The Feeling Good Handbook

by David D Burns

  tended to take advantage of her in a variety of ways. He borrowed money when he ran short and often forgot to repay it.

  When he was in town (often for several months at a time) he assumed it was his right to eat dinner with her family every night, to drink up the liquor, and to use her new car whenever he wanted. She rationalized giving in to his demands by saying: "If I asked him for a favor or needed his help, he'd do the same for me. After all, a loving brother and sister should help each other out. And besides, if I tried to say nc to him he'd explode and I might lose him. Then I'd feel like 1

  did something wrong."

  At the same time, she was able to see the negative consequences of continually giving in: 1) She was supporting his dependent, self-defeating life-style and gambling addiction; 2 1

  She felt trapped and taken advantage of; 3) The basis of the relationship was not love but blackmail—she was constantly 196

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  having to say yes to his demands to avoid the tyranny of his temper and her own sense of guilt.

  Margaret and I did some role-playing so she could learn to say no and stick to her guns in a tactful but firm manner. I played Margaret's role, and she pretended to be her brother: BROTHER (played by Margaret) : Are you using the car tonight?

  MARGARET (played by me) : I'm not planning to now.

  BROTHER: Do you mind if I borrow it later?

  MARGARET: I'd prefer that you don't.

  BROTHER: Why not? You're not going to use it. It'll just be sitting there.

  MARGARET: Do you feel I'm obliged to loan it to you?

  BROTHER: Well, I'd do the same for you if I had a car and you needed it.

  MARGARET: I'm glad you feel that way. Although I'm not planning to use the car, I'd like to have it available in case I decide to go somewhere later on.

  BROTHER: But you're not planning to use it! Haven't we been brought up to help each other?

  MARGARET: Yes we have. Do you think that means I always have to say yes to you? We both do a great deal for each other. You have made a lot of use of my car and from now on I'd feel more comfortable if you'd begin to arrange your own transportation.

  BROTHER: I'm just planning to use it for an hour so I'll get it back in case you need it. It's very important and it's only a half mile away, so I won't wear your car out, don't worry.

  MARGARET: It sounds like it is something important to you.

  Perhaps you can arrange some other transportation.

  Could you walk that distance?

  BROTHER: Oh, that's fine! If that's how you feel, don't come to me for any favors!

  MARGARET: It sounds like you're pretty mad because I'm not doing what you want. Do you feel I'm always

  obliged to say yes?

  BROTHER: You and your philosophy! Shove it! I refuse to listen to any more of this hogwash! (Begins to storm off).

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  MARGARET: Let's not talk about it any further then. Maybe in a couple of days you'll feel more like talking about. I think we do need to talk things over.

  After this dialogue we reversed roles so that Margaret could practice being more assertive. When I played her brother's role, I gave her as tough a time as I could, and she learned how to handle me. This practice boosted her courage.

  She felt it was helpful to keep certain principles in mind when standing up to her brother's manipulations. These were: (1) She could remind him it was her right not to say yes to all his demands. (2) She could find a grain of truth in his arguments (the disarming technique) so as to take the wind out of his sails, but she could then come back to her position that love did not mean always giving in. (3) She was to adopt a strong, decisive and uncompromising position as tactfully as possible. (4) She was not to buy into his role as a weak, inadequate little boy who couldn't stand on his own feet. (5) She was not to respond to his anger by getting angry herself, because this would reinforce his belief he was a victim who was being unjustly deprived by a cruel, selfish witch. (6) She had to risk the possibility he would temporarily withdraw and thwart her by refusing to talk to her or to consider her point of view. When he did this, she was to let him storm off but she could let him know there were some things she wanted to talk over with him later on when he was more in the mood to communicate.

  When Margaret did confront him she found he was not nearly as tough a customer as she imagined. He actually seemed relieved and began to act more adult when she put some limits on the relationship.

  If you choose to apply this technique, you will have to be determined to stick to your guns because the other guy (or gal) may try to bluff you into believing that you're mortally wounding them by not giving in to their requests. Remember that the hurt you inflict in the long run by not following your best self-interest is usually far greater.

  Practicing ahead of time is the key to success. A friend will usually be happy to role-play with you and provide some useful feedback. If such a person is not available to you, or you feel too shy to ask, write out an imaginary dialogue of

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  the type illustrated. This will go a long way to firing up the appropriate circuits in your brain so you'll have the necessary courage and skill to say no diplomatically but forcefully and make it stick when the time actually comes!

  4. Antiwhiner Technique. This is one of the most surprising, delightfully effective methods in this book. It works like a charm in situations where someone—usually a loved one—makes you feel frustrated, guilty, and helpless through whining, complaining, and nagging. The typical pattern works like this: The whiner complains to you about something or someone. You feel the sincere desire to be helpful, so you make a suggestion. The person immediately squashes your suggestion and complains again. You feel tense and inadequate, so you try harder and make another suggestion.

