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Crazy-Makers: Dealing with Passive-Aggressive People

Why Are People Mean? Don't Take It Personally!

When You Have Been Betrayed

Struggling to Forgive: An Inability to Grieve

Happy Habits: 50 Suggestions

The Secret of Happiness: Let It Find You (But Make the Effort)

Excellence vs. Perfection

Depression is Not Sadness

20 Steps to Better Self-Esteem

7 Rules and 8 Methods for Responding to Passive-aggressive People

What to Do When Your Jealousy Threatens to Destroy Your Marriage

Happiness is An Attitude

Guide to How to Set Achieveable Goals

Catastrophe? Or Inconvenience?

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Audio Version of Article: Crazy-Makers: Passive-Aggressive People

Audio Version of Article: Why Are People Mean? Don't Take It Personally!

Audio Version of Article: Happiness Is An Attitude

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PsychNotes August 2014
by Monica A. Frank, Ph.D.
Clinical and Sport Psychologist

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August 31, 2014

Passive-Aggressive Example: Living With Blaming and Guilting Mother (Part 1)

Question: My partner's mum is staying with us and she's quite PA and I'd love to know better ways of dealing with some of what she does...

A) She blamed my partner for not telling me her plans had changed (in the last thirty minutes) and that she did want me to include her for dinner after all. But she didn't tell him she now wanted to eat but only that she was leaving later. She didn't tell me (the person cooking) anything. We offered to split what we had but she made a fuss whilst making a sandwich and saying "I suppose you don't want to share!" Sporadically through the next hour she'd sigh and say to herself "it wouldn't have taken you both MUCH effort to pad out the meal" and "you've got to start passing messages."

B) Partner's mum is upset dishwasher wasn't run overnight. She complains to my partner loudly enough that I can hear: "I know she doesn't CARE about keeping the house tidy but how could anyone NOT run the dishwasher? Why on earth WOULDN'T you?"
Partner: "That's a little unfair when you make these general statements. I know she cares and she must have had a reason."
Mum: "Why on earth wouldn't you! It's just common sense!"
(In fact I hadn't run it because she'd often complained about running it when it wasn't totally full and had even unpacked the top row to demonstrate that you could jam one more glass inside. This time the dishwasher had five or six spaces.)
Partner: "I would like you to think about maybe not making general statements. It upsets people."
Mum: "I'm not allowed to think anything! I've just got to shut up and keep my thoughts to myself. You want me gone. You make it totally clear you HATE having me here!"
Partner: "We like you here. I just want you to know people feel hurt if..."
Mum: "I'm not ALLOWED to say anything!!" Slams door, sulks in room. We leave her to it. Returns two hours later to scream at partner that he's a hateful (expletive)! Slams sitting room door. More sulking.

C) Partner's mum recites lists of what she does for us to her other children. She makes it sound as if we want her running after us and she's totally put upon. We'd rather tidy after ourselves but can't stop her doing this stuff:
Partner (working from home in personal office): "I don't like you coming in here every hour or so to see if I've got any cups. I'll take this cup once I've finished what I'm working on."
Mum: "I'll just take it."
Partner: "I don't want you to. It's distracting and I feel bad like you're slaving after me."
Mum: "I suppose you WANT the house to turn into a sty. You don't mind the house being DISGUSTING."

D) She has a lot of esteem wrapped up in having been an amazing mother and homemaker. If I choose to do a home-based task differently from how she would have, she will nitpick and point out the many flaws with doing it that way. She'll also say I did it that way because I "don't really CARE" and "that's a lazy way" to do that. Anything that's done her way is just "the way it SHOULD be done" and "why would anyone NOT do it that way!" Despite this she claims she doesn't get ANYTHING done her way although every room in the house is layed out how she wanted and most home things are done her way. When she returns from holidays she spends the next week pointing out things I've missed or supposedly done wrong: "I see it was too hot to mow the lawn!" (I'd mowed three days earlier). "I see no one could be BOTHERED to buy a new salt shaker! You guys!" Shakes her head. Salt shaker is still 3/4's full.


August 23, 2014

For OCD: What if I Forget to Lock My Doors?

