Unrequited love and gambling addiction: more similar than you’d think.

I liken having an unrequited love obsession with a gambling habit, linking them through the psychological concept known as partial reinforcement: 630 words.

Some time ago I saw a client who wanted help managing his obsession with a young woman that he’d taken a fancy to, but who hadn’t reciprocated. We did some okay work in the session, but I was improvising quite a lot because I didn’t see much relevance for my clinical training.

Afterwards I spoke to a colleague about the session, and described the client’s predicament as similar to that of a gambling addict: He seemed to be hanging on in the hope of a jackpot, despite realising the odds were against him. My colleague thought this analogy was fitting, because she said both scenarios involve a ‘partial reinforcement schedule’. It was a clever connection to make, and here’s how it works:

Reinforcement

Reinforcement refers to positive consequences that follow an action, and cause that action to be repeated in the future. So if I ask a girl on a date by singing to her in badly pronounced Italian from the streets below her apartment with a rose in my mouth, and she miraculously agrees, then I’m likely to repeat this technique in the future. I’ve learned that performing the action results in a desirable outcome, so I repeat the action with the expectation that I will attain the desired outcome again.

Partial Reinforcement

Partial reinforcement describes a situation in which our actions are followed by positive outcomes only intermittently. Researchers have shown that if an action is not followed by positive outcomes, (not reinforced), human and non-human animals alike will soon give up on that action. This will eventually happen even when the action was previously reinforced: It appears to us that circumstances have changed, and we decide that performing this action will no longer be fruitful. But if our action is followed by positive outcomes every so often, we persist with the action despite it being only somewhat effective. It seems that partial reinforcement keeps our expectations up just enough for us to persist with an action.

Gambling and Partial Reinforcement

The gambling industry knows this psychology well. They want us to bet more, but can’t reinforce our betting every time of course, because they’d lose money. Instead, they allow gamblers to win intermittently, and this keeps them betting. A good example of this are the pokies, (which is what slot machines are known as in Australia; from ‘poker machines’). They are programmed to pay out a certain percentage of the money inserted into them, and they do this intermittently so that the gambler will persist with their betting.

Unrequited Love and Partial Reinforcement

Here’s the fun/sad bit. The love struck individual will try and try to attract their love obsession, and perhaps out of politeness, or because of flattery, or maybe because there’s other benefits in it for them, the love obsession will intermittently reinforce the love struck person’s efforts, despite not being interested. This might be with a simple smile, (oh, they smiled! maybe they  like me), by accepting that lift home at the end of a night out with a group of friends, or just by making polite conversation in the corridor because they couldn’t get away fast enough. In fact it might not matter what the love obsession does, because if a person is infatuated enough they can probably read positive outcomes into anything. Needless to say, in these circumstances the love struck person seldom wins the jackpot, and their losses are measured not only in money spent on overpriced roses, but wasted time, missed opportunities with others who were actually interested in them, in dejection, and in diminished self-esteem. (Then again, I’ve known people to be worn down by persistent suitors they were not initially interested in, so you never know…).

In conclusion, beware of partial reinforcement.

Bracing Ourselves with Worry

I suggest that by worrying we are trying to brace ourselves against the emotional shock that would accompany a calamitous event, only by making a habit of this we are consigning ourselves to a life of stress: 600 words.

For much of my life I was a champion worrier. When I was about 4 or 5 years old my teacher gave me the Mister Men book, Mr Worry, so clearly the writing was on the wall for me from an early age. It was a nice gesture from my teacher, but it would take more repetitions of the basic lesson in this story about needless and excess worry for the message to finally sink in. (I just watched an animated version on YouTube and it actually doesn’t end all that well, which is worrying.)

Why Worry?

Worry can be consider a mental way of bracing ourselves for the emotional shock that would accompany what we perceive to be a calamitous event, and it is thought that worriers are particularly sensitive to such spikes in emotion. To see how this works, let’s represent the event by the bursting of a balloon, and the worrier by a relative of mine who is particularly sensitive to loud noises. I’ve seen him visibly tense up at the prospect of a balloon bursting, and he cannot relax while this is a possibility.

