Feeling Good: The New Mood Therapy (35 page)

The episode involved a letting go, a feeling of closure, and a sense of good-bye. This was in no way frightening or terrible; but in fact, it was peaceful and warm, and added a sense of richness to my experience of life.

When your depression has vanished, it’s a temptation to
enjoy
yourself and relax. Certainly you’re entitled. Toward the end of therapy, many patients tell me they feel the best they’ve ever felt in their lives. It sometimes seems that the more hopeless and severe and intractable the depression seemed, the more extraordinary and delicious the taste of happiness and self-esteem once it is over. As you begin to feel better, your pessimistic thinking pattern will recede as dramatically and predictably as the melting of winter’s snow when spring arrives. You may even wonder how in the world you came to believe such unrealistic thoughts in the first place. This profound transformation of the human spirit never ceases to amaze me. Over and over I have the opportunity to observe this magical metamorphosis in my daily practice.

Because your change in outlook can be so dramatic, you may feel convinced that your blues have vanished forever. But there is an invisible residue of the mood disorder that remains. If this is not corrected and eliminated, you will be vulnerable to attacks of depression in the future.

There are several differences between
feeling
better and
getting
better. Feeling better simply indicates that the painful symptoms have temporarily disappeared. Getting better implies:

Parts I, II, and III of this book were designed to help you achieve the first two goals. The next several chapters will help you with the third and fourth goals.

Although your distorted negative thoughts will be substantially reduced or entirely eliminated after you have recovered from a bout of depression, there are certain “silent assumptions” that probably still lurk in your mind. These silent assumptions explain in large part
why
you became depressed in the first place and can help you predict
when
you might again be vulnerable. And they contain therefore the key to relapse prevention.

Just what is a silent assumption? A silent assumption is an equation with which you define your personal worth. It represents your value system, your personal philosophy, the stuff on which you base your self-esteem. Examples: (1) “If someone criticizes me, I feel miserable because this automatically means there is something wrong with me.” (2) “To be a truly fulfilled human being, I must be loved. If I am alone, I am bound to be lonely and miserable.” (3) “My worth as a human being is proportional to what I’ve achieved.” (4) “If I don’t perform (or feel or act) perfectly, I have failed.” As you will learn, these illogical
assumptions can be utterly self-defeating. They create a vulnerability that predisposes you to uncomfortable mood swings. They represent your psychological Achilles’ heel.

In the next several chapters you will learn to identify and evaluate your own silent assumptions. You might find that an addiction to approval, love, achievement, or perfection forms the basis of your mood swings. As you learn to expose and challenge your own self-defeating belief system, you will lay the foundation for a personal philosophy that is valid and self-enhancing. You will be on the road to joy and emotional enlightenment.

In order to unearth the origins of your mood swings, most psychiatrists, as well as the general public, assume that a long and painfully slow (several years) therapeutic process is necessary, after which most patients would find it difficult to explain the cause of their depression. One of the greatest contributions of cognitive therapy has been to circumvent this.

In this chapter you will learn two different ways to identify silent assumptions. The first is a startlingly effective method called the “vertical-arrow technique,” which allows you to probe your inner psyche.

The vertical-arrow technique is actually a spin-off of the double-column method introduced in Chapter 4, in which you learned how to write down your upsetting automatic thoughts in the left-hand column and substitute more objective rational responses. This method helps you feel better because you deprogram the distortions in your thinking patterns. A brief example is shown in Figure 10–1. It was written by Art, the psychiatric resident described in Chapter 7, who became upset after his supervisor tried to offer a constructive criticism.

Putting the lie to his upsetting thoughts reduced Art’s feelings of guilt and anxiety, but he wanted to know how and why he made such an illogical interpretation in the first place. Perhaps you’ve also begun to ask yourself—is there a
pattern
inherent in my negative thoughts? Is there some psychic kink that exists on a deeper level of my mind?

Figure 10–1.

Art used the vertical-arrow technique to answer these questions. First, he drew a short downward arrow directly
beneath
his automatic thought (see Figure 10–2, page 265). This downward arrow is a form of shorthand which tells Art to ask himself, “If this automatic thought were actually true, what would it mean to me? Why would it be upsetting to me?” Then Art wrote down the next automatic thought that immediately came to mind. As you can see, he wrote, “If Dr. B. thinks I’m a lousy therapist, it would mean I
was
a lousy therapist because Dr. B. is an expert.” Next Art drew a second downward arrow beneath this thought and repeated the same process so as to generate yet another automatic thought, as shown in Figure 10–2. Every time he came up with a new automatic thought, he immediately drew a vertical arrow beneath it and asked himself, “If that were true, why would it upset me?” As he did this over and over, he was able to generate a chain of automatic thoughts, which led to the silent assumptions that gave rise to his problems. The downward-arrow method is analogous to peeling successive layers of skin off an onion to expose the ones beneath. It is actually quite simple and straightforward, as you will see in Figure 10–2.

Figure 10–2.
Exposing the silent assumption(s) that give rise to your automatic thoughts with the use of the vertical-arrow method. The downward arrow is a form of shorthand for the following questions: “If that thought were true, why would it upset me? What would it mean to me?” The question represented by each downward arrow in the example appears in quotation marks next to the arrow. This is what you might ask yourself if you had written down the automatic thought. This process leads to a chain of automatic thoughts that will reveal the root cause of the problem.

You will notice that the vertical-arrow technique is the
opposite
of the usual strategy you use when recording your automatic thoughts. Ordinarily you substitute a rational response that shows why your automatic thought is
distorted
and
invalid
(Figure 10–1). This helps you change your thinking patterns in the here and now so that you can think about life more objectively and feel better. In the vertical-arrow method you imagine instead that your distorted automatic thought is absolutely valid, and you look for the
grain of truth
in it. This enables you to penetrate the core of your problems.

Now review Art’s chain of automatic thoughts in Figure 10–2 and ask yourself—what are the silent assumptions that predispose him to anxiety, guilt, and depression? There are several:

Once you have generated your own chain of automatic thoughts and clarified your silent assumptions, it is crucial to pinpoint the distortions and substitute rational responses as you usually do (see Figure 10–3, page 268).

The beauty of the downward-arrow method is that it is inductive and Socratic: Through a process of thoughtful questioning, you discover on your own the beliefs that defeat you. You unearth the origin of your problems by repeating the following questions over and oven “If that negative thought were true, what would it mean to me? Why would it upset me?”
Without introducing some therapist’s subjective bias
or personal beliefs or theoretical leanings, you can
objectively
and systematically go right to the root of your problems. This circumvents a difficulty that has plagued the history of psychiatry. Therapists from all schools of thought have been notorious for interpreting patients’ experiences in terms of preconceived notions that may have little or no experimental validation. If you don’t “buy” your therapist’s explanation of the origin of your problems, this is likely to be interpreted as “resistance” to the “truth.” In this subtle way, your troubles get forced into your therapist’s mold regardless of what you say. Imagine the bewildering array of explanations for suffering that you would hear if you went to a religious counselor (spiritual factors), a psychiatrist in a Communist country (the social-political-economic environment), a Freudian analyst (internalized anger), a behavior therapist (a low rate of positive reinforcement), a drug-oriented psychiatrist (genetic factors and brain-chemistry imbalance), a family therapist (disturbed interpersonal relationships), etc.!

A word of caution when you apply the vertical-arrow method. You will short-circuit the process if you write down thoughts that contain descriptions of your emotional reactions. Instead, write down the negative thoughts that
cause
your emotional reactions. Here’s an example of the
wrong
way to do it: