When someone normally talks about exercise, we usually don't envision someone doing 700 crunches, push-ups until their arms burn, and running uncountable miles every day, but this is often what people with eating disorders get caught up in. Along with the starvation and/or purging, someone with an eating disorder may also compulsively exercise out of control - sometimes to the point where eventually bones can become permanently damaged.

Why Does Compulsive Exercise Happen?

The exercising demon is always in cahoots with an eating disorder. Compulsive exercising is just another way for the person to purge themselves of guilt and pain. Often it is used as punishment because the person has eaten over a certain amount of calories, because they have binged that day, or because they did not do well on a test, annoyed a parent, etc. Many times the individual must exercise a certain amount in order to be worthy enough to eat that day or be able to do an enjoyable activity. Exercising a certain, exhausting amount and doing the exercises in a certain order will give the person with an eating disorder a certain sense of power and control as well - the same kind that also comes out of being able to starve and/or purge.

Why Can't the Person Just Stop?

Addiction is the keyword here, my dear. As hard as it is for an "outsider" to imagine, compulsive exercising does indeed become an addiction just like the disordered eating behaviors. The reason it is called COMPULSIVE exercising is that the person cannot control what they are doing eventually. It gets to the point where they absolutely MUST exercise or else. If the person does not or is unable to exercise, they get the same feelings and show the same reaction that someone with anorexia has when they are forced to eat or the same reaction that someone with bulimia has when they are forced to keep down the food of a binge. Panic attacks and sometimes even flashbacks bash into the person head-on leading to hallucinations and shallow, erratic breathing. The person is unable to calm down until they somehow get in their exercising.

Oh these little earthquakes
Here we go again
These little earthquakes
Doesn't take much to rip us into pieces-Tori Amos

It isn't uncommon to find out that a person will exercise in a bathroom stall at school, or miss a day of work to make up running when afflicted with this bothersome pest. Often in hospitals nurses must monitor eating disorder patients when they are in the shower or going to the bathroom because patients will try to sneak in exercise. Realize that these exercises are not fun, and are more like grueling and painstaking, taking up the time, energy, and thoughts of the person afflicted. Worst of all, they can't stop once this gets started.

Medical Problems from Compulsive Exercise

A person with an eating disorder who is also afflicted with compulsive exercise is in extreme danger for developing medical problems. Any heart murmurs or arrythmias are naturally aggravated and made worse. Because the nutrition of someone with an eating disorder is so poor, the individual also runs the risk of bone damage and loss from osteoporosis. In athletes with compulsive exercising it isn't uncommon for them to be afflicted with stress fractures and more physical injuries than their other teammates. Any injuries the person does get do not heal, either, or they take an abnormally long time. A bruise on the hip from bumping into a chair may take as long as two months to fully heal because the body is so run down and does not have the proper nutrition to heal the damage.

Treatment Options for Compulsive Exercise

For the adequate treatment of the compulsive exercising bug, something called obsessive-compulsive disorder (OCD) must be treated ALONG WITH the eating disorder. It is important that you or the person you are concerned about lets their therapist or caretaker know that the eating disorder isn't the only problem that they are battling. Realize that until proper treatment, compulsive exercising is just like alcohol to an alcoholic - they cannot just take "one sip" and not go any further. Once you or the person afflicted is in treatment and learns how to do things in MODERATION, then an exercise regime can be set up once more.

THE NATURE OF THE TROUBLE AND THE FORMS OF HELP

What Does "Depression" Mean?

The term "depression" means to psychiatrists and psychologists a continued state of mind with these central characteristics: (1) You are sad or "blue." (2) You have a low regard for yourself. In addition, (3) a sense of being helpless and hopeless is an integral part of the depression process. A variety of other symptoms such as poor sleep may or may not accompany these two core symptoms. They are not central to the depression.

Sadness is not equivalent to depression, and not all sadness is pathological. Everyone is sad from time to time, sometimes in response to genuinely sad events such as the loss of a loved one. The sadness that follows such a loss is natural and even necessary, and should be accepted as such. Unless the sadness continues un-normally -- that is, continues so long that it disturbs a person's life, and the person feels that there is something wrong -- the label "depression" does not apply. But if the sadness does continue un-normally, and then picks up a feeling of worthlessness as a companion and turns into a prolonged state, the condition then becomes an enemy to be fought.

Very occasionally there may be some doubt about whether to call a person "depressed", especially when sadness continues for a long time after a tragic death. In such a case, the person may not feel worthless. But almost always depression is clear-cut, though the depth of depression may vary.

Sadness is caused by the mechanism which will be described shortly. If you understand and manipulate the mechanism properly, you can get rid of the sadness. The depression mechanism does not by itself produce or explain low self-regard. But if you operate the mechanism appropriately, you are likely to get rid of the low self-regard, too, and at the least you will not be preoccupied with it and ravaged by it.

This is the mechanism which causes the sadness in depression: Whenever you think about yourself in a judgmental fashion--which most of us frequently do--your thought takes the form of a comparison between a) the state you think you are in (including your skills and capacities) and b) some other hypothetical "benchmark" state of affairs. The benchmark situation may be the state you think you ought to be in, or the state you formerly were in, or the state you expected or hoped to be in, or the state you aspire to achieve, or the state someone else told you you must achieve. This comparison between actual and hypothetical states makes you feel bad if the state in which you think you are in is less positive than the state you compare yourself to. And the bad mood will become a sad mood rather than an angry or determined mood if you also feel helpless to improve your actual state of affairs or to change your benchmark.

We can write the comparison formally as a Mood Ratio:

Mood=(Perceived state of oneself) (Hypothetical benchmark state)

If the numerator (perceived state of oneself) in the Mood Ratio is low compared to the denominator (hypothetical benchmark state) --a situation which I'll call a Rotten Ratio--your mood will be bad. If on the contrary the numerator is high compared to the denominator--a state which I'll call a Rosy Ratio--your mood will be good. If your Mood Ratio is Rotten and you feel helpless to change it, you will feel sad. Eventually you will be depressed if a Rotten Ratio and a helpless attitude continue to dominate your thinking. This precise formulation constitutes a new theoretical understanding of depression.

The comparison you make at a given moment may concern any one of many possible personal characteristics--your occupational success, your personal relationships, your state of health, or your morality, for just a few examples. Or you may compare yourself on several different characteristics from time to time.

If the bulk of your self-comparison thoughts are negative over a sustained period of time, and you feel helpless to change them, you will be depressed. Check yourself and you will observe in your mind such a negative self-comparison ("neg-comp" for short) when you feel bad, whether or not the sadness is part of a general depression.

Only with this Self-Comparisons Analysis can we make sense of such exceptional cases as the person who is poor in the world's goods but nevertheless is happy, and the person who "has everything" but is miserable; not only do their actual situations affect their feelings, but also the benchmark comparisons they set up for themselves.

The sense of loss, which often is associated with the onset of depression, also can be seen as a negative self-comparison (neg-comp) -- a comparison between the way things were before the loss, and the way they are after the loss. A person who never had a fortune does not experience the loss of a fortune in a stock market crash and therefore cannot suffer grief and depression from losing it. Losses that are irreversible, such as the death of a loved one, are particularly saddening because you are helpless to do anything about the comparison. But the concept of comparisons is a more fundamental logical element in thought processes than is loss, and therefore it is a more powerful engine of analysis and treatment.

The key element for understanding and dealing with depression, then, is the sadness-producing negative comparison between one's actual state and one's benchmark hypothetical situation, together with the attitude of helplessness as well as the conditions that lead a person to make such comparisons frequently and acutely.

Now we are ready to ask: How can you manipulate your mental apparatus so as to prevent the flow of negative self-comparisons about which you feel helpless? There are several possibilities for any given person, and any one method may be successful for you. Or perhaps some combination of methods will prove best for you. The possibilities include: changing the numerator in the Mood Ratio; changing the denominator; changing the dimensions upon which you compare yourself; making no comparisons at all; reducing your sense of helplessness about changing the situation; and using one or more of your most cherished values as an engine to propel you out of your depression. Sometimes a powerful way to break a logjam in your thinking is to get rid of some of your "oughts" and "musts", and recognize that you do not need to make the negative comparisons that have been causing your sadness. I'll say a few words about each possibility now, and I'll discuss each general tactic at length later in the book.

Improving Your Numerator

Are you actually in as bad shape as you think you are? If you have an incorrect unflattering picture of some aspects of yourself that you consider important, then your self-comparison ratio will be erroneously negative. That is, if you systematically bias your estimate of yourself in a manner that makes you seem to yourself objectively worse than you really are, then you invite needless negative self-comparisons and depression.