Bracing ourselves in this way is a natural response to the potential for physical shock, and would likely protect us from more serious injury should that shock eventuate. Worry is often an attempt to anticipate negative events, and generate solutions to deal with those events. So in this way it can be thought of as mentally preparing ourselves—bracing ourselves—for the consequences.

This all sounds great, but if we are sensitive to the possibility of something, anything, going wrong, then we must work extra hard to prevent this. Hence we must keep worrying, constantly bracing ourselves for the moment we have to deal with the next mishap, whatever that may be. Many things in life can go wrong, and these potential negative events—anything from a minor mishap to a great disaster—are like a room full of balloons. There is always uncertainty over when one of these balloons will burst, so the worrier spends their days bracing themselves for this.

The Cost of Worrying

The cost of all this worrying is experienced physically with symptoms of tension and stress, much like you would expect when bracing for a physical shock. And being on edge all the time makes the worrier easy to irritate, like a mouse trap ready to snap. And it’s exhausting being constantly on guard: they say there’s no rest for the wicked, but also none for the worrywart. And how can anyone concentrate when they constantly have things on their mind? And with all that thinking, there’s very little time for action: not much is getting done, which when you think about it, is a bit worrying. Even writing about worry is tiring and repetitive.

Solutions

So what can we do? It’s a good start to recognise what’s happening: that by always preparing ourselves for occasional moments of acute emotional pain, we are guaranteeing ourselves the chronic emotional pain of stress and anxiety. We can ask ourselves whether this is really a worthwhile trade off. And if we decide it is not, then we must first accept that from time to time we won’t be fully prepared for a negative turn of events; but then we can travel through life a lot lighter*. And if this is unconvincing, there are a variety of quite practical ways to reduce our worry. But this post has been long enough, so they’ll have to wait for another day. Don’t worry, I’ll get to it.

(*In another post I make a similar point using a different analogy.)

The Return of Anxiety

After overcoming anxiety, it may nevertheless return unexpectedly. This article explains why, and why you needn’t panic: 790 words.

After the Christmas holidays I returned to work at  my university, taking the train as usual, then walking a short way through Sydney’s Inner West to my office. I used to walk with the majority of students and staff, only I like to walk briskly, and most people take it easy. I felt like a Formula One driver trying to work his way up from last place on the grid; so eventually I chose a different route, cutting through the engineering faculty to avoid the crowds. However, on this first day back I mysteriously reverted to my original route, and only realised what had happened as I was half way along. I chuckled a little, recognising that I had fallen victim to a significant phenomenon relevant to my clinical work, especially related to anxiety.

When we overcome anxiety, we usually learn that what we feared is unlikely to eventuate, or even if it does, it will not be as bad as we thought. An effective way to achieve this insight is to face our fears often enough that our emotional system learns the reality that perhaps our intellect knew all along. For example, the person that fears flying, despite knowing intellectually how safe this mode of transport is, will, by taking enough flights, learn emotionally that there is little to fear about flying. (This method of treating anxiety is called exposure.)

Except some people, after learning not to fear flying, will turn up to the airport one day and be overcome by fear again. Why? Well, we know from extensive research that old learning is not erased: it turns out that what is learned cannot be unlearned, so that our fear of flying, for example, never goes away. But we are able to learn something new that competes with our fear – in this case, that flying is a very safe way to travel. These two nuggets of knowledge compete for influence over our emotions and subsequent actions (whether to fly or not to fly). And a significant factor that can weaken new learning about our anxieties is a change in context compared to when we first learned these facts. This context can be the place, the people involved, or even the time – anything about the circumstances in which we learned to no longer fear something.

So we learn to not fear flying, but after a few months we might then think… “that was then, but this is now: perhaps its no longer safe to fly”. Or, “I felt safe on xyz airline, but this is abc airline – maybe it’s not safe with them”. Or, “I was okay when I flew with my friend, but now I’m alone, so perhaps its not safe after all”. None of these thoughts need be conscious, but there is nevertheless some doubt about feeling safe, so anxiety returns.

