40 Warning Signs of Bad Therapy

If any of the following red flags crop up in the course of talk therapy, it may be time to reevaluate your counselor or therapist.Young Woman with Her Hand on Her Belly and Man Beside Her Writing

  1. Therapist provides no coherent explanation of the methodology that will be used. (Beware the word “modified,” as in “modified Cognitive Behavioral Therapy.” It may simply mean: I get to make up whatever I want as we go along, and some of it may resemble CBT.)
  2. Therapist provides no explanation of how progress will be tracked.
  3. Therapist provides no explanation of how you will know when your therapy is complete, no estimate of how many sessions may be involved.
  4. Therapist does not display certificates, diplomas, licensure.
  5. Therapist is not goal-oriented.
  6. Therapist does not provide you with information about your rights as a client; cancellation policy, in writing; confidentiality; information on fees and duration of sessions; and other information that will allow you to fairly consent to your treatment.
  7. Therapist is judgmental of your condition, your lifestyle, or your religious beliefs.
  8. Therapist assigns blame (to you and/or a partner, family member, or associate).
  9. Therapist encourages you to assign blame to others.
  10. Therapist is routinely late, without offering an apology.
  11. Therapist tries to be your friend; spends time fraternizing, making small talk, etc.
  12. Therapist initiates touch (i.e., hugs) or inappropriate intimacy without your consent.
  13. Therapist engages in sexual repartee or jokes.
  14. Therapist talks excessively about himself or herself and/or self-discloses information, without any therapeutic purpose.
  15. Therapist discusses particulars of other patients’ situations.
  16. Therapist tries to enlist your aid with something not related to your therapy.
  17. Therapist eats in front of you.
  18. Therapist answers phone calls during your session.
  19. Therapist discloses information about your case to others without your consent.
  20. Therapist cannot accept criticism or admit mistakes.
  21. The focus is on accurate diagnosis, rather than on strategies for change.
  22. Therapist talks too much.
  23. Therapist says nothing or offers no insights, or insights are not actionable.
  24. Therapist focuses on cognition or “cognitive distortions” but downplays feelings.
  25. Therapist brings religious or spiritual beliefs into play without taking into account your religious or spiritual orientation.
  26. Therapist tries to keep you in therapy against your will or suggests that only her or his counseling approach works; ridicules other approaches to therapy.
  27. Therapist is contentious, contrary, or confrontational.
  28. Therapist doesn’t remember your name and/or doesn’t remember your issues from one session to the next.
  29. Therapist is not a good listener; doesn’t process what you are saying, misinterprets you, ignores what you are saying.
  30. Therapist seems overwhelmed by your issues; suggests your meds need adjusting.
  31. Therapist does not ask your permission to use a technique you might not want to try.
  32. Therapist focuses on symtpoms or behaviors without trying to get to an understanding of the root cause.
  33. Therapist gives you no warning before going on vacation.
  34. Therapist does not ask for feedback.
  35. Therapist is not up-to-date on scientific findings, thinks depression is due to a “chemical imbalance,” etc.
  36. Therapist suggests electroshock therapy but hasn’t read the literature on fatality rates, hasn’t read the literature on sham therapy versus real shock therapy (there is no difference in outcome between the two after one month), believes ECT is safe and effective based on 50-year-old literature.
  37. Therapist makes unrealistic suggestions (such as stopping compulsive behaviors cold turkey using willpower).
  38. Therapist isn’t familiar with the uses, side effects, and outcomes associated with meds (because he or she doesn’t prescribe meds). A therapist should have a good working knowledge of any meds you are taking.
  39. Therapist is unwilling to read an article you have found or learn about a new treatment option.
  40. Therapist has no e-mail address or won’t share it with you or won’t read e-mail from clients.

No doubt there are items that should be on this list, that aren’t. Let us know what they are. Leave a comment below.

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References for Electroshock Therapy

The following list of references comes straight out of the chapter of Hack Your Depression dealing with electroshock therapy, a chapter that contains vital information for anyone contemplating ECT. These references are essential for understanding the current state of the art around this time-honored (but barbaric, antiquated, ineffective, damaging, and demonstrably dangerous) procedure. For a full discussion of these references and their findings, please consult pages 136-151 of Hack Your Depression. Insist that anyone you know who contemplates undertaking a course of ECT read those pages first. Consent forms DO NOT tell the whole story. For example, consent forms often place the odds of death at 1:50,000, which is incorrect by at least a factor of ten (and must be modified by the fact that the average patient has 6 to 8 treatments, increasing risks 6 to 8 times).

Abraham, K. & Kulhara P. (1987). The efficacy of ECT in the treatment of schizophrenia. British Journal of Psychiatry 15, 152-155.

Allen, I. (1959). Cerebral lesions from ECT. New Zealand Medical Journal 58, 369-377.

Alpers B. (1946). The brain changes associated with electrical shock treatment: A critical review. Lancet 66, 363-369.

American Psychiatric Association (2001). The Practice of Electroconvulsive Therapy Recommendations for Treatment, Training and Privileging. A Task Force Report of the American Psychiatric Association, 2nd ed. APA: Washington, DC.

Avery, D. & Winokur, G. (1978). Suicide, attempted suicide, and relapse rates in depression. Archives of General Psychiatry 35, 749-753.

