Mindfulness / Cognitive Behavioral Therapy (CBT) / Positive Psychology Mental Model (Incl Happiness, Placebo Effect, Hedonic Adaptation, Anxiety/Depression)

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Mindfulness / Cognitive Behavioral Therapy (CBT) / Positive Psychology Mental Model: Executive Summary

If you only have three minutes, this introductory section will get you up to speed on the mindfulness / cognitive behavioral therapy (CBT) / positive psychology mental model.

The concept in one quote:

If you own this story, you get to write the ending. - Brene Brown Click To Tweet

(from “ Daring Greatly” – DG review + notes)

The concept in one sentence: our automatic thoughts and feelings meaningfully impact our decisions, without our permission and often for the worse – whether we’re fighter pilots, investors, or parents.

Key takeaways/applications: becoming aware of our automatic thoughts and behaviors is important regardless of whether we think we’re very emotional or not.  For those who are highly emotional, or struggle with depression/anxiety, it’s obviously a critical quality-of-life issue. For those who don’t struggle with emotions, it’s potentially even more dangerous – because you may never recognize the need to manage them until you’re in a critical, maybe even life-or-death situation where it’s too late to figure out how to do so.

Three brief examples of mindfulness / cognitive behavioral therapy / positive psychology:

The cloud isn’t made of water vapor… it’s made of mindfulness.  To what does Marc Benioff, founder of original cloud disruptor Salesforce, attribute his success at Oracle – and beyond?

It’s multicausal, of course, but Benioff is fond of quoting Sun Tzu’s “The Art of War” – and in a brief digression early in the his autobiography, “ Behind the Cloud ( BtC review + notes), he encourages readers to practice some of the core tenets of mindfulness:

Observe your feelings.  Do not become your feelings.  Be aware of your reactions.

Do I really want a cup of tea, or am I just bored? Charles Duhigg’s “ The Power of Habit ( PoH review + notes) explores the powerful pull of habits, for both good and bad.  We talk about habit in this model.  But, as Duhigg mentions, the first step toward replacing a bad habit with a good one is awareness of your own thoughts and behavior – or mindfulness.

This applies to thought processes as well as behaviors.  My mom used to make 3-4 cups of tea per day, reheating them endlessly because she didn’t really want to drink them – making tea was just a thing to do, a comforting ritual.  Realizing this, she modified the habit and now makes fewer cups.

The same applies for building approaches like probabilistic thinking or avoiding hyperbolic discounting – half the battle is simply becoming aware of what you’re doing wrong cognitively, and nudging yourself in the right direction.

How do you think you’re thinking?  Many people focus on the endless practice – the “10,000 hours” or whatever – that elite chess players put in.  Equally important – and explored by books like Josh Waitzkin’s ‘The Art of Learning” – is their focus on mindfulness. As Nate Silver mentions in “ The Signal and the Noise ( SigN review + notes):

“Elite chess players tend to be good at metacognition – thinking about the way they think – and correcting themselves if they don’t seem to be striking the right balance.”

Silver notes the same premise applies to other fields of endeavor, like playing poker – he recounts his own time as an online poker player, discussing the dangers of playing “on tilt” (when emotions are screwing with cognition.)

If this sounds interesting/applicable in your life, keep reading for unexpected applications and a deeper understanding of how this interacts with other mental models in the latticework.

However, if this doesn’t sound like something you need to learn right now, no worries!  There’s plenty of other content on Poor Ash’s Almanack that might suit your needs. Instead, consider checking out our learning journeys, our discussion of the activation energyfeedback, or sunk costs mental models, or our reviews of great books like “ Deep Work” ( DpWk review + notes), “ Polio: An American Story” ( PaaS review + notes), or “ The Great A&P” ( GAP review + notes).

Boys Don’t Cry (But Maybe They Should)Critical Thresholds + Why Mindfulness Matters

I see a pain behind your eyes.
I know you feel it every day.

It’s better not to say such things out loud.
Just close your eyes and bite your tongue for now.
Don’t let them see you fall.

Just forget about the hole beneath your skin.
That’s swallowing the best of you within.

Just dry your eyes. Keep it all inside.
’cause boys don’t cry.”

