A Visual of How (Effective) Therapy Works
Escaping the Infinite Misery Loop
This post is free for all. If you value the effort behind this newsletter, consider supporting by upgrading to paid.
You Don’t Need a Disorder To Benefit from Therapy
Over five intense years of clinical psychology training, I learned to categorize every possible condition, pairing each with its corresponding therapy. But my training missed the mark - offering support only when a clear diagnosis is stamped on a file.
Picture a person I met who is not clinically "disordered" but struggling.
I had an awful childhood and decided when I was a child myself that I would never bear children. I told myself that the possibility of replicating the generational trauma I experienced at the hands of my mother, and that she experienced at the hands of her mother, was simply too powerful to attempt to defeat. It's the best and kindest decision I ever made for myself and any potential offspring.
And you know what? This is absolutely fine, and I don't need to argue with any misogynistic naysayers about my personal choices.
They don’t suffer from post-traumatic stress disorder nor do they check for 350 mental health disorder boxes.
There are a lot of unhealthy thoughts and feelings that exist, especially if you have a trauma history.
If you experienced abuse this often activates unhealthy thoughts and behaviors. The image above details a network of one person’s difficulties in the aftermath of abuse. A person that could benefit from therapy.
What Exactly Are Psychological Therapies
Psychological treatments are sophisticated. Consider a few treatments for emotional disorders:
In Cognitive Behavior Therapy (CBT) therapists focus on the impact a client’s present dysfunctional thoughts have on current behavior and future functioning. CBT is aimed at evaluating, challenging and
modifying a client’s dysfunctional beliefs (cognitive
restructuring). In this form of treatment the therapist mostly
emphasizes homework assignments and outside-of-session
activities. Therapists exert an active influence over therapeutic
interactions and topics of discussion, use a psycho educational
approach, and teach patients new ways of coping with stressful
situations. This is my favorite book on the science of CBT - here.
In psychodynamic therapy, the primary objective (short-term) is to enhance the client’s understanding about
repetitive conflicts (intra psychic and intrapersonal). An assumption is that a client’s childhood experiences, past unresolved conflicts, and historical relationships significantly affect their present life situation. In this treatment the therapist explores these issues and fears, wishes, dreams, and fantasies. Read more on the science behind it - here.
There are other variants such as problem-solving therapy, interpersonal psychotherapy, behavioral activation, and acceptance and commitment therapy. The common thread is an attempt to help people identify and change emotions, thoughts, and behaviors that produce suffering.
How Do People Change in Therapy
I found a wonderful visual of how therapy helps. Before therapy (at baseline), your suffering is like a tightly wound knot. Depression, anxiety, anger—they all cling to you, demanding escape. You desperately avoid these emotions, using every ounce of energy to suppress or distract yourself from them. Instead of enjoying life's simple pleasures—stretching, reading, conversing, playing with a capybara, or mastering that guitar riff from Sabotage - you’re consumed by the struggle to not feel.
Your life becomes a battleground against your own emotions, leaving little room for joy or growth. Therapy offers a way to untangle this knot, freeing you to reclaim energy and embrace life's richness.
You can see this on the left side of this figure - Baseline. The thickness of the lines among anxiety, depression, anger, and avoidance depict the habitual tendency to avoid feelings. The loops in the “temporal network” show how feeling depressed now leads to avoidance later which only leads to more depression in this infinite misery loop.
After 16 weeks of cognitive-behavioral therapy, the infinite misery loop shatters. Feelings and avoidance behaviors untangle. Now, anxiety, depression, and anger no longer dictate avoidance. These emotions return to mere signals—an alert system that there is something worthy of short-term attention.
Anxiety: This heightened state of alertness helps you avoid potential pitfalls and make more informed decisions.
Depression: Experiencing sadness encourages introspection and self-reflection.
Anger: This energized feeling drives you to address injustices or personal boundaries that have been crossed.
Observe these feelings. Sit with them. Then choose to move forward. Return to that poker game with friends. Hit the gym for a triceps workout. Listen intently to a friend's story. Life continues, irrespective of pain. This is what effective therapy does.
The goal of therapy is not to feel less frequent or intense unhealthy emotions. The goal is to reduce the impact of these emotions on what is truly important.
Thanks for reading Provoked. If you’d like to support my work please:
Leave a ❤️ so that others can find it;
Leave a comment (I’ll do my best to respond);
Share this post by email or on social media;
Start a paid subscription to this Substack (with benefits such as access to monthly virtual calls, premium chat room, and 200+ article archive).
Extra Curiosities
Do read this wonderful article on productive disagreements in the workplace by Henna Pryor who writes a column at Inc. - here. It was one of my favorite interviews on the Art of Insubordination.
Do watch my podcast interview hosted by this energetic father-son duo. We tackle curiosity in depth.
05:09 Raising Curious Kids
08:07 Finding Opportunities for Creativity
10:02 Father/Son Trip to Peru
19:41 What Curious People Do
31:32 Life Satisfaction
43:35 Stress Management
45:02 Curiosity in Relationships
48:15 Communicating Switching Costs
49:40 Choosing Your Thoughts
57:50 Embracing Rabbit Holes
57:39 Decision-Making Tip for Business Owners
Or
Todd B. Kashdan is an author of several books including The Upside of Your Dark Side (Penguin) and The Art of Insubordination: How to Dissent and Defy Effectively (Avery/Penguin) and Professor of Psychology and Leader of The Well-Being Laboratory at George Mason University.
And If You Missed the Celebration, Here Are Past Issues:
50,000 Citations Celebration! My 3 Favorite Well-Being Laboratory Discoveries
For this celebration, free or premium subscriber, I’m inviting you to comment on this article. Let’s see how it goes. I will stick to a “no asshole rule.” Assume positive intentions until proven otherwise. Disagree all you want, but keep it about the ideas, not the person.
Hi Todd, I've wanted to ask you this question on your member's Zoom call, but the time-zone difference doesn't fit for me. Since my question fits with the theme of therapy, I hope it's ok to ask you here. I know you're a prominent Social Anxiety researcher. I'm wondering what your stance is in relation to the Dodo Effect and Social Anxiety? Is there any solid evidence that any of CBT, Meta-CT, ACT, etc. or straight behavioural-only approaches are superior for Social Anxiety? Or have no trials done a head-to-head comparison that could answer this question? Obviously, just statistically, one would expect to have some trials claim one approach is superior but it seems to me, on general, the Dodo Effect still stands on solid ground. However, would you recommend people with Social Anxiety start with one particular approach, or are they all similar in effectiveness? Thank you!
Oh, this sounds interesting..."playing with a capybara"!