Negative Thoughts and How to Change Them (An Overview from Module 4 of the CBT for Tinnitus E-Programme)
This is an introduction to the Cognitive element of Cognitive Behaviour Therapy for tinnitus distress that is best begun after 4-6 weeks of using the breath work and physiological relaxation
Negative thoughts play an important part in influencing our feelings. Negative thoughts tend to:
- make us unhappy
- make us physically uncomfortable
- stop us doing the things we want to do
Negative thoughts are:
- easy to believe
- often untrue
- spring to our minds unsummoned
- make things worse than they are
- predict the future
- are unhelpful and useless
Positive thoughts are different because they are:
- based on good evidence
- do not predict the future
- put things into perspective
- help us to succeed
One way to change negative thoughts into positive is by challenging them. This can be quite difficult because you may not be aware of them. To help you become aware it can be helpful to write them down and then ask yourself the following questions:
1. am I predicting the future negatively?
2. what is the evidence for and against this idea?
3. am I making things worse than they really are?
4. does this thought help me to succeed?
5. does it matter if things don’t turn out exactly right?
Here are some examples of negative thinking.
“I know I won’t be able to cope with this tinnitus for much longer.”
Question 1.
Am I predicting the future negatively?
Yes, you cannot know anything about the future.
Question 2.
What is the evidence for and against?
You are coping with it at the moment – maybe not as well as you would like, but you are doing things to help you cope better, and you are gaining insight into the problem.
Question 3.
Am I making things worse than they really are?
You are making the assumption that you will not be able to cope and that will make it more difficult for you now.
Question 4.
Does this thought help me to succeed?
No, it is most unhelpful and it may prevent you coping well today.
Question 5.
Does it matter if things don’t turn out exactly right?
Nothing’s perfect, every day is a mix of good and bad.
A more positive way to look at the situation would be to think “ I am looking at ways to help myself now and if I practice my relaxation and accept and ignore my feelings of anxiety, I will be able to cope with tinnitus today.”
It may help to write the questions on a slip of paper and when you feel yourself getting tense, or know that you’re thinking in an unhelpful way, get the slip out and apply the questions to the thoughts you are having.
The Tension Cycle
The perception of stress creates a negative thinking pattern which in turn serves to maintain and at times to heighten the arousal or anxiety level. In this way tension creates anxiety.
The place of negative thoughts in the tension cycle:
Event ( tinnitus) …...negative thought ( I can’t cope) ……anxiety (tension)
One of the main reasons for feeling tense is thinking frightening thoughts. If we didn’t think frightening thoughts we wouldn’t feel so tense.
How can you tell if a thought is negative?
Here is a list of features of negative thoughts:
1. Make things worse than they are – “I’ve never felt so awful in my whole life.”
2. Predict the future – “I’ll always feel terrible.”
3. Stop you doing things – “I can’t do that.”
4. Are often not true - “I’ll never be able to forget the tinnitus.”
5. Seem believable; you don’t think to question them.
We all have a running commentary of thoughts or “self talk” going on in our heads in every situation. Self talk can either be positive and helpful or negative, leading to increasing tension. In order to change these negative thoughts you need to become aware of them. If it helps you, you can begin by writing down negative thoughts that you catch yourself thinking. At first you may seem to have a great many negative thoughts, but don’t worry, it means that you are becoming better at catching them. To practice negative thought stopping, when you think an undesired thought, you can make the thought disappear by thinking the word STOP. Some people actually say STOP out loud so if it helps you to do this – when you are on your own of course – give it a try. It may take several attempts for it to become effective. Practice will make perfect. YOU are in control.
It is not only negative thoughts that create tension, but many of the ideas and beliefs which we accept as we grow up. Many of these are not really true, and if we believe them, can cause us to experience unnecessary stress.
The beliefs are much like superstitions, in as much as we rarely think about whether there is any proof to support them, but rather we accept them passively and allow them to influence our view of both the world and ourselves.
Some of the more ”common” irrational beliefs – unrelated to tinnitus - are set out below:
1. Irrational belief: “I must get along with everyone all the time”.
A more rational perspective: It is impossible to control other people’s behaviour and feelings completely. You can’t please all of the people all of the time, but many try to, without even realising what they are doing. This causes problems because by putting the happiness of others before personal happiness we often place our well being in the control of others. It also leads us to spend a great deal of time worrying about whether the other person is happy, if we’ve done enough for them, if they’re pleased with us. The false assumption is that our worth and happiness is determined by the good opinion of others. This is not true, because everyone has worth as a person.
2. Irrational belief: “I must be perfect”.
A more rational perspective: It is impossible to succeed at everything. We all have areas in our lives I which we don’t manage things as well as we would like. Also our achievements are not related to our true worth as people. We don’t change our value by success, or devalue ourselves by failure. Enjoyment rather than achievement is the more sensible goal to seek.
3. Irrational belief: “Life has always got to be the way I want it”.
A more rational perspective: There is no doubt that when things don’t work out the way we planned it is sometimes unpleasant and unfortunate. It is rarely catastrophic or unbearable unless we think it is.
When things go badly we have two choices. We can say to ourselves:
a. I don’t like this much, now what can I do to improve things. If I don’t improve things, it’s hard luck, but not the end of the world.
b. I don’t like this much. I can’t stand this, it’s just unbearable. It’s got to change otherwise I’ll never be happy.
The second of these will lead to misery, self pity, depression. The first will reduce the emotional impact. Only you can defeat yourself, by believing that because you have problems you must be unhappy.
4. Irrational belief: “My unhappiness is caused by things out of my control”.
A more rational perspective: When faced with actual physical pain, injury, or deprivation we can either attempt to eliminate the circumstances, or try to the best of our ability to ignore them.
5. Irrational belief: If something is, or might be, dangerous or distressing, I must be terribly concerned about it and should keep dwelling on the possibility of it happening.
A more rational perspective: Worrying about the possibility of something happening will not prevent it.
Tension provoking beliefs, like negative thinking, can be challenged by asking yourself:
a. have I any proof of this;
b. what is the evidence for and against.
Finding the “evidence” for and against - Freeman D, Freeman J, Garety P (2006) Overcoming Paranoid & Suspicious Thoughts: A self-help guide using Cognitive Behavioural Techniques, Robinson pp 121-122
Sometimes, at first it can be difficult to think of the “evidence” against our negative thoughts, especially when those thoughts are causing distress.
It will probably be helpful to ask yourself the following questions:
- Is there anything that might suggest the thought could be wrong?
- What would my family or friends say if I talked to them about the thought?
- What would I say to a friend who came to me with a similar problem?
- What good things have happened to me that contradict the thought?
- Are there any alternative explanations for what seems to have happened?
- Are my thoughts based more on the way I feel than on solid evidence?
- Have I been jumping to conclusions?
- Am I exaggerating the chances of anything bad happening to me?
- Am I being over-sensitive?
- Am I misinterpreting things because I’m feeling anxious or down?
- If I were feeling happier would I still think of things in the same way?
- Are my past experiences getting in the way of me seeing the present situation clearly?
(Freeman D et al 2006)
There is a wealth of literature available that goes a long way towards an effective use of Cognitive Behavioural tools and techniques through which we can learn to better identify “negative automatic thoughts” and then challenge them in order to evidence them – for and against.