Source: Depression.com
In 1976, Philadelphia psychiatrist David
Burns, M.D., became the father of a son, David Erik. The birth was normal, but something
was clearly wrong with the newborn. His skin looked blue. He had difficulty breathing and
he gasped for air. The obstetrician reassured Burns and his wife that David Erik's
condition did not appear serious, but he explained that the infant's bloodstream wasn't
getting enough oxygen. As a precaution, the obstetrician said he wanted to send David Erik
to the intensive care nursery for extra oxygen.
Dr. Burns consented--then suddenly became depressed and panicky. Intensive care meant
something was terribly wrong. His baby son wasn't getting enough oxygen. That meant that
his brain wasn't getting enough. He could be brain damaged. Burns flashed on a future
ruled by the needs of a severely handicapped child. He wondered if he could love such a
child, and imagined that people would think the less of him for having a handicapped son.
Feeling himself becoming overwrought, Dr. Burns decided to try the disarmingly simple
therapeutic technique his colleague, Aaron Beck, M.D., had pioneered. It involved writing
down negative thoughts and then seeing if they were really true or somehow illogical. But
the moment the idea occurred to him, Dr. Burns dismissed Beck's program as absurd: It was
fine for his patients. They were imagining their problems. His problem was real. Of
course, Dr. Burns' patients had often made the identical comment to him, so he told
himself what he always told them: Just try it. What do you have to lose?
It didn't take the depressed psychiatrist long to identify his negative thoughts:
Intensive care meant the worst. His son was brain damaged. His life would be ruined caring
for a handicapped child. And his child's problems would diminish him in others' eyes.
Next, Dr. Burns looked for fact or fallacy in his stated feelings--and found major
distortions. The obstetrician had said intensive care was a precaution, that David Erik's
condition did not look serious. By assuming the worst, he'd "mentally filtered"
the information available to him, seeing only the most dire possibility, when his son was
probably fine. Thinking that his son was brain damaged, he'd "jumped to a
conclusion" that was unjustified. Even if his son were handicapped, he'd
"magnified" the problem by assuming it would ruin his life. Plenty of people
live full, rich, rewarding lives despite their children's--or their own--handicaps.
Finally, by assuming that others would think the less of him because his son was
handicapped, he'd engaged in "over-generalization." On reflection, he realized
that his friends would judge him for himself, just as he judged them independent of their
children.
This simple exercise immediately calmed Dr. Burns, and improved his mood. Soon after, he
learned that David Erik was breathing normally and that his skin had turned a healthy
pink. Subsequently, he learned that the boy's brain was fine.
In addition, Dr. Burns, a professor of psychiatry at the University of Pennsylvania
Medical Center in Philadelphia, learned that the technique he'd used could benefit not
just those with major psychiatric problems, but anyone dealing with emotional negativity.
He went on to write Feeling Good: The New Mood Therapy, and The Feeling Good Handbook ,
pioneering popular guides to cognitive therapy. "Cognitive" refers to thought
processes. Cognitive therapy is a powerful self-help technique for dealing with depression
and other negative emotions by consciously changing the way we think.
The cause of negative emotions--depression,
anxiety, anger, impatience, frustration, guilt, irritability--is a matter of opinion. To
Freudian psychoanalysts, they are the result of repressed feelings that typically date
back to childhood relationships with parents. To biological psychiatrists, they stem from
chemical imbalances in the brain. To cognitive therapists, they represent distorted
thinking. Cognitive therapy is comparatively new to the mental health profession, but it's
approach was first espoused more than 2,000 years ago by the Greek philosopher, Epictetus,
who said, "People are not disturbed by events themselves, but rather by the views
they take of them." Shakespeare put it well in Hamlet: "There is nothing either
good or bad, but thinking makes it so."
Some emotional turmoil is clearly the result of problems early in life, for example
childhood abuse, and Freudian-style talk therapies can help. "But most people don't
have to spend a great deal of time understanding the past to improve how they react to
potentially depressing situations in the present," says psychologist Mark Sisti,
Ph.D., associate director of the Center for Cognitive Therapy in New York City.
Some mental health problems are caused by chemical imbalances in the brain, and for severe
depression, antidepressant medication is clearly the way to go. Antidepressants may also
help people with mild to moderate depression, but for these conditions, Dr. Sisti says,
"cognitive therapy is also quite effective."
Dr. Burns has documented 10 types of
distorted thinking. How many of these depressing emotional traps have you fallen into?
All-or-Nothing Thinking. You see things as black or white. If you're not perfect,
you're a total failure. You make one mistake at work, and decide you're going to be fired.
You get a B on a test, and it's the end of the world. Your husband reprimands you for not
checking the oil when you got gas, and you decide he doesn't love you.
"Like many people, I was a perfectionist," Dr. Burns explains. "Either I
was terrific, or I was nothing. Either I pleased my boss, spouse, parents, or friends, or
else I was good for nothing. It made me terribly anxious, and I spent a good deal of my
life ashamed of myself because, of course, I wasn't perfect."
