. It’ll stay normal until replaced with a new normal
3. Get better sleep above all else. Everything else gets easier. It took me 6 months of gradually shifting my schedule but I’d have buckled down sooner if I had realized how much it would help.
4. I won’t wake up one day and suddenly feel like doing the things I need to do - so I should stop waiting for that day and do it anyway. Doing it might feel like the hardest thing I’ve ever done. Do it anyway. Starting is the hard part. Doing it is usually far easier.
5. When I start to wallow or abandon good habits, don’t get upset about it, just begin again. It’s more like surfing than mountain climbing. Falling down is part of the process.
I don’t know how I would have received this message from my future self. I might have struggled to receive it. But these are some of the bigger things that I realized along the way, and continue to realize as I work through this.
I agree with all those points, I don't have issues with sleep but I can see how much murkier everything would be if I wasn't lucky in that regard
I would add to that the importance of doing creative work. I would've been inclined to say this is personal, but I'm leaning more into believing that just like you don't need to be "a type of person" to get into mindfulness and yoga, everyone can and should benefit from having a physical space and allocated time to play with some form of creative activity. I might feel lonely or wish my life was better but if I'm being creative it's like I'm in contact with a part of me that is a friend.
It's related to your point about loving yourself, because sometimes it's hard to be convinced that I'm worthy of self love if I'm just indulging in depressive thoughts. But when examined, there's two components to that, the thoughts, and the indulging. If I focus on the indulging but I'm not mindful, I can slip into addiction. But if I do it with the mindset that I'm giving myself "permission" to indulge in child-like play, then I'm becoming a kkind of person I'd like to be around, so it becomes easy to love myself.
That’s a really good point about creative work. This has been a big part of my progress as well, but has been a bit on-again off-again. I’m glad you mentioned this, because I think I need to make it a more consistent outlet, and the self-love connection makes sense.
I'm trying to find a therapist after about 20 intermittent years of disappointing therapy experiences.
I find CBT trite ( https://slatestarcodex.com/2015/07/16/cbt-in-the-water-suppl... )
But psychodynamic is directionless and in a way that never seems to help either, and hides behind the lack of measurement. It could be amazing with a wise Irvin Yalom figure, but 99% of us aren't interacting with somebody that thoughtful.
How well, generally, do you think therapy works? What works best?