237
Figure 10-3. After eliciting his chain of automatic thoughts, using the downward-arrow method, Art identified the cognitive distortions and substituted more objective responses.
Automatic Thoughts
Rational Responses
I. Dr. B. probably thinks I'm a
1. Just because Dr. B. pointed out
lousy therapist.
my error it doesn't follow he
♦
"If he did think this,
thinks I'm a -"lousy therapist."
why would it be. upset-
I'd have to ask him to see what
he really thinks, but on many
ting to me?
occasions he has praised me and
said I had outstanding talent.
2. That would mean I was a lousy 2. An expert can only point out
therapist because he's an
my specific strengths and weak-
expert.
nesses as a therapist. Any time
♦
"Suppose I was a lousy
anyone labels me as "lousy"
therapist, what would
they are simply making a global,
this mean to me?"
destructive,
useless
statement. I have had a lot of
success with most of my
patients, so it can't be true I'm
"lousy" no matter who says it.
3. Overgeneralization. Even if I
3. That would mean I was a total
were relatively unskilled and
failure. It would mean I was no
ineffective as a therapist, it
good.
wouldn't mean I was "a total
♦
"Suppose I was no good.
failure" or "no good." 'I have
Why would this be a
many other interests, strengths,
problem? What would
and desirable qualities that
aren't related to my career.
it mean to me?"
4. This is absurd. If I made a mis-
4. Then the word would spread
take, I can correct it. "The
and everyone would find out
word" isn't going to spread
What a bad person I was. Then
around the state like wildfire
no one would respect me. I'd
just because I made an error:
get drummed out of the medical
What are they going to do, pub-
society, and I'd have to move to
lish a headline in the news-
another state.
paper: "NOTED PSYCHIA-
♦
"And what would that
TRIST MAKES MISTAKE!"?
mean?"
5. Even if everyone in the wor:d
5. It would mean I was worthless.
238
FEELING GOOD
Figure 10-3. Continued.
Automatic Thoughts
Rational Responses
I'd feel so miserable I'd want
disapproves of me or criticizes
to die.
me, it can't make me worthless
because I'm not worthless. If
I'm not worthless, I must be
quite worthwhile. So, what is
there to fed miserable about?
5. This disapproval will mean I am a bad, worthless person.
Once you have generated your own chain of automatic thoughts and clarified your silent assumptions, it is crucial to pinpoint the distortions and substitute rational responses as you usually do (see Figure 10-3, page 238).
The beauty of the downward-arrow method is that it is in-ductive and Socratic: Through a process of thoughtful questioning, you discover on your own the beliefs that defeat you.
You unearth the origin of your problems by repeating the following questions over and over: "If that negative thought were true, what would it mean to me? Why would it upset me?" Without introducing some therapist's subjective bias or personal beliefs or theoretical leanings, you can objectively and systematically go right to the root of your problems. This circumvents a difficulty that has plagued the history of psychiatry. Therapists from all schools of thought have been no-torious for interpreting patients' experiences in terms of preconceived notions that may have little or no experimental validation. If you don't "buy" your therapist's explanation of the origin of your problems, this is likely to be interpreted as `
resistance" to the "truth." In this subtle way, your troubles eet forced into your therapist's mold regardless of what you say. Imagine the bewildering array of explanations for suffer-ine that you would hear if you went to a religious counselor (
spiritual factors), a psychiatrist in a Communist country (
the social-political-economic environment), a Freudian analyst (internalized anger), a behavior therapist (a low rate of positive reinforcement), a drug-oriented psychiatrist (genetic factors and brain-chemistry imbalance), a family therapist (
disturbed interpersonal relationships), etc.!
239
David D. Burns, M.D.
A word of caution when you apply the vertical-arrow method. You will short-circuit the process if you write down thoughts that contain descriptions of your emotional reactions. Instead, write down the negative thoughts that cause your emotional reactions. Here's an example of the wrong way to do it:
First Automatic Thought: My boyfriend didn't call me this weekend as he promised he would.
"Why is that upsetting to me? What does
it mean to me?"
Second Automatic Thought: Oh, it's awful and terrible because I can't stand it.
