The Feeling Good Handbook Page 9

  appropriate solutions. If she had continued to mope, there was the distinct possibility that Bobby would have continued to do poorly, and she would have become increasingly ineffectual.

  How can you apply what Nancy learned to your own situation? When you are down on yourself, you might find it helpful to ask what you actually mean when you try to define your true identity with a negative label such as "a fool," "a sham," "a stupid dope," etc. Once you begin to pick these destructive labels apart, you will find they are arbitrary and meaningless They actually cloud the issue, creating confusion and despair. Once rid of them, you can define and cope with any real problems that exist.

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  Summary. When you are experiencing a blue mood, the chances are that you are telling yourself you are inherently inadequate or just plain "no good." You will become convinced that you have a bad core or are essentially worthless.

  To the extent that you believe such thoughts, you will experience a severe emotional reaction of despair and self-hatred.

  You may even feel that you'd be better off dead because you are so unbearably uncomfortable and self-denigrating. You may become inactive and paralyzed, afraid and unwilling to participate in the normal flow of life.

  Because of the negative emotional and behavioral consequences of your harsh thinking the first step is to stop telling yourself you are worthless However, you probably won't be able to do this until you become absolutely convinced that these statements are incorrect and unrealistic.

  How can this be accomplished? You must first consider that a human life is an ongoing process that involves a constantly changing physical body as well as an enormous number of rapidly changing thoughts feelings, and behaviors.

  Your life therefore is an evolving experience, a continual flow. You are not a thing; that's why any label is constricting, highly inaccurate, and global. Abstract labels such as "

  worthless" or "inferior" communicate nothing and mean

  nothing.

  But you may still be convinced you are second-rate.

  What is your evidence? You may reason, "I feel inadequate.

  Therefore, I must be inadequate. Otherwise, why would I be filled with such unbearable emotions?" Your error is in emotional reasoning. Your feelings do not determine your worth, simply your relative state of comfort or discomfort.

  Rotten, miserable internal states do not prove that you are a rotten, worthless person, merely that you think you are; because you are in a temporarily depressed mood, you are thinking illogically and unreasonably about yourself.

  Would you say that states of mood elevation and happiness prove you are great or especially worthy? Or do they simply mean that you are feeling good?

  Just as your feelings do not determine your worth, neither do your thoughts or behaviors. Some may be positive, creative, and enhancing; the great majority are neutral. Others may be irrational, self-defeating, and maladaptive. These can

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  David D. Burns, M.D.

  be modified if you are willing to exert the effort, but they certainly do not and cannot mean that you are no good. There is no such thing in this universe as a worthless human being.

  "Then how can I develop si sense of self-esteem?" you may ask. The answer is—you don't have to! You don't have to do anything especially worthy to create or deserve self-esteem; all you have to do is turn off that critical, haranguing, inner voice. Why? Because that critical inner voice is wrong! Your internal self-abuse springs from illogical, distorted thinking.

  Your sense of worthlessness is not based on truth, it is just the abscess which lies at the core of depressive illness.

  So remember three crucial steps when you are upset: 1. Zero in on those automatic negative thoughts and write them down. Don't let them buzz around in your head; snare them on paper!

  2. Read over the list of ten cognitive distortions. Learn precisely how you are twisting things and blowing them out of proportion.

  3. Substitute a more objective thought that puts the lie to the one which made you look down on yourself. As you do this, you'll begin to feel better. You'll be boosting your self-esteem, and your sense of worthlessness (and, of course, your depression) will disappear.

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  CHAPTER 5

  Do-Nothingism: How to Beat It

  In the last chapter you learned that you can change your mood by changing how you think. There is a second major approach to mood elevation that is enormously effective.

  People are not only thinkers, they are doers, so it is not surprising that you can substantially change the way you feel by changing the way you act. There's only one hitch—when you're depressed, you don't feel like doing much.

  One of the most destructive aspects of depression is the way it paralyzes your willpower. In its mildest form you may simply procrastinate about doing a few odious chores. As your lack of motivation intensifies, virtually any activity appears so difficult that you become overwhelmed by the urge to do nothing. Because you accomplish very little, you feel worse and worse. Not only do you cut yourself off from your normal sources of stimulation and pleasure, but your lack of productivity aggravates your self-hatred, resulting in further isolation and incapacitation.

  If you don't recognize the emotional prison in which you are trapped, this situation can go on for weeks, months, or even years. Your inactivity will be all the more frustrating if you once took pride in the energy you had for life. Your do-nothingism can also affect your family and friends, who, like yourself, cannot understand your behavior. They may say that you must want to be depressed or else you'd "get off your behind." Such a comment only worsens your anguish and paralysis.

  Do-nothingism represents one of the great paradoxes of human nature. Some people naturally throw themselves into life with great zest, while others always hang back, defeating 75

  David D. Burns, M.D.

  themselves at every turn as if they were involved in a plot against themselves. Do you ever wonder why?

