In the previous articles about ways of thinking that make depression worse we have discussed the negative cognitive triad and cognitive biases. Thinking in these ways is not something someone with depression actively chooses to do. The thoughts can simply appear, as if from nowhere, and the person has little to no control over them occurring.
Negative Automatic Thoughts.
We can use the term negative automatic thoughts (or NATs) to describe these thoughts as they are usually upsetting or distressing in nature (and therefore negative) and occur unintentionally (or automatically).
We can use the analogy of being thrown something, to help us understand just how automatic NATs are. If you unexpectedly see something being thrown at you, it is likely you will react automatically (either to catch the object or to protect yourself from it). This will happen without you pausing to decide which action to take because your brain needs to react fast.
NATs can be just as automatic, which may make you feel out of control or unable to change. Whilst it’s true that you can’t always prevent yourself from thinking negatively, you can choose to consciously challenge the thought you had no control over having. In this way, you break the illusion of NATs being unquestionably true and take their power away. Over time as NATs lose power, they will become less frequent.
NATs are highly likely to be accepted as truth.
NATs can become so natural to the way we think that they are difficult to spot, which is why it’s important to identify types of NAT such as cognitive biases (discussed in the previous article).
Because NATs have probably been largely unchallenged, you are also highly likely to see them as being true, even if you do recognise that the way you are thinking is a sign of depression.
Let’s look at the following scenario to demonstrate just how powerful NATs can be:
There is a woman named Sarah in her early 20’s. She has been with her boyfriend for a year and a half. The relationship is abusive and there are a lot of fights. 6 months into the relationship Sarah began to feel sad a lot and comfort ate to make herself feel better. Comfort eating and the weight she has gained makes her feel disgusting, ugly and worthless.
She now worries that her boyfriend will find her ugly because she has gained weight and will leave her. Once her boyfriend leaves, she predicts that she will not find another boyfriend, will continue to comfort eat and that she will be alone forever. She sees this as inevitable.
Sarah has identified the following:
She sees herself as worthless, ignoring any positives. She sees her situation as entirely negative, despite any positives coming from outside of the relationship. She sees the future as bleak and doesn’t see herself being able to change its course. She recognises that this forms a negative cognitive triad.
She thinks there is a possibility she is using the following cognitive biases:
- Giving yourself hurtful labels/names
- Assuming other’s thoughts
- Predicting the future
Despite recognising the negative cognitive triad and the cognitive biases, Sarah still believes herself to be ugly and worthless, her situation to be negative and her future hopelessly inevitable.
In Sarah’s mind these thoughts are true and anyone telling her that they are an error of thinking (or that the opposite is actually true) is ignoring her perspective in favour of an overly positive one.
Take the power away from NATs by scoring their truthfulness.
How can someone like Sarah reach a point where they are willing to challenge their NATs?
Well, instead of assuming all NATs are untrue, we can question the extent to which they are true and then base our way of thinking about the NAT on that.
For example, if we take the one thought “I am worthless” and tried to flip this into the opposite “I am worthwhile”, someone who is depressed like Sarah may reject the new version of the thought as false and fail to use it to counter argue the original thought.
But if that person were to give the thought a rating for how true they believed the thought was (in its current form), it may help them consider other factors.
We can use a rating of 1-3
1 = not true at all.
2 = there may be some truth to the thought.
3 = the thought is definitely true.
So, we have already established that Sarah (or someone like her) is not going to reject the thought entirely, so they are not going to give it a 1. Even though there is no one alive who is truly worthless, Sarah is not going to see things this way at the moment, because she is depressed.
Sarah is willing however to admit that she may not be entirely worthless. As the statement “I am worthless” is an absolute, it isn’t completely true, but Sarah still believes there is some truth to it. She therefore decides to give the thought a 2.
As the thought got a 2, there is now doubt about how true the thought is. It has gone from being blindly accepted, to being questioned. This is good.
The next step when a thought is given a 2 is to gather evidence. So, in this case, that could mean listing any achievements anyone thought Sarah was worth receiving, any thanks Sarah has received for doing something for someone else and any compliments Sarah has received from friends, family or acquaintances which show Sarah that they value something about her or something she does.
