Answer: First, let’s recognize just how important it is. Exercise is a panacea, the miracle medicine. Almost everything gets better! Low mood, high anxiety, anger, sleep, immunity, energy, concentration and productivity. Self-image, weight, appearance and confidence. Sex, strength, longevity and range of activities…

That’s sixteen things I can list right off the bat. If this stuff was sold in a bottle, we’d pay a skinny arm and a leg for it!

Second, what if you revive your relationship, resolve your depression and cure your phobia…while meanwhile inviting an early and uncomfortable demise? How successful is that?

No health practitioner anywhere will discourage exercise, as long as it’s the right form and intensity for you.

So why aren’t we all doing it?

Mainly because we’re creatures of reinforcement: we do what is rewarding and avoid what is unpleasant. The problem here is that the rewards for exercise are all delayed, while the payoff for passivity happens right here, right now. The consequences for being sedate and inert are grave, but they come later.

We can tell ourselves over and over that the delayed gratification is better, and often this works. It works for those fit and active people you see around you, and it works for anyone who goes through school, raises children and so on. But by and large, immediate reward trumps delayed reward. This is a powerful effect and it is hard to overcome.

Then there is television and the Internet. They employ genius minds designing ways to keep us hooked in and it’s not hard. The allure of the screen, is powerful.

Television creates the illusion of being highly rewarding. We may think we’re relaxing, getting positive stimulation or whatever, but how often do you turn it off and feel better for what you’ve just watched? Can you imagine nearing the end of your life and contentedly thinking on how grateful you are for the programs you saw? Or wishing you’d watched more? Don’t get me wrong – it is plenty of fun. But so is candy.

But while the reward for TV may be insubstantial, it’s quick, vivid and effortless. Again, immediate reinforcement generally beats the pants off delayed gratification – unless we are strategic and conscientiously purposeful.

Another reason it is hard to exercise is that we’re creatures of patterns and familiarity. A body at rest stays at rest, and breaking the inertia takes much more energy than sustaining momentum. If you think about it, why would anyone want to leave a comfort zone?

You do want to exercise, or increase what you going? Contemplating it? Tired of getting it going only to have it drop off? Here are a few extra ways to help yourself:

Watch a program, not the television. Decide in advance what is really worth watching; don’t turn on the tube to see what it has to offer.

Plan before you start. Get everything set up – clothes, schedule, support from others. Anticipate any barriers and scheme around them in advance. Start drinking extra water. You can mark each session in your calendar and program your program your phone to send reminders.

Watch. Watch very intently. Watch for any and all the tiny rewards. Rewards are the key to continuity, but you aren’t conditioned to catch them. You’re conditioned to make note of what a pain in the butt it is, and of all the nice restful things you could be doing instead. You’re also conditioned to look for weight-loss, washboard abs and the “positive addiction”, all of which come much later if at all.

Any improvement in sleep, focus, pride, satisfaction, energy, enjoyment of the activity itself…these things may be very elusive and you must not let them slink away. You’re training yourself to find the payoffs that are available there for you to enjoy. They will grow bigger in time, in part because you’re gaining the strength to generate more, and in part because you’re more alert to them. With time, some elements which feel negative now, like sweating and huffing, solitude and ritual, may actually become positive later.

Accomplished athletes do not have it any easier than you do. They have simply aligned the reinforcers.

Finally exercise every darn day. I did not advise this in the past. I used to advise starting with however many days are realistic, and that approach may be what would work for you. But it doesn’t allow you to develop a hard-and-fast routine. Remember learning to brush your teeth? Did you learn by brushing when it felt right? And how disciplined are you with this dull chore now? Where there is no decision-making, there is no waffling and where there is no waffling you won’t…pancake. So do start small – but only in terms of the duration and the intensity of the exercise, which you’ll expand upon later. The success with frequency starts on day 2.

For more, see Self-Motivating When Stuck.

I decided that my string of failures comes from my lack of self-confidence. I was always fearful and timid and I can see now that this brought me just what I used to dread.

But I’m on a new pathway now. I started my own business, I have a new marriage and a I’m keeping to a solid fitness plan. I know that in the past I would have found some way to sabotage this initiative with doom-and-gloom thinking. This time it’s going to be different! My only enemy is my own fear. I’m visualizing success and refusing to consider a bad outcome. I’m not stupid enough to think failure is impossible, but I do know that we tend to create the reality we expect.

