Online Alcohol Therapy

There is often some misunderstanding of what it really is, so we should perhaps briefly describe what the medically agreed symptoms of depression are:

• low mood most days (feeling sad or empty)
• lack of pleasure in activities
• low motivation
• irritability
• inability to concentrate & poor memory
• lack of activity and energy generally
• feelings of guilt & worthlessness
• appetite changes
• sleep disturbance

The causes of depression are different for each person, of course, but certain similarities occur:

Early life events:
Some people are more predisposed to depression than others, as a result of their life experience – certain events may cause the development of low self-esteem, poor problem-solving skills or hopelessness.

Beliefs:
Depending on what messages people have been given in life (by peers or parents for example), they may develop a range of dysfunctional, rigid beliefs about themselves, other people, or life generally, for example -

• “I’m weak”,
• “I’m unloveable”,
• “if other people don’t approve of me then I’m worthless”, or
• “if I need people they won’t help me”, or
• “I’m not strong enough to cope if unpredictable things happen”.

Thinking styles:
How we make sense of our life has a big influence on how we feel. An example of this is ‘attributional style’. For instance:

• If a negative event occurs, perhaps a mistake with significant consequences, and you attribute it to an internal, enduring cause (e.g. considering yourself useless), then of course it would tend to make you feel low.
• If you attribute the same event to an internal but transient cause (“I wasn’t paying attention right then”), then you might feel less depressed about it.
• Were you to attribute the event to external factors beyond your control (“anyone would make mistakes under this sort of work stress”), then you might barely feel down about it at all.

This is a simple example of the many attributions we make for what happens in our lives, all of which are just opinions, subjective views, not facts. Depressed people might counter “yes, but I AM useless”, but again this is only an opinion, not a fact.

Current events:
If, on top of these predisposing vulnerabilities, current life events occur which deplete emotional energy or make coping difficult, then depression can develop. Some examples of such events might be:

• A loss of some sort (not just of a loved one, but perhaps a loss of some important aspect of life such as status or health for instance).
• Prolonged stress – the perception that the demands being made of you exceed your available resources; if this is chronic then a state of helplessness (“I’ll never escape”) or hopelessness (“what’s the point”) can develop.
• Periods of anxiety can also precipitate depression, as the feelings of vulnerability, unpredictability and lack of control can create pessimistic beliefs about the future.

Once depression develops, what maintains it?

Another aspect of our selves is our moment-to-moment stream of consciousness; the linguistic content of our thoughts. These have an immediate effect on our mood, so depression can be maintained by ‘Negative Automatic Thoughts’ which take the form of unhelpful styles of thinking.

There are three main themes: –

• the self (eg. – I’m defective or inadequate)
• the future (eg. – it’s hopeless and pointless)
• the world/life (eg. – it’s difficult, uncaring, cruel)

Some common unhelpful thinking styles include:

• Over-generalisation (using words like: always, never, everyone, no-one, everything, nothing)
• All or nothing, categorical thinking (if you’re not perfect then you’re a failure)
• Negative filter (only seeing negative evidence about yourself, ignoring any positives)
• Mind reading (“I know they don’t like me”)
• Catastrophising (“that’s it, I’ll never succeed at this now”)
• Labeling yourself based upon your behaviour (“I did something stupid, therefore I am stupid”)

Self blame:
Lack of compassion for yourself is often a factor in maintaining low mood – even if we are capable of being compassionate and caring towards others, we believe that we don’t merit the same compassion or forgiveness for ourselves. Thus guilt and self-recrimination can become entrenched.

Lack of activity:
Once low mood sets in, energy levels and motivation drop, and as a result people do less. Their opportunities for having fun, for feeling a sense of achievement, for sharing experiences with friends, all diminish. Thus a feedback loop is established, potentially leading to further drops in mood.

Alcohol:
And finally of course, alcohol is a well-known depressant, a substance which many people turn to in times of difficulty, thus compounding the problem.

