In the last few chapters we noted that, when we become depressed and feel low and tired, our thoughts tend to take us downward. They rarely encourage us or offer uplifts when we most need them. If anything, our thoughts are rather bullying and critical. In this chapter, we are going to explore ways of breaking out of this downward spiral. Look at the fourth column of the ‘Thought monitoring and creating helpful alternatives’ form in Appendix 1. We are going to learn about how to use this – how to create and refocus on helpful thoughts that are more likely to stimulate soothing rather than threat emotions in us. In the last part of the chapter I will explore with you how to make your own thought forms to suit your needs.
Before we get started, a word of warning. Depressed people are constantly being told that they are too negative and to look on the bright side and focus on positives. Of course, this is very unhelpful because depressed people know this perfectly well for themselves! Moreover, they can get a bit annoyed and resistant. As one of my patients said to me ‘I am fed up with being told I am too negative and to be more positive. The problem is I don’t have a positive thought in my head and if I did I wouldn’t be here.’ It’s a fair point. Everything that we outline below is an invitation to explore and try things out, become your own therapist, learning how to generate thoughts and behaviors that are genuinely helpful to you. It is absolutely not an instruction to ‘Look on the bright side’, ‘Give up your faulty thinking’ or other such unhelpful ideas. It is rather a journey into experimenting with new ideas and to discover helpful things.
Our moods or fears colour and direct our thinking, so we have to help our thinking to stand back from them.1 To help control the spiral downwards into depression, we need to stand back and encourage our fair and rational minds to do more work. As we noted in Chapter 3, high stress anxiety and anger can push this rational part of us to one side. Under stress, we automatically look at the negatives, so try to refocus those thoughts onto helpful ones.
One way of doing this is to be more rational, balanced and fair about them, so let’s look at the functions and qualities of the rational mind, since we want to recruit it to help ourselves.
So the ‘rational and fair approach’ is a side of ourselves that we need to cultivate. We do this by deliberately trying to focus on this part of ourselves and asking ourselves, ‘What would my fair and rational mind (part of me) say about this?’
However, cognitive therapists point out that focusing on evidence and rationality alone is not always helpful and indeed can be positively unhelpful. Imagine that you are on the high-wire or climbing a steep rock face. You could look down and focus on the thought that if you slip you’ll die. That’s absolutely correct – no doubt about it – but it’s not the best or most helpful thought to focus on. It’s better if you look ahead, focus on one step at a time – and keep going. We only use our rational thoughts if they are going to be helpful.
In fact our rational minds work best at combating depression when they are focused and in the service of compassion and kindness; and cultivate our compassionate mind. Thus, we need to develop a compassionate and friendly rationality, not a cold and impersonal one. In the last chapter we developed various exercises to help us engage our thoughts and feelings with compassion. We are now going to use compassion focusing to help us with our depressing thoughts and behaviors.
In the last chapter we considered compassion based on wisdom, strength, warmth and non-judging or condemning. Our compassionate minds are empathic, kind and understanding. Can we treat ourselves like this so that when we generate alternative thoughts (with our rational minds) we hear them in wise, kind, gentle and helpful tones?
When we get depressed, there are not so many of these positive caring signals. We become more self-critical and generally negative. When times are hard we do not take an understanding, warm and kind approach with thoughts like, ‘Well, this has been hard for me and I am bound to feel sad and disappointed about it.’ Instead, we are more likely to become angry or feel hopeless, rather than understanding and supportive. It is understandable, because that is how the brain works – so we have to make an effort to bring our soothing and gentle system back on line in our brain.
To heal ourselves, there are things we can learn to cultivate a compassionate mind. The compassionate mind, like the rational mind, has certain qualities:
We can learn to train our thoughts to be warm and friendly and cultivate the qualities of the compassionate mind. For some of us, especially those who have not received much in the way of warmth and kindness when young, this can be a most difficult but helpful step.
The components of compassion can be broken down into basic attributes and qualities and the skills of compassion. You may feel there are a lot of aspects here, but don’t worry if you only get a sense of what we’re talking about – that’s fine. If you think that the main quality of compassion is kindness, and that is all you can recall – no worries – just stick with that.
Looking at compassion in a slightly more technical way, we can see that it is made up of different aspects of our minds.
