Acceptance builds strong relationships

I work with many couples in my private practice as a counselling psychologist. They come to me with many different relationship problems and issues, that for many results in seemingly constant bickering, quarrelling and escalating conflicts.

One of the most common problems that underlie so many of these painful conflictual situations is that people often do not feel accepted, or alternatively, they feel unable to accept their partner for who they are.   These relationships are often full of judgement, criticism, disapproval and disagreements about the “right” way to see the world.

Many people put unrealistic expectations on their relationship and are unable to accept that their partner has ideas, opinions and worldviews that might be different than their own.     It could be differences in how to drive,  parenting, how to do the dishes “right”,  disagreements about how spare time should be spent, how much sex is “normal” — it could even be bigger things like where to live, how to deal with money, different cultures, different religions, differing political views, or even ongoing disagreements about how much time to spend with the in-laws.

Sometimes people even take these differences in worldview and say:

 “Look we’re different… so that means we must be incompatible!”

As someone who has helped many couples to improve their relationships, differences in ways of seeing the world are normal and expected in any and all relationships.   They do not mean you are incompatible!!!   Almost every couple has a list of differences in opinion about big and little things.   The reality is every person has their own ideas, opinions, ways of doing things, their own quirks, foibles, peccadillos and unique weirdnesses.

But isn’t this a bad thing if two people are different?    Hell no!     If partners in a relationship are different it often actually gives them an advantage in dealing with the troubles of daily life.  It’s actually good to have two people with different ways of seeing and doing things, it’s an advantage!  Having two perspectives and two sets of ideas is great because it increases our brainpower when we are problem-solving all of the challenges that life throws at us!

An example I often use with couples comes from the world of business.   In a business, the last thing you want is two partners who think exactly the same way.   Two partners with different ways of thinking and seeing the world makes for a business that is more flexible, better able to solve problems and deal with change.   Having a partner with different worldviews is an advantage in business and this also applies to marriage!

Here is one of the most important parts of creating a successful relationship.   We don’t always have to agree with our partner!!!   And realistically?   We should even expect to disagree with them sometimes.   How boring would it be if you and your partner were exactly the same?

The cliché of agreeing to disagree.

So how do we learn to accept the differences we have with our partner?    The cliché of agreeing to disagree really carries a lot of truth in it.     The Gottman research on successful marriages identifies two kinds of problems.  Those we can solve and those we can’t.   Sometimes this is about accepting that our partner is different from us in their ideas, thoughts, opinions and beliefs; taking a perspective where we accept these differences as they are and not defining them as a problem!      A good example is what if two people in a relationship have different religious belief systems?   Can they make it work even though religious differences have spurred many conflicts and even wars throughout world history?

Of course this couple can make it work.   They just have to set boundaries, being respectful and accepting of this difference.   They have to start with the basic understanding that although they may have fundamentally different worldviews when it comes to the way they see the spiritual world,  it is not a problem, let alone a marriage deal breaker!    They may begin by setting ground rules to not argue about religion or to not judge the other person based on their beliefs.   By accepting and not judging their partner, they create a space where both partners can feel safe in their belief system even though they may differ in some very fundamental ways.   They make an active and ongoing choice to be accepting and not judgmental!

We DO NOT have to be exactly the same as our partner in all the things we do and believe. 

To deal with a big difference like religion, they need to create a “culture of acceptance” in their relationship where each partner accepts and maybe even embraces these differences;  where each partner feels safe and comfortable.   But this can also apply to other small things too — like how to spend a Saturday afternoon, what books to read, which friends to hang out with or even what to have for dinner!

Conflicts and right fighting

Sometimes couples fight over whose opinion is “right” during a conflict, quite often over the silliest little differences.  These fights are often based on little differences in the way we see the reality in front of us.    When this happens we can let our ego get in the way and many people will fight to “the death” about silly inconsequential things.    We dig in rather than being accepting and open minded.   These continual disagreements and arguments can stir up bitterness & resentments and even, over time, end in contempt.

According to relationship expert John Gottman, resentments can build into feelings of contempt — one of the Four Horsemen portending the end of a relationship:

Contempt is the worst of the four horsemen. In Dr. Gottman’s four decades of research, he has found it to be the #1 predictor of divorce.

When we communicate in this state, we are truly mean.  Treating others with disrespect and mocking them with sarcasm are forms of contempt. So are hostile humor, name-calling, mimicking, and/or body language such as eye-rolling and sneering. In whatever form, contempt is poisonous to a relationship because it conveys disgust. It’s virtually impossible to resolve a problem when your partner is getting the message that you’re disgusted with him or her.

Contempt is fueled by long-simmering negative thoughts about the partner, in the form of an attack from a position of relative superiority. Inevitably, contempt leads to more conflict rather than to reconciliation.

By accepting our partner as human and flawed and different than us, we can avoid devolving into the negativity of resentment and falling into the relationship destroying trap of contempt!  Acceptance creates a safe and positive place where both partners can feel vulnerable and don’t always have to be “on guard” for attacks, criticism and negativity from the person they really should least expect if from.

Successful relationships are based on acceptance, kindness, respect and compromise.  

So, take a deep, deep breath.   Accept that your partner is perfectly imperfect.   Accept and even embrace their quirks, peccadilloes and foibles.  Realise that maybe the differences are even part of what makes them your unique little sunflower!

To judge or accept?