EVENT: Leaving the house

EMOTIONS: anxiety, guilt, frustration

DISTRESS RATING: 7--Feeling distressed, less in control

THOUGHTS: “I need to check to make sure all the doors are locked. What if someone came into my house while I'm gone and robbed me? My dog might get out and something terrible might happen to him. I would never be able to handle that because it would be due to me being irresponsible. I better check the doors again just to make sure.”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 3 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of anxiety, guilt, frustration?


August 22, 2014

New Music Version of Audio is Available: Riding a Horse Across the Plains Relaxation with music

This audio uses the guided imagery of riding a horse across the plains to induce relaxation. You experience the cool morning as you start your ride. You watch the antelope cavorting across the prairie and view the tumbleweeds blowing through a dry riverbed. When the warmth of the midday sun is overhead, you relax and drift off to sleep in the shade of a tree by a refreshing pool of water.


August 20, 2014

Binge Eating: CBT vs. Medication

If you have read my previous writing, you are probably aware that I have a grudge against Big Pharma. Not because medication is ineffective but because it is touted as the treatment of choice in spite of controlled research consistently showing otherwise (when it is not done by those associated with the pharmaceutical companies).

The latest example I have found of this is a study by Grilo and colleagues (2012) examining treatments for binge eating disorder (BED). In a direct comparison of a common antidepressant with cognitive-behavioral therapy (CBT) plus placebo (sugar pill), they found a substantial superiority for the CBT group. In particular, after 4 months of treatment, participants who were in the medication group had only a 3.7% remission at the 12-month follow-up whereas 35.7% of the CBT plus placebo group were still in remission (defined by no binge episodes). Interestingly, those who had combined CBT plus antidepressant were lower in remission rates (26.9%) than the CBT plus placebo which indicates combining CBT with an antidepressant does not improve the outcome over CBT alone.

Such results bring into question the widely followed treatment guidelines provided by the National Institute of Clinical Excellence advising treating binge eating disorder with medication only (Grilo et al., 2012). Again, I question how can medication with all the possible side effects and unknown long-term consequences be justified as an initial treatment given these types of outcomes?

Grilo, C.M., Crosby, R.D., Wilson, G.T. And. Masheb, R.M. (2012). 12-Month Follow-Up of Fluoxetine and Cognitive Behavioral Therapy for Binge Eating Disorder, Journal of Consulting and Clinical Psychology, 80, 1108–1113. DOI: 10.1037/a0030061.

August 19, 2014

New Audio: OCD Hoarding Assistance Audio: What Is Your Life Worth?

Obsessive Compulsive Disorder can involve different types of compulsive behaviors. This audio discusses the compulsion of hoarding which is the fear of losing something. The concept of hoarding and the thinking that needs to be challenged to help make choices regarding saving or throwing things away is discussed. This audio also describes how the fear of loss and grief is associated with hoarding.

The purpose of this audio is to help you become more aware of the specific choice you are making when you engage in a hoarding compulsion. In particular, is the item you are saving worth more than you are? By being aware of this choice, you can take the next step of changing the behavior that controls your life.

August 16, 2014

Did You Know Psychotherapy has Stronger Scientific Evidence than Many Common Medical Procedures?

The general public often thinks of psychotherapy as some sort of “mumbo jumbo” that involves talking with someone about problems. Or, they believe it is probably not much different than talking to a friend. At the same time, the public has the impression of medical care as scientific, based on hard facts.

Yet, interestingly, the actual evidence for psychotherapy is much stronger than many standard medical practices such as beta-blockers, angioplasty, and statins for heart disease, calcium and other pharmacological treatments for osteoporosis, the flu vaccine, certain asthma treatments, and cataract surgery among others (Wampold, 2007). This is not to say those treatments are not effective for the conditions they treat, but that psychotherapy has more evidence for its effectiveness for mental disorders than those treatments have for their corresponding physical disorders.

Yet, psychotherapy is often view as the stepchild of medicine and physicians refer patients to therapists as a last resort rather than for initial treatment. Statistical research shows that primary care doctors in a wealthy and highly educated area of Italy overwhelming believe that anti-depressants are more effective than psychotherapy even though research does not support this belief. As a result, the vast majority of individuals with depression or anxiety are not referred to therapy but provided medication instead (Casini et al., 2013). Here in the U.S. physicians are instructed to refer to psychotherapy when: “One or, at most, two trials of psychotropic medications, under the direction of the primary care physician have failed (Bea and Tesar, 2014).”