Remember these abilities can be gained in small stages, step by step. All of them are engaged with a genuine desire to relieve suffering and increase our growth and flourishing. Although I try to develop my compassion, my beloved wife still tells me I am becoming a grumpy old man – so still much training required for me, I guess!
These involve learning to direct our attention in a compassionate and helpful way, learning to think and reason in a compassionate and helpful way and learning to behave in compassionate and helpful way – all of these with warmth, support and kindness. As we have said, is the glass half full or half empty? When something negative happens or you are unhappy with yourself, can you redirect your attention to something that is helpful? So the attention is very important. Mindfulness is about training our attention.
The next skill is compassionate reasoning or thinking. Can we train our minds to focus on reasoning and thinking about ourselves, our relationships and situations in a way that is compassionate and helpful? When we ruminate on our anxiety, disappointments, anger or aspects of depression this is only going to lock these feelings in. Can we practise deliberately choosing to refocus our reasoning helpfully – to really ask ourselves the question, ‘What is a helpful way for me to think about this problem, situation or difficulty?’ Imagine reasoning it through with a friend, or imagine having a dialogue with your compassionate image (see pages 159–166) and see what is helpful for you here, and what you need, to act on this. Do not become confused with the idea that compassionate thinking is simply ‘being nice’. Thinking things through compassionately means being honest and at times thinking about difficult thoughts or painful, even aggressive, feelings and dilemmas.
The next skill is learning how to behave compassionately, in ways which you identify will be helpful to you and help you with your suffering and difficulties and move you forward in your life’s journey. Sometimes compassionate behavior can mean being nice to yourself, recognizing if you need a holiday, if you need the support of others, or just treating yourself kindly. Maybe you really need chill-out time in a nice bath, or to back off from things for a while. You recognize that you can’t continue to deplete your resources: like a bank account you can’t keep taking money our without putting some back – because then it gets empty! But compassionate behavior can also require courage to do things that may be blocking us. Sometimes it is about acting against the depression or anxiety and doing things even though we don’t want to (see Chapter 12). It’s compassionate because although taking what might seem an easier short-term path (e.g., avoid doing anything) might give us temporary relief, it doesn’t take us anywhere in the long run.
Finally, a key skill to cultivate is generating feelings of warmth and kindness while doing all of the things we have mentioned. This is where many of us struggle. Some say they can feel kindness for others but cannot feel it for themselves. Don’t worry too much about that, as it is common. We know that when we are depressed our feeling systems may not be working quite so well, so it’s only natural if we struggle with the feeling. We might have to wait for that system to get going a bit. We can help it, though, by doing the exercises outlined in Chapters 7 and 8. We can train ourselves to practise compassionate attention, thinking and behavior, and allow the feelings to come with time.
Really the key issue for everything is learning to work out, and then focus on, what is helpful for you – but not in a selfish ‘me-just-me’ way, because you will find that is not helpful and other people will lose interest in you. Genuine compassionate helpfulness thinks about other people as well as ourselves. It is never submissive, however, and does not simply mean giving in to what other people want, leaving us feeling resentful or very needy for their approval. Learning to be assertive can actually be very compassionate. Compassion has to be wise, thoughtful, curious and open.
Compassionate attributes and compassionate skills are used to counteract the feelings, styles of thinking and behavior that arise in depression (a summary is given in Table 9.1).
You might want to consider how, if your threat system is active so that we have ‘threat mind’, this will influence your feelings and motives, what you attend to, what you think about and how you think about it, and your behavior. The kinds of images and fantasies that pop into your head and your dreams may also have threat themes – because the threat system is active. When we are in ‘threat mind’ all these will be quite different to when we are trying to generate a compassionate mind (see figure 9.1). This is why making a real effort to create this mind can help us stand back from ‘threat and depressed mind’ and create different patterns in our mind and brain. With practice we might strengthen compassionate mind patterns – tough, but worth having a go.
Don’t worry if this seems a bit of a handful and too many things to think about, or it seems too tough. As we go through the book you will see how we can use compassionate attributes and skills to help ourselves. Don’t try and learn it all or remember it all. Even if you only have a very vague idea about kindness, that’s fine.
Figure 9.1 Comparing Compassionate Mind with Threatened Mind.
