Don't Let Depression Attack You – David D. Burns - Sadness is Not Depression

"Dr. Burns, you seem to be asserting that misthinking is the sole cause of depression. But what if my difficulties are real?" This is the question I most often ask when I lecture on cognitive therapy. Many patients ask this question at the beginning of therapy and list a series of "real" problems that they say are the cause of "factual depression." The most common problems are:

– bankruptcy or poverty

- Old age

– Body defects

– terminal illness

The pain of losing someone you love

I'm sure the list is long. However, none of these problems lead to "factual depression."

The real problem is how to draw the line between appropriate and inappropriate negative emotions. What is the difference between "healthy sadness" and depression?

Very simple. Depression or sadness will arise after loss or failure in the process of striving to achieve something important. However, sadness is the flow of emotions and, therefore, it is short-lived. Sadness doesn't make you lose your self-esteem. Meanwhile, depression tends to be persistent and repetitive, and always causes you to lose self-esteem.

The cause of depression is negative and misleading thinking.

Your emotions depend on the very meaning you ascribe to the negative event that happened, and the suffering stems from distortions in thinking. When you suppress those false thinking, you'll find that facing the "real problem" is much less painful.

Let's see how effective this is when the problem is related to a serious disease, a malignant tumor, for example. Some of the easiest bouts of depression to deal with are those of someone facing death. Do you know why? These courageous people are often "transcendent warriors." They are often willing to do anything to help themselves. Let's go into detail and you can make your own assessment.

Loss in life. In her mid-40s, Naomi received a report from her doctor that a "black dot" appeared in an X-ray of her chest. She was the type of person who was convinced that going to the doctor was a way to get into trouble, so she delayed getting the test results for months. When she received the results, her worst suspicions were tested. A painful needle biopsy confirmed the presence of malignant cells, and a subsequent lung biopsy revealed that the cancer had metastasized.

The news stunned Naomi and her family. As the months passed, she became more and more depressed about her increasingly weakened condition. Why? The course of her illness or chemotherapy didn't make her physically uncomfortable, but she was upset because her frail condition forced her to give up daily activities that meant a lot to her self-esteem. She couldn't afford housework (her husband now had to shoulder almost everything in the house), and she had to quit two part-time jobs, one of which was volunteering to read books for the visually impaired.

You can assert, "Naomi's problems are real. Your misfortune is not caused by wrong thinking, but by circumstances."

But was her sadness so hard to overcome? I asked Naomi why not being able to function as before made her so depressed, and she wrote down the following negative perceptions: (1) I don't contribute to society; (2) I am not completing my work; (3) I cannot engage in active fun activities; and (4) I am a burden and clinging to my husband. The emotions that accompany these thoughts are: anger, sadness, frustration, and guilt.

When I read what she wrote, a gleam of joy flashed in my heart! These thoughts are no different from the thoughts that depressed patients with healthy bodies I come into contact with on a daily basis. Naomi's depression stemmed not from melanoma, but from her attitude of performance as a measure of her self-worth. Because she equates her self-worth with her accomplishments, cancer means — "You're down! You're about to be thrown aside!" Then I can help you.


Brother David,

This is a very belated but extremely important "postscript" to the previous letter I sent. That is: His simple "charts" of performance that had nothing to do with my worth or self-esteem actually saved me, a power pill that I used so generously! It really made me a psychologist without a PhD. I've found out that it works with a lot of things that annoy us. I've tried applying this idea to a few friends. Stephanie was treated poorly by the secretary of her children's age; Sue is constantly upset over her 14-year-old twin children; Becky's husband had just run away from home... I told all of them, "yes, but our self-worth is UNCHANGING, and the rubbish that life throws at us doesn't diminish who we are."

Again, thank you.



Six months later, she died in pain but full of self-respect.

Limb defects.

People with disabilities — or their families — assume that old age or physical disabilities diminish their ability to enjoy life. Friends tend to express sympathy because they think this is a legitimate response. However, the problem seems quite the opposite. Distressed moods often stem from distorted thinking rather than from a flawed body.

When the person with the disability or their family members learn to think properly, then their spiritual life will be bright and complete.

