Depression debilitates

It saps your energy, erodes your confidence and leaves you in a mental haze that makes it impossible to do the things you once took for granted. You become a prisoner to your racing thoughts and lose interest in the people and activities that used to satisfy you. It’s hard to pick up one foot and put it in front of the other. Just getting out of bed can be overwhelming. Taking a shower and going to work can become impossible. Even mindless TV doesn’t hold your interest. The thoughts just won’t let you go. You beat yourself up for not being able to do the things you once did with ease. You ruminate about conversations that happened decades ago and what you should have said. You can’t let go of the question, “what if this never ends?” Life just doesn’t seem worth living.

Recurrence and Negative Thoughts

The worst of the depression will pass eventually but residual symptoms may remain and there’s always the fear that it will recur. One study estimates 70-75% of patients have one or more residual symptoms after the depression subsides.

The American Psychiatric Association (2000) reports 50% of those who recover from a first episode of depression have one or more additional episodes in their lifetime and approximately 80% of those with a history of two episodes have another recurrence.

Negative thought patterns are part of the problem. People have anywhere from 25,000 to 50,000 thoughts a day. Antidepressants reduce the uptake of serotonin; they don’t change your thought patterns when the medication is withdrawn. If your thoughts are predominantly negative, you are generating thousands of negative thoughts a day. And there is a growing body of evidence that these ruminative negative thoughts perpetuate the residual symptoms and lead to recurrence of depression.

Most depressed people are not aware that the despair and hopelessness they feel flow from their negative thoughts. Thoughts are mistakenly seen as “just who I am,” immune to efforts to change them, representing some immutable truth. You aren’t even aware of your negative thoughts, much less that you have a choice about what and how you think.

That’s not to say it is easy to change your negative thoughts of “what if?” and “why?” Negative thoughts are generally grounded in the future and past.

Ruminating on Negative Thoughts

Everyone has negative thoughts some of the time. In depression, the content of your thoughts is predominantly negative and you ruminate, that is, you compulsively focus your attention on the symptoms of your distress, and on its possible causes and consequences, as opposed to its solutions. You may:

• Assume or expect the worst

• Try to control every possible outcome rather than accepting what is

• Expect certainty, refusing to accept uncertainty

• Judge yourself, others, your life experiences

• Judge your judging

• Label (e.g., “I am stupid”)

• Rehash old events and conversations

• Focus on blaming, justifying, explaining, defending, arguing with yourself

• Over-interpret (e.g., mindreading) or predict the future (crystal ball gazing) 

• Personalize things. “My boss looked at me funny. I must have done something.” 

• “Should” yourself (e.g., I should have …. Why didn’t I?) 

• Perseverate on “all” or “nothing” (e.g., my life is all bad. There’s nothing good about it)

• Focus on the unfairness of life

• Ask “what if?” questions that require crystal ball gazing. “What if I lose my job?” 

• Ask “why?” questions that require mindreading “Why did it happen?

More often than not, ruminative negative thought patterns are rooted in the past or future. In the present moment, you’re alive. The sky is not falling. In spite of the pain, you are surviving. In the present moment, you don’t know what the future will bring and the past is past. The past does not determine the present or future.

All of that said, it’s not easy to change your negative thought patterns or stop ruminating. Willpower may help you get started but it cannot sustain change. You simply can’t “white knuckle” away negative thinking or rumination. In fact, the more you try to willpower away negative thoughts, the more they control you. If I think to myself “I won’t eat that chocolate cake. I won’t eat that chocolate cake. I won’t eat that chocolate cake,” the more you want it, the more likely you are to eat it anyway.

So what works? There are three parts to changing your negative thinking.

Your Thoughts Are Just Thoughts

First, you will need to learn accept that your thoughts are just thoughts. They have no meaning other than the meaning you give to them. You are not the sum of your thoughts. Your thoughts do not define who you are. They are fleeting, here one moment, gone the next. They are neither good nor bad. They are just what they are: thoughts.

Think of your negative thoughts as an urge. You have the urge to overeat. That doesn’t mean you do it. You have a choice about whether to overeat or not. Similarly, you have an urge to think negative thoughts. You have the choice to indulge the urge or not.

Notice Your Negative Thoughts

Second, you will need to learn to notice your thoughts mindfully without judging them (or judging your judging). This takes practice. You may notice the same negative thought five or ten or more times in a 20 minute span. Acknowledge them, saying “oh, a thought?” And then let it pass by as you would watch a passing cloud or water run over rocks in a mountain stream or a train moving through your field of vision to disappear in the distance.

You will measure your progress in small increments, not big leaps, considering frequency (e.g., how often do you catch your urges to think negative thoughts?), duration (e.g., how long does your mind wander before you notice your negative thoughts?) and intensity (e.g., how debilitating are your negative thoughts?).

If you catch yourself -- more often, your wandering mind does not dwell as long on negative thoughts or your negative thoughts are less debilitating -- that is progress, no matter how seemingly small the changes are. It is important to focus on what you have accomplished as opposed to what you have not completed -- noting progress frequently and celebrating rather that minimizing or discounting your progress.

A regular practice of meditation fosters learning to be aware in the present moment. We imagine that meditation requires sitting in the lotus position on the floor. The truth is there is no single “right” way to meditate. Meditation is not about clearing your mind. It is about noticing your thoughts and emotions and bringing your attention back to whatever it is you are focusing on. It is called a practice because it is just that – a practice. There is no such thing as perfection.

Be Curious

Finally, you will need to learn to be curious about your negative thoughts without judging them (or judging your judging). Healthy curiosity crowds out negative thoughts. It is not the same as Pollyannaish positive thinking. It is asking questions, rather than focusing on pat answers. It is accepting uncertainty. It asks “what emotion or belief fuels this negative thought?”

With practice, curiosity will crowd out negative thoughts. Curiosity becomes a habit, unlike willpower that is required indefinitely. Of course, cultivating curiosity is not as easy as changing the channel or replacing a light bulb. It requires practice, noticing your negative thoughts and gently bringing your attention back to curiosity over and over and over again.

The good news is the more you turn your attention to healthy curiosity, the more habitual it becomes, the less intentional effort it takes

What Teachers Say

Many teachers and writers have written about curiosity. Here are three of my favorites:

Seven Attitudes

To summarize, Jon Kabat-Zinn has identified seven foundational attitudes required to notice your negative thoughts (mindful awareness) and crowd them out with curiosity (focusing on questions instead of answers with an attitude of openness, eagerness, and lack of preconceptions).

Acceptance: Coming to terms with things as they are, accepting you think negatively. If you label yourself as stupid, accepting the label while knowing its untruth.

Non-judging: Not getting caught up in your ideas and opinions, avoiding “should” and labeling yourself, others or experiences as good or bad

Beginner’s Mind: Seeing things with fresh eyes, with a clear and uncluttered mind.

Letting Go: Letting our experience be what it is without the need for certainty

Trust: Trusting in your intuition and your own authority. Honoring your trust.

On-striving: Trying less and being more. Using curiosity to crowd out negative thoughts, rather than trying to sustain willpower

Patience: Letting change unfold in its own time, practicing, accepting progress in baby steps

Learn More

To find out more about changing your negative thoughts to improve depression, read about evidence based Mindfulness-Based Cognitive Therapy for Depression. You can read about it in Scientific American or the American Psychological Association or for more in depth coverage The Mindful Way Through Depression.

Sandra Miller, MSW, LCSW and sometimes blogger, is one of five therapists who see clients at St. Louis DBT, LLC. Learn more about St. Louis DBT.