We are talking about assessments of yourself that can be checked objectively. An example: Samuel G. complained that he was a consistent "loser" at everything he did. His counselor knew that he played ping pong, and asked him whether he usually won or lost at ping pong. Sam said that he usually lost. The counselor asked him to keep a record of the games he played in the following week. The record showed that Sam won a bit more often than he lost, which surprised Sam. With that evidence in hand, he was receptive to the idea that he also was giving himself a short count in other areas of his life, and hence producing fallacious negative self-comparisons and a Rotten Ratio. If you can raise your numerator - if you can find yourself really to be a better person than you now think you are -you will make your self- comparisons more positive. By so doing you will reduce sadness, increase your good feelings, and fight depression.

Sweetening Your Denominator

When told that life is hard, Voltaire asked," Compared to what?" The denominator is the standard of comparison that you habitually measure yourself against. Whether your self- comparison appears favorable or unfavorable depends as much upon the denominator you use as upon the supposed facts of your own life. Standards of comparison include what you hope to be, what you formerly were, what you think you ought to be, or others to whom you compare yourself.

"Normal" people--that is, people who do not get depressed frequently or for a long time--alter their denominators flexibly. Their procedure is: choose the denominator that will make you feel good about yourself. Psychologically-normal tennis players choose opponents who provide an even match--strong enough to provide invigorating competition, but sufficiently weak so you can often feel successful. The depressive personality, on the other hand, may pick an opponent so strong that the depressive almost always gets beaten. (A person with another sort of problem picks an opponent who is so weak that he or she provides no exciting competition.)

In the more important life situations, however, it is not as easy as in tennis to choose a well-fitting denominator as the standard of comparison. A boy who is physically weak and unathletic relative to his grammar-school classmates is stuck with that fact. So is the child who is slow at learning arithmetic, and the homely girl. A death of a spouse or child or parent is another fact which one cannot deal with as flexibly as one can change tennis partners.

Though the denominator that stares you in the face may be a simple fact, you are not chained to it with unbreakable shackles. Misery is not your inexorable fate. People can change schools, start new families, or retrain themselves for occupations that fit them better than the old ones. Others find ways to accept difficult facts as facts, and to alter their thinking so that the unpleasing facts cease causing distress. But some people--people we call "depressives"--do not manage to free themselves from denominators that hag-ride them into depression, or even unto death by suicide or other depression-caused diseases.

Why do some people appropriately adjust their denominators while others do not? Some do not change their denominators because they lack experience or imagination or flexibility to consider other relevant possibilities. For example, until he got some professional career advice, Joe T. had never even considered an occupation in which his talent later enabled him to succeed, after failing in his previous occupation.

Other people are stuck with pain-causing denominators because they have somehow acquired the idea that they must meet the standards of those pain-causing denominators. Often this is the legacy of parents who insisted that unless the child would reach certain particular goals--say, a Nobel prize, or becoming a millionaire--the child should consider himself or herself a failure in the parent's eyes. The person may never realize that it is not necessary that she or he accept as valid those goals set by the parents. Instead, the person masturbates, in Ellis's memorable term (and note that Ellis has good words to say about masturbation). Ellis emphasizes the importance of getting rid of such unnecessary and damaging "oughts" as part of his Rational- Emotive variation of cognitive therapy.

Still others believe that attaining certain goals--curing others of illness, or making a lifesaving discovery, or raising several happy children--is a basic value in itself. They believe that one is not free to abandon the goal simply because it causes pain to the person who holds that goal.

Still others think that they ought to have a denominator so challenging that it stretches them to the utmost, and/or keeps them miserable. Just why they think that way is not usually clear to those persons. If they learn why they do so they often stop.

Chapter 13 describes a six step-procedure that can help you change your denominator to a more livable standard of comparison than the one which may now be depressing you.

New Dimensions and Better Ratios

If you can't make the old Mood Ratio rosy or even livable, then consider getting a new one. Folk wisdom is indeed wise in advising us to forcefully direct our attention to the good things in our lives instead of the bad things. Counting one's blessings is the common label for focusing on dimensions that will make us happy: remembering your good health when you lose your money; remembering your wonderful loving children when the job is a failure; remembering your good friends when a false friend betrays you, or when a friend dies; and so on. What folk wisdom does not tell you is that counting your blessings often is not easy to do. It can require great effort to keep your attention focused on your blessings and away from what you consider your curse.

Related to counting blessings is refusing to consider aspects of your situation which are beyond your control at the moment in order to avoid letting them distress you. This is commonly called "taking it one day at a time." If you are an alcoholic, you refuse to let yourself be depressed about the pain and difficulty of stopping drinking for the rest of your life, which you feel almost helpless to do. Instead, you focus on not drinking today, which seems a lot easier. If you have had a financial disaster, instead of regretting the past you might think about today's work to begin repairing your fortunes.

Taking it one day at a time does not mean that you fail to plan for tomorrow. It does mean that after you have done whatever planning is possible, you then forget about the potential dangers of the future, and focus on what you can do today. This is the core of such books of folk wisdom as Dale Carnegie's How to Stop Worrying and Start Living.9

Finding personal comparisons which make your Mood Ratio positive is the way that most people construct an image of themselves which makes them look good. The life strategy of the healthy-minded person is to find a dimension on which he or she performs relatively well, and then to argue to oneself and to others that it is the most important dimension on which to judge a person.

A 1954 popular song by Johnny Mercer and Harold Arlen went like this: "You've got to accentuate the positive...Eliminate the negative...Latch on to the affirmative...Don't mess with Mister In-between." That sums up how most normal people arrange their views of the world and themselves so that they have self-respect. This procedure can be unpleasant to other people, because the person who accentuates his or her own strengths may thereby accentuate what in other people is less positive. And the person often proclaims intolerantly that that dimension is the most important one of all. But this may be the price of self-respect and non-depression for some people. And often you can accentuate your own strengths without being offensive to others.

A more attractive illustration: appreciating your own courage is often an excellent way to shift dimensions. If you have been struggling without much success for years to convince the world that your fish-meal protein is an effective and cheap way of preventing protein-deficiency diseases in poor children (an actual case), you may be greatly saddened if you dwell on the comparison between what you have achieved and what you aspire to achieve. But if you focus instead upon your courage in making this brave fight, even in the face of the lack of success, then you will give yourself an honest and respectable positive comparison and a Mood Ratio which will make you feel happy rather than sad, and which will lead you to esteem yourself well rather than poorly.

Because of childhood experiences or because of their values, depressives tend not to be flexible in choosing dimensions that will make them look good. Yet depressives can successfully shift dimensions if they work at it. In addition to the ways mentioned above, which will be discussed at length in Chapter 14, there is still another -- and very radical -- way to shift dimensions. This is to make a determined effort -- even to demand of yourself -- in the name of some other value, that you shift from a dimension that is causing you grief. This is the core of Values Treatment which was crucial in curing my 13-year depression; more about this shortly.

The Sound of a Numerator Clapping

No self-comparisons, no sadness. No sadness, no depression. So why don't we just get rid of self-comparisons completely?

A practicing Zen Buddhist with an independent income and a grown family can get along without making many self-comparisons. But for those of us who must struggle to achieve our ends in the workaday world, some comparisons between what we and others do are necessary to keep us directed toward achieving these ends. Yet, if we try, we can successfully reduce the number of these comparisons by focusing our minds on other activities instead. We can also help ourselves by judging only our performances relative to the performances of others, rather than judging our very selves -- that is, our whole persons -- to others. Our performances are not the same as our persons.

Work that absorbs your attention is perhaps the most effective device for avoiding self-comparisons. When Einstein was asked how he dealt with the tragedies he suffered, he said something like: "Work, of course. What else is there?"

One of the best qualities of work is that it is usually available. And concentrating upon it requires no special discipline. While one is thinking about the task at hand, one's attention is effectively diverted from comparing oneself to some benchmark standard.

Another way to shut off self-comparisons is to care about other people's welfare, and to spend time helping them. This old-fashioned remedy against depression--altruism--has been the salvation of many.

Meditation is the traditional Oriental method of banishing negative self-comparisons. The essence of meditation is to shift to a special mode of concentrated thinking in which one does not evaluate or compare, but instead simply experiences the outer and inner sensory events as interesting but devoid of emotion. (In a less serious context this approach is called "inner tennis.")

Some Oriental religious practitioners seek the deepest and most continuous meditation in order to banish physical suffering as well as for religious purposes. But the same mechanism can be used while participating in everyday life as an effective weapon against negative self-comparisons and depression. Deep breathing is the first step in such meditation. All by itself, it can relax you and change your mood in the midst of a stream of negative self-comparisons.

We'll go into details later about the pro's and con's and procedures for various methods to avoid self-comparisons.

