The Value of Looking Outside Yourself

24 October 2017 - Dr Jan Orman

Many people who suffer from depression spend a great deal of time looking inward. Even when not depressed, they often have a contemplative or even ruminative style. Depression is rife among philosophers and poets but is it the philosophy and poetry that leads to the depression or is the philosophy and poetry the depressive’s way of managing their mood?

Cognitive behaviour therapy, and many related therapies, teach distraction as one of the ways of modifying strong and unruly emotions. Distraction is about settling the mind on things and thoughts other than the ones that are upsetting us. Many people find reading, watching movies, playing video games, intensive exercise, writing, creative pursuits or work and study helpful in managing their emotional worlds. To a greater or lesser extent these things provide distraction.

Weathering the emotional storms

I love talking to my patients about the things they’ve noticed they do to help them weather their emotional storms. Sometimes they choose harmful things like drugs or alcohol, binge eating or self-harm and that creates another layer of problem. Sometimes it’s obvious and easy for them – they go for a run, watch a movie, talk to a friend or listen to or play some music. But for many people the soothing things are much harder to identify. That’s partly because their emotions come on too fast and too strong. It’s often also because they have never realised they need to help themselves when it comes to moderating their emotions instead of depending on outside events and people to do it for them.

Self-soothing techniques

Marsha Linehan, in developing Dialectical Behaviour Therapy (DBT) for people with lives so chaotic they couldn’t even manage therapy, recognised the need for people to actively learn self-soothing techniques. A whole term of the year long group therapy course is devoted to a discussion of “emotional regulation” and the development of techniques to suit the individual. Linehan’s “Skills Training Handbook for Treating Borderline Personality Disorder” in the edition I have lists 176 possibilities in its Pleasant Events Schedule to use as a starting point for discussion and discusses a variety of ways to distract and self-soothe, often involving engaging the senses.

Music

For some people struggling with surges of emotion, music may do the trick. For them the Music Escape App from Queensland University of Technology may be helpful. The app arranges the music on their smartphones in such a way as to have the music shift their mood in a more helpful direction.

Apps & Websites

For those for whom music is not the answer, more cognitive distraction techniques may help. They may like Virtual Hope Box which come from the US Dept of Veterans Affairs and contains a number of activities including sudoku, jigsaws made from the photos on your phone and word search puzzles among other things.

I have a patient who has discovered the International Cloud Atlas. This is a website with beautiful photos and careful descriptions of types of clouds and discussions of the weather conditions that create them. Whenever my patient feels distressed she looks skywards and consults her phone to help her identify the clouds that are almost inevitably somewhere in view.

Podcasts

And don’t forget podcasts for those with smartphones. There’s something engaging for everyone out there from local radio shows to the iconic This American Life; from the BBC Comedy shows to the New Yorker Fiction Podcasts.

Poetry

But not everyone needs technology to help them with distraction techniques. One of my patients has developed a habit of turning her thoughts to poetry. She catches a phrase hidden in her ruminations and works with it until she has a poem (or sometimes a short story) and the end result is a deep sense of satisfaction at what she has created and a palpable shift to a more positive state of mind. The interesting thing is that in order to make a poem or story she needs to gaze outwards to the physical world to search for words, images and descriptions that fit her needs. In doing so she disengages from her inward looking thoughts.

Is there a secret formula somewhere in all that? Would it help all of us who are prone to rumination to find ways to turn our gaze outward towards the physical world for just a little while longer?