Adjustment Disorder – Counselors and Therapists in North Little Rock, AR (Maumelle)
We All Need Purpose (A Lesson in Cognitive Behavioral Therapy)
I retired from the US Army back in 2014 and decided to open a counseling practice. What I didn’t know back then was how difficult it is to transition from military life to civilian life. I am certain now that opening our new business probably kept me from falling into deep depression. It gave me purpose. What I didn’t know was how to maintain purpose.
This article is really about fighting off depression (feeling of sadness and hopelessness) and preventing anxiety (debilitating stress and worry).
Do you struggle to belong? Do you feel left out? Do you miss the good old days when you were in school, at your former job, or surrounded by people you enjoyed?
Have you stopped doing the enjoyable things you used to do? Have you found little or no motivation for visiting friends, enjoying hobbies, up to and including a lack of sexual desire from time to time?
If you answered yes to some or all of the questions above, then you could be at risk of depression. The most typical symptom that is a combination of the issues listed above is called anhedonia. Anhedonia is a two dollar word that means you no longer get pleasure out of the things you used to love. Here is my story. See if it sounds familiar. Look for the three sides of the cognitive-behavioral triangle (cognition, behavior, and emotion). See if you can figure out what I was missing.
In the military I was very competitive. I was in excellent shape physically and mentally. I was confident, strong, and highly motivated. I was a paratrooper early on. I was an engineer next and then a logistics officer for many years. During my last deployment, I was the commander of over one hundred Soldiers responsible for logistics in Afghanistan. I volunteered to go down range as the first Police Mentor Team Chief in the District of Shajoi, Zabul Province. It was a very dangerous place, and I was charged with training the local militia to fight the Taliban. It was a very exciting time and it changed me.
I returned home after twelve months overseas, and I was no longer the Police Mentor Team Chief. That was a combat-specific job. My previous job, as the commander, was filled by another officer. I came home and my unit had actually relocated to another city about two hours south. In short, I was a man without a job. I still got paid. I still had a boss. I just didn’t see anyone I knew, and I didn’t have a mission. It was like coming home from a long trip and finding an empty house. It was painfully stressful (anxiety). I felt like Kevin Costner in Dances with Wolves.
I started looking for things to do. It was maddening. I ran a lot of PT (Army physical training). I made phone calls and volunteered for small assignments where I had to travel. What I didn’t realize was that my very identity was unraveling. I was alone. Without troops, I felt empty. Most good therapists would call this “adjustment disorder.” I juggled anxiety and depression. It felt like hell.
I was desperate for purpose, so I took a job that wasn’t very exciting. I had to find about two million dollars’ worth of lost/misappropriated military gear left in Afghanistan. It got me out of the office and interacting with two amazing Soldiers. I felt better for a time. I was recognized for my efforts and given awards. When it ended, I fell back into despair. I decided to check on some of my troops from the last deployment. Many were doing well. Some were not. A few were struggling with drugs, alcohol, abuse, violence, indebtedness, and unemployment. It seems they didn’t adjust well either. I wanted to help them. I didn’t realize that I was also secretly or unconsciously trying to find help for myself.
I looked up the symptoms we all shared. They fit the basic definition for adjustment disorder as follows: “An adjustment disorder with depressed mood means that you feel hopeless and sadder than would be expected after a stressful event. Many kinds of events can cause stress, such as moving, changing schools or jobs, marriage, the birth of a child, the loss of a relationship, or a severe illness.” It is interesting that it doesn’t say anything about returning from deployment, but the reference to changing jobs was close enough. It made sense.
I now had a mission. I had purpose. I decided to go up the chain of command and bring my revelations to light. Guess what happened. No one above me really knew what to do about these things. They kept saying the VA handles mental health problems after war. I had some marginal support, but for the most part, no one wanted to do the work required to build a new system or fund a new system to help Soldiers. I suppose it is to be expected that people avoid change. I searched high and low and made it all the way up the chain to the General. He was interested. It didn’t go any further, even after I approached a few congressmen and the governor. Again, they felt systems were in place and Soldiers would be fine.
Well, I was at the end of the mission again. I picked up a few more chores. I was largely dissatisfied. I became angry and depressed. My work suffered. My superiors showed concern but were less than helpful. Those who cared didn’t want to see my career end with a mental health stigma attached, and those who didn’t care just wanted me gone. I was at the end of my career. I had twenty years of service. I was due for promotion to Lieutenant Colonel, but it seemed pointless so I retired. I decided to open a business helping people with depression and anxiety. It seemed to fit.
I know that all sounds like a wonderful ending, but it was hard, and far from over. I relocated our family to Arkansas where my wife had been raised. I left my friends and family behind in South Carolina. I went to work building Thriveworks Counseling. It kept me busy. It gave me purpose. It was pretty much all I focused on. Within a few years, we were doing well in the business. We had clients and employees. My wife and I had built systems that really worked well, and I all but worked myself out of a job. I was at the end again. I ran out of purpose. The mission was pretty much over, so we built another office in the next city. I was back on top again, but that mission ended too, and I realized I wasn’t happy. I was working and managing to get by, but I wasn’t happy.
At this point, if you see a long series of behavior stimulated by need for emotional change, then you have two sides of the triangle. Behavior, emotion, and cognition all affect each other cyclically. When I was highly engaged DOING things, I felt empowered. My behavior affected my emotional state. When I had no purpose, behavior dropped off and I felt like crap (depressed). I then stressed until I found things to do (anxiety).
Do you see these elements in your life? When you were having a blast in school were you emotionally on top of the world? When you had purpose did you feel driven? Did the thought of graduating from high school or college keep you focused? What about that dream job or that one group of friends that felt like heaven? These are all behavior-driven emotional circumstances. It feels like a coincidence when it happens, but we can build this system if we understand it.
So what about the third side of the triangle? What can we do with cognition?
I realized that I felt better when I was active. I realized that behavior changed my emotional state. The more I thought about it (cognition), the more I learned I could set myself up for success. Cognition is the process of thinking and metacognition is thinking about thinking. I started thinking that I needed to plan for behavior, so I could enjoy a better emotional state. I needed to be prepared for the “end of mission blues.” I am now able to predict the onset of the various symptoms associated with depression and in particular adjustment disorder. Can you?
In very simple terms, we must learn to see the train coming, hear its horn warning us, and be able to get off the tracks in time to avoid a catastrophe. If you can see it and hear it coming, then you too can cognitively prepare, establish habits in behavior, and enjoy fewer emotional lows. Lastly, we absolutely must recognize the high points. We need to share our successes with a friend, post on social media, and even dance a little jig when we are happy. Celebrate the victories! This is a cognitive exercise that reinforces those good habits in behavior and ultimately changes our emotions.
If you would like to learn more about beating depression, avoiding anxiety, and ultimately practice these skills with an expert, then give us a call. We promise an appointment within 24 hours. Call us today at 501-404-9737 for a location near you.
By Curtiss Robinson