Although your editor seemed extremely enthusiastic, you notice you are feeling nervous and inadequate due to your thoughts, "They made a terrible mistake when they chose my book! I won't be able to do a good job. I'll never be able to make the book fresh, lively, and punchy. My writing is too drab, and my ideas aren't good enough." Your cognitive distortions include:
a. all-or-nothing thinking;
b. jumping to conclusions (negative prediction); 42
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c. mental filter;
d. disqualifying the positive;
e. magnification.
4. You are lonely and you decide to attend a social affair for singles. Soon after you get there, you have the urge to leave because you feel anxious and defensive. The following thoughts run through your mind: "They probably aren't very interesting people. Why torture myself? They're just a bunch of losers. I can tell because I feel so bored. This party will be a drag." Your errors involve:
a. labeling;
b. magnification;
c. jumping to conclusions (fortune teller error and mind reading);
d. emotional reasoning;
e. personalization.
5. You receive a layoff notice from your employer. You feel mad and frustrated. You think, "This proves the world is no damn good. I never get a break." Your distortions include:a. all-or-nothing thinking;
b. disqualifying the positive;
c. mental filter;
d. personalization;
e. should statement.
6. You are about to give a lecture and you notice that your heart is pounding. You feel tense and nervous because you think, "My God, I'll probably forget what I'm supposed to say. My speech isn't any good anyway. My mind will blank out. I'll make a fool of myself." Your thinking errors involve:
a. all-or-nothing thinking;
b. disqualifying the positive;
c. jumping to conclusions (fortune teller error); d. minimization;
e. labeling.
7. Your date calls you at the last minute to cancel out because of illness. You feel angry and disappointed because you think, "I'm getting jilted. What did I do to foul things up?"
Your thinking errors include:
a. all-or-nothing thinking;
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David D. Burns, M.D.
b. should statements;
c. jumping to conclusions (mind reading);
d. personalization;
e. overgeneralization.
8. You have put off writing a report for work. Every night when you try to get down to it, the whole project seems so difficult that you watch TV instead. You begin to feel overwhelmed and guilty. You are thinking the following: "I'm so lazy I'll never get this done. I just can't do the darn thing. It would take forever. It won't turn out right anyway." Your thinking errors include:
a. jumping to conclusions (fortune teller error); b. overgeneralization;
c. labeling;
d. magnification;
e. emotional reasoning.
9. You've read this entire book and after applying the methods for several weeks, you begin to feel better. Your BDI score went down from twenty-six (moderately depressed) to eleven (borderline depression). Then you suddenly begin to feel worse, and in three days your score has gone back up to twenty-eight. You feel disillusioned, hopeless, bitter, and desperate due to thinking, "I'm not geting anywhere. These methods won't help me after all. I should be well by now. That 'improvement' was a fluke. I was fooling myself when I thought I was feeling better. I'll never get well." Your cognitive distortions include: a. disqualifying the positive;
b. should statement;
c. emotional reasoning;
d. all-or-nothing thinking;
e. jumping to conclusions (negative prediction).
10. You've been trying to diet. This weekend you've been nervous, and, since you didn't have anything to do, you've been nibbling, nibbling. After your fourth piece of candy, you tell yourself, "I just can't control myself. My dieting and jogging all week have gone down the drain. I must look like a balloon. I shouldn't have eaten that. I can't stand this. I'm going to pig out all weekend!" You begin to feel so guilty you push another handful of candy into your mouth in an abor-tive effort to feel better. Your distortions include: 44
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a. all-or-nothing thinking;
b. mislabeling;
c. negative prediction;
d. should statement;
e. disqualifying the positive.
ANSWER KEY
1. ABCDE
6. ACDE
2. ABCE
7. C D
3. ABDE
8. ABCDE
4. ABCD
9. ABCDE
5. A C
10. ABCDE
Feelings Aren't Facts
At this point you may be asking yourself, "Okay. I understand that my depression results from my negative thoughts because my outlook on life changes enormously when my moods go up or down. But if my negative thoughts are so distorted, how do I continually get fooled? I can think as clearly and realistically as the next person, so if what I am telling myself is irrational, why does it seem so right?"
Even though your depressing thoughts may be distorted, they nevertheless create a powerful illusion of truth. Let me expose the basis for the deception in blunt terms—your feelings are not facts! In fact, your feelings, per se, don't even count—except as a mirror of the way you are thinking.
If your perceptions make no sense, the feelings they create will be as absurd as the images reflected in the trick mirrors at an amusement park. But these abnormal emotions feel just as valid and realistic as the genuine feelings created by undistorted thoughts, so you automatically attribute truth to them.
This is why depression is such a powerful form of mental black magic.
Once you invite depression through an "automatic" series of cognitive distortions, your feelings and actions will reinforce each other in a self-perpetuating vicious cycle. Because you believe whatever your depressed brain tells you, you find 45
David D. Burns, M.D.
yourself feeling negative about almost everything. This reaction occurs in milliseconds, too quickly for you even to be aware of it. The negative emotion feels realistic and in turn lends an aura of credibility to the distorted thought which created it. The cycle goes on and on, and you are eventually trapped. The mental prison is an illusion, a hoax you have inadvertently created, but it seems real because it feels real.
