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Perhaps you tried your best to do only good for your children, your parents, or your friends, but things simply didn't go according to plan. Then: "Oh, I should have known better! Why didn't I see that coming? It's all my fault!" The difference between you and the mouse, says Burns, is that you look backward to the misfortune, lament it, and cast blame, and then look forward with uncertainty and fear, whereas the mouse sees only the present, and therefore suffers less in the end. But like the mouse, none of us can realistically demand that we never make a mistake in judgment, no matter how careful we may be! Medication is a surprisingly controversial option for treating anxiety. Broadly speaking, anxiety-fighting drugs fall into two categories; anti-depressants (SSRIs, SNRIs, and tri-cyclic antidepressants) that do double duty as anti-anxiety drugs by helping the brain manage stress in general and drugs that specifically focus on calming a person down (benzodiazepines). Most doctors and lay people believe that medication combined with therapy offers the best results for treating anxiety, but the most recent research disputes this assumption. According to researchers at the University of Manchester and the Norwegian University of Science and Technology, who completed the most comprehensive research project to date examining anxiety treatments, psychotherapy alone (specifically, a type called cognitive behavior therapy or CBT) was actually the most effective method of treatment, beating both medication-alone and combined therapy/medication approaches hands-down. Her mother was extremely proud of the fact that people could come to visit any time, day or night, and never know that she had five children. The children were always out of sight, engaged in some quiet, neat activity, and the house was always in perfect order. Her mother placed a high priority on order and silence. She didn't anticipate that such a highly controlled and ordered environment could affect the development of the children. As it turned out, of the five siblings in Karen's family, one committed suicide, one is in a mental institution, one refused ever to leave home, and one is an alcoholic. Karen herself married an alcoholic, subsequently got divorced, and is struggling to cope with life as best she can. None of the siblings have children of their own, and probably never will. The Internet has had a similarly powerful socially disconnecting pull on people--away from actual interaction in exchange for massive virtual interaction. According to Wikipedia, "Overall Internet usage has seen tremendous growth. From 2000 to 2009, the number of Internet users globally rose from 394 million to 1.858 billion. By 2010, 22 percent of the world's population had access to computers with one billion Google searches every day, 300 million Internet users reading blogs, and two billion videos viewed daily on YouTube." The popular rallying cry of this extraordinary innovation has been "we have never been so connected," but little attention had been given that to be "connected," you must stare at a flat screen and disconnect from the people who live with you or next door to you.

One doctor I know, a married man with two teenage children, says, "In the evening, the four of us go to four different rooms and get online. We don't see each other much after dinner." We tend to avoid things; paying attention to what we're avoiding will at least give us the chance to use strategies to get going, and the small steps is useful again. As an extreme example of procrastinating and avoiding, and often as a direct consequence of it, we can sometimes become totally stuck. We can be stuck, demoralized and paralyzed. Many things in life work in feedback loops, like vicious cycles or whatever the opposite is - beneficial cycles? Psychologically speaking, you put on rose-colored glasses in order to see the past in the best possible light. Incidents are recalled that give your parents the benefit of the doubt, at times skewing the facts, justifying and explaining your parents' behavior so that the past fits within the fantasy scenario that you have skillfully constructed. On the exterior, Karen, a thirty-seven-year-old-women, is happy, motivated, cheerful, fun-loving, competent, open, and a thoroughly delightful person to have around. To talk to her, you would think that she had a perfect childhood. She would describe her parents and four siblings as loving, happy, and wonderful people. She had great memories of summer vacations and fishing trips during childhood. She loved her family and wanted them all to be happy. Karen had painted a rosy picture of her life not because she was fabricating the past, but rather because she made the best of everything in order to survive, and found a way to keep her spirit alive by being cheerful and happy no matter what. When sad feelings would surface, specifically around the issue of relationships, Karen would put on her happy face and simply forge ahead. Not only is it not always possible to predict moral outcomes, but the correct moral option may not even be clear. Suppose you can either help a friend study for an exam or spend the time reviewing for your own exam. Are you being a bad friend if you choose to review for your own exam? Are you being unfair to yourself if you choose to help your friend? And, to leap straight to one of the greatest social divides of our times, is it ever morally permissible to have an abortion? The research showed that while medication can yield short-term benefits for anxiety sufferers, in the long term, it actually caused patients to become embedded in their anxiety.

