How to Deal With Depression and Anxiety?

In one of my recent Tuesday psychotherapy training groups at Stanford, we reviewed the Interpersonal Downward Arrow Technique. This is a high-speed technique I created that allows you to rapidly identify the roles that you play in your relationships with others so you can pinpoint the patterns that create tension and unhappiness for yourself as well as the people you care about.

The Interpersonal Downward Arrow Technique is similar to what psychoanalysts try to do with free association on the couch, except it only takes five to ten minutes, as opposed to five to ten years. In addition, I have also developed fairly rapid ways to change and modify those dysfunctional patterns—IF this is what you want to do.

Some of the psychoanalysts call these hidden patterns “core conflicts.” The late Dr. Lester Luborsky (https://en.wikipedia.org/wiki/Lester_Luborsky), a prominent psychotherapy researcher at the University of Pennsylvania School of Medicine, has written about core conflicts extensively.

He gave as an example of a core conflict, a person who might have the belief that “my needs will never be met in my personal relationships.” Beliefs like this not only create unhappiness, but they can also function as self-fulfilling prophecies.

In addition, most people re not aware of these “core conflicts,” and do not realize they are just beliefs. Most people just believe that “this is just the way the world is,” and think they have a profound insight into the reality of human nature.

But we actually create our own interpersonal realities at every moment of every day. Since we usually cannot “see” what we’re doing, we may wrongly conclude that we’re victims of the “badness” of others. And, of course, there is always a grain of truth in that belief as well!

During the training group, we had group members identify some of their own “core conflicts,” using the Interpersonal Downward Arrow Technique, and this hit one of our members, Sara Shane, like a ton of bricks. She discovered that she sees herself as “an outsider” and has always believed she is stupid and inferior to others. And this intense belief has caused tremendous suffering for Sara for decades, including her participation in the Tuesday training group, where she is usually totally silent.

Sara traced this pattern to her childhood, growing up in a village in Mexico, where she was bullied and put down because she was short and overweight, and had the darkest skin of any of her many siblings. In addition, she struggled with a learning problem and was frequently put down and labeled as stupid.

Sara’s sudden decent into emotional hell was fueled by the fact that she was planning the wedding of her niece at a town in Mexico which was only two hours from the town where she grew up. And the thought of showing her daughter that town filled her with feelings of shame and terror, fearing she would run into the people she grew up with, including the people who cruelly put her down.

Here’s what she wrote prior to doing personal work on this problem in a subsequent Tuesday group:

Hello Jill and David,

Where to begin…all day yesterday it was very painful as I thought about emailing you...

As I’m writing this, I am in tears and I know it is going to take me a while to write everything I want to say. But first let me say that it has taken me a long time to even sit in front of the computer because this has been very difficult for me. I had earlier said I would email you yesterday morning but I know now why I could not. I procrastinating mainly because this hurts a lot, beyond what I had earlier experienced. Right now, I am not even paying any attention to proper writing because I just want to write this without worry about correctness and just express my feelings.

Let me describe what I have been feeling physically all week long since Tuesday. I have been feeling sick to my stomach especially when I was working on the DML. I felt a hole in the pit of my stomach. I felt anxiety all over my body and felt overwhelmed. At times I could not even go one. I had to push myself to complete the Cognitive Distortions on the DML. I just wanted to run away from it all. It was that painful. But I also knew this was a good thing because I was getting down to something very important that I wanted and needed to face.

So the Interpersonal Downward Arrow has been very enlightening, but also, extremely painful. And David, you are absolutely right, there is no doubt in my mind (not that there ever was), that all of our problems are encapsulated in one brief moment in time and that we create our own interpersonal reality at every minute of every day.

Let me explain what transpired on Tuesday that motivated me to be a volunteer during small group practice. After postponing it for more than a year due to COVID, my niece is having her destination wedding in Mexico in November. My husband and I along with our daughter are attending the wedding. While there, we were hoping to travel to show our daughter the town I was born in and where I completed my junior and senior year of high school. After more than 20 years in February 2020, I reconnected with one of my good friends from high school. During this conversation, we talked about making plans to get together with our classmates when I went to Mexico for the wedding. However, I have not been in touch with her since then.