In the next article, we’ll look at ways to overcome depression based upon the causes we’ve identified here.

There are several factors which contribute to social anxiety, and each of them needs to be addressed for the whole problem to be dealt with.

Lets look at them in turn – firstly there is your belief that other people are highly likely to reject you or judge you negatively, when in fact this is probably an overestimation on your part. People are more forgiving than you think.

So you need to test out how likely this is with some experiments. Start with a situation that’s fairly non-threatening (you’ve probably got some scarier situations you could imagine, but we don’t need to jump in at the deep end). When you’ve thought of a slightly anxiety-provoking social scenario, predict how exactly you think others will judge you, and how will they demonstrate their judgment? What evidence can you gather that they have judged you? Then conduct the experiment (expose yourself to the situation) and compare the results with what you predicted would happen. What can you conclude from this? Most likely it will be that other people aren’t quite as judgmental as you believed them to be, and that in fact it’s almost impossible to tell if they are or not – because you are not a mind-reader.

So this brings us to another aspect of social anxiety disorder – that you accept the judgments you imagine other people are making of you, and you predict that this situation will be intolerable, so much so that you want to avoid it at all costs, which is where the fear and anxiety arise. The truth of the matter is that occasionally people are judgmental, but when they are, although it’s unpleasant, it is tolerable and need not be avoided, hence some of the fear and anxiety associated with it can reduce. However, you will only fully accept this once you’ve experienced it several times without avoiding the situation.

During social interactions, you’ve probably developed several ways in which you try to reduce your anxiety, or make yourself feel safe. These range from the obvious ones (like alcohol), to the more subtle (like rehearsing what you’re going to say beforehand), or more common ones (such as pretending to look at something on your phone). These ‘safety behaviours’ are counter-productive, because they reduce the opportunities for you to learn that social situations aren’t really so threatening. What things make you feel calmer in a social situation? You believe these things ensure your safety, when in fact you’re safe without them.

Where you focus your attention is another important factor in reducing social anxiety. You probably pay close attention to the bodily symptoms of your anxiety when you experience it – you become self-conscious, and this acts as a feedback loop because you judge your own anxiety symptoms, making them seem more alarming to you, and so they get worse.

All the while, you are not focusing on the social situation, not engaging fully in the conversation, thus it becomes harder to read the cues other people are showing you, which can lead you to make further mistakes (stuttering, not understanding what someone said, forgetting their name etc.) It’s important therefore to remind yourself to focus your attention outwards, not on your body.

Evaluate the negative thoughts you’re having at the time which might contribute to your fears. Such thoughts may view the situation as catastrophic, or in ‘black or white’ terms (ignoring the grey areas), and may tend to overgeneralise – for example:

“If I get anxious — then I’m a failure”

“If I blush — people will think I’m weak”

“If I stumble over a word — I’m a loser”

“If I act differently to other people — I must be weird”

“If I lose my train of thought — it shows I’m stupid”

Such thoughts need to be challenged and replaced with more helpful, rational alternatives. This takes practice though, as these thoughts are quite automatic and habitual. Taking the examples above;

“If I get anxious — that’s acceptable”

“If I blush — people will feel compassion”

“If I stumble over a word — I’m normal”

“If I act differently to other people — I’m not one of the herd”

Essentially you need to learn that social situations are not as threatening as you imagine them to be, social mistakes you might make are not as catastrophic as you believe they are.

The goal is not to eradicate anxiety altogether, as that would be abnormal, but to reduce it to tolerable levels. Because actually you can learn to tolerate the discomfort that these situations create for you, and such tolerance can be improved with practice.

Anxiety is not a helpful measure of your social performance. You can feel anxious, and other people will still accept you. Imagine for a moment that you encounter someone who is obviously anxious when they are speaking to you – would you reject them and judge them negatively? No, of course not, and neither would most of the people who meet you.

