MENTAL HEALTH

Day 1 | Introduction

The Mind Regulates Itself

Psychologists and therapists have long suggested that depression and other mental health problems afflict us when life becomes challenging and painful. As a result, treatment methods have largely focused on processing the traumas and negative experiences believed to have accumulated in a person’s mind. This idea was commonplace in therapeutic circles when British clinical psychologist, Adrian Wells, and his colleague Gerald Matthews presented an entirely new model of the human mind in the early 1990s. They documented that, as a rule, the mind regulates itself; just as our body can often heal itself, so too can our psyche.

Over thousands of years, the human body has developed the ability to heal wounds and bones after cuts and breaks. We all learn early in childhood that a bloody knee after a fall from a bike doesn’t continue to bleed for the rest of our lives. It is cured in the most wonderful way, without us having to do anything ourselves, and it happens relatively quickly. But if we pick, scratch, and rub at the wound, then it won’t heal properly. On the contrary, we risk making things worse by creating infection and scar tissue.

The same happens in our psyche. In the aftermath of an unpleasant or unhappy experience, such as a divorce, accident or fire, thoughts will naturally focus on this experience. The experience will appear in our mind again and again, several times a day, in the form of thoughts and images. It is natural that these thoughts and feelings will be negative and dominated by grief, fear, sadness, disappointment and perhaps even anger.

Immediately after the bad experience, the psyche will hurt and suffer – exactly like a knee when the skin is scratched off. In the same way that our knee will heal if we resist picking at it, so too will our mind if we refrain from fostering feelings by ruminating on them. Thoughts, images and impulses visit us briefly but will disappear again if we don’t grab them, suppress them or otherwise try to deal with them. If we don’t keep them in the front of our mind for regular access, they will pass through like grains of sand in a sieve.

Self-Analysis Will Make You Depressed and Anxious

Many of us rack our brains trying to solve our problems. We believe that with the help of our thought processes and cognition, we can force out the answers. This may sound counterintuitive, but the best strategy is often to do as little as possible. The answers will either appear by themselves at some point, or the questions will disappear and be forgotten because they weren’t important.

Adrian Wells and colleagues discovered in their research that the same applies when we are melancholic, sad or depressed. If we use all our mental powers to ruminate (to think deeply about something over and over again), we risk maintaining the sad thoughts, thereby making our mood even worse. Therefore, it is best to let your thoughts be. We shouldn’t try to force them away, but rather just passively observe their flow.

It is not the amount of unpleasant experiences and negative thoughts that leads to depression. Instead, pioneering research from Wells and Matthews points to an attention syndrome known as Cognitive Attentional Syndrome (CAS) as the primary cause of most mental illnesses, including depression. In doing so, they also answered a common reservation about this idea: if the mind heals itself, why do some people become depressed after a life crisis while others don’t? The answer is found in the amount of attention that we give to our thoughts about problems and life crises. Simply put: we ruminate ourselves into depression.

Cognitive Attentional Syndrome is not a classical syndrome as it doesn’t contain a collection of symptoms like a syndrome usually does. Rather the syndrome is an umbrella term for four basic strategies that, when used excessively, strengthen our thoughts and feelings and can cause setbacks in the form of depression, anxiety, or other mental illnesses. The four strategies, which will be elaborated on in a moment, are:

• Rumination

• Worry

• Monitoring Behaviour

• Inappropriate Coping Behaviour (e.g. avoiding situations or resorting to excessive rest, sleep, alcohol and so forth)

To be clear, all human beings naturally and inevitably have dark and negative thoughts that we sometimes ruminate on or worry about for a while. That is not a problem. Only when we develop a deep and long-term focus on the dark and negative thoughts do we risk becoming sad and provoking depression.

A common trait of all people with mental health issues is an excessive use of one or more of these four strategies: spending many hours ruminating every day; worrying constantly; monitoring our mood over and over; or regularly dulling the thoughts with sleep, rest or substances like alcohol. This excessive focus is seen in everyone with a mental illness, but it is expressed differently from illness to illness.

Does this mean that it is our own fault if we develop depression or anxiety? Are we asking for it if we tend to worry or contemplate a lot? No, of course not. Nobody should feel guilty about having a mental illness. No one ruminates themselves into the dark on purpose. We all have our own ways of handling our thoughts and feelings. Most of us have in-built strategies that we developed in our youth. Essentially, we learn these strategies in one of two ways:

1. We copy our parents or other people we look up to, or we do what those people tell us we should do. For instance, some of us will be told by our parents that it is important to ‘think long and hard’ before making an important decision – such as choosing a partner or what to study. We will take this literally and will, therefore, spend many of our waking hours extensively overthinking.