For example, Fran is a 35-year-old woman, married and with two children.

She began to show symptoms of depression when her husband's right leg became paralyzed due to an incurable spinal injury. For 6 years, she managed to free herself from miserable despair with various antidepressants and electroshock therapy. But it didn't help. When she reached out to me, she was in a deep depression, and she felt that her problems were incurable.

She cried as she described her frustration trying to manage with her paralyzed husband: "Every time I see other couples doing things we can't do, I shed tears. I watched those couples go for a walk together, jump into the pool or into the ocean together, ride bikes together, and I was heartbroken. It was hard for John and I to do those things. They do it as if it's an obvious normal thing, just like we used to. If only we could do those things now, how great it would be. But you know, I know, and John also knows that it's impossible."

Initially, I also felt that Fran's difficulties were well-founded. At the end of the day, they can't do much that most of us can. The same goes for older people, as well as those who are deaf or visually impaired, or those who have amputated limbs.

In fact, considering this, we all have our own limits. Aren't we all miserable, then? Eventually, I discovered that the cause of Fran's unnecessary misery lay in her refinement mindset. Fran was just focused on every activity she couldn't perform. Meanwhile, there are many things that she and John are capable of or able to do together, but she doesn't realize it. No wonder she felt that life was empty and gloomy.

After all, the solution is simple. I suggested to Fran this: "In your spare time at home, write a list of things you and John can do together. Instead of focusing on the things you and John can't do together, learn to focus on the things you can do. For example, I myself would love to go to the moon, but since I'm not an astronaut, I'll almost never get that chance.

Now, if I focus on the fact that I will never get to go to the moon because of my age and expertise, I will make myself extremely depressed. On the other hand, there's a lot I can do, and if I focus on those things, I won't get frustrated. What can you and John do together now?"

FRAN: Well, we still love spending time together. We went out to dinner together and were good friends.

DAVID: yes. What else?

FRAN: We ride horses together, play cards, watch movies, play cars. He taught me to drive...

DAVID: You see, in less than 30 seconds you have listed 5 things that you two can do together. If I give you time between now and the next time to write this list, how much more do you think you can write?

FRAN: That's quite a lot. I can think of things that we've never thought of, something quite new like freestyle skydiving.

DAVID: That's right. She could even come up with other adventurous ideas. Remember that she and John could do a lot of things that she thought they couldn't. For example, she told me that neither of them could go to the beach. She mentioned that she loves to swim. You could go to a beach that was a little empty, so you wouldn't feel too guilty, would you? If I was on the beach and you and John were there, his physical disability wouldn't make any difference. In fact, I recently went to a nice beach in California with my wife and her family. We accidentally went to a nude beach, and all the young people there were wearing nothing. Of course I don't really look at any of them, I want you to understand this! But despite this, I noticed a young man whose right leg was amputated from the knee down, and he was still there frolicking with the others. So I'm not entirely suggesting we can't go to the beach and have fun there just because we lost our arms and legs. What do you think?

Some people will laugh at seeing such a "real and difficult" problem solved so easily, or that an intractable depression like Fran's can be easily turned around with such a simple intervention. By the end of the treatment, Fran said the discomfort had completely disappeared and that now was the happiest time she had in years. In order to maintain that improvement, over time she definitely needs to constantly make efforts to break her thinking habits, in order to change her vice of weaving a tangled web in her mind and getting stuck in it.


Many people have a mental breakdown when their career changes or loses their livelihood, because according to them, one's self-worth as well as one's ability to be happy are directly related to the level of career success. According to this value system, depression is inevitably associated with financial loss, career failure, or bankruptcy.

If you're in that situation, then I think you'll want to meet Hal. Hal is 45 years old, a father of 3. He worked with his father-in-law for 17 years in a thriving trading company. Three years before he was referred to me for treatment, Hal and his father-in-law had a series of conflicts over how to manage the company.

