May 11, 2003 Chapter 3: Feeling Better By Changing the Way You Talk to Yourself -“I’m going to lose it…I should have done it better…I am so stupid…I feel overwhelmed…Why did I ask him for help? I shouldn’t have…I am so inadequate…I feel overwhelmed…I should have cleaned the house instead of going out…I am so irresponsible…I feel overwhelmed…I should have put the kids’ lunch together last night…I’m a terrible mom…I feel like I can’t make it…I feel like I’m going crazy” The above quotes are a sampling of the phrases one of our clients recorded in a one-week period on a selfmonitoring form—as part of an ongoing homework assignment. These phrases were all either thoughts that crossed her mind or words that came out of her mouth. How much do you know about this woman? In one sentence, what do you know about this woman? _____________________________________________________________________________________________ She’s not very happy, is she?…She’s depressed, isn’t she?…She’s stressed out, isn’t she?…Her self-esteem isn’t very high, is it?…She doesn’t think she is capable of solving her problems, does she?…Is she treating herself with respect?…Do you think she “feels” out of control? We would say so. Does she deserve to be talked to this way, even by herself? _____________________________________________________________________________________________ _____________________________________________________________________________________________ We certainly hope you said “No.” No one deserves to be talked to this way! How do you think those words made this woman feel? Not good, obviously. How do you think she would feel if someone else talked to her this way? In fact, how would YOU feel if someone talked to you this way. Let’s see. “You’re going to lose it…You should have done it better…You are so stupid…You’re overwhelmed…Why did you ask him for help? You shouldn’t have…You are so inadequate… You’re overwhelmed…You should have cleaned the house instead of going out…You are so irresponsible…You should have put the kids’ lunch together last night…You’re a terrible mom… You can’t make it…You’re going crazy.” There’s some good news and some bad news here. The bad news is that when you talk negatively to yourself, it has the same negative effect as when other people talk to us this way. The good news is that you—have
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the potential or power to change the way that you talk to yourself. This is very important because recovery from PTSD requires that you treat yourself with the same respect that you would like to get from other people. The woman who wrote the words, which are presented at the beginning of this chapter, is a formerly battered woman who was receiving Cognitive Trauma Therapy for her PTSD. Do you think that the way this woman talked to herself is unusual or highly atypical? Unfortunately, it is not unusual. We hear clients talking to themselves in similar ways all the time—at least we do at the beginning of therapy. It is essential to your health and happiness that you start treating yourself with the same kind of respect that you would like to get—and deserve to get—from other people. The ways that you talk to yourself—the specific words you use when you think and speak—have a great deal to do with the speed with which you are going to recover from the effects of partner abuse as well as any other traumatic experiences you may have had. There are certain words and phrases—if you never use again as long as you live—you will be a happier person. It’s about negative self-talk. Negative self-talk is not good for you! It’s all about the power of non-negative thinking. In fact, non-negative thinking is more important than positive thinking. If you stop talking to yourself with negative words, it will hasten your recovery from PTSD. Sometimes, we say in jest to our clients that, “If we could, we would send you to the local surgeon to do laser surgery to make it impossible for you to say these words or to think these words!” Treating yourself with respect is a form of self-advocacy. We want you to be your own strongest advocate and your own strongest cheering section by not tearing yourself down in any way. When we hear a client tearing herself down or berating herself, we ask her if she would want us (or any therapist for that matter) to treat her with disrespect. For example, we might then say—in paraphrasing what we just heard her say—“You should have left him the first time he hit you. Why were you so co-dependent? Stupid. What a wimp!” Then we might say, “Feel better? I think not! Now, if I’m treating you with respect, and you’re treating yourself with disrespect, we’re working against each other, canceling each other out, and you are not going to benefit from therapy. We have to be on the same page, with both of us treating you with respect.” We have identified four categories of negative self-talk that many battered women with PTSD say and think to themselves all the time. Category 1 includes the word “should,” the phrases “should have” and “could have,” and “Why” questions. Category 2 includes global, shame-related self-putdowns (slam dunks of your entire personality). Like “stupid, dummy, wimp, selfish, there’s something wrong with me, or I have bad judgment.” Category 3 is the most subtle and the most difficult to get a handle on. It includes all “I feel” statements that end
