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Cognitive Behavioral Therapy (CBT): Self-Talk - What We Say to Ourselves Affects How We Feel

  [ 506 votes ]   [ 16 Comments ]
By Julie Kelly, MS, RN, and Rosalie Devonshire, MSW, LCSW • • May 4, 2007

Excerpted with kind permission from the book Taking Charge of Fibromyalgia - A Self-Management Program for your Fibromyalgia Syndrome by Julie Kelly, MS, RN and Rosalie Devonshire, MSW, LCSW - two health professionals who live successfully with Fibromyalgia. Introduction: Stress Management/Relaxation

Stress is not an external event that produces anxiety or frustration in our bodies; it is our own physical and emotional reaction to external events taking place around us and within us. Studies have shown that there are actual physical changes occurring in our bodies when we are stressed.

Changes which can occur are:

  • Muscle tension and pain
  • Stomach distress
  • Headaches
  • Heart irregularities
  • Anxiety
  • Depression
  • Teeth grinding/TMJ
  • High blood pressure
  • Cold hands/feet
  • Insomnia
  • Ulcers
  • Diarrhea/constipation

    Chronic stress can deplete the body of many chemicals needed for proper functioning, and we can develop various diseases as a result. Research also shows that we can take steps to change the way we respond to stress and create a healing atmosphere for our bodies….The following techniques are useful for reducing the negative effects of stress. With continued practice, these techniques can produce positive changes in how your body and mind react to stress.

    Cognitive Behavioral Therapy (CBT)
    Self-Talk: What We Say to Ourselves Affects How We Feel

    Researchers trying to help people with Fibromyalgia [and Chronic Fatigue Syndrome] have turned to cognitive behavioral therapy as an additional method of alleviating painful symptoms. A therapist using this technique can teach you how to control disturbing emotional reactions by suggesting more effective ways of interpreting and thinking about your experiences. For example, if you make a mistake at work, you might say to yourself, I am the most stupid person in the world! I always make mistakes!

    The therapist would point out that you do not always make mistakes and that everyone makes mistakes and feels foolish at one time or another. The behavioral aspect of this therapy asks you to note your mood or feelings when you are thinking these thoughts.

    Painful emotions such as guilt, shame, and anxiety can aggravate pain and your Fibromyalgia. We are our thoughts. Negative thinking produces negative behavior. Some research suggests negative thinking causes illness. If negative thinking causes illness, can positive thinking create health?

    There are many researchers who believe this is possible. If this idea sounds foolish to you, and you decide it would never benefit your...symptoms, you are probably feeling skeptical and discouraged or maybe even angry. Your pain level may increase as you are having these thoughts. On the other hand, if this sounds like a great idea to you, you may feel an uplift in your mood. If you pay attention to your body at the same time, you may notice a slight decrease in your pain level. Our bodies react immediately to our emotions. If we can control our thoughts, maybe we can control our bodies.

    There are trained therapists who teach people how to change distorted or faulty thinking. If you can’t afford psychotherapy, you can read Feeling Good: The New Mood Therapy, by David D. Burns, M.D., or his handbook The Feeling Good Handbook . Some of the basic ideas of cognitive behavioral therapy are provided for you [here].

    CBT treatment typically lasts for six to 20 weeks and requires you to keep track of symptoms, thoughts, and emotions. You will be given homework assignments to work on between sessions. Cognitive behavioral therapy is not in-depth psychotherapy. We cannot teach this technique to you in the limited confines of this book, but we want you to have an idea of what it is all about, so you can decide if it is something you should pursue.

    Learning To Notice Stress-Inducing Thought Patterns

    During treatment, a cognitive therapist will require you to focus on your negative thoughts and to notice when your thoughts follow any of the following patterns:

    All or nothing thinking. “I have Fibromyalgia, therefore, I can’t lead a normal life.” Wrong. It would be better to say to yourself, “Many people lead normal lives once they get their Fibromyalgia under control, and I can too.”

    Overgeneralization. You see a single negative event as a never-ending pattern of defeat. “My doctor misdiagnosed me; therefore, I can never get better.”

    Disqualifying the positive. Rejecting positive experiences as short-lived and possibly not recurring. “My fibromyalgia symptoms were better this weekend when I rested, but it will never happen again.”

