Special issue with the Sunday Magazine
Well-being : March 12, 2000
Dr. Chittaranjan Andrade
The author is Additional Professor and Head, Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore.
All of us experience feelings of anxiety and depression as a reaction to the stresses and strains of everyday life. These mood disturbances can sometimes become quite serious. Whatever the extent to which we are affected, there is a simple and practical way to improving our emotional well-being.
Manoj K. Jain
Commonsense tells us that the way we think can affect the way we feel. Yet, few of us really change our ways of thinking in order to experience better mental health. In fact, few of us even know what to change, and how to go about it. This article therefore examines the concept of healthy thinking as a means to promoting emotional well-being.
The concept is best explained through the use of a parallel. Physicians emphasise the need for hygiene in the prevention of illness. We know that we must boil water before drinking it, that we must wash our hands before eating, and that our environment must be clean to discourage the proliferation of pests that spread disease.
Likewise, in the field of mental health, psychiatrists recognise that faulty patterns of thinking may produce stress-related emotional disturbances such as anxiety and depression. Many such "unhygienic" thought processes and patterns have been identified. These have become the focus of a practical, commonsense and effective form of treatment called cognitive therapy.
Cognitive therapy seeks first to identify dysfunctional thought processes, and next to correct them. Important dysfunctional ways of thinking include cognitive distortions, repeated intrusive thoughts, unrealistic assumptions, and others.
These are maladaptative thinking patterns that distort reality in a negative way, and make us perceive the world as being more hostile than it actually is. Arbitrary inference, selective abstraction, over-generalisation, magnification, and minimisation are examples of cognitive distortions.
Arbitrary inference refers to the drawing of an unjustified conclusion. For example, a businessman never takes his wife on any of his official trips. His wife is upset. She concludes that he is concealing something from her, perhaps an extramarital affair. She neglects other possible explanations.
Selective abstraction is the focussing of attention on one detail without regard to the rest of the picture. For example, a young man is depressed because he does not have a motorcycle. He feels that no girl will take him seriously unless he has a "bike". He does not consider that he has several assets such as intelligence and a pleasing personality. To him, these are of little importance.
Over-generalisation is the drawing of a general conclusion based upon a limited event. For example, a father discovers that his adolescent son has been smoking. He is distraught. He concludes that the boy has picked up this habit from bad company. He concludes that the boy is probably taking drugs as well. He concludes that his son is untrustworthy, and requires close supervision. He neglects to take into account the possibility that his son, like many other youngsters his age, has probably merely been experimenting with the experience.
Magnification is making mountains of molehills. Failing in an important examination is an unhappy event, but it is not the end of the world. A sensible student would grieve briefly, then pick up the pieces of his life and begin studying again.
Minimisation is an undervaluation of positive attributes. A woman may have low self-esteem because she is not well-off. She neglects the respect that she commands for being an efficient employee, a good mother, a caring wife, a cheerful neighbour, and a loyal friend.
When we are unhappy, it is often because we are using a multiplicity of such cognitive distortions. To lessen our emotional burden, we need to identify the distortions that are responsible for our unhappinesses, recognise these distortions for what they are, and seek alternate explanations for the events that are being distorted.
Repeated intrusive (automatic) thoughts
When we are unhappy, our sadness is often sustained by repeated, intrusive thoughts. These push themselves into consciousness and preoccupy or even dominate the mind, leaving little opportunity for the experience of happier thoughts. There are several categories of such automatic thoughts.
These are thoughts that express an unjustified lack of self-confidence. Examples are: "I cannot do it." "I'm not as pretty as my friends." "No girl is ever going to look at me." "'I'm going to be a failure in life." "I don't deserve to live."
These are thoughts that criticise the self to an extent more than is justified. Examples are: "I should have been more careful." "I shouldn't have said that." "I shouldn't have done that."
These are thoughts that assume more than is justified. Examples are:
"I've been a bad mother." "I've wasted my life." "It's all my fault."
These are thoughts that blame others more than is justified. Examples are:
"If it hadn't been for my family, I could have had a successful career." "If it hadn't been for my father, I would have been twice as rich today."
Ideas of deprivation
These are thoughts that focus on liabilities rather than on assets. Examples are:
"We're so poor." "My friends have been to Europe. I haven't even been to Agra." "Why do I have such a rotten life?"
These are thoughts that insist upon assuming more responsibilities or difficulties than are warranted. Examples are:
"I should do more for my children." "I ought to work harder and earn more money."
All of us have repeated, intrusive thoughts that make us miserable. We need to identify such thoughts, realise their irrationality, and switch over to more positive topics.
These assumptions describe attributes or goals that must be attained; a failure to attain these goals leads to ideas of decreased self-worth. Examples of unrealistic assumptions are:
"I must be perfect."