Labeling. An extension of all-or-nothing thinking. You make a mistake, but instead
of thinking I made a mistake, you label yourself: I'm a jerk. Your girlfriend breaks up
with you, but instead of thinking she doesn't love me, you decide: I'm unlovable.
Dr. Sisti felt himself slipping into labeling during a six-hour professional licensing
exam. When he came to a section he found difficult, his first thought was: This is really
tough. I must be an idiot. "But then I took a deep breath, and realized that I'd
completed other sections that weren't so hard, and that everyone else in the room was
probably having as tough a time as I was."
Over-generalization. The tip-offs are the use of the words "always" or
"never." You drop something and think: I'm always so clumsy. You make a mistake
and think: I'll never get it right.
Mental Filtering. In complicated situations that involve both positive and negative
elements, you dwell on the latter. Your mother clearly enjoys the dinner party you throw
in her honor, but comments that the cake was a bit dry. You filter out all her positive
comments and whip yourself for being such a lousy baker.
"As a perfectionist," says Bruce Zahn, M.A., director of psychology and
cognitive therapy at Presbyterian Medical Center in Philadelphia, "I sometimes slip
into mental filtering. I usually get good feedback on my job and in my personal
relationships, but when people give me minor criticism, I'm apt to think the worst: They
don't love me. They're going to fire me. Then I realize, no, this is a minor criticism,
and all I have to do is correct it."
Discounting the Positive. The tip-offs here are the phrases: "That doesn't
count," "That wasn't good enough," or "Anyone could have done
it." You do well on a test, and think: It doesn't count. Your colleagues praise a
presentation, and you think: It wasn't good enough. You win a commendation and think:
Anyone could have done it.
Jumping to Conclusions. You assume the worst based on no evidence. In
"mind-reading," you decide that another person is reacting negatively to you.
Two of your coworkers are chatting at the coffee machine at work, but as you approach,
they fall silent. Chances are they'd simply finished their conversation, but you assume
they've been criticizing you behind your back. In "fortune-telling," you predict
the worst possible outcome. A test is difficult, so you decide you failed. The sky is
cloudy before you lawn party, so you decide a thunderstorm must be imminent.
Dr. Sisti slipped into fortune-telling recently when he realized he'd lost his automatic
teller machine (ATM) bank card: "My blood pressure shot up as I imagined that I'd
lose all my money. Then I thought: What's the worst thing that could happen? Someone might
use my card. But no one could--not without my personal identification number. But what if
I'd left it in the machine? Then someone could withdraw $250. That would have been a loss,
but not a terrible one."
Magnification. You exaggerate the importance of problems, shortcomings, and minor
annoyances. Your toilet backs up, and you believe you need your entire plumbing system
replaced. You forget to close a window before it rains, and imagine that you'll return to
a flooded home. A neighbor's dog tramples a few flowers and you decide your garden is
ruined.
Emotional Reasoning. You mistake your emotions for reality. I feel nervous about
flying, therefore, it must be dangerous. I feel guilty about forgetting my brother's
birthday, therefore, I'm a bad person. I feel lonely, therefore, I must not be good
company.
"Should" and "Shouldn't" Statements. You play well in the
company volleyball tournament, but miss one shot and berate yourself: I should have made
that shot. I shouldn't have missed. You eat a donut and think: I shouldn't have done that.
I should lose 10 pounds. Other self-demanding tip-offs include: "must,"
"ought to," and "have to."
Personalizing the Blame. You hold yourself personally responsible for things beyond
your control. Your child misbehaves at school and you think: I'm a bad mother.
"Occasionally, I've been late for an appointment because of heavy traffic," Dr.
Sisti says, "and I've felt tempted to personalize it, as in: I must be irresponsible.
But then I've realized that I'd allowed what should have been enough time, and that the
traffic jam is beyond my control. People understand if you get stuck in traffic. It
happens to everyone."
"When you feel badly," Dr. Burns
explains, "your thinking becomes negative. This is the ABC of emotion: 'A' stands for
the Actual event, 'B' for your Beliefs about it, and 'C' for the Consequences you
experience because of your beliefs."
Suppose the actual event is a divorce. You might believe many of the charges your ex
leveled against you: You're selfish, uncaring, vindictive, and lousy in bed. The
consequences of these beliefs might be deep depression. Cognitive therapy tries to change
the "B's" so you don't experience the "C."
How can you change your beliefs about the slings and arrows of outrageous fortune? Dr.
Burns recommends subjecting any negative belief to the following tests:
What would you say to a friend? "People are generally much harder on
themselves than they are on others," Dr. Burns says. Suppose a friend were getting
divorced, and felt like a selfish, uncaring, vindictive failure. What would you say?
Probably something like: You're not a failure simply because your relationship ended. Many
marriages end in divorce, just like many winning teams lose games. It's rough to endure a
divorce, and break-ups never bring out the best in people, but I've known you for years,
and you're a warm, kind, caring person."
Examine the evidence. Your ex says you're lousy in bed, but are you, really? Until
you learned of you ex's unfaithfulness, you had a good sexual relationship. Of course,
after your heart was broken, you didn't have any energy for sex, especially with the
person who'd rejected and betrayed you. That's not being lousy in bed. That's a normal
reaction to your situation.
