Taming Stressful Thoughts: Making Thoughts Work For You

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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 show you how to 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 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, 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."
 

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 people with ME/CFS 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."

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.