Getting Hope Back

Negative self-comparisons (neg-comps) by themselves do not make you sad. Instead, you may get angry, or you may mobilize yourself to change your life situation. But a helpless, hopeless attitude along with neg-comps leads to sadness and depression. This has even been shown in rat experiments. Rats that have experienced electric shocks which they cannot avoid later behave with less fight and more depression, with respect to electric shocks that they can avoid, than do rats that did not experience unavoidable shocks. The rats that experienced unavoidable shocks also show chemical changes like those associated with depression in humans.10

It behooves us, then, to consider how to avoid feeling helpless. One obvious answer in some situations is to realize that you are not helpless and you can change your actual state of affairs so that the comparison will be less negative. Sometimes this requires gradual re-learning through a graded series of tasks that show you that you can be successful, eventually leading to success in tasks that at the beginning seemed overwhelmingly difficult to you. This is the rationale of many behavioral-therapy programs that teach people to overcome their fears of elevators, heights, going out in public, and various social situations.

Indeed, the rats mentioned in the paragraph above, which learned to be helpless when given inescapable shocks, were later taught by experimenters to learn that they could escape the later shocks. They showed diminished chemical changes associated with depression after they had "unlearned" their original experiences.

Mitigating the helpless and hopeless attitude is discussed at greater length in Chapter 17.

A New Hope: Values Treatment

Let's say that you feel you're at the end of your rope. You believe that your numerator is accurate, and you see no appealing way to change your denominator or your dimensions of comparison. Avoiding all comparisons, or drastically reducing the quantity of them, does not attract you or does not seem feasible to you. You'd prefer not to be treated with anti-depression drugs or shock treatment unless there is absolutely no alternative. Is there any other possibility open to you?

Values Treatment may be able to rescue you from your end-of- the-rope desperation. For people who are less desperate, it may be preferable to other approaches to their depressions. The central element of Values Treatment is discovering within yourself a value or belief that conflicts with being depressed, or conflicts with some other belief (or value) that leads to the negative self-comparisons. That is how Bertrand Russell passed from a sad childhood to happy maturity in this fashion:

Now [after a miserably sad childhood] I enjoy life; I might almost say that with every year that passes I enjoy it more. This is due partly to having discovered what were the things that I most desired, and having gradually acquired many of these things. Partly it is due to having successfully dismissed certain objects of desire-- such as the acquisition of indubitable knowledge about something or other--as essentially unattainable.11

Values Treatment does exactly the opposite of trying to argue away the sadness-causing value. Instead it seeks a more powerful countervailing value to dominate the depression-causing forces. Here is how Values Treatment worked in my case: I discovered that my highest value is for my children to have a decent upbringing. A depressed father makes a terrible model for children. I therefore recognized that for their sake it was necessary to shift my self-comparisons from the occupational dimension that led to so many negative comparisons and sadness, and focus instead on our health and the enjoyment of the day's small delights. And it worked. I also discovered that I have an almost religious value for not wasting a human life in misery when it can possibly be lived in happiness. That value helped, too, working hand in hand with my value that my children not grow up having a depressed father.

That description makes the process seem much easier than it really is, of course. Focusing your mind upon your chosen values requires effort, often very great effort. Sometimes the required effort is so great that you cannot will yourself to make it, and instead you let yourself remain in the slough of despond. But the method of Values Treatment teaches you what has to be done, and gives you a reason for making the effort to do what must be done.

The depression-fighting value may be (as it was for me) the direct command that life should be joyful rather than sad. Or it may be a value that leads indirectly to a reduction in sadness, such as my value that my children should have a life-loving parent to imitate.

The discovered value may lead you to accept yourself for what you are, so that you can go on to other aspects of your life. A person with an emotionally-scarred childhood, or a polio patient confined to a wheelchair, may finally accept the situation as fact, cease railing at fate, and decide not to let the handicap dominate. The person may decide to pay attention instead to what he can contribute to others with a joyful spirit, or how he can be a good parent by being happy.

Values Treatment need not always proceed systematically. But a systematic procedure may be helpful to some people, and it makes clear which operations are important in Values Treatment. In Chapter 18 I'll describe such a systematic procedure for Values Treatment.

Is This Magic?

Please let's get this straight: This book, and cognitive therapy in general, do not offer you an instantly-working formula that will transport you from misery to bliss without the slightest effort or attention on your part. In order to transform yourself from being sad to being joyful you'll have to give the problem your attention and some hard work--whether you do the work alone or with the help of a professional counselor. The work includes writing down and analyzing your thoughts, a tedious but invaluable exercise. If you picked up this book looking for a while-you-wait no-sweat miracle, put it right back down again.

Nevertheless I do offer you "magic." I offer you a new analytic way of understanding your depression, upon which you can build a rational, successful procedure for extricating yourself from your unhappy jam. And the cure need not wait for long years of psychotherapy, dredging up the details of your past life and reliving it all. If you do choose to get outside help, ten or twenty sessions with a therapist are par for the course, and insurance often pays most of the cost.

This is not a guarantee that you will succeed with this method. But it is a promise that a speedy cure -- faster than nature's usual regenerative processes -- is possible for a large proportion of depression sufferers. Understanding aspects of your past life may be helpful in figuring out how to reconstruct your present mental life. But cognitive therapy focuses on the present structure of your thinking, and on changing that structure so that you can live with it joyfully, rather than simply proceeding to examine your history in the faith that such an examination will eventually produce a cure.

Though I believe that this book offers the most powerful methods for overcoming your depression, I recommend as strongly as I can that you read other books as well. The more you learn, the greater the chances that you will stumble across sentences or thoughts or anecdotes which will be just the right triggers for you to understand and cure your own depression. The best books for laymen, in my opinion, are David Burns's Feeling Good and Albert Ellis's and Robert Harper's A New Guide to Rational Living. Both contain lots of practical suggestions, as well as dialogues between therapists and depression sufferers which demonstrate the processes involved in dealing with depressed thinking. Your reading of those books will be even better if you bring to them the Self-comparisons Analysis discussed in this book. It will render the ideas in the other books more specific, and easier to understand and put to work. And after you have worked your way through one or both of those books, you might like to study some of the other books, including some intended for professionals, named in the reference at the end of their book.

You may also find crucial nuggets of wisdom in the aphorisms and anecdotes which fill popular self-help books. The common- sense ideas in those books would not live on from generation to generation they it did not help a substantial number of people from time to time.

Making yourself happy when you have been depressed is a great achievement. That achievement can make you proud of yourself in addition to the relief from pain and the new joy it brings. I wish you the same success and joy that I have had in using this method.

Summary

The term "depression" means a continued state of mind with these central characteristics: (1) You are sad or "blue." (2) You have a low regard for yourself. In addition, (3) a sense of being helpless and hopeless is an integral part of the depression process.

This mechanism causes the sadness in depression: Whenever you think about yourself in a judgmental fashion, your thought takes the form of a comparison between a) the state you think you are in (including your skills and capacities) and b) some other hypothetical "benchmark" state of affairs. The benchmark situation may be the state you think you ought to be in, or the state you formerly were in, or the state you expected or hoped to be in, or the state you aspire to achieve, or the state someone else told you you must achieve. This comparison between actual and hypothetical states makes you feel bad if the state in which you think you are in is less positive than the state you compare yourself to. And the bad mood will become a sad mood rather than an angry or determined mood if you also feel helpless to improve your actual state of affairs or to change your benchmark.

If you understand and manipulate the mechanism properly, you can get rid of the sadness. The depression mechanism does not by itself produce or explain low self-regard. But if you operate the mechanism appropriately, you are likely to get rid of the low self-regard, too, and at the least you will not be preoccupied with it and ravaged by it.

We can write the comparison formally as a Mood Ratio:

Mood=(Perceived__state__of__oneself) (Hypothetical benchmark state)

If the numerator (perceived state of oneself) in the Mood Ratio is low compared to the denominator (hypothetical benchmark state) --a situation which I'll call a Rotten Ratio--your mood will be bad. If on the contrary the numerator is high compared to the denominator--a state which I'll call a Rosy Ratio--your mood will be good. If your Mood Ratio is Rotten and you feel helpless to change it, you will feel sad. Eventually you will be depressed if a Rotten Ratio and a helpless attitude continue to dominate your thinking. This precise formulation constitutes a new theoretical understanding of depression.

The comparison you make at a given moment may concern any one of many possible personal characteristics--your occupational success, your personal relationships, your state of health, or your morality, for just a few examples. Or you may compare yourself on several different characteristics from time to time.

If the bulk of your self-comparison thoughts are negative over a sustained period of time, and you feel helpless to change them, you will be depressed.

There are several ways to manipulate your mental apparatus so as to prevent the flow of negative self-comparisons about which you feel helpless. The possibilities include: changing the numerator in the Mood Ratio; changing the denominator; changing the dimensions upon which you compare yourself; making no comparisons at all; reducing your sense of helplessness about changing the situation; and using one or more of your most cherished values as an engine to propel you out of your depression. Sometimes a powerful way to break a logjam in your thinking is to get rid of some of your "oughts" and "musts", and recognize that you do not need to make the negative comparisons that have been causing your sadness.