Why is this a serious health issue? Not only is treatment by primary care doctors less effective (Hartley et al., 1996) but medication has a higher relapse rate as well as disruptive side effects (Lambert, 2013) such as weight gain, sexual dysfunction, sedation. Shouldn't the first line of treatment be the one that is most effective for the long-term and has the least amount of negative impact on the quality of life? In fact, cognitive-behavioral therapy for anxiety has been shown to improve the overall quality of life while effectively treating the anxiety disorder (Hofmann et al., 2014).

The reason that medication is so highly prized by physicians is because many of them obtain most of their on-the-job education about the value of medications from pharmaceutical reps. Even insignificant gifts such as a key-chain can substantially increase prescribing a certain medication (Higgins, 2007). It is important to be an informed consumer and not just rely on the opinion of your physician especially when it regards mental health care.

Bea, S.M. and Tesar, G.E. (2014). A Primer on Referring Patients for Psychotherapy. Cleveland Clinic Journal of Medicine, 69, 113-127.

Casini, F., Sighinolfi1, C., Tedesco, P., Bandieri, P., Bologna, M., Colombini, N., Curcetti, C., Magnani, M., Morini, M., Serio, A., Tarricone, I., Berardi, D. and Menchetti, M. (2013). Primary care Physicians’ perspective on the management of anxiety and depressive disorders: a cross-sectional survey in Emilia Romagna Region. BMC Family Practice, 14, http://www.biomedcentral.com/1471-2296/14/75

Hartley, D., Korsen, N., Bird, D., Agger, M. (1996). How Do Primary Care Practitioners Manage Depression: Treatment or Referral? Maine Rural Health Research Center. https://muskie.usm.maine.edu/Publications/rural/wp07.pdf

Higgins, S.P. (2007). Drug Representatives: Giving You Lunch or Stealing Your Soul? Dermatology Online Journal, 13, 5. http://escholarship.org/uc/item/9h81c13s

Hofmann, S.G., Wu, J.Q. And Boettcher, H. (2014). Effect of Cognitive-Behavioral Therapy for Anxiety Disorders on Quality of Life: A Meta-Analysis. Journal of Consulting and Clinical Psychology, 82, 375-391. DOI: 10.1037/a0035491

Lambert, M.J. (2013). Outcome in Psychotherapy: The Past and Important Advances. Psychotherapy, 50, 42–51. DOI: 10.1037/a0030682

Wampold, B. E. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62, 857– 873. doi:10.1037/0003- 066X.62.8.857

August 15, 2014

New Passive-Aggressive Example: Confronting a Passive-Aggressive Insult

Question: "You know that you shouldn't eat before bedtime, right?" said by brother-in-law (BIL) to overweight mother of nursing baby while she is eating a snack. Said with a giggle. They don't even know each other well and he is staying in their house for the first time.


August 13, 2014

New Music Version of Audio: Cityscape Mindfulness with Music

This audio relaxation exercise teaches mindful awareness by describing relaxing imagery. This audio allows you to experience the view from a rooftop in a city. As you mindfully experience the city, the sun sets and the lights of the city appear.

This type of relaxation has several purposes. It teaches you how to be mindfully aware of your full experience. By practicing the methods of mindfulness, you can develop a greater awareness and appreciation of your daily experiences. In addition, it will help you develop greater relaxation skills. You can use these methods to reduce the symptoms of stress, manage anxiety, and improve your sleep.


August 9, 2014


EVENT: I need to take a leave of absence from work.

EMOTIONS: dread, humiliation, helpless

DISTRESS RATING: 8--High level of distress

THOUGHTS: “I'm having problems with my depression and anxiety which is interfering with work. I need to take a leave of absence for treatment. What will my co-workers think of me if they find out why I'm not at work? They'll either think I'm faking it to take time off work or they'll think I am pathetic because I am anxious and depressed. Either way they won't treat me the same and they might be talking about me behind my back. I am so weak and ashamed that I can't control my problems like other people do”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 3 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of dread, humiliation, and helplessness?