Experiment. You ex called you selfish for wanting to keep the house, but are you
really? If you were truly selfish, you wouldn't give to charity, wouldn't help friends in
need, and wouldn't share credit for your group's accomplishments at work. Test your
reactions the next time a charitable solicitation arrives, or a friend calls with a
problem, or your group's efforts are recognized. If you write a check, offer to lend a
hand, or praise a coworker, you're not entirely selfish. You may not be as magnanimous as
you'd like to be, but you're not the ogre your ex says you are.
Look for partial successes. Instead of thinking your marriage was a "complete
failure," consider how it was successful. You took turns putting each other through
school, and now both have much more fulfilling careers than you had when you met. You have
two great kids, and the problems that led to your breakup have given you valuable new
insights into the kind of person you'll look for in your next relationship.
Take a survey. You ex insists that your refusal to take the kids for an extra day
after a holiday weekend proves you're vindictive. You maintain that you're open to
rescheduling time with the children, but not when it means allowing your ex to jet off to
a luxurious resort with the new lover. You feel justified, but after a screaming argument
on the phone, your confidence is shaken. Perhaps you are a vindictive SOB. That's the time
to call a few friends and solicit their views. Chances are they'll say you're justified.
Define your terms. You had no idea your ex was having affairs. You were blind.
Define "blind." The dictionary says "completely without sight." That
wasn't you. You saw that your ex had withdrawn from you, and was spending an enormous
amount of time "working late." You weren't blind, just too trusting of someone
you had every reason to believe was trustworthy.
Solve the problem. You blew up when you came home early and found your ex, who'd
moved out months ago, unexpectedly in your house. Since that ugly scene, you've been
thinking that your "terrible temper" has turned you into a "monster."
Possibly, but the problem here is that you ex still has keys to your house. Maybe it's
time to change the locks.
Six steps may not sound like many, but
"simplicity is one of cognitive therapy's major strengths," Dr. Sisti explains.
It's quick and easy, and once people understand the basic concepts, almost anyone can
practice it." Sometimes, though, cognitive therapy's very simplicity puts people off.
They say: "It's so simple, it can't possibly work." When that happens, Dr. Sisti
points out that they're jumping to a conclusion, and urges them to try the steps and see
if the process has value:
Step 1. Get pen and paper. Write everything down. "The act of writing
automatically puts some distance between you and your negative thought," Dr. Sisti
says. "Jotting things down provides perspective and helps people detect distorted
thinking more easily." If you can't put pen to paper, Dr. Sisti recommends saying
things out loud.
Step 2. Identify the upsetting event. What's really bothering you? Is it simply the
fact that you got a flat tire? Or is it that you soiled your outfit changing it? Or that
you knew you needed a new tire, but didn't replace it? Or that the flat made you late for
your daughter's soccer game?
Step 3. Identify your negative emotions. You might feel annoyed about the flat,
frustrated that replacing it soiled your outfit, angry at yourself for not replacing it in
time, and guilty for being late to the soccer game.
Step 4. Identify the negative thoughts that accompany your negative emotions.About
failing to replace the tire: I always procrastinate. I never take care of things in time.
About soiling the outfit: I'm a slob. I can't go anywhere and look okay. About being late
for the game: My daughter will make a scene. She'll think I don't love her. And the other
adults there will think I'm a bad parent.
Step 5. Identify distortions and substitute rational responses. About the tire: I
don't always procrastinate. I juggle my job and family, and accomplish just about
everything that has to get done. I would have replaced that tire in time, but I had to
deal with an emergency at work, and the tire just got by me. About the stained outfit: I'm
not a slob. I'm usually very careful about my appearance, more so than most people, which
is why things like this upset me. About the tardiness: My daughter knows I love her. She
knows that if I'm late, whatever detained me was beyond my control. She's unlikely to make
a scene, but if she does, the other adults there will comfort her. I've done the same for
their kids, and never thought them to be bad parents. No one will think the worse of me.
Step 6. Reconsider your upset. Are you still heading for an emotional tailspin?
Probably not. But you still feel annoyed about getting the flat.
Step 7. Plan corrective action. As soon as the game is over, we're getting that
tire. That will take the time I'd planned to spend cooking dinner, so I'll pick up some
take-out instead.
"A major task of adulthood is to balance
striving to do your best while accepting your limits," Dr. Burns says.
"Cognitive therapy has helped me accept my limits without feeling ashamed."
"Cognitive therapy is simply a more organized way to implement traditional
psychological self-care advice," says New York psychotherapist Alan Elkin, Ph.D.
"It boils down to counting your blessings. Most depressing or anxiety-producing
events are not inherently awful. What makes them feel distressing is the way we react to
them. Counting your blessings forces you to step back, get some perspective, and see
challenges in a larger context. The problem with 'count your blessings' is that it's
vague. Cognitive therapy is a step-by-step program, and when you feel depressed or
stressed by negativity, an organized program helps."
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