This chapter explores how our thoughts and feelings are often linked together, and how together they can push and pull us down into depression. Cognitive behavioral therapists argue that when events happen to us, or some feelings and thoughts arise in our minds, we also decide what they mean. The meanings we give to things and dwell upon can deeply affect our well-being. One way of looking at this is to distinguish the event that might stir feelings in us from the meanings we give to them. We can explore this by setting it out in three columns:
Event Meanings Consequences
Triggering event Beliefs and key thoughts Emotions Interpretations Behavior
Physical reactions
Suppose a good friend promises to phone you at 11 p.m. and asks you to wait in for the call, but then the time comes and goes and there is no phone call. What are the various possibilities for the consequences – what might you feel? Well, you could feel many things: anxiety, anger, sadness or even relief, and you would be absolutely right to say that it all depends on what you think the reason is for the person not phoning. That’s the point. We can see this below using the three columns again.
Event Meanings Consequences
No phone call
Something has happened to him/her – maybe an accident. S/he went to
a party and Anxiety
forgot about me. S/he doesn’t care enough Anger
to remember. S/he will phone tomorrow Sad
so I can go to bed now. Calm/relief
Automatic thoughts and feelings
In the above example, the negative emotions of anger, anxiety or sadness indicate that the lack of the phone call is taken as some kind of threat. Jumping to the conclusion that, for example, your friend has had an accident is called an ‘automatic thought’ or ‘automatic reaction’. You can’t know what has happened, or the reasons why she didn’t phone, until you have the evidence. At this point our thoughts are guesses or theories. Nonetheless, you may feel anxious or worried. As the term implies, automatic
thoughts are those interpretations or ideas that seem to come automatically to mind; they are our ‘pop-up’ thoughts. They are immediate, consciously available thoughts that require little or no effort and can seem plausible. They are not arrived at through much in the way of reflective reasoning. They will often flush through our bodies with feelings; as if we are riding on a wave of feeling.1
Let’s consider these thoughts a little more, this time using the example of anger over the missing phone call. The first thing to note is that you probably don’t often think in words like, ‘Oh, I think my friend has gone to a party and has forgotten to ring and left me waiting in for the call.’ More likely, you have flashes of pictures in your mind. If your first flush was anger, how would you answer these questions: Is she having a good time? Is she talking with other people? Is there music playing? Is it classical or disco music? I would imagine that you can answer these questions fairly easily.
Sometimes automatic thoughts are difficult to catch because they happen quickly or are not in full consciousness. Had I not asked you about the party, those thoughts might have gone relatively
unnoticed or been only semi-conscious, but when I drew your attention to them, you may have become aware that you had had them. Sometimes, when we feel a change of emotion, we have to focus on our thoughts and what is actually going through our minds.
It is common for automatic thoughts to occur in images, daydreams and fantasies. As in the example above, we may construct scenarios of seeing the friend in some particular place (e.g., the party) and imagine her having a good time, laughing, drinking and so on. We may also enter into a kind of discussion with ourselves as a result of our automatic thoughts and fantasies. For example, having decided that the friend is out having a good time while you are waiting for her call, you may start to rehearse in your mind an argument or what you intend to say the next time your friend does phone. You might even rehearse something that you know, in reality, you would not do because of fear of being rejected/disliked, or because of moral concerns.
Sometimes we may not be fully aware that we are constructing such scenes in our heads. For
example, when the phone doesn’t ring, you may find yourself becoming more sad or irritated, but your awareness of your thinking processes may be hazy. Sometimes we let the scenes in our minds run on, as if there is some ‘inner director’ in our heads feeding our minds various ideas and pictures that are full of meaning. Hence, we may need to train ourselves to sharpen the focus of our automatic thoughts and make them more easily known, recognized and challenged. We may need to use active
imagination – that is, to allow ourselves to tune into the thoughts so that we can examine and deal with them more easily.
Here is a question for you. If you focus on those thoughts and play those kinds of scenarios in your mind, which brain systems are you stimulating? Is that helpful for you?
One thought leads to another
You may have noticed something important in the examples given above – one thought leads to another. Humans are highly creative in their thinking, and we are usually not happy with just one or two thoughts. At times, especially when we are heading into a depressive spiral, our thoughts spin down into catastrophes. Our threat system is in the driving seat. For example, let’s consider how someone heading into a depressive spiral might think about the friend who didn’t phone. The sequence of thoughts might go like this:
He hasn’t phoned.
This is because he has forgotten about me.
Maybe he had better or more fun things to do.
If he cared about me, he would have phoned.
Therefore, he doesn’t really care.