When we have depressing thoughts and feelings flooding in on us it can be helpful just to notice these and push our pause button. You could use your soothing breathing rhythm, for example – just take a breath or two. Then, when standing slightly back from the thoughts we can learn how to generate alternatives and not be so caught in the narrow focus of threat, loss and depression. Thinking like this can be tough, but it’s important to try. Below is a short selection of useful ideas, divided into three groups to get you started: some are based on rationality and logic, some are based on compassion; and some are based on a problem-solving approach to thinking about life’s problems and tackling them in potentially helpful ways. Some will appeal to you more than others.
• What is the evidence that may support my belief and what is the evidence that may not support it?
• How would I typically see this if I were not depressed? To what degree therefore is this way of thinking reflecting my mood state rather than some ‘truth’?
• What alternatives might there be to this view?
• What other explanations might there be for this event?
• What kind of thoughts would help me cope with this at the moment?
• How might I see this event in three or six months’ time?
• What are the advantages and disadvantages of thinking about this difficulty in this way?
• What are the advantages and disadvantages of changing the way I think?
• If I overcame my depression, how might I look at this situ -ation?
• What might I learn from changing the focus of my thoughts?
• If I had a friend who felt like this, how would I help them see this differently?
• How would a kindly person, who was helping me with this, sound?
• How would I like someone who cared about me to help me see this differently?
• If my thoughts were sympathetic, warm and compassionate, what would they be and how would I feel?
• How would I like a caring person to be with me? How can I be like that to myself?
• If I put myself into compassionate self mode (see pages 149–155) what thoughts and ideas come to me?
• If I imagine my compassionate image (see pages 159–166), how might it help me see this differently; what kinds of things might the image say, and in what tone?
• How could I break this problem down into smaller chunks?
• Is there one bit of this problem I can tackle?
• How could I generate a step-by-step approach to this problem?
• Can I think of anyone who might help me?
• Can I ask them for their help and support?
To generate warmth using thought records, start by writing down some of the alternatives to your distressing thoughts that seem helpful to you (see Appendix 1 for examples). Suppose that you have the kind of thoughts noted above and you lie in bed a lot. You could say to yourself, ‘Come on, get out of bed, you lazy sod. You’ll only feel worse in there. For goodness’ sake make yourself a plan and stop feeling sorry for yourself’, and so on. Note that the tone is impatient and aggressive, even though you are trying to help yourself get up. Having thought or written out your alternative thoughts and got some plans to act against your depression, make sure they are not aggressive or bullying. Develop supportive thoughts, then read them through and express them in your mind with as much warmth as you can. If the words you have written down do not sound encouraging, but instead rather hectoring and harsh, try again to express them in less hostile terms. This may not be easy for you, but persevere: go over your alternative helpful thoughts a number of times, and each time you read them or rewrite them, really feel a certain warmth, understanding and encouragement coming through. If it helps, try going to your compassionate self first (see pages 149–53).
When we jump to conclusions, we usually don’t do much in the way of gathering evidence. We’d make very poor scientists or detectives. We often need to encourage ourselves to do this, and train ourselves to take the time to collect evidence. When we have a negative idea about ourselves, others, our future or the world, we need to ask, ‘Do I have enough evidence for this conclusion?’
Let’s look at a simple example. Anne thought she had ruined a dinner party by overcooking the meal, ruminated on what people must’ve thought of her and felt angry with herself and down. Suppose it is you who is struggling with this kind of event. How might we help you not to dwell on the overcooked meal, but instead to focus on what was good about the evening? (It is the old ‘glass half full or half empty’ issue, and you can choose where to focus your attention.) One way is first to go into the emotions (frustration and disappointment) be understanding and kind and ask, ‘What am I really thinking here?’ Take a moment to become more aware and clarify your thoughts by standing back a bit. Now take a thought, such as, ‘I’ve messed up the whole evening with my overcooked meal’.
Using Anne and her dinner party as an example, let’s spell this out by working on the feelings and thoughts that ‘the whole evening was messed up.’ Look at Table 9.2.
So we have taken a simple event and looked at how to re -focus our attention, thinking, behavior and feelings. These are going to be the basis of all that follows in the rest of this book.
