By Jason Gillespie
Life is a comedy for those who think
and a tragedy for those who feel.
Horace Walpole
The advances in neuroscience, especially over the past thirty years, have yielded groundbreaking insights into the neural architecture of the human brain. But with this new understanding, we find both opportunity and warnings in service to the human advance toward a better, yet unknown future.
Perhaps most powerful is the newly discovered role of the amygdala in the human brain which is derived from the Greek word for “almond”. It is located above the brainstem, near the bottom of the limbic ring. There are two amygdalas, one on each side of the brain, nestled toward the side of the head. And where the limbic structures do much of the brain’s learning and remembering, the amygdala is the specialist for emotional matters. Moreover, the amygdala acts as a storehouse of emotional memories and is the locus of significance and personal meaning in our life; more than affection, all passion depends on it.
We have all been confronted with predicaments, tasks and fearful life experiences that elicited emotional upset and a feeling of imminent threat or danger. In those moments we also discover ‘automatic’ (i.e., instinctive) reactions that are commonly referred to as a fight, flight or freeze behavioral response. Likewise, we can all attest to the efficacy of our response based on the ensuing outcome.
After the danger has passed, we inevitably perform a personal assessment (or others do it for us) of our verbal and behavioral posturing in the face of the crisis. Did we overreact, underreact, or were we just about right in our actions? The answer we give ourselves is of course subjective and based on a multitude of factors that are too lengthy to discuss here.
But we do come to realize that there is something going on in our brains that is on full display; we find ourselves trying to mobilize an appropriate (rational) response in the face of a physical threat whether real or perceived. In such moments, when anxiety and fear and anger are such overwhelming emotions, we are left vulnerable to a neuropsychological event known as emotional hijacking. [1]
As mental health professionals with over 60 years of combined clinical practice, my wife and I have encountered a wide range of mental health problems. This is less a statement of pride and more a confession of the amount of human emotional suffering we can give witness too as frontline clinicians. And in that experience, we can both attest to our observation that the most prevalent reason for mental health referrals is a poor coping response to stress.
Symptomatic behaviors typically include (but are not limited to) the following: anger outbursts; physical and emotional withdrawal or isolation (depression); increased rumination (worry) with or without panic attacks or phobias; drug and alcohol abuse; process addictions (e.g., pornography and overeating, etc.); and suicidal ideation and gesturing.
Further, poor coping responses are also seen in the context of a couple or family referral. However, this requires a more comprehensive treatment approach that addresses communication, interactional and structural problems that are contributing to the presenting complaints and manifested in the symptoms above.
Upon individual interview, complaints emerge that reveal important patterns of feeling and thinking that are contributing to self-defeating behavioral responses. The patient’s degree of emotional stress can be roughly quantified on a scale from low to high much like physical pain. The initial clinical interview(s) then, focuses on a more formal assessment of the intensity and the source(s) of the patient’s (dis)stress.
Treatment using Cognitive Behavioral Therapy (CBT) and its variants, begins with educating the patient as to how the human brain reacts automatically when presented with identifiable environmental triggers (as explained earlier). Patients are then introduced to the most common types of Negative Automatic Distorted Thoughts that contribute to self-defeating behaviors and the ensuing emotional upset. Patients discover even in the initial phases of treatment, that they have been caught in a repetitive and predictable cycle of negative thinking that is driving their emotional upset; and will contribute to further symptom development over time.
The introduction of a cognitive behavioral treatment approach is frequently received with skepticism. But a simple illustration is offered to quickly and effectively demonstrate the way our brains react to stress. It goes like this:
[therapist to patient] … “I want you to focus on a really negative thought (idea) that is very upsetting to you. Keep it simple and just keep thinking about it. Do you have it? Good. Now I want you to make yourself feel good (positive) about that thought.”
[patient to therapist] … “I can’t feel good about it!”