  If a person were condemned to spend months in isolation, cut off from all normal activities and interpersonal relationships, a substantial depression would result. Even young mon-keys slip into a retarded, withdrawn state if they are separated from their peers and confined to a small cage. Why do you voluntarily impose a similar punishment on yourself?

  Do you want to suffer? Using cognitive techniques, you can discover the precise reasons for your difficulties in motivating yourself.

  In my practice I find that the great majority of the depressed patients referred to me improve substantially if they try to help themselves. Sometimes it hardly seems to matter what you do as long as you do something with the attitude of self-help. I know of two presumably "hopeless"

  cases who were helped enormously simply by putting a mark on a piece of paper. One patient was an artist who had been convinced for years that he couldn't even draw a straight line. Consequently he didn't even try to draw. When his therapist suggested he test his conviction by actually attempting to draw a line, it came out so straight he began drawing again and soon was symptom-free! And yet many depressed individuals will go through a phase in which they stubbornly re fuse to do anything to help themselves. The moment this crucial motivational problem has been solved, the depression typically begins to diminish. You can therefore understand why much of our research has been directed to locating the causes of this paralysis of the will. Using this knowledge, we have developed some specific methods to help you deal with procrastination.

  Let me describe two perplexing patients I treated recently.

  You might think their do-nothingism is extreme and wrongly conclude they must be "crazies" with whom you would have little in common. In fact, I believe their problems are caused by attitudes similar to yours, so don't write them off.

  Patient A, a twenty-eight-year-old woman, has done an experiment to see how her mood would respond to a variety of activities. It turns out that she feels substantially better when she
does nearly anything. The list of things that will reliably give her a mood lift includes cleaning the house, playing ten-76

  FEELING GOOD

  nis, going to work, practicing her guitar, shopping for dinner, etc. Only one thing makes her feel reliably worse; this single activity nearly always makes her intensely miserable. Can you guess what it is? DO-NOTHINGISM: lying around in bed all day long, staring at the ceiling and courting negative thoughts. And guess what she does weekends. Right! She crawls right into bed on Saturday morning and begins her descent into inner hell. Do you think she really wants to suffer?Patient B, a physician, gives me a clear, definite message early in her therapy. She says she understands that the speed of improvement is dependent on her willingness to work between sessions, and insists she wants to get well more than anything else in the world, having been wracked by depression for over sixteen years. She emphasizes she'll be happy to come to therapy sessions, but I must not ask her to lift one finger to help herself. She says that if I push her to spend five minutes on self-help assignments, she'll kill herself.

  As she describes in detail the lethal, gruesome method of self-destruction she had carefully planned in her hospital's operating room, it become obvious that she is deadly serious.

  Why is she so determined not to help herself?

  I know your procrastination is probably less severe and only deals with minor things, like paying bills, a trip to the dentist, etc. Or maybe you've had trouble finishing a relatively straightforward report that is crucial to your career.

  But the perplexing question is the same—why do we frequently behave in ways that are not in our self-interest?

  Procrastinating and self-defeating behavior can seem funny, frustrating, puzzling, infuriating, or pathetic, depending on your perspective. I find it a very human trait, so widespread that we all bump into it nearly every day. Writers, philosophers, and students of human nature throughout history have tried to formulate some explanation for self-defeating behavior, including such popular theories as: 1. You're basically lazy; it's just your "nature."

  2. You want to hurt yourself and suffer. You either like feeling depressed, or you have a self-destructive drive, a "

  death wish."

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  David D. Burns, M.D.

  3. You're passive-aggressive, and you want to frustrate the people around you by doing nothing.

  4. You must be getting some "payoff" from your procrastination and do-nothingism. For example, you enjoy getting all that attention when you are depressed.

  Each of these famous explanations represents a different psychological theory, and each is inaccurate! The first is a "

  trait" model; your inactivity is seen as a fixed personality trait and stems from your "lazy streak." The problem with this theory is that it just labels the problem without explaining it. Labeling yourself as "lazy" is useless and self-defeating because it creates the false impression that your lack of motivation is an irreversible, innate part of your makeup. This kind of thinking does not represent a valid scientific theory, but is an example of a cognitive distortion (labeling).

  The second model implies you want to hurt yourself and suffer because there is something enjoyable or desirable about procrastination. This theory is so ludicrous I hesitate to include it, except that it is widespread and vigorously supported by a substantial percentage of psychotherapists. If you have the hunch that you or someone else likes being depressed and doing nothing, then remind yourself that depression is the most agonizing form of human suffering. Tell me—what is so great about it? I haven't yet met a patient who really enjoys the misery.

  If you aren't convinced but think you really do enjoy pain and suffering, then give yourself the paper-clip test.

  Straighten out one end of a paper clip and push it under your fingernail. As you push harder and harder, you may notice how the pain becomes more and more excruciating. Now ask yourself—is this really enjoyable? Do I really like to suffer?

