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'Sad is how I am!' Treating Dysthymia in Children and Adults

Section 25
Children & Adults: From “Fight or Flight” to Unworthiness

Question 25 |
Test | Table of Contents

The primary emotions generated by the Fight or Flight Response are anger (the emotional energy to fight) and fear (the emotional energy to flee). Contained within these two are most of the feelings we generally associate with the word negative. Consider these lists:

guilt (anger at oneself)
hurt (you're usually upset with someone else, or yourself, or both)
shyness (a general fear of others)
grieving (fear that you'll never love or be loved again)

Any others you’d care to add from your own repertoire could probably be considered a variation of anger or fear -- or a combination of the two.

The problem with either emotion -- in addition to the obvious unpleasantness -- is that both tend to mar logical, rational, life-supporting decisions.

How often have you waded into a confrontation, only to find that, as the saying goes, you had stirred up a hornet’s nest?

Peter: While on vacation, I received a traffic ticket from a particularly obnoxious police officer. A ticket plus insults! Too much was enough. I stormed over to the local police station and reported the offending public servant to his superior. While listening to my story, the police captain was tapping into his computer. I thought he was taking some sort of formal report. Oh, boy. The nasty policeman was really in trouble now. What the captain was doing, however was looking up my driving record. He discovered an unpaid traffic ticket of mine from a vacation I had taken seven years before. I was placed under arrest. The anger quickly turned to fear. My anger cost me $110 and several hours in the cooler. Now I know why they call it the cooler.

On the other hand, the cave man could have, at the first sound of a snap, run away. (Remember the movie Monty Python and the Holy Grail? Whenever King Arthur’s men were in even the slightest danger, their battle cry, as they fled in all different directions, was, “Run away! Run away!”) This meant that every time a rabbit snapped a twig or two gophers were going for it in the underbrush, the cave man would abandon his plowing and head for the high country. He would eventually abandon his field, vowing never to return to such a wild and savage place again.

How many fields have you abandoned in your life? The field of a challenging new career? The field of a more fulfilling place to live? The field of relationships? (That’s “relationships” as in “true love, a many-splendored thing.”) The field of your dreams? Because people are afraid of fear, they give up acre after acre of their own life. Some find the snapping of twigs so uncomfortable that they abandon the territory of life altogether.

Where Does Negative Thinking Come From? Or, Why Are We Doing This to Ourselves?
Why do we use the power of our mind to create a negative reality? If our mind can generate health, wealth and happiness as easily as illness, poverty and despair, why aren’t we healthy, wealthy and happy all the time?

If a genie appeared and offered you a choice -- health, wealth and happiness or illness, poverty and despair -- which would you choose? If positivity is the obvious choice, why do we sometimes choose the negative? There must be something else, something deeper within us generating the impulse to think negatively. Although you may have another word to describe the phenomenon, we call this wellspring of negative thinking unworthiness. It’s more than just a feeling or a passing thought. It’s a ground of being, a deep-seated belief that, “I’m just not good enough.” Other phrases for it include insecurity, undeservingness or low self-esteem. Unworthiness undermines all our positive ideas and validates all our negative thoughts.

When we think something good about ourselves, unworthiness pops up and says, “No, you’re not.” When we desire something positive for ourselves, unworthiness says, “You don’t deserve it.” When something good happens to us, unworthiness says, often with our own lips, “This is too good to be true!” When we think something bad about ourselves, unworthiness agrees, “Yes that’s true, and furthermore...” When we tell ourselves we can’t have or do something we want, unworthiness says, “Now you’re being realistic.” When something bad happens to us, unworthiness is the first to point out, “See, I was right all along. I told you so.”

You can think of unworthiness as a vulture that sits on your shoulder, squawking in your ear a seemingly endless stream of “You can’t do it,” “You’re not good enough,” “Don’t even try,” “Who do you think you are?” “You’ll never make it,” “Settle down,” “You don’t deserve it,” and “Somebody better than you should have it.”

Some people cover their unworthiness with an air of self-confidence and an outward bravado bordering on arrogance. Their cover-up includes a self-indulgence and self-absorption that are almost selfish. These people, it appears on the surface, could use a healthy does of unworthiness. But in reality, they are merely involved in a desperate attempt to hide -- from themselves as much as from anyone else -- the fact that they just don’t feel worth it. They think the unworthiness is true, not just another illusion, and they respond by concealing it rather than laughing at it. (Did you ever try to conceal a vulture? It can be pretty funny -- to everyone but the person concealing.)