2. We learn by observing other people’s reactions to our behaviour and by which behaviours help us to achieve what we want. For example, if we have been rewarded for being highly analytical in school, we will reinforce this behaviour in other areas of life.

The four basic, inappropriate strategies in Cognitive Attentional Syndrome (we’ll also refer to these as our ‘CAS responses’) are generally aimed at solving problems, creating control or otherwise managing events in our lives. Everybody uses these strategies, and they aren’t inherently destructive to us. When we ruminate on being fired from a job, we can call it reflection – we reflect on why we were fired. Did we do something wrong? If we worry about how our children will cope with our divorce, we can call it care. If we are sensitive to how we are actually feeling and allow ourselves to lie on the sofa after a divorce, we can call it taking care of ourselves. There is nothing wrong with that.

The problem arises when we come to believe that these strategies are necessary for us and that we can neither control nor limit them. The time we spend thinking determines whether the thoughts remain an appropriate self-analysis or whether we end up overthinking and developing depression. There is a vast difference between analysing your thoughts and feelings for a single hour during the day, and spending twelve days ruminating and contemplating. So, is it best to try to avoid completely ruminating, worrying, keeping checks on your mood and taking an extra rest on bad days? No, it is not. Of course we need to think about things and look inward to solve problems. We just shouldn’t spend all our waking hours doing so.

You can see just how variable CAS can be in an example of two men who, after being made redundant from the same workplace during the same round of redundancies, supported each other. They both felt that the redundancy process had been very unpleasant, and both were filled with negative thoughts and feelings: ‘Why was I let go? What is going on with management? Will I be able to get a new job when I’ve been wronged like this?’ Both men’s spouses were understanding and listened to them, and both men found comfort in their respective families, despite suffering from a feeling of having failed their wives and children by no longer being able to provide their income.

Soon, however, the behaviour of the two men began to differ. One decided to stop the endless ruminating once he realised it was maintaining his bad mood. He owed it to himself and to his family to get over it, he thought. The other man saw no other solution than to search for answers. The ruminations took over, creating new ruminations: ‘Have I completely lost control of my thoughts? What is wrong with me?’ It’s almost unnecessary to tell you that while one man moved on with his life in a new job, the other was diagnosed with depression and prescribed antidepressants. The only difference between the two was the length of the period spent ruminating.

Let’s review the four elements of CAS in more detail.

Strategy no. 1: Rumination

To ‘ruminate’ means to think about things over and over. Interestingly, the word stems from the Latin rumen, the name given to a compartment of a cow’s stomach – where the expression ‘chewing the cud’ also comes from. Cows chew their food twice in order to digest it properly. We talk about something being ‘food for thought’ and having to ‘digest an idea’, but rumination – coming back to that thought repeatedly – can lead to feeling down and to symptoms of depression such as insomnia, a lack of energy, a lack of concentration, difficulty remembering or, in the worst case, to depression itself. There are three reasons why people start to ruminate:

1. We are unaware that we are ruminating;

2. We are convinced that we can’t control our ruminations; or

3. We are convinced that such ruminating is useful.

Typical rumination starts with thoughts about what, why and how:

• What is wrong with me? What do I need to do to get rid of my depression?

• Why can’t I make sense of anything? Why did I get depressed?

• Why can’t I remember anything?

• How do I fix all my mistakes and deficiencies?

Strategy no. 2: Worry

Another strategy in CAS is worrying. For the vast majority of people, worries are just as natural a part of life as, say, joy. We worry about everything and anything: whether the rice pudding is too sweet; whether we remembered to lock the door; whether our newly licensed teenager is driving carefully; whether we’ll lose our job in the next round of redundancies; whether we’ll pass the exam; whether or not we are well liked by our colleagues. All these worries are normal and perfectly alright.

