Behavioral Health Minute

November 2009 - Do something different

The short summary

Behaviors make better goals than feelings, and “What would you do if you felt different?” can often bring out helpful therapeutic directions.

The modestly longer reflection

Patients often come to us because of distressed feelings.  They feel anxious.  They feel depressed.  A patient last week complained about “the ball of hostility in my chest.”

It is, of course, really important to hear what people have to say about their distressed feelings.  Unless people have a chance to tell their stories and have us understand their suffering, they will generally not be very open to making changes.

Feelings, however, do not make very good goals.  “Please make me less anxious,” “Please make me less depressed,” and (as you know well), “Please make me have less pain” can all easily end up being projects in patients chasing their tails.

Goals are much better understood in functional terms… what people would like to be doing… rather than in feeling terms.

Three reasons.

First, functional goals are more observable.  It is easier to determine whether someone is walking down the road (rather than sitting on the couch) or going to Hannaford (rather than staying home playing video games) than it is to determine whether their feelings are different.  Second, most of us as human beings have more control over our behaviors (whether we exercise, or visit Aunt Sophie or express kindness to someone else) than we have over our feelings.

The third reason to think of goals as behaviors rather than feelings is that feelings and behaviors influence each other, and that how you would behave if you felt different is often a good strategy for feeling different.

Clinician:  So, if you felt less anxious, what would you do?
Patient:  I’d probably be more normal.
Clinician:  OK, and what would that look like?
Patient:  Well, get out more, be more sociable I guess.
Clinician:  Good, and what would be some examples of “getting out more” and “being more sociable?”

For this patient, the theoretical consequences of feeling better are probably great strategies to move toward feeling better.

The general rule, as I often express it to patients, is:

“If I felt better, I would _____________.”  Whatever fills in the blank is typically a good strategy to pursue on behalf of meaningful life changes.

Follow-up

When patients express the wish to feel different, look for behaviors that would be associated with this.

Fred Craigie, PhD