One of the worst ways that these little disagreements and differences in opinion over who is “right” can hurt a relationship is that we may start to judge and criticise our partner based on these often minor differences.   Some people may even look at these differences and judge their partner to be lacking in some essential quality or believe that they are fatally flawed, a bad match, or even that they aren’t good enough.

Seeing the world as black and white and our partner as wrong or flawed in some way, can then end in a situation where we can become overly critical of our partner — this is often where the relationship train may start to derail and crash into resentment.

Once a partner feels that their mate is wrong, flawed or “less than” — the other picks up this critical, negative energy and they begin to check out,  avoiding interaction and closeness.   Of course they do, who wants to continually feel criticised and inadequate in the eyes of the person who’s supposed to have their back!     This creates a circumstance where both partners begin to adopt deeply negative attitudes towards each other and relationship damaging resentments and contemptuous feelings can start.

Take an everyday argument about shopping for groceries, for example. What if your significant other has forgotten to get one of the dinner ingredients you asked them to pick up on the way home from work?   In their mind and even out loud, many people will be critical and judge their partner for being forgetful in this situation with thoughts and statements like:

“What kind of a child am I married too?   All they had to do was pick up a few things.   Everything is ruined! They never ever listen to me.   They probably did this just to piss me off”!   They really don’t care about me or my needs! 

Instead of judging your partner in such a dark, negative way with such extreme black and white thinking… could you take a deep breath instead, and maybe consider that perhaps your partner’s had a long day, and so what if they forgot one thing? Maybe they just forgot and really, who’s perfect?   Maybe you could even order their favourite pizza instead and make this situation better?  (with extra cheese even?)

Build a strong relationship.     Stop judging, and instead, embrace your flawed and imperfect partner!    When they do something you think is really, really silly?   (because they will).   Instead of rolling your eyes and being critical, look at them with love and say that’s MY silly partner and I love them anyways!

References

Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. New York: Three Rivers Press.

The Four Horsemen: Contempt   Ellie Lisitsa May 13, 2013 The Four Horsemen: Contempt  https://www.gottman.com/blog/the-four-horsemen-contempt/

https://roberthammel.com/2425-2/

Physical depression

Depression has many different symptoms.    According to the National Institute for Mental Health,  the symptoms may include the following:

• Persistent sad, anxious, or “empty” mood
• Feelings of hopelessness, or pessimism
• Irritability
• Feelings of guilt, worthlessness, or helplessness
• Loss of interest or pleasure in hobbies and activities
• Decreased energy or fatigue
• Moving or talking more slowly
• Feeling restless or having trouble sitting still
• Difficulty concentrating, remembering, or making decisions
• Difficulty sleeping, early-morning awakening, or oversleeping
• Appetite and/or weight changes
• Thoughts of death or suicide, or suicide attempts
• Aches or pains, headaches, stomach cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Many people have depressive symptoms that affect their physical bodies and well being on some level.  In fact, physical symptoms are thought to occur in about 50-90% of depressed patients!

According to researcher M. H. Trivedi the physical symptoms can involve:

chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, sleep disturbances, psychomotor activity changes, and appetite changes.

A high percentage of patients who seek treatment in a primary care settings report only physical symptoms, which can make depression very difficult to diagnose.

Depressed people with physical symptoms are more likely to:

• be severely depressed
• have nonremitting depression
• be at risk for depression relapse
• have complex symptoms
• be difficult to treat
• have other psychiatric comorbidities
• have poor treatment outcomes
• lose work productivity
• require polypharmacy

(Translating Evidence on Depression and Physical Symptoms Into Effective Clinical Practice, 2004.)

Here are the various ways being clinically depressed can also be physical.

Back pain and body aches

Symptoms of chronic body aches, and/or back pain are common especially when it comes to more severe depressions.    A community study in Canada found that only 5.9% of respondents without back pain had major depression but in comparison, 19.8% of respondents with chronic back pain had major depression (Currie and Wang, 2004).

Headaches

A study  in the Journal of Pain in 2004, found that migraine and depression are strongly linked to each other.  People with depressive symptoms are also more likely to get tension headaches more frequently  (Janke et al).

Stomach and digestion

Depression can affect a person’s eating habits in many ways.   Some people binge eat, overeat or eat unhealthy fatty or sugary foods and can become obese or even develop diabetes — strangely enough, other sufferers can have an utter lack of appetite, can even lose unhealthy amounts of weight or suffer from malnutrition.     Depression can also cause stomach upset, constipation, diarrhoea and other digestive issues.

Serotonin, is well known as a brain neurotransmitter but it also has a connection to our gut.   It’s estimated that 80-90 percent of the body’s serotonin is made in our digestive tract and it’s largely responsible for regulating intestinal movement and involved in our sensitivity to and regulation of pain.  People with  depression/anxiety often are susceptible to Irritable Bowel Syndrome and “some research suggests that IBS patients who suffer mainly from diarrhea may have increased serotonin levels in the gut, while those with constipation-predominant IBS have decreased amounts”  (Harvard Health Publications).