Blease, C.R. (2013), Electroconvulsive therapy, the placebo effect and informed consent. Journal of Medical Ethics. 2013 Mar;39(3):166-70

Brandon, S., Cowley, P., McDonald, C., Neville P., Palmer, R. & Wellstood-Eason, S. (1985). Leicester ECT trial: Results in schizophrenia. British Journal of Psychiatry 146, 177-183.

Calloway, S., Dolan, R., Jacoby, R. & Levy, R. (1981). ECT and cerebral atrophy. Acta Psychiatrica Scandinavica 64, 442-445.

Feliu, M., Edwards, C., Sudhakar, S., McDougald, C., Raynor, R. & Johnson, S. (2008). Neuropsychological effects and attitudes in patients following ECT. Neuropsychiatric Disease and Treatment 4, 613-617.

Frank, L.R. (1978). The History of Shock Treatment. Frank: San Francisco. ISBN-13: 978-0960137619.

Freeman, C. & Kendell, R. (1980). E.C.T, Patients’ experiences and attitudes. British Journal of Psychiatry 137, 8-16.

Freeman, W. (1941). Brain-damaging therapeutics. Diseases of the Nervous System 2, 83.

Gabor, G. & Laszio, T. (2005). The efficacy of ECT treatment in depression: A meta-analysis. Psychiatria Hungarica 20, 195-200.

Goldman, H., Gomer, F. & Templer, D. (1972). Long-term effects of ECT upon memory and perceptual motor performance. Journal of Clinical Psychology 28, 32-34.

Greenhalgh, J., Knight, C., Hind, D., Beverley, C. & Walters, S. (2005). Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: Systematic reviews and economic modelling studies. Health Technology Assessment 9, 1-170.

Gregory, S., Shawcross, C. & Gill, D. (1985). The Nottingham ECT study. British Journal of Psychiatry 146, 520-524.

Halliday, A., Davison, K., Browne, M. & Kreeger, L. (1968). A comparison of the effects on depression of bilateral and unilateral ECT to the dominant and non-dominant hemispheres. British Journal of Psychiatry 114, 997-1012.

Huston, P.E. & Locher, L.W. (1948). Manic-depressive psychosis. Course when treated and untreated with electric shock. Archives of Neurology and Psychiatry 60, :37-48.

Impastato, D. (1957). Prevention of fatalities in ECT. Diseases of the Nervous System 18, 34-75.

Janicak, P., Davis, J., Gibbons, R., Eriksen, S., Chang, S. & Gallagher, P. (1985). Efficacy of ECT: A meta-analysis. American Journal of Psychiatry 142, 297-302.

Kellner C., Fink M., Knapp R., Petrides G., Husain M. & Rummans T. (2005). Relief of expressed suicidal intent by ECT. American Journal of Psychiatry 162,977-982.

Kho, K., van Vreewijk, M., Simpson, S. & Zwinderman, A. (2003). A meta-analysis of electroconvulsive therapy in depression. Journal of ECT 19, 139-147.

Lagasse, R. (2002). Anesthesia safety, model or myth? A review of the published data and analysis of current original data. Anesthesiology 97, 1609-1617.

McGirr, A., Berlim, M.T., Bond, D.J., Fleck, M.P., Yatham, L.N., & Lam, R.W. (2014), A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychol Med. 2014 Jul 10:1-12.

Nuttall, G., Bowersox, M., Douglas, S., McDonald, J., Rasmussen, L., Decker, P., Oliver, W. & Rasmussen, K. (2004). Morbidity and mortality in the use of electroconvulsive therapy. Journal of ECT 20, 237-241.

O’Leary, D., Gill, D., Gregory, S. & Shawcross, C. (1994). The effectiveness of real versus simulated electroconvulsive therapy in depressed elderly patients. International Journal of Geriatric Psychiatry 9, 567-571.

Pagnin, D., de Queiroz, V., Pini, S. & Cassano, G. (2004). Efficacy of ECT in depression: A meta-analytic review. Journal of ECT 20, 13-20.

Pippard, J. & Ellam, L. (1981). Electroconvulsive Treatment in Great Britain, 1980: A Report to the Royal College of Psychiatrists. Gaskell: London. ISBN 9780902241077.

Poublon, N.A. & Haagh, M. (2011). The efficacy of ECT in the treatment of schizophrenia. A systematic review. Erasmus Journal of Medicine, 2:1, 16-19.

Porter, R., Heenan, H. & Reeves, J. (2008). Early effects of ECT on cognitive function. Journal of ECT 24, 35-39.

Rami-Gonzalez, L., Bernardo, M., Boget, T., Salamero, M., Gil-Verona, J. & Junque, C. (2001). Subtypes of memory dysfunction associated with ECT: Characteristics and neurobiological bases. Journal of ECT 17, 129-135.

Read, J. and Bentall, R. (2010), “The effectiveness of electroconvulsive therapy: A literature review,” Epidemiologia e Psichiatria Sociale, 19, 4, 333-347.

Ross, C. (2006). The sham ECT literature: Implications for consent to ECT. Ethical Human Psychology and Psychiatry 8, 17-28.

Sackeim, H., Prudic, J., Fuller, R., Keilp, J., Lavori, P. & Olfson, M. (2007). The cognitive effects of ECT in community settings. Neuropyschophamacology 32, 244-254.

Sackett, D., Rosenberg, W., Gray, J., Haynes, R. & Richardson, S. (1996). Evidence based medicine: What it is and what it isn’t. British Medical Journal 312, 71-72.