    Catastrophizing. You exaggerate the importance of things. “I can’t keep my house as clean as I used to. Therefore, I am a failure.” Are you a failure? No, you just cannot do as much as you used to. Ask for help. Learn to live with a messier house!

    Should statements. “I should be able to do all that I did before I had Fibromyalgia.” You can’t, and if you try, you will have a flare-up and frustrate yourself. Be kind to yourself. Treat yourself gently.

    Personalization. You see yourself as the cause of some negative event for which you were not responsible. “My Fibromyalgia must have started because I was not taking care of myself.”

    CBT Attempts to Change Thought Patterns

    No one knows why Fibromyalgia starts; you are not its cause. When you experience problems with distorted thinking, your body reacts to your thoughts within milliseconds. Cognitive behavior therapy attempts to change your irrational thought patterns by finding the positive in your negative thinking, stopping self-blame, defusing anger, and reducing feelings of being overwhelmed.

    Do you say to yourself I am in pain now and will be forever? Is that true? Aren’t there times when you are free of pain? If you have small amounts of time when you are free from pain, using this technique can increase that time gradually, until you have more time when you are pain-free.

    Notice how high your pain level is when you are thinking about your pain, when someone has made you angry, or when you are hurrying to accomplish tasks.

    Notice how low your pain level is when you are engaged in pleasant activities.

    Researchers know that psychological factors influence the degree of pain we feel. If you develop healthier attitudes, change negative thinking, and learn to be optimistic, your Fibromyalgia symptoms can and will decrease when used in conjunction with the other treatments described in this book [including relaxation techniques, abdominal diaphragmatic breathing, meditation, relaxation tapes, hypnosis, Yoga, biofeedback, and Tai Chi].

    It may take many months to benefit from a change in thought patterns, but it is worth trying. You have nothing to lose and everything to gain. This technique can also reduce the risk of becoming depressed.

    Positive Affirmations

    Another technique that is easy to implement is to use positive affirmations throughout the day. We have provided a list of some for you to try. It is better to say these out loud and repeat them on a consistent basis for the affirmations to work. Every day in every way, I am getting better and better. Repeat that 10 times three or four times a day, every day for a month. See if it helps you.

    Some people find it helpful to write down positive affirmations on a card to carry in their purse or pocket. Reading the card a few times during the day can keep your positive thoughts on track and prevent negative thinking from creeping into your mind.

    Positive Thoughts for Coping with Fibromyalgia

    n I am confident of my ability to deal with my health and live a good life.

    n Things are getting better.

    n I am making progress in helping myself feel better.

    n Today I can do what I need to do for my recovery.

    n I can treat myself gently and with the special care I would give a close friend.

    n I am learning what I need to do to take care of my body.

    n I focus on positive actions I can take to advocate for myself.

    n I look for the good this day can bring.

    n I go with the flow of each new day, accepting what I can learn from it.

    n I seek out the positive support I need to live with Fibromyalgia.

    n I let go of any muscle tension or problems over which I have no control.

    n I live with positive expectancy: each day I expect to feel better and more relaxed.

    n I counter each stress with techniques I know will reduce negative stress.

    n I can surmount any problem that occurs today with calm, problem-solving skills.

    n I can look for the resources I need to manage any problems.

    n I maintain slow and easy breathing, bringing fresh oxygen to my muscles and taking away muscle waste products.

    n I keep my muscles loose and relaxed throughout the day.

    n I take time during the day to relax and breathe to refresh my muscles.

    n I creatively manage the problems each new day brings.

    n I can do whatever I need to do to take good care of myself.

    Changing Negative Self-talk

    If you would like to try charting your thoughts on your own, [start a journal to] keep track of your thoughts. Write down your negative thoughts and the feelings associated with them.

    You may be amazed at how often your thoughts are destructive or how quickly you can become pessimistic in your thought patterns.

    What is important is to become aware of your thoughts, for without awareness of how often your thinking heads downward, your thinking will be impossible to change. Once you notice your thoughts turning negative, determine the emotion that you feel when you are thinking badly about yourself. You may feel worthless, guilty, angry, depressed, sad, or confused.

    Once you become aware of a destructive thought, turn it into a more positive statement. Some people find it helpful to imagine a stop sign or a red light in their minds to defuse a negative thought. Other techniques are putting a rubber band on your wrist and snapping it every time a negative thought comes up or paying attention to your breathing to deflect your mind away from negative thoughts.