"I should never fail in anything that I do."
"I cannot be happy if anybody criticises me."
"Everybody must like me."
"I must stand first in the examination."
"I cannot be happy unless I have a lot of money."
Unrealistic assumptions can make us unhappy, and we can wreck the peace and tranquillity in the family as well. It is important that we learn to accept ourself, imperfections and all.
Research has found that certain faulty thought processes frequently run together. Depressed persons tend to have a negative view of themselves, a negative view of their current experience, and a negative view of the future.
Depressed persons tend to feel hopeless:
"What's the use of living?" "I don't have anything to look forward to." "Nobody cares, nobody loves me."
Depressed persons tend to feel helpless:
"What's the use? Nothing that I do makes the slightest difference." "Nobody is going to pay any attention to me." "Things have gone out of control."
Depressed persons tend to feel worthless:
"I'm not as good as the others in my class." "I'm a failure, a good-for-nothing person." "I do not deserve to live."
These cognitive traits develop as a result of the cognitive distortions, the repeated, intrusive thoughts, the unrealistic assumptions and other faulty cognitions that were described earlier.
Other faulty ways of thinking
When we are sad, we tend to focus on unhappy memories. Our thought content is predominantly negative. We do not draw upon positive thoughts and dwell upon them.
When positive events do transpire, we might fail to derive significant satisfaction therefrom. We might discount or belittle positive events.
We may lapse into sadness because of polarisation of thought. Also referred to as dichotomous thinking, this means that issues are perceived as either black or white, never grey. Since in real life, matters are rarely so clear cut, when we polarise events we find it hard to reconcile reality with our mental framework. This makes us unhappy and insecure.
As an example of polarised thought, parents, school teachers, and persons in authority may be perceived as being "good". When these authority figures fail to live up to expectations, disillusionment follows and they become "bad". The disillusionment generates depressive feelings.
We may become unhappy if we personalise events. Occurrences, particularly negative ones, in everyday life tend to take on a personal significance.
"I missed my bus. Why did it have to happen to me? Everything goes wrong for me."
Sometimes, the illogical thought is carried to absurd extremes.
"The illness which struck my child is God's way of punishing me for my sins."
Depressed persons assume failure before they start.
"I'll never complete my assignment on time." "I cannot study... I'll never pass my exams."
Depressed persons overrappraise risks.
"That's too difficult; it's not worth taking a chance." "I won't do it; if I try and fail, I will lose my job."
Depressed persons are plagued by fears of loss of control. They fear that they are no longer in control of their day-to-day affairs; that they are no longer in control of their thoughts and emotions; that they are no longer in charge of their destiny.
Depressed persons experience repeated negative images. This includes, for example, re-living the sight of a traffic accident and imaging a spouse or child under the wheels of the truck.
Depressed persons play "what if" games with themselves.
"What if everybody starts laughing at me?" "What if I lose my job?"
The greatest tragedy is the circularity of thought processes. Thinking in unhealthy ways leads to unhappiness, and being unhappy fosters unhealthy ways of thinking. The more depressed we are, the more depressive is our thought content and the manner of our thinking. The more depressive our thought content and the manner of thinking, the more depressed we become. A vicious circle develops, which produces and maintains a depressive syndrome across months or years.
So, how can we promote emotional well-being? First comes the identification of unhealthy thought processes that predispose to feelings of depression. These thought processes include the cognitive distortions, the repeated intrusive thoughts, the unrealistic assumptions, the cognitive triads, and others.
Next comes the challenging process wherein we examine the evidence for and against our erroneous beliefs.
Then, we examine the connection between our dysfunctional thoughts, our mood, and our behaviour. During these steps, we learn to become aware of our faulty logical processes; we learn to seek alternative explanations.
When negative thoughts enter the mind, distractor activities are helpful. These distractor activities can be ad hoc, such as concentrating on sounds in the environment, focussing on an object in the vicinity, or performing a repetitive activity. Distractor activities can also be planned, such as taking up a hobby or engaging onself in an absorbing task. Structuring one's day also helps. Listing positive thoughts, positive experiences, positive memories, intellectual assets, emotional assets, material assets and interpersonal assets also helps; these lists can be frequently reviewed to provide emotional support.
Such a cognitive approach to the treatment of depression has been popularised in the U.S. by Aaron T. Beck, an eminent therapist with a psychoanalytic background. Dr. Beck was dissatisfied with the emphasis that psychotherapists laid on unconscious processes in the mind; he chose instead to focus on conscious mental processes that were more accessible to direct intervention.
Cognitive therapy, or learning how to think right, has today become an important therapeutic approach to depression as well as several other psychiatric disorders.
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