Heart disease

Heart disease and depression are intricately linked and medical science and psychology are just beginning to understand the connection.     According to Harvard Medical School, patients with depression, when hospitalised for a heart condition, are 2 to 5 times more likely to have severe angina, heart attack, or stroke, in the next year.   On average depression is reported in an about 10 percent of adults and rises to about 30 percent for heart attack patients.    This points to a definite connection between depression and our heart.    As to why depression can harm our heart?   It’s thought that it affects the action and levels of our stress hormones like adrenaline, norepinephrine and cortisol and also affects blood pressure and heart rate, which can all affect the health of our cardiovascular system (Harvard Mental Health Letter, 2016).

Fatigue and exhaustion

Perhaps the most common physical symptom for those who are depressed is feeling high levels of fatigue and exhaustion after doing ordinary daily  activities.  This is a classic physical symptom of being depressed and often keeps sufferers from being able to develop a successful routine of life.    It’s very hard to meet the challenges of life when you have no energy.

Why do we have physical symptoms?

Many people ask, how can there be physical symptoms if depression is something that takes place in our brains?

The short answer is that depression is a complicated disorder that involves biological/physical, environmental, social and psychological factors.   Much more complicated than just feeling blue.

The reality is that it is a disease that is physical, a real and tangible medical disorder, it’s not just getting the blues — and the existence of physical symptoms really proves this out.

Many of the physical symptoms are thought to possibly be caused by miscommunication or malfunctioning in the neural pathways that extend from our brainstem to our spinal cord and then throughout the rest of our nervous system.   As well, possible malfunctioning and imbalances  of the neurotransmitters, dopamine, norepinephrine and serotonin, the drugs targetted by antidepressants, may also contribute to both pain & depression.

When it comes to treating depressed patients exploring the physical symptoms is very important.  In fact:

Many physicians consider a patient to be in remission from depression when his or her acute emotional symptoms have abated, but residual symptoms, including physical symptoms, increase the likelihood of relapse. (Trivedi 2004)

So what do you need to do to start to feel better?

1. Get a full physical to rule out other possible causes for the physical symptoms.

2. Develop a healthy diet and physical exercise routine.

Even walking for 20-30 minutes a day can reduce both pain and depression symptoms.    Additionally, “Being overweight can contribute to pain.   Try to reduce portion size, increase intake of fruits and vegetables, shift away from red meat and saturated fats, and shift toward foods with more omega-3 fatty acids such as coldwater fish and plant sources of fat”.    (Translating Evidence on Depression and Physical Symptoms Into Effective Clinical Practice.,  2007).

Paradoxically, sometimes increasing exercise levels can even help people feel less fatigue and more energy!

3. Develop better “coping skills”.

How do you think about your depression and pain?  Do you see it accurately?  Or is there a tendency to think very negatively?   Here’s a great link to an online self-help workbook to improve your coping skills:

  http://www.comh.ca/pchc/workbook/pages/02-05-Skills-Thinking.cfm4.    

4. Develop stress reduction strategies:

Alleviating stress also seems to reduce pain.  Activities like  yoga, meditation, and other “mind-body” approaches may help with both the emotional depressive symptoms and pain management.

Here’s a link to some basic stress management strategies:

http://www.webmd.com/balance/guide/blissing-out-10-relaxation-techniques-reduce-stress-spot

5. Be kind to yourself & practice better self-care:  

Here’s a link to some self-care tips:

7 steps to emotional self care

6. Finally, consider a course of psychotherapy with a psychologist to explore all of the symptoms and ways to improve your life.   Perhaps even find a psychologist that deals especially with pain and pain management? 

This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health or medical professional.

References

Currie WR, Wang J.. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107:54–60.

Janke EA, Holroyd KA, Romanek K.  Depression increases onset of tension-type headache following laboratory stress. Pain. 2004;111(3):230-238. doi:10.1016/j.pain.2004.06.007.

Trivedi, M. H. (2004). The Link Between Depression and Physical Symptoms. Primary Care Companion to The Journal of Clinical Psychiatry, 6(suppl 1), 12–16.

Targum SD, Fava M. Fatigue as a Residual Symptom of Depression.Innovations in Clinical Neuroscience. 2011;8(10):40-43.

American Heart Association How does depression affect the heart? (2016) http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/HowDoesStressAffectYou/How-does-depression-affect-the-heart_UCM_460263_Article.jsp#.WDNd4KIrI6g

Harvard Mental Health Letter.  2016  Depression and Heart Disease : Mind and mood affect the heart http://www.health.harvard.edu/press_releases/depression_and_heart_disease

Understanding and treating an irritable bowel   Harvard Health Publications   http://www.health.harvard.edu/staying-healthy/understanding_and_treating_an_irritable_bowel

Translating Evidence on Depression and Physical Symptoms Into Effective Clinical Practice. (2007). Primary Care Companion to The Journal of Clinical Psychiatry, 9(4), 295–302.

(A blog about a key strategy in reducing anxiety)

Almost 20% of the North American population suffers from some type of anxiety making it the the most common mental health condition in North America.    According to the DSM-IV anxiety disorders include, Specific Phobias, Generalized Anxiety Disorder (GAD), Post-traumatic Stress Disorder (PTSD), Social Anxiety, Obsessive-Compulsive Disorder (OCD) and even Mixed Anxiety and Depression.    There are also many people who suffer some degree of anxiety that affects their lives and may not fully meet the criteria for a diagnosable DSM disorder.

For many people with anxiety issues, worry and anxiousness can significantly affect the enjoyment and satisfaction in their lives, keeping them from living life the way they would really like to live — instead, they often feel like they are living in a state of worry, fear, self-recrimination and feeling “less than”.

