It is also important for you to look at question 20, which asks if you have been more worried about your health recently. Have you experienced any unexplained aches, pains, fever, weight loss, or other possible symptoms of medical illness? If so, it would be worthwhile to have a medical consultation, which would include a history, a complete physical 24
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examination, and laboratory tests. Your doctor will probably give you a clean bill of health. This will suggest that your uncomfortable physical symptoms are related to your emotional state. Depression can mimic a great number of medical disorders because your mood swings often create a wide variety of puzzling physical symptoms. These include to name just a few, constipation diarrhea pain, insomnia or the tendency to sleep too much fatigue, loss of sexual interest. lightheadedness, trembling and numbness As your depression improves, these symptoms will in all likelihood vanish. However, keep in mind that many treatable illnesses may initially masquerade as depression, and a medical examination could reveal an early (and life-saving) diagnosis of a reversible organic disorder.
There are a number of symptoms that indicate—but do not prove—the existence of a serious mental disturbance, and these require a consultation with and possible treatment by a mental-health professional, in addition to the self-adminis-tered personal-growth program in this book. Some of the major symptoms include: the belief that people are plotting and conspiring against you in order to hurt you or take your life; a bizarre experience which the ordinary person cannot understand; the conviction that external forces are controlling your mind or body; the feeling that other people can hear your thoughts or read your mind; hearing voices from outside your head; seeing things that aren't there; and receiving personal messages broadcast from radio or television programs.
These symptoms are not a part of depressive illness, but represent major mental disorders. Psychiatric treatment is a must. Quite often, people with these symptoms are convinced that nothing is wrong with them, and may meet the suggestion to seek psychiatric therapy with suspicious resentment and resistance. In contrast, if you are harboring the deep fear that you are going insane and are experiencing episodes of panic in which you sense you are losing control or going over the deep end, it is a near certainty that you are not. These are typical symptoms of ordinary anxiety, a much less serious disorder.
Mania is a special type of mood disorder with which you should be familiar. Mania is the opposite of depression and 25
David D. Burns, M.D.
requires prompt intervention by a psychiatrist who can prescribe lithium. Lithium stabilizes extreme mood swings and allows the patient to lead a normal life. However, until therapy is initiated, the disease can be emotionally destructive. The symptoms include an abnormally elated or irritable mood that persists for at least two days and is not caused by drugs or alcohol. The manic patient's behavior is characterized by impulsive actions which reflect poor judgment (such as irresponsible, excessive spending) along with a grandiose sense of self-confidence. Mania is accompanied by increased sexual or aggressive activity; hyperactive, continuous body movements; racing thoughts, nonstop, excited talking; and a decreased need to sleep. Manic individuals have the delusion that they are extraordinarily powerful and brilliant, and often insist they are on the verge of some philosophical or scientific breakthrough or lucrative money-making scheme. Many famous creative individuals suffer from this illness and manage to control it with lithium. Because the disease feels so good, individuals who are having their first attack often cannot be convinced to seek treatment. The first symptoms are so hi-toxicating that the victim resists accepting the idea that his or her sudden acquisition of self-confidence and inner ecstasy is actually just a manifestation of a destructive illness.
After a while, the euphoric state may escalate into uncontrollable delirium requiring involuntary hospitalization, or it may just as suddenly switch into an incapacitating depression with pronounced immobility and apathy. I want you to be familiar with the symptoms of mania because a significant percentage of individuals who experience a true major depressive episode will at some later time develop these symptoms. When this occurs, the personality of the afflicted individual undergoes a profound transformation over a period of days or weeks. While psychotherapy and a self-help program can be extremely helpful, concomitant treatment with lithium under medical supervision is a must for an optimal response. With such treatment the prognosis for manic illness is excellent.
Let's assume that your score on the BDI test is under seventeen, and you do not have a strong suicidal urge, hallucinations, or symptoms of mania. Instead of moping and
26
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feeling miserable, you can now proceed to get better, using the methods outlined in this book. You can start enjoying life and work, and use the energy spent in being depressed for vital and creative living.
27
CHAPTER 3
Understanding Your Moods:
You Feel the Way You Think
As you read the previous chapter, you became aware of how extensive the effects of depression are—your mood slumps, your self-image crumbles, your body doesn't function properly, your willpower becomes paralyzed, and your actions defeat you. That's why you feel so totally down in the dumps. What's the key to it all?
Because depression has been viewed as an emotional disorder throughout the history of psychiatry, therapists from most schools of thought place a strong emphasis on "getting in touch" with your feelings. Our research reveals the unexpected: Depression is not an emotional disorder at all! The sudden change in the way you feel is of no more casual relevance than a runny nose is when you have a cold. Every bad feeling you have is the result of your distorted negative thinking. Illogical pessimistic attitudes play the central role in the development and continuation of all your symptoms.