This book, and cognitive therapy in general, do not offer you an instantly-working formula that will transport you from misery to bliss without the slightest effort or attention on your part. In order to transform yourself from being sad to being joyful you'll have to give the problem your attention and some hard work--whether you do the work alone or with the help of a professional counselor.

The book does offer you a new analytic way of understanding your depression, upon which you can build a rational, successful procedure for extricating yourself from your unhappy jam. And the cure need not wait for long years of psychotherapy, dredging up the details of your past life and reliving it all. If you do choose to get outside help, ten or twenty sessions with a therapist are par for the course.

This is not a guarantee that you will succeed with this method. But it is a promise that a speedy cure -- faster than nature's usual regenerative processes -- is possible for a large proportion of depression sufferers.

*** Note:

Chapter 1 has summarized ideas found in Part I of the book, Chapters 2-9. If you are impatient to get to the self-help procedures in Part II Chapters 10 to 19), you can go directly from here to there, without pausing now to read further about the nature of depression and its elements. But if you have the patience to study a bit more before moving on to the the self-help procedures, it may be worth your while to read through Part I first. Or you can come back to Part II later.

The discussion in this book is pitched at a higher level of abstraction than are most self-help books. Partly this is because cognitive therapy requires somewhat more mental discipline, and more willingness to be introspective, than behavioral and other therapies.14 But the higher level is also partly due to the fact that the book is aimed at psychiatrists and psychologists, too, to present to them these new ideas and methods that render more powerful some ideas and procedures they are already familiar with. And these ideas can only be presented effectively to the professions in the context of working therapy rather than in a more rarefied and theoretical context.

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A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

C. Treatment of Depression and Bipolar Disorder

As has been mentioned several times above, the most effective tools available for the treatment of depression and bipolar disorder are medications (i.e. drugs). Nevertheless, many victims of these illnesses are often concerned and confused about taking medication, and therefore resist treatment.

From my experience with hundreds of people who have CMI, I have concluded this resistance originates from two erroneous ideas. First, there is a confusion of therapeutic psychiatric medication with illegal psychoactive "street drugs''. Anyone beginning treatment with psychiatric medication needs to understand clearly that there is no more connection between the former and the latter than there is between a Greyhound bus and a miller moth.

The street drugs are chosen because they interfere with normal operation of the brain and produce abnormal and often bizarre mental responses. They actually destroy normal brain function, and if abused in sufficient quantity for sufficient time, can lead to injury or even death. In contrast, psychiatric medication has been very carefully chosen, perhaps even "designed'', to restore normal brain function to the greatest extent possible.

They are very carefully tested for efficacy and safety. Only after passing a rigorous review procedure are they released for public use. Subsequent to release, their performance is continuously monitored as they are used in thousands to millions of doses each year. In short, one need not have any fear whatsoever that psychiatric medication will have the same harmful effects as illegal street drugs.

Second, many potential users are fearful that psychiatric medication will degrade or interfere with their mental abilities. These fears are rarely a problem for people with deep depression (who basically will do anything reasonable to gain release from the depression), but often are quite strong for people who are mildly to moderately manic because those people feel ``good'', and believe that they have superior mental (and sometimes physical) abilities and performance.

These people don't want anyone tinkering with their ``mind''. They need to be convinced and reassured that controlling their mania will not degrade their intelligence, insight, cognitive and learning abilities; I can vouch first-hand for this statement. What they will lose is speed: the same tasks take a little longer. But those tasks will typically be done more carefully. It's a tradeoff: one loses the manic sense of speed and power, but one also is no longer driven obsessively, scattered by dozens of intrusive ideas and thoughts. And one loses the sense of isolation that characterizes mania because one is unable to make meaningful person-to-person contact with those around oneself.

For me, the manic state always produced the sensation of my seeming to be living in someone else's mind, or someone else living in mine. That is an unpleasant experience. I am more than happy to sacrifice manic "facility" in order to get rid of the other unpleasant, threatening, and destructive aspects of mania.

I will not go through the catalog of medications here because it has grown quite large, and excellent and authoritative discussions are easily available in the books cited in the Bibliography. In broadest terms, there are three groups of medications used to treat depression: (1) the tricyclics, (2) the MAO inhibitors, and (3) SSRIs (Selective Serotonin-Reuptake Inhibitors). The tricyclics were discovered first, and sometimes remain useful treatment strategies to this day. The MAOIs have restrictive dietary constraints for their use, and can have troublesome side effects; but for some people they provide effective relief. The breakthrough came with the development of the SSRIs. They work by inhibiting the reuptake of the essential neurotransmitter serotonin from a synapse between two nerve cells that have just fired, thus leaving it in place for the next time it is needed. These drugs (e.g. Prozac, Zoloft, Wellbutrin, Effexor) have proven to be extraordinarily effective in treating depression, while having only minor side effects. They have the advantage of not introducing something new to the "ecology" of the brain, but merely inducing the brain to leave one of its own natural "ingredients" in place so that it can be used when next needed.

It must be emphasized that specific person may respond to several of these drugs, just a few or even just one, or none. The challenge to the therapist is to discover, as quickly as possible, the drug that works best for each individual treated. If he/she is skilled (and lucky!), the first choice may work effectively and quickly. But if it doesn't, it is imperative to continue to try other possibilities until one is found that works!

This requires strong commitment on the part of both the victim and the physician. For example, in 1985, I started off with Desyrel, chosen by my doctor because it was the current ``wonder drug'' and putatively had few side effects. For me Desyrel was a disaster: it gave me no relief from depression after months of treatment (typically an antidepressant begins to work within 3 weeks of when it was started), it confused me, it made me uncontrollably sleepy during the day, and interfered with thinking and cognition.

Only after months of being so ``treated'' did I get effective help from Drs. Grace and Dubovsky, who switched me to a tricyclic, desipramine. As described above, within three weeks this different medication broke the depression. If you are not getting relief after a reasonable time, don't be shy about talking to your doctor about trying a different medication. The change might save your life. In 1997, when Desipramine had failed for me, it was clear what to do: Dr. Johnson immediately phased it out, and moved me to the SSRI Effexor without a hitch. That has made a world of difference!

Until recently, the first line of defense against mania was lithium (carbonate). It was discovered by John Cade in Australia in 1949, but was not used therapeutically in the U.S. for almost another 20 years. Sometimes in emergency cases the victim is started off on an antipsychotic drug such as Thorazine, Mellaril, or Trilafon; these are designed to help the victim calm down and make closer contact with reality. In cases of extreme mania -- someone totally out of control, needing to be restrained -- the effects of these antipsychotic drugs are often downright amazing. In the space of a very few days the victim becomes calm, and fairly normal in terms of overall behavior.

In 1997 this approach, including restraint, was necessary for me. If lithium fails to control the mania sufficiently, or has undesirable side effects, the therapist will then try other anti-manic agents such as Valproic Acid (Depakote), Tegretol, or Klonopin. These days Valproic Acid has generally become the preferred treatment for mania.

It is also worth mentioning that the effects of anti-manic treatment generally improve with time. In my own case, for example, I have noticed a definite, continuous "ramping up" in my general sense of well being, and my objective job performance. At the same time, it has been possible to reduce by almost half the amount of the medication I originally took. On the other hand, when lithium failed me, it failed suddenly, and I would have needed intensive medical supervision to have detected the transition.

After I was moved to Depakote, I felt much better than before; a persistent hand tremor that I had while taking lithium vanished, and I feel generally "calm" all the time. It is a blessing. All of these experiences point to the fact that it is essential to stay in close contact with your doctor while being treated for these illnesses; the disease is chronic, and your fight against it is likely to last a lifetime!

There are a number of practical issues to be faced when taking psychiatric medications. Like all medications, psychiatric drugs have side effects. Many of them are inconsequential, some are more serious. For example, with the antidepressants, it is common to experience a dry mouth. Sometimes this is so serious as to prevent one from speaking, and a drink of water doesn't solve the problem because what is needed is saliva produced by the body.

This one has been a problem for me because when I was a professor, I gave lectures. I solved the problem by chewing sugarless chewing gum when I felt the dryness start. It's a bit vulgar in appearance, but I simply explained to my students why I did it, and they accepted it.

Lithium can have two troublesome side effects. One mentioned above is that it often causes small-muscle tremor. I remember a period of time when I could not drink tea because I couldn't lift the cup from the table to my mouth without spilling it all over the table. Tremor was especially troublesome for me because it got so bad that I simply could not write; this seriously interfered with my daily professional activities. My doctor told me there was another drug to control the tremor, but I decided not to take any drugs that I didn't have to; eventually the tremor went away, seen only under extreme stress, and even then only a little.

A more serious side effect of lithium is that if its concentration in your bloodstream gets too large it can damage your kidneys. This problem can be avoided by having blood tests to measure the lithium level in your blood. Typically this will be done fairly frequently (monthly or maybe even weekly) when you first start lithium, but later, if your level is pretty constant, your doctor will check it maybe every 3 months. Similar remarks apply to Depakote.