Sarita, E., Janakiramiaiah, N., Gangadhar, B., Subbakrishna, D. & Rao, K. (1998). Efficacy of combined ECT after two weeks of neuroleptics in schizophrenia. NIMHANS Journal 16, 243-251.

Shorter, E. & Healey, D. (2007). Shock Therapy: A History of ECT in Mental Illness. Rutgers University Press: New Jersey.

Squire, L., Slater, P. & Miller, P. (1981). Retrograde amnesia and bilateral electroconvulsive therapy: Long-term follow-up. Archives of General Psychiatry 38, 89-95.

Strensrud, P. (1958). Cerebral complications following 24,562 convulsion treatments in 893 patients. Acta Psychiatrica Neurologica Scandinavica 33, 115-126.

Taylor, P. & Fleminger, J. (1980). ECT for schizophrenia. Lancet 315:8183, 1380–1383.

Tharyan, P. & Adams, C. (2005). Electroconvulsive therapy for schizophrenia. Cochrane Database of Systematic Reviews Issue 2, CD000076.

UK ECT Review Group (Carney, S., et al.) (2003). Efficacy and safety of ECT in depressive disorders. Lancet 361, 799-808.

Ulett, G., Smith, K. & Gleser, G. (1956). Evaluation of convulsive and subconvulsive shock therapies utilizing a control group. American Journal of Psychiatry 112, 795-802.

Ukpong, D., Makanjuola, R. & Morakinyo, O. (2002). A controlled trial of modified electroconvulsive therapy in schizophrenia in a Nigerian teaching hospital. West African Journal of Medicine 21, 237-240.

Van der Wurff, F., Stek, M., Hooogendijk, W. & Beekman, A. (2003). Electroconvulsive therapy for the depressed elderly. Cochrane Database of Systematic Reviews Issue 2, CD003593.

Ziskind, E., Somerfeld-Ziskind, E. & Ziskind, L. (1945). Metrazol and electroconvulsive therapy of the affective psychoses. AMA Archives of Neurology and Psychiatry 53, 212-217.

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How Common Are Delusional Thoughts?

If there’s one thing I’ve learned from living with someone who has schizophrenia, it’s that “schizophrenic thoughts” are surprisingly common—in those of us who think of ourselves as “normal” (or at least, not psychotic).

This head, those memories...Who am I?We all think schizophrenic thoughts from time to time (as I discuss in Of Two Minds). For example, if you believe in lucky (or unlucky) numbers, that’s a prototypically schizo­phrenic mode of thinking. The idea that a given number has a particular meaning (or special power) outside of its numerical meaning is, after all, plainly delusional. (And yet, over half of tall buildings in North America lack a thirteenth floor, and airliners lack a “Row 13.”) Remember the superstition about counting crows? One’s bad, two’s luck, three’s health, four’s wealth, five’s sickness, six is death. That sort of assignment of concepts to numbers is characteristic of schizophrenia. My wife does it all the time.

Superstitious beliefs, in general, are highly reminiscent of schizo­phrenic mentation. “Step on a crack, break your mother’s back”—completely delusional. “Break a mirror and you’ll have seven years of bad luck”—no basis in reality. “Something old, something new, some­thing borrowed, something blue” (in the context of a happy marriage) is quite obviously delusional.

Paranoia is another hallmark of schizophreniform mentation that’s fairly common in the general population. The fear that government agencies are monitoring you (which of course has some basis in fact), or that government agencies have special hidden agendas (maybe including “black flag” ops and/or the ultimate goal of taking firearms away from citizens and relocating them to detention camps, etc.), or that the moon shots were faked, the World Trade Center disaster (or JFK’s assassination) was an “inside job,” etc., are not only surprisingly commonplace but frankly pathological.

Schizophrenia sufferers often have bizarre religious beliefs. But again, most “normal” people, from time to time, experience at least some religious beliefs that are non-mainstream. For example, if you believe in karma (definitely a mainstream belief in many parts of the world, but less so in the West), or reincarnation, or the idea that you’ve been punished (by a supposedly loving, forgiving God) for some minor infraction, or that guardian angels (or demons) have intervened in your daily life, or that someone you used to know (who is now dead) has revisited you in the form of a bird (or a rainbow, or whatever)—these are all fairly common sorts of thoughts, yet are also delusional in a characteristically schizophreniform way, combining elements of grandi­osity, paranoia, obsession with the supernatural, and interaction with imaginary beings. When it comes to religious matters, the difference between a frankly schizophrenic outlook and a “normal” outlook is most­ly a matter of degree. (Does God talk to you? If so, you might want to ask what it is that makes you normal but makes a “bag lady” walking down the street, talking to an imaginary friend, abnormal.)

Schizophrenics often hear voices. But normal people, from time to time, have “a little voice inside their head.” (Various studies have found that around 15% of adults with no psychiatric diagnosis report having experienced auditory hallucinations.) Perhaps you’ve experienced the (very common) phenomenon of a song getting stuck in your brain, repeating itself over and over, against your will? Something like this (only far more intense) happens in schizophrenia. Again, arguably, the differ­ence between “normal” and schizophrenic is just a matter of degree.