Agreed?

Answer:

Not quite.

Of course confidence is good, and we need to visualize where we want to go. But to think the positive visualization itself has much power is naive. Instead, I might coach you to study your enemy. That is, imagine and list all the ways in which this initiative could fall dead. Not enough business? Or so successful that you can’t fit in the full workout…or that you have to grab a burger just this time…and one more time the next week…

This is not a lack of self-assurance; it’s a recognition of reality. It’s not pessimistic thinking; it’s strategic foresight. And it’s not a lack of hope; it’s building the confidence to know you won’t come upon bad surprises ill-prepared.

If you made a mistake with your past “gloom-and-doom” thinking it wasn’t in predicting bad events, it was in dwelling on them passively, over-estimating their power, and thinking you couldn’t cope when they came. And a mistake now would be to think that fear has more power than it does. Or that you have the power to control an emotion. These are the surprise enemies, oddly familiar to us all.

So visualize failure. Welcome your fear. Harness it as caution, make your contingency plans and build your preparedness. Then go forward with the confidence that makes you strong. Tempered with the anxiety that makes you human.

I moved to Seattle to renew my life, yet I’ve been as depressed as ever. Shouldn’t I be less vulnerable in a beautiful place like this?

Answer:

I encounter people in this situation regularly. Seattle is a city of transplants, and the adjustment is not always quick or easy. Here are several reasons we could designate a special “Seattle depression” for newcomers in the the Emerald City.

First of all, moving sucks. You may have escaped a messy family situation and a doomed marriage, a rotten job and hell-hole physical setting, but you’ve come to a place where you don’t know many people. Isolation correlates with depression. Often, being with irritating people who you know may still better for your mood than being alone. Seattle has a reputation as a place where people are generally insular and hard to get to know. Whether or not the reputation is deserved your feeling blue and insecure will not help your efforts to integrate.

But I’m an introvert, you may say. People are a pain, and I like to be alone! Just the same, being human, you have tribalism in your genes. You don’t have to change you personal nature, but you might benefit by adjusting your patterns of affilliation.

Besides the isolation that comes with moving, you have disrupted your usual routines. Routine is good for your mood, plain and simple. Humdrum activity is still activity. It gives a sense of purpose it keeps you in motion and it lends structure to your day, whereas now that structure may be hard to come by.

The reduced light that comes with our long winters is undeniably a factor in depression, but an overblown one in my opinion. The problem with winter is not just the reduced sunlight but the fact that we don’t move around as much. Physical activity is good medicine for depression and it just doesn’t come as easily in the Seattle winter.  If you get a boost from taking walks in the summer, get a good parka and don’t let the went winter stop you.

All the disruption, lack of routine, reduced activity, seperation and isolation contributes to a sense of anomie – a breakdown in the usual social norms and standards that give us a sense of regulation, stability and belonging. Even a slight sense of dysregulation and weakened structure adds to anxiety.

As I have mentioned several times before, depressed people ruminate to try to find answers. Ruminating is a vortex. It gives the allusion that we are seeking answers when in fact we’re moving farther from solutions.

You can place all blame the nature of the city if you wish.  But if depression is the fault of this locale, we would have a measurably higher rate of depression.  We don’t.  Incidentally, the only city with a measurably higher rate of suicide is Los Vegas.

So what is to be done? As Mark Twain stated, “It takes a heap of livin’ to make a house a home”. You may need a plan to direct your activity more productively, to find more connection, gratification and pleasure, and tune your thinking to be less depressive. Then, you can begin feeling like you belong, perhaps even like it would be depressing to leave. CBT or cognitive-behavioral therapy is a practical way to do this.

Can you explain to me why it helps with post-traumatic stress to revisit the upsetting event or scene?

Answer:

Can you imagine a cowboy getting over a fear of horses by talking about it in an office?

When we’re in the midst of the horror of a traumatic event, our bodies are thrown into a high state of overdrive. This fight-or-flight response instantly puts the body into just the right mode for survival – battle-or-bolt. We need this arousal reaction – it’s very handy for self-preservation, not to mention the survival of the species. But, it has some disadvantages.

