Secrets of Self-Esteem, #3

Defeating All-or-Nothing Thinking

Copyright © by David D. Burns, M.D. 2014. Do not reproduce or quote without written permission.

I send out an email report to the therapists in my Tuesday night psychotherapy training group at Stanford every week after we meet. I comment on what happened and summarize the negative and positive feedback from the Supervision Rating Scale that everyone fills out at the end of the evening. I also try to make a few teaching points.

Live therapy is one of many teaching techniques we use in the training group. Several of us work together as co-therapists and we treat an actual patient while the other therapists in the group watch. We stop every fifteen or twenty minutes to make teaching points, and to get feedback from the patient and from the therapists who are watching. This allows the patient to participate in the training process as well as the therapy.

This blog is based on a recent session with a depressed young man who I’ll call Ned. Many details in the report have been heavily disguised to protect Ned’s identity. After you read my comments, you can do an ultra-fast survey to let me know if you liked it.

Click here if you’d like to read about the session with Ned.

Ned is a Stanford engineering graduate student from South America. Although he is quite talented and intelligent, Ned has been struggling with severe mood problems for many years. Ned felt hopeless and discouraged because the gains from his previous treatments with medications and conventional psychotherapy were minimal at best.

In the group, we worked on Ned’s relentless and harsh self-criticisms. He was telling himself that coming to America was a mistake because

  • there were equally good training programs in Peru, and
  • he had few really good friends here, and
  • he hadn’t been having any fun in California, and
  • one of his parents was quite ill, and
  • he missed his family and homeland tremendously, and
  • he would probably never achieve his goals in life, and was steadily drifting further and further behind.

Ned felt like he should have stayed in Peru, and he was convinced that he’d be miserable and depressed forever. Hopelessness is perhaps the worst symptom of depression, and sometimes leads to suicidal urges because you feel certain that your suffering will never end.

Ned’s negative thoughts are similar to those of many people who feel depressed. Perhaps you’ve had thoughts like these at times—beating up on yourself with shoulds and shouldn’ts, and telling yourself that things will never change. These kinds of thoughts are nearly always loaded with thinking errors such as All-or-Nothing Thinking, Self-Blame, Emotional Reasoning, Fortune Telling and other cognitive distortions listed in my book Feeling Good. But you don’t realize your thoughts are distorted, so you think you’ve discovered some horrible truth about yourself and the world. I’ve often said that depression is one of the world’s oldest cons because you are telling yourself things that simply aren’t true. Depression is also one of the cruelest cons because the deceptive negative thoughts trigger immediate and enormous suffering.

We helped Ned challenge these negative thoughts using a variety of techniques. However, it wasn’t easy because he was incredibly smart and really good at being self-critical, just like so many of us. By the end of the two-hour session, his depression was almost totally gone, and he was feeling much better. Although we cannot always bring about such rapid recovery, we can do it fairly often now, using the new T.E.A.M. Therapy techniques.

It was a privilege to work with Ned, and by courageously volunteering for treatment in front of 20 therapists who attended the training group that night, he contributed significantly to our training program as well. When you see a technique suddenly changing someone’s life before your very eyes, you begin to comprehend the technique at a deeper level and you feel much more motivated to learn it and use it with your own patients.

One of the colleagues in our group, Dr. Jeffrey Lazarus, mentioned that a technique called “Thinking in Shades of Gray” seemed to be especially helpful for Ned. This rather humble technique can sometimes be surprisingly helpful for depressed and anxious individuals who struggle with All-or-Nothing Thinking. Instead of looking at things in absolute, black-or-white categories, you evaluate them on a sliding scale from 0% to 100%. You quickly realize that very few things can be meaningfully evaluated in an All-or-Nothing manner.

It’s really easy to get trapped by All-or-Nothing Thinking without realizing what you’re doing to yourself. When you look at life in black-and-white categories, you may tell yourself that your new job or project will either be a “total success” or a “complete failure.” This creates tremendous pressure, since few experiences in life end up as “total successes” or “complete failures.” Most of the time, we end up somewhere between 0% and 100%.

In fact, there’s almost nothing in the universe that can be described in All-or-Nothing categories. Take this blog for example. It’s not the greatest masterpiece ever written, and it’s not totally horrible or useless. It’s somewhere in-between.

