This guide is written by clinical psychologists from Newcastle, North
Tyneside & Northumberland Mental Health NHS Trust. Used here with
permission.
These are the thoughts of two people who are depressed:
“I
feel so alone, I never see my friends now, I guess they have dropped
me. They probably don’t like me - who would? There is no point in
making any effort. It doesn’t pay off ... I just hate myself."
“I
feel like crying all the time, I am so tired and can’t get interested
in anything. In fact I don’t even get started with jobs I should be
doing, I can’t even do basic things that seem so easy to other people
...”
You may have had similar thoughts yourself. Depression
is a very common problem and many people feel low or down in the dumps
at times. This is often due to life stresses such as bereavement, money
or housing problems or difficulties in relationships. For some people
the problem becomes much worse and gets in the way of normal life.
How can this guide help me?
It may seem that
nothing can be done to help you feel better. But there are things that
you can do to make a difference. There is also further help you can get
if the depression does not seem to be getting any better.
This
guide aims to help you cope with depression and begin to get better.
The approach is called cognitive therapy. Cognitive therapy uses
methods that have been tried and tested and found to be effective. It
involves looking at the way you think about things.
We have
included pen and paper exercises in the guide to help you begin to
understand and begin to deal with depression practically. You should
find it helpful to complete these exercises.
What does research tell us about depression?
Life
is sometimes difficult and we know that factors such as low income,
divorce or relationship problems and loss of work can make people more
likely to become depressed. New research has helped us to understand
depression more clearly. We now realise that thoughts can also play an important role in depression. Changes in feelings may occur gradually,
but the way a person thinks about themselves when they are depressed is
very different from how they thought before. Perhaps you can think
about some examples of depressed thinking in yourself or in someone you
know who has depression.
Here are a few of our examples:
- The business man, who believes he is on the brink of bankruptcy.
- The caring mother who thinks she has lost interest in her children.
- The clever student who thinks he can’t concentrate.
- The ordinary man who thinks that he is useless because he has lost his job.
People who are depressed typically have these thoughts and at
the time they believe them to be true. When someone’s thoughts change
like this, they also begin to experience other changes.
These are some of the signs or symptoms that you may experience if you are depressed:
|
Emotions
or feelings - (tick if you feel like this)
-
Feeling sad, guilty, upset, numb or despairing
-
Losing interest or enjoyment in things
-
Crying a lot or unable to cry when a truly sad event occurs
-
Feeling alone even if you are in company
-
Feeling angry and irritable about the slightest things
Physical or Bodily Signs
|
Thoughts
-
Losing confidence in yourself
-
Expecting the worst and having negative or gloomy thoughts
-
Thinking that everything seems hopeless
-
Thinking you hate yourself
-
Poor memory or concentration
Behaviour
-
Having difficulty in making decisions
-
Can’t be bothered to do everyday tasks
-
Putting things off
-
Not doing things you used to enjoy
|
If
you have ticked many of these then you may be experiencing low mood or
depression. When you’re depressed you may believe that you’re helpless and alone in the world; you often blame yourself for all the shortcomings that you think you have.
At the bottom of all this you feel negative about yourself, about the world and about the future. So you tend to lose interest in what’s going on around you and you don’t get any satisfaction out of the things you used to enjoy. It can become hard to make decisions or to carry out little tasks that you once did with no problem at all.
In summary
Research now tells us that gloomy
thoughts play an important role in depression. When someone is
depressed there are usually changes in the way they feel - their
emotions, how their body reacts, what they think and how they behave.
How can I understand these feelings?
The way
you think about things affects the way you feel, which affects the way
you behave. It is difficult to change the way you feel, but you can
change the way you think.
When you are feeling depressed you
might have negative thoughts a lot of the time. With each negative
thought the feelings of depression are likely to increase.
Sometimes
negative thoughts can stop you from doing the things that you would
normally do. As a result, you may get critical thoughts about being
lazy, or irresponsible which make you feel even worse. In other words,
you get caught up in a vicious cycle.
For example:
Suppose you are walking down
the street and you see a friend who appears to ignore you completely.
You might wonder why your friend has turned against you and you feel a
little sad. Later on, you mention the incident to your friend who tells
you that he was preoccupied at the time and he didn’t even see you.
Normally you would feel better and put what happened out of your mind.
But if you’re depressed, you probably believe your friend has rejected
you. You may not even ask him about the incident, and then the mistake
goes uncorrected. If you’re feeling depressed you’re more likely to
make mistakes like this over and over again.
Has a similar cycle happened to you?
Try and draw it out.
Can I recognise these gloomy thoughts?
