Changing Your Thinking

(Taken from: The Patient's Guide to Chronic Fatigue Syndrome & Fibromyalgia on the CFIDS Self-Help website.)

As mentioned earlier, our thoughts can be a source of stress. This section offers a three-step process for gradually altering your thoughts so they help you rather than increase your suffering. Using this guide, you can learn to reframe your situation, seeing it in a new way that is both more realistic and less stressful.

This approach is based on changing the internal conversations you have with yourself. We all talk to ourselves all the time. Some of the talk is about things outside us. For example, when we find something we've lost, we might say to ourselves, "There it is." Another part of our inner dialogue is about ourselves. It is the things we say to ourselves about ourselves. For example, when we can't find something, we might say something like, "You dummy; you're always losing things."

This self-talk is a habitual way of responding to experience, often an internal critic who can be very pessimistic. For example, if you experience a relapse, your inner voice might say something like, "You'll never get any better. Every time you try something, you fail."

It is not easy to observe your self-talk at these times, because thoughts like these are habitual. But your self-talk can have a big effect on your mood and your self-esteem. Unnecessarily negative thoughts make you feel anxious, sad and hopeless. These feelings, in turn, make it difficult to act constructively. Preoccupation with suffering may even intensify symptoms and trigger more negative thinking. The cycle can be very demoralizing, making it difficult to motivate yourself.

Recognizing Automatic Thoughts

The first step to changing your habitual thinking is to recognize it. This is not easy to do because our thoughts are automatic, so deeply ingrained that they seem self-evident. But if you can recognize the thoughts, you gain some distance from them and remove their self-evident character, the first step to changing your internal critic into an internal cheerleader.

The technique I will outline for recognizing and gradually changing automatic thoughts is the Thought Record, which is described in the book Mind Over Mood by Dennis Greenberger and Christine Padesky. Using this form offers one way to become aware of 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 or learn them from psychologists who specialize in cognitive therapy.

To see how this technique works, imagine a patient who took a walk one day and felt very tired when she got home. Feeling depressed and hopeless, she asked herself what thoughts were going through her mind at that point. They were, "I'll never get better. Every time I try something, it fails." She recorded her experience in the first three columns of the Thought Record (see below). In column 1, she wrote a description of the event. In the second column, she recorded her emotions at the time of the event. And, in the third column, she wrote the thoughts going through her mind when the emotions were strongest.

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. Because these thoughts are automatic, they can be hard to recognize and it can take some time to develop this skill. To capture your automatic thoughts, fill out a Thought Record as soon as you can when an upsetting event occurs.

Evaluating Automatic Thoughts

Once you identify your automatic thoughts by recording them, evaluate them to separate truth from distortions and irrationalities. To help you determine to what extent your automatic thoughts are valid, ask yourself what is the evidence for and against your thoughts. Use column 4 in the Thought Record for evidence in favor of your initial thoughts and column 5 for evidence against.

The idea is to suspend your belief that the automatic thoughts are true and, instead, look for evidence both pro and con. Writing down the evidence you find helps you gain distance from your thoughts and makes them less self-evident. By stepping back, you can more easily see how your automatic thoughts may ignore facts or select only the worst aspects of a situation.

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 last step, you propose a new understanding of your experience. What you write in column 6 of the Thought Record 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. At first, this process may seem artificial and contrived, but it has a point: you are training yourself in a new, more balanced and realistic explanatory style. You are learning to replace one habitual interpretation of experience with another.

Reviewing what she had written in columns 4 and 5, our patient decided that the evidence was mixed. She wrote in column 6 a balanced thought that combined the evidence for and the evidence against.

Realistic Thinking, Not Positive Thinking

The process described in this section 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 process suggested here 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 kind of thinking advocated here integrates all evidence, both positive and negative, in a balanced fashion. Using this way of understanding your experience, you acknowledge the negatives in your life, but praise yourself for your successes. 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.

The value of being realistically positive was expressed well by one of the leaders in our self-help program, a woman with multiple medical problems, who wrote the following to her class:

One of the most valuable techniques I use to keep my attitude positive is to consciously congratulate myself for each small victory. These may be things as simple as getting dressed in the morning, or making myself pause in my activities to take a fifteen-minute pre-emptive rest. I may not seem to have done much by the end of the day, but I know how much I have accomplished when I remember all the times I could sincerely congratulate myself.