Succeeding during the Pandemic, Part 2: Maintaining Mental Health
There is a mental health crisis in higher education, according to many experts, and the COVID-19 pandemic has made matters worse. Understandably, the pandemic has contributed to anxiety, stress, depression, fear, grief, isolation, and insecurity for millions worldwide. And since graduate students already suffer from depression and anxiety at far higher rates than the general population, they are likely to be especially hard hit.
No doubt, the problems caused by the pandemic—and the underlying social issues that it has highlighted—are real. And when faced with real problems, it is normal, and even healthy, to feel negative emotions. Such emotions serve many important purposes, including alerting us to danger or motivating us to pursue change. However, not all emotions are healthy or helpful. In fact, every emotion can take both healthy and unhealthy forms, which raises the questions:
- How can you distinguish between healthy and unhealthy emotions?
- Is it possible to replace unhealthy emotions with healthier alternatives?
Providing practical answers to these questions is the purpose of this webpage.
Specifically, this page focuses on the cognitive behavioral therapy (CBT) techniques promoted by the clinical psychiatrist David Burns. It serves as a complement to “Keeping your spirits up: Managing your mood in graduate school” and “Managing Time and Stress.” All three pages offer advice for maintaining a healthy and positive outlook during graduate study, and all three draw on CBT-based self-help concepts to varying degrees.
However, it’s important to remember that not all mental conditions can be effectively treated by CBT or self-directed techniques. For example, disorders that cause hallucinations and delusions (e.g. schizophrenia) generally require medication in addition to therapy.
In addition, if you are experiencing a mental health emergency, including suicidal feelings, CSULB Counseling and Psychological Services (CAPS) offers the following advice:
- For life-threatening emergencies, please call 911 or campus police at (562) 985-4101.
- If it is a mental health emergency, you can also contact the National Suicide Prevention Lifeline 24/7 at (800) 273-8255 or you can message the Crisis Text Line by texting “HOME” to 741-741 and a crisis responder will assist you.
In short, the cognitive methods discussed here are not a panacea. And nothing on this page should be construed as professional medical advice—only a doctor or certified therapist can offer such advice. However, what this page offers are powerful, research-backed techniques that anyone can use to combat sadness, hopelessness, depression, anxiety, stress, and other negative thoughts and feelings.
What is cognitive behavioral therapy (CBT)?
In the words of the American Psychological Association (APA), cognitive behavioral therapy (CBT) is “a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders and severe mental illness.” It is the most well-studied form of psychotherapy, and it is relatively simple and straightforward to learn and apply. Perhaps more importantly for our purposes, CBT has been shown to work effectively in a self-help format (for example, reading-based therapy or “bibliotherapy”).
In his TEDx talk, David Burns offers a clear and comprehensible overview of the basics of CBT, which he boils down to three core ideas:
- Our thoughts create our moods. When you’re depressed or anxious, you’re giving yourself negative messages (negative thoughts or “automatic” thoughts). For example, you might be blaming yourself for something, or you might be telling yourself that something terrible is going to happen. These thoughts, rather than the objective circumstances of your life, are what make you feel unhappy. In other words, you create your emotions, positive or negative, by how you interpret events in your life.
- Mood disorders like depression are caused by distorted thoughts. When you’re depressed or anxious, those negative thoughts (e.g. “I’m worthless,” or “I’m a loser,” or “The world is going to end”) are not realistic or logical. They contain fallacies and illogical thought patterns, or “cognitive distortions.” And there are 10 basic cognitive distortions (discussed below) that are common among people who are depressed or anxious.
- You can un-learn distorted patterns of thinking. You can train yourself to change the way you think in order to change the way you feel. In fact, un-learning distorted thought patterns is a large part of the CBT approach.
The first step to un-learning these distorted thought patterns is learning to recognize them.
The 10 Basic Cognitive Distortions
Below are the 10 most common cognitive distortions, adapted from Chapter 3 of Feeling Good: The New Mood Therapy by David Burns. While the examples are directly related to graduate study, you can have such distorted thinking about any area of your life:
- All or nothing thinking. You see things in black or white categories. If your performance falls short of perfect, you see yourself as a total failure.
- For example: You’re having a difficult time with online learning, and you get a low score on a test. You tell yourself, “I’m a loser—I have no ability to handle stress.”
- Why it’s distorted: Everyone experiences both successes and failures. What is a “loser” anyway—someone who fails at absolutely everything? Does anyone like that exist? Most things in life are not simple “black or white” issues. Most things come in “shades of gray.”
