Depression Treatment

Positive Psychology in a Negatively Biased World


Dateline, Portland, Oregon—Amelia J. Wilcox, Ph.D.: Nobody has seen a saber-toothed tiger in eons, yet we still behave as though they are out there. Why so negative?

I have a lot to thank my pre-ancestors for—generation by generation, they made the right decisions to land me here, in this moment, writing this post. And those who lived in perpetually hazardous conditions had to be particularly dialed in to the world around them in order to avoid a variety of dangers. The ones who heard the snap of a twig signaling the approach of a predator, or remembered the particular berry eaten by someone who keeled over and died a short time later had an evolutionary advantage. That advantage kept them alive to breed the same attentiveness into subsequent generations.

In today’s world there are no true saber toothed tigers and our berries come vetted by the grocery store, yet we remain preferentially cued in to the negative around us. Is it a survival mechanism? Not for most of us. Instead it provides us with an implicit bias to pay attention to things that distress us, rather than appreciating the positive in our lives.

How do you know if you are doing this? Here’s a common example. You have a day filled with the typical ups and downs—a nice conversation with a friend or co-worker, a pleasant walk in the evening, a good meal, a moment of irritation with a friend. What do you think about as you are winding down for the day? If you are like most people, you will focus on the negative event, playing it over and over in your mind, paying no heed to the pleasantries of the day.

I think it helps us if we can remember this is a bias that made sense from an evolutionary perspective. But what was an essential survival tool back in the day is, in fact, a common contributor to depressed and anxious moods in contemporary times.

Martin Seligman is a psychologist whose observations have brought us many important theoretical models, including the concept of learned helplessness. In the past dozen years he has turned his attention away from what makes us anxious or depressed, focusing, instead, on what contributes to emotional growth. In the process he has become the father of positive psychology. Seligman has developed many tools and techniques (well-grounded in research) that help people create and sustain a greater sense of well-being in their lives, principles I apply routinely in my clinical practice. One of his tools is particularly useful in helping us learn to savor the small, positive events of our day, pushing against our biological drive to preferentially attend to the negative ones.

This easy and most powerful tool is the simple act of writing down three things that went well during the day each evening before sleep. Doing so helps us shift our cognitive bias away from the negative and toward the positive. It is easy to do, and while it sounds simple minded, I have seen this small behavior positively impact literally hundreds of lives.

Want to give it a try? Put a piece of paper and a pen by your bedside. Last thing before turning out the lights, write down three things you appreciated about your day. Maybe your favorite tree is in bloom, or you had coffee with a friend, or your dogs were there to greet you when you got home—these things don’t need to be earth shaking (in fact, they very likely won’t be), your goal is to simply notice the small things and jot them down in a word or a sentence.

Seligman’s research indicates that people who do this for a two-week period learn to savor the positive events of life. Even when they stop keeping the list, they feel significantly better six months later than they did at baseline. But as I tell my students and clients, you are going to savor something—why not make it something positive? it takes ten seconds, so keep it up forever!

Rozen, P., Royzman, E.B. (2001). Negativity bias, negativity dominance and contagion. Personality             and Social Psychology Review, 5(4), 296-320.      

Seligman, M.E.P., Steen, T., Peterson, C. (2005). Positive psychology progress: Empirical validation            of interventions. American Psychologist, 60(5), 410-421.

Common factors: What makes psychotherapy work?

Common Factors in Psychotherapy

There are many reasons why therapy is helpful. A fresh perspective, particular skills, expertise in the various things that ail people…all of these change agents make sense. But research suggests that these skills are not in and of themselves the true mechanisms of change in psychotherapy.

In fact, there is an overarching set of factors that create the benefit in psychotherapy, pathways that are common to all established psychotherapeutic models. They work precisely because humans are social, and psychotherapy heals through social contact.

According to researcher Bruce Wampold (2015) the common factors of psychotherapy can be understood as the development of a relationship, the creation of expectations of change and the establishment of health promoting behaviors.

Relationship: Wampold reminds us that the first order of business in psychotherapy is the establishment of relationship and the exploration of the therapeutic alliance. This bond is critical, and takes time, but some of it happens very quickly and to some extent outside of our conscious awareness. How? The same way it does in any other arena of life—we rapidly and implicitly take in style of dress, mannerisms, voice quality, even office décor and use these things to make judgments and the critical assessment of goodness of fit.

In my professional judgment, the relationship between therapist and client is perhaps the most critical feature of treatment. It is a human connection, and just as we don’t connect with everyone we meet, we cannot expect to connect with every psychologist. For this reason, I always encourage new potential clients to interview several people when choosing a psychologist.