When we are dealing with excessive anxiety our brain focuses again and again on thoughts and feelings of fear, anxiety and trouble. These worried anxious thoughts and fears can be about many different things for different people.

A common key element or symptom in anxiety is the presence of recurring, intrusive and automatic thoughts. These thoughts come unwarranted and often without any provocation.   For some people, they can pop up over and over again in a flurry of anxious worried thinking.

They can often be something like the following “thoughts”:

General worries

“I haven’t heard from my husband all day. I hope he’s OK”

“I have so much work to do, I’m going to fail and risk my job”

“Things are not going to work out.”

“The world is a scary and dangerous place”

“What if something bad happens to my child?”

“Why is my partner taking so long to text me? Did I do something wrong?” Are they mad at me?”

Social concerns

“If I go to that event, I am going to embarrass myself”

“My friends really don’t like me, and think I’m foolish”

“Everyone thinks I acted silly at work yesterday and they’re going to hold it against me”

“People don’t like me because I am nervous”

Worries about forgetting to do something important.

“Did I pay that bill?”

“Did I lock the door when I left home?”

“I feel like I’m forgetting something super important today”

Sometimes people with anxiety even have anxious thoughts about being anxious!

 “I have anxiety about having an anxiety disorder!  Why am I so very anxious all the time? What’s wrong with me” I have no reason to be so anxious. I have a pretty good life. Why can’t I fix this myself   I must be flawed/broken/weak Why can’t I be normal?

Anxiety’s faulty wiring

Anxiety thoughts like these often come automatically and can be repetitive and very, very frustrating.     The types of intrusive thoughts like we listed above can be frightening thoughts about what might happen to you or someone you love; they feel catastrophic and overwhelming, and oh so very real.  They seem to come from outside of your control, and they feel like real & tangible threats coming from the outside world, when, in reality, they are just thoughts!!!

People with more severe anxiety may even experience excessive and even debilitating worrying thoughts that they feel deeply and emotionally (as fear, apprehension, a sense of impending doom).  Sometimes their anxiety is often even felt physically (increased heart rate, muscle tension, rapid breathing, headache, stomach upset, etc.)

The problem with anxiety thoughts is that even though they may be real to some degree, our overactive brain exaggerates their level of threat.  Our brain fools us into thinking there is a dire and immediate threat  — when in fact, the actual risk to us may be minimal or something that is just an ordinary, daily problem of life for most people.   We can see the anxious thinking as being caused by faulty brain wiring — our brain (trying to protect us from bad things in our environment) takes small worries and exaggerates them into something bigger and more malicious.

Luckily we can actually rewire our brain to stop this anxious thinking process through the practice of  becoming aware of and consciously changing how we think.   With effort, we can take those anxious thoughts,  deflate their hold on us and feel calmer and more at peace.

Avoidance

Anxiety tries to fool us into thinking that we are in actually in physical and even mortal danger.   Worse yet, it pushes, cajoles and even drives us to avoid the source of the anxiety –– the result can be that we may avoid people, situations, challenges, places and even avoid opportunities that might better our life in some way – like avoiding a job interview, not applying to university, or even not asking that really interesting attractive person out on a date.

The problem with avoiding anxiety-provoking situations is that this often keeps us from growing into the full and complete people we want to be.    Life by its very nature has significant challenges and avoiding them leaves us living in a compromised way.   Anxiety can truly hobble us in our drive to live a full life.

Looking through a glass clearly

In “The Anxiety Book”  Jonathan Davidson states:

Negative thoughts breed negative emotional states.  To quote from Corinthians in the New Testament, when we see the world “through a glass darkly” meaning that we always expect the worst, we’re going to feel perennially anxious.   When our worldview is clouded by fear, we’re prone to anxiety.  The simple but powerful solution:  change the negative thoughts that breed anxiety and you start the process of healing your anxiety.

By making a pro-active choice and really trying to “look through a glass clearly”, we can start to challenge our negative anxious thoughts  from a more balanced, rational and logical perspective.    Obviously, this is easier said than done when every bit of our fibre is telling us that there is something truly horrible and scary to be frightened about.   But it can be done and in my psychology practice, I have seen many people with anxiety do exactly that!   I have seen many change their anxious thinking to a more balanced and calm kind of thinking.

Through effort and practice people with even the highest anxiety can lower their levels of anxious thinking by attempting to use more balanced and realistic thinking.  It’s really all about making an attempt and practising.   A pile of psychology research shows that through effort, repetition and practice we can actually retrain our brain to be less anxious over time!

How exactly do we do that?    We do that in four steps by accepting, examining, relabeling and challenging the negative anxiety thoughts.

Four steps to help reduce anxiety’s hold

Accepting

Carl Jung said, “What we resist persists”,  meaning that when it comes to conquering our anxieties and worries,  we must first accept that they are there, a reality in our mind;   we need to take a non-judgemental and unemotional approach to accepting that we are having negative anxious thoughts.   To conquer anxious thoughts is to first accept that they are happening and not go into “avoidance mode” — where we push them away, fight against them or even ignore them and deny their existence.   If we don’t become aware and accept our anxious thoughts they may continue to grow in size and influence over time, really throwing a shadow over our happiness and fulfilment.   Jung noticed that people who resisted aspects of themselves would have those things persist or actually even grow larger.    People who deny the reality of their anxiety can use a lot of their energy in a vicious cycle of denial and resistance:   Problem –> resistance –> more problem –> more resistance –> even more problem.    This first step of acceptance can be very hard for many people who prefer to be in denial about how their anxiety is really affecting their feelings and how they live their life.  It can also be hard for people who fight tooth and nail against their anxious thoughts and feelings; they can feel that acceptance is like giving in.   In reality, accepting our anxious thoughts and feelings for what they are can help disarm them and reduce the power they have over us.