    You may come up with your own techniques over time. Share them with a friend.

    * Excerpted with permission from Taking Charge of Fibromyalgia - A Self-Management Program for your Fibromyalgia Syndrome Fifth Edition, by Julie Kelly, MS, RN, and Rosalie Devonshire, MSW, LCSW. Thomas J. Romano, editor. C2005 all rights reserved. Published by Fibromyalgia Educational Systems, Inc.

    Disclaimer: This information is intended for education purposes only and is not to replace the services of a trained health professional. The authors and editor do not accept liability in the event of negative consequences incurred as a result of information presented in this handbook.

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Article Comments Post a Comment

Posted by: fibroscrapper
May 9, 2007
I think that CBT is fine for people who fit the problems addressed in this article as far as dealing with stress. BUT, when I was working and under a lot of stress it wasn't because I was saying negative things to myself or any of the other reasons listed. It was because my job was asking me to do the work of 3 people and I didn't have time to think let alone talk to myself. It was pure running on adrenaline while trying to get through the day. Cutting the stress would mean losing the job. Well, I ended up doing that anyway, but not because I was fired for not doing my job. At least I went out with a fantastic review. I feel that in many cases the CBT thing is just another way to try to make this a psychological issue and not a true physiological illness.
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Posted by: Boopgirl
May 9, 2007
I totally agree with what you said. I feel and felt the same way you did when working. You are absolutely right about the CBT thing being just another way to try to make this a psychological issue and not a truly physiological illness. This is very true when dealing with insurance companies and neuropsych evaluations. You are right on the money! Boopgirl (Patty)


CBT/Talking to myself
Posted by: profzinz
May 9, 2007
When it hurts, it hurts. I do medications, meditation, prayer, breathing exercises, tai chi, and sit in the sauna a lot with hasidic reggae from Matisyahu. But at work, when it hurts, it hurts. At home, when it hurts, it hurts. I can say whatever I want to myself but the reality is still there. Maybe I can talk my way out of a speeding ticket but pain does not listen with any empathy. I think Self-Talk therapy can help to a certain extent when it is a major part of the problem. When it adds to the severity of the condition, then it is time to get some help with it. When it is not a problem, it is just a case of being SOL. I can say whatever I want to myself to improve my inner outlook, but my knees still give out, my shoulder grinds like a millstone, the rest of my joints and muscles ache and I get tired as all get out. I get by, I make due, and I survive the best I can. I try to enjoy the life I have, laugh a lot, and do stuff to help others enjoy life and laugh a lot. I also hope the new antidepressant the DR put me on will help lift some of the clouds, too. Shoulder still hurts though. Pax.
Reply Reply

". . .but pain does not listen with any empathy."
Posted by: artyreader
May 16, 2007
You guys rock! sometimes I get so enraged and am in so much physical/emotional pain that I know I cannot communicate as eloquently as I would ideally like to. That's when I am doubly grateful for this website.

That is poetic "the pain does not listen with any empathy." and the rest of the message is right-on too.

I think if you polled most of us (definitely, if you asked me) we have sincerely and whole-heartedly given ourselves, taken risks, to try various methods/treatments,etc. Maybe we've even been too concientious, too open, too willing to discount our own ongoing,dispiriting experiences with the reality of physical pain and exhaustion. . .I don't know.

I also keep trying, am going to talk to my doc about upping anti-depressant (not something I do lightly), and many many other things to live with as much meaning and fulfillment as possible, but right now I am in deep deep pain (emotional/psychic pain worse than bad bad physical pain) and feel that all my efforts over years and years have not yeilded much in comfort or, most important to me, meaningul connection to others (that has been the cruelest thing. . .to make a suprreme effort most of the time, and to be judged as "not trying hard enough", "not thinking positively enough" etc.) thanks for listening, and my heart goes out to all of you, and all who suffer, for whatever reason, throughout the world. . .