For one, it is easy to get too trigger-sensitive. That is, the merest hint of danger may ignite you. Say, a combat vet hearing a sudden noise, or a rape victim approached by a gentle man just a little too close and quickly. Both of these otherwise calm and poised individuals are instantly pitched into the same dreaded state.

A second disadvantage is that this fight-or-flight just shrieks. It’s terribly uncomfortable and we’ll do almost anything to avoid it. It’s supposed to be uncomfortable by the way. Is there any smoke alarm which gives a comforting little melody? The discomfort puts us on high alert, and trains us to avoid dangerous situations where we might experience the punishing sensation.

Finally, just as we link the “shriek” of the full-throttle fear response to the presence of danger, we also link danger to the response. Pavlov’s dogs hear a bell, therefore, they assume, it’s chow-time. It’s as if we say “I feel like there’s a grave danger, therefore, there must be a grave danger.” The sense of impending doom causes panic, which increases the sense of doom, and through the roof we go.

Now, you can read many books about post-traumatic stress disorder. You can talk with friends and therapists at length and you can perform rituals complete with incense. Actually these things are important – the support of friends and family, a sense of belonging, comforting rituals, a consistent structure to the day, a sense of purpose and meaning in your work and so on. Elements like this in your day-to-day life may prevent a traumatic event from shaping into post-traumatic stress disorder, or may soften PTSD and hasten its resolution. But the instant, patterned reactivity of PTST is in the gut, so to speak, and might remain untouched. In this case, you have to have the bodily experience, in a perfectly safe situation, to “unlearn” the reaction.

Think of the cowboy who’s been thrown from his horse. He can stay away from horses and feel just fine. He walks up to a horse though, and panic wells up. If he’s sensible like I am (or, uh…try to be), he’ll walk away from the horse and instantly feel better. But what just happened? The lesson is “close = danger, and distance = safety”. This has just confirmed to him that the horse is indeed hell-bent on killing him. He feels good for the time being, but has strengthened his PTSD.

Let’s go to the rape victim. She might stay away from a two-mile perimeter of the crime scene, she might avoid unknown men and will avoid imagining the awful event. Then she sees a therapist, who in this case is a little like the dentist in that he or she has to create discomfort to be effective. After plenty of preparation, and when the victim – wait – she was a victim. Now we’ll call her a client. When the client can pronounce with confidence that the office is in fact perfectly safe, she might be instructed to tell the story of the rape. In the present-tense, with detail. In all likelihood it will bring on that old terror. Almost like she’s there. “I feel like there’s grave danger, therefore… hey!” This time she sees that she is alive, safe and intact. She has started to learn, experientially, that she can afford to disconnect this particular alarm.

I’ll leave out other details of the process but if she repeats something like this often enough, very soon she’ll find that the retelling sparks less and less of a reaction. Keep going, and it will become downright manageable. She’ll be instructed to go out at night to safe places with safe people, and so on, to “desensitize” outside the therapy office in the same way.

The trauma happened in the past. Revisiting is not re-experiencing; it just feels like it. But feelings cannot harm you. Saddle up.

I’m so stressed and irritated. I live with my husband, our kids and his mother. The problem is she is too hard to get along with. She pesters and criticizes me constantly. I try to be polite sometimes I just blow up. I don’t want to upset my husband but I’m afraid some day I’m just going to pack up and move out. How can I keep myself calmer?

Answer:

You’re feeling pushed out of your own house, you might lose your marriage, split your children’s’ parents… and you don’t want to upset your husband? Is he that fragile?

I always have mixed feelings about helping someone to have an acceptable mood in an unacceptable situation. Stress and irritability could be looked at as a useful signal, like fear, or pain. If it is indicating there is a problem that needs to be rectified, you don’t necessarily want to just relieve it while the problem persists or grows.

Having your husband’s mother move out could be one solution, but every problem should have more than one. Here are some things I’ll suggest. You might sit down with a friend and draw up a brainstorm list of all conceivable solutions, from the most obvious (including no action), to the overly-exotic (build a bigger house), and so on. Hopefully, by going at some length, resisting the temptation to begin evaluating ideas, you could come up with creative directions. For instance, there could be multiple ways your boyfriend’s mother could give you more space besides moving out, perhaps. There could be changes to scheduling, communication, physical arrangements, ground rules and so on.