Finally there is the very serious problem lithium caused me during rehabilitation from my auto accident: the margin between the therapeutic and toxic levels of lithium in the bloodstream is small. And because I became dehydrated while in the hospital, my lithium blood-level soared way above the toxic level, and induced the terrible coma I have described above. With Depakote, the known therapeutic range is about a factor of four, and the highest dose is still much below toxic. Thus compared to lithium, there is an enormous safety factor. In my case, I take almost the minimum dose, so I never expect to have any trouble with it.

It is crucial to take your medications exactly as your doctor prescribes. Do not "experiment'' with changing the dose on your own. Sometimes it is hard for people to remember whether or not they have already taken a pill that day, but it is vital not to take too many or too few. I beat the problem of an aging memory by using the small compartmented pill dispensers available in drug stores. They usually have seven compartments labeled with the days of the week, so one can tell immediately whether the correct number of pills have been taken.

It should also be stressed that you should never stop taking your pills all at once (``cold turkey''); to do so shocks the nervous system, and could precipitate a very severe psychiatric episode. If your doctor agrees that you should give up on a medication, always ramp the dosage down slowly over several days. For someone like me this is probably useless advice because it seems plain that I will be on my medications for the remainder of my life.

next: Suicide and Bipolar Disorder - Part II
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Tips on the school management of the child with ADD. The following suggestions are intended for teachers in the classroom, teachers of children of all ages.

Teachers know what many professionals do not: that there is no one syndrome of ADD but many; that ADD rarely occurs in "pure" form by itself, but rather it usually shows up entangled with several other problems such as learning disabilities or mood problems; that the face of ADD changes with the weather, inconstant and unpredictable; and that the treatment for ADD, despite what may be serenely elucidated in various texts, remains a task of hard work and devotion.

If anyone ever tells you dealing with a child with special needs is easy, then take little notice of anything they tell you. Dealing with children who present complex learning patterns or challenging behaviour will stretch you to your very limits personally and professionally. When working with a child with ADHD/ADD in the classroom, it is persistence that will prove to be your greatest asset.

The ideas and strategies suggested below are for all age groups and specific age groups. Use your own judgment to decide on the suitability of an intervention technique for the child and age group you are working with.

1. Be sure you are dealing with ADHD/ADD. It is definitely not the role of a teacher or parent to diagnose, but it is your role to pick up on a likelihood/possibility that this condition may be causal in the child's difficulties and refer on to medical personnel who are in a position to diagnose and medicate if appropriate.
2. Have you had the child's hearing and vision checked out?
3. Access to support systems is crucial. Do you know a colleague who has successfully dealt with an ADD/ADHD child? Do you have someone who you can talk to about your frustrations and celebrate your successes with? You will also need access to knowledge. This can come in the form of a person or an information source such as the INTERNET. You could also check on this site at www.adders.org for contacts of a local Support Group in your area as they would be able to give you local information. Also on adders.org you will find many resources which may help. You can also use any of the information on here to give to parents who may want to find out a lot more for their child.
4. Accept the child for who they are, recognise their qualities and their good points as well as those which are disruptive behaviours and irritating points. Trust is a 2 way thing - the child needs to learn to trust the teacher and when they do they will give so much back to that teacher it is quite amazing. Remember these child get used to being told they are wrong or that they are being naughty, this has a major effect on their sense of self worth and well being. A lot of these children end up expecting to be told off or criticised and often will not want to tell the truth as they know from past experience that they will not be believed - other children are also very quick to point the finger of blame as they know that the child is normally held responsible for things which go wrong so try to build up trust between yourself and the child and let them know that you do believe what they are saying and you are going to be fair in any sanctions which may have to be given out. They often have a great sense of injustice when they are the ones to have sanctions imposed on them and they see other children doing things at the same time or at other times who are not even spoken to about these. The ADHD Child will then learn that no matter what they say they will get the blame for things so they may as well do these things anyway!
5. You will need the parents to be on side with you. Encourage them to be open with you and to exchange information with you, sometimes parents have strategies which often work at home which can be applied to the classroom situation. This is also a 2 way thing and be open with the parents and work to build up trust between yourself and the parents to be able to work together for the good of the child.
6. Don't be afraid to ask for help. Teachers are too often willing to soldier on without asking for help. This does not do you any good in the long term. Sick and worn out teachers are a loss to children. So speak up. Say when you need help and advice.
7. Use the child as a resource. Ask what lesson do they recall as being the best they have ever been in. What was there worst ever lesson. How were the two lessons different? Try and unpack the child's learning style with their help.
8. Does the child know what ADD/ADHD is? Can they explain it to you? Can the child suggest ways that their difficulty might be made more manageable within the school setting?
9. ADD/ADHD kids need structure. Lists help. Such as lists of the process they are involved in such as writing an essay. Lists like how to behave when being told off can be of great help.
10. It is crucial that the child is caught being good. Many of the reactions to situations will be impulsive. We tend to notice the impulsive reactions that are overt and noticeable because they break a rule or code of behaviour. However, if you observe the child you will notice a vast array of reactions not all of which are outside accepted behavioural conventions. When an acceptable behaviour is presented. Praise and reward.
11. Having clear behavioural expectations in places the child can see them can help. For instance a sign saying please sit still and listen could be posted behind the place where the teacher often talks. The teacher may then point to the poster as a first reminder to come back on task.
12. ADD/ADHD means that the child has a problem with concentration. Therefore when you have an expectation that a series of instructions will be followed they will need to be presented more than once and in more than one way. They will also need to be presented so that the child can refer back to them as need be.

13. If the child is off task it is often a good idea to get them to move around for a couple of minutes, when they then go back to the task they are more likely to settle back to the actual task then if they are just told to get on with their work. It is often difficult to allow individual children to get up and walk around when the others are all working - it is therefore a good idea to have something set up with another teacher where you can get the child to take a note to the other teacher and bring a message back - this does not have to be very much in fact the note could even just say what are you having for dinner tonight - as long as you and the other member of staff have sorted this out in advance they will be able to realise that this is helping the child to be less disruptive in your class. Another idea is to ask them to come and wipe the board for you. Once they have been able to move around for a couple of minutes they will be able to go back and focus on the work in hand and will probably get much more accomplished than normal.
14. Eye contact is a good way of bringing a child back to task.
15. Seat the ADD child near to your desk and make sure that the child is within your line of sight most of the time. This will help the child stay on task.
16. Don't fall into the trap of getting into discussions where the child is acting as a barrack room lawyer. These are not meaningful to the child and they only serve to wear you out. If the child needs stimulation then the child needs to be encouraged to say so in an assertive way. They need to then engage in an activity that they have found settling in the past. For a short period and with permission.
17. Make the day's schedule predictable and visible. Post the schedule where the child will be able to see it and will see it. For instance on their desk or on the board. Tell the child if any changes to the regular schedule are going to happen. Tell the child well ahead of time about a change of activity and keep on warning them until the transition has taken place.
18. Work toward the child drawing up the schedule for their out of school time.
19. Timed tests are not good measures of knowledge for a child with ADHD/ADD. Therefore they have little if any educational value for these children. It would be best to eliminate them and choose an alternative method of testing for knowledge retention and application.
20. Use alternative methods of recording if the child finds them useful. Remember what matters is that the child processes the information you wish to impart. The method of processing can make a difference to the child. Pen and paper is very simple and convenient for the teacher but if it doesn't work for the child then an alternative needs to be found.
21. Frequent feedback helps keep the ADD/ADHD child on task; it is also very useful in letting them know what is expected of them and if they are achieving expectations. Naturally the resultant praise will be very encouraging.
22. One of the most crucial teaching techniques for children with ADD is to break down large tasks into small tasks. This ensures that the child does not feel overwhelmed. As the child learns they can bite of more and more they will need the chunks to be larger. Increasing and managing the way information and task are presented does take time and is a highly skilled business. However, this will be extremely helpful in avoiding tantrums born of frustration with small children and with older children it can help them avoid the defeatist attitude that so often gets in their way.
23. Novelty and fun are good ways to gain attention. ADD/ADHD children will respond to it with enthusiasm.
24. Try your very best to catch the child being good. Many of their responses are impulsive. We tend to notice the socially inappropriate responses and miss the many acts of generosity and apparent maturity that may also be the impulsive response. Of the real problem with ADD/ADHD children is not the condition but the hostility that has arisen due to the persistent imposition of punishment.
25. Teach the child how to draw up mind maps. Encourage the use of this technique in lessons, it will give the child a greater sense of being in control of what is going on.
26. Many ADD/ADHD children have a tendency toward being visual learners. Therefore some form of visual cue allied with your verbal explanation will probably aid comprehension of the task being set and the expectations you have for the piece of work being set. They also very often have things which they are very interested in - if a child has a passion for cars then most subjects can incorporate cars - English - write about a car, Maths - count cars - Art - draw, paint, model a car, History - of the motor car, Geography - travel / journeys by car. Most things can be incorporated with a little imagination.
27. Keep every thing as simple as possible. Make things fun so that they will attract the child's attention thus increasing the chances that the message will be absorbed.
28. Use difficult situations and moments in the Child's day as opportunities to teach the child and give feedback. Averagely children with ADD/ADHD are quite poor at comprehending how they come over to others. Therefore a piece of silly behaviour can be dealt with by asking the child how it affected others. How it affected the way others will see the child etc.
29. Make your and the schools expectations very clear.
30. Give some thought to the use of a points based reward system as part of a behavioural modification program younger children. Children with ADD respond well to rewards and incentives.

