Feeling Good

My dad bought this book for me in hopes that reading it can help us help my brother better. Reading this book did teach me a lot about common cognitive distortions and how to deal with them, but Feeling Good reads more like a self-help/self-guided therapy kind of book that was meant to be read by the person who is suffering from depression themselves. The book contains several diagnostic tests and exercises that Dr. Burns actually uses during his cognitive behavioral therapy (CBT) sessions, which I think would be very helpful for those seeking help with depression.

Given that the book was published in 1999, some of the examples he uses and his language feel a little bit outdated at times. Even as someone who is not personally suffering from clinical depression, I felt that some of the stories and examples he uses from his past patients needed some sort of a trigger warning. Dr. Burns made some statements that I was/am very skeptical of, and some of his examples feel quite old-fashioned, but overall, I learned a lot about CBT from this book. (Somewhat ironically, the biggest thing I’m skeptical about is the main message of the book, which is that “only our thoughts are responsible for our moods” which I’ll probably go into detail later. I guess in order for CBT to work, that message has to be accepted as a premise.)

I skipped some chapters like the one on managing guilt and the ones that go into detail about the science of mood regulation (serotonin cycle) and different anti-depressants, but below are some of the things I learned and want to remember.

• “Every time you feel depressed about something, try to identify a corresponding negative thought you had just prior to and during the depression. Because these thoughts have actually created your bad mood, by learning to restructure them, you can change your mood.”
• “Your life is a complex and ever-changing flow of thoughts, emotions, and actions, To put it another way, you are more like a river than a statue.”
• “You cannot earn worth through what you do. Achievements can bring you satisfaction but not happiness. Self-worth based on accomplishments is a “pseudo-esteem,” not the genuine thing.”
• Contrary to the procrastinator’s belief, “motivation does not come first, action does.” Action → Motivation → More Action
• “Reciprocity is a transient and inherently unstable ideal that can only be approximated through continued effort. This involves mutual consensus, communication, compromise, and growth. It requires negotiation and hard work. Margaret’s problem was that she didn’t recognize this. She lived in a fairytale world where reciprocity existed as an assumed reality.”
• “The key to emotional enlightenment is the knowledge that only your thoughts can affect your moods.”

The relationship between the world and the way you feel, according to Dr. Burns

A List of Ten Cognitive Distortions

1. All-or-Nothing Thinking (aka dichotomous thinking): evaluating one’s personal qualities in extreme, black-and-white categories; forms the basis for perfectionism causing one to fear any mistake or imperfection; unrealistic because life is rarely completely one way or another.
2. Overgeneralization: arbitrarily concluding that one thing that happened to someone once will occur over and over again
3. Mental Filter (aka selective abstraction): picking out a negative detail in any situation and dwelling on it exclusively, thus perceiving that the whole situation is negative
4. Disqualifying the Positive: transforming neutral or even positive experiences into negative ones
5. Jumping to Conclusions: arbitrarily jumping to a negative conclusion that is not justified by the facts of the situation; two examples: ‘mind reading’ and ‘the fortune teller error.’ Mind reading: making the assumption that other people are looking down on oneself. The fortune teller error: imagining that something bad is about to happen, and taking this prediction as a fact even though it is unrealistic.
6. Magnification and Minimization: magnifying one’s imperfections, fears, and errors while minimizing one’s good points
7. Emotional Reasoning: taking one’s emotions as evidence for the truth (examples: “I feel guilty. Therefore, I must have done something bad” “I feel overwhelmed and hopeless. Therefore, my problems must be impossible to solve”)
8. Should Statements: motivating oneself by saying, “I should do this” or “I must do that,” which causes one to feel pressured and resentful; paradoxically, one ends up feeling apathetic and unmotivated. [SOLUTION: Reformulate the way you tell yourself to do things by eliminating coercive words from your vocabulary. If you translate your shoulds into wants, you will be treating yourself with a sense of respect, which will produce a feeling of freedom of choice and personal dignity.]
9. Labeling and Mislabeling: an extreme form of overgeneralization; “the measure of a man is the mistakes he makes”; self-defeating and irrational; one’s self cannot be equated with any one thing one does; mislabeling involves describing an event with words that are inaccurate and emotionally heavily loaded.
10. Personalization: seeing oneself as the cause of some negative external event which in fact one was not primarily responsible for; confusing influence with control over others; what another person does is ultimately their responsibility, not yours.

People with depression find it much harder to recognize these cognitive distortions/illogical thinking patterns. One of the cardinal features of cognitive therapy is that it stubbornly refuses to buy into one’s sense of worthlessness. “Are you really right when you insist that somewhere inside you are essentially a loser?” The evidence that one presents in defense of one’s worthlessness will usually, if not always, make no sense.

Identifying and Addressing Cognitive Distortions: “Talk Back to That Internal Critic!”