– “The Stigma (Boys Don’t Cry)” off “The Great Depression” by As It Is

Kudos to British band As It Is for tackling the stigma of mental health head-on.

I know what they’re talking about, and maybe many of you do too.  If that’s the case, then I’m writing this for you – yes, you.  I want you to know it doesn’t have to be like that.

Because you can be bigger than your struggles, even if it doesn’t seem that way right now.  There are roughly half a million words on this site; maybe 2% of them deal with mental health even in a tangential way.  And this site doesn’t represent all of who I am.

Depression and anxiety are no longer part of my story.  But they used to be.

Since stories are more  salient than statistics, here’s mine, briefly.  (Feel free to scroll down if you’re not interested – I won’t mind!  The rest of the model still applies to you, promise.)

I grew up struggling with anxiety and depression, without the support of many of the people in my life.  I lost many of my friends because they either couldn’t – or didn’t want to – deal with the depth of my emotions.  They wanted me to be shallow and happy-go-lucky, in a way I wasn’t capable of being.

There have been multiple periods in my life when I was suicidal – i.e., I wanted to kill myself.  Two of these, in high school, were due to actual depression; the third, as a young professional, was due to severe sleep deprivation (as I discuss in the sleep  mental model.)

There have been periods in my life where I was so anxious that I was having panic attacks – and, in one case, spent a few days alternating between a hot bathtub and my bed, because I couldn’t keep my body temperature high enough.  (That, too, was a function of sleep deprivation.)

There were times when if you’d asked me the last time I was happy, to quote positive psychologist Shawn Achor in ‘ Before Happiness – BH review + notes, I would’ve answered:

“I don’t remember being happy.”

Guess what, though?  All of that helped make me the investor, thinker, and person I am today.  I’m happier and less under the influence of emotions than the vast majority of people I know.

And I’ll explain how – with some work – you can be, too.  Happiness turns out to be a learnable skill.  In “ The Happiness Advantage ( THA review + notes), Achor notes that, surprisingly,

External circumstances predict only about 10 percent of our total happiness. - Shawn Achor Click To Tweet

This is why people as unfortunate as those who have incurable diseases like multiple sclerosis (as Shawn discusses) can end up being way happier – in the face of extreme challenges – than healthy, wealthy lawyers, with prestigious jobs and big bank accounts, who, as Achor explores, have an unusually high rate of depression and alcoholism.

Shawn’s pretty happy now, too.  (See right.)  His life’s work, in fact, is researching happiness and spreading its best practices throughout the world’s schools, businesses, and other organizations.  We’ll explore that work a bit later.

Unfortunately, the view of many boys and men when it comes to emotions is roughly the same view as I reference in the  empathy model – “guys don’t do that.”  As Brene Brown discusses in “ Daring Greatly (DG review + notes),  society often puts boys in a small, dark, cramped box labeled don’t be weak.”  Some guys even hold this box up as a source of pride.  Look Mom, I don’t have emotions!  I’m a Real Man Now!

This is bad for several reasons.  I’m going to diverge from my usual approach of  scientific thinking and posit an admittedly speculative mechanism for an interesting finding I’ve seen.  Some research – admittedly with a small  sample size – suggests that women make better investment managers than men (on average).

I think most reasonable people would agree that women tend to be – outwardly, anyway – more emotional than men.  Recall Hermione Granger, in Harry Potter, chiding Ron for having “the emotional range of a teaspoon.”

Finally, it’s generally well-accepted that emotion can distort our  cognition; think of the classic stock market behavior of buying at the top (FOMO – fear of missing out) and selling at the bottom (panic selling).

So how is it that women – generally regarded as more emotional than men – might be better investment managers in spite of that?

Again, this is a reasonably scientifically tenuous line of argumentation, but it lines up with my own personal experience.  I’m going to evoke the model of critical thresholds to answer this.

Most women, as a result of being more emotional, often have emotions exceeding a  critical threshold – i.e., they are meaningful enough to be noticeable, and bothersome – so women develop strategies, such as social connection, for dealing with and separating themselves from those emotions.

