"What if I make a mistake and embarrass myself?" "Maybe I could have done it before, but it's too late now." "I'll never be able to do it, so what's the point of trying?" Everyone hears negative "voices" in their heads, but for persons living with HIV/AIDS, they can have a serious impact on both emotional and physical health. Convincing ourselves that something negative -- whether it is related to finances, a relationship or our physical or emotional health -- is inevitable can actually affect its outcome, even if only by undermining our belief in ourselves.
For the most part, this self-talk isn't a conscious choice. It bubbles out of the subconscious and quietly and subtly whispers in our ear, undermining our self-worth and confidence. And we aren't born with these beliefs about ourselves -- they are mostly taught to us as children when we have few defenses against them. As adults, however, we can rewrite these tired, old scripts into self-talk that is much more affirming.
I have found it helpful to group similar types of negative self-talk into categories that make them much easier to identify and counteract. Some people might relate to just one of these categories, but for most of us, all of them will be familiar.
The Worrier promotes anxiety by jumping to the worst possible scenario, something therapists call "catastrophizing." The worrier can often be identified by the words "What if ...?" The Worrier scares us with often-grandiose fantasies of disaster when we are about to confront something we fear. This pattern can sometimes be traced to anxious parental messages eliciting a sense of fragility, or can result from the trauma of life events. For example, for years after surviving Non-Hodgkin's Lymphoma in the time before protease inhibitors, I worried that any ache or pain was certainly the return of a devastating cancer, even long after doctors cleared me. In addition to fabricating catastrophic endings, the Worrier plays a role in fears about embarrassment or making a mistake, thereby acting as a powerful force to limit us and keep our world small.
This form of negative self-talk primarily targets our self-worth: the value we place on our abilities and ourselves. It does this primarily with expressions of self-contempt such as, "That was stupid!" The Critic is among the most powerful forms of negative self-talk, constantly judging and evaluating our behavior, highlighting whenever possible to us (and perhaps others) our self-perceived flaws and limitations. I frequently see this in persons who have engaged in some form of high-risk behavior and berate themselves for that risk. For those already living with the HIV virus, it may involve harsh self-judgments about not paying attention to a medical symptom or missing a dose of medication. Of course, we do need to take responsibility for these behaviors, but berating and shaming ourselves does nothing to improve the situation.
And speaking of not taking responsibility, meet the Victim. This is the voice that often uses the words "I can't" and reflects that part of us that feels hopeless or helpless. Identifying too closely with the Victim is a sure path toward depression. The Victim is particularly dangerous for people living with HIV/AIDS since there is so much shame and stigma concerning the virus. This voice is rooted in the belief that there is something inherently wrong with us and that we are defective or unworthy. I hear this most often with clients saying, "I am damaged goods." While shame and stigma are very real and can be crippling, the way out of what some people have called the "victim trap" is not to embrace one's powerlessness, but rather the opposite. We need to gently take responsibility for our thoughts, feelings and actions (beware of another voice, the Critic, who likes to chime in at this point) and keep our lives moving forward.
Finally, meet the Perfectionist. Anytime our self-talk utilizes words like "should," "always," or "never," we are in dangerous territory. The Perfectionist doesn't do anything for us except put us into a place of chronic stress. The Perfectionist is closely related to the Critic, but encourages us to strive for perfection (as opposed to pushing us down). The Perfectionist is a perfect match for those parts of ourselves that we find undesirable or intolerable. Perfectionism can be a problem for people living with HIV/AIDS whose "normal" lives, occupations, relationships and even sense of a future have been interrupted. It often results in comparing ourselves with others in terms of externals, such as job, income and status, or can be seen in patterns of behavior, such as constantly trying to please others. Learning how to recognize our strengths, tolerate our mistakes and avoid repeating them is key to pulling the plug on the Perfectionist.
Counteracting Negative Self-Talk
Once identified, there are many ways to counteract negative self-talk. Some of the more effective ones are listed below:
- Engage Damage Control: When we succumb to one form or another of negative self-talk, things can quickly becoming worse when we overgeneralize from one mistake, reminding ourselves of every blunder we've ever made. One single "should" can spin into how we are the worst person ever. It is important to quickly and decisively limit the damage and remind ourselves that this chatter is confined to a very specific situation. Don't allow it to melt into oversimplified generalizations about everything in life. Many visual people find it helpful to picture that negative self-talk inside a wall or fence where it can be confined and brought under control.
- Perform a Reality Check: It is always helpful to take a step back from the situation and evaluate it the way a scientist might approach the issue. What is the evidence for this belief? Is this always true, and has it been true in the past? In the case of the Worrier, it's also useful to ask oneself about the odds of our worst fantasy outcome actually happening. Once we move past an emotional reaction, our more objective, thought-oriented prefrontal cortex can regain control. It is then useful to actually take a look at the worst thing that might (even remotely) happen. What would be so bad, and what could be done if it really happened? I remind myself of the difference between fruitless worry (which usually includes avoiding action) and actually making a plan for a bad outcome, even if it is highly unlikely. Planning one's response (versus endless worry), even in a situation where we have may have limited options, can provide a sense of control that can actually impact the outcome.
- Regain Balance: Once we are reacting to these voices along with their underlying, damaging thoughts about ourselves, it can be very difficult to think clearly and identify alternative, more affirming thoughts. At such times, while our minds dredge up everything related to a same or similar feeling, we are actually in a bit of shock that can be dissociative, making us feel somewhat detached from our feelings and physical sensations. Practicing some controlled breathing or physical movement or, after checking in with our body, drinking a hot or cold liquid, can help us move out of this reactive state. At that point, we will be able to take a step back and ask ourselves whether we are really seeing the whole picture. How many other times has this not been true?
- Reclaim Objectivity: Finally, it is important to be as objective about a situation as possible. Being able to observe the situation as if we were a third person can provide a more realistic, objective perspective. Psychologists have identified a phenomenon called "negativity bias" where we subconsciously pick out negative things around us, and over time, this becomes such an entrenched pattern that we actually lose awareness of positive things in our lives. One way to help reclaim objectivity is to ask ourselves what a friend might tell us, or in turn, how we might counsel a friend (with whom we are usually far more gentle than we are with ourselves).
No one escapes negative self-talk and, because it often represents such early "programming" of how we view ourselves, it can be persistent. Becoming aware of it, classifying it and actively counteracting it are very effective strategies for releasing the endless chatter in our ears and living our lives with more objectivity, balance and far more peace of mind.