- Overgeneralization. You see a single negative event as a never-ending pattern of defeat.
- For example: You mess up a class presentation. You stumble over words, stutter, and make confusing statements. You tell yourself, “I always do this! I never get anything right.”
- Why it’s distorted: One, or even several, bad experiences do not add up to “always.” If you flip a coin a thousand times, you might get long stretches of only heads, but eventually you’ll get some tails. Overall, the heads and tails will balance, about fifty-fifty. The same goes for good or bad performance, or outcomes, in life.
- Mental Filter. You pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes clouded.
- For example: You realize that, because of the pandemic, you can’t easily access a library resource that could help with your research paper. You think: “Everything is ruined and awful now. There’s no hope.”
- Why it’s distorted: While it’s perfectly natural to be frustrated by inconveniences and difficulties, it’s not true that “everything” is bad. Even the worst situations are usually a mix of good and bad (or at least neutral and bad). After all, if you’re able to feel frustrated, you’re fortunate in at least one way: you’re still alive!
- Discounting (or Disqualifying) the Positive. You reject positive experiences by insisting that “they don’t count” for some reason or other.
- For example: Your professor says “Great job in class today,” and you think: “She’s just being nice. She’s only saying that because she feels sorry for me.”
- Why it’s distorted: You’ve taken evidence for a positive thing and magically transformed it into evidence for a negative thing—what’s more distorted than that?
- Jumping to Conclusions. You make a negative interpretation of events without having any evidence for this interpretation. Two common types of this distortion are “mind reading,” in which you assume that you know what someone else is thinking, and “fortune telling,” in which you assume that you know what’s going to happen in the future.
- For example: You’re meeting with your thesis advisor, and he doesn’t seem enthused about some aspects of your project. You start thinking: “He thinks I’m so stupid. He’s probably wondering how I got into graduate school” (mind reading). Then you start to tell yourself, “I’m going to fail out of school. I’ll never get my degree” (fortune telling).
- Why it’s distorted: No one can read the future or read other people’s minds. We’ve all had times when our casual predictions or expectations were wrong, so we should never jump to firm conclusions without having firm evidence.
- Magnification (or Catastrophizing) and Minimization. You exaggerate the importance of things (e.g. mistakes you’ve made), or you inappropriately shrink things (e.g. your achievements or someone else’s imperfections).
- For example: You turn in your paper and, after the fact, realize that you left a typo in the title. You think, “This is a disaster. My professor is going to lose all respect for me. She might even fail me!”
- Why it’s distorted: By definition, when you minimize or magnify things, you’re assigning outsized meaning to them based on emotions, anxieties, or opinions, not on objective facts. Something may feel like a “disaster” in the moment, but it’s important to soberly and rationally assess facts to determine whether something really is a big deal (hint: it’s usually not).
- Emotional reasoning: You assume that your emotions necessarily reflect the way things are (facts).
- For example: You feel intimidated by an upcoming assignment, so you decide that you are unprepared for it or incapable of succeeding at it (“it’s a fact”).
- Why it’s distorted: As mentioned earlier, emotions are not always reliable guides to reality. For example, some people are deathly afraid of snakes and others feel similarly about cockroaches. While some snakes are deadly (so perhaps this is a rational fear), cockroaches are, for the most part, harmless. Feeling something doesn’t make it true.
- Should statements. You motivate or castigate yourself with “shoulds,” “musts,” and “oughts.”
- For example: Your professor expresses dissatisfaction with some of your academic writing skills and suggests that you visit the Graduate Writing Specialist. You think: “What’s wrong with me? I’ve been in school for years—I should be able to write well by now.”
- Why it’s distorted: You’re replacing a preference (e.g. “I’d prefer my academic writing skills to be more advanced”) with a necessity (“I MUST have acquired these skills by now—therefore, if I haven’t, I’m a failure”). People develop at different rates, and life events can unfold in many different ways. There is no law of nature that requires your preferences or expectations to be realized in fact.
- Labeling and Mislabeling. You label people, rather than behavior, as essentially good or bad.
- For example: You make a mistake or fail at something, and instead of simply acknowledging the failure, you tell yourself “I’m a loser.” Or, someone does something to upset you and you tell yourself, “that person is a total jerk.”