Intense negative thinking always accompanies a depressive episode, or any painful emotion for that matter. Your moody thoughts are likely to be entirely different from those you have when you are not upset. A young woman, about to receive her Ph.D., expressed it this way:
Every time I become depressed, I feel as if I have been hit with a sudden cosmic jolt, and I begin to see things differently. The change can come within less than an hour. My thoughts become negative and pessimistic. As I look into the past, I become convinced that everything that I've ever done is worthless. Any happy period seems like an illusion. My accomplishments appear as genuine 28
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as the false facade for the set of a Western movie. I become convinced that the real me is worthless and inadequate. I can't move forward with my work because I become frozen with doubt. But I can't stand still because the misery is unbearable.
You will learn, as she did, that the negative thoughts that food your mind are the actual cause of your self-defeating emotions. These thoughts are what keep you lethargic and make you feel inadequate. Your negative thoughts, or cognitions, are the most frequently overlooked symptoms of your depression. These cognitions contain the key to relief and are therefore your most important symptoms.
Every time you feel depressed about something, try to identify a corresponding negative thought you had just prior to and during the depression. Because these thoughts have actually created your bad mood, by learning to restructure them, you can change your mood.
You are probably skeptical of all this because your negative thinking has become such a part of your life that it has become automatic. For this reason I call negative thoughts àutomatic thoughts." They run through your mind automatically without the slightest effort on your part to put them there. They are as obvious and natural to you as the way you bold a fork.
The relationship between the way you think and the way you feel is diagramed in Figure 3-1. This illustrates the first major key to understanding your moods: Your emotions result entirely from the way you look at things. It is an obvious neurological fact that before you can experience any event, you mus
t process it with your mind and give it meaning. You must understand what is happening to you before !
vu can feel it.
If your understanding of what is happening is accurate, Four emotions will be normal. If your perception is twisted and distorted in some way, your emotional response will be abnormal. Depression falls into this category. It is always the result of mental "static"—distortions. Your blue moods can be compared to the scratchy music coming from a radio that is not properly tuned to the station. The problem is not that the tubes or transistors are blown out or defective, or that the 29
David D. Burns, M.D.
Figure 3-1. The relationship between the world and the way you feel.
It is not the actual events but your perceptions that result in changes in mood. When you are sad, your thoughts will represent a realistic interpretation of negative events. When you are depressed or anxious, your thoughts will always be illogical, distorted, unrealistic, or just plain wrong.
THOUGHTS: You interpret the
events with a series of thoughts
that continually flow through
your mind. This Li called your "
internal dialogue."
WORLD: A series of positive, I
MOOD: Your feelings aro
neutral, and negative events.
created by your Martha and not the actual anon AU experiences mutt be proceued through your
brain sad gins • conscious
meaning Were you mains*
any ensthional response.
signal from the radio station is distorted as a result of bad weather. You just simply have to adjust the dials. When you learn to bring about this mental tuning, the music will come through clearly again and your depression will lift.
Some readers—maybe you—will experience a pang of despair when they read that paragraph. Yet there is nothing upsetting about it. If anything, the paragraph should bring hope. Then what caused your mood to plunge as you were reading? It was your thought, "For other people a little tuning may suffice. But I'm the radio that is broken beyond repair. My tubes are blown out. I don't care if ten thousand other depressed patients all get well—I'm convinced beyond any shadow of doubt that my problems are hopeless." I hear this statement fifty times a week! Nearly every depressed person seems convinced beyond all rhyme or reason that he or she is the special one who really is beyond hope. This delusion reflects the kind of mental processing that is at the very core of your illness!
I have always been fascinated by the ability certain people 30
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have to create illusions. As a child, I used to spend hours at the local library, reading books on magic. Saturdays I would bang out in magic stores for hours, watching the man behind the counter produce remarkable effects with cards and silks and chromium spheres that floated through the air, defying all the laws of common sense. One of my happiest childhood memories is when I was eight years old and saw "Black-stone—World's Greatest Magician" perform in Denver, Colorado. I was invited with several other children from the audience to come up on stage. Blackstone instructed us to place our hands on a two-feet by two-feet birdcage filled with live white doves until the top, bottom, and all four sides were enclosed entirely by our hands. He stood nearby and said, "
Stare at the cage!" I did. My eyes were bulging and I refused to blink. He exclaimed, "Now I'll clap my hands." He did. In that instant the cage of birds vanished. My hands were suspended in empty air. It was impossible! Yet it happened! I was stunned.
Now I know that his ability as an illusionist was no greater than that of the average depressed patient. This includes you.
When you are depressed, you possess the remarkable ability to believe, and to get the people around you to believe, things which have no basis in reality. As a therapist, it is my job to penetrate your illusion, to teach you how to look behind the mirrors so you can see how you have been fooling yourself.