This is similar to what happened to me that first day back at work. After a couple of weeks off my brain decided to revert to an old habit-old learning if you will-which caused me to walk an old and less convenient route. When our anxiety returns we are simply walking an old route, but the good news is that the new route is still fresh in our mind, and research has shown that we can return to this route with less effort than it originally took to forge it.

A clever analogy taught to me by a former colleague (Jess), is to think of your existing fear as a wide track through a thick forest. Overcoming this fear requires you to laboriously push your way through virgin forest, making a new track, one that leads to a feeling of safety. At first this is very hard work, but over time you push back the plants and firm the ground, making it easier and easier to travel this route. And all the while the old route, which led to fear and anxiety, is becoming overgrown from lack of use. But it will never quite disappear, so it may be that some days, depending on the circumstances,  you might accidentally travel back down your old trail, ending up in a fearful place. This is perhaps inevitable, but just as certain is that our new track is still available; and we can, after realising what has happened, decide again to choose the route which leads to that sense of confidence we get from facing our fears.

So, if you find yourself beset by fear once again, remember that this is just a wrong turn. Retrace your steps, and pick up where you left off. You’ll find your sense of confidence will return more easily the second (or third, or fourth…) time around.

Finance Analogies: Mental Accounting and the Positive Events Diary

I make a case for paying extra attention to the positive events in our lives, and offer one way of doing this: 460 words.

As a former accounting and finance professional I like to find some common ground between my two careers. Here’s my fourth attempt…

In life we can expect some events to add value, and some to reduce value. For example, when we receive a compliment this adds value, and when someone insults us this diminishes value, if we take it seriously anyway. As an accountant, I would record transactions that increased and decreased the value of an organisation, namely income (credits), and expenses (debits). Of course, many expenses are necessary, as we can’t expect to achieve anything without incurring cost. But on the whole we hope to make a net profit (more income than expenses).

Sometimes, though, our mental version of accounting goes a bit haywire. We start recording only the negatives, and fail to notice the positives. This is very common in depression, when we become biased towards noticing failure and setbacks. The reality for the depressed person may well be okay, but their disorder stops them from seeing this.

In accounting we record financial transactions in a ledger. If we are keeping a kind of depressive ledger, recording just the expenses in our life, then we will soon start to question whether it’s worth doing anything at all; we become hopeless. To counter this, we can start to keep a second set of books, in which we will record only mental ‘income’.

Clinicians call this a positive events diary. At the end of the day we can take a simple note of the good things that have happened during that day, whether little or big, and by doing this we begin to build a more accurate picture of our lives. It’s an unashamedly biased exercise, because depression is biased too. Think of it as affirmative action for your positive thoughts.

Each time you do something that your depression would have prevented you from doing, record this as a positive event. It’s an achievement for many depressed people just to get out of bed in the morning. All the usual good things can go in there, and don’t take things for granted. If you make someone laugh, enjoy your morning coffee, or get a question right at college, or in a work meeting, all these are positives and deserve to be recorded. Social media can be used in this way. If we take Facebook as an example, spend less time examining others’ highly curated lives, and record your own ‘best of’; you don’t even need to share these publicly, but going to the trouble of recording these events will remind you of them, and you can look back over them in the low times.

However you do it, keeping a positive events’ diary is a relatively simple way of balancing your mental books. And although you don’t need to be an accountant to do it, you might find consulting with a therapist will help you keep track of all those mental credits.

Finance Analogies: Spread Your Risk

A short analogy reminding the reader that we should apply prudent investment strategies to our lives more generally: 300 words.

Here’s my third attempt to find crossover between my former career in finance and my new career as a psychologist…

The idea of not putting all your eggs in one basket is fairly well accepted. You spread your risk, putting a few eggs in a few baskets. You might drop one or two baskets but probably not the lot, thereby averting disaster. Following this principle, financial advisers will suggest that their clients invest in a portfolio of investments, rather than betting their life savings on just one or two.