This is useless. We already know you feel awful and terrible. The question is—what thoughts automatically crossed your mind that caused you to feel so upset? What would it mean to you if he had neglected you?
Here's the correct way to do it;
1. My boyfriend didn't call me this weekend as he promised he would.
•
"Why would that be upsetting to me? What does it mean to
me?'
2. That means he's neglecting me. That means he really doesn't love me.
•
"And suppose that were true. What would that mean to
me?"
3. That would mean there's something wrong with me.
Otherwise he'd be more attentive.
"And suppose that was true. What would that mean to
me?"
4. That would mean I was going to be rejected.
•
"And if I were in fact rejected, what then? What would that
mean to me?"
5. That would mean I was unlovable and I would always be rejected.
"And if that happened, why
would it upset me?"
240
FEELING GOOD
6. That would mean I'd end up alone and miserable.
Thus, by pursuing the meaning rather than your feelings, your silent assumptions became obvious: (1) If I'm not loved I'm not worthwhile; and (2) I'm bound to be miserable if I'
m alone.
This is not to say your feelings aren't important. The whole point is to deliver the real McCoy—valid emotional transformation.
The Dysfunctional Attitude Scale (DAS). Because of the crucial importance of eliciting the silent assumptions that give rise to your mood swings, a second, simpler method for eliciting them called the "Dysfunctional Attitude Scale" (DAS) has been developed by a member of our group, Dr. Arlene Weissman. She has compiled a list of one hundred self-defeating attitudes that commonly occur in individuals predisposed to emotional disorders. Her research has indicated that while negative automatic thoughts are reduced dramatically between episodes of depression, a self-defeating belief system remains more or less constant during episodes of depression and remission. Dr. Weissman's studies confir
m the concept that your silent assumptions represent a predisposition to emotional turbulence that you carry with you at all times.
Although a complete presentation of the lengthy Dysfunctional Attitude Scale would be beyond the scope of this book, I have selected a number of the more common attitudes and have added several others which will be useful. As you fill out the questionnaire, indicate how much you agree or disagree with each attitude. When you are finished, an answer key will let you score your answers and generate a profile of your personal value systems. This will show your areas of psychological strength and vulnerability.
Answering the test is quite simple. After each of the thirty-five attitudes, put a check in the column that represents your estimate of how you think most of the time. Be sure to choose only one answer for each attitude. Because we are all different, there is no "right" or "wrong" answer to any statement. To decide whether a given attitude is typical of your own philosophy, recall how you look at things most of the dine.
241
David D. Burns, M.D.
EXAMPLE:
Disagree
Agree
Agree
Disagree
Very
Strongly Slightly
Neutral
Slightly
Much
35. People
who
have
the marks of success
(good looks, social
status,
wealth,
o r
fame)
are
bound
to be happier than
those who do not.
In this example the checkmark in the Agree Slightly column indicates that the statement is somewhat typical of the attitudes of the person completing the inventory. Now go ahead.
The Dysfunctional Attitude Scale *
Disagree
Very
Agree
Agree
Disagree
Much
Strongly Slightly
Neutral
Slightly
1. Criticism will obvi-
ously upset the per-
son who receives the
criticism.
2. It is best to give up
my own interests in
order to please other
people.
• Copyright 1978, Arlene Weissman.
242
Disagree
Agree
Agree
Disagree Very
Strongly Slightly Neutral Slightly Much
3. I need othcr people's
approval in order to
be happy.
4. If someone impor-
tant to mc expects
me to do something,
then I really should
do it.
5. My value as a person
depends greatly on
what others think of
me.
6. I cannot find happi-
ness
without being
loved
by
another
person.
7. If others dislike you,
you arc bound to be
less happy.
8. If people whom I
care about
reject
me, it means there
is something wrong
with mc.
9. If a person I love
does not love me, it
means I am unlov-
able.
10. Being isolated from
others is bound
to
lead to unhappiness.
11. If I am to be
a
worthwhile person, I
must be truly out-
standing in at least
one major respect.
243
Disagree
Agree
Agree
Disagree
Very
Strongly Slightly Neutral Slightly Much
12. I must be a useful,
productive,
creative
person
or life
has
no purpose.
