If you value the relationship more, you may let go of the attempt to make her stop smoking. These choices are not easy, but you can approach them assertively. This negative self-talk is very damaging and we do it a lot. It just keeps eroding our morale, damaging our self-esteem and our self-image. As the patient's therapy progresses, we will be able to identify this kind of self-talk and look at where it came from, when they were a child. We can study the situation now from an adult viewpoint and see how inappropriate that reaction was. Saying things like that is not the way an adult is supposed to treat a child. However, for many of us, especially those of us with ADD, that is the kind of message we got, even if it wasn't always spoken out loud. We just took it in and it became a part of us, as if it was valid. And now we say those things to ourselves. By the way, ADD has nothing to do with intelligence; we cover the full range from impaired to genius, just like the general population. Thomas Edison and Leonardo da Vinci had ADD. ADD does cause impulsiveness, and our tendency to mess up, and we're often also clumsy, but that's not because we're stupid. At its extreme, medical incidents can drive people to financial ruin. Over 60 percent of all bankruptcies in the United States in 2007 were driven by medical incidents. The share of bankruptcies attributable to medical problems rose by 50 percent between 2001 and 2007. I firmly believe that one of the most critical parts of your financial and health planning is to have insurance. Countless individuals do not take the necessary precautions to insure themselves for sudden and unexpected emergencies. As a direct result, out-of-pocket expenses can be devastating and overwhelming. Self-talk is ubiquitous; we're all doing it all the time.

But we can learn to use it. As a patient becomes aware of their self-talk we can work with it in therapy. It's hard to stop negative self-talk, although that is the goal. The first step is spotting. The next is countering. I ask the patient to think of a "helpful encourager", a good aunt or uncle or grandmother, or how they would choose to talk to one of their own children. So if the patient is about to take a test and notices the tapes saying, "You're going to fail; you always mess things up. There is no way you can pass this; you've goofed off and you haven't studied enough," they can counter this and give themselves the same kind of talk the encourager would give : "Wait a minute! You've studied pretty hard. Maybe you don't know it perfectly but you have a good chance of passing. You passed the last test you took and it was as hard as this one. And if you don't pass it, so what? It's not the end of the world. You're still a good person. It just means that you'll need to study some more and then try again. And it will be easier next time because you'll have taken the test once and you'll know what it's like. So just go in and do what you can. Then we'll see how it comes out and what you need to do next." Thus you can counter negative self-talk with positive self-talk. What you can expect, though, is that the more you use your new language - positive thinking - the more you will improve and the more you improve, the more likely you will be to use that language or think in that way again. Remember the science: when you think or do something new, you create new connections - neural pathways - in your brain.

Every time you repeat a behaviour or way of thinking, your brain uses those same neural pathways and they become stronger and deeper. So, when it comes to thinking in a different way, just like using a new language, every time you practise using it you make it more likely that it will become your predominant way of thinking. And if, for one reason or another, you find yourself slipping into negative thinking, just remember that all is not lost! It's amazing how quickly you can turn this around; you have a chance to practise positive thinking again every time you're aware that you need to do so. As Oprah Winfrey said `The greatest discovery of all time is that a person can change their future by merely changing their attitude.' Choose a positive attitude! I will do some of this countering in the therapy, usually in the form of questions, "So if you don't pass, what would that mean? What would it say about you as a person?" Then we can discuss the answers, but the person needs to learn to use the countering self-talk on their own. They don't have to just let the negative self-talk hog the floor. This is an actual example from work with a patient who was about to take a difficult professional test. She in fact didn't pass it the first time, but she did learn about countering the negative self-talk, and she passed it easily the second time. Even if a conversation does not go as well as you hoped, remember to congratulate yourself for trying to change. Communication is a work in progress and change takes time. You might even give yourself a small reward for trying, like a favourite snack or some "downtime." Assertive delayDon't say "yes" to any requests immediately. Give yourself time to think before you decide on your answer. For example, you could say: "Let me think about it, and I'll get back to you" or "Once I have looked at my schedule I'll give you my answer." Accept compliments. Whenever someone pays you a compliment this week, instead of casting it aside, practice acknowledging and accepting it. For example, you could say: "Thank you" or "I'm glad you liked it" or "Thanks. I appreciate the fact that you noticed." Learning assertive communication strategies can help you get your needs met in a way that is direct, honest and respectful to others. It takes time and practice to learn a different way of communicating, so be patient with yourself and learn from any mistakes along the way. If you have something to say, but don't know how to put it into words, try following the "3 F" script by stating the facts, feelings and a fair request.

Using assertive body language, negotiating, saying no and dealing with criticism are all useful assertive skills. There are many ways to counter negative selftalk. You can call on the internal helpful encourager, whoever that may be for you: "It's going to be alright; you're going to be fine." You can bring up facts: "Well, the last two times, I did fine. In fact, I've only really messed up once, and that was a long time ago, and it wasn't the end of the world anyway." You can just argue in your own defense: "I am not stupid! I am a worthwhile person who has accomplished a lot and come through a lot of hard times." You can use hard logic: "Is there any real data to support that idea? Is there any data that refutes it?" You probably will need several different types of insurance policies if you want to safeguard your health and finances to live a comfortable economic existence. In my case, a close friend, Thell Dodd, a former financial analyst, mentored me. Thell, who is twenty years older than I am, talked in detail about the importance of having insurance and the different types of insurance policies to consider, such as homeowners, auto, disability, health, life, and long-term care policies. I remember her saying, Carolyn, you are only in your thirties and you're healthy. This is the time you need to get prepared for the just-in-case. Years later, I can't tell you how grateful I am that I listened to my friend. It may be hard to stop the negative self-talk, but there is no requirement that you let it have the floor all to itself or go unchallenged. Therapy can be very helpful with this, but you can learn to handle it on your own even if you're not getting therapy. It's clear how the negative self-talk can produce more discouragement and demoralization. It also increases anxiety and helps set up a self-fulfilling prophecy. It's harder to get yourself to study for a test that you know you're going to fail anyway. And the anxiety about failing markedly decreases the effectiveness of your studying. Then the anxiety you have while taking the test interferes with your memory and your ability to think clearly. It can possibly even induce brain freeze, which we'll discuss later. So you fail the test, which is what you always knew was going to happen anyway.

Self-talk tends to lead to self-fulfilling prophecies. "Oh, I'm not going to be able to do this. This isn't going to turn out well. I'll mess this up too." Then we mess it up. It doesn't turn out well. This is what I always used to do with projects before I carefully and successfully built the cabinets I'm going to tell you about. Since I knew that a project wasn't going to turn out well, I didn't want to waste much time on it, so I would rush through it and take short cuts. To save time (and to protect my self-esteem), I wouldn't plan it out or get the right tools for the job. I would just dive in and rush and slop through it. And guess what? It didn't turn out well. I've had to learn to listen to myself, to listen for those negative messages and to counter them. And I remind myself of those cabinets. Perfectionism is the bane of many who feel pressured, stressed, and miserable because they wrongly make their human value depend on their work performances, how well they get along with others, controlling uncertain conditions, and more. Perpetual stress also is on the horizon for those who expect others to think and behave in a certain way, and for life to unfold blissfully. Unlike standards for excellence, perfectionism standards for attaining self-worth are preludes for feeling like a failure even if you achieve eminent successes. Worse, striving for something that cannot be detracts from having quality relationships and an enjoyable career. Lessen this toxic form of perfectionism and you can lessen these related problems as well. There is more. When perfectionism cuts across different forms of depression, anxiety, and other unpleasant states, perfectionism balloons the misery.