Introducing Self-Comparisons Cognitive Therapy
All of us hanker for instant magic, a quick fix for our troubles. And that's what the simple-minded variety of get-happy self-help books promise, which explains why so many people buy them. But in the end there seldom is a one-stroke magical cure for a persons' depression.
The understanding of depression provided by cognitive therapy and Self-Comparisons Analysis is an exciting advance over the older ways of dealing with depression. But this new theory also shows that there is more to understanding depression than a single magical button. Instead, you must do some hard thinking about yourself. Whether you have the help of a psychotherapeutic counselor, or fight your depression by yourself, the battle takes effort and discipline.
Writing down and analyzing your depressed thoughts is a very important part of the cure. Some detailed suggestions are given below. Learning more about the nature of depression is worthwhile, too. I particularly recommend two excellent practical books, Feeling Good, by David Burns, and A New Guide to Rational Living, by Albert Ellis and Robert A. Harper, both of which are which are available in inexpensive paperback. Other works which have two or three stars in the reference list at the end of this book also are valuable for the depression sufferer; the more you read, the better your chances to find insights and methods which will fit your mind-set and your daily needs. When reading those books, you will quickly see how their general notion of negative thoughts can be translated into the more precise and useful notion of negative self-comparisons.
A bit later, this chapter discusses whether you should try to win the battle by yourself or seek a counselor's aid, and whether you can expect to sail into a permanent harbor of total untroubled bliss. First we must discuss the first requirements of almost any successful battle against depression.
Before proceeding further, here is a nice tidbit for you which -- even if it will not cure your depression by itself -- every depression specialist agrees is valuable therapy. Do some things which you enjoy. If you enjoy dancing, go out and dance tonight. If you like to read the funny papers before you start work for the day, read them. If you delight in a bubble bath, take one this evening. There are plenty of pleasures in this world that are not illegal, immoral, or fattening. Let it be the first step in your program to overcome depression to brighten up your days with some of these pleasures.
Pleasurable activities reduce the mental pain which causes sadness. And while you are enjoying pleasure you do not feel pain. The less pain and the more pleasure, the more value you find in living. This advice to find pleasure clearly is "just" common sense, and I do not know of any controlled scientific studies proving it is curative. But this shows how the core of the contemporary scientifically-proven cognitive theory is a return to the common-sense wisdom known for ages, though systematic modern research has made large advances with new theoretical understanding of the principles and practical development of the accompanying methods.
You Must Monitor and Analyze Your Thinking
The understanding of depression provided by cognitive therapy and Self-Comparisons Analysis is an exciting advance over the older ways of dealing with depression. But this new theory also shows that there is more to understanding depression than a single magical button. Instead, you must do some hard thinking about yourself. Whether you have the help of a psychotherapeutic counselor, or fight your depression by yourself, the battle takes effort and discipline.
Writing down and analyzing your depressed thoughts is a very important part of the cure.
Self-Comparisons Analysis teaches that your negative self- comparisons, together with a sense of helplessness, cause your sadness. Obviously, then, you will have to eliminate or reduce those negative self-comparisons in order to banish depression and achieve a joyful life. But with the possible exception of drug therapy or electroshock, every successful anti-depression tactic requires that you know which depressing thoughts you are thinking. Cognitive therapy also requires that you monitor your thinking in order to prevent those self-comparisons from entering and remaining in your mind.
So there it is. Fighting depression requires the work and discipline of observing your own thoughts. Watching over anything--watching over a child lest it get into the fireplace, or taking notes on what is said at a meeting, or listening to a travel guide give you directions to your destination--requires the effort of paying attention. And it requires the discipline of paying attention often enough and long enough. Many of us are sufficiently short of such discipline so that without a counselor to hold our hands we certainly will not do it, and even with a skilled counselor we may not be willing and able to do it. On the other hand, if you decide to do it--and making that decision to break out of depression, to give up its benefits and to do the necessary work is a key step -- if you decide to apply yourself to the task, you almost surely can do it.
