As a counselor the variety of approaches to helping people function and feel better is almost dizzying. This article on GoodTherapy.org lists somewhere in the neighborhood of 150 different types. For someone seeking a therapist, how does a client figure out which approach is best?

The client coming to therapy usually doesn't have a concern about what approach is being used, but she does care about the general philosophy of how an improvement in functioning will take place. For instance, does the therapist believe insight about childhood experiences and their connection to poor current functioning will lead to better functioning? Or, does the therapist believe negative self-talk is the cause? Ultimately, the client wants to feel that he can make improvements through his work with the therapist and is only going to follow that therapist's lead if he believes in that therapist's competency. A certain type of therapy can be nice guidelines for a therapist, but, ultimately, the therapist's ability to connect with the client and effectively convey the principles of change to the client are the more important factors. Most of the therapies out there can be learned about through books, articles, vidoes, etc., but, for many people, the added human touch of a therapist is a key addition that helps the client apply the principles and not give up on that process of change. 

(Jon Kabat-Zinn, known for helping to increase the popularity of secular mindfulness in the West, defines mindfulness as "paying attention, in the present moment, non-judgmentally." I'll use that definition.)
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Tough not to bump into the term "mindfulness" nowadays especially around those working in mental health or education (and I'm sure many other fields). What is the appeal? One possibility is that mindfulness is a tool for turning off or quieting a bit our internal editors, the voices in our brains that critique, analyze, judge ourselves and others. Those editors serve some good purposes, but they seem to steer toward worry and anxiety, possibly hard wired to do so after billions of years of evolution. In my own mindfulness practice and those of the much more experienced, mindfulness can often be helpful in reducing the power of that voice. If I'm having doubt, I find myself better able to interrupt that thought loop should I decide it makes sense to do so. And, turning off that doubt allows for getting back to the actual experience of life whatever that experience may be in the moment. 

Try listening to the experts out there and their explanations of what mindfulness does for them. Some of the experts I've found incredibly insightful:
Dan Harris -https://youtu.be/ywp4vaFJASE
Sam Harris - https://youtu.be/qGIjJ1yohHs
Joseph Goldstein - https://youtu.be/unwBdzxJLUM
​Sharon Salzberg - https://youtu.be/LML17BRZppU

Below is a nice screenshot synopsis of mindfulness research along with a link to the actual page it came from on Mindful Schools' website. The research on mindfulness still has a ways to go in, and is far from conclusive, but, as the graph below from the American Mindfulness Research Association (https://goamra.org/), you'll see that the amount of research is picking up. Some/Many contend that the rigor of the research often leaves something to be desired, especially when grandiose claims are made about its usefulness. Still, mounting evidence appears to back up claims about its usefulness for dealing with anxiety, depression, and chronic pain. My thinking on it is that engaging in the practice - or at least giving it a try - has little to no downside, while the benefits could be substantial. And, some people would state that, for them, the practice has been unbelievably positive. 

https://www.mindfulschools.org/about-mindfulness/research/  

Success. It's easy to define it in narrow terms, and we label others or ourselves based on that specific definition. For example, LeBron James is a success, because he is better than anyone else at basketball. Warren Buffet is a success because of his accomplishments in the investment world. We even do it with companies. Apple. Amazon. Microsoft. 

But, so much more goes into being a success, much of it easily overlooked, much of it unseen. Indeed, LeBron James is a phenomenal basketball player but that is just one realm of success. How does he treat others? Good friend, husband, father, son, etc.? Amazon does an admirable job of selling and delivering products efficiently, but how does it treat its employees? How does its approach affect society in general? Other companies?

And what about important character traits that aren't easily identifiable? Humility? Integrity? Sincerity? Those can often lead to success in some of the more identifiable areas of life such as ones's career but not always. The person of integrity sometimes loses out financially to someone willing to cut corners, the humble person to the boastful, the sincere one to the deceptive. Still, those character traits are to be admired regardless of the outcome. Simply possessing and displaying those characteristics signifies success regardless of the outcome.     

I'm not sure how to define success, simply proposing that we take a second before labeling others a complete success and then comparing ourselves to that label. Better to celebrate their accomplishments in one area and maybe aspire to similar success, while also realizing that, because of their humanity, they fall short in other areas. Such an approach prevents idealizing them and then holding ourselves to some impossible standard.  

(I think the one on the right feels a bit left out.) 

How does one become less anxious in social situations, or, if the anxiety becomes pathological, help the brain change itself enough to adequately function in social situations? it seems a bit more complex than the examples from my last post - snakes and planes.