  The third hypothesis—you're "passive-aggressive"--rep-resents the thinking of many therapists, who believe that depressive behavior can be explained on the basis of "in-ternalized anger." Your procrastination could be seen as an expression of that pent-up hostility because your inaction often annoys the people around you. One problem with this theory is that most depressed or procrastinating individuals simply do not feel particularly angry. Resentment can sometimes contribute to your lack of motivation, but is usu-78

  FEELING GOOD

  ally not central to the problem. Although your family may feel frustrated about your depression, you probably do not intend them to react this way. In fact, it is more often the case that you fear displeasing them. The implication that you are

  intentionally doing nothing in order to frustrate them is insulting and untrue; such a suggestion will only make you feel worse.

  The last theory—you must be getting some "payoff" from procrastination—reflects more recent, behaviorally oriented psychology. Your moods and actions are seen as the result of rewards and punishments from your environment. If you are feeling depressed and doing nothing about it, it follows that your behavior is being rewarded in some way.

  There is a grain of truth in this; depressed people do sometimes receive substantial support and reassurance from others who try to help them. However, the depressed person rarely enjoys all the attention he receives because of his profound tendency to disqualify it. If you are depressed and someone tells you they like you, you will probably think, "He doesn't know how rotten I am. I don't deserve this praise." Depression and lethargy have no real rewards. Theory number four bites the dust with the others.

  How can you find the real cause of motivational paralysis?

  The study of mood disorders gives us the unique opportunity to observe extraordinary transformations in levels of personal motivation within short periods of time. The same individual who ordinarily bursts with creative energy and optimism may be reduced during an episode of depression to pathetic, bedridden immobility. By tracing dramatic mood swings, we can gather valuable clues that unlock many of the mysteries of human motivation. Simply ask yourself, "

  When I think about that undone task, what thoughts immediately come to mind?" Then write those thoughts down on a piece of paper. What you write will reflect a number of maladaptive attitudes, misconceptions, and faulty assumptions. You will learn that the feelings that impede your motivation, such as apathy, anxiety, or the sense of being overwhelmed, are the result of distortions in your thinking.

  Figure 5-1 shows a typical Lethargy Cycle. The thoughts on this patient's mind are negative; he says to himself, "

  There's no point in doing anything because I am a born

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  David D. Burns, M.D.

  SELF-DEFEATING

  THOUGHTS: "There's no

  point In doing anything. I don't

  have the energy. I'm not in the mood. Fit probably fail if I try.

  Things are too difficult. There

  wouldn't be any satisfaction if I

  did anything anyway. I don't feel

  like doing anything, so I don't

  have to. FE just lie here in bed

  for a while. I can sleep and forget

  about things. It's much easier.

  Rest is best."

  T

  SELF-DEFEATING EMO-

  SELF-DEFEATING ACTIONS!

  TION& You feel tired, bored,

  You stick to bed. You avoid

  apathetic, self-hating, discour-

  ■Iel,

  — people, work, and all potentially

  aged, guilty, helpless, worthless,

  satisfying activities.

  and overwhelmed.

  CONSEQUENCES OF THE

  LETHARGY CYCLE: You

  become isolated from friends.

  This convinces you that you

  really are a loser. Your decreased

  productivity convinces you that

  you actually are inadequate.
You

  sink deeper and deeper into an

  unmotivated state of paralysis.

  Figure 5-1. The Lethargy Cycle. Your self-defeating negative thoughts make you feel miserable. Your painful emotions in turn convince you that your distorted, pessimistic thoughts are actually valid. Similarly, self-defeating thoughts and actions reinforce each other in a circular manner.

  The unpleasant consequences of do-nothingism make your problems even worse.

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  FEELING GOOD

  loser and so I'm bound to fail." Such a thought sounds very convincing when you are depressed, immobilizing you and making you feel inadequate, overwhelmed, self-hating, and helpless. You then take these negative emotions as proof that your pessimistic attitudes are valid, and you begin to change your approach to life. Because you are convinced you will botch up anything, you don't even try; you stay in bed instead. You lie back passively and stare at the ceiling, hoping to drift into sleep, painfully aware you are letting your career go down the drain while your business dwindles into bankruptcy. You may refuse to answer the phone for fear of hearing bad news; life becomes a treadmill of boredom, apprehension, and misery. This vicious cycle can go on indefinitely unless you know how to beat it.

  As indicated in Figure 5-1, the relationship between your thoughts, feelings, and behaviors is reciprocal—all your emotions and actions are the results of your thoughts and attitudes. Similarly, your feelings and behavior patterns influence your perceptions in a wide variety of ways. It follows from this model that all emotional change is ultimately brought about by cognitions; changing your behavior will help you feel better about yourself if it exerts a positive influence on the way you are thinking. Thus, you can modify your self-defeating mental set if you change your behavior in such a way that you are simultaneously putting the lie to the self-defeating attitudes that represent the core of your motivational problem. Similarly, as you change the way you think, you will feel more in the mood to do things, and this will have an even stronger positive effect on your thinking patterns. Thus, you can transform your lethargy cycle into a productivity cycle.