The first step is every tactic we shall describe, then, will be to observe your thoughts closely when you are depressed, analyze which negative self-comparisons you are making, and write them down if you can make yourself do so. Later, when you have learned how to keep depression at bay, an important part of your continuing exercise will be to identify each negative self- comparison before it gets a firm foothold, and pitch it out of your mind with the devices we shall describe.
One useful trick is to watch your thoughts in a disengaged fashion, as if they were the thoughts of a stranger whom you were reading about in a book or hearing at the movies. You can then examine the thoughts and see how interesting they are, including the peculiar illogical tricks we all play with our thinking. Watching your thoughts in this way is like what happens in meditation, which is described in Chapter 15. Watching your thoughts at a distance desensitizes them; it removes the sting of neg-comps. You will be amazed at the fascinating stream-of- consciousness drama that goes on inside your head, how one thing leads to another in the most peculiar way, with astonishing emotional ups and downs within a minute or less sometimes. Try it. You'll probably like it.
Learning to monitor your thoughts also is like the first crucial step in stopping smoking: You must first be aware of what you are doing before you can intervene to change the behavior. Confirmed smokers often pull out and light cigarettes without being fully aware of the process, and do not make a conscious decision to do so.
Other hard thinking also is necessary to overcome depression. You may have to straighten out some misapprehensions or confusions that customarily depress you. You may need to re- think your priorities. It may even help to search your memory for some childhood experiences. Perhaps hardest of all, you may have to study how you misuse language, and how you fall into linguistic traps. For example, your vocabulary probably makes you think that you must do some things which, upon inspection, you will conclude you have no obligation to do, and which may have dragged you into depression.
Conquering depression is not easy - rather, it is difficult. But difficult ...does not mean impossible. Of course you will find it hard to think and to act rationally in an irrational world. Of course you will have trouble reasoning your way out of circumstances which have unreasonably bogged you down for many years. All right, so you find it difficult. But it also proves difficult for a blind man to learn to read Braille, a victim of polio to use his muscles again, or a perfectly normal person to swing from a trapeze, learn ballet dancing, or play the piano well. Tough! But you still can do it.(1)
How To Observe Your Thoughts
You should -- I'd say "must" except that I don't want to add any must's to your life, and besides, there always are exceptions -- you should observe your thoughts with pencil and paper in hand, and write down the thoughts and their analysis. Better yet, because it makes writing easier, use a computer when you are near one.
Let's take this idea further. It is crucial that you actually take action to fight your depression. Writing down and analyzing your thoughts is one such action. But other actions are important, too, such as getting out and participating in pleasurable activities so that you will enjoy life more, or, arriving at meetings on time if you know that getting there late will start you thinking depressing thoughts. Certainly, all this takes effort. But cranking yourself up to carry through with the actions is often a crucial part of the cure of depression. More about this below.
Now back to your thoughts. Ask yourself, "What am I thinking right at this moment, as I am feeling so sad?" Record your thought in the format of Table 10-1. This table guides you from the raw "uninvited thought" ("automatic thought", some writers call it) which floats into your mind and causes you pain, into and through an analysis of that thought which pinpoints the problems and the opportunities to intervene so as to get rid of the painful negative self-comparison you are making.
Table 10-1
Let's follow through an example I have taken from Burns 1.1 so that a reader who uses his book can expand this method (developed over many years by Aaron Beck) with Self-comparisons Analysis. Let's call it the case of Ms. X, a woman who suddenly realizes that she is late for an important meeting. The thought then zips uninvited into her mind, "I never do anything right". Ms. X writes down this thought in column 1 of Table 10-1. She also writes down in column 2 the event that triggered the uninvited thought, being late for the meeting.
The thought in column 1 creates pain. Let's assume that X has a hopeless attitude, too. The uninvited thought then produces sadness.