  You get the same response. Anytime you try to break loose from the conversation, the other person implies he or she is being abandoned, and you are flooded with guilt.

  Shiba lived with her mother while she completed graduate school. Shiba loved her mother, but found her constant harangues about her divorce, the lack of money, etc., so intolerable she sought treatment. I taught her the antiwhiner method the first session, as follows: Regardless of what her mother said, Shiba was to find some way to agree (the disarming technique), and then instead of offering advice, she was to say something genuinely complimentary. Shiba initially found this approach astonishing and rather bizarre because it differed radically from her usual approach. In the following dialogue, I asked Shiba to play the role of Mother while I played her role so I could demonstrate this technique: slum (as her mother) : Do you know that during the divorce proceedings it came out that your Dad sold his share in the business, and I was the last person to know about it?

  DAVID (as Shiba): That's absolutely correct. You didn't hear about it until the divorce proceedings. You really deserve better.

  slum: I don't know what we're going to do for money.

  How am I going to put your brothers through college?

  DAVID: That is a problem. We are short on money.

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  SHIBA: It was just like your father to pull something like this. His head isn't screwed on straight.

  DAVID: He never was too good at budgeting. You've always been much better at that.

  SHIBA: He's a louse! Here we are on the verge of poverty.

  What if I get sick? We'll end up in the poorhouse!

  DAVID: You're right! It's no fun at all to live in the poorhouse. I agree with you completely.

  Shiba reported that in her role as Mother she found it was

  "no fun" to complain because I kept agreeing with her. We did a role-reversal so she could master the technique.

  In fact, it is your urge to help complainers that maintains the monotonous interaction. Paradoxically, when you agree with their pessimistic whining, they quickly run out of steam
.

  Perhaps an explanation will make this seem less puzzling.

  When people whine and complain, they are usually feeling irritated, overwhelmed, and insecure. When you try to help them, this sounds to them like criticism because it implies they aren't handling things properly. In contrast, when you agree with them and add a compliment, they feel endorsed, and they then usually relax and quiet down.

  5. Moorey Moaner Method. A useful modification of this technique was proposed by Stirling Moorey, a brilliant British medical student who studied with our group in Philadelphia and sat in with me during therapy sessions during the summer of 1979. He worked with a chronically severely depressed fifty-two-year-old sculptor named Harriet with a heart of gold. Harriet's problem was her friends would often bend her ear with gossip and personal problems. She found these problems upsetting because of her excessive capacity for empathy.

  Because she wouldn't know how to help her friends, she felt trapped and resentful until she learned the "Moorey Moaner Method." Stirling simply instructed her to find a way to agree with what the person was saying, and then to distract the moaner by finding something positive in the complaint and to comment on it. Here are several examples:

  1. MOANER: Oh, what in the world can I ever do about my daughter? I'm afraid she's been smoking pot again.

  RESPONSE: There sure is a lot of pot going around 200

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  these days. Is your daughter still doing that outstanding art work? I heard she recently got an important award.

  2. MOANER: My boss didn't give me my raise, and my last raise was nearly a year ago. I've been here for twenty years, and I think I deserve better.

  RESPONSE: You certainly do have seniority here and you've made tremendous contributions. Tell me, what was it like when you first started working twenty years ago? I'll bet things were a lot different then.

  3. MOANER: My husband never seems to have enough time at home. Every night he's out with that darned bowling league.

  RESPONSE: Weren't you also doing some bowling recently? I heard you got some pretty high scores yourself!

  Harriet mastered the Moorey Moaner Method quickly and reported a dramatic change in her mood and outlook because it gave her a simple, effective way to handle a problem that had been very real and overwhelming. When she returned for the next session, her depression—which had crippled her for over a decade—had lifted and was entirely gone. She was bubbling and joyous, and heaped well-deserved praise on Stirling's head. If you have a similar problem with your mother, mother-in-law, or friends, try Stirling's method.

  Like Harriet, you'll soon be smiling!

  6. Developing Perspective." One of the commonest distortions that leads to a sense of guilt is personalization—the misguided notion that you are ultimately responsible for other people's feelings and actions or for naturally occurring events. An obvious example would be your sense of guilt when it rained unexpectedly on the day of a large picnic you had organized to honor the retiring president of your club. In this case you could probably shake your absurd reaction off without a great deal of effort because you clearly cannot control the weather.

  Guilt becomes much more difficult to overcome when someone suffers substantial pain and discomfort and insists it results from their personal interaction with you. In such cases it can be helpful to clarify the extent to which you can realis-201

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  tically assume responsibility. Where does your responsibility end and the other person's begin? The technical name for this is "disattribution," but you might call it putting things into perspective.

  Here's how it works. Jed was a mildly depressed college student whose twin brother, Ted, was so seriously depressed he dropped out of school and began to live like a recluse with his parents. Jed felt guilty about his brother's depression.