If Anne focuses on going through her alternatives, trying to feel support and kindness in the words, this will help. Again, you can try this for yourself. Read Anne’s alternatives through as if you’re trying to convince yourself of an argument. Judge it on its logic, evidence and accuracy. Now read them through again, but this time focus on the kindness, support and warmth in the words – the real understanding of the upset and fear. Stop reading and try it. Can you see how the combination of taking a rational and fair approach, and then putting kind feelings into it, can be helpful? That’s why we need our rational and compassionate minds to work in harmony with each other.
Conflicts with others are often a source of unhappiness, and some of our more extreme and black-and-white views emerge there. For example, Jane and Terry had an argument over money.
Because the argument got rather heated, Jane concluded that Terry no longer loved her. You can imagine the difference between having a heated argument, where you know it will end and you will go back to feeling that you care for each other, in contrast to losing contact with those feelings and memories. Sometimes, therefore, it really helps us to recognize when an argument is no more than an argument and is not an indicator of being unloved (despite our feelings in that moment). Table 9.3 shows how Jane might develop a more balanced perspective.
In this example we see that Jane tries to switch perspective and think about it from Terry’s point of view. She tries to imagine what is actually in Terry’s mind rather than just focus on her feelings and fears of being unlovable. This is using empathy: she has refocused her attention from herself to the mind of the other (Terry). If she then focuses on going through her alternatives trying to feel support and kindness in the words she has written down, this will help. The idea is not to ‘excuse’ Terry but to see how a shift of perspective can be helpful.
The idea of these examples is to give some thoughts and ideas that you can try for yourself. Note the importance of kindness in the alternatives. For example, read them through as if you’re just trying to convince yourself of the reasonableness of the alternatives. Now read them through again but this time read them slowly and ‘hear them in your mind’ with as much kindness, support and warmth as you can. Look at them as wise ideas. Can you see the difference? This is why we need the rational mind to help us get a balanced perspective and the compassionate mind to generate the feelings for change and growth.
When Jane went through some alternative reasons for the hurtful things that had been said, she still felt unhappy about the conflicts in her relationship with Terry. However, she recognized that there were a number of factors related to the argument and not just the idea that she was not loved. When the heat had gone out of the situation, she decided to talk to Terry about this. At first, he said that he thought that she didn’t really understand how he felt and how difficult things were for him – in other words, it was not that he did not love Jane but that he felt mis -understood by her. Although they then got into something of a competition over who was the less understanding, eventually they talked about the fact that the shortage of money was the common problem. They agreed that both were under stress because of that, and that they needed to join together against the common problem rather than venting their anger at each other. This would have been difficult to achieve if Jane had hung on to the idea that Terry’s anger was evidence of his not loving her. In fact, both of them tended to interpret arguments as evidence of a lack of love.
Of course, it may well be that, when you are angry, the person you are arguing with is not your best-loved person at that moment; but this does not mean that you do not love them, nor does it mean that they don’t love you. And we all need to watch out for the terrible ‘must’: ‘I must be loved all the time’, or ‘In a love relationship we must never be angry with each other’. Many people in good, caring relationships have times when they wonder why they got married at all and why they are still there! But in the back of their minds they know that these feelings and thoughts are coming from the moment, the power of the emotion, and in a few days’ time they will feel different again.
Sometimes, however, the evidence points in the other direction – that there may not be much caring in a relationship. Karen had been going out with Tim for about 18 months. He tended to be demanding and rough sexually. At times he would come to her flat drunk, and he often broke their dates. Increasingly depressed, Karen made excuse after excuse for him. It was her positive ideas that were the problem not her negative ones (see Table 9.4).
Here Karen needed to focus primarily on the evidence that this is not such a loving relationship. Doing this was difficult for her, but when she began to look at alternatives to her idea that Tim did care for her, unfortunately the evidence was that he did not – or at least, not in the way that she wanted. 18 months was a reasonable time to get enough evidence!
Generating alternatives means that we get more than one point of view. Sometimes we don’t want to think about the alternatives because they lead to painful decisions. In Karen’s case, she had a deeper belief that if she gave up this relationship, she might not find another. It was this belief that had stopped her looking at alternative thoughts about whether Tim cared or not, and really focusing on the evidence that he did not. When she did look hard at the evidence, she realized that, on the whole, this was not a good or supportive relationship to be in. There was more pain than gain.