You might even say that I'm planning to dis-illusion you! But I don't think you're going to mind at all.
Read over the following list of ten cognitive distortions that form the basis of all your depressions. Get a feel for them. I have prepared this list with great care; it represents the distilled essence of many years of research and clinical experience. Refer to it over and over when you read the how-to-do-it section of the book. When you are feeling upset, the list will be invaluable in making you aware of how you are fooling yourself.
Definitions of Cognitive Distortions
I. All-or-Nothing Thinking. This refers to your tendency to evaluate your personal qualities in extreme, black-or-white 31
David D. Burns, M.D.
categories. For example, a prominent politician told me, "Be-cause I lost the race for governor, I'm a zero." A straight-A student who received a B on an exam concluded, "Now I'm a total failure." All-or-nothing thinking forms the basis for perfectionism. It causes you to fear any mistake or imperfection because you will then see yourself as a complete loser, and you will feel inadequate and worthless.
This way of evaluating things is unrealistic because life is rarely completely either one way or the other. For example, no one is absolutely brilliant or totally stupid. Similarly, no one is either completely attractive or totally ugly. Look at the floor of the room you are sitting in now. Is it perfectly clean?
Is every inch piled high with dust and dirt? Or is it partially clean? Absolutes do not exist in this universe. If you try to force your experiences into absolute categories, you will be constantly depressed because your perceptions will not con-form to reality. You will set yourself up for discrediting yourself endlessly because whatever you do will never measure up to your exaggerated expectations. The technical name for this type of perceptual error is "dichotomous thinking." You see everything as black or white—shades of gray do not exist.
2. Overgeneralization. When I was eleven years old, I bought a deck of trick cards at the Arizona State Fair called the Svengali Deck. You may have seen this simple but impressive illusion yourself: I show the deck to you—every card is different. You choose a card at random. Let's assume you pick the Jack of Spades. Without telling me what card it is, you replace it in the deck. Now I exclaim, "Svengalil" As I turn the deck over, every card has turned into the Jack of Spades.
When you overgeneralize, this is performing the mental equivalent of Svengali. You arbitrarily conclude that one thing that happened to you once will occur over and over again, will multiply like the Jack of Spades. Since what happened is invariably unpleasant, you feel upset.
A depressed salesman noticed bird dung on his car window and thought, "That's just my luck. The birds are always crapping on my windowl" This is a perfect example of overgeneralization. When I asked him about this experience, he 32
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admitted that in twenty years of traveling, he could not remember another time when he found bird dung on his car window.
The pain of rejection is generated almost entirely from overgeneralization, In its absence, a personal affront is temporarily disappointing but cannot be seriously disturbing, A shy young man mustered up his courage to ask a girl for a date. When she politely declined because of a previous engagement, he said to himself, "I'm never going to get a date, No girl would ever want a date with me. I'll be lonely and miserable all my life." In his distorted cognitions, he concluded that because she turned him down once, she would always do so, and that since all women have 100 percent identical tastes, he would be endlessly and repeatedly rejected by any eligible woman on the face of the earth, Svengalil 3. Mental Filter. You pick out a negative detail in any situation and dwell on it exclusively, thus perceiving that the whole situation is negative, For example, a depressed college student heard some other students making fun of her best friend, She became furious because she was thinking, "That's what the human race is basically like—cruel and insensitivel"
She was overlooking the fact that in the previous months few people, if any, had been c
ruel or insensitive to herl On another occasion when she completed her first midterm exam, she felt certain she had missed approximately seventeen questions out of a hundred. She thought exclusively about those seventeen questions and concluded she would flunk out of college. When she got the paper back there was a note attached that read, "You got 83 out of 100 correct. This was by far the highest grade of any student this year. A.+"
When you are depressed, you wear a pair of eyeglasses with special lenses that filter out anything positive. All thal you allow to enter your conscious mind is negative. Because you are not aware of this "filtering process," you conclude that everything is negative. The technical name for this process is "selective abstraction." It is a bad habit that can cause you to suffer much needless anguish.
4. Disqualifying the Positive. An even more spectacular mental illusion is the persistent tendency of some depressed individuals to transform neutral or even positive experiences 33
David D. Burns, M.D.
into negative ones. You don't just ignore positive experiences, you cleverly and swiftly turn them into their nightmarish opposite. I call this "reverse alchemy." The medieval alchemists dreamed of finding some method for transmuting the baser metals into gold. If you have been depressed. you may have developed the talent for doing the exact opposite—you can instantly transform golden joy into emotional lead. Not intentionally, however—you're probably not even aware of what you're doing to yourself.
An everyday example of this would be the way most of us have been conditioned to respond to compliments. When someone praises your appearance or your work, you might automatically tell yourself, "They're just being nice." With one swift blow you mentally disqualify their compliment.
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