various tools for building things are layed out on a table next to a safety mask and goggles

AVOID AVOIDANCE

By William J. Knaus, EdD, Alex Korb, PhD, Patricia J. Robinson, PhD, Lisa M. Schab, LCSW, and Kirk D. Strosahl, PhD, coauthors of The Depression Toolkit

What to Know

Checking out at the supermarket, you’re presented with an array of enticing candy bars and magazines. Do you stick to your shopping list or reach for a candy bar? The key to understanding impulses is that everything pleasurable releases dopamine in a specific part of your brain called the nucleus accumbens. Sex releases dopamine. Winning money releases dopamine. Drugs release dopamine. Chocolate releases dopamine.

The really interesting thing about the brain, however, is that it learns what’s pleasurable and how to anticipate getting it. For example, when you eat a candy bar for the first time, dopamine is released. The next time you pick up a candy bar, dopamine is released as soon as you open the wrapper. And the next time, dopamine is released simply when you see the candy bar from across the room. Pretty soon, dopamine is released as soon as you walk into the store, just from the anticipation of seeing it, opening it, and eating it.

With impulses, something you do or sense triggers the anticipation of a specific pleasurable outcome. The problem is that the dopamine that is released in anticipation of pleasure actually motivates the actions that lead to that pleasure. Each step along the way gives you a little boost of dopamine that propels you on to the next step.

If you were a caveman, your impulses wouldn’t be such a problem. Life would be pretty simple. If something tasted good, you’d eat as much as possible, and if something felt good, you’d do it as much as possible. Nowadays, though, there are too many easily obtainable pleasures which hijack your brain with dopamine and create a tendency to act for immediate gratification.

It becomes even more problematic in depression, because when you’re depressed, there’s less dopamine activity in your brain in general. First, that means things that used to be enjoyable no longer are. Second, with reduced dopamine activity, the only things that motivate are things that release lots of dopamine, such as junk food, drugs, gambling, and porn. All these impulses mean your actions are guided only by what’s most immediately pleasurable, which is not usually good for you in the long term. And while most impulses are easy to recognize, bad habits—which insidiously become routine—are more difficult to spot.

What to Do

1. Figure out your triggers. It’s much easier to avoid temptation than to resist it. If you know what triggers a particular habit, sometimes you can get rid of that habit simply by removing that trigger from your life. For example, Billie realized he was watching too much television, and the trigger was seeing the television set itself. He moved it out of his bedroom, and now, he doesn’t have a problem watching too much television. As another example, if you don’t want to buy cookies, don’t walk down the cookie aisle at the supermarket. Seeing all those delicious baked goods will release dopamine and push you toward buying them.

2. Take a deep breath. When you start to feel antsy or compelled to act on a bad habit, take a deep breath. Let it out slowly, then take another deep breath. Repeat as necessary. Long, slow breathing calms the brain’s stress response.

3. Look back at the activity list that you made earlier in the book, if you did Activity 3—or make your own list of activities you find pleasurable now. Whenever you feel triggered toward doing something you know is a bad habit, like binge-watching TV or overeating, go to your activities list instead.

PP. 52-54 Excerpt taken from The Depression Toolkit

William J. Knaus, EdD, is a licensed psychologist with more than forty-six years of clinical experience working with people suffering from anxiety, depression, and procrastination. He has appeared on numerous regional and national television shows, including The Today Show, and more than one hundred radio shows. His ideas have appeared in national magazines such as U.S. News & World Report and Good Housekeeping, and major newspapers such as The Washington Post and Chicago Tribune. He is one of the original directors of postdoctoral psychotherapy training in rational emotive behavior therapy (REBT). Knaus is author or coauthor of more than twenty-five books, including The Cognitive Behavioral Workbook for Anxiety, The Cognitive Behavioral Workbook for Depression, and The Procrastination Workbook.

Alex Korb, PhD, is a neuroscientist, writer, and coach. He has studied the brain and mental health for more than fifteen years, starting with an undergraduate degree in neuroscience from Brown University; before earning a PhD in neuroscience from the University of California, Los Angeles (UCLA). He is author of The Upward Spiral and The Upward Spiral Workbook, and is currently adjunct assistant professor at UCLA in the department of psychiatry and biobehavioral sciences. Outside of the lab, he is available for personal coaching, consulting services, and speaking engagements. He is head coach of the UCLA Women’s Ultimate Frisbee team, and has a wealth of experience in yoga and mindfulness, physical fitness, and even stand-up comedy.

Patricia J. Robinson, PhD, is director of training and program evaluation at Mountainview Consulting Group Inc., a firm that assists health care systems with integrating behavioral health services into primary care settings. She is coauthor of Real Behavior Change in Primary Care and The Mindfulness and Acceptance Workbook for Depression. After exploring primary care psychology as a researcher, she devoted her efforts to its dissemination in rural America, urban public health departments, and military medical treatment facilities.

Lisa M. Schab, LCSW, is a practicing psychotherapist in the greater Chicago, IL, area; and author of several self-help books, including The Anxiety Workbook for Teens and The Self-Esteem Workbook for Teens, as well as the teen guided journals, Put Your Worries Here and Put Your Feelings Here. She has been interviewed as an expert on the Milwaukee television stations WTMJ-TV and WISN-TV, and for articles in The New York Times, Scholastic’s Choices magazine, Teen Vogue, Psych Central, and Your Teen Magazine. Schab has authored regular columns on tweens and teens for Chicago Parent, and on healthy families for The Sun Newspapers. She is a member of the National Association of Social Workers (NASW).

Kirk D. Strosahl, PhD, is cofounder of acceptance and commitment therapy (ACT), a cognitive behavioral approach that has gained widespread adoption in the mental health and substance abuse communities. He is coauthor of Brief Interventions for Radical Change and In This Moment. Strosahl provides training and consultation services for Mountainview Consulting Group Inc. He is a pioneer in the movement to bring behavioral health services into primary care.

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