In anger, Hal resigned. Three years later, he switched jobs repeatedly but still hadn't found a satisfactory job. He can't seem to succeed at anything and starts to see himself as a failure. His wife has to work full-time to cover expenses, and this makes Hal feel even more offended because he has always prided himself on being the main breadwinner in the family. As the years passed, his financial situation worsened, and his depression worsened as his self-esteem hit rock bottom.

I first met Hal when he was working on a three-month internship at a real estate company.

He has leased a few buildings but has yet to sell any.

Since his income only comes from commissions, the amount of money he earns during this starting period is quite low. He wilted in depression and procrastinated. He used to lie in bed all day thinking, "What's the use? I'm a failure. Going to work doesn't help. Just lying in bed like this is less miserable."

Hal volunteered for psychiatrist interns in our training program at the University of Pennsylvania to observe one of Hal's psychotherapy sessions through a one-way mirror. During this session, Hal recounted the conversation in the dressing room of the club he joined. A well-off friend told Hal that he wanted to buy a particular building. You might expect Hal to jump with joy when he learns this, as the commission from such a deal will provide a much-needed boost to his career, his confidence, as well as his bank account.

But instead of moving forward to close the deal, Hal procrastinated for several weeks. Why? Because he thinks like this, "Transacting a commercial property is too complicated. I've never done this before. Anyway, he would have pulled out at the last minute. That means I can't stay in this industry, which means I'm a failure."

I then evaluated that session along with the intern doctors. I wanted to know what they thought of Hal's pessimistic, self-defeating attitude. They feel that Hal has a gift for sales, but he makes it unreasonably difficult for himself. I made this comment at the next treatment session. Hal admits he is more himself than on anyone else. For example, if one of his associates missed a big contract, he would simply say, "It's not the end of the world, let's get excited." But if it happened to himself, he would tell himself, "I'm a failure." Basically, Hal admits he is applying "double standards" — being generous and sympathetic towards others but being harsh and critical with himself. Maybe you have that tendency too. At first, Hal countered that double standard by arguing that it was useful to him:

HAL: Well, first of all, my part of responsibility and interest in others is not the same as my part of responsibility for myself.

DAVID: All right. Let's be clearer.

HAL: If they don't succeed, it won't threaten my life, it won't cause any negative feelings for my family. So the only reason I care about them is because it's good for everyone to succeed, but...

DAVID: Wait, wait! You care about them because it would be good if they succeeded?

HAL: yes. I said...

DAVID: The standard you apply to them is the one that you think will help them succeed?

HAL: That's right.

DAVID: And is the standard that you apply to yourself what will help you succeed? What do you feel when you say, "Missing a trade proves I'm a failure"?

HAL: Depressed.

DAVID: Does that help?

HAL: Well, it didn't produce any positive results, so it probably didn't help.

DAVID: So is it realistic to say, "Missing a deal proves I'm a failure"?

HAL: Not really.

DAVID: So why do you apply this "eat all, fall to zero" standard for yourself? Why did he apply useful and realistic norms to those around him, whom he cared little about; While you impose a miserable norm on yourself, someone you really care about?

Hal begins to understand that living by double standards doesn't help him. He judged himself by strict criteria that he never applied to anyone else. He initially defended this approach — as perfectionists often do — by asserting that being more rigorous with himself than others would help him to some extent. However, he quickly acknowledged the fact that his personal standards were completely unrealistic, causing him to set himself up for failure, because if he tried to sell that building and didn't succeed, then he would view it as a disaster. The mindset of "eat all, fall to zero" is the cause of the fear that paralyzes him, unable to keep trying. As a result, he spent most of his time lying in bed whining.

Hal asked me to give him some specific guidance on what he could do to break the perfectionist double standards, so that he could judge everyone, including himself, by an objective standard. I suggested that in the first step, Hal could use automated thoughts and logical feedback techniques. For example, if you're wandering around at home, you might think, "If I don't get to work early, spend all day there, and get things done, there's no point in making an effort. I'd rather stay in bed." After writing that, respond reasonably, "This is just a 'eat all, fall to zero' kind of mindset, and it's. Even if I go to work for half a day, it's an important step that can help me feel better."