In 2011, Rachel Pechey and Peter Halligan, of the University of Cardiff, published a paper in Psychopathology about the prevalence of delusional thoughts in the general population. They presented people with 17 statements designed to uncover delusional thoughts, then scored the percentage of people who revealed weak, moderate, or strong identification with those statements. The following table shows the percentages:






You are dead and/or do not exist





Relatives or close friends are sometimes replaced by identicallooking impostors





Part of your body does not belong to you





Some wellknown celebrity is secretly in love with you





You are infested by parasites





The world is about to end





The reflection in the mirror is sometimes not you





People you know disguise themselves as others to manipulate or influence you





Some people are duplicated, i.e. are in 2 places at the same time





There is another person who looks and acts like you





Your thoughts are not fully under your control





Certain people are out to harm or discredit you





People say or do things that contain special messages for you





Certain places are duplicated, i.e. are in 2 different locations at the same time





You are an exceptionally gifted person that others do not recognize





You are not in control of some of your actions





Your body or part of your body is misshapen or ugly





The statements in italics are considered bizarre delusions in the sense that there is no objective way to validate or invalidate the beliefs in question; also, such beliefs center on highly implausible ideas (which is key to how the DSM defines bizarre mentation). Pechey and Halligan found that strong belief in one or more delusional statements was reported by 39% of participants, with 91% reporting ‘weak’, ‘moderate’ or ‘strong’ belief in at least one delusional statement. They conclude: “Both bizarre and non-bizarre DLB are frequently found in the general population, lending support to the psychosis continuum account” (that is, the idea that psychosis occurs on a spectrum and “frank psychosis” represents a statistical extreme).

For more on what’s normal and what’s not, what’s treatable and what’s not, be sure to take a look at Of Two Minds. It talks in depth about depression, bipolar, dysthymia, schizophrenia, schizoaffective disorder, meds, talk therapy, and latest research (384 pages, 300 footnotes). Cheaper than an hour of therapy, and a lot more entertaining.


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When Therapy Goes Wrong

When talk therapy works, it can work wonders. When it doesn’t work (which is a fair amount of the time), all bets are off, because anything can happen.

woman-in-therapy-sessionWhile psychiatric drugs are required to undergo efficacy testing before being released to the public, no efficacy requirements are placed on non-drug therapies. Talk therapy is just assumed to work for most people, and new therapies are routinely rolled out willy-nilly on live patients with no oversight by anyone and no guarantee of safety, much less efficacy.

That’s not to say some therapies haven’t been subjected to controlled testing. In recent years, Cognitive Behavioral Therapy (CBT), in particular, has been the subject of hundreds of published trials. There’s reason to believe, however, that many of the CBT trials are biased and that (as with drug trials that don’t come out the way the researchers wanted) unflattering trials simply go unpublished.

Cuijpers et al. in 2010 found substantial reason to suspect publication bias in 175 talk-therapy trials. Notice the asymmetry in this funnel plot.

In a 2010 paper in The British Journal of Psychiatry (“Efficacy of Cognitive Behavioral Therapy and Other Psychochological Treatments for Adult Depression,” 196:173-178, non-paywall-protected version here) Cuijpers et al. looked at published trials that made 175 comparisons between particular talk therapies and a control group. The funnel plot for these 175 trials (see graphic) strongly suggests publication bias. The majority of the trials (92) involved CBT.

With drug trials, we usually think in terms of a med either helping or not helping. In reality, patients tend to follow one of three trajectories: the drug helps, it does nothing, or it actually makes the condition worse. (These trajectories exist for placebos as well.) Individual trajectories typically aren’t reported in the literature (unless they culminate in adverse events, like suicide). Instead, they’re lumped together into an overall score that shows yea-many-points average improvement on the Hamilton scale (or whatever), for the treatment arm as a whole.

It’s difficult to say how often therapy goes off the rails. But a meta-analysis of 475 talk-therapy outcome studies (reported in Smith, Glass, and Miller, The benefits of psychotherapy, Baltimore: Johns Hopkins University Press, 1980) found that 9% of the time, effect sizes were negative, meaning patients got worse in therapy. Shapiro & Shapiro found much the same thing in “Meta-analysis of comparative therapy outcome studies: A replication and refinement,” Psychological Bulletin, 1982, 92, 581–604.

In a 2006 paper, Charles M. Boisvert and David Faust (“Practicing Psychologists’ Knowledge of General Psychotherapy Research Findings: Implications for Science–Practice Relations,” Faculty Publications Paper 42, available here) tracked down the 25 most highly cited researchers in the Handbook of Psychotherapy and Behavior Change (4th ed.; Bergin & Garfield, 1994) and asked each one to agree or disagree with a number of assertions, including the statement: “Approximately 10% of clients get worse as a result of therapy.” The average response to that statement was 5.67 on a scale of 1 to 7, where 1 meant “I’m extremely certain that the assertion is incorrect” and 7 meant “I’m extremely certain that the assertion is correct.” (For comparison’s sake, the statement “Therapy is helpful to the majority of clients” scored just 6.33.)

While 10% seems to be an accepted ballpark figure for iatrogenic talk-therapy outcomes, the true number could be as high as 30% (see this paper).

If we count incorrect diagnosis as a form of patient harm, two of the most harmful therapeutic tools in psychiatry are the Rorschach Test (or ink-blotch test) and the Thematic Apperception Test. Around 70% of normal individuals who take the Rorschach Test score as if they’re seriously disturbed (Professor James M. Wood, Univ. of Texas, quoted here). In 2000, an extremely thorough meta-analysis found the Rorschach Test, the Thematic Apperception Test, and human figure drawing to have so many problems, not just with repeatability but with basic validity, that they shouldn’t be used any more, basically.