The uninvited thought in column 1 translates logically into the negative self-comparison, "I do fewer things right than does the average person". So Ms. X writes down in column 3 this analysis of her uninvited thought. Now we may consider various aspects of this neg-comp. The methods for dealing with the various aspects of neg-comps are discussed in detail in the chapters to follow, but we shall now skim through the process briefly in order to focus on the process rather than upon the particular methods.
Look first at the numerator. Is the assessment of her actual situation correct? Is she "always" late, or even usually late? She asks this question, and writes it in column 4. Now X realizes that she is very seldom late. She had told herself, "I'm always late", and then "I never do anything right", because she has a typical cognitive-distortion habit of depressives, generalizing to "always" or "everything" bad from just a single bad instance. She specifies this self-fooling device in the last column of the table.
Ms. X now can see how she has created a painful neg-comp unnecessarily. If she has any sense of humor she can laugh at how her mind plays silly tricks on her -- but tricks that make her depressed -- because of habits built up through the years, for reasons that are long in her past.
Notice how the pain of depression is removed by examining present thoughts. It might be interesting and useful to know how and why X developed the habit of over-generalizing from a single bad instance, but it is usually not necessary to have that knowledge. (Freudian doctrine erred fundamentally in this matter.)
It is worth mentioning that if you are usually late for meetings, you should re-arrange your life so that you get there on time. Depressives often fail to do this because, even when they acknowledge that they could change the situation so as to remove the causal event, they say they are helpless to change. Often the effort to get things right seems worse than the pain and sadness that getting it wrong produces; as long as a person feels this way, the person will continue to be depressed.
The analysis of X's actual-state numerator may be sufficient to demolish this painful neg-comp. But perhaps Ms. X is not easily convinced that she is playing the self-depressing mind game with her numerator that is shown in the table. People's capacity to fool themselves by using additional plausible- sounding distorted arguments is almost limitless. Therefore, let us go on to a second possible way to deal with this neg-comp, the denominator.
Ms. X agrees that her statement "I never do anything right" implies that others do better than she. Now she can ask herself, Do others really usually do things more right than I do? And is my benchmark comparison really appropriate? Hopefully she will see that this is not a correct assessment, and she is not on average a poor performer. Once more, she may come to see how her biased assessment of others is biased against herself, and hence will let go of the depressing neg-comp. And perhaps she will see the humor in this, too, which will help even more.
Table 10-1 shows still a third line of analysis. Is the dimension of Ms. X being late for meetings important and appropriate for her to rate herself upon? When she asks herself that question, she answers "No". Even if she is late for meetings, this does not mean that she is an incompetent person. And having realized this to be true, she can focus on other aspects of her life which are more important and on which she looks good to herself.
The analysis above provides three different tactics to deal with the neg-comp. Any one of these strategies may be appropriate and effective for a given circumstance for a given person. Sometimes, however, using more than one tactic increases your effectiveness in combating the neg-comp.
There are still other ways to address the problem Ms. X causes herself by telling herself "I never do anything right", and we will discuss them later. The important point emphasized now is writing down the analysis, as a way of forcing your thoughts out into the open so that you -- perhaps together with a therapist -- can analyze their logic and their factual support. The rest of this Part II of the book expands on this advice.
The moment just after awakening in the morning commonly is the bleakest, blackest of the day, depressives commonly say. Therefore, this moment is one of the most interesting to observe, just as it is one of the most challenging to deal with. It takes a bit of time, usually, to get one's morning thoughts directed onto a non-depressing path. This makes sense when you realize that when you first awake your thoughts have just been in the less-consciously-directed sleep state, which tends to be negatively-directed for depressives.
Can You Do It Alone?
Can you really conquer depression by your own efforts, or do you need the help of a professional counselor? Many of us can do it alone, and if you are able to, you will gain great satisfaction and renewed strength from doing so. And nowadays you can have the assistance of Kenneth Colby's computer program OVERCOMING DEPRESSION, which comes with this book and is based on the principles of Self-Comparisons Analysis set forth in this book; experimental research shows that computer-based cognitive therapy does as well as therapy with a counselor (Selmi et. al., 1990), and avoids several possible dangers touched on below.