I don’t ever seem to be able to find someone who cares about me.
What’s wrong with me?
Maybe I am just too boring and unattractive.
I’ll never have a good, long-lasting relationship.
I’ll always end up abandoned.
Life is completely pointless and empty.
This cascade can be so rapid that we hardly notice it. Rather than just being disappointed or slightly irritated by the phone not ringing, we end up feeling much more depressed because we become focused on being boring, not cared for, are going to be abandoned or are being used by
others. When we enter into depression brain patterns, we often experience rapid cascades of thoughts like those above. One reason for this is because our threat-protection system is hypersensitive and always goes for ‘assume the worst’ and ‘it is better to be safe than sorry’ while our rational and soothing-reassuring systems struggle to keep a perspective or help us calm down – and we will explore what to do about it shortly.
Sometimes it is what we feel within our bodies that generates negative thoughts. For example, people who have panic attacks may notice that their heart rate goes up when they become anxious.
This leads to the thought: ‘There must be something wrong with my heart for it to beat like this.’ They then focus attention on their heart rate, and because they are thinking that there is something wrong with their heart, they become more anxious. And, of course, as they become more anxious, their heart rate goes up even further. Even though the heart is basically a pump and is designed to increase and decrease its beating as circumstances require, the idea that an increased heart rate signals an
oncoming heart attack produces an intense anxiety spiral (Figure 6.1).
Hence we can see that we can have negative thoughts about ourselves, others and the future, all of which can increase our depression, and that these can be sparked off by events, our inner feelings, things we notice in our bodies or past actions.
Figure 6.1 How thoughts and feelings interact.
Downward spirals and emotional amplifiers
Usually thoughts like these provide feedback for each other. For example, when we are depressed we often don’t feel like doing much; when we don’t achieve much, we may tell ourselves how useless we are or feel unlovable or defeated because we are depressed and ratty, which increases depression;
we feel depressed about being depressed (Figure 6.2).
You can probably see that if we are caught up in understandable spirals, it can be difficult to get out of it, unless we take steps to stop them. These thoughts might be called emotional amplifiers because, as they go around and around, they become more intense. There is nothing in the spiral that damps them down. You need to build in emotional dampeners – ways to break the cycle. You may also see that there are some key links in this spiral that you could challenge. You might ‘mindfully’ accept your depression as your current state of mind (see Chapter 7), which is not your fault, and be kind to
yourself. You could do a little bit of some activity and then give yourself a lot of praise for doing something even though you’re depressed (see Chapter 12). You know praise will stimulate your positive emotion systems, so you can learn to praise your efforts rather than the results. Think about how you would speak to a friend in the same situation and treat yourself the same way (see Chapter 9).
Figure 6.2 How thoughts and behaviors interact.
If you are depressed, don’t be surprised if these suggestions don’t impress you. You can be
expected to discount them – after all, you feel depressed, and that’s what we tend to do when we are depressed. We stick rigidly to what we think and the way we see things. A thought to keep in mind for later is to consider whether your feelings of being useless or unlovable are related to frustration and anger about being tired, and you then direct these feelings at yourself, or whether you might actually be frightened to see that you are better than you think you are.
Thoughts about feelings
Although it is often situations and events that spark off threat-related thoughts, this is not always so.
Our moods can set us up for certain types of thought – we think differently when in a depressed,
anxious, angry or happy mood. Sometimes our feelings can be triggered by things of which we are not fully conscious.2 Importantly too, we can have inner feelings such as anger or feeling trapped and then have thoughts about those inner feelings. For example, you might think it is bad to have intense
feelings of anger. Or you might have sexual feelings about someone and feel very guilty because you tell yourself that such feelings and fantasies are bad. Or you might feel anxious about something and then think that you are stupid or weak for feeling anxious. You may wake up feeling tired and think,
‘Oh, God, another bloody day! How am I going to get through it?’
When depressed we can have all kinds of beliefs about some of our own inner feelings. For example, we may believe we have fantasies or feelings that other people don’t have. These may be related to frightening, escaping, sexual or aggressive fantasies. We feel we can’t talk about them because people will regard us as odd.3 But of course humans have had these thoughts and fantasies for millions of years, and when it comes to frightening, defeatist, sexual or aggressive ones some people write books about them and make a lot of money! They may be pretty horrible fantasies, but they are not abnormal. People may believe that their feelings will overwhelm them. Of course
feelings can be very powerful at times, and we need to learn how to tolerate them without acting them out. Stories and films like The Hulk appeal to us because we have all had the experience of feeling high levels of rage, which can frighten us. Sometimes it is sadness, tearfulness and grief that
depressed people feel they are overwhelmed by, and sometimes they try to avoid feeling. Sometimes depressed people can have conflicts with those they love, and they may believe that this means there is something wrong with their relationship. They may believe that if you love somebody you should never feel very angry or want to leave them.
