In the words of psychiatrist David Burns, MD, people who are depressed are often masters of illusion. Their pessimistic outlook -- and some unconscious tricks of the mind -- can turn triumphs into setbacks, and setbacks into personal failings. Those of us prone to depression may be successful and accomplished, but we're often plagued by negative thoughts about ourselves and our future. This thinking distorts our view of the world until everything seems dreary and hopeless.
Burns is among the leading cognitive-behavior therapists, a group of psychiatrists and psychologists who think that changing negative, distorted thinking is crucial to overcoming depression. The tendency toward negative thinking isn't merely a symptom of depression, they say -- it's the root of the disease. Since our thoughts or "cognitions" shape our moods, positive thoughts can translate into an energetic, hopeful mood, while pervasive negative thoughts may cause us to sink into despair.
A study of 349 college students published in the Journal of Abnormal Psychology underscores this point. Students with pessimistic outlooks were eight times more likely than others to become depressed in the next two and a half years.
But negative thoughts don't have to be a way of life -- and neither does depression. If you're in the grip of depression, you need to seek professional help for your illness; if the depression is accompanied by mania, hallucinations, or suicidal feelings, you need to get help immediately. Help can be a call to a crisis center, to your local mental health agency, to your primary care physician, or even to 911.
The good news is that with time, effort, and treatment, even a crushing depression can lift. Many people who are depressed find relief through antidepressants or therapy: Interpersonal therapy and cognitive behavioral therapy are two types that have been shown to be effective at dealing with even the most stubborn cases of the illness. But as an adjunct to treatment, therapists have developed a number of "self-care" exercises you can use to help you control your thoughts and moods.
The idea that you can "unlearn" self-defeating ways of thinking that pave the way toward mood disorders is the basis of cognitive therapy, developed by Aaron T. Beck, MD, Burns, and others. In an updated version of his book Feeling Good: The New Mood Therapy (Avon Books, 1999), Burns outlines a set of cognitive therapy techniques that people can use at home and at work to help boost their self-confidence and break the cycle of repeated depressions. His first set of exercises has to do with eliminating the distorted, self-defeating, and ultimately destructive thoughts that pave the way to depression.
Negative thinking: The 10 grand illusions
Before you can control destructive thoughts, of course, you have to recognize them. In his book Feeling Good, Burns identifies what he and other cognitive-behavioral therapists view as the 10 major mental or "cognitive" distortions that can open the door to depression. If you suffer from depression -- and you have plenty of company if you do -- some of these are bound to sound familiar.
1. All-or-nothing thinking. In this type of thinking, you're either a hero or a failure. Any small misstep marks you as a failure. This kind of thinking can lead to crippling perfectionism.
2. Overgeneralization. Whenever something bad happens, it's bound to happen again and again. If somebody you've idealized turns you down for a date, for example, you feel certain that the next person will, too.
3. The mental filter. You dwell on the downside of any situation while overlooking anything positive. If you're an editor, you may become obsessed with a typo that escaped into print rather than congratulating yourself for getting out a great issue.
4. Diminishing the positive. In this kind of thinking, you tend to twist positive events into negative ones. If you just got a raise, for example, you may put yourself down for not getting a bigger raise.
5. Jumping to conclusions. You become either a mind reader or a fortuneteller -- whatever it takes to see trouble on the horizon. If a friend doesn't return a call, he secretly dislikes you. If you like your job, you'll probably lose it soon.
6. The binocular trick. It's as if you're wearing special lenses that let you see everything blown out of proportion. Little problems become monstrous; major victories, trifling.
7. Emotional reasoning. You believe mood reflects your true identity: You feel lousy because you are lousy.
8. 'Should' and 'must' thoughts. You constantly remind yourself of things you should or must do. (One expert calls this "musterbation.") At the end of the day, you feel buried in guilt and shame. You may also dwell on things that other people should or must do, setting yourself up for frustration and bitterness.
9. Labeling and mislabeling. You tend to equate your "self" with what you do, and since everyone makes mistakes, over time you develop a negative self-image based on errors you've made. If you invested in a high-tech stock deal that blew up in your face, for example, you view yourself as a failure. Failure, loser, dummy: The labels stick. If you tend to label other people as well, you'll reap a lot of hostility.
10. Personalization. You assume responsibility for anything that goes wrong, even when it's not your fault. Burns calls this line of thinking "the mother of guilt."
Writing away depression
You may not be able to eliminate all these self-defeating thoughts, but you can keep them from wrecking your mood. To rid yourself of relentless self-criticism and distorted thoughts, Burns suggests spending 15 minutes every day capturing your thought process on paper. Looking at your thoughts on paper will allow you to search the list above to see what's distorted or "wrong" about them; next, take the time to come up with a fair and rational rebuttal. Whether you're depressed or just a bit down, the exercise may help you feel better within a couple of weeks. Here's his approach:
Start by briefly describing an event that bothered you, perhaps a comment by your spouse or something that went wrong at work. Write down the emotions you felt. Were you mostly sad, mostly angry, a little of both? Record the thoughts that led to those emotions (such as, "My marriage is in deep trouble," or "I'm doing a lousy job."). It's important to write down the thoughts that led to the emotions rather than the emotions themselves, because if you write, "I feel awful," well, that's probably true. Instead, write down the thoughts that are causing you to feel awful, then decide which, if any, of the 10 categories above your thoughts fall into (Overgeneralization? Jumping to conclusions?).
Once you identify the fallacies behind your negative thinking, you're ready to move forward. Look again at your thoughts and try to think of a more rational, optimistic response. For instance, "My marriage is in deep trouble" may give way to "My wife wasn't in a good mood today." You could counter "I'm doing a lousy job" with "I wasn't at my best today, but everyone makes mistakes" or "I still have some room to improve."
You may find that the simple act of writing down your problems gives you some newfound power and control. Things just don't seem so overwhelming on paper. And if the exercise helps break the stream of negative thoughts and mental illusions, you'll have more protection against depression. Now that's a pleasant thought.
National Institute of Mental Health 5600 Fishers Lane Rockville, MD 20857 800-421-4211
National Foundation for Depressive Illness, Inc. P.O. Box 2257 New York, NY 10016 800-826-3632
Beck, Aaron. T., MD. Cognitive Therapy and the Emotional Disorders. Penguin.
Feeling Good: The New Mood Therapy. David D. Burns, MD. Avon Books
Alloy LB et al. The Temple-Wisconsin cognitive vulnerability to depression project: Lifetime history of axis I psychopathology in individuals at high and low cognitive risk for depression.
Scogin, F et al. Outcome of cognitive bibliotherapy with depressed adults. Journal of Consulting and Clinical Psychology 63, 644-650.