Self talk
Posted by: BeckySanders
Jun 4, 2007
I just feel like I'm lying to myself when I do afirmations. When I'm in agaony, I'm in agony-



I disagree with the premise
Posted by: desertlass
May 9, 2007
I feel that there are some cases when our own reactions to events cause anxiety. But to make the blanket statement that ALL stress is internal and is never a result from an outside source is a theory or a belief, and one to which I don't personally subscribe. CBT can obviously help a minor subset of people who create their own stressors, but on the whole, CBT seems to submit that certain thoughts (unpleasant ones labeled "negative") are like germs in our brains and it cheerfully tries to remove them in a hygienic manner. Write down your thoughts, recognize the negative "distortions", and then change them to "positive" ones, and you have successfully disinfected your mind. An alternative to CBT is to honor all of our thoughts and feelings as valid but temporary. We don't have to cling to horrific or fatalistic visions that arise from fear, nor do we have to force ourselves to view our situations from someone else's perspective, or from where _they_ would rather we saw it, rather than from where we currently are in the process.
Reply Reply

well said, well said, desert lass AND person who said CBT not good for physical illness
Posted by: artyreader
May 16, 2007
I love love love this website,newsletter and all--amazing! And I realize they want to offer a variety of viewpoints, and that not everyone is going to to benefit from each and every approach--but, having said that---iI HATE THAT F$%#*ING SIMPLISTIC, CBT CRAP!

OK, OK, i'M ROYALLY PISSED! To me, this is another, very cleverly worded excuse for people to keep people like us (sufferers of fibro/cfs, other chronic stuff) at arms-length and subtly judge our experiences and reactions to experiences and not take responsibilty for the fact that they are being judgemental. Most of them are well-meaning, but CLUELESS!!!!

You wanna know what'll help me? (can't speak for everyone but here goes--)1. MONEY--so I can buy a decent used car and/or pay for taxis so I can get out these four walls from time to time, money for supplements, massages, money I do not have, because of my illness, 2, A HEALTHY SUPPORTIVE FAMILY--Never had that, instead, abuse, rages, and instability on every level (financial, emotional,etc) 3. A LOVING,accepting relationship--much much harder to even meet people at all when illness and poverty limit you 4. A sense of being needed, having something to give, being engaged in the world--maybe the most painful loss of all--something I did have as healthy person, and have not been able to find a replacement for in almost a decade of this, 5. Community/supportive network: Have some amazing friends, but have lost others from not understanding disease, some due to their own traumas (in one case, dementia)--Neighbors have their own lives, not having car, way of getting out makes so hard to meet others--still make the effort when I can (and treasure those who still are in touch,but most people are too busy, have their own families, concerns, and since I am not "useful" anymore. well. . . 6. RESPECT--along with loving, supportive relationships, maybe the most important (and the rarest) of all. I (and most people on this board) have lived in two worlds--the WORLD OF THE WELL AND THE WORLD OF THE SICK--WE NEED TO BE LISTENED TO AND RESPECTED and we need people to just "be" with us sometimes. We don't need to be "scolded" for our "negative" thoughts--we need for people to understand what we go through and show us some openess and understanding and to take some time to get to know us for our unique gifts and talents hidden under all the pain. TO BE DEPRESSED AND TO FEEL DESPAIR AFTER YEARS OF EFFORT (and yes, affirmations and self-talk,etc), after years of povery, hopelessness, loss of dreams, extreme lonlieness, misunderstanding and isolation is not strange--it's NORMAL, and I would challenge any of those health CBT people to live a week (even a day!) in our pain and limitations and see how well their philosophy holds up!


Posted by: 545
May 16, 2007
I think that the crutch of it is that sometimes these "negative" thoughts are true: Often, things are *not* getting better; Often, we do *not* have all the resources we need to deal with our illness; Often, we do *not* have the problem solving skills to deal with problems as they face us. If our thoughts appear catastrophic, it's because our symptoms are catastrophic. You wouldn't tell someone dying of cancer not to worry about death because he's not dying. Moreover, ignoring the reality makes it worse: Around the onset of my symptoms, I continued to consiously go through life believing that I could navigate most of life's daily problems; this exacerbated things, and it was only when I broke this "positive" thought that I began to learn how to deal with my new life.

CBT often does make a lot of sense; it's point is that you need to recognize your inferences, especially about yourself, and know when to stop them. If someone gets fired and starts to look for a new job, he can confidently tell himself, "Things will get better.", then that thought will facilitate his goals. However, if someone presents with all of the disabling symptoms of CFS or FM and then tells himself "Things will get better", well, it's simply not necessarily true. At the same time, that doesn't make you any worse of a *person*.

The difficulty is that it really is important to keep an open mind: Many illnesses do improve in the long run, and it's important that negative thoughts not hinder recovery. If, at some point, you can manage your problems, then that should be reocgnized, so that you can start managing them. But in the meanwhile, blaming and then correcting negative thoughts is merely distracting: It is the truth that'll set you free.