So it is not just things that happen in the outside world that can worry or upset us. It can also be thoughts and feelings that come into our minds, which we think indicate something bad about us, that can also be distressing. Learning how to cope with our own minds, and realizing that a lot of what goes on in them is because of how our brains evolved, and is not our fault, is important. You have the capacity for intense anxiety, rage or grief because your brain has been built to have those capacities;
and you can read about them in novels and see them acted out in films. We have to learn how to cope with strong feelings, what they mean and how they can blend together; but not blame ourselves for having them.
So you see we can have feelings about feelings. We can become anxious about being depressed, depressed about being anxious, angry about being anxious, anxious about being angry – and round and round we go.
Thoughts and behaviors
We may also have negative thoughts about what we have done or failed to do. For example, because we are anxious, we might not go to a party or some other function to which we have been invited. We might then think that we have behaved badly and let other people down. We become preoccupied with guilt. For example, because he suffered from social anxiety, Colin did not go to a friend’s leaving party at work. He had the following thoughts:
I should have gone.
I’ve let my friend down.
He will be angry that I didn’t go and will lose interest in me.
Others will wonder what’s the matter with me.
I have missed out on a good time again.
I’m useless in social situations.
I’m pathetic to get anxious.
The more these thoughts took hold, the more anxious and depressed he became.
When Richard looked back at his life he picked out things he felt bad about and dwelt on them.
This of course kept him depressed, and stopped him doing anything about them. He recognized that when he was not depressed, he could see his life as complicated and that like all human beings he had made helpful and unhelpful decisions. It is very easy for us to fall into focusing on regrets – ‘if only I had or if only I hadn’t.’ Acknowledging but coming to terms with, maybe grieving for, and moving on from regrets can be helpful to us. We cannot change a single second that has passed, but the future is yet to be written.
Some of the decisions we feel bad about can be major things such as getting drunk and sleeping with somebody we didn’t want to, or staying in or pulling out of a relationship and then regretting it.
As we will see later in this book, it is important to learn to become kind to ourselves and balanced in our thinking about things in our lives we are not comfortable with, or are disappointed in ourselves about. Very few of us get through life without making mistakes and having regrets. It is how we think about and deal with those things that is important for either learning from them or getting lost in depression over them. Depressed people often are not just unhappy with their behaviors but tend to judge themselves as a person rather negatively. We will address these issues in Chapter 13 on self-bullying and Chapter 17 on shame.
Writing down your thoughts
In Appendices 1 and 5 you will find a form where you can write down automatic thoughts, similar to the one we used with the phone call example on page 96. Turn to the appendix quickly and have a look. In this form you will see that, in the first column, various things can spark off negative thoughts and lead to various negative evaluations and conclusions. You can include events such as people criticizing you or things not working out as you would like (such as not receiving the phone call). We can also make negative evaluations of our feelings (e.g., I am a bad person for feeling angry; it is wrong to feel sexual attraction towards someone else who is not my partner), our behavior (I should not have acted like that; I am a bad person for losing control) or our bodies (when my heart rate goes up, this means there is something wrong with it and I might die). Then you can fill in the other two columns as before, that is, the beliefs and key thoughts of the ‘triggering’ event and its consequences.
The key thing is to choose what you want to focus on, then write down the thoughts that go through your mind. If you habitually write these down, you will get better at identifying them. Writing thoughts down helps to clarify them and allows you to concentrate on them, thus avoiding having them slip in and out of your mind in a rather chaotic fashion. A good way to start is to notice how your moods and feelings change. Try to remember what might have been happening to you at the time your mood
dipped or you had a flush of unwanted feelings, or unwanted thoughts popped into your mind – for instance, a criticism, or something that did not work out as you wanted it to, or something you hadn’t done or thought you ought to do. Next, write down the thoughts associated with these situations.
Sometimes you will not be able to identify specific things, so just write down thoughts that seem associated with difficult feelings.
Stop reading for a moment and see if you can think of a situation that made you upset recently. Try to identify your thoughts and interpretations that went along with those feelings. Practise this on a few events that you can remember happening to you recently. Gradually you’ll get the hang of noticing that
Stop reading for a moment and see if you can think of a situation that made you upset recently. Try to identify your thoughts and interpretations that went along with those feelings. Practise this on a few events that you can remember happening to you recently. Gradually you’ll get the hang of noticing that