"I'll never get pregnant." "I'll never have a baby." "I'll never be a parent." "It's my fault." "I must have done something really wicked and evil." "God is punishing me." "It's because of that abortion I had years ago." "I should have started sooner." "I'm a failure as a wife and woman." "I'm a failure in life."


Any of these thoughts sound familiar?? These and other variations are all too often thoughts running like an endless tape loop through the minds of women experiencing infertility. This negative automatic tape gets going and is hard to stop as it spirals into worse and worse thoughts and therefore seriously affects emotions and behavior.

Most of these thoughts are what we call irrational and distorted, that is to say, they are not true and do not make sense. This is what Dr. Alice Domar calls the "nasty mind" which will not give up and let a positive thought in. Dr. Domar is the founder of the well-known mind/body program for infertility that has for 15 years been helping women handle the stress, depression and anxiety of infertility. Learning to cognitively "restructure" or "reframe" these negative thoughts is one of the cornerstones of mind/body programs in general and of Dr. Domar's infertility program in particular.

Cognitive restructuring is a "rethinking" process which comes out of the field of cognitive therapy. I like to describe it as "learning to think about how you think, and learning to reframe negative self-talk." Cognitive therapy is one of the most successful approaches to treating depression. While the early research and work in this field was done by Dr. Aaron Beck, the wider applications have been popularized by Dr. David Burns in his Feeling Good Handbook. The premise is fairly simple: thoughts and attitudes cause your moods - not external events. Therefore, if you change your thoughts, you can change your moods and emotions. Maybe sometimes easier said than done!

In the case of infertility patients in particular, negative thoughts such as the ones above contribute to a feeling of depression, sadness, worthlessness and hopelessness. If the cognitive restructuring process can be applied by the patient to that negative, often distorted thinking, the research is very clear - depression decreases, anxiety decreases, self-esteem increases, and stress in general is handled better. The idea is to try to become aware of the negative thoughts, figure out if they are true, challenge them if they are not true, and come up with a thought/statement that is more accurate.

Clearly, however, some negative thoughts may also be accurate and can't be restructured - the thought "I should have started sooner" may have an element of truth if you are trying to have your first child at age 44. Even though the circumstances are such that you have just gotten married for the first time or remarried, and couldn't really start a family sooner, there is still the tendency to blame yourself for not starting sooner. The truth is that you can't know what you didn't know, and you couldn't foresee a problem, so sometimes it's good to cut yourself a little slack about "should haves."

A fairly simple approach to begin to challenge some of the negative thoughts is one which Dr. Domar uses in her program and which I also use in my mind/body groups in Houston. As Dr. Domar points out, and as you will find, the process is simple but not necessarily easy. There are four questions to ask and answer about those negative thoughts that keep jumping around in your mind:

Does this thought cause me stress?
Where did I learn this thought?
Is this thought logical?
Is this thought true?

For example, using the recurring thought, "I'll never get pregnant," the dialogue might go like this:

Q: Does this thought cause you stress?
A: Yes.
Q: Where did you learn this thought?
A: Well, I haven't been able to get pregnant, so I don't think I can.
Q: Is this thought logical?
A: Well it seems logical based on the past.
Q: Is this thought true? Has anyone said you can't get pregnant?
A: I don't know. It seems true and logical to me since I haven't been able to get
pregnant. No, all the doctors say there's no physical reason why I can't get pregnant.
Q: If you don't think you can get pregnant, why do you keep trying?
A: I guess part of me still thinks I can get pregnant.

A reframe of the original thought might be, "Right now I'm having an infertility problem. I'm doing everything I can do address that. I may be able to get pregnant. Maybe I can have a baby. I'll leave open the possibility. I don't know what the future will bring."

The most important outcome of this process is to keep hope alive and to stay out of depressed thinking, which feeds on itself and makes everything appear so bleak. Practice the above process with a friend - it helps with the infertility distress and with life in general.

Mary Jane White, M.S., L.M.S.W. is the Director of Wellness Works and the Mind/Body Wellness Program for Infertility in Houston, TX. Cognitive restructuring is a major part of the work she does with her infertility groups. For more information on her program in Houston, contact Mary Jane at 713.874.1878 or by email at mjwhite22@aol.com.

For more information on cognitive therapy and cognitive restructuring applied to infertility, see:
Healing Mind, Healthy Woman, Alice D. Domar, Ph.D.
Conquering Infertility, Alice D. Domar, Ph.D.
The Feeling Good Handbook, David D. Burns, M.D.