Characteristic changes in thinking in depression
Patients with depression are more negative about things when compared with
other people, having a negative triad: a negative view of self, the world and
the future.
Characteristic changes in thinking in anxiety disorders
In contrast to the negative content of thought in depression, for patients with
anxiety disorders (panic disorder, agoraphobia, generalized anxiety and phobic
disorders) common thinking themes are an increased perception of danger and
threat combined with a decreased perception of their own ability to cope with
that danger. Typical thoughts and images include themes of vulnerability, loss of
control, fear of social ridicule, physical harm and death. In terms of how
information is processed, anxious people are more prone to scan for potential
threats than are non-anxious people and they have lower thresholds for noticing
potential threats. The result is the avoidance of anxiety-provoking situations, or
the start of unhelpful behaviors such as reassurance-seeking, drinking to excess
or misusing sedative medication
Characteristic thinking associated with anger
Beck (1976) suggests that the content of thoughts associated with anger is
derived from a perception that someone else has broken an individual’s
idiosyncratic rules of what is fair and just, or acts to threaten or frustrate the
individual in some way. Typical thoughts include ‘shouldn’t’ or ‘mustn’t’
statements (‘She shouldn’t say that to me!’), or taking things personally (‘He is
doing that on purpose’). The individual may jump to the conclusion that the
other person is completely bad (‘He’s a total jerk’) and this leads to actions such
as making critical comments or attacking the other person, either actively or
passively.
Characteristic thinking associated with guilt
The content of thoughts associated with guilt is derived from a perception that
the individual has broken his or her own idiosyncratic rules of what is fair and just.
Typical examples include statements such as ‘I should have done that’ or selfcritical thoughts such as ‘It’s my fault’ and frequently involve themes of
excessive responsibility-taking and underlying rules to put duty before all else.
Individuals may judge themselves to be totally bad and overlook their strengths.
They may act in ways that confirm this by setting themselves up to fail or taking
part in self-punishing behaviors such as deliberate self-harm.
Characteristic thinking associated with shame
The content of thoughts associated with shame is derived from individuals’
perceptions that they have undesirable qualities (e.g. physical appearance,
emotions, personality traits) or behaviors/actions which, if revealed to others, will
result in ridicule and humiliation. The thought that they are total failures and that
others see them in this way drives their behaviors, which aim to hide these
undesirable qualities
‘When you were in the pub with your friends at what point did you feel most
anxious?’‘ How anxious did you feel at that time on a scale of 0 to 10, where 0 is
feeling no anxiety at all and 10 is the most anxious you have ever felt?’‘ At that
moment when you came back from the bathroom and your friends were all
laughing and you felt 95% anxious, what was going through your mind?’ ‘When
you noticed the thought “They think I’m an idiot and will end up rejecting me”,
how much did you believe it at the time, on the same 0 to 10 scale?’‘ Is it
possible that that thought and how anxious you felt are linked?’ The aim of this
series of questions is to identify and rate the belief in an extreme and unhelpful
thought, and at the same time teach the Individual skills in recognizing the links
between his thoughts and feelings.
Table 1
Identifying unhelpful thinking styles (from Williams, 2001)
Unhelpful thinking style
Typical extreme and
unhelpful thoughts
Bias against myself
I overlook my strengths
I focus on my weaknesses
I downplay my achievements
I am my own worst critic
Putting a negative slant on things (negative
I see things through dark-
mental filter)
tinted glasses
I tend to focus on the
negative in situations
Having a gloomy view of the future (making
negative predictions/jumping to the worst
I make negative predictions
conclusion: catastrophizing)
about the future
Unhelpful thinking style
Typical extreme and
unhelpful thoughts
I predict that things will go
wrong
Negative view about how others see me (mind-
I mind-read what others
reading)
think of me
I often think that others
don’t like me
Bearing all responsibility
I often take things to heart
I take the blame if things go
wrong
I take unfair responsibility
for things that are not my
fault
I often use the words
‘always’ and ‘never’ to
Making extreme statements/rules
summarize things
I make ‘must’, ‘should’ or
‘ought’ statements to myself
I use the word ‘typical’ a lot
to describe things that go
wrong
Catch the negative thought: Keep a journal, taking notes of the actual thoughts
you are thinking when you’re in a situation that upsets you and ends in selflimiting and self-sabotaging behavior. Example: ‘It’s going to be awful, I’m going
to embarrass myself…’- (and then avoiding an event).
Thought Stopping: As you notice yourself saying these negative automatic
thoughts, you can stop them mid-stream by saying to yourself “STOP”. Saying it
aloud, or silently in your head if you are with people. You might also wear a
rubber band around your wrist, giving it a little twang each time you notice you
are allowing negative thinking to take over your head in a never-ending loop. It
will make you more aware of how often, and in what situation, you are having
the negative thoughts.
Challenge the negative thought: Challenge the thoughts, examine them to see
if they’re valid. ‘Where’s the evidence for this? Is there another way to look at
it?’. Example: ‘Actually, that’s fortune telling, I don’t actually know what’s going
to happen, all I can do is my best, maybe I’ll be a bit anxious, I can cope with
that if it happens, and it might not happen, I was okay last week at that other
event even though I tortured myself before it with this kind of thinking….’
Summary: reframe and replace: Note the negative thought – stop it in its tracks –
examine it for evidence – and if you decide it is irrational and unhelpful, replace
it with alternative healthy thinking.
The Ellis idea is that we have distorted thinking about:

How *I* am: e.g. I must be successful and respected and attractive all the
time, or else I can’t be happy.

How *you* are: e.g. You should be kind and respectful and loving toward
me all the time, or else you’re a terrible person (or I’m a terrible person),
and I can’t be happy.

How *the world* is: e.g. Things ought to be comfortable and as I want
them to be all the time, or else it’s awful, I can’t stand it, it’s unbearable –
and I can’t be happy.