In the much-cited “Psychological Treatments That Cause Harm,” Perspectives on Psychological Science, March 2007 2(1):53-70 (PDF here), Emory University’s Scott Lilienfeld identifies a number of different types of therapy that have been shown to have the potential to hurt patients more than they help them. Potentially harmful therapies identified by Lilienfeld include the following:

Type of Therapy Adverse Outcome(s) Source of Evidence
Critical incident stress debriefing Heightened risk for post-traumatic stress symptoms RCTs
“Scared Straight” interventions Exacerbation of conduct problems RCTs
“Facilitated Communication” False accusations of child abuse against family members Low base rate events in replicated case reports
Attachment therapies (e.g., rebirthing) Death and serious injury to children Low base rate events in replicated case reports
Recovered-memory techniques Production of false memories of trauma Low base rate events in replicated case reports
DID-oriented therapy Induction of ‘‘alter’’ personalities Low base rate events in replicated case reports
Grief counseling for bereavement Increases in depressive symptoms Meta-analysis
Expressive-experiential therapies Exacerbation of painful emotions RCTs
Boot-camp interventions for conduct disorder Exacerbation of conduct problems Meta-analysis
DARE programs Increased intake of alcohol and other substances RCTs

DID means Dissociative Identity Disorder; DARE refers to Drug Abuse and Resistance Education.

Lilienfeld is quick to point out that even a therapy that’s not bringing about actual deterioration in a patient’s condition can be harmful if it delays seeking out a more effective therapy. For example, it’s fairly well accepted that behavioral therapies tend to be more effective than nonbehavioral therapies for obsessive-compulsive disorder, generalized anxiety disorder, and phobias. Some patients have spent years trying to cure a phobia, only to find that by switching therapists (and using a more appropriate therapy) the phobia becomes manageable after one visit.

Lilienfeld and others have noted that negative outcomes tend to be far more frequent in treatment programs aimed at adolescents than those aimed at adults, especially in group-oriented programs, where social effects can overwhelm the therapy. Many examples of shockingly negative outcomes in youth programs can be found in the literature (start by reading this excellent paper by Rhule). Perhaps the most celebrated disaster (in the U.S., at least) is the Scared Straight program, which has repeatedly been shown to be counterproductive (actually increasing the odds of kids going to prison) yet has been rolled out to dozens of U.S. cities and continues to be the basis of popular TV shows. (See this meta-analysis.)

Want more of this kind of information? Find 384 pages of it in Of Two Minds, or 160 pages in Hack Your Depression.

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Can Positive Activities Increase Your Happiness?

In their model of happiness, Lyubomirsky, Sheldon, and Schkade (2005) suggested that three main factors contribute to people’s levels of subjective well-being: (1) their happiness setpoint (the person’s inherent, stable level of happiness), which accounts for roughly 50% of well-being, (2) the person’s life circumstances (e.g., factors such as income, marital status, or religiosity, which are typically found to account for roughly 10% of individual differences in well-being), and (3) cognitive, behavioral, and goal-based activities (which have the potential to account for a significant portion, up to 40%, of individual differences in well-being). The latter factor, positive activity, has been the basis of many recent research efforts into bolstering people’s pereived happiness levels.

hand_heartLyubomirsky (2005) prompted participants to engage in five acts of kindness on a particular weekday (e.g., donating blood, feeding a friend’s pet). Results showed that well-being increased for these participants, compared to a control group.

Likewise, Seligman et al. (2005) showed that participants who used personal strengths in novel ways each day and those who considered three good things that happened to them each day showed increases in their happiness and declines in their depressive symptoms over a 6-month period.

A legitimate criticism of these sorts of studies involves recruitment bias: Participants are generally fully aware of the study’s aim and volunteered with the hope (or expectation) that their well-being would increase. That was not the case for the work by Lyubomirsky and colleagues, which used designs in which participants were unaware of the true purpose of the study.

Recent follow-up work by Lyubomirsky (2011) found that one has to be engaged in doing the “right” activity, in addition to simply believing or hoping that the activity will be effective, in order to see a chang in well-being. In their recent study, 355 college students were randomly assigned to express optimism (by spending 15 minutes a week writing about an imagined, triumphant future self), convey gratitude (by writing gratitude letters), or generate a list of their experiences over the past week (i.e., a control condition). Students who practiced optimism or gratitude reported greater increases in well-being relative (using a modification of the Positive Activation and Negative Activation Scale, and a test called the Subjective Happiness Scale) relative to those in the control group.

When Moynihan and colleagues (2013) examined the Wisconsin Longitudinal Study, which surveyed 10,000 Wisconsin high school graduates from the class of 1957, they found that people who said, in their mid-30s, that helping others in their work was important were apt to report being more satisfied with their lives nearly three decades later. A followup study found, likewise, that those who help others are happier at work than those who don’t prioritize helping others.

Bottom line, various experiments tend to show that you can influence the degree of your own sense of well-being, but you have to be willing to take positive action, and it helps if the action is altruistic or involves gratitude.

Want more real-world advice on how to beat depression? Hack Your Depression is filled with short, easy-to-read chapters that outline a path toward positive change. Invest in a copy today!