August 8, 2014

New Audio: The Great Desert Mindfulness with Music

This audio relaxation exercise teaches mindful awareness by describing relaxing imagery. This audio takes you for a walk in the Great Desert experiencing the beauty, heat, and sounds of the sand dunes. You return to a quiet oasis pool and fully experience the sunset over the desert.


August 4, 2014

Does Sadness Cause Depression?

Many people with clinical depression are aware of the tendency to focus on the negative aspects of their life while in a depressive episode. Likely, this is due to the brain's tendency to organize information in memory according to the emotional state that occurred during the memory. Think of it like a file cabinet containing files of different emotions. If you look in the file labeled “Sad” you find all the different events related to that emotion. When you are looking at a particular file, other items in that same file are more accessible to you. As a result of this type of organization in the brain, the individual is more likely to access memories that are similar to their current emotion.

For instance, you may have had the experience of being angry with someone and at the time could only remember all the previous times you were angry with that person even though positive events existed as well. This occurs because when an emotional state exists it is more directly connected with other memories of that same emotional state. Anger is connected to angry memories. Sadness is connected to sad memories.

This concept is well-known. Clearly, in the case of clinical depression, people have easier access to the negative, particularly sad, memories. Yet this could be true of any time when a person is feeling bad such as from an injury or physical illness as well.

Researchers Clasen and colleagues (2013) wanted to know how the sad mood evoked by memory affected the depression in turn. In particular, does the focus on sadness contribute to a persistence of the sadness?

To examine this question, the researchers manipulated attention to sad information. In addition, they created a sad mood by having participants either watch a sad film clip or listen to sad music. The research showed that sad mood could be induced in both depressed and non-depressed individuals but tended to last longer for those who were more severely clinically depressed. This indicates that depressed individuals, in general, are more susceptible to a sad mood persisting.

However, I think the more interesting finding in this research is that a great deal of difference in recovery from a sad mood can occur between different depressed individuals and that the same is true for non-depressed individuals. In other words, not all people with depression are more attuned to the negative information in the world around them nor do they take longer to recover from a sad mood state. Not only that, but although depressed individuals who do have a negative focus take longer to recover from a sad mood, they do recover!

To me, this is support for the premise of my article Depression is Not Sadness. The reaction to creating a focus on sad information as well as the process of recovery from a created state of sadness is very similar for depressed and non-depressed individuals. The fact that depressed individuals recover from a sad mood in a similar way as non-depressed people supports the idea that sadness and depression are different experiences and that sadness is not the cause of clinical depression.

Clasen, P.C., Wells, T.T., Ellis, A.J. and Beevers, C.G. (2013). Attentional Biases and the Persistence of Sad Mood in Major Depressive Disorder. Journal of Abnormal Psychology, 122, 74–85. DOI: 10.1037/a0029211

August 3, 2014

New Audio: Riding a Horse Across the Plains Relaxation

antelope on the prairie This audio uses the guided imagery of riding a horse across the plains to induce relaxation. You experience the cool morning as you start your ride. You watch the antelope cavorting across the prairie and view the tumbleweeds blowing through a dry riverbed. When the warmth of the midday sun is overhead, you relax and drift off to sleep in the shade of a tree by a refreshing pool of water.

As with all guided imagery exercises, choose the imagery that seems the most relaxing to you. This may be used while sitting or lying down in a quiet, comfortable place.  Just close your eyes and listen without trying to force yourself to relax.  If your mind wanders, gently bring yourself back to focus on the words. You may use this for sleep because it describes waking up whenever you are ready.

Do not use while operating a vehicle!


August 2, 2014

New Audio: OCD Intrusive Thoughts Reassurance

This audio discusses the intrusive thoughts that occur with a certain obsessional type Obsessive-Compulsive Disorder in which the individual is anxious or fearful due to experiencing unacceptable thoughts, images, or impulses. The purpose of this audio is to help the person with OCD understand that having such thoughts is normal and that worrying about the thoughts creates the obsessional process.

Although this audio may provide reassurance for the individual who has such thoughts, it is meant to be a step in the treatment process and not relied upon solely for reassurance. The individual with OCD should try to make this a way of thinking so they can learn to dismiss the thoughts as other people do.


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Dr. Monica Frank

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