We don’t always apply this principle more generally across our life though. We invest time, effort and emotions in all aspects of our lives, and to spread our risk in life makes sense as an investment strategy. How many people dedicate themselves wholly to their careers, see only their immediate family, or perhaps spend all of their spare time at the gym. These situations are great so long as nothing goes wrong. But consider the career oriented person who’s made redundant, or the person who unexpectedly gets divorced and realises they don’t have friends anymore, or the gym junky who develops a chronic injury, and can no longer get their fix of exercise. Each of these people will lose a significant source of self-esteem, comfort and coping overnight, and will have little else to turn to.

We can be dedicated to our spouse and family, but also spare some time for friends. We can be ambitious in our career whilst remembering that it’s not the only thing that makes us valuable. And we can benefit from a regular exercise routine without obsessing over it.

So, try taking an inventory of the investments in your life, and see whether you could benefit from diversifying a little. It will take more effort, but even if all of your existing investments continue to pay a return, you just never know how rewarding other opportunities might be.

Finance Analogies: Don’t Over-insure Yourself

A finance metaphor illustrating the cost of trying to eliminate all risk from our lives, and presenting an alternative to this: 480 words.

Here’s another go at finding commonality between my former career in finance and my work as a psychologist.

When we purchase insurance we incur a small cost upfront to eliminate the risk of greater losses later on. That all sounds lovely, only insurance companies earn a profit margin on these transactions, ensuring that in the long run they will earn more in insurance premiums than they will pay out to cover people’s losses. In fact, over a lifetime a large majority of us will claim less in insurance than we will pay out in premiums. So why take out insurance at all? Well, one reason would be if there is a plausible risk of a major loss that you could not expect to cover, such as your house burning down. But aside from these situations, the benefits from insurance are mostly psychological – specifically, we gain peace of mind.

But another way to achieve peace of mind in these circumstances is to take a long term view of risk. If we can accept that over a lifetime there is only a very small chance of ever claiming enough on our insurance to justify it, then we could do away with insurance on all but those big ticket items like a house. Sure, we will have a few occasions when we do have to replace an item that we didn’t insure, but the money we save will most probably more than offset this. But many of us struggle to take this long term view. Our emotions are built to focus on more immediate concerns, and if I’m concerned about my new refrigerator breaking down unexpectedly then I’ll buy that extended insurance to allay my concerns. Consequently many of us over-insure our lives.

But this tendency to over-insure doesn’t only apply to financial transactions. We do the same thing if we always carry an umbrella as insurance against it raining, or when we put in unpaid overtime to prepare for almost every possible question at the next work meeting, or when we take a swath of vitamins each day just in case we pick up a particularly virulent flu virus. The cost of carrying that umbrella may be small, but add that up over a lifetime and then compare it to the odd occasion when we’ll get wet, and it’s likely that we could benefit in the long run from leaving the brolly at home.

My examples may seem trivial, but the risk-averse people amongst us insure almost every aspect of their lives, and in doing so, weigh themselves down with the burden of all that insurance. If that is you, then try and take a long term view of the risks in your life, learning to accept the smaller risks that you can deal with should they eventuate, (and you can cope with a lot more than you think). Allow yourself a wry smile when you get caught in the odd rainstorm, but remember that you travel lighter nowadays.

Finance Analogies: Disregard Sunk Costs When Investing

A finance analogy explaining why we should disregard time and effort invested in the past when deciding what to do in the future: 500 words.

My first career was in accounting and finance. You’d think that there wasn’t much overlap between finance and psychology, and you’d be right, however I have occasionally come across principles of good financial management that I like to relate to clients. Here’s the first…

Disregard Sunk Costs

When determining whether to commence a project we must assess whether the project benefits will likely exceed the costs. This is not an exact science, but the idea is straightforward – we need to decide whether this is a good investment.

However, project managers sometimes find themselves part-way through a project when the viability of the endeavour is called into question. At this point decision makers may get distracted by what are called sunk costs, which are the costs already incurred on the project.