Most men – at least, the ones who don’t have a high emotional range like I do – often tend not to see their emotions cross this critical threshold most of the time.  So, most of the time, the impact of emotions on their behavior creeps beneath the radar; they never even notice it – because they haven’t learned to, or felt the need to.

If you think you’re exempt from emotions affecting your decisions, decades of scientific research says you’re absolutely wrong.  The only situation in which you’re right is if a sociopath (in which case, please seek professional help.)

Tough-guy macho fighter pilots’ decisions are affected by emotions, as we’ll explore.  Superstar athlete football players’ decisions are affected by emotions, as anyone who’s ever watched wide receivers like Dez Bryant or Odell Beckham could attest to:

Kicking Net New York Giants GIF by NFL

Paradoxically, then, having higher emotional range – and thus being forced, simply by the reality of needing to deal with life – can lead to some people (such as women) being more emotionally intelligent and rational in their decision-making, despite naturally being more prone to being influenced by emotions.

What’s step 1 to becoming more emotionally intelligent, whether or not we have a high natural emotional range?  Mindfulness – the process of being aware of our own thoughts and feelings, and working through how they impact our behavior.

Mindfulness, Habit, And Life or Death

I always find  useful definitions to be more helpful than formal ones.  The way I understand mindfulness, then, is something like this:

Mindfulness: the practice of becoming aware of our thoughts and feelings, and their relation (or lack thereof) to reality.

Each word was chosen carefully, as with my definition of  empathy in that mental model.

First, note that mindfulness is a practice – it’s a learnable skill; something we make a  habit of doing.

Second, in my conception of it, it’s an active rather than passive approach: we’re not just letting our thoughts and feelings float by like pollen on the wind; rather, we’re actively evaluating them, and deciding whether or not they’re in good shape – or if they need to bust their butt a little bit at the Gym of Good Thoughts.

Perhaps the easiest way to introduce the idea of what we’re talking about here is a quote from Dan Harris’s “ 10% Happier ( 10H review + notes).

Harris, at one point during his journey, realizes that his thoughts:

“weren’t irrational, but they weren’t necessarily true […]

I was able to see my thoughts for what they were: just thoughts, with no concrete reality.”

Harris found the answer in meditation (sort of – he uses other techniques too.) I don’t meditate myself, but  10% Happier ( 10H review + notes) is still a great book on mindfulness.  Harris calls mindfulness “the space behind the waterfall” – a place where you can observe your thoughts without getting dragged along for the ride.

When I reference Harris using other techniques, I’m talking about those from the field of cognitive behavioral therapy – a scientifically validated, utility-focused form of therapy that is often more effective than medication for anxiety and depression, but even a wide range of other conditions like chronic pain and insomnia.

I’ve never seen a therapist (not that there’s any reason not to), but cognitive behavioral therapy can be self-implemented, just like Harris’s meditation practice.

What is CBT?  Dr. Judith Beck, practicing therapist and the daughter of the field’s founder Aaron Beck, explains in her book “ Cognitive Behavior Therapy ( CBT review + notes) that CBT is based on the premise that depression and anxiety have at their core a:

 “systematic bias in the way the patients interpreted particular experiences.”

Training patients to notice these biased interpretations and replace them with more adaptive ones leads to an:

“almost immediate lessening of the symptoms.”

Beck notes that we all have automatic thoughts that we may be “barely aware” of, and – like Dan Harris before his realization –

“you most likely accept them uncritically […] you don’t even think of questioning them.”

The good news, Beck notes, is that:

“dysfunctional beliefs can be unlearned, and more reality-based and functional new beliefs can be developed”

via CBT techniques.  Core beliefs (“I’m an incompetent person”) lead to intermediate beliefs (“this class is too hard for me”) which leads to automatic thoughts (“why bother trying to read the book”).

Beck further notes that:

“the quickest way to help patients feel better and behave more adaptively”

is to help them build more adaptive core beliefs (i.e. modify their schema.)  Why? Because:

“once they do so, patients will tend to interpret future situations or problems in a more constructive way.”

As with many things, awareness is half the battle: simply realizing that you have automatic thoughts that drive much of your behavior, that you accept uncritically, will help you start noticing those thoughts and evaluating them critically.