  Why? Jed told me he had always been more outgoing and hardworking than his brother. Consequently, from early childhood he always made better grades and had more friends than Ted. Jed reasoned that the social and academic success he enjoyed caused his brother to feel inferior and left out. Consequently, Jed concluded that he was the cause of Ted's depression.

  He then carried this line of reasoning to its illogical extreme and hypothesized that by feeling depressed himself, he might help Ted stop feeling depressed and inferior through some type of reverse (or perverse) psychology. When he went home for the holidays, Jed avoided the usual social activities, minimized his academic success, and emphasized how blue he was feeling. Jed made sure he gave his brother the loud and clear message that he too was down and out.

  Jed took his plan so seriously that he was quite hesitant to apply the mood-control techniques I was trying to teach him.

  In fact, he was downright resistant at first because he felt guilty about getting better and feared his recovery might have a devastating impact on Ted.

  Like most personalization errors, Jed's painful illusion that he was at fault for his brother's depression contained enough half-truths to sound persuasive. After all, his brother probably had felt inferior and inadequate since early childhood and undoubtedly did harbor some jealous resentment of Jed's success and happiness. But the crucial questions were: Did it follow that Jed caused his brother's depression, and could Jed effectively reverse the situation by making himself miserable?

  In order to help him assess his role in a more objective way, I suggested Jed use the triple-column technique (Figure 8-4). As a result of the exercise, he was able to see that his guilty thoughts were self-defeating and illogical. He reasoned that Ted's depression and sense of inferiority were ultimately 202

  Figaro 8-4.

  Automatic Thoughts

  Cognitive Distortion

  Rational Responses

  I. I am part of the cause for Ted's depres-1. Jumping to conclusions 1. I myself am not the cause of Ted's de-sion due to our relationship since early

  (mind reading);

  pression. It is Ted's illogical thoughts and

  childhood. I have always worked harder

  personalization

  attitudes that are causing his depression.

  and been more successful.

  The only responsibility that I can take is

  that of being part of the environment that

  Ted is interpreting in a negative, distorted

  manner.

  2. I feel it would upset Ted if I told him /

  2. Jumping to conclusiong (

  2. It might cheer Ted up and give him some

  was having a good time at school while he

  fortune teller error)

  hope if he knows I'm feeling better and

  is home alone doing nothing.

  having a good time. It probably only de-

  presses Ted more if I act as miserable as N

  he does because this takes away his

  hope.

  too

  3. If Ted is sitting around doing nothing, it 5. Personalization

  is my responsibility to correct the situa-

  3. I can encourage him to do things, but I

  tion.

  cannot force him. Ultimately this is his

  4. I will be doing something for him by not 6. Jumping to conclusions (

  responsibility.

  doing anything for myself. In fact, it will

  mind reading)

  4. My actions are totally independent of his

  help him if I am depressed.

  actions. There is no reason to think that

  my depression will be helpful to him. He

  has even told me he doesn't want me to

  be dragged down. If he sees that I am

  improving, this might actually encourage

  him. I can possibly be a good role model

  for him by showing him that I can be

  happy. I can't eliminate his sense of in-

  adequacy by botching up my life.

  David D. Burns, M.D.

  caused
by Ted's distorted thinking and not by his own happiness or success. For Jed to try to correct this by making himself miserable was as illogical as trying to put out a fire with gasoline. As Jed grasped this, his guilt and depression rapidly lifted, and he was soon back to normal functioning.

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  PART III

  "Realistic" Depressions

  CHAPTER 9

  Sadness Is Not Depression

  "Dr. Burns, you seem to be claiming that distorted thinking is the only cause of depression. But what if my problems are real?" This is one of the most frequent questions I encounter during lectures and workshops on cognitive therapy. Many patients raise it at the start of treatment, and list a number of "

  realistic" problems which they are convinced cause "realistic depressions." The most common are:

  bankruptcy or poverty;

  old age (some people also view infancy, childhood, ado-lescense, young adulthood and mid-life as periods of inevitable crisis);

  permanent physical disability;

  terminal illness;

  the tragic loss of a loved one.

  I'm sure you could add to the list. However, none of the above can lead to a "realistic depression." There is, in fact, no such thing! The real question here is how to draw the line between desirable and undesirable negative feelings. What is the difference between "healthy sadness" and depression?

  The distinction is simple. Sadness is a normal emotion created by realistic perceptions that describe a negative event involving loss or disappointment in an undistorted way. Depression is an illness that always results from thoughts that are distorted in some way. For example, when a loved one dies, you validly think, "I lost him (or her), and I will miss the companionship and love we shared." The feelings such a thought creates are tender, realistic, and desirable. Your emotions will enhance your humanity and add depth to the meaning of life. In this way you gain from your loss.

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  In contrast, you might tell yourself, "I'll never again be happy because he (or she) died. It's unfair!" These thoughts will trigger in you feelings of self-pity and hopelessness. Because these emotions are based entirely on distortion, they will defeat you.