In the example above, Ms. X can conduct the analysis in Table 10-1 by herself. And if she does so, she will gain considerable satisfaction from it. But a trained therapist can be helpful in helping X unravel her patterns of thought, and may help her discipline herself to proceed through the analysis.
Lest you doubt that a person can cure himself of depression without assistance from a physician or psychologist, keep in mind the millions of people who have done just that, in our times and in earlier times. Religion has often been the vehicle, though this is clearer in Eastern religion than in Western religion. The continued practice for 2500 years of Buddhism, which aims to reduce suffering, should itself be proof enough that at least some people can successfully combat depression without medical help. Granted, there do not exist scientifically-controlled experiments measuring whether just the passage of time would have induced as much improvement as such intercession, as we do have controlled experiments for cognitive therapy with the aid of a therapist (see Appendix A). But people's own experiments on themselves, sometimes using such depression-preventing methods and sometimes not, would seem to constitute rather reliable evidence.
People's power to radically change the course of their own lives has been quite underestimated in recent years, in large part because of the emphasis of Freudian psychology on childhood experience as determinants of the adult's psychological state. As Beck described the dominant view in psychotherapy prior to cognitive therapy: "The emotionally disturbed person is victimized by concealed forces over which he has no control."(2) In contrast, cognitive therapy has found that "Man has the key to understanding and solving his psychological disturbance within the scope of his own awareness."(3)
Even delinquency and drug addiction can be "kicked" by some people simply by deciding to do so. Alcoholics Anonymous provides massive evidence that it can be done. Another example is the Delancey Street Foundation of San Francisco: When a reporter asked its director about his "pioneering" new way of rehabilitation, he was told, with glee: "Yeah, you could say we have a 'new' way of fighting crime and drugs. It's a way that hasn't been tried lately. We tell 'em to stop."(4)
The simple fact is that all of us, all the time, make and carry out decisions about how our minds will act in the future. We decide to study a book, and we do so. We focus our attention on doing this or that, and we do it. We are not beyond our own control.
As interesting evidence that "ordinary" people can willfully alter their own thinking so as to make themselves happier at some times than at others, consider the example of Orthodox Jews on the Sabbath. Jews are enjoined not to think sad or anxious thoughts on the Sabbath (not even when in mourning). And for roughly twenty-six hours each Sabbath they do just that. How? The way a house-wife chases out cats when they come in--as if with a mental broom.
This raises the question: Why not perform the same simple trick all week long? The answer is that the world prevents it. A person cannot, for example, neglect thoughts of work all week; one must make a living, and the world of work inevitably implies strife as well as cooperation, losses as well as gains, failure as well as success.
The operational question is whether you are better off attacking your depression on your own, or getting the help of a professional counselor. The appropriate answer is - a definite maybe.
The help of a counselor clearly can be valuable, as even such self-help advocates as Ellis and Harper agree:
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One of the main advantages of intensive psycho- therapy lies in its repetitive, experimenting, revising, practicing nature. And no book, sermon, article, or series of lectures, no matter how clear, can fully give this. Consequently, we, the authors of this book, intend to continue doing individual and group therapy and to train other psychotherapists. Whether we like it or not, we cannot reasonably expect most people with serious problems to rid themselves of their needless anxiety and hostility without some amount of intensive, direct contact with a competent therapist. How nice if easier modes of treatment prevailed! But let us face it: they rarely do...