- Why it’s distorted: Bad behavior does not necessarily make a “bad person.” As suggested earlier, it’s almost impossible to be a “jerk” or “loser” 100% of the time (e.g. by failing at absolutely every undertaking, or being malicious on every possible occasion). So, labeling yourself and others in such absolutist terms is unhelpful and inaccurate.
- Personalization. You blame yourself for external events that you were not primarily responsible for.
- For example: You struggle with the shift to online learning as a result of the pandemic, and you end up earning a lower course grade than you expected. You tell yourself, “I screwed up. I should have worked harder.”
- Why it’s distorted: While it’s healthy to take responsibility for your actions, it is unhealthy to blame yourself for events outside of your control. You didn’t cause the pandemic, so you cannot be 100% responsible for every negative outcome of it, including your own responses to it. See Succeeding during the Pandemic, Part 1 for more on this point.
There are other possible distortions. In fact, distortions are closely related to logical fallacies and cognitive biases, of which there are far more than 10. However, as mentioned, most cases of depression involve these 10.
A few things to keep in mind about cognitive distortions:
- A single negative thought can involve multiple distortions. Consider the thought: “I’m so stupid, because I always mess everything up and fail at everything, just like I’m going to do with my dissertation.” That is (arguably) a single thought that involves all-or-nothing-thinking, overgeneralization, fortune telling, and labeling (and possibly more).
- Feelings cannot be distorted. Only thoughts can. For example, you might feel (the emotions of) sadness and anger because you think (the distorted thought) that you are a “hopeless loser who will certainly fail at graduate school.” Recognizing the distortions involved in this thought can help eliminate the emotions caused by it. But it’s incorrect, and usually unhelpful, to tell yourself “My sadness is distorted”; in fact, it can lead to further distortions (e.g. “There is something wrong with me because I’m sad”).
- Questions are not thoughts. The questions, “What’s wrong with me? Why am I not good at this?” are not thoughts (in CBT terms, at least). But they can be re-stated as thoughts by putting them in statement form, for example: “There is something wrong with me. I should be better at this.”
- Not all negative thoughts are distorted. For example, if you lose a loved one, it is completely natural and healthy to feel sadness and grief. Such feelings need not be distorted. In fact, these feelings show that you loved the departed person, which is a beautiful thing. However, thoughts like “my loved one is gone, therefore I will never be happy again,” or “I cannot live without my loved one” do involve distortions. Such distorted thoughts can lead to depression. Burns’s website, FeelingGood.com, offers a free online quiz that can help you determine whether you are suffering from depression.
Now that you have a handle on cognitive distortions, let’s look at some ways of overcoming them.
Overcoming Cognitive Distortions
There are hundreds of CBT techniques for overcoming cognitive distortions and developing a healthier outlook. What follows is one of the most common and easiest-to-use:
The Daily Mood Log/Triple Column
- Identify a topic or event that’s upsetting you. At the top of either a paper or a computer document, write the negative emotions you’re feeling as a result of this event or topic. For example, you could write, “I feel: angry, sad, humiliated, irritated.” Writing is very important in CBT—it helps you to identify your thoughts and feelings and create a healthy “analytical distance” from them.
- Draw 2 vertical lines on your paper to create 3 columns (see an example here). In the first (leftmost) column, write down the negative thoughts that cause the emotions listed in part 1. The previous discussion of distortions gave multiple examples of negative thoughts, including “I’m a loser” and “My professor will lose all respect for me” and “Everything is ruined and awful now.” Write down your own. This exercise is just for you, so be honest.
- In the middle column, identify and write down any distortions that are present in each negative thought. This process can be challenging, but you’ll get better with practice. Refer back to the list of distortions as needed. Remember that a single thought can involve multiple distortions.
- In the last (rightmost) column, write down rational, undistorted thoughts to replace your irrational, distorted thoughts. Make sure that the rational thoughts are truthful statements of fact, not simply “cheerleading.” For example, if the thought is “I’m a loser; I fail at everything,” a “cheerleading” response would be: “No, I’m awesome.” It’s positive, and might make you feel good, but it contains only opinions, not facts. A fact-based rational response would be: “It’s true that I fail at some things. But I’ve also been successful at many things. For example, I completed my BA, I got admitted to grad school, and I earned an A in my methods class last semester.” Notice that it can be helpful to acknowledge the truth in the negative thought (“I fail at some things”) as long as you also respond to the distorted part (“I don’t fail at EVERYTHING”).
For more information, see this episode of the Feeling Good podcast, which includes links to some sample daily mood logs.