Hal agrees that before his next round of therapy, he will write down some thoughts that depressed him at times when he felt worthless and failed. (See Table 9-2) Two days later, he received a dismissal notice from the company, and he went to therapy, convinced that his self-critical thoughts were completely valid and valid. He hadn't been able to think of any reasonable response. The other announcement implied that he was fired for frequently failing to show up. During the session, we discussed how he could counter his self-critical arguments.

Figure 9-2 . Hal's homework: acknowledging and countering self-critical thinking. He wrote down Reasonable Responses during the treatment session.
Negative thoughts (SELF-CRITICISM) Rational feedback (SELF-DEFENSE)
1. I'm a lazy person. 1. I've been working hard for most of my life.
2. I like to be miserable like that. 2. It's not fun.
3. I'm incompetent. I'm a failure. 3. I've had some success. I have a happy home. My wife and I raised 3 wonderful children. Others admire and respect us. I also participate in community activities.
4. Lying around all day expresses your true self. 4. I'm sick, but lying around all day isn't my "real self."
5. I could have done more. 5. At least I've done more than most people. It doesn't make sense to say, "I could have done more" because everyone can say that.

In the end, Hal admits that the symptoms he is experiencing—boredom and procrastination—are merely a manifestation of a temporary illness, rather than a manifestation of his "true self."

At the end of treatment, the Beck Depression Scale showed that Hal had improved by 50%. The following weeks he continued to prop himself up by using the method of drawing 2 parallel columns. As he learned to criticize negative thoughts, he judged himself less harshly in a misleading way, and felt more elated.

Hal left the real estate company and opened a bookstore. He reached breakeven; However, despite his great efforts, he was still not profitable enough to continue the business after the first year of testing.

As a result, his external achievement scores did not change significantly during this time. Despite this, Hal remains confident. The day he decided to close the bookstore, his financial situation was still pathetic, but his self-esteem did not suffer. He wrote a short post to read every morning while looking for a new job:

Why am I not worthless?

As long as I contribute to the well-being of myself and others, I am not worthless.

As long as I'm making a positive impact, I'm not worthless.

When my existence makes a difference to even one person, then I am not worthless (and this person can be myself, if need be).

If giving love, sympathy, friendship, encouragement, friendliness, advice, comfort still matters, then I am not worthless.

If I can respect my opinions and intellect, then I am not worthless. If the people around me respect me too, that's a plus.

If I retain my self-esteem and dignity, then I am not worthless.

If contributing to the livelihood of my employees' families, then I am not worthless.

If I do my best to help clients and partners with creativity and efficiency, then I am not worthless.

If my presence in this situation makes a difference to those around me, then I am not worthless.

I'm not worthless. I'm worth it immensely!

Loss of loved ones.

One of the most severe cases of depression I've ever treated before was Kay, a 31-year-old pediatrician whose brother killed herself in a very gruesome way outside her apartment 6 weeks earlier. The most painful thing for Kay is that she feels responsible for her brother's death, and the argument she uses to support this view is quite convincing. Kay felt she had to deal with an overwhelming problem, completely real and unsolvable. She felt she deserved to die and had attempted suicide by the time she was brought to me.

She felt that her life was better than her brother's, so she did her best to compensate him by providing emotional and financial support during his depression. She arranged psychotherapy for her brother, paid for his expenses, and even found him an apartment near her so he could call her anytime.

Her younger brother was a physiology student in Philadelphia. On the day of his suicide, he called Kay to ask about the effects of carbon monoxide on his blood in preparation for the discussion he would be doing in class. Since Kay was a hematologist, she assumed the question was normal and answered it without thinking. She didn't talk to him for long because she was preparing an important presentation the next morning at the hospital where she was working. He used the information he had obtained from her to commit his fourth and final suicide attempt just outside her apartment window, while she was preparing her presentation. Kay claimed responsibility for her brother's death.

During her first treatment sessions, she listed why she blamed herself and why she believed she was the one who deserved to die: "I have to take responsibility for my brother's life. I failed at that, so I felt responsible for her death. I should have known that she was in a difficult situation. She's had three failed suicide attempts. If only I had questioned her when she called me, I would have saved her. I got angry with her several times that month, and to be honest, at one point she became my burden and a boredom. I remember once finding her annoying and telling myself that maybe she should die. I feel downright guilty for this thought. Maybe I wanted her dead! I knew I had let her down, so I felt like I deserved to die."

