This is a post on how to feel good. I wrote this to be my "go-to" link that I could send to people when they ask, rather than copy-pasting the same advice from email thread to email thread.
If you've found this, hello!
I'm Evan, I used to run a mental health company.1 I also previously suffered from severe panic disorder for most of my life, often having multiple panic attacks a week. I'm doing fine now though. This is a post about that.
Should you read this?
Probably, this post doesn't assume you have a severe condition of any kind, nor does it exclude those that do. The stuff that works for many severe conditions is also quite useful for folks who believe they only have mild issues. Depression and anxiety are more like sliding scales rather than easily classifiable diseases. This post explains many of the "big ideas" of modern mental health, or at least the parts that I recommend to folks.
If nothing else, it might be fairly interesting read. The mind is pretty weird.
What's in this post
The core of what's below is based on Cognitive Behavioral Therapy (CBT), the "gold standard" treatment for depression and anxiety. CBT is incredibly effective (on par, or exceeding SSRIs) with mountains of evidence behind it. If you go into just about any psychiatrist's or therapist's office in the modern day, it's typically the first thing they will try with you.
CBT is much more like physical therapy than the talk therapy you may have seen in popular culture. You get better by doing the exercises. You'll probably want a therapist, but it's worth noting that the exercises are publicly available and there's research that do-it-your-self "bibliotherapy" is effective. CBT with a therapist is still shown to be "more" effective, especially if the therapist is good. As an analogy, you'll likely make progress quicker with a personal trainer, but many people still can run a marathon on their own with practice and some online resources.
On top of this core, I've added in some sections that I will hearby classify as the "Weird Brain". The Weird Brain is a collection of old and modern models of how the brain works. 2 I've added these because I believe that CBT is often quite watered down and at least personally, I wasn't willing to engage with the exercises until I more deeply understood what was going on.
It's not a chemical imbalance
At least as depression and anxiety goes, this is a software problem, not a hardware problem. Some rare mental illnesses, such as schizophrenia, may have real physical causes. Depression and anxiety (likely) do not.
Or at least, not in the "chemical imbalance" way that folks typically talk about. You are not doomed. Almost all forms of depression and anxiety are not only treatable, but curable. There is no evidence that your depression or anxiety is caused by some "chemical imbalance" as is so often repeated by lay-folk. This is a myth, but one with a grain of truth that keeps it spreading. It is true that your emotional state is caused by various hormones in the body, but there's no reason to believe that depression and anxiety, as well as happiness and serenity are outside the normal range of a healthy person. If you broke a bone, you wouldn't say that you were doomed from birth to have gotten in a skiing accident or whatnot. And like broken bones, it's very possible to heal and get better.
This is a skill
Reading this post may not make you feel better, just as reading a post on how to juggle will not make you capable of juggling. Much of what's discussed below is something you will need to immerse yourself in and practice.
So with all that said, let's begin.
The thoughts think themselves
In your head, there's a voice. You know the voice I'm talking about, it's the one that's reading these words right now! You can make it talk if you want. Here, make it say "purple octopus fiddle-dee-dop". See?
You're not that voice. You're the thing hearing that voice.2
Sometimes it says really bad things like "I'll bet I'm going to get fired" or "so-and-so probably hates me". Maybe it makes comments on the current state of the world like "everything sucks right now" or "I'll never get out of this".
There's other stuff going on in your head too; like that movie that's always playing. You know the one, the one that plays "the perfect response in the argument I had earlier" or "that really embarrassing thing that happened years ago". When the movie plays, every part of your body reacts. It's a really good movie. If the movie plays "the imagined slight from a co-worker", you'll start to feel angry, even though that's not even happening right now.
That movie is also not you. You're the thing watching the movie.
CBT calls the voice, the movie, and other mental objects "cognitions", but we'll use the more common term: thoughts. To be clear, you are not your thoughts, you're not thinking them. You're the thing watching the thoughts. Sure, you can make the voice say stuff. You can make it say "purple octopus fiddle-dee-dop" again. But most of the time, thoughts just pop in there. It's for this reason that CBT will frequently refer to these thoughts as "automatic". They just happen.