[therapist to patient] … “Exactly! That’s because you cannot have an upsetting feeling without FIRST having an upsetting thought. The sequence is hard wired in your brain (the amygdala). First comes the thought then the feeling. So if you want to learn how to feel better when you get upset or stressed, you will have to learn how to work with your brain rather than pretending you can change the way you feel without first changing your thinking.”
It is always a moment of joy when patients acquire this simple but factual insight. But then the real work begins by helping patients identify their particular Categories of Automatic Distorted Thought patterns. Here are some of the more common distorted thoughts that we have all experienced at various times but are especially destructive when you are under any kind of duress:
Mind reading: You assume you know what people think without sufficient evidence of their thoughts. “He thinks I’m a looser.”
Fortunetelling: You predict the future negatively. “I know I’m not going to get the job.”
Catastrophizing: You believe that what has happened or will happen will be so awful and unbearable that you won’t be able to stand it. “It would be terrible if I fail that test.”
Labeling (Name-calling): You assign global negative traits to yourself and others. “He’s really a jerk” or “I was an idiot for believing her.”
Overgeneralizing: You perceive a global pattern of negatives based on a single incident. “This happens every time I’m in rush hour traffic.”
Dichotomous thinking (black and white): You view events or people in all-or-nothing terms (good or bad, right or wrong, etc.) “That was a complete waste of time.”
Shoulds: (shoulda, woulda, coulda): You interpret events in terms of how things ‘should be’ rather than focusing on what is. “I should have done better.”
Blaming: You focus on the other person as the source of your upset and refuse to take responsibility for changing yourself. “She caused this and she’s to blame for what happened.”
Unfair Comparisons (apples to oranges): You have standards that are unrealistic and find yourself inferior or superior in the comparison. “She’s prettier than me.”
10. What if?: You keep asking a series of questions about “what if …”
something happens and you fail (refuse) to be satisfied with any of the
answers. “But what if I have a panic attack” or “What if they don’t hire me.
These are among the most common categories of distorted (negative) thinking but there are more. Patients find both insight and humor when exploring how this type of thinking manifests itself in their daily encounters with their world. Some become so masterful at recognizing when they are engaged in negative thinking that they start pointing it out when they observe it in others. They are, of course, instructed to avoid this and focus on what they can control.
The addition of Mood Logs (documenting negative thoughts) augments the treatment effort by giving homework to patients between interviews. Logging an upsetting situation holds the patient accountable for their negative thinking whenever and wherever they encounter emotional upset. The CBT treatment effort is typically concluded in 8-10 interviews depending on the severity of symptoms and the patient’s compliance with the treatment protocol. Additionally, a referral for further psychiatric follow-up for medication assessment can be a useful tool if there is evidence of familial (genetic) predispositions toward anxiety and mood disorder.
In summary, we must always take note of the reality that the Creator endowed us with two minds. The rational mind is prominent in awareness, thoughtful, able to ponder and reflect. But we are also given another system of knowing; impulsive and powerful and sometimes illogical … the emotional mind. The spiritually minded know this as the “heart” and the “head”. In most moments, these minds are exquisitely coordinated. But when passions surge the balance tips and the emotional mind rules supreme. The ancients knew this well:
Anyone can become angry ─ that is easy.
But to be angry with the right person,
to the right degree, at the right time,
for the right purpose, and in the
right way ─ this is not easy.
Aristotle, The Nicomachean Ethics
We are living in trying times. The historical reality is that we have always lived in trying times. Our Humanity is as resilient as it is fickle. Along the way we innovated ways to mitigate danger and increase survival by storing information in our large brains and translating it into words and then writing which advanced knowledge. That knowledge now reminds us of the delicate balancing act our brain performs in service to our individual well-being and the well-being of our neighbor.
The next time you find yourself upset, pause and take a moment to evaluate how your amazing brain has just tricked you into some category of negative and irrational thinking. Laugh at it and then make the necessary correction and move forward while remaining open to the possible need for additional help and support. And in that moment, you will discover how wondrously we are made in His image.
[1] Adapted from Daniel Goleman, Emotional Intelligence, October 1995