Understanding our Minds and Moods: Cognitive Processing

Many of us keep falling short of being truly happy and relaxed in life, often due to the invisible baggage of negative thoughts at the back of our minds that anchor our moods and feelings.

Some of the common conditions such as excessive anger, anxiety, depression, guilt, hopelessness and sleep disturbances could stem from “traumatic” experiences of the past that our minds are “stuck” at that sometimes keep transmitting “negative” pulses.

A simple example could be a child being brought up to believe that the world is full of kind and trustworthy people, till one day he sees a soft-spoken elderly male relative whom he loved, ruthlessly beat a helpless dog on the street to death. This could constitute a trauma as his past belief about elderly relatives and the present cruel spectacle are difficult to reconcile. This “shock” could prevent him from “trusting” elderly soft-spoken people, and in fact cause him to feel helpless, angry and anxious whenever confronted by situations that conjure fragments of the old experience now lying buried in some part of the mind.

A new approach to identify “trauma” and resolve it could settle much of our miseries, suggests Professor of Psychiatry Patricia Resick, PhD, who has come up with a new approach called Cognitive Processing Therapy (CPT).

According to her hypothesis, once freed from the shackles, a person can see enhancement in self-esteem, intimacy, trust, safety and behavior.

While there is a plethora of counselling techniques to resolve the “past” problems, almost all psychologists and mind-therapists of different genres agree on one common denominator, that unpleasant traumatic experiences of life, sometimes perhaps in early childhood, could be casting long shadows and shaping our thoughts and feelings of our present days, and making us partly what we are.

The controversy seems to be in the approach to tackle it.

Cognitive Behavior therapy (CBT) is presently in fashion. In this method the counsellor or guide helps you identify how and what “triggers” your thoughts and emotional responses, how these in turn affect your body responses, and then your behavior. CPT is one of its parts, specifically targeting past “traumas” such as the helplessness and trauma you felt when an elderly relative contracted COVID and died without getting access to ICU care, helping you get unstuck from its persistent impact.

Most of you may not need or go on to seek therapy, but this post could help you understand how your mind, thoughts, emotions and behavior are shaped, with past “trauma” sometimes being an important factor. Leaving the past behind is easier said than done.

And if a “negative” feeling is not letting you enjoy life to its full, you may try monitoring your thoughts and their triggers.

Advertisement

Divorce takes a Toll on Health

Quite a few “celebrity couples” have recently announced their intentions to part ways with their spouses after decades of marriage. Used as they are to the glare of publicity, their proclamations made with smiling faces, have appeared to suggest that divorce could be almost as exciting as matrimony itself.

What has been particularly spectacular in the recent weeks is that two of the couples (Bill and Melinda Gates, Jeff Bezos and Mackenzie) have been the wealthiest in the world, making many, especially in India, wonder what was it then that they were possibly missing after decades of married life and children. 

And equally startling, for many who believe marriages are made in heaven, was to hear the announcement by our dear Lagaan hero Aamir Khan and his wife of several years, Kiran Rao to end their marriage, and embark on a “new relationship”.

Researcher Linda J Waite from the University of Chicago studied over 8500 people about health issues after divorce. They were aged 51 to 60 years, half were married, a quarter lived alone after separation or death of a spouse, while a quarter had remarried.

She noted that while depression and anxiety were common early symptoms after separation, many did get over them with time, especially after remarriage. Long term effects on physical health such as difficulty in climbing stairs, hypertension, cardiac disease and diabetes and increased frequency to cancers were however seen as long-term health tolls till several decades later in those who had been through separation.

This paper does not however address the question of what could be the health consequences of remaining locked in an unhappy marriage, or perhaps if the health effects were possibly due to the trauma of the time spent together rather than the separation itself.

Divorce is indeed a double-edged sword. Although the first recorded case of Henry and Anne in England was in 1552, and in USA in 1643, it was not until the enactment of a law in 1857 that the flood gates opened. The initial reasons were men seeking separation blaming their wives for a variety of reasons, before being utilized by “individuals” trapped in a relationship, unable to get free.

Of the 7500 cases filed in India annually, infidelity, finance, substance abuse, lack of intimacy and domestic violence form the top reasons. Divorce is often the only door that allows escape of a trapped individual from living in subjugation, brutality or a relationship that has turned toxic.

Divorce however remains a double-edged sword, and should not be resorted to for flimsy reasons, as it leaves its bruises and scars.

The Second wave of COVID and Post-Traumatic Stress Disorder (PTSD)

The pandemic, especially the recent second wave, has shaken us all up so badly that even when it recedes and goes, life may not be the same gain.

Some have gone through the fever, cough and fear of death. Many saw the trauma happening to others, and shared the feeling of uncertainty and helplessness of getting a hospital bed, oxygen or medications, or the fear or grief of loss of life.

This kind of trauma affecting a large section of society, does not go away easily. It leaves behind its shadow on our moods, attitudes, relationships and goals.

Post-traumatic stress disorder (PTSD), now more specifically adapted to the pandemic as Post-Covid Stress Disorder (PCSD) is characterized by inability to return to “normal” after experiencing a terrifying event. It may last for months or years and may include flashbacks or depressing thoughts, avoidance of situations that bring back the trauma, anxiety, anger, depressed mood, inability to concentrate, and poor motivation at work.

Many people feel detached, start wondering about the purpose of achieving targets or working, stop enjoying things they once liked doing, constantly feel fearful, and fail to have fun with relatives or friends.

The three roots of the present surge in PCSD are fear, loss, and grief.

Fear has affected almost all of us: from catching the infection, to falling ill, to developing a serious or critical disease, to finding a hospital bed or oxygen, or of dying.