What is the key to releasing yourself from your emotional prison? Simply this: Your thoughts create your emotions; therefore, your emotions cannot prove that your thoughts are accurate. Unpleasant feelings merely indicate that you are thinking something negative and believing it. Your emotions follow your thoughts just as surely as baby ducks follow their mother. But the fact that the baby ducks follow faithfully along doesn't prove that the mother knows where she is going!
Let's examine your equation, "I feel, therefore I am." This attitude that emotions reflect a kind of self-evident, ultimate truth is not unique to depressed people. Most psychotherapists today share the conviction that becoming more aware of your feelings and expressing them more openly represent emotional maturity. The implication is that your feelings represent a higher reality, a personal integrity, a truth beyond question.
My position is quite different. Your feelings, per se, are not necessarily special at all. In fact, to the extent that your negative emotions are based on mental distortions as is all too often the case—they can hardly be viewed as desirable.
Do I mean you should get rid of all emotions? Do I want you to turn into a robot? No. I want to teach you to avoid painful feelings based on mental distortions, because they are neither valid nor desirable. I believe that once you have learned how to perceive life more realistically you will experience an enhanced emotional life with a greater appreciation for genuine sadness—which lacks distortion—as well as joy.
As you go on to the next sections of
this book, you can learn to correct the distortions that fool you when you are upset. At the same time, you will have the opportunity to reevaluate some of the basic values and assumptions that create your vulnerability to destructive mood swings. I have outlined 46
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the necessary steps in detail. The modifications in illogical thinking patterns will have a profound effect on your moods and increase your capacity for productive living. Now, let's go ahead and see how we can turn your problems around.
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PART II
Practical Applications
CHAPTER 4
Start by Building Self-Esteem
When you are depressed, you invariably believe that you are worthless. The worse the depression, the more you feel this way. You are not alone. A recent survey by Dr. Aaron Beck revealed that over 80 percent of depressed patients expressed self-dislike.' Furthermore, Dr. Beck found that depressed patients see themselves as deficient in the very qualities they value most highly: intelligence, achievement, popularity, attractiveness, health, and strength. He said a depressed self-image can be characterized by the four D's: You feel Defeated, Defective, Deserted, and Deprived.
Almost all negative emotional reactions inflict their damage only as a result of low self-esteem. A poor self-image is the magnifying glass that can transform a trivial mistake or an imperfection into an overwhelming symbol of personal defeat. For example, Eric, a first-year law student, feels a sense of panic in class. "When the professor calls on me, I'll probably goof up." Although Eric's fear of "goofing up" was foremost on his mind, my dialogue with him revealed that a sense of personal inadequacy was the real cause of the problem: DAVID: Suppose you did goof up in class. Why would that be particularly upsetting to you? Why is that so tragic?
ERIC: Then I would make a fool of myself.
DAVID: Suppose you did make a fool of yourself. Why would that be upsetting?
* Beck, Aaron T. Depression: Clinical, Experimental, & Theoretical Aspects. New York: Hoeber, 1967. (Republished as Depression: Causes and Treatment. Philadelphia: University of Pennsylvania Press, 1972, pp. 17-23.)
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ERIC: Because then everyone would look down on me.
DAVID: Suppose people did look down on you? What then?
ERIC: Then I would feel miserable.
DAVID: Why? Why is it that you would have to feel miserable if people were looking down on you?
ERIC: Well, that would mean I wouldn't be a worthwhile person. Furthermore, it might ruin my career. I'd get bad grades, and maybe I could never be an attorney.
DAVID: Suppose you didn't become an attorney. Let's assume for the purposes of discussion that you did flunk out. Why would that be particularly upsetting to you?
ERIC: That would mean that I had failed at something I've wanted all my life.
DAVID: And what would that mean to you?
ERIC: Life would be empty. It would mean I was a failure.
It would mean I was worthless.
In this brief dialogue, Eric showed that he believed it would be terrible to be disapproved of or to make a mistake or to fail. He seemed convinced that if one person looked down on him then everyone would. It was as if the word REJECT would suddenly be stamped on his forehead for everyone to see. He seemed to have no sense of self-esteem that was not contingent upon approval and/or success. He measured himself by the way others looked at him and by what he had achieved. If his cravings for approval and accomplishment were not satisfied, Eric sensed he would be nothing because there would be no true support from within.
If you feel that Eric's perfectionistic drive for achievement and approval is self-defeating and unrealistic, you are right.
But to Eric, this drive was realistic and reasonable. If you are now depressed or have ever been depressed, you may find it much harder to recognize the illogical thinking patterns which cause you to look down on yourself. In fact, you are probably convinced that you really are inferior or worthless.
And any suggestion to the contrary is likely to sound foolish and dishonest.