The general principal remains in that exposing oneself to those situations makes it more likely the brain will figure out how to navigate them. The opposite tack, avoiding social situations, does not have that potential. Though it offers temporary relief as the anxiety-provoking situation does not need to be experienced, the brain has had no chance to change the connections leading to less anxiety.

Most would not argue with this line of thinking and understand that the best way to overcome anxiety is to face it, and it's like likely that person has tried that approach many times. Still, the anxiety remains or even gets worse. So, how come it's not working? 

One reason likely is that the individual is not experiencing safety in the situations. Each exposure simply reinforces what the body already feels such as general unease with the interaction or the racing heartbeat, shortness of breath that feels like a physical threat. After the individual exposes herself to such an experience for the 500th, her brain decides it is better off avoiding that or similar situations.  

For the brain to feel there is nothing to fear, it and the body have to feel safe in those situations. That safety could be a relaxed state, feelings of elation, a real connection with the other individuals, etc. The brain has to associate positive feelings with those interactions so that it will look to engage in those interactions going forward.

The difficulty with anxiety is that it can often hinder such feelings of safety. For the individual who experiences intense anxiety, most forays into the social world end up feeling crappy. The individual pushes herself to take yet another chance to engage and feels failure more often than not. "Feels" is the key word here. Objectively, everything could be going fine, but the individual 

Most of us can look at ourselves and see aspects we would like to improve upon. We have little difficulty identifying areas of growth i.e. we know we could be kinder, healthier, more compassionate, more grounded, more at peace.  Yet, close to the same amount of us have much trouble effecting those changes. We rationally know what to do but that rational understanding does not lead to change. If rational understanding were enough, many more people would be closer to their best selves, and the world would correspondingly improve.

So, identifying the needed change is not enough. Still, working in the field of change, the most common approach appears to be along these lines. "If I can just get this person to see that they need to be more compassionate, studious, respectful, mature, responsible, etc., they would then make the change and be so." But, since most people generally know what changes need to take place, most of us struggle with the process. "Why can't I change though it's clear that I need to change? I should exercise more. Eat better. Drink alcohol less." More than rational understanding needs to happen. Something deeper needs to take place for the change to happen. 

Depression must serve some kind of purpose for humans, else it wouldn't be around. After eons of evolution, the traits most necessary for our survival have arisen through natural selection. If depression was a pure detriment to our survival, humans prone to it should not have had success passing on their genes. Yet, depression is alive and well, so what purpose might it serve?

Perhaps anxiety can help give us an answer. One theory on the purpose of anxiety is that it makes us vigilant; it helps us keep an eye open for predators. Back in the early days of the Homo genus, we'd be on the lookout for that lion, avoid its location, live another day, and pass on our genes eventually. Even now, anxiety can help us spot an unsafe situation and steer away from it.

The causes of depression are a mystery as yet unsolved. Ask people what causes depression, and you'll get a variety of answers, but one I've often heard and used myself was: "Chemical imbalance in the brain." In theory, antidepressant medication can help bring the balance back. But, depression is a bit more complicated than simply restoring some kind of balance. Researchers still don't have all the answers, but they are learning more about the complexity of emotions.

Two articles helped me understand some of these biological complexities; they are listed at the end of this post. What caught my attention was how little we know about the science behind depression. Though we have learned much and have some good ideas to explore concerning depression's mechanisms, we are still very much in the dark. Some things these articles pointed to as biological explanations of depression:

Darkness Visible was written back in 1989 by William Styron, the same author who wrote Sophie's Choice. It's a firsthand account of Mr Styron's struggle with depression. I read it again the other week twelve years after reading it the first time, and I came away even more impressed with its description of the despair and pain that depression brings. Maybe because of that realism, the book is one of hope as Mr Styron manages to emerge from his depression. In a similar vein, the Anxiety and Depression Association of America (ADAA) has a nice feature on its website where people suffering from different emotional disorders share their own stories (https://adaa.org/living-with-anxiety/personal-stories). 

Reading these types of stories can help remind people dealing with mental illness they are not alone. All sorts of people are walking around dealing with a seemingly unyielding anxiety or overbearing depression. In addition, all sorts of people have survived such trying times and have learned to manage or even overcome such powerful negative emotions. The stories can stir up hope and help someone suffering start on the path toward healing.

Rational Emotive Behavior Therapy (REBT) is a therapeutic approach focused on helping people identify irrational thoughts that lead to unhealthy emotions and unproductive behaviors. Irrational thoughts in REBT take the form of dogmatic statements such as "I have to do well all the time to be considered a success," or "Others must treat me exactly as I want to be treated." These statements qualify as irrational, because they leave no room for the ambiguities of life. No matter how competent we are, we'll still make mistakes. No matter what, at times, people are going to let us down, not meet our expectations, etc.