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with words that are not emotions. Like “I feel obligated…I feel overwhelmed…I feel sorry for…I feel responsible.” The problem is that the feelings associated with each of these conclusion are not evidence for the conclusions. However, the feelings associated with the conclusions give the conclusions a false ring of truth, and saying “I feel” in sentences that end with words that are not emotions impairs or interferes with your ability to think clearly. For example, an obligation is not an emotion, and just because a woman “feels obligated” to forgive her abuser and give him another chance does not mean she is obligated to do so. An obligation is a debt we are obligated to repay. If a housekeeping service cleans your house, you are obligated to pay them for services rendered. If you are obligated to give your abuser another chance, doesn’t that mean that he has been doing all the giving and you have been doing all the taking; and now you have to pay him back by giving him another chance? Is that the way it was? The fourth category of self-talk that is not good for you is something we discovered in the course of our treatment-outcome research on the effectiveness of Cognitive Trauma Therapy. Do you apologize very much? ____________________________________________________________________________________________ Many of our clients say they apologize “all the time.” One client said that she even says “I’m sorry” when she bumps into a chair. We will elaborate later on reasons why many battered women with PTSD apologize a great deal—even when there is nothing to apologize for. Do you know what you get that you “like” when you apologize?…How would you feel if you didn’t apologize? Guilty? Anxious? You felt less guilty or less anxious when you apologized, right? What you get that you like when you apologize is relief, and relief from anxiety or guilt is a very powerful reward. In states of pain, people will do almost anything to get relief. We are going to teach you in Chapter 6 that behaviors that lead to relief are usually not good for you and may be contributing to the persistence of your PTSD. To break any habit, you need to increase your awareness of the habit. Awareness precedes change. One way to do this is by carefully observing and documenting the habit when it occurs. Research has shown that “around the clock” self-monitoring can aid in breaking a variety of habits, including negative ruminations (refs). To increase your awareness of your negative self-talk, we are going to teach you a method for keeping track of the four categories of negative self-talk that we described above. Look at the self-monitoring form on the next page. Make several copies of this form because we will want you use these forms to document your negative self-talk, as a way of enabling you to break these habits. It may take several weeks to break some of your “bad” self-talk habits so you will need several blank forms.
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The form is broken into three sections. You can see at the top of the form that there are four categories of negative self-talk that we want you to keep track of. Category 1 includes the phrases “should have,” “could have” and “Why” questions. Category 2 includes put-downs of your entire personality, character, or intelligence. Category 3 includes the use of the phrase, “I feel” in sentence that end with words that are not emotions. Category 4 includes apologies. In the next section of the form, the days of the week are broken into 4-hour blocks. The first time in each time that you catch yourself saying or even just thinking a Category 1 statement in each 4-hour time block, write the number “1” in the day and time block when this habit occurred. For example, if you caught yourself calling yourself a “dummy” at 3 p.m. on Monday, write the number “1” in the noon to 4 p.m. block in the “Monday” column. We only want you to document the occurrence of each category of self-talk the first time that it occurs in each time block. For example, if you catch yourself calling yourself “stupid” at 3:30 p.m. on Monday after you recorded a “1” for yourself calling yourself a “dummy” a half hour earlier, you are not to record another “1” in the noon to 4 p.m. time block. Anyone examining your completed form will not be able to tell whether Category 1 statement occurred only once between noon and 4 p.m. on Monday or whether it occurred many times. The maximum number of symbols you can have written in any 4-hour block is a ‘1,’ a ‘2,’ a ‘3,’ and an ‘S’ (for apologies). This method of recording is simpler and easier to do than if I asked you to record every single occurrence of negative self-talk. In the bottom section of the form, there are spaces for you to write examples of your negative self-talk. The first time each day that you engage in each category of self-talk, write down below exactly what it is you said or said to your self. For example, if you say, “I should have been stronger” on Wednesday at 8:30 a.m. write that phase down after the number “1” (for Category 1) in the Wednesday time block. A completed self-monitoring form is shown on page *. The actual form was completed by a woman receiving Cognitive Trauma Therapy and reflect the woman’s actual responses. Note that there are a maximum of four symbols in any 4-hour time block. For example, the recordings 3, S, 2, and 1 in the 12-4 p.m. time block on Monday indicates that each of the four self-talk categories occurred at least once between noon and 4 p.m. on Monday. Notice that on Saturday the only category self-talk that occurred was at least one instance of saying, “I feel” in statements ending with words that are not emotions. Thus, in the bottom section of the form, the only statement written for Saturday is, “I feel like I’m going crazy.” There is no documentation of negative self-talk on
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Person Observed: _________________________________
Dates: From _______________
To _______________
Phrases of Concern: 1 = “…should…I should have...I could have...Why...?” 2 = Self-Put-Downs of your entire personality or character (e.g., Stupid…I’m inadequate…I’m a wimp, etc.) 3 = “I feel...” statements ending with words that are not emotions (e.g., I feel obligated…overwhelmed…responsible) S = Apologies (i.e., “I’m Sorry) Dates Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
Comments:
8 am – 12 pm 12 pm – 4 pm 4 pm – 8 pm 8 pm – 12 am 12 am – 8 am
Monday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
Tuesday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
Wednesday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
Thursday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
Friday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
Saturday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