In making more concrete plans on Tuesday morning for our trip, I realized we would be able to travel to my birth town. So the possibility of visiting with my high school classmates whom I have not seen for about 38 years produced a lot of anxiety for me. This was very disturbing because this is not even a set event. It is only a possibility. Thus, I started wondering way it was making me so anxious just thinking about it and knowing that I did not need to visit with anyone if I did not want to. I was quite distraught, thus, I decided to share these feelings during small group practice. I was feeling anxious, insecure, and afraid of being judged and criticized.

I’m so glad I was able to volunteer during our small group because prior to this I didn’t realize the multitude of feelings that were buried. One of the biggest revelation was how lonely I was feeling and the immense grief I was experiencing. But even more surprising was the extreme feeling of inferiority I felt although I denied it at first when Jill asked if I was feeling inferior. It was not until we were going over the “Rules” that govern the relationship that it was very clear to me how inferior I felt. And here lays all my PAIN: “I am always an outsider because I will never be good enough.” This brings me to tears!

Although I understand intellectually that my suffering results from the belief that I have a self that is not good enough and a self that others can judge, as you so beautifully wrote David in your book, Feeling Great, it is still hard for me to let go emotionally.

When doing the DML, I believed my negative thoughts 100% and found 7 to 8 distortions on each, which as I mentioned earlier, it was very painful to complete.

Negative Thoughts:

1. 1. I am always an outsider because I will never be good enough
   2. I shouldn’t get close to people so I won’t be criticized nor judged
   3. I’m not professionally successful as I should be, after all, that is why I went to school
   4. Mexican people are very judgmental

Perhaps instead of typing all the DML information on here, I should send you a copy along with a copy of the CBA. I will do this in a second email.

Self-Defeating Beliefs:

Perceived Perfectionism - My high school classmates will not accept me with all my flaws

Achievement Addiction - My worthwhileness depends on my accomplishments, professional success, and the way I look (preoccupied with my overweight)

Worthlessness - I’m basically worthless, defective, and inferior to others especially some of classmates

Brushfire Fallacy - Everyone will talk about me and look down on me (“Mexican people are very judgmental”)

Spotlight Fallacy - Talking to people feels like I have to put on an interesting mask and perform in order to impress those around me

Superwoman - I should alway be strong and never appear weak in front of others

As I worked through the DML, CBA, and S-DB these last few days so much has come up for me. I couldn’t help it but to feel lots of pain as some of my childhood memories emerged of the horrible times when I was humiliated, teased, and bullied primarily by family members (both immediate and extended family members). Sadly enough, in the Mexican culture, being dark completed, short, and chubby are frown upon and a reason to be ridiculed and humiliated. And unfortunately for me, I possessed all three characteristics beside having a learning disability which was translated as me being dumb, stupid, and slow. There were plenty of moments growing up that this was extremely painful especially moments when my own family crudely laughed in my face. I quickly learned to withdrawal and became rather introverted. As I got older, I also quickly learned to tell myself things like; “But one day I’m going to show them that I am not as stupid as they think I am” and “One day I will prove them wrong.”

I believe this also became my strength, motivation, and determination to go to college. I was always just an average student in college, and at times, I struggled, but what got me through was my determination to succeed and ultimately prove that I could do it. However, this also created strong fears of being humiliated and ridiculed by people in general. Thus, I have protected myself from being criticized or judged by pushing and staying away from people and have been very cautious and guarded regarding having close relationships. Also, for many years, I have avoided family gatherings where I know extended family members that use to tease me when I was a child are going to be in attendance. I have been rather sensitive to people’s humor and hardly ever joked myself unless I knew the person very well. I am happy to say though that I have made some growth in this area ever since I have joined TEAM. And, that is thanks to your innate humor, David. ; )

Any way, I hope this makes sense…

Thank you so much to the two of you for the opportunity to allow me to grow and learn from my painful thoughts. I know more than ever that the only way to over come this pain is by the death of my belief in the “self”.

Love,

Sara

This will be the first of two podcasts showcasing the amazing work that Sara did in a subsequent Tuesday group. Dr. Jill Levitt and I worked together as co-therapists, and we went through the TEAM model in a step-by-step manner.

In this podcast, you’ll hear the first half of the session (T = Testing and E = Empathy) and next week you’ll hear the last half of the session (A = Assessment of Resistance) and M = Methods.)

If you click here, you can see Sara’s Brief Mood Survey at the start of the session.

If you click here, you can see Sara’s Daily Mood Log at the start of the session.

If you click here, you can see the CBA that Sara completed prior to her personal work.

Thanks for listening!

Rhonda, Jill, Sara and David