Expectations: Wampold tells us that a person’s expectations for treatment have a huge impact on treatment outcome. Sometimes people arrive with a ‘last ditch’ attitude, the sense they’ve tried everything else and, having reached the bottom of their personal barrel are now subjecting themselves to the scrutiny of a stranger. Other times, people arrive with an expectation that together with their psychotherapist they’ll explore what has and has not worked in their lives, and come up with new solutions to old challenges. Perhaps these people are arriving with similar challenges—they are likely to have very different notions about what psychotherapy is about.

I firmly believe that we as a species are growth oriented, even when demoralization has led us to forget that fact. I also believe that people’s symptoms are not just signs of problems, they are representative of best efforts at coping and change. I think goal setting is critical to progress in treatment, and a collaborative effort that clearly places the locus of change where it belongs—in the middle of the treatment alliance, surrounded by the tasks and rituals of psychotherapy.

Tasks and Rituals: And what are the tasks and rituals of psychotherapy? That very much depends on the nature of the problem, the individual’s goals, and the background of the clinician. Regardless of the details, each task of therapy is focused in one way or another on what Wampold calls “salubrious actions.” The treatment alliance allows trust, and gives a person room to think about his or her world in new ways, to consider thoughts and feelings from a different point of view, to experiment with new ways of being in the world and to collaborate with the trusted other on the mechanisms of change.

But the heart of the entire endeavor is the treatment relationship. So when you are looking for a psychologist, consider goodness of fit as carefully as you do any other quality.

Wampold, B.E. (2015). How important are the common factors in psychotherapy? An update. World
       Psychiatry, 14(3).


The power of a good laugh

Dateline, Portland, Oregon—Amelia J. Wilcox, Ph.D.: A good laugh is hard to beat, and turns out to be contagious, and good for us. But why?

In 1979, Norman Cousins wrote a book titled Anatomy of an Illness. In it, the writer, political activist and editor of The Saturday Review outlined the story of his exuberant approach to a diagnosis of Ankylosing Spondylitis. The apocryphal story tells us that he checked himself out of the hospital and spent a month in intentional laughter. When he returned for an evaluation he was found to be disease free. His physicians did not believe he’d laughed himself to health. But note that in the next phase of his career he was appointed an adjunct professor of medical humanities in the UCLA School of Medicine, where he did research on the biochemistry of human emotions.  

I have written elsewhere in this blog about our habitual emotional states, and work with my patients around these matters all the time. In addition, for the last five years my Introductory Psychology students have chosen to do a positive psychology project each semester. I have seen hundreds of them engage in an examination of their habitual emotional states as a result of this project. And news from the front—Norman Cousins was right! Laughter is excellent medicine.

I am thinking about this today because of the viral video featuring a Texas woman who purchased a Chewbacca mask, and shared her joy with the entire internet world this week from the front seat of her car. At this moment, 1,037,162 people have viewed this hilarious clip. Why is it so popular? Well, it is (to say the least) contagious. She is sharing a moment of pure joy with all the world, and the world is laughing along.

Why are such things so popular on the internet? We love to watch kittens and puppies do silly things, babies giggle hysterically at fathers who tear up sheets of paper, and zoo animals behaving in unexpected ways. And seeing someone laugh—even if it is on a computer screen—makes us laugh, too.

To understand the contagious power of laughter, it helps to understand the role of mirror neurons. Mirror neurons are thought to be the home base of empathy, imitation and the recognition and capacity to share emotions that promote social engagement. These special neurons are found in the frontal and parietal lobes. They fire when we engage in behavior, and also when we observe behavior in others. In theory, observing laughter causes our mirror neurons to fire as though we were laughing ourselves.

When we choose laughter, we are making a choice to engage in something that bathes our bodies in stress-reducing hormones. There is evidence that this boosts our immune system, improves blood flow, boosts mood and dulls pain. Will it cure major illness? The evidence for this remains unclear, but there is no question that laughter creates a sense of engagement, soothes tension and destresses. So go ahead and find something funny to laugh about.

And to the wonderful woman in the Chewbacca mask, thank you! 

One effect of meditation on the brain

Dateline, Portland, Oregon--Amelia J. Wilcox, Ph.D.: Mindfulness-meditation is getting serious attention from scientists and consumers alike. Businesses are including it in their benefit packages, elementary schools are recognizing its power to improve classroom atmosphere, and psychologists are incorporating it into many treatments for conditions such as stress, anxiety and depression, pain management and insomnia. How, exactly, does it work on the brain?

Master meditators:
A number of years ago, psychologist and neuroscientist Richard Davidson began to look at meditation. In an effort to gain a clear picture of its effect on the brain, body and psyche, he went straight to the master-meditation source, Tibetan Buddhist monks. Monks in this tradition work for decades to become fully skilled in meditation practice, and they demonstrate the many positive effects of leading a life of contemplation. Monks are capable of a quality of focus, clarity, emotional control and mastery over bodily experience most of us would probably never expect to have in our own busy lives.

