Thursday, February 19, 2009

Negative Thinking and Depression

I recently finished reading one book and am in the middle of another about cognitive behavioral therapy (CBT), which is a type of therapy that has been scientifically proven to be at least as effective, if not more, than antidepressant medication in the treatment of depression. According to both authors, when you are depressed, you are much more prone to automatic negative thoughts. In fact, the main idea behind CBT is the belief that negative thoughts are actually what cause depression. CBT teaches the patient to identify habitual negative thoughts and then learn to analyze and refute them. So, if you all of a sudden find yourself feeling bad, you can think back to what negative thought caused you to start feeling bad, analyze and refute the thought, and then start feeling relief from its negative emotional consequences. Even though I haven't known about this concept very long and it is really rather simple, it has already proved very useful to me, so I am definitely a fan.

For example, when I am not feeling my best, I will often assume that when someone approaches me or walks by looking distressed or unhappy that I am the person who caused their unhappiness, that they are upset with me, that they think I'm not doing my job well enough, or something along those lines. Conversely, if someone smiles and looks very happy, it would never occur to me that it had anything to do with me. This hypocritical way of thinking is just one negative pattern that can be "cured" by cognitive therapy. Another example is a tendency to exaggerate failures and minimize successes to such a degree that each new failure or rejection lead to thinking,

I am such a loser. I am always getting rejected.

The first step in overcoming these cognitive distortions is to become aware of them. The next time you find yourself feeling depressed or anxious, ask yourself, "What thought caused me to start feeling bad?" And then, once you've identified the thought, analyze it. Is it true? If so, how true is it? What other relevant information am I ignoring in order to continue believing this negative thought?

A little over a month ago, I was rejected from the San Francisco Opera Chorus. I waited over a month for the result after taking the audition and in the meantime had put a lot of importance on it in my mind. When the letter finally came politely stating that the chorus master would not be able to offer me a position, I found myself overcome with emotion. I couldn't help but think of how long I had been waiting, of how hard I had worked to prepare the audition, and of what a great opportunity (one for steady musical employment with a very well-respected organization) I had lost out on. And then I started thinking about what a loser I am, how I am always getting rejected, how that must mean I am a terrible singer, that I am a terribly unorganized and irresponsible person, full of flaws that make me essentially an unsuccessful person who will never achieve anything. It took a lot of moral support from someone close to me before I was able to start looking up a bit and see that I need not be so discouraged. Later, I even learned some things about the financial health of the organization that made me wonder how they were even able to hold auditions in the first place. And, of course, I had to admit that the competition was very stiff and that (of course!) I need to take more auditions in order to increase my odds of winning one. But, at the time, wallowing in my own self-pity, I was not able to see that my negative thoughts weren't true.

Here's how CBT techniques might have helped me by analyzing and refuting each negative thought. Here are the thoughts:

I am a loser.
I am always getting rejected.
I am a terrible singer.
I am unsuccessful.
I will never achieve anything.

The idea is not to turn them into positive affirmations in the sense that I'm lying to myself and telling myself something that isn't true or exaggerating something so that it makes me feel better. The idea is to acknowledge the truth -- the positive truth that I was ignoring when I was wallowing in my downward spiral of negativity.

Let's start with the first one, "I am a loser". Well, what is the definition of loser anyway? If it means that I lost the audition, well, that's true. I did not win that audition. But, if it means that I am always losing everything, that's simply not true. I have had a lot of blessings in my life to be very thankful for.

"I am always getting rejected". The truth is, of the seven musical organizations I have auditioned for since arriving in California, I have been welcomed by six of them.

"I am a terrible singer". I have no reason to believe this is true. People often tell me they like my singing.

"I am unsuccessful. I will never achieve anything." In relation to the extremely ambitious goals I set for myself when I was much younger, I have not been nearly as successful as I had hoped. But, I have done a lot of cool things in my life and I'm sure I will do many more. This is a bit of a sore spot for me and an area I could use more work on.

This is an extreme example of a situation in which CBT techniques might be useful. When faced with major rejection, it is surely hard to see things in perspective immediately. But, I have found that even in a very short time, the brain does respond pretty well to retraining. The trick, I think, might be not only to learn to respond to the negative thoughts, but to remind myself of those positive truths more often, so that they are not so far from the surface.

For further reference, Feeling Good: The New Mood Therapy by David Burns is an easy read and addresses many helpful issues. Cognitive Therapy Techniques: a practitioner's guide by Robert Leahy has been even more useful to me, but I am doubtful that would be the case for most others. Leahy actually writes out the script of a number of therapy sessions so that the reader can understand exactly how he applies each technique with the patient. For me, it has been fascinating to peek into those sessions to see the humanity of others who are destructively self-critical and go along for the ride as their negative arguments are deconstructed and they are forced to admit the faulty nature of their critical thinking and subsequently find great relief and hope.


tgstock said...

Very true. Another technique to combat this is to make a "Gratitude List," remindig oneself of all the positive things in one's life. It will typically outweigh the negatives.

However, WHY I fall into this behavior perplexes and frustrates me. I need to be careful of my physical being (am I tired? have I been eating right?), as that seems to trigger this cycle. But, other times, I can't figure out the origin.

Scott said...

My closest friend since I was, oh, 14 years old, beat some serious, major, crippling depression (which landed her in mental hospitals numerous times) this way. For her and her doctor, though, it was less about turning the negative thoughts into positive ones, than it was about becoming aware of those negative thoughts and analyzing them thoroughly.

She carried a notepad with her at all times, and any time she had a negative thought, she wrote it down, and rated it on a scale of 1 to 10 as to how much she believed it. And the end of the week, she met with her doctor, and was made accountable for all these thoughts, and discussed why she might have thoughts that she herself didn't believe, and so on. After months and months of this, she began to work on eliminating the processes that led to the negative thoughts that she didn't believe were true. And she's been off meds for 10 years or so now.

Not a strategy for everyone. But she's a hyper-analytic mind. For her, the other-ness of drugs was horrible, and she almost killed herself a few times so she could "prove the drugs wrong" and such. And "positive thinking" had the same problem for her; if she didn't believe life was positive, no conscious effort to do so could change her. But serious behavioral therapy allowed her to see the truth behind her negative thinking, and then her "I AM IN CONTROL" mentality allowed her to work the unnecessary negative thought out of her mind.

In short, extremely powerful stuff, but I don't think for everyone. It requires HUGE amounts of self-motivation, toughness, and an unflinching nature.

Pam said...

Thanks for your comments. My strategy in blogging about this topic was to focus on one simple aspect of CBT so that it might be immediately usable by anyone interested, but I acknowledge that there are many complex angles to the therapeutic process and that what works for one person may not work for others. I do think that this one simple tool could be useful for a number of people who haven't realized the relationship between their habitual negative thinking and their struggles with bad moods. I know it has been helpful for me already and negative thinking and moodiness have been major challenges in my life.

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