Examination

Secondly, once we’ve accepted that we are having repetitive, anxious thoughts we can examine them. The goal is to examine our thoughts in the cold clear light of day. Really look at what our inner voice (the little automatic voice in our mind that everyone has) is telling us.   What are the exact thoughts that are causing us to feel anxiety?    Writing them down on paper can help too.   Writing things down can often allow us to see things more clearly and in a more evenhanded way.  The purpose of this stage is to learn to accept our anxious thoughts without creating an opinion about them and to really look at them from a non-judgemental place.

Relabeling

The next step is to relabel those anxious thoughts.  More accurately we need to stop seeing them as tangible, “real” fears and instead call them what they really are, anxious thoughts.     This is a super important step!   If we continue to see them as and call them “fears” it gives them a validity and “realness” they really don’t  deserve!     Instead, re-labelling them as “anxiety or worry thoughts” allows us to realise they may not really have much power over us!    It’s about accepting that even though our feelings and emotions are real and valid, they are possibly based in “faulty thinking” that we can often challenge and then relabel!

99 times out of 100 the anxiety thoughts we have are just exaggerated and not real concrete things to fear.  Our human mind is a powerful machine very affected by language;  changing the words and labels we use is a powerful way to start laying the groundwork for more balanced and less anxious thinking.

How to challenge and “debunk” the anxious thoughts.

The last step is to be brave and actually challenge and expose the anxious thoughts as exaggerated and inaccurate.  By taking an anxious thought and debunking it, we can decrease the power it has over us to some degree.

Here are some great questions to debunk our faulty anxious thinking in the style of David Burns:

Do some reality testing  

• What evidence supports my anxious thought?
• Are my thoughts based in facts or is my interpretation of the situation biased towards being anxious?
• Am I jumping to negative and worrisome conclusions without ALL of the evidence?
• How can I find out if my worried thoughts are true? Can I ask a friend, my therapist or can I examine these thoughts on a deeper level myself

Getting a wider perspective

• Is this thought truly as anxiety provoking as I’m making out to be?       Is my inner voice exaggerating?
• What’s truly the worst thing that could happen?
• What’s an alternative neutral or even a good thing that could happen instead?
• Will this worry even matter in five years?

Am I jumping to conclusions?

• Am I drawing negative conclusions from little (if any) evidence?

Am I disqualifying the positive?

• Am I  deemphasizing, or “shooting down the possibility that the thing I am worrying about is going to work out OK?

Am I fortune telling?

• Am I exaggerating and/or assuming how things will turn out before they actually happen?

Am I catastrophizing/magnifying?

• Am I imagining the worst case scenario?   Am I focusing on the worst possible outcomes, even if they are really highly unlikely.  Am I thinking that a situation is unbearable or impossible when it is really just uncomfortable or temporary?     Am I always expecting disaster to strike, no matter what?

Am I using emotional rather than logical reasoning?

• Am I assuming that because I feel a specific “emotional” way, that that feeling must be the truth or reality?  The emotions we’re feeling are just emotions.  They aren’t necessarily the reality of a situation. 

Being inundated with anxious thinking on a regular or frequent basis is not easy for many people.   The first step to reducing their emotional toll is through realising that anxious, worried, fear based thoughts are often being magnified and exaggerated by our faulty brain wiring.  The feelings, emotions and physical symptoms of anxiety are real and for some people even debilitating — however, once we accept that we may actually have some degree of control of what we can do with these thoughts and feelings, we can begin to regain control.   By going through the steps of accepting, examining, relabelling and challenging faulty anxious thinking, we can begin to rewire our brain to construct a more balanced, logical and fair way of seeing the world.

Here’s a great page with more information about how to change from anxious and worried thinking to more balanced and realistic thinking style:

https://www.anxietybc.com/adults/realistic-thinking

And here’s page with a great strategy to calm our anxiety feelings:

 Practice the pause.

This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health professional.

References

Burns, D. D. (1999). Feeling good: The new mood therapy. New York, NY: Avon Books.

JONATHAN DAVIDSON  HENRY DREHER  (2004)  The Anxiety Book  DEVELOPING STRENGTH IN THE FACE OF FEAR PENGUIN.

https://roberthammel.com/2253-2/

Marriage as a verb.

When we think of marriage we often think of it as an object, as a noun.  As a “thing” or “entity” that we have little control over. When we see marriage in this limiting way, we can lose sight of the fact they are in fact ever changing and evolving “things” that we have actually have some level of control over!  We can actually control and guide their direction and even their quality.    When it come down to it, each person in a marriage can choose to make an effort in how they think, act and behave and this can significantly effect the quality of any relationship.