Our own position? People with personality disturbance usually have such deep-seated and long- standing problems that they often require persistent psychotherapeutic help. But this by no means always holds true.(5)
But a counselor will only help you if the counselor is well skilled, and has a point of view which fits your particular needs. The chances of finding such a skilled counselor are always uncertain. For one thing, therapists tend to be typecast by their training, and there have occurred "increasingly sharp disagreements among authorities regarding the nature and appropriate treatment."6 What you get depends on the accident of where the therapist studied and which "school" she therefore belongs to; too few are the therapists whose thinking is broad enough to give you what you need rather than what they have in stock. Additionally, many practicing therapists got their training before cognitive therapy had been shown to be clinically effective (as none of the earlier therapies had been).
There is real danger here. Two experienced therapists and teachers of therapists write: "Some people are hurt... by the wrong types of therapists for them...Most people really have no sound basis on which to choose...Most therapists are trained in and practice a particular type of therapy, and in general you will get what that person knows, which may not necessarily be what is best for you."7
Depression is a profoundly philosophical disease. A person's most basic values enter into depressive thinking. On the one hand, values can cause depression when they set up over- demanding and inappropriate goals, and therefore a troublesome denominator in a Rotten Mood Ratio. On the other hand, values can help overcome depression as part of Values Treatment, as discussed in Chapter 18. Helping you deal with such issues requires a depth of wisdom which is not learned in school, and which is too seldom in any of us. But without such wisdom, a therapist is useless or worse.
Depression is also a philosophical matter when it arises from disorder of logical thinking and misuse of linguistic. And starting in the 1980s, professional philosophers have begun to work with depressed people, with some apparent success (Ben-David, 1990). The participation of philosophers is quite reasonable given that cognitive therapy is seen by its creators as being "primarily educative", with the therapist being a "teacher/shaper", and the process as being a Socratic "problem-solving question-and-answer format" (Karasu, February, 1990, p. 139)
But a counselor will only help you if the counselor is well skilled, and has a point of view which fits your particular needs. concepts. The interesting dialogues in Ellis and Harper's A New Guide to Rational Living and in Burns's Feeling Good illustrate how a skilled therapist with a sound grasp of logic can help patients correct their thinking and thereby overcome depression. But few therapists -- or anyone else, for that matter -- have the necessary skill in manipulating logical concepts. All this makes it difficult to find a satisfactory therapist, and provides additional incentive for you to proceed without a therapist.
Furthermore, the computer is not subject to some failings of human therapists: The computer never wears out from fatigue late in the day, and becomes inattentive and therefore useless. The computer never burns out from emotional overload, as is not uncommon with human therapists - because they are human. The computer never becomes involved with the client in a troubling sexual relationship - as occurs in a surprisingly large number of cases, recent reports indicate. And you never feel that the computer is exploiting you financially, which bothers some clients whether or not there is a real basis for the feeling. These are additional reasons to at least give computer therapy a try before seeking a human therapist.
The ill-effects of getting involved with a counselor who is unsympathetic to your particular needs, or does not understand how to deal with your particular mentality, or is temporarily ineffectual or worse, can be great. The encounter can discourage you further, and drive you further into depression, compounded by the pain of having paid your good money in return for being made worse off. Given all this, it would at least make sense to try to work on yourself for a while before seeking out professional help. And even if you do eventually seek out a counselor, you will be better prepared to find one you like, and to work with that person, if you have studied your own psychology and the nature of depression beforehand.
Can You Reach Permanent Bliss?
You can hope to get rid of your depression, and by your own efforts. You can hope to remain depression-free most of your life. But if your depression is more than a passing episode you should not expect that after learning to fight and overcome deep depression you will have the same psychological make-up as nondepressives.
Just as alcoholics who have stopped drinking are forever different from other people with respect to alcohol (though recently there has been some scientific question raised about this), depressives who pull out of deep depression often are different than other people. They must constantly reinforce the dikes and guard against the first incursions of depression in order to keep a trickle from becoming a flood. Consider John Bunyan and Leo Tolstoy. Bunyan wrote as follows: "I found myself in a miry bog...and was as there left by God and Christ, and the Spirit, and all good things...I was both a burthen and a terror to myself...weary of my life, and yet afraid to die."(8) Tolstoy's relevant description of his depression is in Chapter 3.