Second, it could be that your quarrel is not so much with your mother-in-law as with your husband. If she is asked to move out, wouldn’t he have to be the one to convey the news? And, if he is giving her signals that contradict yours, you may never feel she is hearing you. So, you could be so blunt as to tell him you will not accept the current arrangement, and that it is up to him to fix it. Hopefully, you won’t have to be quite that stark, and there would be a productive process between the two of you. But, if he is not hearing you, not picking up on just how important this is, it would be natural that you would amp up in order to get the message across.

Irritability can be pretty useful in putting some intensity into a message, so that it is not ignored. However, it can backfire. When there is a little too much, the receiver begins to block it out and to shut down. This will give rise to a vicious cycle: more anger bringing on more resistance, bringing on more anger. We have all these cultural images of the communicative one, who needs to agitate for change (maybe more often the female), getting nasty labels like shrew, nag, and worse, while Mr. Brick Wall, protecting the status quo, hides behind the newspaper (and two of the classic insults for him actually apply to his mother!). It is not anyone’s fault, just a pattern we can naturally fall into. So, you might pay attention to what kind of approach is going to be the most effective with him. Consider a careful choice of timing, a soft and gentle voice, and as powerful a statement about your misery as you can compose.

Other than this, I just don’t know how you can find some kind of solution without your boyfriend having to make some tough choices, which doesn’t come without disturbance. You can help him without being upset but I’m not sure you want to protect him from it.

I take care of my ailing mother, and I’m very willing to do it. One problem though, is that she expects more than I can provide. I know that if I give her all the time she wants from me, her life would be better. On the other hand, mine would be worse, and by a larger proportion -a net loss between the two of us. She cannot recognize this, and her expressions of sadness at the neglect she experiences makes my want to cry. I am plagued by guilt. What can I do?

Answer:

Guilt is an interesting word. It’s a feeling, and it’s also a status based on fact. A feeling is never right or wrong. We cannot “correct” an emotion. But a fact is either true on untrue. We are either guilty of doing something wrong, or we are not guilty. If we do something wrong, then we should feel guilty. It’s an important emotion, a signal that you are not aligned with your values and your community. To feel better, we have to make things right, and stop the improper behavior. If you have earned guilt and don’t feel guilty, it could be a problem.

On the other hand, it’s easy to feel guilty when we aren’t actually guilty of anything. If you take some time to attend to other matters and to rejuvenate yourself, and your dependent mother complains, you are getting a signal from her that you’ve done something wrong, that you’re unfairly causing her pain. You could assume guilt, and of course you’ll feel guilty. But then you could ask:

• Is this signal from my mother an accurate one?

• If she say’s I am unfair could she be wrong?

• If she does not take responsibility for her own contentment, then must I assume the duty?

• Are there other signals telling me I am not unfair? There is my doctor’s advice, my friends, my wife, an article, etc..

• Is it not possible to be compassionate and “selfish” at the same time?

There is another aspect to this. Without guilt, you would probably still feel badly. It is hard, and sad, to see your mother suffer. And it is harder to experience a degree of helplessness in the face of this. It is difficult to accept this limitation in the ability to help someone you love. But there is an escape. If you assume guilt, the implication is that you are making a choice. Even the implication that you are making a bad choice still implies that you have some control. Oddly, this sense of having power is easier to fathom than to fully acknowledge the lack of power. So, you could make the harder – but perhaps more wholesome and congruent – stark sadness about your mother’s suffering. Or there is the possibly easier – but less authentic – sense of guilt. I’m not which is more appealing.

I cannot bear my wife’s alcoholism any longer. If I stay I’ll perish. But if I leave her I’ll be in the financial pits. And strangely, I still love her!  I’ve been to an Al-Anon meeting but it’s not enough. Most of my friends tell me to leave her, and my family tells me to stick it out. What do I do?

Note: I first wrote this answer as a way to talk about methods to approach tough dilemmas, and since that time it has grown into the forum you see now. 

Thank you.