Choosing to work on our marriage, to honestly and truly make an effort…  is the most important thing we can do to make it a better one.   Trying new books and strategies and even trying therapy won’t be much help unless you first decide to put forth real effort.   That means actually reading the whole marriage self-help book,  taking it to heart and trying the things it’s suggests.   Or going to marital therapy and really making an attempt to pay attention to the ideas and concepts that your therapist helps with.  Even just making a decision to treat your partner with kindness and generosity.   And I mean really making an effort to treat your partner well.   Listening and responding to them with a sense of respect, affection and compassion.    The effort to just be kind to your partner can make a night and day difference!

Here is a great article on how kindness and generosity can improve your marriage:

http://www.theatlantic.com/health/archive/2014/06/happily-ever-after/372573/

Avoiding the Blame Game by taking responsibility

A big problem that often keeps people from making an effort is that sometimes it’s really hard to admit that they are more likely than not partially at fault for the problems in their relationship.   It takes two to tango.  Marriage at a fundamental level is really about how two people interact together on a daily basis.     When things go sideways and conflicts happen…. people often feel emotionally hurt and put the blame on their partner side skirting their own role and shortcomings.  For many, it’s easier to just blame our spouse than it is to accept that we may be imperfect or flawed in some way.

Realistic Expectations and Blame

We often have super high, even unrealistic expectations for our spouse.   Or we might have a mistaken belief that relationships should always be easy — and when they aren’t, we can end up feeling inadequate, lost and couples start to blame each other and pull apart rather than pulling together as a team to tackle the relationship together.  The blame game starts and the couple starts splitting apart emotionally and may even start seeing their partner as an opponent or as someone who is inadequate, fatally flawed or isn’t trying.  They say things like.   If only my partner would “start doing this or that” or “stop doing that thing all the time” everything in the marriage would be fine.   This can cause them to shift the blame to their spouse and ignore their own faults and marriage damaging behaviour.

This denial of our own role can also make us feel hopeless and helpless about the fate of our relationship — we feel that we are on a runaway train — when in fact, we can begin to make changes in ourselves that may change our relationship for the better.   I’ve often counselled individuals about their marriages and they have been able to improve their relationships significantly just by making small changes in themselves and how they act and react toward their partner.

Like Gandhi said:

“We but mirror the world. All the tendencies present in the outer world are to be found in the world of our body. If we could change ourselves, the tendencies in the world would also change.  As a man changes his own nature, so does the attitude of the world change towards him. This is the divine mystery supreme. A wonderful thing it is and the source of our happiness. We need not wait to see what others do.” – Mahatma Gandhi

By changing ourselves our marriage and partner may follow suit.

Getting dirty

We have  to accept the reality  that sometimes relationships can be a hard row to hoe.     One  perspective I’ve often heard in modern culture and sometimes from clients in my private practice of marriage therapy is that if a relationship is meant to be, it will be easy and have few difficulties.

To that,  I say:  “define easy”.

Of course, there are some people whose relationships are seemingly “blessed” and it really does seem to come easy.    But those are probably few and far between.        Relationships by their very nature are sometimes difficult.   It’s hard to always get along with someone and improbable that we will always discuss and negotiate all of our conflicts in a calm and productive manner.     Frankly, for most people,  marriage will be challenging and in order for them to work, we have to put in a substantial and focused effort.   That piece of information is one of the true secrets of making a marriage work.

When it comes to marriage, like most things in life:  effort = reward.

If you want a marriage to work you have to accept the fact that sometimes it will take significant effort and time.    If you want a relationship to work long term you have to accept and work within this reality.

Making an effort is being intentional in your marriage

According to marriage expert John Gottman:

“A relationship is a contract of mutual nurturance. Relationships have to be a rich climate of positivity. For relationships to be strong, the ideal climate is one teeming with positive interactions.” 

GOTTMAN, May 2009 

And that right there is one of the most important things to know.   To create the needed positive interactions that Gottman suggests,  there has to be an effort.    Sometimes that takes a concerted effort to put the relationship and your partner first in your list of priorities.

According to Gottman spouses have to:

“make it intentional how we move through time together. Those actions are about working towards shared meaning.

GOTTMAN May 2009

The word “intention” is super important here.   Intention is about approaching your marriage with an open minded determinedness and commitment — and truly believing that with the right amount of effort you can make it work.   Doing things like being focussed on the good things about your partner rather than emphasising their faults.   We need to develop an attitude that doesn’t dwell on the last three disagreements or that our partner often forgets to do the dishes or leaves the milk out.   It’s about developing an attitude of intention that chooses to focus on the good things  about our spouse and accepts their imperfections and peccadilloes WITHOUT grumbling.    It’s about accepting that we are ourselves a flawed human being who has married another flawed human being and that sometimes this will end up in disagreements, arguments or negative feelings.    We have to realise that we won’t always be happy in a marriage and that is OK too.   It’s about having realistic expectations.

One of the most important ways to “try” is to start to listen!    Here’s how:  Good Listening 

I have worked with  hundreds of couples in my practice and the one crucial thing that seems to really make a difference in whether or not they successfully repair or improve a marriage is the amount of determination and effort that they put into fixing the relationship.    I know making an effort seems obvious, but often when we are entangled in a marriage that isn’t working, our strong emotions, resentments and grudges can keep us from truly making the effort that’s needed.    Accepting our own role in the problems, deciding to be intentional and making an honest effort are the most important things you can do to make your marriage work and last.