The Daily Mood Log/Triple Column is only one of many helpful CBT techniques for beating depression, anxiety, and stress. Here are a few others:
- The Double Standard. This technique is one of the simplest methods for overcoming cognitive distortions. Imagine that a close friend or family member has come to you and expressed a negative thought identical to one that is bothering you, for example: “I think I’m too stupid to succeed.” Imagine how you would respond to this person, and then apply that same love, compassion, and empathy to yourself.
- Putting Your Thoughts on Trial. When you “put your thoughts on trial,” you subject your distorted thoughts to a mock court case. You evaluate concrete, factual evidence for and against each thought, similar to how a jury might assess a defendant’s guilt or innocence in a criminal court. If your thoughts are indeed distorted, you’ll quickly realize how little evidence there is “in their defense.”
- The Downward Arrow: In addition to negative thoughts, many of us hang on to destructive values that makes us unhappy. Burns calls these “toxic” values “self defeating beliefs” (they are also sometimes called “core beliefs”). A useful technique for uncovering self-defeating beliefs is the “downward arrow technique,” which requires you to interrogate a distorted thought by asking yourself “What would that mean to me if it were true?” or “Why is that upsetting to me?” For each answer—which takes the form, “It would mean that (blank)” or “Because (blank)”—you apply the same questions to the “blank” part. You keep repeating this process until you uncover your deep-seated self-defeating beliefs.
Consult the further reading selections at the bottom of this page for more information on CBT techniques for overcoming negative emotions by crushing cognitive distortions.
Next steps and final thoughts
Even after you become effective at identifying and crushing the distortions in your thinking, and even if you replace your old self-defeating beliefs with new, healthy, life-affirming values, negative feelings are bound to recur now and then. When this happens, give yourself a “tune-up” by returning to whichever technique worked best for you in the past.
In a larger sense, occasional negative feelings are an unavoidable part of life. No one should expect to be elated all day, every day. David Burns likes to joke that we’re all entitled to 5 good days and 2 bad days every week. If you have fewer than 5 good days, you might be depressed and need to do some CBT techniques. If you have more than 5 good days, you might be getting a little manic and need to be prescribed a mood stabilizer like lithium. So, as long as you’re not falling into depression, which is characterized by distorted feelings of hopelessness, personal worthlessness, and despair, then it’s perfectly natural to feel down sometimes. In fact, failing to recognize this fact is a consequence of a distorted “should” statement: “I should be happy all the time.” While we might prefer such perennial happiness, it isn’t realistic to demand it.
Finally, this page has focused on personal CBT self-help. But there is also a whole category of interpersonal CBT techniques that focus on getting along with others. During the stress of the pandemic, which for many people involves quarantining in uncomfortably close quarters with housemates or family members, such techniques are especially relevant. Fully discussing this interpersonal model is outside the scope of this page, but it is worthwhile to draw your attention to episodes 54-57 and 65-71 of the Feeling Good Podcast along with useful concepts like the 5 Secrets of Effective Communication, the aforementioned self-defeating beliefs, and Burns’s law of opposites.
Mood disorders like depression likely do not have a single cause, and experts have not reached consensus on exactly what the causes are. Regardless, CBT techniques have been shown to be effective at improving mood and reducing depression. In some ways, these techniques are like the positive coping habits of happy, well-adjusted people. Perhaps some people are born into perfectly well-adjusted, loving families, and grow up knowing instinctually how to respond with equanimity and poise to whatever life throws at them. If you are one of these people, count yourself lucky. For the rest of us, there’s CBT.
Burns, D. (1980). Feeling good: The new mood therapy. Harper.
Burns, D. (2020). The feeling good podcast. https://feelinggood.com/list-of-feeling-good-podcasts/ (the podcast includes a 7-episode series specifically devoted to the COVID-19 pandemic: The CoronaCast series).
Burns, D. (2010). Feeling good together. Harmony.
Padesky, C. A. & Greenberger, D. (2015). Mind over mood: Change how you feel by changing the way you think (2nd ed.). Guilford Press.
Mewburn, I. (2020, July 8). How not to be an academic a--hole during COVID. The Thesis Whisperer. https://thesiswhisperer.com/2020/07/08/lets-just-stop-it-with-the-toxic-positivity/
Suttie, J. (2020, July 29). A psychiatrist’s tips for calming your pandemic stress. Greater Good Center. https://greatergood.berkeley.edu/article/item/a_psychiatrists_tips_for_calming_your_pandemic_stress