When you are depressed, you invariably believe that you are worthless. The worse the depression, the more you feel this way. You are not alone. A survey by Dr. Aaron Beck revealed that over 80 percent of depressed patients expressed self-dislike. Furthermore, Dr. Beck found that depressed patients see themselves as deficient in the very qualities they value most highly: intelligence, achievement, popularity, attractiveness, health, and strength. He said a depressed self-image can be characterized by the four D’s: You feel Defeated, Defective, Deserted, and Deprived.
Almost all negative emotional reactions inflict their damage only as a result of low self-esteem. A poor self-image is the magnifying glass that can transform a trivial mistake or an imperfection into an overwhelming symbol of personal defeat. For example, Eric, a first-year law student, feels a sense of panic in class. “When the professor calls on me, I’ll probably goof up.” Although Eric’s fear of “goofing up” was foremost on his mind, my dialogue with him revealed that a sense of personal inadequacy was the real cause of the problem:
DAVID: Suppose you did goof up in class. Why would that be particularly upsetting to you? Why is that so tragic?
ERIC: Then I would make a fool of myself.
DAVID: Suppose you did make a fool of yourself. Why would that be upsetting?
ERIC: Because then everyone would look down on me.
DAVID: Suppose people did look down on you? What then?
ERIC: Then I would feel miserable.
DAVID: Why? Why is it that you would have to feel miserable if people were looking down on you?
ERIC: Well, that would mean I wouldn’t be a worthwhile person. Furthermore, it might ruin my career. I’d get bad grades, and maybe I could never be an attorney.
DAVID: Suppose you didn’t become an attorney. Let’s assume for the purposes of discussion that you did flunk out. Why would that be particularly upsetting to you?
ERIC: That would mean that I had failed at something I’ve wanted all my life.
DAVID: And what would that mean to you?
ERIC: Life would be empty. It would mean I was a failure. It would mean I was worthless.
In this brief dialogue, Eric showed that he believed it would be terrible to be disapproved of or to make a mistake or to fail. He seemed convinced that if one person looked down on him then everyone would. It was as if the word REJECT would suddenly be stamped on his forehead for everyone to see. He seemed to have no sense of self-esteem that was not contingent upon approval and/or success. He measured himself by the way others looked at him and by what he had achieved. If his cravings for approval and accomplishment were not satisfied, Eric sensed he would be nothing because there would be no true support from within.
If you feel that Eric’s perfectionistic drive for achievement and approval is self-defeating and unrealistic, you are right. But to Eric, this drive was realistic and reasonable. If you are now depressed or have ever been depressed, you may find it much harder to recognize the illogical thinking patterns which cause you to look down on yourself. In fact, you are probably convinced that you really are inferior or worthless. And any suggestion to the contrary is likely to sound foolish and dishonest.
Unfortunately, when you are depressed you may not be alone in your conviction about your personal inadequacy. In many cases you will be so persuasive and persistent in your maladaptive belief that you are defective and no good, you may lead your friends, family, and even your therapist into accepting this idea of yourself. For many years psychiatrists have tended to buy into” the negative self-evaluation system of depressed individuals without probing the validity of what the patients are saying about themselves.
The way a therapist handles your feelings of inadequacy is crucial to the cure, as your sense of worthlessness is a key to depression. The question also has considerable philosophical relevance—is human nature inherently defective? Are depressed patients actually facing the ultimate truth about themselves? And what, in the final analysis, is the source of genuine self-esteem? This, in my opinion, is the most important question you will ever confront.
First, 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! My many successful but depressed patients would all agree. Nor can you base a valid sense of self-worth on your looks, talent, fame, or fortune. Marilyn Monroe, Mark Rothko, Freddie Prinz, and a multitude of famous suicide victims attest to this grim truth. Nor can love, approval, friendship, or a capacity for close, caring human relationships add one iota to your inherent worth. The great majority of depressed individuals are in fact very much loved, but it doesn’t help one bit because self-love and self-esteem are missing. At the bottom line, only your own sense of self-worth determines how you feel.
“so,” you may now be asking with some exasperation, “how do I get a sense of self-worth? The fact is, I feel damn inadequate, and I’m convinced I’m really not as good as other people. I don’t believe there’s anything I can do to change those rotten feelings because that’s the way I basically am.”