When she tried to use her compassionate mind by focusing on how she might talk to a friend, Karen came up with these ideas:
I know I’m worried about being on my own. But I can learn to face this possibility. I might be more miserable if I stay in than if I get out. Even if I get out of this relationship, this doesn’t mean that I’ll give up trying to find a better one. I can think about the qualities I could bring to a relationship and not just focus on my bad points. I’m honest and very loyal. I try to consider other people’s feelings. Of course, no one’s perfect but I deserve better. In my heart, I know this. It has just seemed too frightening to end it. But then again, I have survived on my own before, and rather than hoping that a relationship with a man will make my life great, I can start to work on relationships with other people who can give me some pleasure and closeness. Ending this relationship doesn’t make me unlovable.
Karen wrote this down and recorded these ideas on tape when she wasn’t feeling too depressed. She was then able to read and listen to them whenever she felt down. She was encouraged to feel kind and compassionate when she offered herself these alternative ideas and words of advice (today I would stress this aspect much more). This helped her to stop sinking into depression and face up to getting out of the relationship. Once again, we see compassion is about the courage to be honest and to act.
One typical response at this stage might be, ‘Well, okay, I can generate alternative views; but I don’t really believe them. I’m just trying to fool myself.’ If this is what you think, consider that this is typical of depression – depression always thinks it knows what’s real and accurate. At this stage, the act of generating alternatives and avoiding concentrating on single ideas is the important first step. Then bringing in the feelings of caring and kindness can help even more. Even if it is difficult to generate kindness in your alternatives, don’t worry because it’s the practice and the effort that count. Sometimes people like to start from the caring position or to imagine their compassionate images, or become the compassionate self and think of the alternatives once they have those feelings a bit – try it and see which you like.
Writing things down can also help you to clarify conflicts and dilemmas. In this case you can write down two columns: advantages (pros or gains) and disadvantages (cons or losses) of making a change. Kevin was in two minds about moving house, so he wrote out the advantages/pros and disadvantages/cons (Table 9.5)
Kevin’s next task was to weigh each pro and con. He did this with his family, with him and his wife putting arguments for and against. Through discussion, it became clear that it was the un -familiarity of a new house and district that was the biggest hurdle. Kevin realized that he did not like to leave the familiar. Once this was clarified in his mind, he was able to reconsider this view and accept that although it might take him time to adjust to a new home, in the long term it would be a good decision to move.
Sometimes we can feel very blocked in changing our basic views of ourselves or changing our ways of doing things. There always seems to be a cost or fear. In therapy, Karen realized that, if things went wrong in relationships, she tended to blame herself. Although she readily acknowledged that giving up doing this would be helpful, she found it difficult to do. She wrote down the pros and cons of giving up self-blame to discover why (Table 9.6).
By writing these thoughts down, it became clear that, for Karen, there were a number of unrecognized disadvantages to changing – not least the fear of becoming the kind of person she did not like. Of course, no one would change if they saw that as the possible result. Karen needed to consider the evidence for the disadvantages that she had identified. What evidence was there that not taking the blame for everything would make her arrogant? Aren’t there lots of people who do not blame themselves but are also not arrogant? See the responsibility circle on page 285.
In therapy, people often see many disadvantages to changing. Of course, they don’t want to be depressed – but getting out of depression may appear to involve rather difficult things. We identify what these might be. What would change involve? What might be the fear in that? Not every advantage of change has a countering ‘but’ or problems associated with it; still, it is useful to think of such possibilities. We can continue to resist change if the perceived disadvantages and fears associated with change are not explored. Once we can see more clearly what is blocking us, we may be better placed to start (kindly but firmly) challenging some of those blocks.
Sometimes advantages and disadvantages are not seen. For example, someone who feels a need to be in an intimate relationship to be happy can become dependent and tend to stay in unsupportive relationships – as in Karen’s case. Someone who, by contrast, feels a need to be strong and independent might suffer the disadvantage of being unable to ask others for help. They may keep others at arm’s length and find it difficult to let other people become emotionally close.
You can do these written exercises on pros and cons many times, and can carry them out quite slowly, allowing time for self-reflection and/or discussion with others along the way.