When you are feeling low the gloomy thoughts may be so familiar and happen so often to you that you just accept them as fact.
Gloomy thoughts are often about yourself, for example:
“I’m no good”, “People don’t like me”, “I’m a bad mixer”, “I look ugly”.
Do you have any gloomy thoughts about yourself? - jot them down.
These thoughts are sometimes about other things such as the world around you or the future. For example:
“People are unkind”, “the world is a horrible place”, “nothing will work out well”.
Do you have any gloomy thoughts about other things? - jot them down.
What more should I know about these gloomy negative thoughts?
We
have given examples of the negative thoughts people have when they are
depressed. It is important to remember that you might still
occasionally have some of these sorts of thoughts when you are not
depressed. The difference is that you would generally dismiss them from
your mind. When you are depressed, however, these thoughts are around
all the time.
Let's look at these negative thoughts in more detail:
- Negative thoughts tend to be automatic. They are not actually arrived at on the basis of reason and logic, they just seem to happen.
- Often the thoughts are unreasonable, and unrealistic.
They serve no purpose. All they do is make you feel bad and they get in
the way of what you really want out of life. If you think about them
carefully, you will probably find that you have jumped to a conclusion
which is not necessarily correct. For example, thinking someone doesn’t
like you because they haven’t phoned recently.
- Even though these thoughts are unreasonable they probably seem reasonable and correct to you at the time.
- The more you believe and accept negative thoughts, the worse you are likely to feel. If you allow yourself to get into the grip of these thoughts, you find you are viewing everything in a negative way.
When people become depressed their thinking often changes. They
may make some of the following errors when they are thinking negatively:
1. Exaggerating the negative
This means you
think things are much worse than they really are. For example you make
a small mistake at work and fear that you may be dismissed because of
it. In other words you jump to a gloomy conclusion and believe that it
is likely to happen. You may spend a long time worrying that you have
upset a friend only to find later she didn’t even remember the comment.
Do you ever exaggerate the negative?
Think back over the last 2 weeks and please list.
2. Overgeneralising
For example, if one
person doesn’t get on with you, you may think “no one likes me”. If one
of your many daily tasks hasn’t been finished you think “I’ve achieved
nothing - nothing has been done”.
In other words from
one thing that has happened to you, you draw a negative conclusion
which is much bigger and covers all sorts of things.
Do you ever overgeneralise?
Think back over the last 2 weeks and list examples.
3. Ignoring the positive
People who are
depressed tend to focus their thinking on negative or bad events and
ignore positive or good events. You might have had a game of football
and missed the goal once, but played well in general. After the game
you just think about that one missed shot and not the rest of the game
played well. You may have many good friends who you have known for
years but you concentrate and worry about one that has fallen out with
you rather than remembering all the other good friendships.
Do you sometimes ignore the positive?
Jot down examples from the last 2 weeks.
4. Taking things personally
Often if our
mood is low we blame ourselves for anything which goes wrong, even if
things have nothing to do with us in reality. For example, you go into
a local shop and the assistant who knows you is ‘off-hand‘, your
automatic thought is "she doesn’t like me ... ... have I done something
wrong?”, but the most likely reason is that she’s tired or upset or has
had a ‘bad day‘. In this example you have taken the blame personally.
Do you sometimes take things personally when they probably have little to do with you?
Give some examples from the last 2 weeks.
In Summary
When people are depressed they
often have gloomy or unhelpful thoughts about themselves, the world and
the future. They can also make errors in the way they think. They
exaggerate the negative, overgeneralise bad events, ignore positives in
their lives and can take things personally. It is important to uncover
gloomy thoughts and errors in thinking.
How can I help myself?
So far we have talked
about how what we think affects the way we feel. We have looked at
particular ways of thinking which can lead to us getting depressed. In
this section we will look at practical steps to help to overcome
depressive feelings and thoughts.
1. Making a daily plan
When people are depressed they often
don’t feel like doing anything, find it hard to decide what to do each
day and can end up doing very little.
Begin to tackle this by making a list of things you want to do. Then plan out an action list,
start off with the easiest task at first and don’t aim too high. Work
through your action list and tick off what you’ve done. At the end of
the day you’ll be able to look back and see what you’ve achieved. Physical exercise and activity
can really help to lift your mood. Try and build a little in each day.
Mixing with friends, family and neighbours can also help.
List
some exercise or activities which you could do. This can be as simple
as a brisk walk; or doing a crossword with a member of your family.
Try to fill in the following action plan – - continue with similar ones.
2. Achievements and pleasure
When people are
depressed they often forget what they’ve achieved and what they enjoy.