By contrast, 85 percent of patients receiving CBT alone experienced either significant relief or complete recovery from their anxiety. But why would people receiving both medication and psychotherapy have worse outcomes than people receiving CBT alone? Researchers found that patients who took medications, even if they participated in CBT, benefited less from therapy because of a tendency to lean too heavily on the medication to do the work for them. Unfortunately, medications can only do so much. Because of that people in the CBT-only group had an easier time, long-term, learning skills and making life changes that enabled them to beat anxiety and keep it away. Those in the combined medication and therapy group tended to get stuck at a lower, but persistent, level of anxiety that was more resistant to treatment over time. In order for you to survive, function, and integrate into your family and society, it was necessary for you to deny, suppress, and sublimate those feelings that were deemed unacceptable. Many feelings were probably declared offensive, and, appropriately, you sought euphemistic ways of dealing with them. They were avoided altogether, denied, or completely suppressed. Put simply, when you are in communication with someone on the Internet (somewhere else), you are not interacting with the people in your home. Nor are you going out on the front porch to interact with your neighbors, or going to a meeting place to talk with people in real life and real time--to look into the eyes of a fellow human being and develop a more subtle and deeper relationship. When our ADD wins out and we drift away from our track, get distracted, can't get started, can't finish, and so on, then we get down on ourselves; we feel frustrated and demoralized. We say bad things about ourselves, to ourselves and often to others. That makes us get further down and further demoralized. And that makes it harder to start anything or to make progress on anything, which makes us more demoralized. That's how a feedback loop works. We can spiral down into the pit and become overwhelmed with inertia. Situations can and do arise where two of your moral principles conflict, so that satisfying one of them violates another. For example, should you lie to a friend to avoid upsetting him? If you tell the truth, you risk upsetting him; if you lie, or omit the truth, you violate your principles of truth-telling and honesty.

Either way, you appear to violate one of your moral principles. When you're a moral perfectionist, moral conflicts are likely to weigh heavily on your psyche, leaving you with an intense guilty aftertaste no matter what you do. This is unavoidable when you demand perfection in the way of moral decisions, because by their nature moral conflicts require accepting less than perfect solutions. For example, making a decision to sign a do not resuscitate (DNR) order for a beloved, very ill parent or grandparent in the event the patient goes into cardiac arrest can be daunting, even in cases where the quality of life and prognosis are extremely poor. This is unfortunate. Considering that 1 in 6 people in the United States are on psychiatric medications of some kind and that Xanax, a popular benzodiazepine, is the third most common psychiatric drug prescribed, it is not unreasonable to assume that many or most people taking these drugs are not receiving any kind of psychotherapy. The Anxiety and Depression Association of America estimates that less than 37 percent of anxiety sufferers receive any kind of treatment (CBT, medication, or combined) at all. Based on the most recent research, it would appear that even less are receiving anything like adequate treatment. The good news, of course, is that with proper treatment (i.e., CBT alone) most people will experience a full recovery from their anxiety disorders. At the urging of her doctor, Karen finally stopped smoking. When she did, she realized how difficult it was to continue suppressing her feelings. She discovered underneath the deep inhalations some old unresolved feelings that she eclipsed by smoking. Without the smoking mechanism to anesthetize her feelings, she started to feel edgy, nervous, and fearful. She would wake up in the morning feeling anxious and resist getting out of bed. She didn't know what was going on with her, and was fearful that something was seriously wrong. She started feeling irritable and cranky. She began to feel disoriented and had difficulty figuring out what she liked or wanted. She went out with friends who would ask her offhandedly, "What do you want to do?" or "What do you want to eat?" Her response more often than not was "I don't know. What do you want?" out of touch with her feelings and her wants, she would defer to others. She sought to be accommodating and acquiescent, and became resentful later when she didn't have a good time.

Mammals communicate with each other primarily without making sounds. Their survival depends upon their ability to read the body language of potential rivals and predators. A zebra knows the body language of the big cats, for example, and relies on this knowledge for its survival. It determines whether or not a lion will attack by immediate assessment of body language, not by words or even sounds. According to studies, humans communicate ninety percent nonverbally.11 When I first heard this statistic, I was stunned; I had no idea that language was so subordinate to nonverbal communication. But in the context of the linguistic development of humankind, it makes sense; proper language has, after all, only been in use about 100,000 years, whereas we communicated mainly nonverbally for some 2.3 million years prior. So, if we modern humans communicate ninety percent nonverbally, that means that whenever we communicate with text, we are using only ten percent of our communication potential. We are diluting communication down to what I call the ten percent relationship ... the very opposite of intimacy. Emotional intimacy involves personal knowledge of the deeper dimensions of another and is developed through trust, and trust can begin or end with a first glance because, like other mammals, we inherently know a great deal about each other through body language and other nonverbal cues. We often ascertain the trustworthiness of a person in mere seconds, without a word spoken. Sounds awful doesn't it? But it doesn't have to be that way. We can use strategies to break a link in this chain of events. Although it is hard to use a strategy when we are demoralized - which of course is pretty demoralizing. OK, you can't clean the kitchen. It's too much. You're stuck. But maybe you can do the dishes. Or maybe not.