Unfortunately, when you are depressed you may not be alone in your conviction about your personal inadequacy. In many cases you will be so persuasive and persistent in your 52
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maladaptive belief that you are defective and no good, you may lead your friends, family, and even your therapist into accepting this idea of yourself. For many years psychiatrists have tended to "buy into" the negative self-evaluation system of depressed individuals without probing the validity of what the patients are saying about themselves. This is illustrated in the writings of such a keen observer as Sigmund Freud in his treatise "Mourning and Melancholia," which forms the basis for the orthodox psychoanalytic approach to treating depression. In this classic study Freud said that when the patient says he is worthless, unable to achieve, and morally despicable, he must be right. Consequently, it was fruitless for the therapist to disagree with the patient. Freud believed the therapist should agree that the patient is, in fact, uninteresting, unlovable, petty, self-centered, and dishonest. These qualities describe a human being's true self, according to Freud, and the disease process simply makes the truth more obvious:
The patient represents his ego to us as worthless, incapable of any achievement and morally despicable; he reproaches himself, vilifies himself and expects to be cast out and punished. . . . It would be equally fruitless from a scientific and therapeutic point of view to contradict a patient who brings these accusations against his ego. He must surely be right in some way [emphasis mine] and be describing something that is as it seems to him to be. Indeed we must at once confirm some of his statements without reservation. He really is as lacking in interest and incapable of love and achievement as he says [emphasis mine]. . . . He also seems to us justified in certain other self-accusations; it is merely that he has a keener eye for the truth than other people who are not melancholic [emphasis mine]. When in his heightened self-criticism he describes himself as petty, egoistic, dishonest, lacking in independence, one whose sole aim has been to hide the weaknesses of his own nature, it may be so far as we know, that he has come pretty near to understanding himself [emphasis mine]; we only 53
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wonder why a man has to be ill before he can be acces-sible to truth of this kind.
—Sigmund Freud, "Mourning and Melancholia"
The way a therapist handles your feelings of inadequacy is crucial to the cure, as your sense of worthlessness is a key to depression. The question also has considerable philosophical relevance—is human nature inherently defective? Are depressed patients actually facing the ultimate truth about themselves? And what, in the final analysis, is the source of genuine self-esteem? This, in my opinion, is the most important question you will ever confront.
First, you cannot earn worth through what you do.
Achievements can bring you satisfaction but not happiness.
Self-worth based on accomplishments is a "pseudo-esteem,"
not the genuine thing! My many successful but depressed patients would all agree. Nor can you base a valid sense of self-worth on your looks, talent, fame, or fortune. Marilyn Monroe, Mark Rothko, Freddie Prinz, and a multitude of famous suicide victims attest to this grim truth. Nor can love, approval, friendship, or a capacity for close, caring human relationships add one iota to your inherent worth. The great majority of depressed individuals are in fact very much loved, but it doesn't help one bit because self-love and sell-esteem are missing. At the bottom line, only your own sense of self-worth determines how you feel.
"So," you may now be asking with some exasperation, "
how do I get a sense of self-worth? The fact is, I feel damn inadequate, and I'm convinced I'm really not as good as other people. I don't believe there's anything I can do to change those rotten feelings because that's the way I basically ant"
One of the cardinal features of cognitive therapy is
that it stubbornly refuses to buy into your sense of worthlessness. In my practice I lead my patients through a systematic reevaluation of their negative self-image. I raise the same question Freud, S. Collected Papers, 1917. (Translated by Joan Riviere, Vol. IV, Chapter 8, "Mourning and Melancholia," pp. 155-156.
London: Hogarth Press Ltd., 1952.)
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over and over again: "Are you really right when you insist that somewhere inside you are essentially a loser?"
The first step is to take a close look at what you say about yourself when you insist you are no good. The evidence you present in defense of your worthlessness will usually, if not always, make no sense.
This opinion is based on a recent study by Drs. Aaron Beck and David Braff which indicated that there is actually a formal thinking disturbance in depressed patients. Depressed individuals were compared with schizophrenic patients and with undepressed persons in their ability to interpret the meaning of a number of proverbs, such as "A stitch in time saves nine." Both the schizophrenic and depressed patients made many logical errors and had difficulty in extracting the meaning of the proverbs. They were overly concrete and couldn't make accurate generalizations. Although the severity of the defect was obviously less profound and bizarre in the depressed patients than in the schizophrenic group, the depressed individuals were clearly abnormal as compared with the normal subjects.
In practical terms the study indicated that during periods of depression you lose some of your capacity for clear thinking; you have trouble putting things into proper perspective.
Negative events grow in importance until they dominate your entire reality—and you can't really tell that what is happening is distorted. It all seems very real to you. The illusion of hell you create is very convincing.
The more depressed and miserable you feel, the more twisted your thinking becomes. And, conversely, in the absence of mental distortion, you cannot experience low self-worth or depression!
What types of mental errors do you make most generally when you look down on yourself? A good place to begin is with the list of distortions you began to master in Chapter 3.
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