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Talking your way out of emotional lows

columns Updated: Aug 11, 2013 00:41 IST

We’ve all been in situations were we’ve done things we’ve hated doing just because it was expected of us. We usually do it out of guilt, out of a need to please and not hurt others even though it makes us miserable and very, very resentful. And if we go against expected behaviour even within reason, it makes us feel mean and scum-like.

Psychologists say it’s flawed emotional reasoning that makes us believe there is reason for guilt just because we feel guilty. Warped emotional baggage makes us to put up with other people’s unreasonableness and unrealistic expectations, which over time can leave us angry, bitter and depressed.

But now it’s possible to rewire the brain and make people think differently.

Cognitive behavioural therapy (CBT) involves talking to people with psychological issues to nudge them to assess and react to situations in a more positive way. Since a chunk of the problems you face are not caused by situations themselves but by how you interpret and react to them, both emotionally and physically, CBT is now used to treat almost all the common psychological disorders, from depression and addictions to phobias and obsessive-compulsive disorder.

Like guilt, some other common errors in perceiving situations are jumping to conclusions (“He didn't say hello because he doesn’t like me”), perfectionism (“If I can't be the best, why make an effort at all"), warped mental filtering (“Focussing excessively on what's wrong and not what's right with your life”), over-generalisation (“Noticing failures more than successes”), and over-generalising (“My life sucks, I’m a loser”).

Most of us develop negative thinking patterns through negative reinforcement, psychologists use CBT to whittle away negativity with a technique called graded exposure. By repeatedly confronting situations that trigger feelings of guilt, fright or aversion and observing that things are not half as bad you thought they were, it’s possible to slowly retrain your brains to think and react differently.

Primitive survival instincts like fear and guilt are processed in a parts of the brain called the limbic system that regulates emotion and memory (the amygdala processes emotion, and the hippocampus is involved in reliving traumatic memories). Studies of brain scans of people with phobias show overactivity in these two regions returns to normal after patients undergo CBT, with talk therapy being at least as effective as medication.

Scans are the most scientific validation possible. Increasingly, psychotherapy is turning to diagnosis based on science and not symptoms as advocated by modern psychiatry's touchstone, the Diagnostic and Statistical Manual of Mental Disorders, which is in its fifth revised avatar, called DSM-5.

Thomas Insel, director of the US National Institute of Mental Health, has asked for a shift away from categorising diseases such as bipolar disorder and schizophrenia according to a person's symptoms. Instead, Insel wants mental disorders to be diagnosed as objectively as other diseases such as heart disease and cancers. He advocates the use of genetics, brain scans that show abnormal patterns of activity and cognition, rather than symptoms or reported mood.

Scans have some drawbacks, such as diagnosing patients with multiple disorders who may have parallel or overlapping brain activity. Roughly three in four children with autism have social-anxiety disorder or attention-deficit hyperactivity disorder, while one in three people with anxiety have mood disorders.

Given the complexity of mental illness, CBT works well to help you cope by giving you the tools to change how you think and behave in a social situation even after therapy is over. The other pluses are that it has no side effects or cost once the sessions are over.

So, if you’re feeling stifled and unable to deal with people and situations, perhaps a few sessions of CBT are in order to make the sun shine in you once again.