Here is a list of some great ways to start to be more intentional in your marriage:

Make an effort in your marriage

References:

Gottman, J. M., & Silver, N. (1999). The seven principles for making marriage work. New York: Three Rivers Press

Horne, Amanda.  Gottman’s “Art and Science of Love” November 3, 2009   http://positivepsychologynews.com/news/amanda-horne/200911034418

Having depression or another mental illness like anxiety or PTSD is a very difficult time for many people and often they turn to their family doctor for help. Seemingly, more often than not, the very first step of treatment involves being given a prescription for antidepressants (AD’s) as a way to medicate and treat the symptoms. Unfortunately using antidepressants before looking at other alternatives may come with some risks and may not be the best first choice for treatment.

Side Effects and the Long Term

A new critical review of the scientific research on the effects of the newer classes of antidepressants builds on earlier concerns and brings up a number of significant concerns about using antidepressants as a “first line treatment” for depression.

Researcher André F. Carvalho and his colleagues  published their review of the current research in the August 2016 edition of the journal Psychotherapy and Psychosomatics.    This review looked at the research regarding the long-term use of antidepressant drugs and their side effects.   The review was based on examining research studies on people diagnosed with Major Depressive Disorder (MDD), and found that there were a number of  important safety issues and even some potentially serious adverse events, which may occur as a consequence of using antidepressants.    (The newer classes of antidepressants fall into the category of SSRI’s and SNRI’s which include drugs under brand names like Prozac, Effexor, Pristiq, Paxil, Celexa, Lexapro, Zoloft and a long list of many others).

Here is a full list of  the problematic and possibly dangerous side effects according to this study:

Several side effects are transient and may disappear after a few weeks following treatment initiation, but potentially serious adverse events may persist or ensue later. They encompass:

gastrointestinal symptoms    (nausea, diarrhea, gastric bleeding, dyspepsia),

hepatotoxicity,

weight gain and metabolic abnormalities,

cardiovascular disturbances (heart rate, QT interval prolongation, hypertension, orthostatic hypotension),

genitourinary symptoms (urinary retention, incontinence),

sexual dysfunction,

hyponatremia,

osteoporosis and risk of fractures, bleeding,

central nervous system disturbances (lowering of seizure threshold,    extrapyramidal side effects, cognitive disturbances),

sweating,

sleep  disturbances,

affective (mood) disturbances (apathy, switches, paradoxical effects),

ophthalmic manifestations (glaucoma, cataracts)

and hyperprolactinemia.

The authors of the study concluded that when it comes to side effects:

ADs, particularly following long-term use, may increase the risk of experiencing additional psychopathological (e.g. treatment emergent affective switches and paradoxical symptoms), or medical (e.g. obesity and bleeding) problems that do not necessarily subside after discontinuation of the drug, and that may modify responsiveness to subsequent treatments.

AD’s used over the long term may cause psychological problems to worsen in some patients, may even cause new symptoms  to appear and may also cause medical problems that may continue long after the drugs use is stopped.

They also make note that we should be aware that:

the history of toxicology reminds us vividly of the lag that often occurs between the first approval of a drug for use in humans and the recognition of certain adverse events from that drug.

Carvalho and his colleagues came to the  overall conclusion that when it comes to antidepressant use for depression:

the use of ADs should be limited to those patients with the more severe and chronic forms of MDD, (Major Depressive Disorder) for the shortest possible  period of time.

and  that consumers should err on the side of caution:

the findings of this review suggest that long-term treatment with new generation ADs should be avoided if alternative treatments are available.

Suicidality, Antidepressants and Young People

Carvalho and his colleague’s paper also draws attention to and makes note that suicidality may also be a possible side effect of antidepressants, most especially when it come to children and adolescents.

There has been much concern of late that antidepressants used by young people may come with a risk of suicidality —  this certainly raises a red flag.   In fact, both the US Food and Drug Administration and Health Canada caution their use in young people.

Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories to patients, families, and health professionals to closely  monitor for warning signs of suicidal behaviour in children and adults younger than 25 who take antidepressants. This is especially important at the beginning of treatment or when doses are changed.

Health Canada and the FDA also advise patients to watch for an increase   in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviours in children, who are less able to control their impulses and may be at greater risk for suicidal behaviours.  (myhealth.alberta.ca 2015)

Do antidepressants even work in young people?

In addition to the suicide risk,  other new research questions the very effectiveness of antidepressant use with young people.

In a recent paper, lead author Dr. Andrea Cipriani from Oxford University and her colleagues reviewed the scientific evidence for 14 different antidepressant studies in children and young adults and found that the majority of antidepressants are no better than sugar pills (placebos) at relieving the symptoms of major depression in young people.    The study did find that one AD, Prozac, (Fluoxetine) was found to be effective but only just barely so.

The authors of this study come to a pretty clear conclusion that for children and adolescents antidepressants may not be a good first choice and state:

When considering the risk–benefit profile of antidepressants in the acute  treatment of major depressive disorder, these drugs do not seem to offer a clear advantage for children and adolescents.

What about antidepressant and adults?

German Psychologists Jürgen Margraf and Silvia Schneider in an editorial for the  issue of the journal EMBO Molecular Medicine put forward that psychotropic drugs are not proving to be an adequate solution to mental health issues.   They argue that the effects of psychiatric drugs for disorders like depression, anxiety, and ‘ADHD’ are very short-lived, are not a long term solution and may even have negative long-term consequences.