Worrying becomes a problematic mental activity when you dwell on certain thoughts. For instance, you might seize upon the idea of infidelity at a Christmas party – perhaps you saw this happen at your own workplace, or it featured in a TV show you watched – and you start worrying about whether your own spouse could be unfaithful at such festivities. If you get caught up in this worry, nurturing it to an exaggerated degree, you risk developing physical symptoms such as heart palpitations, a racing pulse and dizziness. The same physical reactions can be caused by worrying about more general anxieties about the future, for example: ‘What if I get sick? What if I’m not allowed to participate in the project at work? What if I never get better?’ If you seize upon such thoughts and worry a lot, you risk developing anxiety and symptoms of depression. If you have been feeling down for a long time or have been depressed, then you probably know the feeling that these worries go round in circles in your head. Perhaps you fear that the worries will never disappear.

In contrast to ruminations, worries typically form around hypothetical scenarios and so start with ‘What if …’ statements. For example:

• What if my brain gets damaged from depression?

• What if my spouse gets tired of me and wants a divorce?

• What if I never get better?

Strategy no. 3: Monitoring Behaviour

As with the previous two strategies, it is quite normal to pay attention to your mood once in a while. We can all feel whether we are happy, sad, dejected or in need of care. We all experience feeling sadder or more lethargic at some points in time, then wake up one morning to discover that we have more energy and are in a lighter mood. This is also quite normal.

However, when checking our mood becomes a trigger for feeling down for a prolonged period and, in the worst case, for depression, it is due to how much we focus on our mood. Do you often think that your mood is so bad that you need a day on the sofa? Do you notice yourself being a bit sad or a little happier several times a day? Do you ask yourself:

• How am I doing today?

• Am I sadder than usual?

• Why am I feeling like that?

If you often feel down, or if you have or have had depression, you probably focus more on your mood than is wise. Monitoring thoughts and feelings in the hope of catching any first symptoms of depression is a common strategy. Perhaps you think that if you are feeling a period of sadness coming on, you can take the right measures by taking care of yourself and slowing the pace so it doesn’t develop. It’s a tempting strategy, but it takes time and mental energy away from other experiences and chores in everyday life and can, therefore, result in a setback, where you risk stress and symptoms of depression in the aftermath.

People who pay close attention to their emotional life inevitably feel any small irregularity. In order to help clarify this monitoring behaviour, ask yourself how often you monitor your mood, or if you just leave your mood alone without analysing it. Our normal mood is dynamic and alternates from day to day. Sometimes, we wake up in an inexplicably worse mood than the day before. Therefore, the best thing we can do when we feel sad is to do as little as possible with the sad thoughts and instead let our emotions regulate themselves. Look at emotional life like breathing: it regulates itself best when we don’t always think about it and try to breathe in a certain way.

Strategy no. 4: Inappropriate Coping Behaviour

The fourth strategy that can lead to setbacks is inappropriate coping behaviour. The term includes all those things we do to dull unpleasant thoughts and feelings. These inappropriate strategies are very common, but just like excessive rumination, worry and excessive monitoring behaviour, they can bite back in the form of sadder thoughts, feeling even more down and symptoms of depression. For people with depression and anxiety, inappropriate coping mechanisms can worsen the conditions. Let me illustrate this with some examples.

1. We avoid or suppress certain thoughts and feelings.

It is a firm and widely accepted belief that the source of depression is having many negative thoughts. In light of this, it makes sense to try to avoid or escape from negative thoughts. However, thoughts don’t work like this, and the more we focus on avoiding them, the more we can be sure they will occupy our consciousness.

2. We try to change the negative thoughts into more positive or realistic thoughts.

A tempting approach can be to try to think more carefully or positively about yourself: ‘You’re doing your best. It’ll all be ok,’ we affirm again and again. The strategy is energy intensive and involves more thinking. Your problem is not your negative thoughts but first and foremost too much thinking.

3. We become angry with ourselves for thinking or feeling a certain way.

Some of us get angry with ourselves when we lack energy or when we spend yet another evening on the sofa watching television. We may also become angry and judge ourselves if, for example, we feel we have lost the love of those we care for or if we no longer enjoy activities we usually find fun and exciting, such as playing sports, visiting museums and having dinner with friends. When experiences and relationships that usually bring happiness no longer feel enjoyable, we understandably become both sad and frustrated.

When we get angry with ourselves on top of these feelings, it gives rise to new ruminations: ‘Why am I so ugly? Why can’t I get myself together? What am I doing wrong that I don’t feel happy?’ But this strategy of blaming ourselves for our lethargy and lack of feelings doesn’t contribute to more positive feelings – quite the opposite. It is equivalent to ruminating about ruminations and, as a result, we end up ruminating even more. If our strategy is to force ourselves to think and feel differently, then all we are doing is replacing our first ruminations with new ones – and we're back at square one. It is impossible to think yourself to fewer ruminations.

