This is an excerpt from my upcoming book, We Get Better: 48 Treatment Options for Chronic Depression.

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Treatment option 33: Challenging unhelpful thoughts

Catch it. Check it. Change it. This is a succinct description of the cognitive behavioral therapy (CBT) process. Catch unhelpful thoughts as they come. Check them for accuracy. Then find a helpful, balanced replacement. This can be done anytime, anywhere, but it seems to work best (especially at first) when you do it in written form.

Cognitive therapy guides recommend a variety of ways to identify inaccuracies in your thinking. Many make use of detailed worksheets for recording negative thoughts, feelings arising from the thoughts, cognitive distortions within those thoughts, replacement thoughts and more. Though these processes are shown to be effective, they’re also rather time-consuming. The method I prefer is a bit simpler.

Here is that method: Grab a pen and paper and make a list of all of the negative thoughts that are currently bothering you. Distressing experiences, personal shortcomings, difficult people, challenging situations, core fears–these are all great candidates for reframing. When you can’t think of any more, reread the list. Circle the ones that are most harmful to you or that feel the most stuck.

For each thought that you have circled, ask yourself some of the relevant questions in the list below. If needed, you can also notice if your distressing thought contains any cognitive distortions–common logical fallacies that sometimes creep into our thinking, especially in moments of acute depression or anxiety. These include: exaggerating, using all-or-nothing thinking, overgeneralizing, mind reading, jumping to conclusions, catastrophizing, personalizing, using “should” statements, disqualifying the positive, using emotional reasoning, minimizing, labeling, blaming and more. When you notice one of these distortions in your thoughts, that’s a sign that it might not be true, or fully true. Knowing this can help you find its weakness.

Once you’ve challenged your distressing thought, find at least one helpful reframe and write it down. For example, the thought “I am sad all the time” can be rewritten as, “I am sad some of the time, but not all of the time. I have many good moments and even hours throughout my week and I am learning how to expand those good times.”

If you prefer not to use the list of questions provided, no problem–just use the last one: “What is a more balanced, more realistic and more helpful perspective of this problem–a new story that I can remind myself of as needed?” That should do the trick.

Many people benefit greatly from a daily or weekly cognitive therapy ritual, but if that idea doesn’t appeal to you, use this process during times of higher-than-usual anxiety, depression or stress. Cognitive therapy can be difficult at times. It forces you to think in ways that might be unfamiliar or uncomfortable. But it is also one of the most evidence-supported depression treatments available, and I can’t imagine willingly passing it up.

If desired, add “challenging unhelpful thoughts” to your depression treatment plan. Then add it to your ongoing to-do list as well.

Questions for Reframing

Is this story true? 

What percentage of this story is true, and what percentage is not true? 

What aspects of this story are true, and what aspects are not true? 

If I were to put this story on trial, what evidence would there be both for and against it? Would the judge find enough evidence to declare it true? 

Is the opposite story also true? Is it more true than the original story? 

Does this story include all-or-nothing thinking? 

Does this story include exaggeration? 

Does this story include catastrophizing? 

Does this story minimize positive aspects of the problem? 

Does this story overgeneralize or include words like always, never, nothing, and everything? Does this story include words like should or must? 

Does this story include labels like stupid or bad? Do those labels always apply? 

Does this story include jumping to conclusions, worst-case assumptions or guessing the thoughts or motives of others? 

Does this story imply a need for perfectionism? 

Does this story feel true partly or mostly because it’s familiar? 

Does this story relate to any of my triggers or past experiences? 

Does this story relate to any of my fears? 

Does this story include self-blame for things I’m not responsible for? 

Is the voice who is telling me this story the real me, or is it someone else that I know or used to know, such as a parent or authority figure?

Does all of me believe this story, or does only a small part of me believe it, such as the wounded child in me or the rejected lover in me? 

Does this story bring up underlying desires or needs? What are other, more effective ways I can meet those needs? 

Does this story include blame of others? Does it focus on what another should do differently, even though I cannot change their actions? How helpful is that strategy? What is a better strategy? 

Does this story include anger? If so, is this because an important boundary of mine has been crossed (for example, a boundary regarding how people should treat me)? How can I reestablish that boundary for the future? 

For any aspects of the story that are true, what are the real effects of the problem, and are they manageable? 

How distressing is this problem on a scale of 1 through 10, with 10 being extremely distressing? 

Is this problem always a problem, or is it only sometimes a problem? How often and to what degree is it actually a problem? 

If I were to ask myself three times per day if the belief was true right then, how often would it be true? For example, if my belief is that I am not smart enough, would this be true when I am in the shower? Eating lunch? Writing an email? Having a work-related conversation? Performing a work duty? Relaxing with friends? 

Is this a true problem (ongoing unfixable issue) or is it merely a challenge? Will this problem still exist one year from now? 

How much of my emotional energy do I want to devote to this problem? 

What is the worst case scenario that could arise as a result of this problem? On a scale of 1 to 100, how likely is that scenario to come to pass? 

If the worst case scenario were to happen, how would I respond? How would I handle it and what would I learn from it? After I fully went through it, what would the outcome be and would it be as terrible as this story implies? 

For any aspects of the story that are true, what can I do to fix or lessen these difficulties, even in part? Am I willing to do these things? 

For any aspects of the story that are true but unfixable, can I accept these challenges?

Is this problem a normal part of life that many people manage well? 

What image can I bring to mind when thinking of this situation that would help me feel more calm? 

Can I find a place of acceptance inside of me in which to put this problem? 

What acceptance self-reminder can I use when the unfixable aspects of this problem come to mind? 

If I were to ask a friend for their perspective of this problem, what would they say? If a friend of mine had this problem, what would I tell them? 

And finally, and most important: What is a more balanced, more realistic and more helpful perspective of this problem–a new story that I can remind myself of as needed? 

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