Don’t be scared off by the T-word.  One of the reasons I say that depression and anxiety has helped me become who I am today is that it turns out the techniques for modifying thoughts and beliefs that cause depression and anxiety are not application-specific.

Put another way, CBT techniques can be used to become better at  probabilistic thinkingscientific thinking Bayesian reasoninginversion, noticing  multicausality, or any of the other cognition-enhancing models mentioned on this site.

One technique often recommended – by Beck, as well as by others like the aforementioned Brene Brown, in “ Daring Greatly ( DG review + notes) – is to pretend that the thought is happening to someone you really care about and have  empathy for – a close friend, a family member, a child.

If someone else who you cared about was thinking like this, what would you tell them?  It’s much easier to recognize and point out mistakes in others – and, sometimes, easier to be kind to others than to ourselves.

Many of us, for example, have seen our friends trapped in unhealthy relationships that they can’t garner the courage to quit… it’s easy to recognize.  It can be harder to recognize when it’s our relationship.  Stepping outside our own schema can give us a more objective point of view.

Similarly, many of us can see the cognition-distorting effects of strong  ideology in our crazy coworker… or Uncle Jim at Thanksgiving.  But how often do we think our own ideas are crazy?  Nah, man – all MY ideas are TOTALLY, 100% right and you’re cuckoo if you don’t agree.  😉

Once you’ve got that process down, you can start using some of the practical techniques for changing those thoughts in the sections below.  (I also discuss some of Beck’s techniques in the probabilistic thinking mental model, so please check that out.))

One of the keys, though, is you need to make this a  habit.  That will allow you to, as Beck puts it,

“spontaneously (i.e. without conscious awareness) respond to the thought in a productive way.”

Why is this important?  Let’s take the extreme example: fighter pilots.  Laurence Gonzales’s wonderful Deep Survival (DpSv review + notes) opens with the story of a pilot crashing into the side of an aircraft carrier.  How did that happen?

Gonzales notes that much of our behavior is driven by  conditioning – which, in turn, is driven by the reinforcing power of emotion.  Books like Charles Duhigg’s “ The Power of Habit ( PoH review + notes) provide a salient example – Eugene Pauly, who lost the use of his  memory thanks to a rare infection, was still able to learn some surprising things due to emotional rewards.

The way Gonzales puts it, our brains create strong emotional bookmarks” for both good and bad experiences; that’s why we may always be fond of our grandpa’s house, or feel sick just thinking about that ramen place where we got food poisoning, one time.

For pilots, “down” is a very strong emotional bookmark.  Flying a fighter jet, as you imagine, is an exhilarating experience – and trying to land one on an aircraft carrier is a terrifying one.

So, sometimes, in their eagerness to just get down – down is good; they like down – Gonzales explains that their amygdala (the emotional part of their brain) can wrench control – a ‘hijack” – from the frontal cortex, the rational part of our brain.  This is mediated by the release of cortisol – the  stress hormone – and a number of other powerful biochemical responses.

It turns out this is exactly the same mechanism that often operates in more pedestrian emotional situations.  But it’s important to train it – your brain has to be able to do this automatically, to restore this balance via  habit – because when we’re making critical decisions in response to external circumstances, Gonzales notes thatcognition and logic:

“simply takes too long, often impossibly long.”

On the other hand – thankfully – mindfulness can become a  habit, as Beck explores above.  Indeed, as Shawn Achor mentions in “ The Happiness Advantage ( THA review + notes):

“in resilient individuals, the prefrontal cortex rapidly won over the limbic system.”

Gonzales explores some adaptive short-term responses to regain cortex control, as does Achor; they include  empathy and humor.  I discuss these more in the cognition / intuition / habit / stressmental model.  Check that out for details.  Here, we’ll focus on more deliberate, longer-term practices.

Thankfully, most of us don’t have to worry about our wayward thoughts crashing us into an aircraft carrier.  How can we replace our maladptive thoughts with more  adaptive ones?  Let’s explore.

Mindfulness Hyperbolic Discounting x Contrast Bias: Hedonic Adaptation

“Our sensations being very much fixed to the moment, we are apt to forget that more moments are to follow the first, and consequently that man should arrange his conduct so as to suit the whole of life.  