Can average people gain meditation’s benefit?
Davidson wondered whether some of the benefits of mindfulness-meditation practices could be taught to ordinary people with busy and stressful lives, and if so, whether the people who mastered basic skills would have a different experience of their world. To explore his idea that meditation might change people’s lives for the better, he brought a simple meditation training course to busy US executives. Eight weeks later he compared them to a matched sample of executives who had gone about life as usual.

Neural findings and experiential changes:
Davidson’s findings were powerful. EEG and fMRI data demonstrated that those who were taught simple meditation techniques shifted brain activity from parts of the brain associated with hypervigilance and stress toward brain regions associated with more positive mood states. Meditators in Davidson’s study also demonstrated improved immune response, when compared to those who were not taught simple meditation techniques.

What happens in the brain when we meditate:
Decades ago, neuropsychologist Donald Hebb coined the phrase neurons that fire together wire together. Some years later neuroscientists Per Andersen and Terje Lomo did basic brain research that led to the discovery of long-term potentiation, the scientific observation of Hebb’s neuropsychological theory. What does this have to do with meditation? Neurons that learn to fire together are developing habitual patters of action that have behavioral, emotional and learning correlates. As this applies to meditation and the frontal lobes, specifically, the meditating brain increases left prefrontal activation. With repeated practice, this activation becomes easier to produce, because healthy and functional neural pathways are created in the brain, and are strengthened and reinforced through meditation exposure. This is but one example of what is likely to be happening when you sit down to meditate.

Anecdotal reports:
Theory or practice, most people I know who make meditation part of their lives have a great deal to say about its positive impact on their mood and stress levels. And the research seems to back them up—indicating regular meditation may have powerful effects on a host of symptoms that are accepted as part of being alive in a stressful age.

People flock to yoga studios and meditation retreats in order to capture some of the effects in their own lives. But research indicates that even a few minutes a day spent in meditation, even if they happen while sitting at your desk, waiting in the carpool line or just before taking a big test in school, can lead to improvements in attention, concentration and clarity, and an improved sense of well-being.

Pond with lotus blossom.jpg

Getting started:
How do you get started? There are countless meditation apps available for your smart phone. Find one that works for you and see how it goes—keep a journal to track your progress. See what happens when your neurons fire together and wire together.

Following your path and appreciating your journey

Dateline Portland, Oregon--Amelia J. Wilcox, Ph.D.: The importance of insight, narrative review and developing a coherent sense of self.

In my professorial world, I frequently find myself talking with students who are trying to sort out their path in life. I have come to appreciate how easy it is for them to look at me and my faculty colleagues and figure we strode down a clear and well-marked hallway to get to where we sit today. Perhaps that is true for some, but for most of us (myself certainly included) it was more of a mountain trail, and the clarity of that journey is only truly visible when we look back. Looking back we find a clear and golden cord that leads from then to now, a cord woven by circumstance and design, and for most of us a good bit of chance and serendipity, too.

For many people—young and old alike--looking backward down the path of life is a kind of ritual of review. Milestones get revisited, mentors and friends celebrated, tragedies re-understood, family stories and fables and events remembered. Doing so reinforces how important it is to understand the self in this way. This backward review is sometimes a celebration, an opportunity to laugh with loved ones about events and strengthen connections that come from shared history. Sometimes it is an individual journey of reflection that highlights important truths and in doing so informs decisions and next steps. And sometimes it is a bittersweet struggle to make sense of a loss or manage a difficult and necessary life change. But review happens. And it makes people stronger in a bunch of ways.

For some, the backward glance down the path is threatening—a quick peek to make sure something isn’t sneaking up behind them in the dark. Often they experience their journey as a dash through a murky thicket of thorns and rough patches and potential danger. Why review it when the goal is simply to get through it as best you can? The past is ignored—appreciated only for having been survived.

Most people find themselves between these two extremes—pushing through challenges, appreciative of clearings when they come, as they allow for moments to catch their breath, review the journey a bit and prepare for the next uphill climb.

The question I am pondering today, as the New Year approaches, is whether there is merit in the ritual of review. Is there a useful purpose in finding your cord—the one woven from circumstance, design and serendipity? Is there value in pausing to intentionally sort through your narrative identity? Wise people have answered that question in many ways. And psychotherapeutic techniques across the decades have evolved to emphasize the importance of understanding the past and how it informs the present for each one of us.

One of the things I find most interesting about the narrative journey is the way in which our stories evolve over time. The historical truth doesn’t change, but our understanding of ourselves does, and as we learn more about our past, as we understand more about how it informs our present, and as our present lives evolve to reflect these new understandings so do our stories and truths and personal myths evolve. This is a gift of the psyche—one that allows us to appreciate anew the narrative of our lives, one that gives us opportunity to weave new strengths into the cord that leads us along the path into our present.

I wish for you an interesting path through the New Year, one that celebrates your life and builds on strength and hope and peace.