Answer:

You have a mighty dilemma. My first suggestion would be to treat with skepticism any advice to take choice 1 over choice 2. In the end, only you can decide. And only you will know just how much sadness and anxiety is going to be inherent with either option.

Try viewing your dilemma as four-pronged: Choice 1 would be that you decide to leave your wife and that you do so in the most careful, strategic manner, doing the most that you can to ensure this unfolds as becoming the right choice. Choice 2 would be that you leave in a way that magnifies the potential for a negative outcome, say by being mean, impulsive or passive, neglecting the care of your self, your social network, financial interests and so on. Choices 3 and 4 would be the most attentive, well-equipped approach to staying with her, vs. the approach that would leave you the most hurt.

In other words, the way in which you select a choice and then follow through on it what is important, and it is where you can make nitty-gritty choices on a day-to-day basis. The working out of those specifics might be where your attention is going to be productive.

There is another general rule in making a wrenching decision. Make the mistake you can correct. That is, whichever course is more reversible might be considered first. In your case, it is much easier to recover from the mistake of waiting a bit more, than to recover after discovering that divorce was a mistake. Naturally, this is a general guideline only.

One more thing. Loneliness and anxiety, among other troubles, are almost universally difficult for partners of alcoholics. Reaching out is good. More reaching out is better. Al-Anon is not for everyone in your situation, but those who do find it helpful would probably say that it’s the repeated attendance that makes it work.

Several years ago I survived a devastating divorce. With the help of therapy and a support group I came through some pretty heavy depression. Now, I’m happy to have a new mate in my life and we’re talking about getting married. Here’s what’s weird: suddenly I find myself crying about my old divorce again from time to time. Is this normal?

Answer:

Some might remember Elizabeth Kubler-Ross, who wrote On Death and Dying. The work was good in that it helped to break our taboo about talking about death, and it also helped to normalize and explain grief. She was the first to talk about grief coming in stages: denial, anger, bargaining, depression, and acceptance. Some talked about additional stages such as shock and testing, but the common belief back then was that we were supposed to go through each stage in turn. You finish up one, then move to the next.

It was a lie. The fact of the matter is, everyone grieves differently. The idea of stages is a nice one in general, but we don’t all have to hit all stages, and we certainly don’t hit one at a time, nor fully complete each one, never to look back. It’s much messier. No one has to take my word on this. Just look to your own experience or ask someone who has had a catastrophic loss. Many years afterwards, when you think the bereavement is settled, you can be startled by a new wave of depression, anger or whatnot. The best way to make it all worse might be to assume what’s happening is abnormal, since you aren’t following the “rules”. It would be pretty reasonable to assume these aftershocks are likely to come at a time of transition when our new handholds on normalcy get rattled.

Answer:

Yours is a good description of a common predicament. Depression robs you of motivation. You might also experience fatigue and poor concentration, and it may well be that you seem to have a disabling stream of negative self-talk. Lines of thinking such as “anything I do I screw up anyway” or, “there is no point in anything any more” can take on a logic of their own.

You might consider that even getting out of bed and to the couch can be considered a start, since you could ultimately choose to stay in bed all day if you wanted. So, almost anything you do next is an advance.

Second, it makes sense, in a way, to be very hesitant about what you set yourself up to do, because it is not a time when you want to experience defeat. In some ways it may be better to remain cautiously inactive than to suffer repeated false starts. Make sure your goals are modest enough.

So you should start small, of course, with something you are likely to succeed with, but also you should choose something likely to be as rewarding as possible. You can keep in mind that there are two categories of gratifying activity. One is accomplishment, such as cleaning up a room (or even one surface area). The other category is pleasure. This means anything enjoyable, such as people-watching from a park bench. Some activities, like walking somewhere scenic, cover both categories. Put some thought into which area will give you more bang for the buck.

During and after the activity, remember that depression dampens your perception of the experience. This means that you do not want to take your initial assessment of the experience at face value. Look hard for everything positive you can get from it. An initial thought, “that movie was awfully flat, and getting there was exhausting” might translate to “I see I haven’t lost my knack for panning a bad movie, not that was 100% percent bad, and getting there was an achievement.”