CBT NOT for physical disease
Posted by: DaWolf
May 9, 2007
When youre sick, you ARE sick. Bogus claims abound with this CBT stuff. We use CBT a lot with mental disorders but it does not work with physical diseases.I have told myself a thousand times "I feel so GOOD"---hasnt changed a thing for my physical symptoms. I am surprised that such a dumb theory is even posted on Rich Carson's website.
Reply Reply

CBT in The Netherlands
Posted by: Herbert
May 9, 2007
Here in The Netherlands it is a real tragidy. The so called CFS Expertise group of the university in Nijmegen claim that CBT is the solution for Chronic fatigue syndrome. They manipulated with their statistics, makes no differense between Chronic Fatigue and Chronic Fatigue SYNDROME. They published in medical magazines and they instructed the general practictioners here in Holland not to do much tests. CBS is the cure. If you can't work, you are forced by the doctors who decide about your sickness benifit to do CBT. I have so much immunological (elevated IL's), auto-immune disorders and viral reactivation (possitive PCR test for EBV, HHV6, HHV7 etc measured over the last 10 years!) but the docters here in Holland don't do this tests, because this is to expencive and most of them can't interpretate this immunological and auto-immune tests so I think this is the main reason why doctor's recommand CBT. They have nearly any knowledge of the immune system. What doctor's don't know, don't exist. My tests were done in Belgium by Prof. M. de Meirleir and Germany by Dr. Hilgers. In the routine lab.tests you will not find a serious disorder. CBT make's that you will cope better with your disability but physical there is no significant improvent. If you can not work, you will still not after CBT.
Reply Reply

Self-Talk - It really matters how you feel to enjoy life!
Posted by: chaplo
May 16, 2007
I received some training from Albert Ellis and Fr. John Powell and others incorporating self-talk into ways of replacing negative feelings with positive ones, for the sake of denying the lies that are "running" our moods and decisions and behaviors through techniques that denounce these lies and suggest replacing them with the truth, which will set us free and which is, in fact, positive self-talk. I have FM and the thought of keeping a record of anything, diet or thoughts and feelings, triggers a negative feeling in me, "I'm too tired to do that, I need to save my energy for something more important". That negative self talk (too tired to do what is good for me) causes me to feel more discouraged and angry that someone expects me to do that when I can barely do anything, as if mental games are more successful than medications and therapies. That is the hidden thought that needs to be brought to the surface and challenged. Is it true or not? New selftalk: "I don't know, but I might try it to see if my negative thinking and feeling is being scripted by old selftalk so I can get out of my fibro funk." So I'm thinking of buying that darned log book, to do the self-reflection I might need to identify negative thinking and to see if it is true or not and if it is causing negative feelings and influencing my decisions to live life more fully. Now I feel more hopeful that something might help me to gain more control over my life instead of letting FM control me so much. I pray it works, and with God's enlightenment, perhaps it will. I have used it in the past and have identified "old scripts from childhood" believed still as an adult, that have crippled me. I believe with a disease and old age, I need time for more introspection, especially since I recently lost my job for being absent and tardy too much. I know God still has another door for me to open to enjoy life even now (postive, true thought). New feeling; hopeful, happier, more energized to get off the bed!
Reply Reply

Posted by: sterrenkijker
May 20, 2007
Many patients in the Netherlands - where CBT is now being seen as the "nec plus ultra" among all therapies against FM and CFS by the Health Care Providers and politicians - believe it is the biggest medical fraud ever. Norbert
Reply Reply

use CTB techniques even if you're psychologically healthy
Posted by: anthromom
Nov 16, 2016
I hear what you are saying about CBT techniques and stress. I hear you saying that your stress is very real and that because it is real, using techniques such as positive self-talk may not be as appropriate for you. However, my experience is that using these techniques actually helped mitigate against the stress. I was left in a very bad situation in 2010. I think I had over 300 stress points that year. I used these kinds of methods every day for two or three years. I didn't have "psychological problems," but given how much stress I was under, it was nearly miraculous that I didn't get sick. In fact, my health improved. So you don't need to have psychological problems to benefit from CBT techniques, and these techniques can go very far toward making sure that you don't develop physical or psychological problems as a result of the stress.

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