Kay believes her guilt and pain are appropriate and authentic. She felt she deserved that punishment and torment. I knew that something wasn't right in her interpretation, but I wasn't able to see through her faulty reasoning during the first few sessions, because she was an intelligent and persuasive person, and she had created a solid rationale against herself. I had almost begun to believe that her mental anguish was justified. Then I realized her mistake was her individualized mindset.

In the 5th round of treatment, I used this knowledge to change Kay's misconception. First, I insisted that if she was responsible for her brother's death, then she had to be the cause of it. Because the cause of suicide has not yet been found, even with expert intervention, there is no reason to conclude that she was the cause.

I told her that if I guessed the cause of suicide, it was because he believed he was worthless and unworthy of living. It was his mistake, not hers.

I emphasized that she was responsible for her own life and happiness. At this point, she could think that she was acting irresponsibly, not because she had "let her brother down" but because she was letting herself be melancholy and suicidal. The responsibility she should take on is to let go of her guilt and end her depression, and then live a fulfilling life. This is responsible action.

We pointed out misperceptions that made her want to take her own life. After that, she decided to continue therapy for a while to improve her quality of life.

Sadness does not carry suffering.

So there's the question: What is the nature of "healthy sadness" when it's not affected by misguided thinking? In other words, does sadness necessarily accompany suffering?

Since I can't claim to know the exact answer to this problem, I share an experience I had as a less confident medical student. I was practicing in the urology department of Stanford University Medical Center in California at the time. I was assigned to take care of an elderly man who had just had surgery to remove a tumor in his kidney. Medics predicted he would be discharged soon, but his liver function suddenly declined, and they discovered that the tumor had spread to the liver and could not be treated, and his health deteriorated rapidly within days. As his liver function worsened, he gradually became weak and tended to fall into an unconscious state. His wife sat beside him day and night for more than 48 hours. When she was tired, she put her head on his bed, but never left. At one point she stroked his head and said, "You're my man, I love you."

In the afternoon, the person in charge asked me to stay with the sick person and monitor the situation. When I entered the room, I realized he was about to fall into a coma. There were 8 or 10 of his relatives there, some elderly and others very young. One of his sons realized that his respected elderly father was nearing his last moment and asked if I would be willing to remove the urinary catheter inserted into his bladder. Removing the urinary catheter would let his family know that he was leaving, so I went to ask the nurse if it was appropriate. The nurse told me it was appropriate, because he was really leaving. When I removed his urinary catheter, his relatives knew that medical help was gone, and the son said, "Thank you. I know that tube makes my dad feel uncomfortable, and he'll appreciate what you just did."

I felt a surge of sadness. I felt close to this kind and courteous man because he reminded me of my grandfather, and I had tears in my eyes. I had to decide if I was going to stand there and let his family see me cry, or if I was going to leave and try to hide my feelings. I chose to stay and told them with all sincerity, "He's a great person. He can still hear people, even though he's almost in a coma, and tonight is the time for us to be with him and say goodbye to him." Then I left the room and cried. Family members also cried and sat around his hospital bed, chatting with him and saying goodbye. Within an hour, he was in a deep coma until he lost consciousness and died.

Although his family, and myself, are saddened by his passing, this experience has a bright spot that I will never forget. The loss and tears reminded me — "We know how to love. We care." In my opinion, this makes sadness a precious experience and there is absolutely no pain or suffering. Since then, I've had so many similar experiences that brought tears to my eyes. For me, that sadness represents an upliftment, an experience of ultimate greatness.

The dean told me that the patient's family had asked him to thank me for being there, making his last moment beautiful and loving. He told me that he loved the old man too and showed me the picture of the horse hanging on the wall that the old man had painted.

This experience gave me a sense of peace and warmth, as well as enriched my life capital.


