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Tuesday 19 April 2011

The Short Term / Long Term Problem

When treating depression and anxiety it’s always worthwhile to ask “What do you do when you feel especially awful and you want to feel better right now?”

Most people will have at least a few answers.  Some of these are pretty good:  Call a supportive friend, get outside, try to get something done.

But usually there are some unproductive things too.  Close the curtains.  Go back to bed.  Take more antianxiety medication.  Call in sick.  Binge-eat.  Unplug the phone.

Novice therapists are often mystified by these behaviours.  Who ever thought that sitting alone in the dark would solve an anxiety problem?  Isn’t it obvious, after months and months, that this isn’t working?  Frustrated family members sometimes arrive at what seems like the only possible explanation.  “You must like feeling this way.”

But even as the thought occurs to them, they know it’s wrong.  No one likes to be anxious or depressed.  So why do they do these things?  The answer is quite simple.

They work.

If you’re afraid of dogs and you want to feel better, it’s easy.  Just avoid places where you might run into dogs.  If you’re depressed and coping with the world overwhelms you, then stay home.

The problem is this:  Almost everything that an anxious or depressed person feels tempted to do when they feel especially uncomfortable will help them to feel a bit better in the short run, but has the cost of making them feel worse in the long run.

When people go to therapy, they know quite well that the therapist is not going to advise them to sit more often in the dark, or avoid dogs at all costs.  They know that therapy is going to involve turning around and doing the opposite.

Of course, any therapy that advises a depressed person to fill their schedule, exercise three times a day, socialize all evening, eat a perfectly balanced diet, adopt a rigidly healthy sleep schedule, and take on three hobbies is doomed to failure.  “Just go to the dog park and let all the dogs jump on you for three hours” is not going to work because it is never going to happen.  When therapists get the dreaded “Yes, but…” the problem is usually not the client’s personality but the therapist’s pushiness.

But therapy will usually involve taking note of our unhelpful temptations and gently, gradually doing the opposite.  You’re a bit oversensitive to light, so open the curtains.  You have no energy, so go for a short walk.  You fear dogs, so look at dog pictures on the internet.

Therapy, then, is inherently a pain in the butt.  The job will almost always be to make ourselves slightly more uncomfortable in the short run in order to feel less uncomfortable in the long run.

This is the short term / long term problem.  The question is not “Do you want to feel better?” but “When do you want to feel better, and how much?”

This is not just true in therapy, but in life in general.  On a daily basis we are faced with situations in which we have to make a choice between momentary relief and more lasting  happiness.  If we feel stuck, or if our behaviour seems self-destructive, we can ask ourselves “What am I doing to make myself feel better right now, and is this contributing to the problem?”

1 comment:

  1. Interesting post - thanks Dr. Patterson!