13. Peoplewhohave
good ideas are more
worthy
than
those
who do not.
14. If I do not do as well
as other people,
it
means I am inferior.
15. If I fail at my work,
then I am a failure
as a person.
16. If you
cannot do
something well, there
is little point in do-
ing it at all.
17. It is shameful for a
person to display his
weaknesses.
18. A person should try
to be the
best
at
everything he under-
takes. -
19. I should be upset if
I make a mistake.
20. If I don't set
the
highest standards for
myself, I am likely
to end up a second-
rate person.
21. If I strongly believe
I deserve something,
I have reason to ex-
pect that I should
get ft.
244
Disagree
Agree
Agree
Disagree Very
Strongly Slightly Neutral Slightly Much
22. It is necessary to be-
come frustrated if
you find obstacles
to getting what you
want.
23. ItI put other peo-
ple's needs before
my own, they should
Help me when I
need something from
them.
24. If I am a good hus-
band (or wife), then
my spouse is bound
to love me.
25. If I do nice things
for someone, I can
anticipate that they
will respect me and
treat me just as well
as I treat them.
25. I should assume re-
sponsibility for how
people feel and be-
have if they are
close to me.
27. If
I criticize
the
way someone does
something and they
become angry or de-
pressed, this means
I have upset them.
23. To be a good, worth-
while, moral person,
I must try to help
everyone who needs
it
._..
245
g t 1
, .
Agree
Agree
Disagree'
Strongl Slightly Neutral Slightly
y
29. If a child is having
emotional or behav-
ioral &faculties, this
shows that the child's
parents have failed
in some important
respect
30. I should be able to
please everybody.
31. I cannot expect to
control how I feel
when something bad
baPPa•
32. There is no point in
trying to change up-
setting emotions be-
cause they are a
valid and inevitable
part of daily living.
33. My moods are pri-
marily created by
factors
that
are
largely beyond my
control, such as the
past, or body chem-
istry, or. hormone cy-
cles, or biorhythms,
or chance, or fate.
34. My
happiness
is
largely dependent on
what happens to me.
35. People who have
the marks of success
(good looks, social
status,
wealth, or
fame)
are
bound
to be happier than
those who do not.
246
FEELING GOOD
Now that you have completed the DAS, you can score it in the following way. Score your answer to each of the thirty-five attitudes according to this key:
Agree
Agree
Disagree
Disagree
Strongly
Slightly
Neutral
Slightly
Very Much
—2
—1
0
+1
+2
Now add up your score on the first five attitudes. These measure your tendency to measure your worth in terms of the opinions of others and the amount of approval or criticism you receive. Suppose your scores on these five items were +2; +1; —1; +2; 0. Then your total score for these five questions would be +4.
Proceed in this way to add up your score for items 1
through 5, 6 through 10, 11 through 15, 16 through 20, 21
through 25, 26 through 30, and 31 through 35, and record these as illustrated in the following example:
SCORING EXAMPLE:
Value System
Attitudes
Individual Scores
Total Scores
L Approval
1 through 5
+2,+1,-1,+2,0
+4
IL Love
6 through 10 —2,-1,-2,-2,0
—7
II/. Achievement 11 through 15 +1,+1,0,0,-2
0
IV. Perfectionism 16 through 20 +2,+2,+1,+1,+1
+7
V. Entitlement 21 through 25 +1,+1,-1,+1,0
+2
VL Omnipotence 26 through 30 —2,-1,0,-1,+1
—3
TU. Autonomy
31 through 35 —2,-2,-1,-2,-2
—9
247
David D. Burns, M.D.
RECORD YOUR ACTUAL SCORES HERE:
Value System
Attitudes
Individual Scores
Total Scores
I. Approval
1 through 5
II. Love
6 through 10
III. Achievement
11 through 15
IV. Perfectionism
16 through 20
V. Entitlement
21 through 25
VL Omnipotence 26 through 30
V1L Autonomy
31 through 35
Each cluster of five items from the scale measures one of seven value systems. Your total score for each cluster of five items can range from +10 to —10. Now plot your total scores on each of the seven variables so as to develop your "