Lyubomirsky, S., Dickerhoof, R., Boehm, J.K., and Sheldon, K.M. (2011), Becoming Happier Takes Both a Will and a Proper Way:
An Experimental Longitudinal Intervention To Boost Well-Being, Emotion 2011,
Vol. 11, No. 2, 391402

Lyubomirsky, S., Sheldon, K. M., & Schkade, D. (2005). Pursuing happiness: The architecture of sustainable change. Review of General Psychology, 9, 111–131.

Moynihan, D., DeLeire, T., Enami, K. (2013), “A Life Worth Living: Evidence on the Relationship Between Prosocial Values and Happiness,” The American Review of Public Administration July 4, 2013.

Seligman, M. E. P., Steen, T. A., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410–421.

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Of Two Minds

When people ask how my wife and I met, I have a ready answer: I tell them I met a schizophrenic on Craigslist. Which is exactly what happened.

I thought I knew a thing or two about mental illness before my wife and I met (I’ve struggled for years with depression), but it turns out I didn’t know much about schizophrenia, really. She gave me a crash course.

Over time, both of us have found one thing to be true: You can’t outsource, offshore, or contract out your mental health. You have to be proactive in your own recovery, and that means learning everything you can about your disorder, the drugs (and other treatment options) available for it, and latest scientific findings. Time and again, my wife and I have found out the hard way that mental health care providers aren’t always (how shall we say?) 100% as knowledgeable as they should be. I’ve lost count of the number of times I’ve been told by so-called professionals that SSRIs and SNRIs are highly effective and work for most people (even though half of efficacy trials submitted to FDA showed no difference from placebo), that the drugs treat a “chemical imbalance in the brain” (which is nonsense), that the drugs—when they work—take weeks to do anything (which isn’t what the studies say), that going up or down on antidepressant dose matters (it doesn’t), that electroshock therapy is very effective (in fact, it’s no more effective than placebo after 30 days), that the side effects of shock therapy are minor (a dangerous lie), that Cognitive Behavioral Therapy is more effective than other therapies (it depends on the study), etc. etc.

Mental health is serious business. To stay out of trouble, you have to educate yourself. I decided I had to research and write a book of my own, Of Two Minds, available now on Amazon (ISBN 1507753926), to let others know some of the unbelievable things my wife and I have learned the hard way, about meds (and adverse outcomes associated with various meds), talk therapy, substance abuse, suicide, shock therapy, “the mental ward,” psychosis, mania, depression, dysthymia, and much else. I started writing Of Two Minds in September 2014. In little more than six weeks, I had written 60,000 words. Before long, the manuscript was past 100,000 words (with 300 footnotes). I was shocked at how quickly it came together.


List Price: $24.95
6″ x 9″ (15.24 x 22.86 cm)
Black & White on White paper
384 pages
ISBN-13: 978-1507753927
ISBN-10: 1507753926
BISAC: Psychology / Mental Health

Rather than follow a highly structured approach to the book, I just started writing. What I found was that on every topic I visited, not only was there a ton of fascinating science to talk about, but also my wife and I had each had personal experiences that tended to put the science in perspective. As I wrote, I began to weave together personal experience and science in a way I’d never attempted before. The result is a book that’s part memoir, part science, part questions, part answers, and 100% personal.

The best way to understand what the book is like is to read some sample chapters (and maybe glance at the Index and TOC). Each link below leads to an unlocked PDF. Please choose one or more and either download them or read them in your browser:

Table of Contents
Introduction (explains how my wife and I met!)
Living with Schizophrenia (or: how to know if your wife is schizophrenic)
Are We Ill? (or: how good is the “illness” model of mental pathology?)
Appendix A: Twin Studies (debunks the “genetic” theory of mental illness)
Appendix C: Psych Meds and Children (read this before medicating your child)
Appendix E: Akathisia (a serious adverse drug reaction; be on guard for it)

If you’ve read my writing before, you know I don’t mince words; I call bullshit on bogus concepts. I tell it like it is. And for those who want to dig even deeper into things, I’ve included footnotes (over 300 references, most with web links) to back up any statements I make that might be construed as the slightest bit conjectural or controversial. You can read the literature for yourself. I show you exactly where the buried bodies are.

This is the right book for you if you have (or someone you know has) major depression, bipolar illness, mania, dysthymia, schizophrenia, schizoaffective disorder, a substance use disorder (alcoholism in particular), or a trauma-related disorder. If you’re a care-giver, a patient, or even a clinician, you’ll learn essential, accurate, up-to-the-minute information here (the kind you’re not likely to find anywhere else, unless you’re crazy enough to spend hundreds of hours scouring scientific journals).

Click on the book-cover image above to order the print edition from Amazon. (Kindle edition coming soon!) Meanwhile, my wife and I thank you. If we can answer any questions, write to us. Our e-mail address is shown at the end of the Introduction (see sample chapters above).—Kas Thomas

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Laugh Inappropriately

I’ve always been fascinated by the term “inappropriate laughter.” I tend to view laughter the way the French view champagne: always appropriate.

“Inappropriate humor” is another term that’s foreign to me. It might as well be Sanskrit. I don’t know how any humor can truly be called inappropriate. If that makes me sick, so be it.

monks_on_a_rollIt’s hard to laugh when you’re depressed (although frankly, I still find myself drawn to dark humor, even when I’m at my lowest). And I’m not suggesting there’s anything funny about your situation, or that you should have someone tickle you just to get you to smile for a change.

But you should find a way to laugh once in a while.