Don’t look for motivation. Remember, motivation is simply too scarce when you’re depressed, so you need other mobilizing forces. Here are ten of them. Together they spell “PRESCRIBER”. Use as many as you can to be your own prescriber of a cure:

P – Plan the activity ahead of time.

R – Reinforce the commitment by writing it down and involving one or two others.

E – Expect considerable difficulty so that you are not caught off guard. Use inevitable failures and setbacks to instruct you in your next effort.

S – Schedule the time to do it and put it in your calendar.

C – Commit yourself. “I will do this” not “I will try”.

R – Rearrange your environment ahead of time. For example, place your walking shoes in front of the coffee pot. Place a reminder note on your TV remote, or a neglected friend’s phone number on the refrigerator.

I – Ignore the negative inner dialogue, which uses funny logic to argue that you should stay on the couch. Recognize that this depression chatter does not reflect what you really value.

B – Build a routine from what you’ve done so that the later repetitions start to become automatic. It is likely that you have already done this with certain activities, like brushing your teeth.

E – Enjoy the hidden rewards. Your perceptions otherwise will not be oriented in this direction.

R – Record your efforts in a brief, simple format: What worked and how well, what did not, what got in the way, and how was your mood before and after. This provides more good reinforcement as well as useful information.

None of the advice makes this easy. Every one of these items deserves (and will get) more discussion, but following any of them to any degree will help you to get momentum. You might choose just one to start with if this is all you can do, as long as this is enough to give you a sense of traction. It is still work, and it requires that you persevere. Keep in mind that while the short-term incentive is a bit of respite from your depression, the long-term aim is rich one: A life with more meaning.

Tracy: I love Taylor. We’re the best of friends and in many ways, are closer than we ever were before. This makes it all the more perplexing that sex has become flat. It’s loving, but it’s routine, and less appealing all the time. I don’t know how to bring this up without hurt feelings, but our relationship is lacking in nourishment.

Taylor: I love Tracy. We’re the best of friends and in many ways we’re closer than ever before. And so it’s all the more painful when I hear that our sex life is dissatisfying. I am able to accept that we can’t possibly maintain the fervor and sense of novelty we used to have. And I don’t want the same frequency either, much less the pizazz. Hearing it should be different more makes me want it less. You could say that we have occasional good protein and I’ve grown beyond the taste for spice and desert.

(Names made gender-neutral for the sake of broader applicability.)

Answer:

Sex is like food in quite a few ways. Leaving aside many of the other similarities, it’s nice to have familiarity leavened with some variety to remain appealing. I don’t mean variety in partners. It’s within the container of a committed, trusting relationship that we can really range out. It’s like…you can stay in Seattle and explore to any restaurant you want.

In this ranging there are a couple of branches, in my way of thinking. One is the romantic. This is like comfort food. Good, wholesome, sustaining regular meals. Sex is tender, loving, mutual, familiar and nice, and you can find new dimensions the older you get.

The other branch is adventure. Exotic food. By adventurous sex, I don’t mean weird, or always novel and inventive. The pressure to maintain this over the years would not be sexy. I mean the spirit of adventure, where you dare to test the bounds of conventionality a bit, where comfort is high but excitement is higher. Where the atmosphere has some electricity and stimulation becomes thrill. Simply put, it’s hot.

An ironic quality to sex with this edge is that both people can be selfish. You assert exactly what you want. Be bold about it. And of course your partner must do the same. It may be that you are more or less “doing” the other at any one time, with all the attention on maximizing pleasure for the other – while he or she can indulge purely in his or own pleasure, thanks to your full devoted focus. “Tonight I’ll cook, you eat.”

Hot sex is not for all phases of a relationship. When when stress is high, parenting is hectic or insecurities and resentments are up and communication is crimped – then you probably need just the nourishment of comfort food. And even that may be in small portions.

Tracy-types take note: Rest, trust and affirming communication first. Then, adventure sex maybe. If your quest becomes a battle, you’re getting further from what you want.

Taylor-types take note: Loving, stable, trusting couples can get embedded in the comfort zone. Once a groove, now a rut. Both of you may feel secure with it, but also under-appreciated. And your mate’s klutziness in talking about this doesn’t mean it shouldn’t be talked about.

A therapist or marriage counselor can help with restocking the kitchen.