Other people are not as critical towards you as you are yourself. Hence what you believe people will think about you is more likely to be a reflection of your own self-critical beliefs. And changing that is the subject of another article.

Social anxiety is a common problem, characterised by being apprehensive and nervous about potential rejection or humiliation by other people.

If you find yourself getting worried about upcoming social events, and imagining how uncomfortable they’re going to be, or how other people will notice your anxiety, then you might well get into the habit of drinking alcohol in order to calm your nerves.

You might believe that you will behave in an unacceptable way, which will result in other people making an unfavourable evaluation of you, and this feels very threatening. You might believe that people will think you are weak, crazy, stupid or boring, and as such you might find it very difficult to engage in conversation or eat a meal.

Sometimes social anxiety escalates to include a panic attack, which can then fuel further anxiety, as you become worried that another panic will occur next time you socialise.

As such you might often find yourself preoccupied with thoughts about your visible symptoms of anxiety (sweating, blushing etc.), and how other people might be viewing them. You really want to make a good impression, but you’re worried that you’re just not able to. Social phobia like this can simply be described as a fear of being embarrassed.

As such, the consumption of alcohol can become an easy solution for people finding themselves in this position – drinking quickly and easily reduces the anxious feelings, boosts confidence and aids conversation. However, many people find that they end up binge drinking, and thus embarrassing themselves in exactly the way they were hoping to avoid.

Next week, we’ll look at how this problem can be overcome.

“I wish I could quit drinking so much, but I just don’t have enough willpower”.

As a therapist, I hear this quite often, but perhaps we need to explore what willpower really means in order to find a solution to the problem.

The capacity to resist the urge to drink arises initially from various motivations – like the desire to avoid a hangover, or the need to be able to concentrate at work the next day, or the preservation of a close relationship perhaps. If sufficient motivations can be brought to mind, and they feel more compelling than the potential pleasure of alcohol, then a person can exercise self-control and not drink despite wanting one at the time. This is a reasonable definition of willpower.

Some people seem to have more willpower than others regarding their drinking, but perhaps only because alcohol has not taken on so many important functions for them (like stress-relief, confidence boosting, avoiding boredom etc.), or they have found other ways of achieving those results.

People with alcoholism are unable to resist the urge to have a drink, despite knowing that in balance it’s not doing them any good. Partly this is because short term consequences are often more effective at influencing behaviour than long term consequences, and in the short term the pleasure/relaxation of a drink outweighs the negative effects tomorrow or at some indeterminate time in the future (or so it seems to them). A strategy to deal with this tendency of course is to concentrate on the negative effects of alcohol in the short term, rather than the vague long term ones.

People can learn to have more control over their urges to drink, to predict when they are likely to occur so they don’t come as a surprise, to learn to bring to mind all the ‘pros and cons’ rationally, or to address those needs that alcohol has filled some other way – and so they increase their willpower.

A survey by the British Association for Counselling and Psychotherapy (BACP) has found that talking therapies are becoming more acceptable in UK culture, people are less embarrassed to admit they have had therapy, and more would consider it as an option than they used to.

Thankfully it seems our society is changing into one which acknowledges the difficulties we all face with our mental health, and as such does not stigmatise those who decide to seek help in the form of counselling or therapy.

All we need now is sufficient access to these therapies, because at present (and with cuts in public spending under way) there is just not enough capacity to meet demand. The cheaper option of medication is often suggested by GPs with limited funds, which though effective at dealing with symptoms, does not address the underlying issues.

Further coverage in the Guardian.co.uk

A good article on the BBC today about what happens in an AA meeting – well worth reading.

A lot of people consume alcohol as a way to manage stress. How often this is effective as a coping strategy probably decreases as the amount you drink increases. But although alcohol doesn’t really work as a long-term way of handling stressful situations, it does provide relief in the short term. And this is where the problem starts.

Our tendency to consider short-term effects in preference to longer term ones is visible in many areas of our lives. But why can we not more easily use the negative consequences of alcohol in helping us decide how much to drink?