Your attribution appears to have been applied to your life, and the passing moments of it have been enlivened with content and enjoyment, instead of being tormented with foolish impatience or regrets.”

– Benjamin Vaughan (in a letter to Benjamin Franklin, featured in ” The Autobiography of Benjamin Franklin” – ABF review + notes)

I feature that quote in the  hyperbolic discounting mental model, which explores more deeply our tendency to overweight the present moment.  Everyone intuitively understands this – Patton, Ury, and Fisher make the analogy, in “ Getting to Yes ( GTY review + notes) of how missing a plane seems hugely important at the time, but trivial later.  This is a technique mentioned by Harris and Beck as well – “decatastrophizing” – realizing that what seems like the end of the world now isn’t really the end of the world.

Yet most of us don’t live our lives assuming this will be the case.  One of the most surprising, well-replicated, and profoundly unintuitive findings in psychology is that future events neither make us as happy nor as sad as we expect.

This is called hedonic adaptation, and it underlies that quote I referenced earlier from Shawn Achor about circumstances predicting only 10% of our happiness.

Megan McArdle, for example, notes in “ The Up Side of Down ( UpD review + notes) – a wonderful book about dealing with failure – that people often cite horrible tragedies, like life-changing car accidents or a divorce, as some of the most profoundly and positively impactful moments in their lives.

The underlying mechanism here is  contrast bias: as explored thoroughly in that mental model, humans have a strong tendency to notice changes.  But, as Nobel prize-winning behavioral economist Richard Thaler puts it in my favorite book, “ Misbehaving ( M review + notes):

When we have adapted to our environment, we tend to ignore it. - Richard Thaler Click To Tweet

In a personal context, this is often known as the hedonic treadmill.

Shawn Achor drives home in “ The Happiness Advantage that our lives are often a series of statements that go something like:

WHEN X happens, THEN I’ll be happy

Of course, the second we get to X, we just move the goalposts, as Shawn explains.  And now our life story looks like:

WHEN Y happens, THEN I’ll be happy

Y, of course, is replaced by Z, and we cycle through the alphabet a few times on our way to our graves.

Achor explores this concept in depth in “ The Happiness Advantage ( THA review + notes), a book which changed my life.  He is, of course, not the only person to make this observation… but he is the funniest.  (See his TED Talk – he is really hilarious.  It’s better than stand-up comedy, even if you don’t care about the topic.)

In the aforementioned “ 10% Happier ( 10H review + notes), Dan Harris observes  how rarely we:

“bother to examine the lie that fuels our lives.”

On a meditation retreat that Harris attends, the leader, Goldstein, makes a point that’s right out of the Achor playbook:

“How often are we waiting for the next pleasant hit of… whatever?  […] We just live in anticipation of the next enjoyable thing that we’ll experience […]

we’ve been, most of us, incredibly blessed with the number of pleasant experiences we’e had in our lives.  Yet when we look back, where are they now?”

There are two fairly obvious take-homes here.

The first is that an important part of making more accurate emotional judgments – i.e., being happier if we’re down – is simply taking the time to notice all those “pleasant experiences.”  Achor notes that the simple practice of identifying and vocalizing (or writing down) three things a day that you’re grateful for can rewire our brains to search for positives and counteract our natural tendency towards  loss aversion.

The second is that when we miss the proverbial plane, we need to develop a sense of equanimity based on our logical understanding that how we’re feeling now is not how we’ll always be feeling.  We need to realize that if we face challenges, we’ll adapt to them; again, very little of our happiness is predicted by outside circumstances.

Mindfulness Framing x Contrast Bias x Agency: Positive Psychology (“Belief Behavior Matters”)

One of the most well-replicated – and yet overlooked – findings in science is the placebo effect.

The reason that researchers have to run blind experiments is that, in many cases, participants simply believing they’ve taken a pill can be quite effective.  Shawn Achor cites some research in “ The Happiness Advantage ( THA review + notes) to this effect:

 “placebos are about 55 to 60% as effective as most active medications like aspirin and codeine for controlling pain.”  

In other words, say you invited me over to your house for dinner.  Sneaky Sammy excuses himself from the table, walks into your bathroom, and swaps out all your Advil with little blue gels that look exactly the same, but are just full of blue jello.

