Part 1 – The Sense of Agency

 

From: Healthy Gamer with Doctor K.

 

Developing A Sense of Agency.

So the first thing to understand about developing a sense of agency, is that it has nothing to do with power.

Suicidality is about taking control when you believe you have none left.

I had a patient once who kept a noose in their basement. And the hardest thing for them was to give up the noose.  

I was like “Hey friend, you need to get rid of the Noose.”

And they were like “Yeah I know.”

So what do you think happened psychologically when they got rid of their noose? Huge spike in anxiety.  Their mental health got way worse. And why is that?  It's because the noose offers comfort.   The noose is a way of saying “You know what? If everything gets too hard, I can make it stop. I can end it.”

And the noose should be taken away because about 60 - 90% of people who attempt to kill themselves, do so impulsively. 

Maybe 30 to 40% of people, within 60 seconds they'll decide to kill themselves. And I’m not clear on the exact number, maybe 60 to 70% within 5 minutes of the act, they make the decision.

So protecting against suicidality is protecting against impulsivity. Most people will change their mind if the means to kill themselves are not immediately available to use.

So suicidality is about control.  And this explains why people who have lost their sense of agency feel that this is the one thing they have power over.  “I get to decide.”

 

So how do we develop a sense of agency?

Anhedonia means “the loss of interest or pleasure in usual activities”. It’s a characteristic of depression, sometimes anxiety, substance use and in schizophrenia.  Anhedonia is a predictor of poor long-term outcomes, including suicide and poor treatment response. 

There are two ways of seeing failures.

1)    I tried something and it didn't work and

2)    This is one of a series of things that I'm going to try that will eventually get me to where I want to go

But that’s not the way we think.

So if we look at passive suicidality, anhedonia is a huge part.

What part of the brain is responsible for wanting / craving / yearning?
What is the part of the brain that gives us pleasure?

What is the part of the brain that motivates us to action?

 It turns out its all one part, the nucleus accumbens, that is responsible for the brains  dopamine. Dopamine is the brain chemical that gives us a feeling of pleasure.

Medications are not very effective for treating anhedonia. Medications for depression enhance a feeling of calm by increasing the serotonin in the brain. Serotonin puts the person is a rest mode.  It also decreases the feeling of pleasure and craving. Serotonin is released to calm the body after strong emotions end to restore a sense of balance in the body.

A common weapon against depression is to build up serotonin in the system, which reduces pleasure and cravings.

People who are passively suicidal already have an absence of wanting things. They have an absence of motivation and an absence of reward.

So eventually, someone realized “Hey, what we need to do is not just remove the negative.  We need to help people cultivate positive feelings.”

 They also figured a methodology, a means to do this.

 The problem if you're passively suicidal is that, you look at life, you think that the events around you will determine whether you're happy or not. If I invest in this, and it works out, then I will be happy.

Psychotherapy is a beautiful system that has been targeted at reducing negativity… not building positivity.  That's not it’s focus.

  

Here Are A Couple of Steps you Have to Take. 

One, you have to change the way that you anticipate rewards. You have to be internally reward focused.

To do something that take many steps to finish and that takes lots of energy, it is helpful to say to yourself,

“Imagine how nice it will be to not have to worry about this tomorrow” 

This is the twist that the anhedonic brain does, though.  It never sees a benefit to anything that you do.  It literally doesn't see it.

The second thing we want to do is scan for positives.

Sometimes this gets turned into toxic positivity.  So toxic positivity is when we ignore our negativity or we transform all of our negativity into positivity. “Everything is a learning experience.”  I think everything can be a learning experience, but it's okay for some things to just suck.

What we want to do is be able to see the positive in things.  So even if I wasted my whole day, I can guarantee you that there were some moments that something good happened. 

You need to cultivate some degree of positivity in your life.

There's a cognitive bias in depression that makes us focus on the negative that we need to develop skills to get around.

  

Research on Aging and Happiness

There’s a great researcher at Stanford who is looking at healthy aging.  So as you grow old your physical body gets worse, the number of friends you have literally reduces because they start dying.  So you can look at your life at 40 and your life at 75, and your life at 75 in a lot of objective ways will be worse.  But what they found when they really looked into it, is that everyone's life when they're old, is objectively worse than when they were young.  But some their happiness actually increases over time.

Wait, what?

Happiness for most elderly people increases over time. As they're as they need a hip replacement, as their friends start dying, they start getting happier and happier.

There's one variable that correlates with when your life feels worse, gets worse, for if you're an old person. 

What is the one variable that determines whether you're okay with it or you're not okay with it? 

It's your ability to see your life as bittersweet.  That's it.

So when old people start to view their lives, the more that they view their life is bittersweet, the more happy they become. Life is not good, life is not bad.  They don't chase good. They don't run away from bad.  They accept that life is bittersweet. That’s it.
 

The Need to Look for the Positive

 Now if you look at people who are anhedonic, who have difficulty developing that positive emotionality, what they do is just see the negative, they can't see any positive.  So they must look for the positive.  So for whatever experience that they had today, what were three things that were positive, either things that they did well, or things that they enjoyed. And three things that are negative. They need to just be balanced. 

So we want to be as bittersweet as possible.

So, when we're looking at some positivity in what we've done, it counteracts anhedonia.

They found that this outperforms negative emotion focused therapy.  It outperforms traditional therapy, which is focused on the negative, because they're cultivating positivity.