When the depression wears off, you'll want to enjoy life and relax. Of course you have the right to do so. At the end of the session, many patients tell me that it was their happiest time ever. It may seem that the more hopeless, severe and intractable your depression may be, the higher your feelings of joy and self-esteem will be. When you start to feel better, pessimistic thoughts will recede quickly, like melting snow and ice when spring arrives. This complete spiritual transformation has never ceased to amaze me. Time and time again, I have always had the opportunity to observe this miraculous transformation in my daily life.

Because your outlook on life can change radically, you'll be confident that your melancholy is gone forever. But there is still an invisible vestige of emotional disorder. If you don't correct and erase this, you'll be more likely to be attacked by depression in the future.

There are several differences between feeling happy and being cheerful.

Feeling happy only indicates that the symptoms that made you miserable have temporarily disappeared. Being cheerful means:

1. You understand why you are depressed.

2. Know why and how to be happier.

This includes mastering a few self-development skills that are suitable for use when needed.

3. Gain confidence and self-esteem.

Confidence comes from knowing that you are capable of some degree of success in your personal and professional relationships. Self-esteem is the ability to love and be satisfied with yourself at any stage of life, whether you succeed or not.

4. Identify the root cause of your depression.

Although your negative thinking will be significantly reduced or completely eliminated after you overcome depression, there are still some "hidden defaults" still lurking somewhere in your mind. These implicit defaults help explain most of the reasons for your depression and can help you predict when you might be attacked again.

What is implicit default? The implicit default is an equation that you use to determine your self-worth. It represents your value system and philosophy of life, which are fundamental to your self-esteem.

For example: (1) "If someone criticizes me, I feel miserable because obviously this means I did something wrong." (2) "I must be loved in order for me to be a fully human being. If I had to be lonely, I would be miserable and alone." (3) "My human worth is directly proportional to my achievements." (4) "If I don't express (or feel or act) perfectly, then I fail." You'll learn that these irrational defaults can knock you down, or put you in a mood swing. That's your psychological Achilles heel.

In this chapter, you will learn two methods of defining implicit defaults. The first is the "vertical arrow" method; This method helps you probe internally by writing down negative thoughts automatically in the left column and replacing them with reasonable, more objective responses. This will make you feel more comfortable because it breaks your wrong mindset.

Table 10-1 below is a simplified example that Dr. Art, the psychiatric intern mentioned, gives. He wanted to know why he had understood things so absurdly before.

Group 10-1
Automatic thinking Reasonable response
Dr. B said that the patient felt his comments hurt him. He must have thought he was a bad doctor. Mind reading; screening thinking; labeling. Just because Dr. B points out his mistakes doesn't mean he thinks he's a "bad doctor." I should have asked him what he really thought, but on many other occasions, he complimented him and said he was talented.

Art used the vertical arrow method to solve this problem.

First, just below his automatic thinking, he draws a short arrow pointing down (See Table 10-2). The downward arrow tells Art to ask himself, "If this automatic thinking is true, then what does it mean? Why does it make me sad?" Then Art writes the next automatic line of thought that comes to mind. As you can see, he wrote, "If Dr. B thinks I'm a bad doctor, that means I'm a bad doctor because Dr. B is an expert in the field." Next, Art draws the second downward arrow just below this thought and repeats the process, creating another automatic thought. Every time he had a new automatic thought, he immediately drew a vertical arrow just below it and wondered, "If this is true, then why does it make me sad?" In doing so continuously, he creates a chain of thoughts automatically, leading to implicit defaults that set the stage for his problems. The vertical arrow method is similar to the process of peeling off the skins of the onion in turn to reveal the inner layers. This method is actually quite simple and straight to the point, as you can see in Table 10-2.

Table 10-2. Use the vertical arrow method to bring up implicit defaults that lead to automatic thoughts. The downward arrow is a kind of shorthand for the question: "If that thought is true, why does it make me sad? What does it mean to me?" Each downward arrow represents a question, and that question is written in quotation marks next to the arrow. This process creates an automatic sequence of thoughts that help you get to the root of the problem.
Automatic thinking Reasonable response
1. Dr. B thinks he's a bad doctor.


"If he really thinks that, why does this upset me?"