Loss has been common: there is hardly anyone who has not lost a relative or neighbor or colleague. And when the person has been a “not too old” or in apparent good health, it has brought the additional unexpected distressing “it could have been me” feeling.

Grief has followed loss, and made many go through several stages: from denial (“it can’t be happening to me”), to anger (“the hospital that could not provide a ventilator should be destroyed or sued”), to bargaining (“my elderly mother died but at least the children are alive”), guilt (I wish I had taken her to hospital earlier), depression, and finally acceptance.

It is estimated that one of every three of us might suffer from PCSD.

Let us not forget that a large brunt of the trauma has been borne by front line workers: apart from over 600 doctors who have died during the second wave alone, they have had to live through the nightmarish three months of attending to dying patients or breaking bad news to shattered relatives all every day.

If life has to return to normal again, PCDS needs tackling.

A simple first step is to talk, vent and unburden one’s traumatic experience and feelings to a relative or friend.

Professional counsellors are in short supply, but helplines such as those of NIMHANS, Bangalore, are super busy. They often guide and train patients to CBT (Cognitive Behavior Therapy), training them to identify the trigger thoughts, which in turn generate intense negative feelings…which then are modifying behavior).

A short course of medications for stress often helps many to recover faster. And Yoga and meditation can help calm and strengthen the disturbed mind.

Managing PCDS is being feared to emerge as the major health challenge in times to come!

Stress: Can you Perceive it in Yourself?

Many may not be knowing whether or how much stressed they are. This is often the case when family, friends or the doctor may see it in your face, behavior or clinical symptoms and suspect it, while you may not be able to recognize it and go on denying it.

We are familiar with only one of the stages of stress: the fright-flight-fight response.. If a loss of job or death of a near one seems possible or imminent, a person with average insight is usually able to recognize the animal called stress stirring, growling or whining somewhere inside you.

The second stage of stress, that of “resistance” or coping, is when one struggles and fights on, sometimes for long periods, often not realizing that a battle is still raging on. It may becomes a habit for years. This stage is often overlooked

This is when heart rate, blood pressure, headaches, bowel symptom, irregular periods or sleep disturbances could take center stage, with several rounds of visits to doctors, tests and medicines.

The third stage is one of exhaustion…as might be expected to occur after any prolonged battle that drains you.

Psychologists, led by Dr Cohen, therefore came up with a Perceived Stress Scale (PSC) to help people make a self-assessment and take control of their own stress levels before they cause problems. It can be taken on-line  www.bemindfulonline.com/test-yc.

The key questions posed are 10, but the short form with 4 key questions that you need to answer are below.

Looking back at the last month:

1. How often have you felt that you were unable to control the important things in your life?
2. How often have you felt difficulties were piling up so high that you could not overcome them?
3. How often have you felt that things were going your way?
4. How often have you felt confident that you can handle your personal problems?

You would notice that questions 1 and 2 assess negative emotions while 3 and 4 your positive coping ones, hence the way they are scored are different.

Recognizing or perceiving stress is not an admission of weakness as many fear, but an opportunity to take control of it before it causes harm and spoils your quality of life (QOL). I think every person should introspect and explore it  in today’s day and age.

The Slipping Mind

If you have taken your elderly relative to the doctor, the conversation can go sometimes like this:

“Can you tell me which year are we in? Season? Day? Month? Thank you

Could you tell me where we are? Town? Country? Good

Now name the three things I am pointing at (pencil, paper weight, paper). Thanks

Could you count backwards from 100 by sevens? Yes, Please try. 93, good, then…

Earlier I showed you three things. Can you remember them?”

And although heartbreaking, you would realize that the doctor is trying to assess whether your relative’s mind has started to slow or even slip.

As we are living longer, and having crossed the jaws of fatal heart attacks in our 60s, we often find ourselves slipping into dementia. Recent statistics show that dementia has overtaken heart disease as the leading cause of death in several parts of the Western world.

Slowing of the mind, slipping into dementia and thereafter slithering into coma is the next hazard, as we survive longer.  Its consequences can be challenging and devastating, not just to the patient but to the family.

How does one look after a demented relative in these times? Our families are no longer the large undivided ones where there was always someone at home to care. We are now more often “nuclear” and sometimes even fragmented, living in towns and cities with all members rushing to work in the mornings and returning late just for dinner and sleep.

Reliance on domestic help is a threat and a luxury: apart from security concerns, how sure can I be that the caregiver is not being harsh or cruel to my father during my absence. The patient may not even be able to remember or complain!

Institutional care is not an easy option. Apart from making most Indians feel guilty as well as the high costs involved, most care centers are notorious for rough regimented jail-like treatment. The demented relative will of course flash a generous smile when you visit and not remember to tell you of what he went through, as he has lost his lost his memory for recent things.

What is worrying about Alzheimer’s disease, the typical and commonest cause of dementia, is that we are making very little progress finding a cure.

For instance, while there are close to 6000 ongoing trials to discover cures for cancer, there are only 99 for Alzheimer’s, laments, Alice Thomson, a British researcher.

This empty space of medical therapy has therefore been filled by several claimants such as green tea, chocolates, fruits, nuts, green vegetables and anti-oxidants, that are largely speculative.

But when you see your own parent going down the slippery slope of dementia, forgetting to switch off the fire in the kitchen, or wandering off to an unknown area during an evening walk and not knowing how to return, or forgetting the name of his favorite grandson, your desperation will drive you to try almost anything that, not just doctors, but even neighbors advise you. Anything that gives hope to bring his mind back!