Taming Stressful
Thoughts: Making Thoughts Work For You
By Bruce Campbell
As
someone with chronic illness, you are aware of many sources of stress,
including the severity of your symptoms, financial pressure, strained
relationships and uncertainty about the future. This article deals with
another source of stress, your thoughts. What we think, especially our
thoughts about ourselves, can intensify the stress we experience from
other sources. In this article, I’ll discuss how this process works
and also suggest how you can use your thoughts to reduce stress.
How
Thoughts Create Stress
To
see how thoughts can create stress, think what you might say to
yourself when you have a setback. An increase in symptoms can trigger
negative thoughts like “I'm not getting anywhere” or “I'll never
get better” or “it’s hopeless.”
Thoughts like these can actually increase your suffering, because
they make you feel anxious, sad and hopeless, which in turn
makes it difficult to act in constructive ways.
How
Thoughts Affect Mood and Action
Being
in a situation in which you seem to lack control can create a strong
sense of helplessness. But, just as feelings of pessimism and despair
can be learned in response to experience, so can optimism. To understand
the connection between thoughts, feelings and actions, imagine the
reactions of two different patients to an increase in symptoms following
a short walk. One says, “Another setback! I’ll never get any
better.” The other says, “I walked too far today.”
The
two patients have different explanatory styles.
The first has a pessimistic way of interpreting experience.
She sees specific events as examples of permanent, far-reaching
negative forces. The other
patient has a more optimistic way of seeing her experience.
She sees an event as something specific, limited and temporary.
The
thought “I’ll never get any better” tends to lead to frustration,
depression and despair. The mood of despair is associated with learned
helplessness, the sense of not having control, the belief that effort
will not be effective. The thought “I walked too far today” is more
hopeful. It suggests the person can learn from experience, that
tomorrow need not be the same.
Recognizing
Automatic Thoughts
The
process of changing explanatory style from a pessimistic, helpless one
to a more optimistic and hopeful one occurs in three steps.
The first is learning to recognize self-defeating
thoughts. This is not easy
to do because the thoughts are automatic and habitual, so deeply
ingrained that they seem self-evident.
A
technique for recognizing automatic thoughts is the Thought Record. (For
a detailed explanation, see the book Mind Over Mood by Dennis
Greenberger and Christine Padesky).
Using this form offers a way to become aware of your automatic
thoughts and their effects on your mood and behavior.
You can find similar techniques in other books, such Learned
Optimism by Martin Seligman or Feeling Good by David Burns.
To
see how this technique works, we’ll use an example of a patient who
took a walk one day and
felt very tired when she got home. Feeling depressed, she
asked herself what thoughts were going through her mind. They were:
“I’ll never get better. Every
time I try something, it fails.”
She wrote a description of the event in column 1 of the Thought
Record. (See below.) In the
second column, she recorded her emotions at the time, noting that she
felt depressed and hopeless. And in the third, she wrote the thoughts
going through her mind when the emotions were strongest: “I’ll never
get better. Every time I try something, it fails.”
|
Thought Record #1 |
|
1 |
2 |
3 |
|
Event |
Emotions |
Initial Thoughts |
|
Walked 30 min. Very
tired after |
depressed hopeless |
I’ll never get
better. Every time I try something, it fails. |
The
purpose of this exercise is to help you gain some distance from your
thoughts, to remove their taken-for-granted or self-evident character.
Often we are more harsh and judgmental toward ourselves in our inner
dialogue than we would be with others. Self-defeating thoughts often go
through our minds when something upsetting occurs. Because these
thoughts are automatic, they can be hard to recognize and it can take
some time to develop this skill.
Evaluating
Negative Thoughts
Once
you have identified negative thoughts, the next step is to examine them
for reasonableness. Ask yourself to
what extent the thoughts are valid. Negative thoughts tend to ignore
facts or to select only the worst aspects of a situation. One way to
determine reasonableness is by asking, “What is the evidence for
and against my thoughts?” The idea is to suspend temporarily
your belief that the thoughts are true, and instead look for both
evidence that supports and evidence that refutes the thoughts. Writing
down the evidence you find helps you gain distance from your thoughts
and makes them less self-evident.
You
use column 4 in the Thought Record for evidence for, and column 5
for evidence against. The patient in our example wrote in column
4 that she has frequent setbacks and that she had often felt worse after
exercising. She wrote in column 5 that she had improved over the last
year and knew that many CFS patients improve.
|
Thought Record #2 |
|
1 |
2 |
3 |
4 |
5 |
|
Event |
Emotions |
Initial Thoughts |
Pro |
Con |
|
Walked 30 min. Very
tired after |
depressed hopeless |
I’ll never get
better. Every time I try something, it fails. |
I have frequent
setbacks. Exercise often makes me worse. |
Overall I’m
better than a year ago. Many people improve. |
Your
thoughts at moments of strong emotion may seem irrefutable, so it may
help to have in mind some questions you can ask yourself in order to
find evidence that does not support your thoughts.
Among them:
Do I know of situations in which the thought is not completely
true all the time?
If someone else had this thought, what would I tell them?
When I felt this way in the past, what did I think that helped me
feel better?
Five years from now, am I likely to view this situation
differently?
Am I blaming myself for something not under my control?
Seeing
Alternatives
In
the first step, you identify your self-defeating thoughts by recording
the thoughts associated with strong emotions.
In the second step, you challenge the accuracy of the thoughts by
testing them to find distortions and irrationalities. In the last step of the process, you propose a new
understanding of your experience.
You
use column 6 of the Thought Record for this purpose. What you write in
column 6 should be either an alternative interpretation of your
experience (if you refuted the thought) or a balanced thought that
summarizes the valid points for and against (if the evidence was mixed).
In either case, what you write should be consistent with the
evidence you recorded in columns 4 and 5.
Reviewing the evidence she had written in columns 4 and 5, our
patient decided that the evidence was mixed.
She wrote a balanced thought that combined the evidence for and
the evidence against. “I have frequent relapses, but I've made progress and
that gives me
hope.”
|
Thought Record #3 |
|
1 |
2 |
3 |
4 |
5 |
6 |
|
Event |
Emotions |
Initial Thoughts |
Pro |
Con |
Corrected Thoughts |
|
Walked 30 min. Very
tired after |
depressed hopeless |
I’ll never get
better. Every time I try something, it fails. |
I have frequent
setbacks. Exercise often makes me worse. |
Overall I’m
better than a year ago. Many people improve. |
I have frequent
relapses, but
I’ve made progress and that gives me hope. |
The
Goal: Reduce Stress Through Realistic Thinking
The
process described in this article involves changing deeply ingrained
habits of thought. The long-term results can be dramatic, but
improvement is gradual, and there may be some bumps along the road.
Becoming aware of negative thoughts may produce a short-term drop in
mood.
The
three step process does not involve replacing negative
thoughts with positive, but inaccurate, thoughts. I am not suggesting
you adopt something like the motto, “Every day, in every way, I am
getting better and better.” Rather, the goal is to learn to see your
situation in an accurate, yet hopeful, manner, retraining your habits of
thought in a more realistic direction.
The
type of thinking integrates all evidence, both positive
and negative, in a balanced fashion. This approach should reduce your stress by
helping you feel better, less anxious and sad. And, at the same time, it
should help you to deal more effectively with your illness.
