The Feeling Good Handbook Page 8
Gail's experience is not unusual. The simple exercise of answering your negative thoughts with rational responses on a daily basis is at the heart of the cognitive method. It is one of the most important approaches to changing your thinking. It is crucial to write down your automatic thoughts and rational responses; do not try to do the exercise in your head. Writing them down forces you to develop much more objectivity than you could ever achieve by letting responses swirl through your mind. It also helps you locate the mental errors that depress you. The triple-column technique is not limited to problems of personal inadequacy, but can be applied to a great range of emotional difficulties in which distorted thinking plays a central role. You can take the major sting out of problems you would ordinarily assume are entirely "realistic,"
such as bankruptcy, divorce, or severe mental illness. Finally, in the section on prophylaxis and personal growth, you will learn how to apply a slight variation of the automatic-thought method to penetrate to the part of your psyche where the causes of mood swings lurk. You will be able to expose and transform those "pressure points" in your mind that cause you to be vulnerable to depression in the first place.
2. Mental Biofeedback. A second method which can be very useful involves monitoring your negative thoughts with a wrist counter. You can buy one at a sporting-goods store or a golf shop; it looks like a! wristwatch, is inexpensive, and every time you push the button, the number changes on the dial.
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FEELING GOOD
Click the button each time a negative thought about yourself crosses your mind; be on the constant alert for such thoughts.
At the end of the day, note your daily total score and write it down in a log book.
Figure 4-3. Excerpts from Gail's daily written homework using the "
triple-column technique." In the left column she recorded the negative thoughts that automatically flowed through her mind when her roommate asked her to cleadup the apartment. In the middle column she identified her distortions, and in the right-hand column she wrote down more realistic interpretations. This daily written exercise greatly accelerated her personal growth and resulted in substantial emotional relief.
Automatic Thoughts Cognitive Distortion
Rational Response
(sup-carnets/A)
(SELF-DEFENSE)
1. Everyone knows
Jumping to conclu-
1. I'm disorganized at
bow disorganized
sions (mind reading);
times and I'm or-
and selfish I am.
overgeneralization
ganized at times.
Everybody doesn't
think the same way
about me.
2. Fm completely
All-or-nothing think-
2. Fm thoughtless at
self-centered and
ing
times, and at times I
thoughtless. I'm
can be quite thought-
just no good.
ful. I probably do act
overly self-centered at
times. I can work on
this. I may be imper-
fect but I'm not "no
goodl"
3. My roommate
Jumping to conclu-
3. My friendships are
probably hates me. sions (mind reading);
just as real as any-
I have no real
allornothing
-
-
thinking
one's. At times I take
friends.
criticism as rejection
of me, Gail, the per-
son. But others are
usually not rejecting
me. They're just ex-
pressing dish le for
what I did (or said)
—and they still ac-
cept rat afterward.
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David D. Burns, M.D.
At first you will notice that the number increases; this will continue for several days as you get better and better at identifying your critical thoughts. Soon you will begin to notice that the daily total reaches a plateau for a week to ten days, and then it will begin to go down. This indicates that your harmful thoughts are diminishing and that you are getting better. This approach usually requires three weeks.
It is not known with certainty why such a simple technique works so well, but systematic self-monitoring frequently helps develop increased self-control. As you learn to stop haranguing yourself, you will begin to feel much better.
In case you decide to use a wrist counter, I want to emphasize it is not intended to be a substitute for setting aside ten to fifteen minutes each day to write down your distorted negative thoughts and answering them as outlined in the previous pages. The written method cannot be bypassed because it exposes to the light of day the illogical nature of the thoughts that trouble you. Once you are doing this regularly, you can then use your wrist counter to nip your painful cognitions in the bud at other times.
3. Cope, Don't Mope—The Woman Who Thought She
Was a "Bad Mother." As you read the previous sections, the following objection may have occurred to you: "All this deals with is my thoughts. But what if my problems are realistic?
What good will it do me to think differently? I have some real inadequacies that need to be dealt with."
Nancy is a thirty-four-year-old mother of two who felt this way. Six years ago she divorced her first husband and has just recently remarried. She is completing her college degree on a part-time basis. Nancy is usually animated and enthusiastic and quite committed to her family. However, she has experienced episodic depressions for many years. During those low periods she becomes extremely critical of herself and others, and expresses self-doubt and insecurity. She was referred to me during such a period of depression.
I was struck by the vehemence of her self-reproach. She had received a note from her son's teacher stating that he was having some difficulty in school. Her immediate reaction was to mope and blame herself. The following is an excerpt from our therapy session:
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FEELING GOOD
NANCY: I should have worked with Bobby on his homework because now he is disorganized and not ready for school. I spoke to Bobby's teacher, who said Bobby lacks self-confidence and doesn't follow directions adequately.
