Improving Your Mood - LAP BC

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Improving Your Mood - LAP BC Powered By Docstoc
					Improving Your Mood

   Lawyers Assistance
   Facilitated by Robert

• 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

• We are working on the 50% that can be
  changed, that is the way you live your
  life and the interpretations you put on
• “Insanity is doing the same thing over
  and over and expecting a different
• 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

• Improving your mood is about
  changing your experience of your
  reality-after basic needs have been met
  it is difficult to imagine anything more
• 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
• Lets start by completing the exercise
  on p.6-what have you been missing due
  to low moods?

• 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
• 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

• 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)

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

• 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
• 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
Goal Setting That Works!
• 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
• 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
 “If you want to change you
life you need to change your
• 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
       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
• 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
• 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 Help
• 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
• 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
• Exercise-design a helping team of
  people that are already helping or
  could be helpers
     Psychotherapy and
• CBT-Cognitive Behavioral
  Therapy-well researched and very
  effective-we use this a lot at the
• 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
• 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
• 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
• 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

• 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
    Changing Behaviors
          C 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
      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
      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
• Sleep deprivation has very serious
  consequences and is severely impairs
• 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
• Any problems you have will be
  made worse by drugs and alcohol-
  alcohol is depressogenic agent-not
  what you need if you are
• 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!!

• 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

• 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
• 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”
• 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
  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
  “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
• 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
 Common beliefs that are
• 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
• 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
           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
• 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
• See my article on various forms of
    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
    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
• 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
     Building your Social
• 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
• Both passive and aggressive
  people are afraid of intimacy and
  contact-they just defend
  themselves in different ways

• Being assertive is the solution to
  going from one extreme to the
• 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
       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
• Almost all crises contain a great
  learning, if you allow yourself to
  discover it and then move on
       Growth Requires
• 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 is necessary for growth but
  most suffering is unproductive-it is
  endless criticism or “coulda woulda
• 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
• 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

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