I hate taking out the garbage.  Like, I really hate taking out the garbage. Every week, I forget that I have to take out the garbage until I am sitting on the couch relaxing and then, BAM, I remember. In those moments, I get really irritated and start thinking (that is when the real problems start): “why didn’t I do this earlier?” “why does this stupid task get me so cranky?” “what is wrong with me?” “what is it about taking the trash out that gets me so irritated?” “if I could just figure out why I am so irritated, then maybe I won’t mind taking out the garbage so much.” Imagine how much time it would take me to figure out answers to these questions. Actually, I wonder if it is even possible to find any fact-based answers at all. And even if I had those answers, I’d still be left with a big problem: the garbage still needs to be taken out to the curb.

 

You know what makes my irritation about taking the garbage out go away immediately? Getting up and taking out the garbage. And guess what? It doesn’t matter if I want to take out the garbage or if I know why I got so irritated in the first place. In fact, I just need to move my arms and legs. No changes to my psychology need to occur. The one thing that will end my suffering is seeing that garbage can out in front of the house. All the thinking and insight in the world won’t accomplish that for me. I need to make it happen.

 

It’s funny: I’ve noticed that people (including myself) often want the solution to a problem to be complex while at the same time wishing that the actions we need to take to solve that problem will not require too much effort. Sometimes, we are quick to reject practical solutions because they might seem “unsophisticated” or “simplistic.” Other times, we confuse the actual problem with the story our minds create about the problem. Ok, this happens probably more than sometimes. It’s almost like we would rather suffer than accept that maybe we can start to solve our problems by changing small things about our behavior. Or we demand that solutions not add any more stress to the situation, even if it’s just a little bit and lasts a short amount of time.

 

I’ve seen the same thing with many of my clients. That isn’t to say that life’s major challenges are easy to “fix” with one or two simple changes. However, it’s usually a host of small, but fundamental, changes that are practiced consistently and turn into new, healthy habits that makes all the difference. It’s usually not some huge insight that instantly leads to recovery. Insights can be useful, but even the most profound insights are useless unless they are accompanied by effective action. I can understand that taking the garbage to the curb will make my irritation go away, but my irritation will persist until I get off my butt and actually do it. Likewise, you can understand that facing your fears is the pathway to conquering them, but then you need to go out and face them.

This conundrum reminds me of a parable attributed to the Buddha:

It’s just as if a man were wounded with an arrow thickly smeared with poison. His friends & companions, kinsmen & relatives would provide him with a surgeon, and the man would say, ‘I won’t have this arrow removed until I know whether the man who wounded me was a noble warrior, a brahman, a merchant, or a worker.’ He would say, ‘I won’t have this arrow removed until I know the given name & clan name of the man who wounded me… until I know whether he was tall, medium, or short… until I know whether he was dark, ruddy-brown, or golden-colored… until I know his home village, town, or city… until I know whether the bow with which I was wounded was a long bow or a crossbow… until I know whether the bowstring with which I was wounded was fiber, bamboo threads, sinew, hemp, or bark… until I know whether the shaft with which I was wounded was wild or cultivated… until I know whether the feathers of the shaft with which I was wounded were those of a vulture, a stork, a hawk, a peacock, or another bird… until I know whether the shaft with which I was wounded was bound with the sinew of an ox, a water buffalo, a langur, or a monkey.’ He would say, ‘I won’t have this arrow removed until I know whether the shaft with which I was wounded was that of a common arrow, a curved arrow, a barbed, a calf-toothed, or an oleander arrow.’ The man would die and those things would still remain unknown to him.

“Cula-Malunkyovada Sutta: The Shorter Instructions to Malunkya” (MN 63), translated from the Pali by Thanissaro Bhikkhu. Access to Insight (BCBS Edition), 30 November 2013, http://www.accesstoinsight.org/tipitaka/mn/mn.063.than.html 

Admittedly, I am taking the quote out of its spiritual context, AND I think that the basic idea fits the problem we’ve been exploring in this blog. So what does this have to do with evidence-based psychotherapy (EBP)? Well, it turns out that EBP for things like major depressive disorder, panic disorder, social anxiety disorder, and even posttraumatic stress disorder (and many other common presenting issues) are pretty straightforward versions of Cognitive Behavior Therapy (CBT). CBT tends to focus on fairly direct “arrow removal techniques” rather than developing insight for the sake of insight. For example, CBT for depression usually involves something called “behavioral activation” which involves essentially forcing yourself to do things that result in feeling a sense of pleasure, meaning, or mastery. Most CBT protocols for anxiety involve creating a list of the things that trigger anxiety and then systematically pushing yourself to face those things in a gradual way. It’s actually not necessary to know all the reasons “why” depression or anxiety showed up in the first place for these things to work. The data has born this out again and again.

The road to recovery isn’t necessarily a straight line, but it turns out that effective therapy isn’t rocket science. It’s science, of course, just not incomprehensible and complicated, at least in terms of the basic principles and techniques.

I’ll be posting more about these specific principles and techniques in the future, so be sure to check back. In fact, the whole point of this website is to get the word out about EBP and telepsychology and to reach people who can’t get these therapies in their area.

 

Thanks for reading!