Introducing Cognitive Behavioural Therapy (Introducing...) (15 page)

Small, gradual changes in your activities can begin to boost your mood. Break things down into small steps – don’t expect too much of yourself too quickly.

Step 2: challenge negative thinking

Research tells us that when people are depressed their thinking style changes. Experiments comparing depressed thinking with usual thinking show that when depressed we tend to have a negative bias in how we evaluate the world. We see negative events and outcomes as our fault, while ignoring positive outcomes or crediting other people or chance with making them happen. When depressed, it is as if we have put on dark glasses and can only see gloom. Negative thoughts in low mood tend to be automatic; we don’t even notice they are there. This isn’t really surprising, as the pessimistic nature of the thoughts is perfectly in tune with our low mood. So, everything fits together, meaning we’re often not aware of the thoughts, or able to challenge their accuracy. Instead, the first thing we’re aware of is that we feel low. Step one in changing this is to get better at recognizing these thoughts. Next time you feel low ask yourself ‘what was going through my mind just before this?’ You’ll find if you start looking, the negative thoughts are there – you just have to recognize them.

Common types of biased thinking in depression

There are a number of ways in which our thinking style may become distorted when we are in a low mood. Let’s think about a few of them now.

Mental filter

My boss said I hadn’t got that report right – I’m useless
.

When we are low we tend to only notice and accentuate the things which fit with our negative view of ourselves, other people or the world around us. We ignore the fact that our boss also said we had done really well in another project or that we were given an award for our work last year – we concentrate on the things that fit with our depressed view, blind to anything more balanced or positive. Conclusions based on only half the evidence wouldn’t stand up in court!

Over-generalizing

I can never do anything right
.

No-one will ever love me
.

When we are depressed we tend to make global statements about negative events, using words like ‘always’ and ‘never’ instead of ‘sometimes’ or ‘right now’. Look out for these words. Then work on collecting
all
the evidence, not just the negative.
Try to recognize that the way things are now is just how they are
now
.
Things seldom stay the same, and we can’t predict the future. Nothing is ever
always
the same.

Catastrophizing

I haven’t finished that project on time. My boss will be furious. I’ll lose my job! The mortgage won’t get paid. I’ll be homeless
…

When feeling low we often allow our thoughts to run away into the worst case scenario before anything has actually happened. We then tell ourselves that such scenarios are inevitable.
Try to take one thing at a time.
The worst doesn’t always happen, and catastrophizing makes our mood even lower. Instead, try to think about one thing at a time. You may be able to take measures to prevent the worst happening. Overwhelming yourself with catastrophes, however, means you are more likely to panic and so less likely to take effective action.

Black and white thinking

I am not perfect at work, therefore I am a failure
.

My home is not completely spotless, so I’m a slob
.

When we think in ‘all or nothing’ terms like this we feel inadequate or a failure. The problem with this is that not much in life is really ‘all or nothing’. Nobody can be perfect and if we always aim for this we will never be satisfied.
Try aiming for a good job, rather than perfection!
In fact, for minor things like washing the car, experiment with the idea that ‘good enough is good enough’.

Mind-reading

Rob didn’t phone. He thinks I’m an idiot
.

Mum didn’t say I looked nice. She thinks I’m fat and ugly
.

Try as we might we can’t actually read other’s thoughts – a psychologist’s job would be much easier if we could! Sometimes we can be reasonably good at reading people, but when we are depressed our negative bias kicks in. We tend to assume we
know
people are thinking negative things. Any ideas why else Rob didn’t call? Maybe he was just busy and actually feels bad for not having had time to call, because he likes you. Perhaps Mum did think you looked good but was preoccupied, or just forgot to say so.
Don’t jump to conclusions based on biased appraisals.

Emotional reasoning

I feel upset and anxious about work. That must mean something is really wrong. I am obviously doing really badly
.

Sometimes the way we feel about something isn’t the best guide to how it really is. Try looking at the facts instead of using your feelings as a guide. Ask someone else who isn’t experiencing this emotional reaction what they think.
Weigh up the evidence separately from how something
feels
.

Do you recognize any of these thinking biases? They are very common ways of thinking when we get low in mood, distorting the way we see things, maintaining, prolonging and deepening depression.

CBT sometimes gets accused of being ‘just positive thinking’. Actually the way CBT views thoughts is that we should try to re-evaluate them, not making them ‘positive’, but finding a more realistic, balanced way of viewing and interpreting events. Rarely is any situation either all good or all bad. As Einstein wrote, ‘the world … is a product of our thinking; it cannot be changed without changing our thinking’.

A simple example
:

Look out the window. It’s pouring with rain.

An overly
negative
view would say:

It’s raining. It’s never going to stop. I’ll be stuck inside forever and I’ll never get to do what I want to do outside
.

An overly
positive
view would say:

Another lovely day! I’ll rush out right now and do what I want to do
.

A
realistic
or
balanced
view would say:

It’s raining, that’s disappointing – but it might stop in a couple of hours. If it doesn’t I can use an umbrella and still do some of the things I wanted
.

Watch out for distortions in the way you are thinking. Ask yourself – is there another way of seeing this? If I wasn’t so down right now would I still see it like this?

Finding balanced alternatives to negative thoughts

When you notice yourself feeling low, try to identify the negative automatic thoughts that are driving that mood. Write them down. Now ask yourself the following questions:

• Is there another way of looking at this?
  
• How might I view this if I was feeling more positive?
  
• How might I view this in a week’s/month’s/year’s time?
  
• What would someone else say about this? How might my partner/parent/sibling/friend view this?
  
• What is the evidence for this thought? Is my thinking distorted or biased in any way? Can I find any evidence that contradicts this thought? What am I missing?
  

Asking these questions will help you to evaluate your thoughts and to recognize that you may not be seeing things as clearly as you think.

Now, next to the thought you wrote down, list any alternative or balanced thoughts – different ways of looking at the situation which may not be as negative as your original thought.

Let’s look at how Linda balances her thoughts:

You won’t need to write down your thoughts forever, but it is important to practice this as a new skill when you are low. Writing things down in this way helps to develop a new habit of automatically balancing your thoughts, but without practice you’ll never get the hang of it.

Write it down – help yourself learn the new skill of balancing your thoughts through regular practice.

Silencing the critic

Lots of us use self-criticism as a tool to spur us on. Over the years we may have learnt that being tough on ourselves can sometimes help to motivate and get us moving when we are flagging. That voice in your head that says ‘come on lazy bones – you can’t lie around all day – get up and walk the dog/clean the car/call your mother’. We’re all familiar with this and can sometimes, in small doses, find it effective. The problem is that when you are low, this critic in your head turns into a bully who no longer has your best interests at heart and isn’t motivating, but attacking. Because this bully is part of you, they know exactly what upsets and worries you most and can pounce on those things in a way that just depresses you further.