Consequently, his schoolwork has been deteriorating. I had a number of self-critical thoughts after the call and I felt suddenly dejected. I began to tell myself that a good mother spends time with her kids on some activity every night. I'm responsible for his poor behavior—lying, not doing well in school. I just can't figure out how to handle him. I'm really a bad mother. I began to think he was stupid and about to flunk and how it was all my fault.
My first strategy was to teach her how to attack the statement "I am a bad mother," because I felt this self-criticism was hurtful and unrealistic, creating a paralyzing internal anguish which would not help her in her efforts to guide Bobby through his crisis.
DAVID. Okay. What's wrong with this statement, "I am a bad mother"?
NANCY: Well ...
DAVID: Is there any such thing as a: "bad mother"?
NANCY: Of course.
DAVID: What is your definition of a "bad mother"?
NANCY: A bad mother is one who does a bad job of raising her kids. She isn't as effective as other mothers, so her kids turn out bad. It seems obvious.
DAVID: So you would say a "bad mother" is one who is low on mothering skills? That's your definition?
NANCY: Some mothers lack mothering skills.
DAVID: But all mothers lack mothering skills to some extent.
NANCY: They do?
DAVID: There's no mother in this world who is perfect in all mothering skills. So they all lack mothering skills in some part. According to your definition, it would seem that all mothers are bad mothers.
NANCY: I feel that I'm a bad mother, but
not everybody is.
DAVID: Well, define it again. What is a "bad mother"?
67
David D. Burns, M.D.
NANCY: A bad mother is someone who does not understand her children or is constantly making damaging errors. Errors that are detrimental.
DAVID: According to this new definition, you're not a "bad mother," and there are no "bad mothers" because no one constantly makes damaging errors.
NANCY: No one ... ?
DAVID: You said that a bad mother constantly makes damaging errors. There is no such person who constantly makes damaging errors twenty-four hours a day. Every mother is capable of doing some things right.
NANCY: Well, there can be abusive parents who are always punishing, hitting—you read about them in the papers.
Their children end up battered. That could certainly be a bad mother.
DAVID: There are parents who resort to abusive behavior, that's true. And these individuals could improve their behavior, which might make them feel better about themselves and their children. But it's not realistic to say that such parents are constantly doing abusing or damaging things, and it's not going to help matters by attaching the label "bad" to them. Such individuals do have a problem with aggression and need training in self-control, but it would only make matters worse if you tried to convince them that their problem was badness. They usually already believe they are rotten human beings, and that is part of their problem. Labeling them as "bad mothers" would be inaccurate, and it would also be irresponsible, like trying to put out a fire by throwing gasoline on it.
At this point I was trying to show Nancy that she was just defeating herself by labeling herself as a "bad mother." I hoped to show her that no matter how she defined "bad mother," the definition would be unrealistic. Once she gave up the destructive tendency to mope and label herself as worthless, we could then go on to coping strategies for helping her son with his problems at school.
NANCY: But I still have the feeling I am a "bad mother."
DAVID: Well, once again, what is your definition?
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FEELING GOOD
NANCY: Someone who doesn't give her child enough attention, positive attention. Pm so busy in school. And when I do pay attention, Fm afraid it may be all negative attention. Who knows? That's what I'm saying.
DAVID: A "bad mother" is one who doesn't give her child enough attention, you say? Enough for what?
NANCY: For her child to do well in life.
DAVID: Do well in everything, or in some things?
NANCY: In some things. No one can do well at everything.
DAVID: Does Bobby do well at some things? Does he have any redeeming virtues?
NANCY: Oh yes. There are many things he enjoys and does well at.
DAVID: Then you can't be a "bad mother" according to your definition because your son does well at many things.
NANCY: Then why do I feel like a bad mother?
DAVID: It seems that you're labeling yourself as a "bad mother" because you'd like to spend more time with your son, and because you sometimes feel inadequate, and because there is a clear-cut need to improve your communication with Bobby. But it won't help you solve these problems if you conclude automatically you are a "
bad mother." Does that make sense to you?
NANCY: If I paid more attention to him and gave him more help, he could do better at school and he could be a whole lot happier. I feel it's my fault when he doesn't do well.
DAVID: So you are willing to take the blame for his mistakes?
NANCY: Yes, it's my fault. So I'm a bad mother.
DAVID: And you also take the credit for his achievements?
And for his happiness?
NANCY: No—he should get the credit for that, not me.
DAVID: Does that make sense? That you're responsible for his faults but not his strengths?
NANCY: No.
DAVID: Do you understand the point I'm trying to make?
NANCY: Yep.