You're just following along with the thoughts, like you might watch a good movie. You feel what the character feels, but you're not the movie. The movie's just playing. You're just watching it. You may rationalize it after the fact; you say that "I'm thinking this", but you're not.
If you don't believe me, close your eyes and try to not think about anything. Just sit there and breathe. Give it 30 seconds and your mind will wander off onto things like "why am I doing this, this is such a waste of time" or "my back hurts, why does my back hurt" or even "I'm not thinking about anything, this is dumb". See? You try to turn off the thoughts and they still happen. You're not thinking these thoughts; the thoughts think themselves. Your experience isn't like what we did with the purple octopus. You didn't force the voice to say anything, you explicitly told it not to do that, and it did it anyway! This is totally normal; it's a natural part of the human condition.
Just sit on this for a moment. Isn't that weird? Isn't that really, really weird? Floating around in your head are mental objects that are no more you than the device you're reading this on right now. You may have a strict barrier setup that says anything "out there" is not you, and anything "in here" is you. But that's not true. There's plenty of things that exist in your head that are not you, just like there's plenty of things outside your head that are not you.
Your thoughts cause your moods
Let's say you've just finished a job interview and the voice in your head spits out "you took too long to answer that last question, they're going to think you're stupid." You grab onto the thought and suddenly more thoughts appear like "you definitely failed that one". And now, you're physically feeling disappointment and shame. The voice spits out "they probably won't even send me a rejection letter, they'll just ghost me, those jerks" and suddenly you're fuming. Then it says "because I failed that interview, I'll probably fail all the next ones" and "I should probably just quit applying to places."
Notice that each thought seems to get progressively worse. This is called "castrophizing", or the tendency for one bad thought to spiral out of control into more and more bad thoughts that are disconnected from what's really happening.
In your head, you're constructing a reality where some "bad thing" has happened, and your body is reacting as if it was really truly happening right now. But it's not happening right now. It's just a movie. When the thought passed by, it felt like you thought it. But you didn't. The thoughts think themselves.
Often, folks that don't understand mental health say things like "it's all in your head" as a way to dismiss the physical symptoms you might be feeling. Most folks will naturally push back and latch on to a belief that their problem is purely physical in order to justify their distress to those in their life who don't understand. The unstated assumption of the "it's all in your head" theory is that you have some control over these thoughts that cause your physical feelings. It implies that you're thinking them and that all you have to do is just stop thinking them. But that's wrong, because as we saw above, the thoughts aren't you; the thoughts think themselves. Meanwhile, the "it's purely physical" theory comes with the assumption that these thoughts are like a disease, that you're somehow broken, and that there's nothing you can do. But this theory is wrong too, because again, the thoughts aren't you. You're not broken, because you're not these thoughts. You're thing watching these thoughts. And there is something you can do.
You can let the thoughts happen and not suffer the physical feelings.
If you read that and you haven't had any life changing relevations, you're not alone. Understanding this intellectually isn't typically enough to make you feel better long-term; just as reading about juggling won't immediately make you able to juggle. This is a skill, but one that's possible to master. After all, you've already mastered it in many other contexts. You can turn on a TV show, skip to the end and watch a character you know nothing about die. And you won't feel anything, since you didn't know who the character was and didn't follow the story.
To be clear, the skill you'll be building is not "how to be an emotionless robot". You're building optionality. It's the ability to chose when to stop watching the movie, and when to continue. People who build this skill become happier because they get to choose what things effect them, and how much.
You may have heard advice that sound similar to this before, such as "just don't let it bother you." I want to assure you that the advice that's given here is more nuanced and effective than that. Upon hearing the lay-person's "just don't let it bother you" advice, you might have thought something like "right, and how the hell am I supposed to do that?" But look, there's the voice again. It's been here the whole time. When the lay person says "just don't let it bother you", it's like they're asking you to change the plot of the movie. And so you rationally think, "how am I supposed to change the plot of movie, I'm not in charge of the movie." The skill that I'm describing here isn't how to change the movie, it's how to recognize that it's a movie. It's realizing that you're not Tarzan, you're sitting and watching Tarzan with a coke and popcorn. It's realizing that you're sitting here with notebook in hand, like a film critic, ready point out all the plot holes and the bad acting.