James wrote as follows about the lives of Bunyan and Tolstoy after their depressions:
Neither Bunyan nor Tolstoy could become what we have called healthy-minded. They had drunk too deeply of the cup of bitterness ever to forget its taste, and their redemption is into a universe two stories deep. Each of them realized a good which broke the effective edge of his sadness; yet the sadness was preserved as a minor ingredient in the heart of the faith by which it was overcome. The fact of interest for us is that as a matter of fact they could and did find something welling up in the inner reaches of their consciousness, by which such extreme sadness could be overcome. Tolstoy does well to talk of it as that by which men live; for that is exactly what it is, a stimulus, an excitement, a faith, a force that reinfuses the positive willingness to live, even in full presence of the evil perceptions that ere- while made life seem unbearable.(8)
Depressives less exceptional than Tolstoy and Bunyan share this condition:
You rarely ever completely win the battle against sustained psychological pain. When you feel unhappy because of some silly idea and you analyze and eradicate this idea, it rarely stays away forever, but often recurs from time to time. So you have to keep reanalyzing and subduing repeatedly. You may acquire the ridiculous notion, for instance, that you cannot live without some friend's approval and may keep making yourself immensely miserable because you believe this rot. Then, after much hard thinking, you may finally give up this notion and believe it quite possible for you to live satisfactorily without your friend's approbation. Eventually, however, you will probably discover that you, quite spontaneously, from time to time revive the groundless notion that your life has no value without the approval of this--or some other--friend. And once again you feel you'd better work at beating this self-defeating idea out of your skull.(9)
But this does not mean that you are doomed to a constant and unrelenting struggle. As you learn more about yourself and your depression, and as you build habits to keep negative self- comparisons at bay, it gets easier and easier.
Let us hasten to add that you will usually find the task of depropagandizing yourself from your own self- defeating beliefs easier and easier as you persist. If you consistently seek out and dispute your mistaken philosophies of life, you will find that their influence weakens. Eventually, some of them almost entirely lose their power to harass you. Almost.(10)
Furthermore, one often develops a commitment to remaining free of depression, just as a person who has stopped smoking has an investment in keeping a "clean record" and sustaining his or her success. One then feels a justifiable pride that helps keep you on the rails and away from sustained depression.
One Stroke For All?
Self-comparisons Analysis makes clear that many sorts of influences, perhaps in combination with each other, can produce persistent sadness. From this it follows that many sorts of interventions may be of help to a depression sufferer. That is, different causes--and there are many different causes, as most psychiatrists have finally concluded, call for different therapeutic interventions. Furthermore, there may be several sorts of intervention that can help any particular depression. Yet all these interventions may be traced to the "common pathway" of negative self-comparisons.
In short, different strokes for different folks. In contrast, however, each of the various schools of psychological therapy--psychoanalytic, behavioral, religious, and so on--does its own thing no matter what the cause of the person's depression, on the assumption that all depressions are caused in the same way. Furthermore, each school of thought insists that its way is the only true therapy.
Self-comparisons Analysis points a depression sufferer toward whichever is the most promising tactic to banish the depression. It focuses on understanding why you make negative self-comparisons, and then develops ways of preventing the neg- comps, rather than focusing on merely understanding and reliving the past, or on simply changing contemporary habits. With this understanding you can choose how best to fight your own depression and achieve happiness.
In a capsule: Your thoughts about yourself cause your depression, though of course your thoughts may be prompted by conditions outside you. To overcome your depression, you must think about yourself in ways different than your habitual patterns. Self-comparisons Analysis systematically suggests many possible kinds of change.
There are also some unsystematic tactics that sometimes effectively change your thinking about yourself. One of these is humor -- jokes about your situation, as well as humorous songs. (Albert Ellis is big on these).(11) The switch in perspective that is the heart of much humor causes you to view your situation less seriously, and in that fashion takes the sting out of the negative self-comparisons that the humor makes fun of.
