Navigating Psychiatric Medications

Ask  David With Special Guest Expert, Dr. Matthew May Daily Mood Log: Does it have to be done perfectly? Somatic Complaints: How does TEAM Help?  Passive Aggression: What distortions cause it?

1. Roger, from Australia, asks: Do daily mood logs still work if you complete them ‘imperfectly’?
2. Roger also asks: Based on your clinical experience, what causes a reduction or complete elimination of in symptoms for people who present with somatic complaints or chronic pain?
3. TOZ asks: Does passive aggressive behavior result from All-or-Nothing Thinking?

The answers below were written prior to the show, based on correspondence with those who asked the questions. The live answers on the show will be different in many cases.

 1, Roger, from Australia, asks: Do daily mood logs still work if you complete them ‘imperfectly’?

2. Roger also asks: Based on your clinical experience, what causes a reduction or complete elimination of symptoms for people who present with somatic complaints or chronic pain?

Dear David,

Sure, I would love to have my questions be on an Ask David! It would be okay for you to use my real name and my location as being in Australia for the podcast and show notes.

I’ve reworded the questions so that they get across what I was actually trying to ask in my previous email. You might now have a slightly different response based on the new questions. I have to apologise as my wording in my previous email was confusing, even for me.

Here’s a shorter version of the first question:

“Dear David, I’ve got a question about doing daily mood logs as part of my psychotherapy homework. I tend to start a lot of new daily mood logs where I write my negative emotions and thoughts, as well as do positive reframing, but then get stuck when it comes to doing methods for challenging my negative thoughts, as I get caught up on trying to do the exercise perfectly. I get worried that I won’t see as much benefit from the exercise if I don’t do the steps perfectly or in order. Did you see improvements in patients who filled out their daily mood logs imperfectly? Perhaps they may have skipped steps or maybe they couldn’t crush their negative thoughts completely, but continued to move on to working with new thoughts and seeing if they could crush those.”

An even shorter version of the question would be:

“Do daily mood logs still work if you complete them ‘imperfectly’?”

A shorter version of the question about somatic complaints and pain is:

“I’ve also got a question on treating somatic symptoms and chronic pain. Some clinicians have seen people improve by doing journalling or expressive writing about life stressors such as past stressors, current stressors, and self-limiting behaviours or beliefs.

Other activities which seem to be useful include writing unsent letters to people who’ve hurt you, or doing behavioural changes for self-limiting beliefs like learning how to designate free time for yourself if you have a tendency to take on too much or feel guilty about spending time relaxing and not doing work. I was wondering what you’ve seen in your clinical experience and what you’ve seen patients do which helps them reduce or eliminate their somatic symptoms and chronic pain?"

An even shorter version of that question would be:

“Based on your clinical experience, what causes a reduction or complete elimination of in symptoms for people who present with somatic complaints or chronic pain?"

Regards,

Roger He

David’s reply

Thanks, these short versions are a big improvement. Here are the quick answers:

1. The critical thing is to come up with one or more positive thoughts that are 100% true, and that reduce your belief in the negative thought. If you send a specific example, it would help. There are several rules about getting workable negative thoughts as well. Perfection is never possible in the universe of daily mood logs, but excellence certainly is. A change in belief in neg thoughts is the goal.
2. In my experience, somatic complaints, such as undiagnosed pain, dizziness, fatigue, and more, are often created or magnified by (or the expression of) negative emotions, as well as hidden emotions / problems. The average reduction of pain, for example, will be 50% if there is a dramatic reduction in negative feelings, or if the patient identifies and tackles some unexpressed problem, like anger, or unexpressed grief, or loneliness when the kids go off to college, and so forth. An average of 50% means that some people will experience a complete elimination of the negative symptoms, like pain. Some will experience no improvement. And some will experience some improvement.

With regard to how or why this works, I don’t really know, and don’t think that anyone knows. But it seems like negative feelings, like depression, anxiety, anger and so forth have a magnifying effect on negative feelings.

On the podcast, I can give a personal example of when I was in the Stanford emergency room, screaming in pain from a broken jaw.

I can also give an example of what happens to my low back pain when I am in an especially good mood and I am out jogging.

Best, David

3. TOZ asks: Does passive aggressive behavior result from All-or-Nothing Thinking?

Hi David,

I thought my therapist will tell me once he gets to know me that I'm passive aggressive and therefore I do things particularly anxiety disease as all or nothing black or white.  I was wondering for you not to answer my case but in general does passive aggressive attitudes or approaches result from all or nothing thinking?

Thanks, Toz

David’s reply.

Thanks, Toz. Great question!

To find out, you would have to do what I have recommended for nearly 50 years. Write down your negative thought on a piece of paper (can you do that?) and identify the distortions in it, using my lit of ten cognitive distortions. Let me know if you’ve done this.

Most people refuse to do it!

Warmly, david

Toz replies:

So I did your exercise. My thoughts were:

I'm crashing.  Help I'm scared.  I'm going to die.  Help me laud.  Help me laud.

Distortions:  predicting the future.  Magnification

How is that?

I looked up. Saw that was fine. Felt better.

Then I checked my pulse.  Not too fast so okay. Toz.

David’s reply to Toz,

That, Toz, is totally cool! Way to go!

Could also add: Emotional Reasoning. You identified two super important distortions that are always present in fear, paranoia and anxiety.

Cool, cool, cool!

David's comment: This is why I ask for specific examples when people ask general questions. As you can see, Toz asked about passive aggression, but his specific example turned out to be all about something entirely different: anxiety and panic. He did a great job of testing his negative thoughts with the Experimental Technique.

Warmly,

Rhonda, Matt,  and David