The CFIDS & Fibromyalgia Self-Help Book

Chapter 10: Reducing Stress by Taming Thoughts

In the last chapter, I mentioned several sources of stress for people with chronic illness, including the discomfort created by symptoms, financial pressures, strained relationships and uncertainty about the future. This chapter deals with another source of stress, our thoughts. What we think, especially our thoughts about ourselves, can intensify stress, making symptoms worse. By changing your thoughts, you can reduce stress.

We have encountered some of these ideas in passing earlier in the book. A woman described in Chapter 6 extended her energy by changing her thoughts about her role as a hostess for a birthday party. Having different expectations for herself enabled her to relax and expand greatly the time she could spend at the party. The last chapter described how making mental adjustments can reduce stress and help us avoid unnecessary activity. This chapter looks at thoughts in a systematic way, offering a three-step technique for changing your thoughts so they help you rather than increase your suffering.

Being in a situation in which you seem to lack control can create a strong sense of helplessness. Psychology has coined the term learned helplessness to describe the lasting effects of going through an uncontrollable bad situation. But just as feelings of pessimism and despair can be learned in response to experience, so can optimism. Martin Seligman, the psychologist who developed the idea of learned helplessness, also wrote a book called Learned Optimism to explain how to change your thinking in a more positive direction.

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.” This person has a pessimistic way of interpreting experience. She sees specific events as examples of permanent, far-reaching negative forces. 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 and a belief that effort will not be effective.

Pessimistic thoughts can increase your suffering because your thoughts affect your perception of your symptoms. Negative thoughts make you feel anxious, sad and hopeless, which in turn makes it difficult to act constructively. Worry and preoccupation with suffering may even intensify symptoms and trigger another round of negative thinking. The cycle can be very demoralizing and make it difficult to motivate yourself.

The second patient responds to her increase in symptoms by saying: “I walked too far today.” She has a more optimistic way of seeing her experience. She sees an event as something specific, limited and temporary. Her thought is more hopeful. It suggests she can learn from experience, that tomorrow need not be the same. The more optimistic mood is associated with the willingness and even eagerness to try again.

From this perspective, feelings are created by thoughts, and feelings in turn are powerful sources of motivation, moving us to action if positive or leading to despair if negative.

Negative thoughts can be quite common in chronic illness. Focusing on symptoms, for example, can lead to thoughts like “I’m always in pain.” Such thoughts lead to frustration and discouragement. An inner dialogue featuring the word “should” can also produce frustration and anger towards oneself. An example is saying: “I should be able to do more.” Self-esteem can be undermined by thoughts like “I’m useless.”

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.

The thoughts are part of our constant inner dialogue. Some of the talking we do inside our heads is about things outside us. For example, when we find something we’ve lost, we might say to ourselves “There’s the paper I’ve been looking for.” Another part of our inner dialogue is about ourselves. It is the things we say to ourselves about ourselves. For example, when we lose a paper we might say something like “You dummy; you’re always losing things.”

This self-talk is called automatic thinking because it is a habitual way of responding to experience. Often we are more harsh and judgmental with ourselves in our inner dialogue than we would be with others. Self-defeating thoughts often go through our minds when something upsetting occurs. For example, when we experience a relapse, we might say something like “I’ll never get any better. Every time I try something, I fail.” It is not easy to observe yourself at these times, because thoughts like these are automatic and habitual. But if you can recognize the thoughts, you gain some distance from them and remove their self-evident character.

A technique for recognizing automatic thoughts is the Thought Record, which is described in 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 as 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 and hopeless, 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.”