Viktor Frankl uses a method he calls "paradoxical intention" which radically switches a person's perspective in a fashion akin to humor. Often this is akin to the Values Treatment discussed in Chapter 18. Consider this case of Frankl's:
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A young physician consulted me because of his fear of perspiring. Whenever he expected an outbreak of perspiration, this anticipatory anxiety was enough to precipitate excessive sweating. In order to cut this circle formation I advised the patient, in the event that sweating should recur, to resolve deliberately to show people how much he could sweat. A week later he returned to report that whenever he met anyone who triggered his anticipatory anxiety, he said to himself, "I only sweated out a quart before, but now I'm going to pour at least ten quarts!" The result was that, after suffering from his phobia for four years, he was able, after a single session, to free himself permanently of it within one week.(12) Frankl's procedure can be understood in terms of altering negative self-comparisons. Frankl asks the patient (who must have some power of imagination for the method to work) to imagine that his actual state of affairs is different than what it is. Then he leads the person to compare the actual with that imagined state, and to see that the actual state is preferable to the imagined state. This produces a positive self-comparison in place of the former negative self-comparison, and hence removes sadness and depression.
Are the Best Things In Life Free?
"The best things in life are free," says the song. In money terms, that may be true. But the real best things in life--such as true happiness, and the end to prolonged sadness--are not free in terms of effort. Not to recognize this can be disastrous.
The failure of all popular remedies for depression arises from their unwillingness to recognize that every anti-depression tactic has its cost. As with a farmer, giving up the struggle to plant and raise a crop means not having a harvest and not making a living. To avoid going to parties or business meetings that lead to negative self-comparisons is to forego the pleasures or profits that may also be present there. Another misleading example is the popular recommendation to "accept yourself as you are."
Accepting yourself certainly can have its benefits. But there is also a drawback with simply accepting--either "accepting yourself," in the popular sense, or making no comparisons, as in Eastern meditative practices. If one wants to change one's habits or personality in order to improve or remedy a difficulty, one cannot avoid making comparisons. You cannot conduct any program of self-improvement without comparing and evaluating various modes of behavior.
An example: Wanda L. did not get much affection or respect from people in her work or personal life, other than from her husband and children. There were no obvious objective facts to explain this; she is a productive and talented worker, a very decent person, and not personally unpleasant. But a wide variety of aspects of her personality and behavior apparently combine to lead others to distrust her or not seek her out or to choose her for positions of responsibility.
Wanda can accept the situation as it is, not dwell on it in her thinking, and hence reduce the amounts of negative self- comparisons and sadness. But if she does that, she will not be able to study and analyze herself to change her behavior so as to improve her relationships.
Which should Wanda choose to do? The decision is like that of a business investor who must guess at the chances that the investment will pay off. So there is a price for Wanda to "accept" herself as she is. The price is foregoing the chance of changing her life. Which is the better choice in this trade-off? That is a tough decision--and a choice that is ignored in the usual self-help books. And this makes those simplistic books, and their promises of quick and free miracles, unrealistic and ultimately disappointing.
Whereas this book focuses mostly on changes in how you think, this example focuses on changing the actual state of affairs so as to produce a more Rosy Ratio. But the underlying principle is exactly the same: reduce the negative self- comparisons.
Table 10-1
Column 1 Column 2 Column 3 Uninvited thought Causal Event Self-Comparison "I never do anything Late for a I do fewer things right right." meeting than do most people. Column 4 Column 5 Analysis Response Numerator: Are you usually late for meetings? Almost never. Denominator: Do most other people do most things more "right" than you do? Not really. Dimension: Is your timeliness at meetings an important aspect of your life? Of course not. Column 6 Behavior you wish to change Inappropriately generalizing from a single instance to your entire life. Biased assessment of what other people are like, making you look bad. Focusing on a dimension which a) you need not attribute importance to, and b) does not reflect well upon you.
