Psychotherapy and Training Collective of New York




BodyŚMind Strategies for Dealing With Anxiety and Depression

by Gerald Gersh, LCSW, BCD

One Day At A Time
That slogan was started in AA to deal with overwhelming anxiety and depression and has since helped thousands of people in anonymous groups. But you don't have to be in AA to use the phrase and I frequently use it with my patients. I even recommend 'one hour at a time' when in a crisis. You have to train yourself to think that way to avoid high levels of fear or 'catastrophizing'. This is often accompanied by destructive, hurtful obsessional features. Three concepts or techniques need to be used against anxious or depressing catastrophizing.

Step 1: STOP, DISTRACT, RELAX
It was a popular cognitive behavioral exercise created for panic attack patients over 30 years ago. One must first 'Stop' negative obsessional thinking by imagining a red stop sign in your head but most patients find snapping a thin rubber band against their wrist is more effective. This mild pain only allows seconds for you to implore 'Distraction'. You must distract yourself by utilizing your five senses in the most creative way possible, i.e. bite into an apple, smell a flower, read something or look out the window, splash cold water on your face, go take a walk outside or just into the other room. Distraction has now prepared you for conscious 'Relaxation'. Twenty minutes a day, three times a day (if necessary), lie down and listen to a recording of a waterfall, crickets at night, or any music you like. From head to toe, focusing on each body part, allow your full body weight to sink into the floor. Allow busy or negative thoughts to come and go and take slow deep breaths as practiced in yoga and meditation.

Step 2: SELF-SOOTHING
Children need to have their self-worth reflected back to them or "mirrored" by empathic and caregiving others. A core concept in Self Psychology. These affirming experiences allow them to learn self-soothing. Often, when we do not come from, as D.W. Winnicott would say "good enough mothering", that is a mother who did not adequately anticipate and meet our needs in infancy and adolescence or soothe us, we missed out on internalizing this function in our psyche. As a result, we have to learn how to meet our needs ourselves as adults or learn how to self soothe. But to meet our needs ourselves means going it alone and this brings to mind Winnicott's hallmark paper, "The Capacity to be Alone". In therapy, the therapist tries to accompany the patient and figuratively holds the patient's hand. In so doing, the patient doesn't go it alone as the process tries to stretch the patient's capacity to be alone. This is essential for meeting our needs ourselves.

Step 3: The JOY LIST
So how does one self soothe? Many years ago St. Vincent's Hospital conducted a study which resulted in the "JOY LIST". They found that anxious and depressed patients were anxious and depressed because they did not do what they liked to do. So they first had patients think of what they used to like to do and/or think of things they never did but would like to try. However, the study found that just thinking about what you liked to do was not enough. You had to write it down. Furthermore, the "JOY LIST" had to be placed in an every day location, i.e. on refrigerator. Even then, it was a given that patients would ignore or be too busy to look at this on multiple occasions. However, eventually, a patient would say, "I do have a free hour now so what did I write on that list?" They would do one of the activities they thought they'd enjoy and low and behold felt better.

I have been in private practice over 30 years and have treated patients from all walks of life. To this day it's remarkable when I ask patients what they like to do. 90% can only mention three things. I encourage them to try and get to ten. If you don't do what you like to do there's a good chance you'll feel depressed.

Finally, it may sound easy or over simplified, but one large aspect of my practice now focuses on getting patients to do what they like to do. Many people, however, have a natural resistance to doing this and that's where therapy can help. Freud felt the "working alliance "or "therapeutic alliance" between patient and therapist was essential to confront one's resistance, not alone, but as a team.