4. We sleep or rest more than usual.

Most of us experience having less energy when we are depressed or sad. On such days or during such periods we therefore want to rest more or sleep for longer. It’s nice to go to bed early or take a nap in the middle of the day if you’re feeling a little down. It’s both normal and fine to give yourself a little extra care some days. But if this habit takes over, it’s an inappropriate coping mechanism that can lead you to feeling even more down and to symptoms of depression. We don’t become happier and more energised by lying on the sofa for hours every day. For people with depressive symptoms or depression itself, fatigue, lethargy and doing the bare minimum often go hand-in-hand. It can be tempting to try to rest or sleep so as to increase our energy. The problem with this strategy is that it leads to the opposite: if we rest a lot and sleep more than seven to nine hours a day, we risk feeling even more tired, unhappy and sad.

5. We dull our feelings with drugs or alcohol.

After a long, hectic day it may be nice to relax with a glass of wine at dinner or perhaps a beer with colleagues after work. It’s not uncommon for a couple of glasses in the evening to feel soothing during stressful periods, such as during a highly pressured period at work or when coping with family illness or marital problems.

However, it is obvious that the soothing effect is only temporary. Alcohol can – like marijuana and other intoxicating substances – make us feel free and happy, but when you come down from the high, the ruminations return at full force. Alcohol and drugs actually only cause more negative thoughts and ruminations because the fear of being unable to keep away from the red wine or the joint creates new negative thoughts, ones that can lead us into a vicious spiral that feels uncontrollable. Another negative consequence is that the alcohol keeps us from discovering our ability to control our ruminations. We hand over control to alcohol and the outside world instead.

6. We avoid social situations, hobbies or work.

When we’re in high spirits, well and full of energy, many of us want to be with friends and family, to arrange gatherings and parties, and to participate in events at work, with clubs and at the children’s school. When we are feeling down, we are more likely to withdraw from other people, decline to attend social activities and stop partaking in our hobbies. It is, of course, completely fine to reduce your number of social gatherings for a while, but the strategy may be inappropriate if it takes over. At first, it seems easier not to have to go to a friend’s birthday party or a family event at your aunt and uncle’s, but that sense of relief doesn’t last.

Unfortunately, by avoiding social interactions, you only increase the amount of time you spend on rumination. Because now you can also contemplate whether not going to the party was the right thing to do. And about what the others at the party must think: whether they will be upset and talk about how you always decline invitations. Social isolation leads to more ruminations which, in turn, can lead to symptoms of depression.

One reason for avoiding social gatherings can be to escape new negative thoughts and ruminations that result from seeing the happiness of others. It can be difficult to handle thoughts such as: ‘Everyone else is so happy. They are better than me. My life has no meaning, and others have goals and plans for the future.’ Evasive manoeuvres are always inappropriate. They only provide relief in the short term. In the long run, they maintain symptoms of depression or depression itself. When we avoid life, we don’t experience that we can actually handle the challenges it brings. If we isolate ourselves from the world, we miss out on potentially good experiences, encounters and events that might lighten our mood. And if we end up having to take a leave of absence from work, we create even better conditions for spending time ruminating, worrying and keeping an eye on our mood.

7. We avoid thinking about and planning for the future.

If we lack energy and are afraid of things going badly, we may try to get rid of the dark thoughts by completely refraining from thinking about and planning for the future. Instead of solving the problems we face, we avoid thinking about them. We stick our heads in the sand like an ostrich and are fine as long as we don’t think about reality. But when we choose to look the other way for a long time, the problems grow bigger and bigger, and we end up feeling like we need to focus on them even more, spending increasing amounts of time thinking about them.

Re-Establishing Control Over Your Ruminations

Many people are convinced that they have no control over their ruminations. Rather they believe that the thoughts just appear, attracting attention to themselves, and that they can’t control the time they spend ruminating. Others have so often heard that depression and anxiety is caused by a flaw in the brain that they are quite surprised to hear that little is wrong with their brain function but instead, the main problem lies with their strategies.

Becoming Aware of Trigger Thoughts, Negative Thinking Patterns, and Ruminations

Rumination, worry, monitoring behaviour and inappropriate coping mechanisms – these may seem like a lot of new ideas to grasp and an ever-harder challenge to overcome them. How can we break free from old habits? Is it even possible? The short answer is yes, and within three weeks, you can set yourself on a path to improved mental wellness.