When deciding whether to continue with this project we should disregard the sunk costs. This is because the sunk costs cannot be recovered; that money has already been spent, so no matter what happens next we are not getting it back. If the stakes are high then accepting this reality may entail facing some complex negative emotions, so we’ll have to let these wash over us if we are to make the right decision.

But we do want to prevent, as the saying goes, throwing good money after bad. So our analysis is like wiping the slate clean and performing the cost-benefit analysis again, to ensure we get sufficient benefit from any further money that we spend.

In a similar way, you may find yourself part-way through a life project, such as a marriage, when it begins to experience problems. Should you continue with this marriage? What if you have been with the person for 25 years? A 25-year investment in a marriage – surely it would be a waste to throw that all away? But these years are sunk costs. You can never get that time back, but you can ensure that the next 25 years are well spent. And it may well be that investing more years in the same marriage would be worthwhile, but it may also be that spending those years by yourself, or with another person, would provide a better return on your investment. Your task is to decide what is best for the future, not justify decisions made in the past.

I have learnt this lesson the hard way by persisting with life projects of my own well past the point at which I should have quit. For example, although my business career had its moments, it was never really for me, but I doggedly persisted with this career because I had spent so much time, effort, and money on becoming qualified. (This wasn’t the only reason of course, but it was particularly significant in the years after I completed my qualifications, when my perceptions of waste were strongest.) If I had accepted this reality earlier I could have enjoyed the benefits of my new career for longer. Better late than never though.

An Unstable Sense of Self

A short analogy on the experience of having an unstable sense of self: 340 words.

Most people take for granted a stable sense of the self. We know roughly our main character traits, our strengths and weaknesses, and the ways in which we relate to other people. We also can expect that these attributes will remain largely stable over time, and are not highly dependent on outside events or influences.

But not everybody feels this way. For some, their sense of self, and indeed their value as human beings is very much dependent on the outside world, particularly other people. In order to feel valuable and secure they require unambiguous and constant confirmations that others adore or admire them. Without these they begin to crumble. It is as though they must always be in the sun to keep warm, unable to generate body heat from within. And if a comparison to cold blooded reptiles seems unkind, it nevertheless represents the harsh way in which society judges such people. We interpret their psychological sunbathing as being needy, selfish or arrogant, and find their unpredictability and emotionality troublesome at best, destructive at worst. Related diagnoses such as Borderline and Narcissistic personality disorders carry a stigma, although for some the recognition of their experience as a ‘thing’ can be a relief.

Of course the majority of people who are psychologically ‘warm blooded’ still benefit from a little time in the sun – occasional compliments, hearing “I love you” from our family, a promotion at work – but cannot easily understand what life would be like if our whole identity depended on a constant supply of these events. We’d be always searching for that patch of sunlight in which to bask, and forever vigilant and defensive over threats to our self. There’d be no respite, and so it is not surprising that such experiences can lead people to make suicide attempts.

Overcoming an unstable sense of the self should be considered a long term project, and just realising what is going on is a good start. Then find a qualified clinician to help you or your loved one to take the next steps.

The Differences between Mental Health Professionals

The difference between psychiatrists, psychologists, therapists, counsellors and coaches explained using a physical health analogy: 500 words.

With a plethora of impressively titled mental health professionals out there, it can be difficult to know what they all do and how they differ from each other. The clearest way to explain this is to use a physical health analogy; so, let’s assume you have a problem with your physical conditioning, anything from sub-optimal fitness to a serious injury.

Personal Trainers = Coaches

If you’re simply unhappy with your fitness level, and there’s nothing particularly wrong, then you should consider working with a personal trainer. Perhaps you want help attaining a certain goal, like running a marathon, or just want to get fit.

Coaches are our mental PTs, helping the still functioning individual to function better. They may offer a generalist ‘life coaching’ service, or something more specialist, like executive coaching.

Physiotherapists = Psychologists, Counsellors and Therapists

If you’ve suffered an injury then you’ll want to consult a physiotherapist. They can diagnose your injuries, and guide you through specific exercises that will target those injuries. They will help you to gain insight into possible causes, facilitating improved management in the future.