One of the cardinal features of cognitive therapy is that it stubbornly refuses to buy into your sense of worthlessness. In my practice I lead my patients through a systematic reevaluation of their negative self-image. I raise the same question over and over again: “Are you really right when you insist that somewhere inside you are essentially a loser?”
The first step is to take a close look at what you say about yourself when you insist you are no good. The evidence you present in defense of your worthlessness will usually, if not always, make no sense.
This opinion is based on a recent study by Drs. Aaron Beck and David Braff which indicated that there is actually a formal thinking disturbance in depressed patients. Depressed individuals were compared with schizophrenic patients and with undepressed persons in their ability to interpret the meaning of a number of proverbs, such as “A stitch in time saves nine.”
In practical terms the study indicated that during periods of depression you lose some of your capacity for clear thinking; you have trouble putting things into proper perspective. Negative events grow in importance until they dominate your entire reality—and you can’t really tell that what is happening is distorted. It all seems very real to you. The illusion of hell you create is very convincing.
The more depressed and miserable you feel, the more twisted your thinking becomes. And, conversely, in the absence of mental distortion, you cannot experience low self-worth or depression!
What types of mental errors do you make most generally when you look down on yourself? A good place to begin is with the list of distortions you began to master in Chapter 3. The most usual mental distortion to look out for when you are feeling worthless is all-or-nothing thinking. If you see life only in such extreme categories, you will believe your performance will be either great or terrible—nothing else will exist. As a salesman told me, “Achieving 95 percent or better of my goal for monthly sales is acceptable. Ninety-four percent or below is the equivalent of total failure.”
Overcoming the Sense of Worthlessness
By now you might be saying, “Okay, I can see that there is a certain illogic which lurks behind the sense of worthlessness. At least for some people. But they are basically winners; they’re not like me. You seem to be treating famous physicians and successful businessmen. Anyone could have told you that their lack of self-esteem was illogical. But I really am a mediocre nothing. Others are, in fact, better looking and more popular and successful than I am. So what can I do about it? Nothing, that’s what! My feeling of worthlessness is very valid. It’s based on reality, so there is little consolation in being told to think logically. I don’t think there’s any way to make these awful feelings go away unless I try to fool myself, and you and I both know that won’t work.” Let me first show you a couple of popular approaches, used by many therapists, which I feel do not represent satisfactory solutions to your problem of worthlessness. Then I’ll show you some approaches that will make sense and help you.
In keeping with the belief that there is some deep truth in your conviction you are basically worthless, some psychotherapists may allow you to ventilate these feelings of inadequacy during a therapy session. There is undoubtedly some benefit to getting such feelings off your chest. The cathartic release may sometimes, but not always, result in a temporary mood elevation. However, if the therapist does not provide objective feedback about the validity of your self-evaluation, you may conclude that he agrees with you. And you may be right! You may, in fact, have fooled him as well as yourself! As a result, you probably will feel even more inadequate.
Just as emotional ventilation for its own sake is usually not enough to overcome the sense of worthlessness, insight and psychological interpretation generally don’t help either. For example, Jennifer was a writer who came for treatment for panic she experienced before publication of her novel. In the first session she told me, “I have been to several therapists. They have told me that my problem is perfectionism and impossible expectations and demands on myself. I also have learned that I probably picked up this trait from my mother, who is compulsive and perfectionistic. She can find nineteen things wrong with an incredibly clean room. I always tried to please her, but rarely felt I succeeded no matter how well I did. Therapists have told me, ‘Stop seeing everyone as your mother! Stop being so perfectionistic.’ But how do I do this? I’d like to, I want to, but no one ever was able to tell me how to go about it.”
Jennifer’s complaint is one I hear nearly every day in my practice. Pinpointing the nature or origin of your problem may give you insight, but usually fails to change the way you act. That is not surprising. You have been practicing for years and years the bad mental habits that helped create your low self-esteem. It will take systematic and ongoing effort to turn the problem around.