Summary
This chapter begins the section of the book that discusses ways to overcome depression and the sadness-creating mechanisms that the earlier chapters discussed. The understanding of depression provided by cognitive therapy and Self-Comparisons Analysis is an exciting advance over the older ways of dealing with depression. But this new theory also shows that there is more to understanding depression than a single magical button. Instead, you must do some hard thinking about yourself. Whether you have the help of a psychotherapeutic counselor, or fight your depression by yourself, the battle takes effort and discipline.
Self-Comparisons Analysis teaches that your negative self- comparisons, together with a sense of helplessness, cause your sadness. Obviously, then, you will have to eliminate or reduce those negative self-comparisons in order to banish depression and achieve a joyful life. But with the possible exception of drug therapy or electroshock, every successful anti-depression tactic requires that you know which depressing thoughts you are thinking. Cognitive therapy also requires that you monitor your thinking in order to prevent those self-comparisons from entering and remaining in your mind. Writing down and analyzing your depressed thoughts is a very important part of the cure.
The first step in every tactic is to observe your thoughts closely when you are depressed, analyze which negative self- comparisons you are making, and write them down if you can make yourself do so. Later, when you have learned how to keep depression at bay, an important part of your continuing exercise will be to identify each negative self-comparison before it gets a firm foothold, and pitch it out of your mind.
You may have to straighten out some misapprehensions or confusions that customarily depress you. You may need to re- think your priorities. It may even help to search your memory for some childhood experiences. Perhaps hardest of all, you may have to study how you misuse language, and how you fall into linguistic traps.
One may seek the help of a counselor or choose to tackle depression by yourself. Self-cure certainly is feasible. The simple fact is that all of us, all the time, make and carry out decisions about how our minds will act in the future. We decide to study a book, and we do so. We focus our attention on doing this or that, and we do it. We are not beyond our own control.
The help of a counselor clearly can be valuable. But finding a counselor who meets your needs is not easy. Depression is a profoundly philosophical disease. A person's most basic values enter into depressive thinking. On the one hand, values can cause depression when they set up over-demanding and inappropriate goals, and therefore a troublesome denominator in a Rotten Mood Ratio. On the other hand, values can help overcome depression. Helping you deal with such issues requires a depth of wisdom which is not learned in school, and which is too seldom in any of us. But without such wisdom, a therapist is useless or worse
Depression is also a philosophical matter when it arises from disorder of logical thinking and misuse of linguistic
Self-comparisons Analysis makes clear that many sorts of influences, perhaps in combination with each other, can produce persistent sadness. From this it follows that many sorts of interventions may be of help to a depression sufferer. That is, different causes--and there are many different causes, as most psychiatrists have finally concluded, call for different therapeutic interventions. Furthermore, there may be several sorts of intervention that can help any particular depression. Yet all these interventions may be traced to the "common pathway" of negative self-comparisons.
Self-comparisons Analysis points a depression sufferer toward whichever is the most promising tactic to banish the depression. It focuses on understanding why you make negative self-comparisons, and then develops ways of preventing the neg- comps, rather than focusing on merely understanding and reliving the past, or on simply changing contemporary habits. With this understanding you can choose how best to fight your own depression and achieve happiness.
next: Good Mood: The New Psychology of Overcoming Depression Chapter 18
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Excerpted from Saving Graces: Finding Solace and Strength from Friends and Strangers by Elizabeth Edwards Copyright © 2006 by Elizabeth Edwards. Excerpted by permission of Broadway, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher 
Deciding which medicine to use to treat your child with ADHD used to be easy. The big choice was whether to use generic or brand name 
Impotence or erectile dysfunction (ED)
Conference workshops included "Zaftig Women in a Barbie Doll Culture," "Chopped Liver and Chicken Soup: Soothing Food for the Traumatized Soul" and "Bagel Politics: Jewish Women, American Culture and Jewish Culture."