Now that isn't to say that you can't turn off the thoughts at all. These thoughts are like habits; they're little feedback loops. If you feed them, they'll get stronger. If you avoid them, they'll also get stronger. But if look at them, distance yourself from them, and critically examine them, you'll cause the trigger but not the reinforcement that comes from the emotional response. In other words, as you get better at this skill, you'll have less negative thoughts to deal with.
I will also recommend some phyiscal things you can do to reduce the emotional response that gets triggered if you latch on and identify with the thoughts, as well as physical things you can do to reduce the frequency of negative thoughts. These won't make the thoughts go away all together; they're a natural part of the human condition. But they'll let you build the other skills on "easy mode" instead of facing whatever you are right now.
That said, I want to remind you again that no matter how many or how bad the thoughts are, you are not broken. There's nothing wrong with you. And you know this, because you are not the thoughts. It's like you're walking down the street and you see a bike without it's front wheel. You look at that and say "something's wrong with me! There's a bike without a wheel!". It's sounds absurd right? You're not the bike. You just saw the bike. But without the skill of disowning the thoughts, of critically examining them, you frequently forget that the thoughts aren't you. You're just watching them.
This is a skill that is (to borrow the language of an old teacher) "against the stream." It is not something that most people acquire on accident, especially in the modern world. It really does require a bit of practice and immersion. After all, evolution has created you to mostly fight off physical threats. In order to keep your genes alive, anything "out there" is a potential danger, and anything "in here", must be protected. Thankfully, it's extremely possible to change this perception; our ability to redefine the way we view things is what allows humans to be so relentlessly adaptable.
Your negative thoughts are untrustworthy
The first step towards building this skill is realizing that your negative thoughts are almost always untrue and untrustworthy. After all, negative thoughts and negative emotions, such as fear, anger, and sadness are your body's emergency management tools. From evolution's perspective, they don't need to be 100% accurate in order to accomplish their goal of keeping you alive, keeping predators away, or keeping you aligned with the tribe. False positives still get your genes across. But the experience of being a modern human is to have all of these emergency tools fire without reason even when there are no lions and tigers in sight.
Mental health professionals call these untrue, negative thoughts "congitive distortions."
Let's go back to that interview example. When you see the thought "because I took too long to answer that last question, I probably failed the job interview", was that true? If you've noticed this thought immediately after you've exited the interview, it cannot be true. You have no way of knowing unless they tell you. If you have completely decided that you have failed already, then you are "mind reading". Mind reading is one of many cognitive distortions that have been named and classified.
Your voice might pop out a thought like "well, I know I failed it, I'm a good judge of what people think." Take a moment and deeply question this. Truly, honestly hold the voice accountable. Has there ever been a time when you thought someone was thinking one thing and then you were wrong? The last time your voice said someone thought something terrible about you, did you validate it? Did you ask the person? Or did you just "know".
Too often, we just "know" things are going to turn out one way. But you do not have the ability to read minds or tell the future. Believing you just "know" something is going to happen without evidence is a form of magical reasoning, but one that we accept from the voice in the head all the time.
It's like you have a conspiracy theorist in your head. They just "know" that come January 9th, the reincarnation of JFK will take over the white house, and all satellite communications will broadcast the public arrest of Nancy Pelosi or whatever. But when the day roles around and nothing happens, they just double down on the bullshit conspiracy. Would you believe this person? Would you honestly take their counsel? Do they seem like a stable, reliable person to you?
Say they were right and you failed the interview. Is the next thought true? Is it true that failing the interview means you're going to fail every interview? Most of the time, when people go job hunting, they fail lots of interviews. And what about the next thought? Say you failed every interview, would it be the end of the world? A doctor might make a terrible lawyer. A teacher might make a poor politician. You do not need to be good at every career path.
What we're doing here is the first and most common exercise in CBT, challenging a thought. You may have heard of this as "the three column technique" or sometimes "catch it, check it, change it." This exercise requires you to carry around a sort of journal, though a notes app is typically fine.