And you don’t need a reason. That’s the beautiful part. Zen monks sometimes engage in a “laughing meditation.” Perhaps you’ve seen it on TV. They assemble in a room. At the stroke of a gong, all the monks begin to laughfor no reason. They have to laugh whether they feel like it or not, because it’s an exercise. But then something weird happens, because after a few minutes, the laughter becomes contagious, and soon everyone in the room is laughing genuinely, heartily, uncontrollably.

Have you tried the exercise? I know, exercise is repugnant. But that’s because you’re not doing it.

Remember the first time someone asked you to dance and you didn’t feel like dancing? It turns out the only reason you didn’t feel like dancing was because you weren’t dancing. Once you agreed to dance, and got on the dance floor, it felt like it was the right thing to do after all.

American philosopher William James said: “We do not sing because we are happy, we are happy because we sing.”

I was at a dorm party once, in college. We were dancing to some wild music. Suddenly, some genius decided to put on a mix-tape of Beatles songs, from the Hard Day’s Night era. My initial reaction was: “What the hell are we listening to this old stuff for?” (Bear in mind, this was in 1971. The songs were less than ten years old, and already I considered them “oldies.”) Within five minutes, even the most sober and stodgy wallflowers in the room were singing along with the Beatles at the top of their lungs, me included. It was an exercise in contagion, like the Zen laughing meditation. And I must say, it was therapeutic.

Listening to jokes is not a meaningful depression-fighting strategy, but laughing for no reason can be.

If you need to be in a room full of Zen monks to make it happen, go ahead and do that; but know that you can also tap into your inner monk.

This post is a brief excerpt from Hack Your Depression. Buy a copy for someone you love.

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WARNING: Don’t scroll down unless you’re in a mood to laugh.






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On Learning to Cry Again

I was born male and have accepted that gender assignment with a genuine, abiding gratitude. I have seldom, if ever, regretted being born maleexcept for one thing, which I in fact regret bitterly, with a bitterness that borders on rage.

cryingLike most little boys in this and many other cultures around the world, I was taught not to cry. From an early age, I was subjected to the “boys don’t cry” cultural narrative, a monstrously cruel, abhorrent perversion of nature.

My entire adult life, I’ve been unable to cry, even under circum­stances that demand it.

That’s not 100% true any more. I can cry now (I’ve spent a lifetime regaining that precious skill), but only with extraordinary difficulty. I consider it a true handicap. I want my blue parking permit.

Seriously, crying is a tremendous tool to have. I realize its healing potential now. For years, I was deprived of experiencing it. I mourn for that, believe it or not.

As a man, you grow up trained to tough it out, suck it up, man up, etc., ad nauseam. You grow up thinking women who cry at the movies are addle-brained ninnies.

Guys? Guess what? The joke’s on us.

Crying is priceless. It’s cleansing. I can’t begin to describe the benefits if you’ve never experienced them. (If you’re a woman reading that last sentence, believe me when I tell you in all seriousness, there are, indeed, men who literally know nothing about crying; men who’ve never experienced the benefits, have no idea there are benefits to it.)

If you’re a woman, imagine how crippling it would be if you could never cry. Imagine, if you can, losing a loved one and not being able to cry. Think of the torture to the soul that would cause. Think how messed up you’d be, how incapable you’d be of bringing grief to the surface, how emotionally stunted you’d feel. Think what that would do to you.

That’s where I lived for decades. That’s how most men live, all the time.

My parents died. I didn’t cry until years later.

Things happened to me in childhood that I didn’t cry about until forty years later.

But then, I decided to learn to cry again.

How do you regain the ability to cry? There’s no single foolproof method. It differs for each person. If you’re a man reading this, and you haven’t cried in years (or decades, maybe), you’re missing out. You need to learn this skill. I imagine you can learn it in a good acting class (although many actors do admit crying on demand is one of the harder skills to acquire). I’ve had to invent my own ad hoc methods.

I still can’t cry on demand, when I need to. I have to trick myself into it. I can tell you some of the tricks that work for me, even though they may not work for you. They’re laborious. They involve playing movies and songs. My hope is that in a few more years, I’ll have learned to do without the tricks. Like a disciplined actor, I’ll be able to reach into that special place where the right emotions live, and go straight to the wet-works, as needed. I’m not there yet. Not even close.

You know the movie Awakenings? Robin Williams plays the New York physician who gave L-dopa to institutionalized catatonia patients in 1969patients left profoundly disabled by the 1918 epidemic of encephalitis lethargica. For the first time in 50 years, the patients regain the ability to move, walk, speak. Eventually, the drug slowly loses its effect and the patients go back to their pathetic catatonia. But the Robin Williams character learns something about hope, in a way he couldn’t have otherwise.

That movie has brought me to tears more than once. It did so long before Robin Williams died. Now it’s even sadder, of course. Plus I’m married to someone who, had she been born 75 years earlier, would have been in an institution of the kind shown in that movie; my wife has schizophrenia. And as I watch her slide into and out of psychosis (as the drugs work, then fade, then have to be replaced with other drugs that work, then fade) my heart slowly breaks, then heals. Breaks, then heals.

The Awakenings story arc is similar to that of another favorite “crying tool” of mine, the novel Flowers for Algernon by Daniel Keyes. In it, a profoundly retarded man, Charlie Gordon, submits to an experimental surgery that gives him intelligencenot just normal intelligence, but monumental intelligence. It changes his entire life, of course, in expected and unexpected ways. Meanwhile, the laboratory mouse, named Algernon, who had the surgery first, “proving” its safety and effectiveness, unexpectedly begins to deteriorate (and dies). Charlie, in turn, also begins to regress, slowly at first, then ever-faster.