Sunday Phrases:
1: __________________________________________________________________________________________ 2: __________________________________________________________________________________________ 3: __________________________________________________________________________________________
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Person Observed: _________________________________
Dates: From _______________
To _______________
Phrases of Concern: 1 = “…should…I should have...I could have...Why...?” 2 = Self-Put-Downs of your entire personality or character (e.g., Stupid…I’m inadequate…I’m a wimp, etc.) 3 = “I feel...” statements ending with words that are not emotions (e.g., I feel obligated…overwhelmed…responsible) S = Apologies (i.e., “I’m Sorry) Dates
7/1
7/2
7/3
7/4
7/5
6/29
6/30
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
8 am – 12 pm
1S3
3S1
132
123
123
12 pm – 4 pm
3S21
253
31S
S31
S12
4 pm – 8 pm
S32
S123
235
231
3S1
8 pm – 12 am
S32
312
321
312
3S21
12 am – 8 am
132
321
321
321
312
Comments:
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1: ___I could have got this ready sooner___________________________________________________________________ Monday Phrases:
2: ___I am going to lose it______________________________________________________________________________ 3: ___I feel overwhelmed.______________________________________________________________________________
Tuesday Phrases:
1: ___I should have done it better________________________________________________________________________ 2: ___I am so stupid___________________________________________________________________________________ 3: ___I feel overwhelmed_______________________________________________________________________________
Wednesday Phrases:
1: ___Why did I ask him for help?________________________________________________________________________ 2: ___I am so inadequate_______________________________________________________________________________ 3: ___I feel overwhelmed_______________________________________________________________________________
Thursday Phrases:
1: ___I should have cleaned house today instead of going out__________________________________________________ 2: ___I’m so irresponsible______________________________________________________________________________ 3: ___I feel overwhelmed_______________________________________________________________________________
Friday Phrases:
1: ___I should have put the kids’ lunch together last night._____________________________________________________ 2: ___I’m a terrible mom._______________________________________________________________________________ 3: ___I feel like I can’t make it.___________________________________________________________________________
Saturday Phrases:
1: __________________________________________________________________________________________________ 2: __________________________________________________________________________________________________ 3: ___I feel like I’m going crazy.__________________________________________________________________________
Sunday Phrases:
1: __________________________________________________________________________________________________ 2: __________________________________________________________________________________________________ 3: __________________________________________________________________________________________________
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Sunday. This could either mean that Sunday was a “good day” and no self-talk occurred or that the woman did not track and document her negative self-talk on Sunday. It is extremely important that you carry this sheet around with you at all times and to write down the numbers immediately when the self-talk occurs. If you wait until later, it defeats the purpose of the exercise. Writing down the numbers is an inconvenience or hassle and may be mildly punishing. But that’s the whole idea. Mild punishment for this behavior may help break the habit. On the other hand, if you do not engage in any negative self-talk, you do not have to write anything down. Would you be willing to carry this form around with you at all times and to record all instances of self-talk immediately—when they occur, during all waking hours—for at least one month? Yes ___ No ___ We can tell you with certainty that almost all our clients who conscientiously or “religiously” performed the self-talk homework assignment and did the other homework in Cognitive Trauma Therapy have gotten rid of their PTSD. Clients who did not do the self-talk homework assignment on a regular or conscientious basis, were less likely to get over their PTSD. If you said “No” to the above question, you not advocating for yourself. We cannot think of anything that would be a better use of your time. Would you be willing to reconsider your decision? The goal of this exercise during the first week is to increase your awareness of using these statement. The immediate goal is not to decrease their occurrence. Later, as you start becoming more aware, you will probably start to realize when you are about to say them. You will start catching yourself when you start to think or say these words, and this may interrupt a chain of negative self-talk, which in the past may have had a life of its own—of which you may not even have been aware. When you get to that stage, you might then be able to start using different words to express what you are trying to say. On page * is a form you can use for estimating the amount of negative self-talk you engage in weekly for eight consecutive weeks. If you diligently keep track of and document your negative self-talk, we can almost guarantee that you will be treating yourself with less disrespect and will probably feel better as a result. If you selfmonitor and document your negative self-talk using this form for eight weeks, it will also be a measure of your commitment and motivation to change. In Cognitive Trauma Therapy, the clients who had the highest motivation to change and the strongest commitment to do the homework were the ones who benefited the most.