1. Recognize and write down the (automatic) self-critical thoughts
2. Identify the cognitive distortions
3. Practice ‘talking back’ to them (substitute with more objective, rational responses) so as to develop a more realistic self-evaluation system.

“Ten Things You Should Know About Your Anger”

1. The events of this world don’t make you angry. Your “hot thoughts” create your anger. Even when a genuinely negative event occurs, it is the meaning you attach to it that determines your emotional response. The idea that you are responsible for your anger is ultimately to your advantage because it gives you the opportunity to achieve control and make a free choice about how you want to feel.
2. Most of the time, your anger will not help you. You will feel better if you place your emphasis on the active search for creative solutions.
3. The thoughts that generate anger more often than not will contain distortions. Correcting these distortions will reduce your anger.
4. Ultimately, your anger is caused by your belief that someone is acting unfairly or some event is unjust. The intensity of the anger will increase in proportion to the severity of the maliciousness perceived and if the act is seen as intentional.
5. If you learn to see the world through other people’s eyes, you will often be surprised to realize their actions are not unfair from their point of view. If you are willing to let go of the unrealistic notion that your concepts of truth, justice, and fairness are shared by everyone, much of your resentment and frustration will vanish.
6. Reward the desired behavior instead of punishing the undesired behavior.
7. A great deal of your anger involves your defense against loss of self-esteem when people criticize you, disagree with you, or fail to behave as you want them to.
8. Frustration results from unmet expectations. Some examples of unrealistic expectations: “If I want something (love, happiness, a promotion, etc.), I deserve it”; “I should be able to solve any problems quickly and easily”; “People should think and act the way I do”; “If I’m nice to someone, they should reciprocate.”
9. It is childish to insist you have the right to be angry. Of course you do! The crucial issue is — is it to your advantage to feel angry?
10. It is not true that you will be an unfeeling robot without anger. In fact, when you rid yourself of that sour irritability, you will feel greater zest, joy, peace, and productivity. You will experience liberation and enlightenment.

Things That Don’t Sit Right With Me/I Find Hard to Accept

• “Other people really cannot make you angry […] The bitter truth is that you’re the one who’s creating every last ounce of the outrage you experience […] Anger, like all emotions, is created by your cognitions […] Even if you are genuinely wronged, it may not be to your advantage to feel angry about it. The pain and suffering you inflict on yourself by feeling outraged may far exceed the impact of the original insult”

But if someone or some event does genuinely wrong me, is the pain and suffering really inflicted on myself by myself due to my cognitions, as Dr. Burns says? Or is the pain and suffering actually inflicted by the person or event that actually stimulated my anger? Sometimes (or always? I don’t know), emotions are not (necessarily) made by choice, and I feel like it would be incredibly unnatural and suppressive to never let myself respond to situations that naturally incite anger with anger. Dr. Burns says emotions in themselves have no validity, but I disagree.

The examples that he gives, however, almost all involve distorted thinking, so maybe his advice doesn’t apply to situations that lead to anger after rational thinking. He goes on to talk about the ‘productivity’ of anger, which makes sense (the criteria: “Is my anger directed toward someone who has knowingly, intentionally, and unnecessarily acted in a hurtful manner?”) but also doesn’t really make sense because I can’t cherry-pick whether I feel a certain emotion or not based on its productivity. It is possible and valid for me to feel upset if someone says something hurtful unintentionally. But maybe then, the emotion I feel would be sadness and disappointment, rather than anger? Sometimes the lines get blurry.

• “Your feelings are created by your thoughts and not the actual events.”

Now, this is the central message of not only this book, but of CBT. It’s only when this notion is accepted as a premise that Dr. Burns’ suggestions/CBT can work, since they focus on changing our thought process in order to change our moods. To some extent, I think that this statement is and can be true. Some events (Dr. Burns would say all, but I hesitate to agree) require some kind of personal interpretation before we can process what they mean to us emotionally. In that case, it is not the event, but the way we think about the event that determines our feelings. But in other instances, putting all of the emotional onus on oneself would be inaccurate/misleading/self-defeating. For example, if a loved one passes away and one feels sad, I would say that it is the event (the death of a loved one) that causes/creates the feeling of sadness, but Dr. Burns would say that it is thought of the person that causes/creates the feeling of sadness, not the actual event itself. According to Dr. Burns, if you change the way you think about the event, you can change the way you feel… I don’t know how realistic or helpful that would be. But maybe his advice only applies to fixing cognitive distortions in patients with depression, not to everything.

Although I have some lingering doubts about Dr. Burns’ claim that every feeling is created by one’s thoughts rather than the actual events of the world, I also understand and can see how accepting his claim is necessary for CBT to be successful. The most important takeaways from Feeling Good for me are the list of cognitive distortions and the techniques that I can use to identify them and substitute them with more realistic and rational thoughts. These cognitive distortions are experienced by not only patients with clinical depression, but by everyone, albeit to varying degrees. Since reading this book, I found myself catching some of my own cognitive distortions as well as noticing them from my family and friends.