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It's like the ring of a cellphone during a particularly intimate moment, that harsh intrusion of an automatic thought into your otherwise calm life. When you recognize the thought whizzing past your ears, it's usually an internal voice. The voice--the one that sounds like your domineering mother or the bully from 9th grade or an innocent-but-nosey child. It's the voice; it repeats the same ugly phrases in your head like someone slipping poison into your tea, taking years of passive aggression to finally kill you.

When I was younger, people told me it was low self-esteem. That's not it, exactly. Because these thoughts--you aren't willfully thinking them. Not thinking them at all, exactly. They sort of spring up on their own, echoing something you once heard or experienced. Sometimes true, sometimes completely off-base. Always important. Always pervasive. Everywhere. Seeping into every action, every moment, until they produce a pattern in your life that makes the theme blatantly obvious to everyone but you.

Everyone knows but you. You're stupid. You'll never amount to anything and nobody likes you.

They say that in any anxious or fearful situation, there is a curve of tolerance. The first 45 minutes are the most difficult, but statistically if you can get through that first three quarters of an hour, your anxiety level drops dramatically. The human body simply cannot function in a state of constant anxiety. I bank on that rule. That rule that makes me early for everything, inspiring me to plan out the details of my life to utter minutiae. The longer I have to mentally prepare, the less likely I'll get stuck in the middle of an anxiety "attack." Not attack. More than attack. This is guerilla warfare. The enemy is in your head. It knows all your secrets.

So I live with a bunch of these thoughts because my brain is overactive as it is. The obsession isn't my choice; rather it's something doled out to me by a part of my brain over which I have little if any control. They say it's at the frontal lobe, where obsessive-compulsive people learn their rituals. It's not exactly the same, but close.

Too close for comfort and if she felt anything in return, she'd reach out and touch me. Her not touching me means she doesn't want me. No, worse. She hates me. She thinks I'm disgusting. I *am* disgusting.

These thoughts grant you the gift of mindreading: you can suddenly hear or instantly deduce what everyone is thinking. Most of their thoughts involve you. They make you nervous. They make you shake and sweat and sometimes they make you cry.

Tears. Again? You're crying? Everyone will laugh at you if you cry. You're pathetic. You're a loser.

Automatic thoughts are a major component of most depression and anxiety disorders, including PTSD. While they can be part of a rambling inner monologue, we get so used to hearing them that they echo constantly, even into the most random of places.

Often people recognize that they've experienced automatic thoughts, even though they are exceedingly bad at hearing them every time they're "played." It's easier to uncover them if you keep a notepad or something close by. When your moods change, when you notice a difference in facial expression, when your heart starts to pound or you notice the beginning of a panic attack--think. Think. Allow yourself to free-associate on the thought that comes to mind and eventually, you'll get at your automatic thought.

My heart's pounding. Oh, God. This isn't normal. I'm going to have a heart attack. I'm going to have to be rushed to the hospital right here in front of everyone. This is it. My life is over. I'm going to die.

Normally this entire process takes milliseconds in your head, but on paper it can take several minutes if you're completely unaware of the thought. In fact, in many cases a patient will present with a physiological problem (IBS, migraines, etc) when the real problem is anxiety, triggered by impressive fears, worries, or doubts. So, how do you treat something that's often lurking below your realm of conscious thought?

Cognitive Behavior Therapy (CBT)is a rapidly-growing field which seems to have found a rather effective--although wholly unpleasant--answer.

What prompted your hyperventilating at school last week?
I don't know. I was just thinking about the test and--
How did the test make you feel?
Well it doesn't matter how much I study. I suck at tests.
So what if you suck at tests? What will happen if you don't do well?
I'll fail.
And if you fail?
I'll flunk out of school. No one will ever hire me because I'm a failure. I'll be a loser all my life.

With CBT, the therapist and patient work together to identify the most pervasive automatic thoughts in a given setting. Then the patient is asked to present all the evidence for and against their automatic thought. In this case, the person's most automatic thoughts were "I suck at tests," "I'll fail," and "I'm a loser." (Incidentally, did you know graduate school is one of the most common environments for anxiety disorders? I digress.) So first the patient comes up with aaaaaaaaaaaaaaaaaall the evidence that they do, in fact, suck at tests.

  1. In third grade I bombed a spelling test.
  2. I freaked out on my physics exam and flunked in 10th grade.
  3. The professor laughed when he handed back my psych midterm in March.

Etc, etc, as far down as they can go. Every shred of evidence. Every sliver of shrapnel lodged in your soul. Then, you do the opposite. Think of all the evidence you have against this thought.

  1. I get As in most of my classes.
  2. Last week I got an 88% on my psych test.
  3. Mrs. Morton complimented me on my essay in AP History last year.

Again, as far down as they can go. Typically the evidence against your thought far outweighs the evidence for it. But what if it doesn't? What if you genuinely do suck at tests? Doesn't matter. Same process: for/against ad nauseum.

It doesn't matter whether your automatic thought is illogical (No one will ever love me.) or logical (I'm fat.). You can't help but think it anyway--however irrational it may be. The real power of CBT is in the retelling. You learn to sketch out all the evidence for and against every time you have the thought. Imagine if every time that sneaky whisper "I'm so obnoxious. Nobody likes me" forced you to sit down for 20 minutes and write out all the reasons why you actually are obnoxious. At first it would be painful, but you can't be hurt by something that bores you. Boredom is the key; you hash out the argument again and again until you've demistified it and it's no longer some powerful mantra.

Rather than stopping the automatic thought, the goal of therapy is to examine it with clinical eyes. This isn't a feel-good remedy; the fact may very well be that you're going to die, or that you're ugly, or that you're awful at your job. The point, then, is to acknowledge that these thoughts exist, and to pick them apart until they're tedious. Picture Alice, growing larger before the Queen of Hearts. When you shrink down automatic thoughts to what they really are--tiny pieces of a much bigger you--they fade from importance, and the real you becomes that much easier to see.

I wholeheartedly recommend that people who KNOW WHAT I'M TALKING ABOUT seek out a Cognitive Behavior Therapist to help them work through their thoughts. Of course this sort of thing can be done on your own, but it's easier (and more effective) if you have a professional. Let me know if this helps you. Please, please, please.

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