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Weekly Estimates of Negative Self-Talk (in Speech and Thoughts) The purpose of this questionnaire is to estimate the frequency of your negative self-talk—in five categories—over 8 consecutive weeks. Fill in the dates for each week (e.g., From 3/19 to 3/26) and then record your estimate of the frequency of each category of self-talk for that week (from 0 [Not at all] to 4 [Very Frequently]) 0=Not at all 1=Rarely 2=Occasionally 3=Frequently 4=Very Frequently From: Categories of Negative Self-Talk
To:
/ /
From: To:
/ /
From: To:
/ /
From: To:
/ /
(1) “should” e.g., “I should…What should I do?”—said in context of deciding what to do (2) “I should have” or “I could have” (3) “Why” questions (e.g., “Why did I…Why did he…Why me?” etc.) (4) Self-Put-Downs of your entire personality or character (e.g., “I’m stupid…a fool…a wimp…a failure…There’s something wrong with me,”) (5) “I feel...” statements ending with words or conclusions that are not pure emotions (e.g., “I feel obligated…I feel overwhelmed…I feel responsible…I feel sorry for”) WEEKLY TOTALS: From: Categories of Negative Self-Talk (1) “should” e.g., “I should…What should I do?”—said in context of deciding what to do (2) “I should have” or “I could have” (3) “Why” questions (e.g., “Why did I…Why did he…Why me?” etc.) (4) Self-Put-Downs of your entire personality or character (e.g., “I’m stupid…a fool…a wimp…a failure…There’s something wrong with me,”) (5) “I feel...” statements ending with words that are not pure emotions (e.g., “I feel obligated…I feel overwhelmed…I feel responsible…I feel sorry for”) WEEKLY TOTALS:
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To:
/ /
From: To:
/ /
From: To:
/ /
From: To:
/ /
Once in a great while, clients will object to giving up negative self-talk “because it’s true.” Whether or not negative self-talk is accurate or not, is not the point of the self-talk modification exercise. The point is that, negative self-talk—such as, “I feel ugly,” “I’m a loser,” “I feel overwhelmed”—makes the person feel bad and makes their symptoms worse.” we occasionally illustrate this point with the following anecdote: In the first session, a client said, “My ex-boyfriend made me feel like a worthless piece of crap.” In the second session, she said, “I feel like a worthless piece of crap.” Her therapist said, “You need to stop talking to yourself that way.” “But it’s true!,” she replied. Her therapist then said, “Do you want to get over your depression and PTSD?” She said, “Of course. I wouldn’t be here if I didn’t want to get rid of PTSD.” Then, her therapist said, “Well, you’re not going to if you continue to talk to yourself that way. Does calling yourself a worthless piece of crap make you want to try harder or to get down on all fours and crawl away?…Would calling one your children “stupid” or “lazy” make her more likely to try harder or more likely to give up and stop trying? The woman then said, “O.K. I understand. I’m going to try to stop talking to myself that way.” In our experience, many clients start to decrease their use of negative self-talk almost immediately after being given the self-monitoring homework assignment. For some clients, especially women who dissociate (mentally wander off, “space out”) a lot, who are not used to attending to their mental life, the habit-breaking process is slower. However, if you are strongly motivated to break bad habits of self-talk, you will be able to do it by paying close attention to your mental life and documenting occurrences of negative self-talk on the self-monitoring form. Research has shown that self-monitoring is an effective technique for breaking bad habits. Do you still think it is going to be difficult to stop talking to yourself in negative or derogatory ways?…If you think so, let us ask you this. If you had a bad slice in golf or a faulty back hand in tennis, do you think that you would be able to break this habit if you got some good lessons from a golf pro or tennis pro and practiced diligently?…Almost all our clients answer “yes” to this question, and you probably did too. Well, changing “bad” self-talk habits is no different than breaking any kind of bad habit. If you learn a technique for breaking the habit, and you diligently practice or rehearse doing it the right way, you will break the habit. We have given you a technique or tool that will enable you to break negative self-talk habits, and all you have to do to break these habits is to diligently keep track of your negative self-talk and record occurrences on the selfmonitoring form. In the next chapter, we will give you much more information as to why the identified categories of self-talk are so destructive and how they interfere with clear thinking and rational decision making. A major purpose in providing this “psychoeducation” will be to increase your desire or motivation to get negative self-talk out of your thinking and speaking
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repertoires. The more motivated you are to stop treating yourself with disrespect, the easier it will be to break negative selftalk habits. What did you learn from reading this chapter and answering the few questions we posed? ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________
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