Reprinted with permission from the CFIDS/Fibromyalgia Self-Help Program: CFIDSselfhelp.org.

How Thoughts Create Stress To see how our thoughts can create stress, think what you might say to yourself when you have a setback. An increase in symptoms can trigger negative thoughts like “I'm not getting anywhere” or “I'll never get better” or “it’s hopeless.” Thoughts like these can actually increase your suffering, because our thoughts affect our perception of and attitude toward our symptoms. Negative thoughts make you feel anxious, sad and hopeless, which in turn makes it difficult to act in constructive ways.

How Thoughts Affect Mood and Action Being in a situation in which you seem to lack control can create a strong sense of helplessness. But, just as feelings of pessimism and despair can be learned in response to experience, so can optimism. To understand the connection between thoughts, feelings and actions, imagine the reactions of two different patients to an increase in symptoms following a short walk. One says: “Another setback! I’ll never get any better.” The other says: “I walked too far today.”

The two patients have different explanatory styles. The first has a pessimistic way of interpreting experience. She sees specific events as examples of permanent, far-reaching negative forces. The other patient has a more optimistic way of seeing her experience. She sees an event as something specific, limited and temporary.

The thought “I’ll never get any better” tends to lead to frustration, depression and despair. The mood of despair is associated with learned helplessness, the sense of not having control, the belief that effort will not be effective. The thought “I walked too far today” is more hopeful. It suggests the person can learn from experience, that tomorrow need not be the same. The more optimistic mood is associated with the willingness and even eagerness to try again.

Recognizing Automatic Thoughts The process of changing explanatory style from a pessimistic, helpless one, to a more optimistic and hopeful one, occurs in three steps. The first is learning to recognize one’s self-defeating thoughts. This is not easy to do because the thoughts are automatic and habitual, so deeply ingrained that they seem self-evident.

A technique for recognizing automatic thoughts is the Thought Record. (For a detailed explanation, see the book Mind Over Mood by Dennis Greenberger and Christine Padesky). Using this form offers a way to become aware of your automatic thoughts and their effects on your mood and behavior. You can find similar techniques in other books, such Learned Optimism by Martin Seligman or Feeling Good by David Burns.

To see how this technique works, we’ll use an example of 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. They were: “I’ll never get better. Every time I try something, it fails.” She wrote a description of the event in column 1 of the Thought Record. (See below.) In the second column, she recorded her emotions at the time, noting that she felt depressed and hopeless. And in the third, she wrote the thoughts going through her mind when the emotions were strongest: “I’ll never get better. Every time I try something, it fails.”

Thought Record #1

1: Event Walked 30 min. Very tired after.

2: Emotions Depressed, hopeless.

3: Initial Thoughts I’ll never get better. Every time I try something, it fails.

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. Often we are more harsh and judgmental toward ourselves in our inner dialogue than we would be with others. Self-defeating thoughts often go through our minds when something upsetting occurs. Because these thoughts are automatic, they can be hard to recognize and it can take some time to develop this skill. Evaluating Negative Thoughts Once you have identified negative thoughts, the next step is to examine them for “reasonableness.” In evaluating your thoughts, ask yourself to what extent the thoughts are valid. Negative thoughts tend to ignore facts or to select only the worst aspects of a situation. One way to determine reasonableness is by asking, “What is the evidence for and against my thoughts?” The idea is to suspend temporarily your belief that the thoughts are true, and instead look for both evidence that supports and evidence that refutes the thoughts. Writing down the evidence you find helps you gain distance from your thoughts and makes them less self-evident.

You use column 4 in the Thought Record for evidence for, and column 5 for evidence against. The patient in our example wrote in column 4 that she has frequent setbacks and that she had often felt worse after exercising. She wrote in column 5 that she had improved over the last year and knew that many CFIDS patients improve.

Thought Record #2

1: Event Walked 30 min. Very tired after.

2: Emotions Depressed, hopeless.

3: Initial Thoughts I’ll never get better. Every time I try something, it fails.

4: Pro I have frequent setbacks. Exercise often makes me worse.

5: Con Overall I’m better than a year ago. Many people recover.

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 first step, you identify your self-defeating thoughts by recording the thoughts associated with strong emotions. In the second step, you challenge the accuracy of the thoughts by testing them to find distortions and irrationalities. In the last step of the process, you propose a new understanding of your experience.

You use column 6 of the Thought Record for this purpose. What you write in column 6 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. Reviewing the evidence she had written in columns 4 and 5, our patient decided that the evidence was mixed. She wrote a balanced thought that combined the evidence for and the evidence against. “I have frequent relapses and don't know if I'll recover. But I've made progress and now have some tools that give me hope.”

Thought Record #3

1: Event Walked 30 min. Very tired after.

2: Emotions Depressed, hopeless.

3: Initial Thoughts I’ll never get better. Every time I try something, it fails.

4: Pro I have frequent setbacks. Exercise often makes me worse.

5: Con Overall I’m better than a year ago. Many people recover.

6: Corrected Thought I have frequent relapses and don’t know if I’ll recover, but I’ve made progress and now have some tools that give me hope.

The Goal: Reduce Stress Through Realistic Thinking The process described here involves changing deeply ingrained habits of thought. The long-term results can be dramatic, but improvement is gradual. Let me be clear that the change being suggested is not to replace negative thoughts with positive but inaccurate ones. 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 way: retraining your habits of thought in a more realistic direction. The kind of thinking advocated here integrates all evidence both positive and negative. It 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.