All-or-Nothing Thinking is nearly always accompanied by Should Statements, as well as Self-Blame. You tell yourself that you should be better than you are, and you may constantly blame yourself for all of your shortcomings, failures, and mistakes. Does that pattern sound familiar to you? This type of thinking is common among individuals who are perfectionists, as well as individuals who struggle with depression, anxiety, and self-doubt from time to time. You can attack All-or-Nothing Thinking with a variety of techniques including Thinking in Shades of Grey, Little Steps for Big Feats, Externalization of Voices, the Acceptance Paradox, and the Paradoxical Double Standard Technique, to name just a few.

Thinking in Shades of Grey seemed to help Ned the most. For example, he decided to tell himself that although his friendships here were not as close and warm as his relationships with friends he grew up with in Peru, he was beginning to make friends with a number of people, and that this was a process that could grow and develop if he worked at it. He also admitted that he was feeling quite close to the therapists in the Tuesday group, who responded to him with a lot of warmth and compassion. Ned realized that it was not realistic to think of his friendships in Peru as 100% and his friendships here as 0%.

In addition, friendships are not fixed and static. Friendships can develop over time, by spending time with people, by putting in the effort to get to know people, and by taking risks and opening up and being vulnerable, just as he did in the Tuesday group.

By the same token, the decision to come to the United States for graduate school was not “totally good” or “totally bad.” Although his experiences so far have been somewhat disappointing, a lot of learning and growing has happened at the same time, and there are tons of career opportunities here in Silicon Valley.

Thinking in Shades of Grey has been a relief for me as well. This technique, along with the Acceptance Paradox, has helped me get away from some of my own All-or-Nothing Thinking and perfectionistic tendencies.

Right now I am working on an exciting programming project with Jeremy Karmel. We’re developing some potentially powerful electronic tools to help therapists and patients alike. If I avoid All-or-Nothing Thinking, I can have fun with the process without being anxious or stressed. I can be creative and move forward systematically, step-by-step, without having to worry about the “outcome” of our project.

In a way, there really are no true “outcomes” in life. We are more like rivers that flow, sometimes in this direction, sometimes in that direction. It’s okay to get into the flow and to enjoy the process of being alive, learning, and relating to others. Few or none of these experiences are “all” or “nothing”— most of them are somewhere in-between.

Every day when we work on the project, it gains strength and focus. When we are ready to launch it, bit by bit, we will have a much better idea how effective each tool we have created will be, but we will undoubtedly find bugs and problems, and many of these tools will fall short in various ways as well, so we will need revisions and modifications, and some may not work out at all. They will not be zeros, or “complete failures,” but simply experiments that we learned from.

If, over time, the project is not sufficiently successful to justify further investment of time and resources, we will move on to the next thing, and we will know that we learned a great deal, even though the project was not as successful as we’d hoped. This way of looking at it removes the pressure. And we might be lucky and find that a great many people will benefit from these new tools, just as so many people have benefitted from my books, such as Feeling Good. In fact, we are discovering that there are some things that computers can do better than human therapists, although human therapists will always be needed by some people.

Another concept that seemed helpful for Ned is the idea that we have the RIGHT to be WRONG. We have the right to make “bad” decisions sometimes. But even bad decisions can be viewed as partial successes because we successfully learn that the choice we made did not work out in the way we hoped. In other words, bad decisions can also be opportunities for growth, especially if you stay away from All-or-Nothing Thinking.

These ideas may seem overly obvious to many people, and may even sound trite. But I have treated many people, including some who were severely depressed and suicidal, who were trapped by All-or-Nothing Thinking, and challenging this distortion can sometimes be one very useful focus for the therapy. Letting go of All-or-Nothing Thinking can accelerate recovery, and can even lead to feelings of enlightenment and great joy.

Giving up All-or-Nothing Thinking, Shoulds and Self-Blame involves the death of the ego, because you have to accept yourself as less than what you think you should be. The death of the self, or ego, is one of the deepest and most spiritual aspects of treatment. You might even say we are creating secular methods for achieving spiritual understanding, although that formulation may offend some people. Spirituality is so often a con, and is often promoted in a pretty superficial manner. I may be guilty of that right now.

So let me know what you think!

David Burns, MD

The following is a response from one of the therapists who attends our training groups.

Hi David and Tuesday groupers,

So wise! I love this stuff. Your last comment David allows me to put my “failed” marriage in perspective. I’ve learned a lot about what I want and don’t want in other relationships! I feel so lucky to have this group!

Hopefully I’ll see some of you on the Sunday hike tomorrow!

Take care,

Name withheld