Since ventilation of emotions and insight—the two staples of the standard psychotherapeutic diet—won’t help, what will? As a cognitive therapist, I have three aims in dealing with your sense of worthlessness: a rapid and decisive transformation in the way you think, feel, and behave. These results will be brought about in a systematic training program that employs simple concrete methods you can apply on a daily basis. If you are willing to commit some regular time and effort to this program, you can expect success proportionate to the effort you put in.
Are you willing? If so, we’ve come to the beginning. You’re about to take the first crucial step toward an improved mood and self-image.
I have developed many specific and easily applied techniques that can help you develop your sense of worth. As you read the following sections, keep in mind that simply reading them is not guaranteed to bolster your self-esteem—at least not for long. You will have to work at it and practice the various exercises. In fact, I recommend that you set some time aside each day to work at improving your self-image because only in this way can you experience the fastest and most enduring personal growth.
Specific Methods for Boosting Self-Esteem
1. Talk Back to That Internal Critic! A sense of worthlessness is created by your internal self-critical dialogue. It is self-degrading statements, such as“I’m no damn good,” “I’m a shit,” “I’m inferior to other people,” and so on, that create and feed your feelings of despair and poor self-esteem. In order to overcome this bad mental habit, three steps are necessary:
a. Train yourself to recognize and write down the self-critical thoughts as they go through your mind;
b. Learn why these thoughts are distorted; and
c. Practice talking back to them so as to develop a more realistic self-evaluation system.
One effective method for accomplishing this is the “triple-column technique.” Simply draw two lines down the center of a piece of paper to divide it into thirds. Label the left-hand column“Automatic Thoughts (Self-Criticism),” the middle column “Cognitive Distortion,” and the right-hand column “Rational Response (Self-Defense).” In the left-hand column write down all those hurtful self-criticisms you make when you are feeling worthless and down on yourself.
Suppose, for example, you suddenly realize you’re late for an important meeting. Your heart sinks and you’re gripped with panic. Now ask yourself,“What thoughts are going through my mind right now? What am I saying to myself? Why is this upsetting me?” Then write these thoughts down in the left-hand column.
You might have been thinking, “I never do anything right,” and “I’m always late.” Write these thoughts down in the left-hand column and number them. You might also have thought, “Everyone will look down at me. This shows what a jerk I am.” Just as fast as these thoughts cross your mind, jot them down. Why? Because they are the very cause of your emotional upset. They rip away at you like knives tearing into your flesh. I’m sure you know what I mean because you’ve felt it.
What’s the second step? You already began to prepare for this when you read Chapter 3. Using the list of ten cognitive distortions (page 42), see if you can identify the thinking errors in each of your negative automatic thoughts. For instance, “I never do anything right” is an example of overgeneralization. Write this down in the middle column.
You are now ready for the crucial step in mood transformation—substituting a more rational, less upsetting thought in the right-hand column. You do not try to cheer yourself up by rationalizing or saying things you do not believe are objectively valid. Instead, try to recognize the truth. If what you write down in the Rational Response column is not convincing and realistic, it won’t help you one bit. Make sure you believe in your rebuttal to self-criticism. This rational response can take into account what was illogical and erroneous about your self-critical automatic thought.
For example, in answer to “I never do anything right,” you could write,“Forget that! I do some things right and some wrong, just like everyone else. I fouled up on my appointment, but let’s not blow this up out of proportion.”
Suppose you cannot think of a rational response to a particular negative thought. Then just forget about it for a few days and come back to it later. You will usually be able to see the other side of the coin. As you work at the triple-column technique for fifteen minutes every day over a period of a month or two, you will find it gets easier and easier. Don’t be afraid to ask other people how they would answer an upsetting thought if you can’t figure out the appropriate rational response on your own.
One note of caution: Do not use words describing your emotional reactions in the Automatic Thought column. Just write the thoughts that created the emotion. For example, suppose you notice your car has a flat tire. Don’t write“I feel crappy” because you can’t disprove that with a rational response. The fact is, you do feel crappy. Instead, write down the thoughts that automatically flashed through your mind the moment you saw the tire; for example, “I’m so stupid—I should have gotten a new tire this last month,” or“Oh, hell! This is just my rotten luck!” Then you can substitute rational responses such as “It might have been better to get a new tire, but I’m not stupid and no one can predict the future with certainty.” This process won’t put air in the tire, but at least you won’t have to change it with a deflated ego.