When a negative thought arises, first write it down. (This is the "catch it".) If thought is more like a movie, such as a fantasy, describe it. Record the emotions that appear. Then, on a new line, truly challenge the thought as we did above. Note any cognitive distortions. (This is the "check it".) And finally, on the next line, write a new thought or movie that shows a more rational view of the situation. (This is the "change it".)
For example, let's use the interview example and do this exercise here:
# Thought I took too long to answer that last question, I probably failed the job interview Sadness, shame # Challenge This thought is not trust worthy, just because I feel like I took too long does not mean I failed the interview. I am mind reading. Even if I did fail the interview, it is good experience that I can take to my next interview. # New thought I wonder if taking too long to answer questions will lead to a more successful interview, I will have to wait to see the results to see if I should do that again.
One goal of this exercise is to sloooowwww down. Instead of letting yourself catastrophize and getting yourself more and more worked up, we'll take a moment to see if the first thought is even valid. It forces you to stop and notice what's going on and to take the time to detach yourself from this rollercoaster of emotions.
Another goal is just to see your thoughts as a scientist. Really question their validity and challenge them. If you have trouble challenging your thoughts in this way, you may want to see a therapist. This is what therapists are good at; they can help you see where your logic is going wrong. For the moment though, let's explore some common cognitive distortions that have been classified and labeled.
- Mind Reading is the distortion that happens when we pretend we know what someone else is thinking. You cannot know what someone else is thinking unless they tell you. Often, what someone else thinks of you doesn't matter.
- Fortune Telling is the distortion that happens when we pretend we are able to know what will happen in the future.
- All or Nothing Thinking is the distortion that happens when you see things in binary categories. The "I failed this interview, so I'll fail all my interviews" is all or nothing thinking.
- Filtering is the distortion that happens when you focus primarily on the bad things, and minimize the good things that are happening. In our interview example, notice that we only focused on the last question. Maybe all the other questions went great and we instead chose to focus on a minor detail.
- Should Statements is the distortion that happens when we think something should or ought to be one way or another. Typically there is no real reason why something should be, yet you may think that you should have done better. But says who?
- Emotional Reasoning is the distortion that happens when we justify our actions and beliefs based on emotions. For example thinking "I am afraid of flying, therefore flying is dangerous" is emotional reasoning. This one is subtle, but it's frequently a root of our feeling like we "just know" something will happen.
There are many more cognitive distortions; there's a pretty good list of them on Wikipedia.
CBT has enormous amount of exercises that are targeted at specific cognitive distortions. It's bit out of scope to discuss them all in this article, so you may want to check out "Feeling Great" by David Burns, which is one of the most approachable books on the subject. You can also work with a therapist who can come up with specific exercises for your situation.
But before we move on, let's discuss one more exercise that's broadly useful: predictions. This exercise is an experiment designed to show you that you really, truly, do not have the ability to tell the future.
When you assume that something bad will happen in the future, write it down in your notebook. For example, if you have a thought such as "I just know I'm about to get fired", write it down. Record how bad you assume the thing will be. Record what would happen if the prediction came true and how you will feel. Then, set a reminder for some period of time in the future when you expect the prediction to have come true. And check back up to see if it actually happened. Was it actually as bad as you thought? Did it even come true?
What you will find is that you are woefully bad at telling the future. But now you have data to fight the "I just know" feeling. You can look back at your notebook and see "the last 10 times that I thought X would happen, it just didn't."
This is especially useful for panic attacks, since panic attacks are often about a sense of some terrible bad thing that must be about to happen. Because panic attacks aren't dangerous, that terrible bad thing never happens. So if you record every attack with a "did it actually happen?" check, you can use this as raw data to prove that "I just know feeling" is wrong. If everytime you feel like "this time is different", record that in the prediction. How many times have you felt "this time is different" only to be wildly wrong?
Predictions are also quite useful for the fighting lack of motiviation to do things that accompanies depression. You can use "pleasure prediction" to really validate your claim that nothing feels good anymore. For example, you might write down on a scale of 0 to 10 how much pleasure you think going on a bike ride would feel. Then, go on the bike ride, probably with another person. Then, as soon as possible record how pleasurable the experience was. You may find that it was better than the "0" you might have given it. If it's not, you don't need let your voice shame you or say anything else. This is just an experiment. You can try lots of things, with different combinations of people and activities, and really prove out what you're feeling.