In mental health, counsellors, therapists and psychologists all provide knowledge-based or behavioural therapies to address some level of dysfunction.

Orthopaedic Surgeons = Psychiatrists

Finally, some injuries warrant a direct biological intervention, so you’ll need to see a doctor. In particular, an orthopaedic surgeon has the most relevant specialist knowledge. Of course, a surgical procedure carries an increased level of risk, but it may be the most potent treatment available.

Psychiatrists are doctors with specialist mental health training, and usually employ biological treatments including medications, the not-as-bad-as-it-sounds Electroconvulsive Therapy (ECT), and more recently developed treatments like Transcranial Magnetic Stimulation (TMS). (Psychosurgery is very rare nowadays.)

Let’s now consider some variations on these basic roles:

  • Psychologists work in various fields, not just mental health. For example, there are neuropsychologists, educational psychologists, organisational psychologists and forensic psychologists to name but a few. Psychologists working in mental health may have engaged in further training on mental health disorders and the therapies used to treat these disorders. In some countries they may hold a specialist designation like ‘Clinical Psychologist’.
  • Doctors often favour the ‘medical model’, that is, using biological treatments to address mental illness; but some will also use psychological therapies. And not only psychiatrists treat mental illness; general practitioners may often prescribe drugs to treat mental ill-health, and of course many GPs are helpful counsellors also.
  • People calling themselves counsellors or psychologists may well provide coaching services.
  • Depending on which country you live in, the various titles used by mental health workers might be regulated by law, and if not, it’s likely there are professional bodies that regulate the standards of their members, so look for these when choosing someone.

*I’ve left out mental health nurses because most people know roughly what nurses do; they care for patients in a hospital, clinic or community setting, and administer treatments, often in consultation with and/or on behalf of doctors. It’s similar in mental health.

Post Traumatic Stress is like an Injury

Post Traumatic Stress Disorder (PTSD) is like an injury, and evidenced based psychological treatments are like rehabilitation exercises for this injury: 429 words.

In my early thirties I decided to get involved with a local soccer team. On my first training run, confident in the knowledge of how fit I used to be, I had a cursory warm up and started kicking the ball around with my new team mates. Within 20 minutes I had torn my calf muscle. I played on for a while that day, numbed by the adrenalin, and not realizing the seriousness of the injury. Afterwards I could still walk slowly, but any sudden movements and running were out of the question. When I later consulted my physiotherapist she said my muscles may never be as strong again, but with the right rehabilitation I could get back on the field.

Post Traumatic Stress Disorder is the mental health condition most like an injury. It can result from single or multiple traumatic events, and places significant limits on normal functioning, although not always right away. Certain experiences will trigger the mental pain of anxiety and anger. Many will try to kill this pain by self-medicating with alcohol and drugs, but this does not repair the damage. The traumatized live in fear of re-injury, and avoid situations they associate with their trauma. But it’s never enough to feel safe, and their lives narrow. Depression may follow.

A debilitating mental injury is a bad break for anyone, but for highly trained members of the military, emergency services and other high-risk occupations, their being confined to the bench can be a shaming experience. We may feel only sympathy for an elite athlete who suffers a career-limiting injury, but those impacted by post-traumatic stress fear being stigmatized as weak and unworthy. Attitudes towards mental illness and injury remain negative compared to their physical counter-parts.

Rehabilitation for physical injury is a gradual process, slowly building the strength and flexibility of muscles, and psychological treatment for PTSD usually proceeds in a similar way. For trauma survivors this involves slowly building confidence – confidence that they can face the memory and reminders of their trauma without suffering harm. Jumping straight in at the deep end is often too much too soon, but to hide away at home will only result in atrophy. Gradually facing fears is necessary if they want to get back on their feet, and then one day take to the field again.

People routinely seek help from physiotherapists, doctors and other health professionals for physical injury. It is my hope that greater awareness of PTSD as a kind of mental injury will make accessing treatment for this debilitating but treatable condition just as routine.