Addressing Despair Through CBT Part 2
I tried to get up, but anguish reacquainted my face with the ground. My thoughts echoed in my head, prodding me on as if I were a mindless herd animal, "You need to get off the floor. There is too much to do." But I felt paralyzed. Streams of images trickled through my mind: the faint outline of a yellow bottle of methotrexate, a syringe slowly withdrawing the enzyme inhibiting substance, my hand shaking as I pinched my leg, the thought of no more biking, skiing, and acrobatics, the shock of collapsing from weakness and pain while trying to shovel snow, my voice screaming in rage at the sky, "I can't live like this! I hate this!"
There are certain thinking patterns I am prone to while living with RA that can get me stuck in a sinkhole of sorrow. As I discussed in the first installment of this series, I have found that at times I make incomplete or biased appraisals of my life, and that when I resolve these it bolsters my mental health. In addition to resolving misleading evaluations, there is another aspect of CBT I find very helpful in dealing with downward spirals. Certain thoughts pop into my head as if by reflex. Many of these thoughts are negative, black-and-white, statements like "always" and "never," or strong judgments made in the heat of the moment. In Cognitive Behavioral Therapy, these instantaneous thinking patterns are referred to as "automatic thoughts." These automatic thoughts tend to be about others, the past, the future, RA, or myself.
One of the aims of CBT I find helpful is to reframe these automatic thoughts in a more complete and accurate manner. To demonstrate what it looks like in application, below is a table with some of my automatic thoughts on the left, and a reframing of them on the right.
Automatic thoughts about RA:
Reframed thoughts about RA:
- “I will always be in pain.”
- “It will never get better.”
- “I hate living like this.”
- “I am often in pain. Some days are worse than others.”
- “It is hard right now.”
- “Life with RA can be brutal at times.”
Automatic thoughts about myself:
Reframed thoughts about myself:
- “I am weak.”
- “I am no good at this.”
- “I am proud of what I can do while living with RA.”
- “I do the best I can with what I’ve got.”
Automatic thoughts about others:
Reframed thoughts about others:
- “They are so stupid!”
- “Their life is so easy!”
- “They don’t get it!”
- “They probably don’t know why that was offensive.”
- “I wonder what they go through that I never see?”
- “There are a lot of misconceptions about RA.”
Automatic thoughts about the past:
Reframed thought about the past:
- “Things used to be so much better.”
- “If only I had been stronger.”
- “I have always felt alone.”
- “The past was both good and bad, though things are harder right now.”
- “I did the best I could with what I knew.”
- “Life has been very lonely at times. Not everyone understands me, but a few do.”
Automatic thoughts about the future:
Reframed thoughts about the future:
- “This is never going to change.”
- ”It is only going to get worse.”
- “It has been hard for a long time.”
- “I don’t know how long this will last, or how bad it will be, but I hope it gets better.”
The feeling of reading the automatic thoughts on the left is quite sad. Life seems impossible, the future appears dreadful, and other people seem like my enemy. I don't appear to like myself very much, and RA feels like a prison sentence. The feeling of reading the reframed thoughts on the right is more kind, composed, and judicious. RA feels very difficult, but not hopeless. Others are not my enemies, but complicated people who I come into misunderstanding with. The future remains uncertain, and the past is seen more realistically and with acceptance.
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