Sarah could also ask people she knows to share one thing they like or appreciate about her, ask for positive feedback at work, or (if she were able to) think about things she thinks she is good at/ positive qualities she has.
If there was no evidence at all that Sarah was worthwhile, then she may conclude that actually, the thought should be ranked as a 3. But this is EXTREAMLY unlikely, and it is much more likely that Sarah’s original NAT “I am worthless” is over generalised, untrue and unkind.
Challenging NATs in this way takes their power away, and puts you in control. You are not being asked to blindly believe the opposite of your original thought, but to be critical and questioning of it. If you really struggle to be objective and questioning, you can ask someone who cares about you to also give your NATs a score and to help you gather evidence.
So, what do you do if you score a 3?
If you score a 3 on a thought, you can question what the impact of that thought being true has on your life. You can also question how motivated you are to rectify the situation.
For example, if Sarah’s boyfriend were to leave her and to state that the reason WAS that he found her ugly and worthless, then Sarah may well give the thought “My boyfriend left because he found me ugly and worthless” a 3.
Sarah can then choose how to address her thought. What impact on her life does that thought being true have?
Well, Sarah is now single. So as long as she doesn’t fail to question any additional untrue NATs (such as “I will be alone forever” or “I am unlovable”), she may see this as an opportunity to find someone who will value her for factors other than her weight.
Just because Sarah’s boyfriend stated that she was worthless, it doesn’t mean that she actually is. Those are just one person’s words, and they do not mean that others will not view Sarah as valuable.
This is an important distinction because the thought Sarah gave a 3 to was that her boyfriend found her worthless, not “I am worthless”. In time, Sarah may even begin to see herself as being worthwhile, but that could take longer than accepting that her boyfriend’s thoughts do not define her existence.
Sarah can also consider the motivation she has to address the thought being true. Does Sarah want another partner right now? Is that something she is interested in? If so, she could take steps towards finding a new partner, and if not, she may choose to focus on being happy alone.
Scoring a thought a 3 doesn’t have to be a bad thing as it can lead to change and personal growth. But, if there is any doubt, thoughts should be given a number 2 status first. After all, Sarah’s boyfriend could have had a very different reason for breaking up with her, but didn’t tell her the truth.
Keep a record of your triumphs over NATs.
Every time you challenge a NAT’s truthfulness, you diminish its power. Every NAT that becomes less powerful, is a battle you have won in your fight against depression.
Keeping a record of these wins can remind you of your achievement and help you if you battle a similar NAT in the future.
You can record your triumphs in any way you like. But you may want to structure it something like this:
“My boyfriend left because he found me ugly and worthless.”
Negative Cognitive Triad section:
- Black and white thinking
- Thinking everything is my fault.
Evidence for & against:
For – He told me the reason he left me.
Against: – His friend is overweight, but he doesn’t think of his friend as worthless, so this likely isn’t actually about my weight. He has often called me names and then taken it back, so it isn’t clear when he is telling the truth. He may be hiding something and wanted an “easy” out.
“My boyfriend said he left because he found me ugly and worthless, but he may have been lying.”
“I am unlovable”.
Negative Cognitive Triad section:
- Over generalising
- Giving myself hurtful labels
- Mind reading (assuming others will deem me unlovable)
- Black and white thinking
Evidence for & against:
For – My boyfriend left me.
Against: – My friends and family tell me they love me. I have lovable qualities like making people laugh and caring about other people. I have had people who really liked me before this last boyfriend. I am only young and there are lots of other people out there who haven’t had the chance to get to know me yet. I do also love some things about myself.
“My relationship ending doesn’t have any impact on how lovable I am.”
Get help facing up to your NATs from a counsellor.
But depression isn’t something you should ever have to face alone. A counsellor can support you as you work through the steps suggested. They can also help you explore the possible reasons for the way you feel and work on other strategies with you to help you feel better.
You deserve to be well and getting counselling can be a huge step towards achieving that goal. If you would like to see if we would work well together as client and counsellor, get in touch at: firstname.lastname@example.org or 07588 117305 .