People use the word “stress” quite a lot, but what does it really mean? Do we all use the word to mean the same thing? Everyone perceives different things to be stressful, but a few aspects of our experience are probably universal.

The first aspect is that a feeling of stress arises when we believe situations in our lives require more of us than we are able to give in terms of emotional or mental energy. We become depleted, and our decision-making abilities seem to lessen along with this.

Another aspect of stress is that we encounter events which trigger the ‘fight or flight’ reaction inherited from our ancestors. When we sense threat, or the possibility of emotional pain ahead, or any outcome that might make us anxious at some level, adrenaline is produced to prime our bodies to take action and our blood pressure goes up.

Of course not many stressful situations require physical responses these days, we have to deal with most events through more subtle behaviours than running away or fighting. And yet consumption of alcohol does seem to allow us to effectively ‘run away’ doesn’t it? Maybe this explains it’s popularity.

How is it then that some people seem to manage stress better than others? Is it just their resilience? More likely it depends on our beliefs about ourselves, our estimation of our ability to handle the events in our lives, which is a self-fulfilling prophecy. If we can effectively deal with events, there may be less urge to run away from them, and hence perhaps less urge to drink. If you are drinking less, then undoubtedly your capacity to respond to stress is improved.

We all make mistakes from time to time, it’s inevitable. But how you react to them can make a big difference to your self esteem.

What do you tend to say to yourself when you make a mistake? If you have a judgemental inner voice that says something like “I’m so stupid, I always make a mess of things” or, “why did you do that again, you’re so useless”, then of course you’ll feel bad about yourself as a result.

If you have many of these self-criticisms happening regularly, it tends to lower your opinion of yourself, and can lead to depression, and from there to drinking more.

Similarly, how you respond to your alcohol consumption has an impact on how you feel about yourself. If you drink more than you intended one night, you might judge yourself for it, saying something like “you’re such a loser, you got drunk again”. The consequences of such a thought are probably feelings of hopelessness and low self esteem. Contrast that with a different reaction to getting drunk, like “I wish I hadn’t done that again, I really need to work out what’s going wrong” – there’s no judgement or self-criticism in that, and you’re more likely to feel hope that you can change.

This is just one small example, but the important point is to listen out for the content of your inner voice, and notice when it’s being harsh or critical, then stop to consider what you could say to yourself instead that would be more understanding and caring.

And before you reject this idea, saying “but that’s just how I am”, these self-statements are not a fixed part of your personality, they are just habitual, so they can be changed.

You can start by making yourself more aware of what you habitually tend to say to yourself. Write it down when you notice you’re being self-critical, then you can begin to challenge such thoughts when they pop up next time, maybe something like “hang on a second, I’m not useless, I just made a mistake, that’s all”. No judgement, no labelling yourself as faulty, just an acknowledgement of human error, and maybe some forgiveness too.

As if you needed another excuse to have a drink. Now researchers in Spain have conducted a study of 40 000 people and found that those who drank alcohol regularly tended to have a lower risk of a heart attack than those who were teetotal (particularly for men over the age of 40). And the more you drink, the greater the protective effect.

Don’t forget of course that all the other health risks still apply – so you might not have a heart attack, you’ll just get liver cirrhosis instead, or pancreatitis, a stroke perhaps, or you could develop diabetes, or stomach cancer. So don’t take this as an excuse to have a drink after all.

The Independent

A recent research study published in the Lancet has demonstrated the effectiveness of online psychological counselling for mental health problems. The study followed a group receiving therapy over typed internet chat (or instant messaging), and found it more than doubled their chance of successful recovery from depression when compared to a control group just taking anti-depressants.

The study director Dr David Kessler said these results are comparable with those seen in face to face therapies. Clearly, some people find it useful to write down their thoughts as a way of talking through them.

If you think you might want to give it a try to help with your alcohol problems, get in touch with us here.