31. If the child appears to have difficulty with social skills and appropriate behaviours. It would be very useful to analyze just what skills are lacking and then teach or coach the child in these skills. There are some very good resources about specific ADHD coaching on adders.org
32. Make a game out of things. Motivation improves ADD.
33. Pay particular attention to who sits next to who.
34. Your life will be much easier if you can keep the child engaged and motivated. Time spent planning activities to make them as engaging as possible will be repaid many times over.
35. Give as much responsibility as possible to the child.
36. Try a home-to-school-to-home positive contact book.
37. The development of self-assessment and self-reporting is crucial to the development of internal limit setting. For instance the use of daily reporting sheets can be very effective. More effective still if the child sets the behaviours to be monitored. The child decides if they have achieved the set behaves. Usually I ask the child to get the teacher to initial if they agree or disagree with the child's perception of their own behaviour. This should be done in a clinical fashion if the teacher disagrees but with lots of praise if the child has achieved targets and is correct in their perceptions.
38. Suddenly given these children unstructured time can be a recipe for disharmony. Let them know well in advance when unstructured time will be so they can plan out what to do and how to fill the time.
39. Give as much praise as you are humanly able.
40. Develop active listening skills by encouraging children to take notes of not only what they hear but the ideas they have and their thinking around an issue.
41. Give serious consideration to the use of alternative methods of recording.
42. Get the full attention of the class before starting to teach.
43. Try and arrange for students to have a study partner or be part of a study group. Get the children in the group to exchange telephone numbers and other contact information. This will enable the child to clarify points that they may have missed quickly and easily. It will also allow other members of the group to benefit from their energy and enthusiasm.
44. Explain and normalize the treatment the child receives to avoid stigma. Be prepared to sit down with the whole class and explain in language they understand about how people are all different and that a lot of children have problems of one sort or another and then explain about how ADHD symptoms can show in a child and how the rest of the class can help that child to fully integrate with their peers. Peer relationships are often very difficult so it is essential for the child's self esteem and general well being to help them to fit in with their peers and for them to be accepted by their class mates.
45. Review with parents often. Avoid the pattern of just meeting around problems or crises, celebrate success. It is very nice on occasions for parent to receive a phone call from school to let them know when their child has had a good day. They often sit at home or work dreading that phone call to say that their child is in trouble again at school. This is also very good for the child and their self esteem as when they get home the parents can give spontaneous praise and tell them how wonderful it was that their teacher had phoned them today to tell them how well the child has done.
46. Read aloud at home and in class as much as possible. Use story telling. To help the child build up a sense of sequence. Help the child build the skill of staying on one task.
47. Repeat, repeat, repeat.
48. Vigorous exercise helps work off excess energy, it helps focus attention, it stimulates certain hormones and neurochemicals that are beneficial, and it is fun. Make sure the exercise is fun, so the child will continue to do it for the rest of his or her life.
49. With older children, their learning will be enhanced considerably if they have a good idea of what will be learnt that day.
50. Be on the lookout for things to enjoy about the child. The energy and dynamism they have can be very beneficial to their group/class. Try and pick up on their talents and nurture these. As they have taken many of life's knocks they tend to be resilient, always bouncing back because of this they can be generous of spirit, and glad to help out.

About the authors: Drs. Hallowell and Ratey are experts in ADHD in children and have written many books on the subject including "Driven To Distraction."

• I am a capable person.

• I am a competent person.

• I am an intelligent person.

• I am a worthwhile person.

• I can dare to take a risk.

• I am entitled to good.

• I choose to be happy.

• I can ask for what I want.

• I can say what I feel.

• I am a radiant expression of God.

• I trust and follow my inner guidance.

• I am an unlimited being.

• I can create anything I want.

• I picture abundance for myself and others.

• I have a right to exist.

• I can dare to see what I see.

• I can dare to think what I think.

• I can dare to question anything.

• I can dare to feel what I feel.

• I have a right to come to my own conclusions.

• I am Happy Joyous and Free.

• I have a right to make mistakes.

• I have a right to be wrong.

• I have within myself the answers to all my needs.

• I am a beautiful person.

• I am free to be me.

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continue story below


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• I do not need to prove myself.

• My mind and body are now in balance and harmony and manifest divine perfection.

• I accept responsibilities in my life happily and enthusiastically.

• I am the master of my being and an active co-creator of my life.

• The entire Universe Loves me, serves me, nurtures me and wants me to win.

• I am a success to the degree that I feel warm and loving to myself.

• My debts represent my & others beliefs in my future earning ability.

• The most important thing to my loved one's happiness is that I be happy first.

• My value and worth are increased by every thing I do.

• All my experiences are opportunities to gain more power, clarity and vision.

• I can fill all my needs if I am willing to pay the price.

• I have a right to ask for and expect something in life.

• Comparison of myself with another is meaningless.

• I am the center of my universe; my world revolves around me.

• The Christ/Goddess/Spirit within me is creating miracles in my life here and now.

We can tell ourselves good things!

I AM a magnificent Spiritual being having a Joyous and exciting human adventure!

If we Truly believed the positive affirmations we would not have to say them. When we most need to say them is when we least believe them when we are feeling the worst. The source of all of our wounds ultimately is feeling abandoned by God, feeling unlovable to our Creator.

"Integrating the Spiritual Truth (the vertical) of an unconditionally Loving God-Force into our process is vital in order to take the crippling toxic shame about being imperfect humans out of the equation. That toxic shame is what makes it so hard for us to own our right to make choices instead of just reacting to someone else set of rules."

Column "Empowerment" By Robert Burney

We need to own that we have the power to choose where to focus our mind. We can consciously start viewing ourselves from the witness perspective. It is time to fire the judge - our critical parent - and choose to replace that judge with our Higher Self - who is a loving parent. We can then intervene in our own process to protect ourselves from the perpetrator within - the critical parent/disease voice.

Article "Learning to Love your self" by Robert Burney

We need to stop giving power to the monster within.

"The "critical parent" voice in my head has always berated me for not being perfect, for being human. My expectations, the "shoulds," my disease piled on me were a way in which I victimized myself. I was always judging, shaming and beating myself up because as a little child I got the message that something was wrong with me.

There is nothing wrong with me - or you. It is our relationship with ourselves and life that is dysfunctional. We are Spiritual beings who came into body in an emotionally dishonest, Spiritually hostile environment where everyone was trying to do human according to false belief systems. We were taught to expect life to be something that it isn't. It isn't our fault that things are so screwed up - it is however our responsibility to change the things we can within ourselves."

"I needed to learn how to set boundaries within, both emotionally and mentally by integrating Spiritual Truth into my process. Because "I feel like a failure" does not mean that is the Truth. The Spiritual Truth is that "failure" is an opportunity for growth."

"The part of you that tells you that you are not lovable, that you are not worthy, that you are not deserving, is the disease. It is trying to maintain control because that is all that it knows how to do. We are not "better than." We are also not "less than." The messages that we are "better than" come from the same place that the messages of "less than" come from: the disease. We are all children of God who deserve to be happy. And if you are right now judging yourself for not being happy enough or healed enough - that is your disease talking.

next: Romantic Relationships and How We Set Ourselves Up For Failure

For me, unhealthy boundaries are overt or covert attempts to control another person's behavior according to what I want and desire, rather than as a path to my own self-growth and serenity.

As a recovering co-dependent, I have the right to define my personal boundaries. I set my own boundaries in order to enhance my relationships, to promote my own serenity, and to ensure that my process of self-growth continues. My right to set healthy boundaries carries with it the responsibility for me to clearly communicate my boundaries to those persons closest to me who may be affected by my boundaries. I never use my boundaries as bludgeons for punishing another person or as a tool to control others.

Also, I don't assume or expect others to intuitively know and respect my boundaries. That is a fantasy. In regard to boundary setting, my boundary is "no surprises." If you are in a relationship with me, you are entitled to know my boundaries and the price for violating them before you violate them. Also, you are entitled to discuss the boundary openly and honestly with me. If warranted, I'll negotiate and adjust the boundary to help minimize any resulting conflict.