The 1968 movie Charly (based on the Keyes book) won an Oscar for Cliff Robertson (Best Actor), but with all due respect to Robertson, the book is far more moving than the film.

Flowers for Algernon is written in an epistolary form (in first person, by the Charlie Gordon character, who has an IQ of 68), so the writing initially contains many misspellings (“progris riport 1 martch 3”Charlie calls the Rorschach test a “raw shok test,” etc.), but of course, by the middle of the book, the Charlie character is writing like an intellectual giant. Then he regresses.

I’ve made a lot of progress with Flowers for Algernon. It used to take me 30 or 40 pages of reading to start to tear up. Now I get misty-eyed after looking at the first two or three pages of that book. Soon I should just be able to think of the book in my mind and feel the tears starting to come. I lack the emotional availability to do that right now, though. But I’m getting there.

Why does that book provoke tears in me? I don’t know. I’m not sure I need to know, right now. I’m just glad it works.

Call me sappy, but the climactic scene of Good Will Hunting also “does it” for me. You know the scene where Robin Williams (the psychologist character) says, over and over again, as Will looks at photographs of the physical abuse inflicted on him as a child, “It’s not your fault”? That. That works for me. I know someone who was abused as a child. I know what that does to a person. I also know that some things are far worse than mere physical abuse. Your body gets over physical abuse (assuming you survive it, of course). Your mind? That’s another story.

The right music can move me to tears, under the right circum­stances. Strap me to a chair and make me listen to a couple of Karla Bonoff albums and I’ll crack, guaranteed. (Get the mop.)

I haven’t tried this yet, but I think maybe a good technique for me, to take my emotional availability (in terms of crying) to the next level, might be to find a song that’s deeply affecting and ties in, thematically, with the book Flowers for Algernon; then practice reading the first few pages of the Keyes book with that song playing. I have near-photographic memory for music (if that metaphor even makes sense); I can remember a recording in exquisite detail, and “play it back” in my head any time I want. Who knows if maybe, with practice, I’ll get to the point where I can “play back” the Algernon song (whatever that turns out to be) in my head and bring forth the emotional wherewithal to cry, on demand. That would be an achievement.

If you’re one of those people who can cry easily, count your blessings. You don’t know how good you have it.

This post is an excerpt from Hack Your Depression. Buy a copy for someone you love.

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Stop Fearing Problems

It’s a mistake to go through life fearing problems. Society teaches us that problems are bad; comfort is good. We all look for the easy way out. But really, do all problems have to be bad? What if you were to celebrate your problemsyes, celebrate theminstead of fearing them?

“Every problem in your life,” Richard Bach once said, “carries a gift inside it.”

“Trouble is only opportunity in work clothes,” said Henry J. Kaiser.

failure-grows-plantDr. Andrew Weil goes so far as to suggest (in his book Spontaneous Healing) that we regard illness as a gift. Illness can be a powerful impetus for change. For this reason, Weil says: “Perhaps it is the only thing that can force some people to resolve their deepest conflicts. Successful patients often come to regard it as the greatest opportunity they ever had for personal growth and developmenttruly a gift. Seeing illness as a misfortune, especially one that is undeserved, may actually obstruct the healing system. Coming to see the illness as a gift that allows you to grow may unlock it.”

Sometimes it can be useful to change your perspective so that problems look more like unresolved opportunitiesthe “before” frame of a before/after picture in which the “after” picture is a happy one in which you’re congratulating yourself on a job well done.

It’s said that when people took their problems to legendary insurance magnate W. Clement Stone, he’d shout out: “You’ve got a problem? That’s great!” (Amazingly, no one ever assassinated him.)

Remember that song by Steven Demetre Georgiou (birth name), also known as Yusuf Islam? Sure you do.

And if I ever lose my legs, I won’t moan, and I won’t beg,
Yes if I ever lose my legs, I won’t have to walk no more.
And if I ever lose my mouth, all my teeth, north and south,
Yes if I ever lose my mouth, I won’t have to talk . . .

It takes courage and open-mindedness to confront the wisdom of those lyrics. But the lesson is worth considering. Every capability we have can be seen as a gift or a burden. It’s a matter of perspective. If your car dies, you no longer have to worry about keeping the tank full, putting air in the tires—or the possibility of the car dying. Maybe it’s time to buy a motorcycle. Or walk. Or bike. Or carpool. If it takes you a month to save up for car repairs, maybe you can use that “break” from carmageddon™ to change your transportation priorities in a way that improves the quality of your life. If your car dying causes you great unhappiness, maybe you should look at why your happiness is tied to a piece of metal.

Stever Robbins writes, in a blog post, “A friend of mine was diagnosed with AIDS. He used that as an excuse to quit his job and start doing things he loves. It’s about ten years later. He’s still in great spirits, and has spent the last ten years doing all the things in life he never previously let himself do—and finding ways to get paid for them at the same time. As bad as his problem was, it gave him the push to revolutionize his life.”

If you see all problems as curses, you’ll live a cursed life. And that gets to be tiresome. Wouldn’t you like to try a change?

This post is based on a chapter in Hack Your Depression. For 30+ additional tips, buy a copy of Hack Your Depression, and for even more great advice, take a look at Of Two Minds.

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