Feeling Good: The New Mood Therapy

by Burns, David D.

  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:

  SHIBA

  (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.

  SHIBA:

  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.

  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 commenting 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 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 realistically 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 miser
able?

  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 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.

  * * *

  Figure 8–4.

  * * *

  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,

  adolescence, 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.

  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.

  Either depression or sadness can develop after a loss or a failure in your efforts to reach a goal of great personal importance. Sadness comes, however, without distortion. It involves a flow of feeling and therefore has a time limit. It never involves a lessening of your self-esteem. Depression is frozen—it tends to persist or recur indefinitely, and always involves loss of self-esteem.

  When a depression clearly appears after an obvious stress, such as ill health, the death of a loved one, or a business reversal, it is sometimes called a “reactive depression.” At times it can be more difficult to identify the stressful event that triggered the episode. Those depressions are often called “endogenous” because the symptoms seem to be generated entirely out of thin air. In both cases, however, the cause of the depression is identical—your distorted, negative thoughts. It has no adaptive or positive function whatsoever, and represents one of the worst forms of suffering. Its only redeeming value is the growth you experience when you recover from it.

  My point is this: When a genuinely negative event occurs, your emotions will be created exclusively by your thoughts and perceptions. Your feelings will result from the meaning you attach to what happens. A substantial portion of your suffering will be due to the distortions in your thoughts. When you eliminate these distortions, you will find that coping with the “real problem” will become less painful.

  Let’s see how this works. One clearly realistic problem involves serious illness, such as a malignancy. It is unfortunate that the family and friends of the afflicted person are often so convinced that it is normal for the patient to feel depressed, they fail to inquire about the cause of the depression, which more often than not turns out to be completely reversible. In fact, some of the easiest depressions to resolve are those found in people facing probable death. Do you know why? These courageous individuals are often “supercopers” who haven’t made misery their life-style. They are usually willing to help themselves in any way they can. This attitude rarely fails to transform apparently irreversible and “real” difficulties into opportunities for personal growth. This is why I find the concept of “realistic depressions” so personally abhorrent. The attitude that depression is necessary strikes me as destructive, inhuman, and victimizing. Let’s get down to some specifics, and you can judge for yourself.

  Loss of Life. Naomi was in her mid-forties when she received a report from her doctor that a “spot” had appeared on her chest X ray. She was a firm believer that going to doctors was a way of asking for trouble, so she procrastinated many months in checking this report out. When she did, her worst suspicions were validated. A painful needle biopsy confirmed the presence of malignant cells, and subsequent lung removal indicated that a spread of the cancer had already occurred.

  This news hit Naomi and her family like a hand grenade. As the months wore on, she became increasingly despondent over her weakened state. Why? It was not so much the physical discomfort from the disease process or the chemotherapy, although these were genuinely uncomfortable, but the fact that she was sufficiently weak that she had to give up the daily activities that had meant a great deal to her sense of identity and pride. She could no longer work around the house (now her husband had to do most of the chores), and she had to give up her two part-time jobs, one of which was volunteer reading for the blind.

  You might insist, “Naomi’s problems are real. Her misery is not caused by distortion. It’s caused by the situation.”

  But was her depression so inevitable? I asked Naomi why her lack of activity was so upsetting. I explained the concept of “automatic thoughts,” and she wrote down the following negative cognitions: (1) I’m not contributing to society; (2) I’m not accomplishing in my own personal realm; (3) I’m not able to participate in active fun; and (4) I am a drain and drag on my husband. The emotions associated with these thoughts were: anger, sadness, frustration, and guilt.

  When I saw what she had written down, my heart leaped for joy! These thoughts were no different from the thoughts of physically healthy depressed patients I see every day in my practice. Naomi’s depression was not caused by her malignancy, but the malignant attitude that caused her to measure her sense of worth by the amount she produced! Because she had always equated her personal worth with her achievements, the cancer meant—“You’re over the hill! You’re ready for the refuse heap!” This gave me a way to intervene!

  I suggested that she make a graph of her personal “worth” from the moment of birth to the moment of death (see Figure 9–1, page 235). She saw her worth as a constant, estimating it at 85 percent on an imaginary scale from 0 to 100 percent. I also asked her to estimate her productivity over the same period on a similar scale. She drew a curve with low productivity in infancy, increasing to a maximum plateau in adulthood, and finally decreasing again later in life (see Figure 9–1). So far, so good. Then two things suddenly dawned on her. First, while her illness had reduced her productivity, she still contributed to herself and her family in numerous small but nevertheless important and precious ways. Only all-or-nothing thinking could make her think her contributions were a zero. Second, and much more important, she realized her personal worth was constant and steady; it was a given that was unrelated to her achievements. This meant that her human worth did not have to be earned, and she was every bit as precious in her weakened state. A smile spread across her face, and her depression melted in that moment. It was a real p
leasure for me to witness and participate in this small miracle. It did not eliminate the tumor, but it did restore her missing self-esteem, and that made all the difference in the way she felt.

  * * *

  Figure 9–1. Naomi’s worth and work graphs. In the upper figure Naomi plotted her human "worth" from the time of her birth to the time of her death. She estimated this at 85 percent. In the lower figure she plotted her estimated productivity and achievement over the course of her life. Her productivity began low in childhood, reached a plateau in adulthood, and would ultimately fall to zero at the time of death. This graph helped her comprehend that her "worth" and "achievement" were unrelated and had no correlation with each other.

  * * *

  Naomi was not a patient, but someone I spoke with while vacationing in my home state of California during the winter of 1976. I received a letter from her soon after which I share with you here:

  David—

  An incredibly belated, but really important “P.S.” to my last letter to you. To wit: the simple little “graphs” you did of productivity as opposed to self-worth or self-esteem or whatever we shall call it: It has been especially sustaining to me, a plus which I dose out liberally! It really turned me into a psychologist without having to go for my Ph.D. I find that it works with lots of things that badger and bother people. I’ve tried these ideas out on some of my friends. Stephanie is treated like a piece of furniture by a chit of a secretary one-third her age; Sue is put down constantly by her 14 year old twins; Becky’s husband has just walked out; Ilga is being made to feel like an interloper by her boy friend’s 17 year old son, etc. To them all I say “Yes, but your personal worth is a CONSTANT, and all the garbage the world heaps on you doesn’t touch it!” Of course in many cases I realize it’s an over-simplification and cannot be an anodyne for all things, but boy is it helpful and useful!