The point of this is to be a scientist studying yourself. You're not the depression, you're not the panic attacks, you're not the anxiety; you're the thing watching.
You may misunderstand meditation
Meditation is firmly in mainstream mental health now, to the point where the CDC recommended it along side "social distancing" and "wearing a mask" during the pandemic. Most folks in modern western culture have a pretty good understanding that meditation is not supernatural in any sense; it's not some strategy to achieve levitation or spirtual powers. Meditation, and the surrounding Buddhist philosophies are extremely similar to CBT, at least according to Dr. Aaron Beck, the creator of CBT.
But many, many people, even those who have tried meditation, have a misunderstanding of what meditiation is for.3
Some assume that meditation is a type of calming exercise, meant to distract you from whatever is going on. You may assume that your current emotional state is "worked up" and that meditation is meant to "calm you down". This is a dangerous misunderstanding of meditation. If you use meditation in the same way you might breathe into a paper bag or take a xanax, it's not better than any other avoidance behavior. As I mentioned earlier, if you avoid the thoughts, you feed the habit. In reality, there are many non-calming, non-sitting forms of meditation. To clarify, calming meditation isn't bad, it's actually what I'm going to recommend; it's just that this isn't the reason I'm recommending it to you.
Others assume meditation is a type of concentration exercise. They believe that the purpose of meditation is to get very good at focusing. To some extent this is true, in that meditation will build concentration. But it is a very particular type of concentration. It is not the type of concentration that is required to force the mind to focus on one thing. It's the type of concentration that you get when you're in a state of flow, when your brain is doing the thing it's doing and not concerned with anything else. It's similar to the type of concentration seen by artists, programmers, athletes, and so on. But this is still not the reason I would recommend meditation.
The reason to meditate is to practice seeing reality. The consistent theme of everything we've talked about is that inside your head are mental objects that are distinctly not-you. But no matter how many times I repeat this, it can be hard to see, especially if you have spent years believing that you and the movie were one in the same. Meditation is a way to not just see this intellectually, but to really, physically, feel it. If I tell you that I have gem in my closed fist, you have to believe that it's there. But if I open my hand and I show you the gem, that's a different type of "knowing" because you can see it. That's what meditation is.
It does not require endless hours of meditation to start to see this. You do not need to abandon your life to become a monk. Just as I showed you in the beginning of this post, you can close your eyes for 30 seconds and watch as your thoughts occur without your input. The fact that this is difficult, that you so often get "pulled along" by the thoughts only to recognize what's happening and come back to your breathing, is what I'm trying to tell you. What you're doing when you're meditating is getting a feel for what things are really you and what things are not.
If you sit and breathe and watch your breath and the thoughts that float by for much longer than 30 seconds, you may hit a point where the thoughts have mostly faded away. Without the mental objects to occupy your focus, the focus departs as well, just as it does when you're in a flow state. You may have noticed a similar state before in your life. If you don't attach yourself to the voice and the movie that try to distract you, it happens all the time. It's the default state, a very good feeling, one without the burden of constantly getting pulled away by some thought. And if your thoughts aren't there, and your observation of the thoughts aren't there, then you may find that if there is a "you" in there, it's much smaller than you thought it was.
This "small you"4 is the entire goal of everything I'm talking about. A "small you" can walk by a bike that's missing a wheel without feeling like you're broken, because the "small you" doesn't include the bike in the "you". A "large you" incorrectly thinks that the thoughts that flow by are you and so has no mechanism to escape from getting pulled along by every random thought. The large you thinks that many parts of the outside world are you as well, and so when real, physical loss happens, it feels like a bodily threat even when it isn't. A "small you" doesn't see a threat in the thoughts, nor in the things that happen in the real world, and so the body doesn't react with the emergency emotional tools. A "small you" is just the observer; one that can look at the situation with empathy and kind skepticism towards both the outside world, as well as the inside, mental world.