DAVID: "Bad mother" is an abstraction; there is no such thing as a "bad mother" in this universe.
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David D. Burns, M.D.
NANCY: Right. But mothers can do bad things.
DAVID: They're just people, and people do a whole variety of things—good, bad, and neutral. "Bad mother" is just a fantasy; there's no such thing. The chair is a thing.
A "bad mother" is an abstraction. You understand that?
NANCY: I got it, but some mothers are more experienced and more effective than others.
DAVID: Yes, there are all degrees of effectiveness at parenting skills. And most everyone has plenty of room for improvement. The meaningful question is not "Am I a good or bad mother?" but rather "What are my relative skills and weaknesses, and what can I do to improve?"
NANCY: I understand. That approach makes more sense and it feels much better. When I label myself "bad mother," I just feel inadequate and depressed, and I don't do anything productive. Now I see what you've been driving at. Once I give up criticizing myself, I'll feel better, and maybe I can be more helpful to Bobby.
DAVID: Right! So when you look at it that way, you're talking about coping strategies. For example, what are your parenting skills? How can you begin to improve on those skills? Now that's the type of thing I would suggest with regard to Bobby. Seeing yourself as a "bad mother" eats up emotional energy and distracts you from the task of improving your mothering skills. It's irresponsible.
NANCY: Right. If I can stop punishing myself with that statement, I'll be much better off and I can start working toward helping Bobby. The moment I stop calling myself bad mother, I'll start feeling better.
DAVID: Yes, now what can you say to yourself when you have the urge to say "I'm a bad mother"?
NANCY: I can say I don't have to hate my whole self if there is a particular thing I find I dislike about Bobby, or if he has a problem at school. I can try to define that problem, and attack that problem, and work toward solving it.
DAVID: Right. Now, that's a positive approach. I like it.
You refute the negative statement and then add a positive statement. I like that.
70
Figure 4-4. Nancy's written homework concerning Bobby's difficulties at school. This is similar to the "triple-column technique," except that she did not find it necessary to write down the cognitive distortions contained in her automatic thoughts.
Automatic Thought
Rational Response
(SELF-CRITICISM)
(SELF-DEFENSE)
1. I didn't pay attention to Bobby.
1. I really spend too much time with
him; I'm overprotective.
2. I should have worked with him 2. Homework is his responsibility, on his homework, and now he is
not mine. I can explain to him
disorganized and not ready for
how to get organized. What are
school.
my responsibilities?
a. Check homework;
b. Insist it be done at a certain
time;
c. Ask if he's having any diffi-
culties;
d. Set up a reward system.
3. A good mother spends time with 3. Not true. I spend time when I her kids on some activity every
can and want to, but it isn't
night.
feasible always. Besides, his
schedule is his.
4. I'm responsible for his poor be- 4. I can only guide Bobby. It's up to havior and not doing well in
him to do the rest.
school.
5. He wouldn't have gotten into
5. That is not so. Problems will
trouble at school if I had helped
occur even if I'm around to over-
him. If I had supervised his
see things.
homework earlier, this problem
wouldn't have occurred.
6. I'm a bad mother. I'm the cause
&nb
sp; 6. I'm not a bad mother; I try. I of his problems.
can't control what goes on in all
areas of his life. Maybe I can
talk to him and his teacher and
find out how to help him. Why
punish myself whenever someone
I love has a problem?
7. All other mothers work with
7. Overgeneralization! Not true.
their kids, but I don't know how
Stop moping and start coping.
to get along with Bobby.
71
David D. Burns, M.D.
We then worked on answering several "automatic thoughts" she had written down after the call from Bobby's teacher (see Figure 4-4, page 71). As Nancy learned to refute her self-critical thoughts. she experienced much-needed emotional relief. She was then able to develop some specific coping strategies designed to help Bobby with his difficulties.
The first step of her coping plan was to talk to Bobby about the difficulties he had been having so as to find out what the real problem was. Was he having difficulties as his teacher had suggested? What was his understanding of the problem? Was it true that he was feeling tense and low in confidence" Had his homework been particularly hard for him recently? Once Nancy had obtained this information and defined the real problem, she realized she would then be in a position to work toward an appropriate solution. For example, if Bobby said he found some of his courses particularly difficult, she could develop a reward system at home to encourage him to do extra homework. She also decided to read several books on parenting skills. Her relationship with Bobby improved, and his grades and behavior at school underwent a rapid turnabout.
Nancy's mistake had been to view herself in a global way, making the moralistic judgment that she was a bad mother.
This type of criticism incapacitated her because it created the impression that she had a personal problem so big and bad that no one could do anything about it. The emotional upset this labeling caused prevented her from defining the real problem, breaking it down into its specific parts, and applying