What strikes me about the way my depressed patients think is that they are relentlessly negative, even when the facts are positive. Cognitive therapists have found that when we are depressed we tend to have a negative view of ourselves, our experiences, and our future. We call this “the negative triad.”

When you take this negative view of yourself, anything you do looks to you like a failure or a flop. Even when someone points out your positives, you discount them as irrelevant: “That’s no big deal—anyone could do that.” You can’t seem to enjoy anything; you think that your exercise is a waste of time, your vacation was a waste of money, and your relationships are boring and demanding. You take a dim view of the future, too, anticipating that you will never get better, you will fail the exam, you will get fired from your job, and you will end up alone for the rest of your life. Which comes first—the thought or the depression? It’s really everything—these negative thoughts lead to depression, maintain it and prolong it, and are often the result of depression. The important thing is to catch them, test them out, and change them.

This overriding negativity is expressed in certain specific biases in your thinking. In cognitive therapy we call these typical biases “automatic thoughts.” These are thoughts that come to you quite spontaneously; they seem plausible and true to you, and they are associated with feeling down. Look at the list below and see if any of these thought biases seem familiar.

• Mind Reading: You assume that you know what people think without having sufficient evidence of their thoughts. “He thinks I’m a loser.”
• Fortune-Telling: You predict the future negatively: things will get worse or there is danger ahead. “I’ll fail the exam.” “I won’t get that job.”
• Catastrophizing: You believe that what will happen will be so awful that you won’t be able to stand it. “It would be unbearable if I failed.”
• Labeling: You broadly assign negative traits to yourself and others. “I’m undesirable.” “He’s a rotten person.”
• Discounting Positives: You write off the positive things you or others do as trivial. “That’s what wives are supposed to do, so it doesn’t count when she’s nice to me.” “Those successes were easy, so they don’t matter.”
• Negative Filtering: You focus almost exclusively on the negatives and seldom notice the positives. “Look at all of the people who don’t like me.”
• Overgeneralizing: You perceive a global pattern of negatives on the basis of a single incident. You go beyond one experience and generalize to a pattern that characterizes your life. “This always happens to me.” “I seem to fail at a lot of things.”
• Dichotomous thinking: You view events or people in all-or-nothing terms. “I get rejected by everyone.” “It was a complete waste of time.” You are either a “winner” or a “loser” and you seldom think in shades of gray.
• Shoulds: You interpret events in terms of expectations and demands rather than simply focusing on what is. “I should do well. If I don’t, then I’m a failure.”
• Personalizing: You claim a disproportionate amount of the blame when bad things happen, and you don’t see that certain events are also caused by others. “The marriage ended because I failed.”
• Blaming: You focus on another person as the source of your negative feelings, so you refuse to take responsibility for changing yourself. “I’m lonely because of her.” “My parents caused all my problems.”
• Unfair Comparisons: You interpret events by standards that are unrealistic—for example, you focus primarily on others who do better than you. Ironically, you seldom compare yourself to people who are worse off. “She’s more successful than I am.” “Others did better than I did on the test.”
• Regret Orientation: You focus on the idea that you could have done better in the past, rather than on what you can do better now. “I shouldn’t have said that.” “I could have had a better job if I had tried.”
• What if?: You keep asking questions about “what if” something happens, and you refuse to be satisfied with any of the answers. “Yeah, but what if I get anxious?” “What if I can’t catch my breath?”
• Emotional Reasoning: You let your feelings guide your interpretation of reality. “I feel depressed; therefore, my marriage is not working out.”
• Inability to Disconfirm: You reject any evidence or arguments that might contradict your negative thoughts. For example, when you have the thought “I’m unlovable,” you reject as irrelevant any evidence that people like you. Consequently, your thought cannot be refuted. It’s impossible to prove that your negative thinking is wrong, so you hold onto it. “That’s not the real issue.” “There are deeper problems.” “There are other factors.”
• Judgment Focus: You evaluate yourself, others, and events as good/bad or superior/inferior, rather than simply describing, accepting, or understanding. You are continually measuring things according to arbitrary standards and finding that they fall short. “I didn’t perform well in college.” “If I take up tennis, I won’t do well.” “Look how successful she is. I’m not successful.”

Challenge your negative thinking. Although cognitive therapy and medication are both effective for treating depression, it’s interesting that dysfunctional attitudes change more as a result of cognitive therapy than they do in response to medication. In some cases, patients experience sudden improvement in their depression, sometimes in just one or two sessions of therapy. Patients with sudden improvement are even more likely than patients who gradually improve to maintain their improvement a year later. Researchers have found that changes in negative thinking precede this improvement—so changing the way you think changes the way you feel.