TREATMENT Client to write about each of the following heading and how they impact on their life.

Self-references: "People always focuses attention on me, especially when I fail."

Selective abstraction: "Only my failures matter. I am measured by my failures."

Overgeneralizing: "If something is true in one setting, it is true in every setting."

Excessive responsibility: "I am responsible for every failure and every bad thing that happens."

Dichotomous thinking: Viewing the world in extremes, black or white, with nothing in between.

Worthlessness can be described as a feeling of desperation and hopelessness . Individuals who

feel worthless may feel insignificant, useless, or believe they have nothing valuable to offer the

world. People diagnosed with depression often report these feelings, and children who were

neglected or abused may carry a sense of worthlessness into adulthood. When worthlessness leads

one to experience thoughts of suicide or causes other immediate crisis, it may be best to contact a

crisis hotline or seek other help right away.

UNDERSTANDING WORTHLESSNESS
Worthlessness, a feeling that may cause an individual to feel as if they have no significance

or purpose, can have a significant negative effect on emotional health. A recent study

conducted by researchers at Seoul National University found that feelings of worthlessness

were significantly associated with lifetime suicide attempt in adults who reported major

depression and had also experienced trauma . The study concluded that, among symptoms

of depression, worthlessness had the strongest association with lifetime suicide attempt.

Circumstances such as job loss, divorce, or financial difficulties can quickly cause someone

to become overwhelmed, and those who experience one setback after another may be more

likely to experience feelings of worthlessness and find themselves questioning whether their

lives have any meaning. People who experience worthlessness may find it difficult to see

any aspect of life as positive and may believe there is no prospect of improvement. This

perception is generally a distorted one and is often likely to result from underlying conditions

such as depression, anxiety , grief , or stress. The longer one experiences feelings of

worthlessness, however, the more difficult it may be for them to overcome these feelings

without help.

Feelings of worthlessness may develop into a prolonged state of negative mood, but

they can also affect physical health. A study evaluating the relationship between mortality

and worthlessness in Chinese men 65 and older found worthlessness, out of all other
symptoms of depression, was the only independent predictor of non-suicidal mortality in the

approximately 2,000 individuals studied. Five years after the study, 18.2% of the men who

had reported feelings of self-worthlessness, but only 9.9% of the men who did not report

feeling worthless, had died. This may be due to a variety of reasons, such as the likelihood

that individuals experiencing feelings of worthlessness may be less likely to seek

preventative health care or engage in health-promoting behaviors and may be more likely

to smoke or engage in other behaviors shown to negatively affect health. They may also be
more likely to lack social support.

PSYCHOLOGICAL ISSUES ASSOCIATED WITH WORTHLESSNESS

In the Diagnostic and Statistical Manual, worthlessness is associated mainly

with depression, but these feelings might also appear as symptoms

of schizophrenia , anxiety, or on certain personality spectrums. Strong feelings of

worthlessness in children may be indicative of peer conflicts or neglect or abuse and should

be taken seriously.The feeling of worthlessness may also be related to other feelings,

including hopelessness, guilt , persistent sadness, or loss of motivation .

Worthlessness may present in different ways. An individual might experience:

 Heavy, dull pain in the body

 Negative thoughts about oneself

 Tearfulness, despondency

 Social anxiety

 Loss of life purpose, diminished interest in life

 Thoughts of suicide

An individual who feels worthless may:

 Withdraw from relationships

 Abuse alcohol or drugs

 Have diminished emotional expression

 Continually verbalize negative thoughts

 Become lethargic
  Neglect self-care /activities of daily living, such as showering, eating, and washing

one's clothes

TO ADDRESS WORTHLESSNESS
When one's feelings of worthlessness go unaddressed, they may rapidly become

overwhelming and interfere significantly with the ability to function. It may be difficult to cope

with these feelings without professional help, and when worthlessness occurs as a symptom

of depression or any mental health condition, other than immediate crisis, therapy is often

beneficial.

CASE EXAMPLES
 Feeling unlovable and insignificant: Greta, 29, sees a therapist. She reports that she feels like

crying all the time and that once she starts crying, she finds it difficult to stop. She feels

insignificant, believing no one cares for her, and she tells the therapist she thinks she has no

value as a person and no one will ever love her. Antidepressants , prescribed by a previous

therapist, have helped her a little, but she says they cause her to feel anxious and lose sleep.

They also have sexual side effects, and Greta believes her last relationship ended as a

consequence of these side effects, which led to an increase in her feelings of worthlessness. She

says she has considered suicide briefly, but not seriously, and admits to the therapist that she

drinks too much and too frequently. After a few sessions, Greta reveals a sense of frustration

with the path her life has taken and deep feelings of anger toward her parents, whom she
describes as critical and distant. She tells the therapist that she chose her college and career in

an attempt to win their approval, but her plan failed, leaving her unhappily employed at a job

she does not enjoy. Therapy—and hard work in her personal life—helps Greta develop a sense

of competence and increases her motivation to work toward what she truly desires for herself.

This strengthens her sense of self, and she reports feeling hopeful for the future, which, she

tells the therapist, she thought she would "never feel again."

 Experiencing worthlessness while questioning sexual orientation: Derek, 14, is brought to

therapy by his parents, who report that he shows little emotion, has withdrawn socially, and is

suddenly performing poorly in school. His parents suspect drug use, telling the therapist that

Derek's older sister showed the same signs when she was using drugs, but Derek strongly

denies any drug use. The therapist meets alone with Derek and discovers he is questioning
 his sexual orientation and is afraid to tell his parents, who, he states, will not "let" him be gay.

He tells the therapist there must be something wrong with him, and he must have a "disease"

that makes him "think about other boys." Through several sessions, the therapist works with

Derek to address the negative beliefs he holds, relaying facts about sexual orientation without

trying to convince Derek of anything. He tells Derek many young men have thoughts about

other boys as part of normal sexual development, whether or not they later identify as gay,

bisexual, or queer. He also tells Derek research has shown homosexuality is a normal sexual

orientation, not a disease or an illness. After a few sessions, Derek reports an improvement in

his depressed mood. He has been able to focus on his schoolwork and household

responsibilities, and his parents are pleased with his progress. He tells the therapist he is not

yet ready to tell them what caused his distress. Derek also expresses a wish to join a queer

youth group, and the therapist helps him find a group nearby. Derek continues to attend therapy

sessions on occasion and reports that the youth group is extremely helpful.