I want to be clear that I'm not talking about a metaphorical you. This isn't an analogy. I'm really talking about the real you. Your brain's perception of you. It may sound like we've gone off the deep end, that somehow we've entered into some high-minded metaphysical conversation, when all you were looking for is how to feel a bit better. But I promised you at the start that I would give you the full explanation, and that this was going to be a more nuanced discussion of how you can start to feel better.
The way to shrink the you in there, to feel the "small you" and to therefore to start feeling better, is through mindfulness. I'm not introducing a new skill here; the exercises we talked about in CBT are mindfulness. Catching the thoughts as they happen, disowning them, and skeptically questioning their validity is mindfulness. Those exercises are meditation. Or at least, they're one form of meditation, one that can be a bit easier to carry through your day.
But it's worthwhile to leave you with another form of meditation. To do this, sit down. I use a chair, but you may want to do some googling to learn about some other postures that might make it easier to still for awhile. Consider setting a timer, perhaps for 15 or 20 minutes. If you can, block out time to do this. Accept that while you're doing this, you do not need to be doing anything else. Everything else can wait. Then, watch your breath. You do not need to force your breath. Your body is already quite good at breathing if you let it. Just observe it doing it's thing. Your mind may wander and this is normal. It's not a bad thing for your mind to wander, you're not "failing to meditate" because you mind wanders. Noticing the mind wandering is what we're doing here, the noticing is the meditation. Watch the thoughts think themselves. If you notice that your mind is wandering, gently let the thought go and bring your attention back to the breath. If the voice says "this is boring", notice the thought, notice the boring. Then let it go, and bring the attention back to the breath. If the voice says "20 minutes feels like such a long time", notice the thought, examine it, and hold the judgement until you've experienced the 20 minutes.
You may want to consider meditating more times throughout the day, such as in morning and the evening. You should try to carry the mindfulness through your day. This is hard to do on it's own, but the CBT exercises can be helpful here.
And remember that this is a skill, it takes practice and time.
Playing on easy mode
All of this is much easier to do if you sleeping and exercising. Mental illness, especially depression, is a negative feedback loop where negative thoughts cause negative moods which in turn cause negative behaviors like sleeping poorly and not exercising. Sleeping poorly and not exercising will then cause more negative thoughts and make the emotional responses from attaching to them stronger.
So it's worth taking a wholistic approach: do all the strategies at once. Build mindfulness through meditation, and the CBT exercises, but also fix your sleep and get phyiscal exercise. Unfortunately, I am not expert in getting better sleep, nor am I an expert in physical exercise. For me, getting better sleep just meant buying a weighted blanket and then going to bed earlier. Likewise, getting more exercise meant running more.
If you're struggling to sleep well, you may want to consider seeing a sleep therapist. You can do this online at shuni.io. As exercise goes, I would recommend high-intensity aerobic exercise that tires you out, such as running, biking, or swimming.
Just as sleep and exercise can help you build mindfulness, mindfulness can help you build sleep and exercise. If a voice or movie is keeping you up at night, you can notice it and examine it, and then let it go. If you struggle to find the motivation to exercise, you can notice the thought, examine it, and then let it go.
The Weird Brain Reading List
If you'd like to learn more about what I've talked about in this post, below is a list of approachable "weird brain" books. The "weird brain" is a collection of models and beliefs that are discussed in this post that you may find interesting.
- Feeling Good. This is the "CBT Bible." Pay no attention to the "self-help" feel of the book, it's the thing the popularized CBT to the world.
- What the Buddah Taught.
- I am a Strange Loop. A much, much smaller you.
- Full Catastrophe Living. A stronger guide on how to meditate than I can give.
- The Untethered Soul.
2 Models of how the brain quickly get into the realm of philosophy and unresolved science with competing theories. Most of what I'm doing here is giving a reasonable argument for why these are a valid way of seeing the mind and why they're useful from a feeling-good standpoint.
3 When I say "meditation", I'm typically referring to the mindfulness, sitting & breathing meditation.
4 "Small you" is a watered down version of Douglas Hoffstader's view of "I" as "I am a strange loop", and possibly the buddhist concept of "not-self".