Until your bottle runs out, every time you pop two fake Advil, you’ll still be getting the exact same effect as if you’d taken one real one.

The underlying mechanism, per Achor:

“expectations create brain patterns that can be just as real as those created by events in the real world.”

Achor refers to this power as “belief behavior matters” – he goes on to cite some astonishing research from Ellen Langer in which a group of old men was put back in an environment where they were constantly made to think they were 55.

Their  memory, eyesight, flexibility, strength, and other measures improved meaningfully; objective observers judged them to be younger-looking (by their pictures.)

Josh Waitzkin even claims in The Art Of Learning that, by visualizing himself using a muscle while he recovered from an injury, he was able to prevent it from atrophying.  I was skeptical, but Achor actually cites research with directionally similar findings – maids who were primed to view their daily work as exercise, for example, saw measurably higher results in fitness.

Achor, elsewhere, observes that his work has benefited even those suffering from severe, incurable medical conditions like multiple sclerosis (MS).

This isn’t to say that aging isn’t a real phenomenon (it is), or that medical conditions can be cured by positive thought (they can’t).  Anyone who tells you either of those two things is a scam artist.  But the point is that notwithstanding our (very real) external circumstances, we still have a lot of power over how we choose to view them.

Or, as Stephen Covey put it in the landmark ‘ The 7 Habits of Highly Effective People ( 7H review + notes):

Between stimulus and response, we have the power to choose. - Viktor Frankl via Stephen Covey Click To Tweet

Stephen Covey goes on to note:

It is our willing permission, our consent to what happens to us, that hurts us far more than what happens to us in the first place.

I admit this is very hard to accept emotionally, especially if we have had years and years of explaining our misery in the name of circumstance or someone else’s behavior.

But until a person can say deeply and honestly, “I am what I am today because of the choices I made yesterday,” that person cannot say, “I choose otherwise.”

I discuss this in more depth in the  agency mental model, with assists from those like Stephen Colbert.

In the context of mindfulness, one important conclusion integrates two mental models.  The first is framing – the idea that the way information is presented to us impacts how we perceive it – and the second is  contrast bias – which, discussed earlier, means we tend to be sensitive to changes, and also that we tend to naturally “compare” things.

Beck uses this to patients’ advantage with a technique she calls the “cognitive continuum” – as she explores in “ Cognitive Behavior Therapy ( CBT review + notes), it can be helpful to re-frame a given thought by finding additional context points.

For example, if you’re frustrated about your performance on a test and think you’re the worst student ever, actually create a mental graph of the worst student ever.  You’re still in college and getting a decent GPA overall… there are a lot of students off way to the left: the ones who are getting worse grades, the ones who dropped out of college, or the ones who didn’t even make it to college.

So, yeah, maybe you’re not the best student ever – but you certainly aren’t the worst.

This process of adding “vantage points” is discussed extensively by Achor in “ Before Happiness ( BH review + notes).  One particularly memorable example of re- framing: Achor asks you to imagine you go to the bank, and a robbery happens, and you get shot in the arm.

You basically have two choices at this point: you can moan “oh, why me?”

Or, you can be grateful that you were only shot in the arm.

Contrast bias.  It’s amazing just how much this little technique can change the way you think about the world.  It transforms you from someone who walks into a restaurant and notices all the things that are wrong – the slightly tilted poster, the fact that the waiter forgot to bring your iced tea – into a person who notices all the things that are right.  How great the food us.  How funny and caring your friends are.

It’s a simple choice, but the results are powerful.

Conclusions

This may not seem earth-shattering to you.  You may feel a little let down.  You may have been waiting for some profound “aha” insight.

Practice re- framing.  Don’t feel that way.  Look at it from another vantage point.  The good news is that these steps are not conceptually difficult.  You just need to implement them – again, and again, and again – until they become second nature.  And you’ll find yourself much less influenced by emotion, much happier, and much better at making decisions.

It did all that for me.  It changed my life.

Remember to check out the  probabilistic thinking agency cognition / intuition / stress / humor, and  sleep mental models, all of which have important interactions with this one.