CBT Therapist Michael O'Sullivan talks about how he sees it is possible to stop avoiding our anxieties and face them head on 

"When we do anything in life we act in accordance with what seems valuable to us at that time. 

We value one set of actions over another. 

However, this is a problem in depression. One of the difficulties in working with goals in CBT is the problem of the “instant gratification” of avoidance. 

If we feel anxious we value the act of avoiding that anxiety rather than staying with the distress. When we “avoid” our anxiety comes down almost instantly. The “sting in the tail” with all actions like this is that avoidance makes our world “shrink” and as it shrinks we fall into depression.  

Walter Mischel’s Marshmallow Test demonstrated that those children in the experiment who avoided the instant gratification of eating marshmallows seemed to fare better in life. 

Any successful recovery from depression it would seem, would be helped by “avoiding” avoidance. 

So how do we develop the will power not to avoid? There are four areas we can look at:

Changing to an “external spotlight of our attention”

If our spotlight of attention is “internal”, focussing on patterns of rumination and/or worry it is thought that we will be more likely to succumb to avoidance.

As a CBT therapist I believe that focusing externally on anything that is happening outside our skin helps.

This is a technique that is part of many therapies from Gestalt to Mindfulness based cognitive therapy.

“One thing at a time”

The cognitive behavioural analysis system of psychotherapy advocates focussing just on “the problem in hand”. This will be whatever situation you happen to be in.

This is a variation on “changing the spotlight”.

It’s believed by CBT therapists that if we begin to ruminate on our past and worry about our future as well as the problem in hand, we will be overwhelmed.

And if we are overwhelmed we are more likely to succumb to instant gratification. Both of these techniques keep us anchored in the present.

Anti-depressant activities

The longer we have to wait for a reward, the less we value it. This is one of the reasons why it is hard to think of pensions when we are in our twenties.

The goals we set ourselves in depression are in the medium and long term, and we have to wait before we see any benefits. 

Visualising our activity as anti-depressant can help. Many clients I have worked with recognise that their anti-depressants do not work immediately.

They recognise that the actions of medication are cumulative and that any response it will be felt after 3 to 4 weeks.  

Explaining the setting of small goals in this way helps. The goals we set ourselves to tackle depression will not work immediately but will like medication have a cumulative effect.

Visualise the future self

In one episode of the Simpsons, Homer consumes an enormous quantity of mayonnaise and vodka. Marge tells him how unhealthy it is. Homer is a man devoted to instant gratification and his response is: That's a problem for future Homer! Man, I don't envy that guy!”

We tend to think of our future selves as someone unrelated to ourselves “now”.

That isn’t the case.

The future version of yourself out there is you. When we are delaying gratification, we are valuing that future version."