In a scathing critique of the use of psychotropic drugs Margraf and Schneider argue that mental health issues have continued to grow exponentially in the populations of the Western World over the last fifty years.  They argue that psychotropic drugs have been portrayed as a miracle cure and therefore our mental health issues should be reduced and not increasing.

…the percentage of disabled mentally ill patients in the USA has risen by more than 600% since the 1950s (Whitaker, 2010) and similar rates are seen in European countries. Most epidemiologists agree that this “epidemic” is not caused by increased incidence. Moreover, the once rapid succession of new therapeutic developments seems to have halted, at least in pharmacology, as big companies are withdrawing from research on mental disorders. How can this apparent contradiction be explained? Could it be that therapeutic progress is much less than we think or are being told? Could it be that the course of depression, anxiety, schizophrenia, or ADHD has been altered for the worse? Could it be that we cannot make therapeutic progress because the concept of mental illness and its treatment is deeply flawed? There are strong reasons to assume that all three suspicions are in fact true (2016).

So given that the side effects and possible risks of antidepressants caution against their widespread use as a first-line treatment and that many warning bells are sounding that AD’s may not be the effective panacea they have been made out to be…   what are other options?

The Case for Psychotherapy

One safe and proven alternative to antidepressants is psychotherapywith an educated and qualified professional like a Psychologist or a Clinical Social Worker.

Hundreds upon hundred of studies since the 1960’s have found that psychotherapy helps people deal with mental health issues in an effective way.   According to Lambert (2006) about 75 percent of people who enter psychotherapy show some benefit.   In another earlier study, Smith, Glass, & Miller (1980) found that people who entered psychotherapy were better off than 80% of those who didn’t receive treatment.

Margraf and Schneider suggest that  psychotherapy is a  better choice than psychotropic drugs, most especially over  the long term:

What really counts therefore is lasting improvement. Here, the picture looks radically different: Lasting success after the end of treatment has only been shown for psychotherapy (typically CBT), whereas the effects of drug treatments vanish rapidly once the drugs are withdrawn. This is obvious for anxiety disorders, depression, and ADHD and may also apply to schizophrenia. There are now plenty of data and evidence that, in the long term, the drugs do not work (2016).

In August 2012, the American Psychological Association released their Recognition of Psychotherapy Effectiveness document in which they laid out their case for using psychotherapy based on hundreds of research studies over decades of time and came to a number of  conclusions.  Here are some very important ones that make the case for psychotherapy as an effective treatment for mental health issues:

• The general or average effects of psychotherapy are widely accepted to be significant and large.
• The results of psychotherapy tend to last longer and be less likely to require additional treatment courses than psychopharmacological treatments.
• There is a growing body of evidence that psychotherapy is cost-effective, reduces disability, morbidity, and mortality, improves work functioning, decreases use of psychiatric hospitalization, and at times also leads to reduction in the unnecessary use of medical and surgical services including for those with serious mental illness.
• For most psychological disorders, the evidence from rigorous clinical research studies has shown that a variety of psychotherapies are effective with children, adults, and older adults.
• In studies measuring psychotherapy effectiveness, clients often report the benefits of treatment not only endure, but continue to improve following therapy completion as seen in larger effect sizes found at follow-up.
• The research evidence shows that psychotherapy is an effective treatment, with most clients/patients who are experiencing such conditions as depression and anxiety disorders attaining or returning to a level of functioning, after a relatively short course of treatment, that is typical of well-functioning individuals in the general population.

Looking at the APA’s conclusions, which are based on many years of solid research, it seems that psychotherapy may be an effective and safe first line alternative to using antidepressants for many people without the risks of side effects or long term problems.

This blog is not intended to be medical advice or diagnosis and should in no way replace consultation with a medical professional about your own particular circumstances — especially when it comes to using or ending the use of psychiatric drugs which may have dire consequences.   Please consult with a medical professional about your own unique situation. 

References:

American Psychological Association.  (2013)  Recognition of Psychotherapy Effectiveness  2013 American Psychological Association 2013, Vol. 50, No. 1, 102–109 http://www.eagt.org/research/APA-Resolution-Recognition-of-Psychotherapy-Effectiveness.pdf

Carvalho A, F, Sharma M, S, Brunoni A, R, Vieta E, Fava G, A, The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom 2016;85:270-288

Cipriani, Andrea et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis The Lancet , Volume 388 , Issue 10047 , 881 – 890

Lambert, Michael J.; Archer, Andrea Goodheart, Carol D. (Ed); Kazdin, Alan E. (Ed); Sternberg, Robert J. (Ed), (2006). Research Findings on the Effects of Psychotherapy and their Implications for Practice. Evidence-based psychotherapy: Where practice and research meet. , (pp. 111-130). Washington, DC, US: American Psychological Association, xi, 295 pp. doi:10.1037/11423-005

Margraf, J., & Schneider, S. (2016). From neuroleptics to neuroscience and from Pavlov to psychotherapy: more than just the “emperor’s new treatments” for mental illnesses?. EMBO Molecular Medicine, e201606650.

Smith M., Glass, G. & Miller, T. (1980). The Benefits of Psychotherapy. Baltimore, MD: John Hopkins University Press.

myhealth.alberta.ca (2015)  Health Canada and FDA Advisories for Antidepressants. https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=zu1129

“Life’s under no obligation to give us what we expect.”

― Margaret Mitchell, Gone with the Wind