2. That means I'm a bad doctor, because he's an expert.


"Let's just say I'm a bad doctor, so what does this mean to me?"

3. It means you're a failure and nothing good.


"Let's just say I don't have anything good. So what is the reason why this is a problem for me? What does that mean?"

4. Then the bad reputation will spread and people will know how bad they are. After that, no one will respect me anymore. I'm going to be removed from medicine.


"And what does that mean?"

5. It means that we are useless.


I'm going to feel so miserable that I want to die.

You'll notice that the vertical arrow method is the opposite of the method you're used to jotting down automatic thoughts.

Often you write down reasonable feedback to show that your automatic thinking is misleading and irrational (Table 10-1). This helps you change your current mindset to look at life more objectively and feel happier. With this vertical arrow method, you imagine that your automatic thoughts are completely rational, and you go looking for the truth in them. This helps you understand the core of the problem.

Now, take a look at Art's automatic sequence of thoughts in Table 10-2 and ask yourself – what are the implicit defaults that make you anxious, guilty, and sad? Here are a few examples:

1. If someone criticizes us, they must be right.

2. My self-worth is based on my achievements.

3. Just one mistake can ruin everything. If we're not successful all the time, then we're a well-rounded zero.

4. Others will not accept their imperfections. I have to be perfect for people to respect and like me. When we fail, we face strong opposition and punishment.

5. This objection means that we are terrible and worthless.

Once you've completed the automatic thought sequence and outlined implicit defaults, it's important that you identify misperceptions in them, as well as write down reasonable responses as you normally would (see Table 10-3).

Table 10-3. Having mapped out the automatic sequence of thoughts using the vertical arrow method, Art identifies misperceptions and replaces them with more objective responses.
Automatic thinking Reasonable response












1. Dr. B thinks he's a bad doctor.
"If he really thinks that, why does this upset me?"
1. Just because Dr. B talks about his mistakes doesn't mean that he thinks he's a "bad doctor." I have to ask him what he really thinks, because there are many times when he has complimented me and said that I have talent.
2. It means that he is a bad doctor, because he is an expert.
"Let's just say I'm a bad doctor, so what does this mean to me?"
2. An expert can only point out his strengths and weaknesses as a doctor. Anyone who at any time says they are a "bad" person is just speaking uselessly and not constructively. I've treated many cases, so no matter what anyone says, I'm not "bad."
3. It means you're a failure and nothing good.
"Let's just say I don't have anything good. So what is the reason why this is a problem for me? What does that mean?"
3. Overgeneralization.
Even if we're an immature and ineffective doctor, that doesn't mean we're a "miserable failure" or "nothing good." I have many other desirable strengths and qualities besides my expertise.
4. Then the bad reputation will spread and people will know how bad they are. After that, no one will respect me anymore. I'm going to be kicked out of medicine.
"And what does that mean?"
4. This is silly. If we make a mistake, we can correct it. "Bad reputation" won't spread far just because I make a mistake! What would people do, post with the headline: "MISTAKE OF A FAMOUS DOCTOR"?
5. It means that we are useless.
I'm going to feel so miserable that I want to die.
5. Even if everyone in the world does not recognize us or criticize us, this does not make us useless because we are not worthless. If we're not worthless, we must have our own worth. So why should we feel miserable?

The beauty of the vertical arrow method is this: Through the process of self-inquiry, you will find beliefs that destroy you. You dig to the root of the problems you are facing to understand the core of the problem objectively and systematically.

When you apply the vertical arrow method, don't write down thoughts that describe your emotional reaction. Instead, write down the negative thoughts that led to that emotional response. Here's an example of how to misapply

First Automatic Thought:

My lover didn't call me on the weekend as promised.

"Why am I upset about that? What does that mean to me?"

Second automatic thought:

Oh, this is horrible because I can't stand it.

This sentence is useless. It's about what you think, not how you feel about the situation that upsets you. If he doesn't care about you, what does that mean to you?

Here's how to apply it correctly:

1. Your partner doesn't call you on weekends as promised.

"Why am I upset about that? What does that mean to me?"

2. It means that he neglects me and doesn't really love me.