For me, there is a distinct difference between "boundary setting" and the process of disciplining my children. Child rearing, training, and discipline is my responsibility to my children. One of the many areas where I am striving to teach my children is how to set boundaries for themselves. For example, "don't start smoking just because someone you look up to is smoking or so that someone else will accept you." I'm trying to get my children to set a "no smoking" boundary for themselves, based on my educating them and giving them knowledge that smoking is harmful to their health. That way, it's not just a "rule" of mine they must obey (and probably violate behind my back). It becomes their decision. It becomes a boundary they own.

If someone is violating my boundaries, and it is truly harming me or hurting me, I am responsible for doing something about the situation. I can express my boundary, but if they don't respect it, I can't make them respect it or own it, even if I take them to court. All I can do is protect myself from that person.

Here then, are the guidelines for boundary setting that are currently working for me:

• I will keep my boundaries as simple and as few as possible.
• I reserve the right to change my boundaries as I grow and change.
• I will communicate my boundaries lovingly and clearly, before they are violated, when possible.
• I will not become a boundary ogre. I will be mindful that my perspective of reality is unique, and will not use boundaries as a means of forcing my perspective upon others.
• I will endeavor to treat all people as my guests, especially those closest to me.
• I will be kind, yet firm with those people who choose to violate my boundaries. If they continue to do so, I will take the steps necessary to protect myself, with care and mindfulness, seeking the path of minimum psychological harm to myself, the other person, and any one else who may be affected.
• I will not use boundaries to intentionally create conflict in any relationship.
• I will re-examine and question my boundaries if unhealthy results occur because of the boundary (for example, a situation gets worse because of the boundary, rather than better).
• I will respect the boundaries that other people set and communicate to me.
• I will honor and accept that all people need room and space to grow; I will not expect the world to conform 100% to my expectations.

Questions I ask myself about my boundaries:

• Is this a healthy boundary? Am I setting this boundary for myself? to enhance my serenity?
• Am I setting this boundary as an attempt to control someone else's behavior?
• Am I setting this boundary merely to antagonize someone else?
• Will this boundary honestly help me be a better person?

• Is this boundary still necessary? Do I need to let go of it

next: One Day at a Time

A short essay on overcoming fear, the meaning of our dreams, and dealing with nightmares.

Life Letters

To a frightened friend,

You fear your dreams, dread your inevitable surrender to them. How true the old cliché, that we most fear what we don't understand. I look into your eyes and recognize the pleading in them. They beg me to make your fear go away. I wish I could. I can't.

What I can do is attempt to assist you in coming to some understanding of your dreams. You see, our wholeness brings us many gifts. And dreams, my friend, are one of them. They tell us in yet another way about our deepest selves, about our inner conflicts and how we characteristically deal with them. They show us our fears, our secrets, our uncertainties - and they serve as signposts that can guide us toward answers. They are messengers, which travel to us, again and again, until they are received. They may frighten us with their dramatic stories, and yet we can come to appreciate that in delivering up to us in symbolic forms, our worries and our obstacles, they often present us with solutions. Dreams reflect elements of their extraordinary creators and contain both darkness and light, as does the very essence of life.

Your nightmares are not demons, nor foreign and dangerous invaders sent to conquer and destroy. Instead, they are your offspring. And much like your children, while they can be troublesome, they, too, are gifts, and require your attention.

When I envision you at night, I see you trembling in terror, hopelessly seeking to push back and away from the images of sleep. I want to provide you with comfort and lullabies, soothe you as you gently drift into the darkness. We both know that this is not possible.

And so, instead, I ask you to peer back with me- way back - to the time of ancient man and woman. Imagine that thousands of years have just slipped away, and that together we are watching a prehistoric scene. Our ancestors have just come upon a fire, and we watch them cringe in terror. How evil and alive it must seem. The smoke threatens to swallow them up and steal their very breath away. The heat reaches out towards them, much like the flames of hell that so many children of the future will someday envision. The fire before them is a deadly creature and they flee from it.

Move forward in time just a bit with me now. Some brave soul has begun to study fire, to explore its possibilities and to perceive it multidimensionally. This courageous one eventually discovered that fire, while still threatening and powerful, can also be used to serve. He or she now attempts to call it forth, determined to make use of its force. Soon fire, which for so long was a horrifying mystery, becomes to humankind a source of light, warmth, protection, energy, and even an instrument of healing!

So very much that has been learned by those who came before us now remains within our keeping. The very same magnificent spirit who came to understand the value of fire exists within you, my friend. Carry it with you into the dark and cold places of your fear. Call upon that spirit tonight. Call it forth in prayer, or meditation, or in song. Allow it to gently guide you into sleep. Permit it to silently issue you strength and courage as you face your own fire. You will come to understand that your nightmares, however violent, are like ancient woman's flames - they illuminate the shadows. Let your fire bring you light!

Love, A Fellow Traveler...

next: Life Letters: Appreciating the Gift

Raising a child with a disability can be very stressful. Find out about stress, how to prevent a build up of stress and relaxation techniques.

All of us experience stress and the experience can be painful, distressing and sometimes overwhelming. Parents of children with disability often have good reasons to feel stressed. When we are able to recognize the feeling of being stressed, we then become able to make choices that will ease the stress. This page describes stress, how it affects us and provides some suggestions for how to be in control of our stress.

Contents

• What is stress?
• Steps to prevent a build up of stress
• How we react to stress
• Long-term effects of stress
• Relaxation - how it helps
• Ways to relax
• For further information

What is stress?

In our increasingly busy world, more and more people are becoming aware of feeling stress and the way that it affects their lives.

Stress:

• Is the body's way of dealing with situations that are dangerous or threatening;

• Prepares us to either stand up and fight the threat or run away and escape it;

• Is found in many daily situations;

• Can range from being a mild worry to extreme panic;

• Is caused by events called 'stressors' (some are good stressors and some are bad stressors), and

• Is not always caused by 'bad' events. Even happy events, such as getting married or having a baby can be quite stressful.

One of the keys to being able to get control of stress is to become more aware of our feelings when we are stressed. Ask yourself the following questions:

• What happens when I am stressed?
• How do I feel?
• In what ways does my body react to stress?

Using normal activities to relax can be quite useful. Ask yourself:

• How do I like to relax?
• What happens to my body when I relax?

For people who may be under more extreme stress, normal activities may not be enough to help them relax. It may be necessary to use relaxation exercises to consciously relax the muscles of the body and focus thoughts positively to really reduce stress levels.

Disclaimer: General information only - you should consult with the relevant professional before applying it to a particular situation.

Steps to prevent a build up of stress

Some of these include:

• Being realistic about what you expect of yourself;

• Get enough rest;

• Make sure you have a good diet;

• Get a reasonable amount of exercise;

• Try to take some time out just for yourself;

• Develop a method that helps you deal with stress, especially unexpected stress - this might include things such as progressive muscle relaxation, visualization or imagery and self-talk;

• Talk to someone who you feel understands you about what stresses you;

• Try to take active steps to resolve conflict in your life;

• Try to avoid taking on things that provide extra pressures, and

• Be positive!

How we react to stress

Some of the common ways we react include:

• Becoming forgetful or having difficulty concentrating - our brains may feel as though they are overloaded;

• Becoming anxious and worried;

• Crying or feeling like crying;

• Having difficulty concentrating, due to the brain seeming to be overloaded;

• Eating, drinking or smoking too much;

• Experiencing headaches, indigestion, nausea or diarrhea;

• Feeling our muscles tensing;

• Experiencing dizziness;

• Having a lowered resistance to infections;

• Experiencing trembling or shaking in hands, legs or other parts of the body;

• Finding yourself holding something tight (like a steering wheel or the arm of a chair);

• Frequent nail biting or teeth grinding; and

• Having trouble speaking.

The list could go on! Needless to say, there are many different ways that people react to stress.

Long term effects of stress

If the stress is not reduced it can have long-term affects on our health, causing:

• Allergies;
• Ulcers;
• High blood pressure;
• Strokes, and
• Heart attacks.

Relaxation - how it helps

The opposite to stress is relaxation. Relaxation helps by:

• Lowering blood pressure;
• Relieving muscle tension;
• Increasing our stamina or endurance;
• Improving our mood;
• Helping us feel less angry, agitated or anxious.

Disclaimer: General information only - you should consult with the relevant professional before applying it to a particular situation. See disclaimer details.

Ways to relax

Some things that people find useful for relaxation include:

Massage and yoga
There are many courses, books and videos available that teach people how to use these methods. Each method teaches how to consciously relax the body and make the brain clear and able to function well during stressful situations. Consciously relaxing the body and the mind can result in a feeling of peace and quiet seldom experienced in other ways.

Massage
Massages can be great for relaxing muscles and relieving tension. It is not necessary to follow any set type of massage to get a good result and there are many types of massages available.