Our brains bombard us with thoughts – hour after hour, night and day. Like other organs in the body our brains do this completely automatically and continuously. Our hearts beat, our stomachs digest and our brains create endless thoughts and images. The content of this input from the brain is a mix of pretty much everything we have paid attention to and remembered.

Try asking yourself these questions:

• How many thoughts did I have yesterday?

• Where are these thoughts now?

It’s impossible to answer. Nobody can count their thoughts individually. Thoughts have their own lives. They do not necessarily begin and end clearly but interact and intersect with one another, and thus do not allow themselves to be accounted for. Researchers exploring the number of thoughts produced by the human brain estimate that people have between 30,000 and 70,000 thoughts a day.

We can compare our thoughts to trains at a busy railway station with a large number of platforms. Intercity trains, local stopping services and perhaps also underground or metro trains arrive into and depart from the station. There are departures all the time to hundreds of different destinations. Each train represents a thought or sequence of thoughts.

Let us take as an example the thought: ‘What should I make for dinner?’ Such a thought can, so to speak, arrive at the mental platform while we are doing something else – for instance, reading a book or checking emails on our phone. We may catch the thought and then notice that several others join onto it: ‘What have I got in the fridge? Perhaps I should buy a bag of potatoes and some broccoli on the way home.’ Or maybe we dismiss the thought, letting the train pass us by, since we suddenly remember that our neighbour has invited us over for dinner. Maybe we just let the thought about the evening meal be – sitting at the platform until we’re ready to catch it – and turn our attention back to the book or phone, fully engaged with the content.

The question is whether we are conscious of our choice to engage with the thought or not. What happens to the thought that we do not expend energy on? The answer is that if we don’t seize upon the thought, it will either remain on the platform for later or simply pass us by. The majority of the 30,000−70,000 thoughts that our brain produces every day are completely insignificant to us. But some will affect us emotionally. These thoughts have some significance to us and, for one reason or another, demand our attention. In cognitive therapy these thoughts are sometimes referred to as ‘trigger thoughts’. They are thoughts which can set a strong reaction in motion.

Trigger thoughts can trigger us in positive ways: for example, we are happy thinking about going on holiday with the whole family to a sunny Caribbean island, or about cosy evenings filled with warmth and moonlight. They can, however, also trigger us in negative ways and can run the risk of leading us into a web of extensive ruminations: for example, thinking about being fired from a job, a conflict in the workplace, or family problems. When life is difficult it is natural to have more trigger thoughts than when life is full of happiness. These thoughts can be the first steps towards depressive symptoms, and therefore it is vital that we discover our trigger thoughts in time. This way we can let them be before they start to run away with us.

But how do we know which of the thousands of thoughts we have are trigger thoughts? It can be hard to sort through them all. A trigger thought is the first thought in a sequence of associations which has not yet turned into long-term rumination, like a train to which more and more carriages are joined, one after another. The train gets heavier and heavier and slower and slower, and finally it can no longer propel itself up even the slightest hill. The same applies to our trigger thoughts. The more time we spend on these thoughts the heavier they make us feel. Ultimately, recognizing our trigger thoughts is the first step to preventing them from accumulating and overwhelming us, allowing us to regain control and move forward in life with greater ease.

From: Live More Think Less by Pia Callesen (Chapter 1)

Homework

Take a moment to reflect: How much time in a typical day do you find yourself caught in the cycle of worrying, replaying painful memories, or endlessly mulling over thoughts? Consider whether these patterns of thinking serve you well. Do they leave you feeling refreshed and clear-headed, or do they tend to drain your energy, leaving you feeling tired, anxious, and upset?

Optional Creative Activity

Exploring Thought Patterns

Supplies Needed: Paper, coloured pencils, markers, pens, crayons, pastels, or paint.

Choose one recurring worry, thought, or painful memory and represent it visually in a simple, abstract way—using colours, shapes, lines, or symbols that capture its emotional weight. Focus on simply observing and expressing the thought or worry, without the goal of changing or transforming it. Notice how you feel as you explore this thought in a visual form. Reflect on whether seeing it in a new light helps you understand it better or makes you more aware of its impact on your emotional state. This activity is a way to recognize and explore your thoughts, creating a space for them without judgment or the pressure to alter them.