If unworthiness is so fundamental, does this mean we’re born with it? We believe humans were born to have joy and to have it more abundantly; that the birthright of everyone is loving, caring, sharing and abundance. All the negative stuff has just been layered on top of our essential core of goodness. So where does unworthiness come from? A look at how children are raised might offer a clue.

Imagine a child -- at two, three or four -- playing alone in a room. An adult, usually a parent, is nearby. What for? To come in and praise the child every five minutes? No. For “supervision.” (Did your parents have super-vision?) The adult is there to be on hand “in case there’s any trouble.” The child is playing and having a wonderful time. Two hours go by. The child is “behaving” wonderfully. The interaction with the adult has been minimal.

Suddenly, the child knocks a lamp off a table. It crashes to the floor. What happens next? Lots of interaction with the adult, almost all of it negative. Yelling, screaming (“This was my favorite lamp,” “How many times have I told you?” “Bad, bad, bad”) and probably, for good measure, some form of physical punishment (spanking, deprivation of a toy, etc.). Almost the only interaction in two hours from the adult community was, “You are bad. Shame on you.”

As an infant, we get unconditional, almost never-ending praise. Goo-goo ga-ga. Once we grow a little and begin exploring our world, our primary form of interaction with adults -- the symbols of power, love, authority and life itself -- is usually corrective. Don’t do this. Don’t do that. (This phase in growth is known as the “Terrible Twos” by the people who write how-to-raise-children book -- real positive, huh?)

If we draw a picture, we get praise. If we draw the same picture again, we get less praise. If we draw the same picture five times in a row, we are told to try something new. If we pour jam on the cat, we are scolded. If we pour jam on the cat a second time, we are scolded more severely. If we pour jam on the cat five times, we may begin wishing that, like that cat, we had nine lives.

The more we do something good, the less praise we get for it. The more we do something bad, the more punishment we receive. Some children learn to do negative things just to get attention, because even negative attention is better than no attention at all. Being ignored, to a child, can seem like abandonment.

A part of us inside begins to add up all the times we’re called “wonderful” and all the times we’re called “bad.” The bad seems to outnumber the wonderful by a significant margin. We may begin to believe we are bad. That unless we do something new and remarkable and tremendous, we’re not going to be thought of as good. That we must strive, work hard and never disobey if we hope to get even a little appreciation in this world. That our goodness must be earned because we are, after all, essentially bad.

Bad, unlovable, not good enough, undeserving, unworthy. We may grow to believe this about ourselves, and from this fertile ground spring our negative thoughts. Sure, we have a lot of positive thoughts, but the negative ones tend to be more believed. A positive thought, checked against this belief of unworthiness, is labeled “False.” A negative thought feels right at home. The unworthiness proclaims it true, accurate, right.

Adapted from You Can’t Afford The Luxury of a Negative Thought. John-Roger & McWilliams, Peter. Prelude Press: Los Angeles, California. (1990)

Depression in Adolescence

- Thapar, A., Collishoaw, St., Pine, D. S., and Thapar, A. K. (2012). Depression in Adolescence. Lancet, 79(9820). p. 1056-1067. doi:10.1016/S0140-6736(11)60871-4

“Personal Reflection” Journaling Activity #5
The preceding section was “Children & Adults: From 'Fight or Flight' to Unworthiness.” Write three case study examples regarding how you might use the content of this section of the Manual in your practice.

The Importance of Recognizing Worthlessness
for Suicide Prevention in Adolescents
with Attention-Deficit/Hyperactivity Disorder

Katzenmajer-Pump, L., Komáromy, D., & Balázs, J. (2022). The importance of recognizing worthlessness for suicide prevention in adolescents with Attention-deficit/hyperactivity disorder. Frontiers in psychiatry, 13, 969164.

Peer-Reviewed Journal Article References:
Chesin, M. S., Brodsky, B. S., Beeler, B., Benjamin-Phillips, C. A., Taghavi, I., & Stanley, B. (2018). Perceptions of adjunctive mindfulness-based cognitive therapy to prevent suicidal behavior among high suicide-risk outpatient participants. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(6), 451–460.

Geschwind, N., Bosgraaf, E., Bannink, F., & Peeters, F. (2020). Positivity pays off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression. Psychotherapy, 57(3), 366–378.

Gómez Penedo, J. M., Coyne, A. E., Constantino, M. J., Krieger, T., Hayes, A. M., & grosse Holtforth, M. (2020). Theory-specific patient change processes and mechanisms in different cognitive therapies for depression. Journal of Consulting and Clinical Psychology, 88(8), 774–785.

What generally happens the more the client does something well? To select and enter your answer go to

Section 26
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