Progressive muscle relaxation
Progressive muscle relaxation is a way to learn about how your muscles feel when they are tight and relaxed. It includes a series of exercises where you tighten and release different muscles in your body. This type of relaxation can be done at any time during the day - while standing, walking, or driving the car.

Visualization or imagery
Visualization or imagery is a way to control your thoughts so that you can replace stressful thoughts with relaxing ones, and in this way, give yourself new energy. This involves finding a quiet place to sit for a few moments, and picturing in your mind something that you find relaxing - this may be something like walking on the beach or laying in a field on a warm, sunny day. If stressful thoughts come back into your mind, don't worry as this is normal. Just go back to thinking about your chosen image. With practice, you should find it easier to stick with this thought and you will end up feeling much more relaxed.

Self-talk
When people are feeling stressed they may find their stress is made worse by negative thoughts running through their minds. Quite often these messages are not accurate and come about because of fear or because we don't believe in ourselves. 'Self-talk' is where you consciously decide that you are going to replace these messages with different messages.

Exercise
Exercise is one of the best forms of relaxation. Going for a brisk walk is easy and inexpensive, and releases chemicals in your brain that help you to relax. It is also a great way to stay fit, and a fit body can handle stress better!

Aromatherapy
Aromatherapy is the use of oils and herbs that help reduce stress. Some people burn fragrant oils or incense. Others use pillows that contain the particular herbs or plants that aid them to relax. Something as simple as a few drops of your favorite oil in a warm bath can be wonderfully relaxing. Many health stores sell aromatherapy products and will be able to assist you in choosing oils that are right for your needs.

Disclaimer: General information only - you should consult with the relevant professional before applying it to a particular situation. See disclaimer details.

Laughter - the best Medicine
Laughter can be a very quick and helpful way to relax. It helps to deal with emotionally tense situations, face challenges and responsibilities and relieves anxiety by expressing what might otherwise be negative and stressful thoughts through jokes and humor.

If it's been a while since you had a good laugh, think about some things you could do that would increase your chances of having a good laugh. Hire a video or DVD of a movie that made you laugh in the past or take up a fun activity such as belly dancing with a group of friends. You will be sure to laugh!

For further information

Books

• Atkinson, J M (1988). Coping with stress at work. Thorsons Pub. Group - Distributed by Sterling Pub Wellingborough, Northamptonshire, England & New York.
• Bell, S (1996). Stress control: how you can find relief from life's daily stress. SkillPath Publications, Mission, KS.
• Blake, R (1987). Mind over medicine: can the mind kill or cure? Pan, London.
• Garfield, C (1979). Stress and survival. Mosby, St. Louis.
• Grace, C & Goffe, T (1993). Relax. Child's Play International Ltd., Swindon, England & New York.
• Hayward, S (1998). Relax now: removing stress from your life. Sterling, New York.
• Henderson, L (1996). Slow down, take a deep breath and relax. Gore & Osment Publications. Kelly, John M (1991). The executive time & stress management program. Alexander Hamilton Institute ,Maywood, NJ.
• Kidman, A (1986). Tactics for change: a self-help manual. Biochemical & General Consulting Service, St. Leonards, N.S.W.
• Lake, D (1994). Strategies for stress. Gore & Osment, Rushcutters Bay, N.S.W.
• Montgomery, B (1984). You and stress: a guide to successful living. Nelson, Melbourne. Montgomery, B (1982). Coping with stress. Pitman, Carlton, Victoria.
• Roe, D (1996). Young children and stress: how can we help? Australian Early Childhood Association, Watson, A.C.T.
• Saunders, C & Newton, N ( 1990). Women and stress. Angus & Robertson, North Ryde, N.S.W.
• Schultz, C & Schultz, N (1997). Care for caring parents. Australian Council for Educational Research, Camberwell, Victoria.
• Schultz, N (1990). The key to caring. Longman, Cheshire, Melbourne.
• Sutherland, V J (1990). Understanding stress: a psychological perspective for health professionals. Chapman and Hall London & New York.
• Tickell, J (1992). A passion for living kit. Formbuilt, Coolum Beach, Queensland.

More Alternative and Complementary Medicine Books

Videos & Cassettes

• Australian Broadcasting Commission (1992). PGR - Stress and tension ABC Television. Adelaide, South Australia (video recording).
• (1995). The coral reef. Flinders Media, Bedford Park, South Australia (VHS videotape - 16 min. 40 sec).
• Davies, M (1988). Sitting by the creek. Training, Health and Educational Videos, Heathcote, Victoria (video recording).
• Mellott, Roger (1989). Stress management for professionals: staying balanced under pressure. CareerTrack, Boulder, CO Publications (sound recording). Miller, E E & Halpern, S (1980). Letting go of stress. Stanford, California. (sound recording).
• Rainbow, M (1993). Jonathan's magical journey. Inner dimensions, Kew, Victoria (sound recording).
• Sanders, Matt (2000). Triple P Positive Parenting Program: Coping with stress. Families International, Milton, Queensland. (video recording).
• (1986) Stress and health: Kit. Flinders Medical Centre, South Australia (1 audio tape, 2 brochures).
• Todd, J (1989). Springtime Sunset. Flinders Media, Bedford Park, South Australia (video recording).

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

THERE AIN'T MUCH to it: Just give up desires. Of course, you can't possibly do that permanently, but you can do it right now. Ask yourself What do I want right now? You almost always want something. And the state of wanting is a state of discontent. Whatever you want right now, just give it up. Say to yourself I don't want that. Decide you don't want it.

Don't worry, it'll come back. But for right now, you'll gain yourself a peace-of-mind break. This is not difficult, and you can do it.

Notice what you want right now, and let it go. Give it up. Then notice what else you want and let that one go too. You'll notice a relaxing feeling of contentment come over you.

If you don't notice that contentment, and you want to feel it, give up that desire too.

To learn more about how to accomplish this feat, read The How of Tao.

Here's a conversational chapter on optimism from a future book:
Conversation on Optimism

If worry is a problem for you, or even if you would like to simply worry less even though you don't worry that much, you might like to read this:
The Ocelot Blues

Learn how to prevent yourself from falling into the common traps we are all prone to because of the structure of the human brain:
Thoughtical Illusions

next: The Root of All Happiness And Contentment

The antidote to stress is relaxation. To relax is to rest deeply and that's where restorative yoga comes in.

Picture this scenario: You feel sick. You go to the doctor and he tells you to go home and relax, so you go straight to the couch and turn on the television. You may think you've ratcheted down, but, explains Judith Lasater, PhD, author of Relax and Renew: Restful Yoga for Stressful Times, relaxing is a dynamic state that requires separation from external stimuli like TV. Unfortunately, most people don't know how to accomplish that and need to be taught. "Doing nothing is the healthiest thing you can do for yourself," says Lasater, "because when the body's in a state of relaxation, all measurable indices of stress are reduced—you can't be anxious and relaxed at the same time."

Once you know how to achieve a state of dynamic relaxation, you can then learn to dis-identify. Meaning? You separate yourself from your thoughts: you have them, but they aren't who you are. You can observe them arising but can detach from them. "If we're at the mercy of our thoughts, which can change 60,000 times a day," explains Lasater, "we'll always feel stress and suffer because what we think is never going to fully satisfy us." Learning to relax, therefore, is learning to let go of what you think and who you think you are. You aren't your body or your thoughts.

The purpose of props

Research shows you need four things in order to relax: a feeling of safety, darkness, warm hands and feet, and a cool core body temperature. Props, such as blankets, bolsters, blocks, straps, eye pillows, and sandbags, help create this environment by manipulating the nervous system so the only possible response is relaxation. "Really, we manipulate our nervous system all the time with cigarettes, coffee, anti-depressants, and other drugs to create a certain inner state," says Lasater. "Restorative yoga is doing the same thing except it's using only your body and breath."

If you don't have formal yoga props, improvise. Use a chair or a couch; a small, firm pillow; a few blankets; and something to cover your eyes. Then test out the environment with something simple: Lie on the floor with your legs raised up on the chair, your head and neck supported by a pillow, your body under a blanket if you're cold, and your eyes covered. Now breathe comfortably for 15 to 20 minutes. According to Lasater, it takes the average person 15 minutes in a basic restorative pose to relax deeply, so set your timer and enjoy.

Ease on down the road

Restorative yoga works wonders when you're stressed or over-tired, but it also has therapeutic value when you're injured or not feeling well enough to do your regular practice. Whether your lower back is bothering you, your head hurts, or hot flashes have zapped your strength and energy, doing supported poses allows your body to reap the benefits of traditional poses without taxing your muscles or re-injuring yourself. We've asked a few of our favorite therapeutic yoga teachers to suggest poses that might feel good and help ease particular conditions. Feel free to experiment, see which pose feels best, and mix up the order of the sequences. Keep in mind: If something doesn't feel good, don't do it.

Source: Alternative Medicine

next: Coping With Trauma When Living With A Mental Illness