Most people have more things going for them than they are usually aware
of.
On your daily action plan write down all events of the
day, put a P next to those which have given you pleasure and an A next
to those activities where you felt you achieved something and did well.
Try not to be too modest; people who are depressed tend not to take
credit for their achievements. Try and build some pleasant events into
your day each day - treat yourself, it will help you.
3. The ABC of changing feelings
Most people
who are depressed think their lives are so awful that they have every
right to feel sad. In fact our feelings come from what we think about
and how we make sense of what has happened to us.
Try to think about a recent event which had upset and depressed you. You should be able to sort out three parts of it:
A. The event
B. Your thoughts about it
C. Your feelings about it
Most people are normally only aware of A and C. Let's look at an example.
Suppose someone at work criticises you for a piece of work you have done.
A. The event - criticism
B. Your thoughts - “He thinks I’m no good at my job, and he’s right I’m hopeless, I shouldn’t be in this job”
C. Your feelings - hurt, embarrassed
How
depressing! No wonder you feel bad! The important point about trying to
become aware of these three stages A, B and C is that we can change
what we think about an event and therefore we can change how we feel
about it.
4. Balancing
A useful technique to try is
called balancing. When you have a negative, critical thought, balance
it out by making a more positive statement to yourself. For example:
The thought: “I’m no good at my job”, could be balanced with: “my boss
said how much he appreciated the piece of work I did yesterday”.
5. The double column technique
Another thing
you could do is right down your negative automatic thoughts in one
column - and, opposite each one, write down a more balanced positive
thought. Like this:
6. Try and remember details
Research tells us that the
person who is depressed doesn’t remember detail of events but tends to
think in general statements, such as “I’ve never been any good at
anything”. Try and train yourself to remember details so that good
times and experiences are easy to recall. Think of particular times.
A
daily diary can help you to do this. Make lists of actual achievements
and good aspects of yourself such as “I’m always on time”, “I helped my
friend on Tuesday”, “My partner complimented me on my work last week”.
Try to keep a diary of events, feelings and thought. Use the approaches described to gain more balanced thoughts.
Look out for errors in thinking.
In summary.....
Using a
daily plan, mastery and achievement notes and
keeping a diary of
automatic thoughts and more
balanced thoughts can help you to fight depression and the gloomy thoughts that go with it.
7. Solving difficult problems
Sometimes we
feel overwhelmed by the very complicated and difficult things we have
to do. One thing which helps with this sort of problem is to write down each of the steps which you have to take in order to complete the job - then tackle one step at a time.
Problem
solving can seem more difficult when you feel depressed. If you have a
particular difficult problem, try and look back to times when you may
have successfully solved similar problems and use the same approach. Or
ask a friend what they would do in a similar situation.
Be
clear. Write down all your possible options. Use ‘brainstorming‘- where
even apparently silly solutions are written down to be considered.
Choose the best approach.
Try this way of problem solving yourself.
What is the problem? (Write it down).
Try the following:
List all sorts of solutions (brainstorming). Remember how you may have
solved similar problems in the past. What would your friends advise?
Choose the best of the above. (write it down).
Steps to tackle it:
Step 1.
Step 2.
Step 3.
Step 4.
Step 5.
8. Long term beliefs
Sometimes people have
long held views about themselves that are very self critical - for
example, “I’m not a very clever person” or “I’m not a very lovable
person”. These beliefs are often a product of our past experience and
may hold no truth in present reality. Try to challenge this self
criticism, stop knocking yourself down and look for evidence that
disproves the beliefs. What would you say to a good friend if they held
that belief about themselves?
9. Particularly stressful times
Many people
experience a difficult time in their lives that is linked with events
that they cannot change. For example, a bereavement, or several
bereavements over a short period, unemployment, longstanding illness,
chronic financial problems or isolation. Sometimes several of these
events happen together and depression can result. In time, most people
bounce back, but it may be hard to do this without help.
10. Further help
We hope you will use the
exercises suggested in this guide. They should help you to begin to
overcome your depression and get back control over your thoughts and
your life.
If you feel that you are making little progress then other help is available to aid you in overcoming your problem.
Your
family doctor is the best person to talk to first. He or she may
suggest a talking treatment or antidepressant tablets or both. He or
she may suggest you see a mental health worker who can offer expert
help with your problems. If you feel so depressed that thoughts of
harming yourself have been in your mind then visit your doctor as soon
as possible and tell him or her how you are feeling.
Where can I find extra help?
If you think
you may be depressed, your GP is the best person to talk to in the
first instance. They will have information about local services which
may be able to help. Help can be obtained from your practice nurse or
health visitor who is based at your GP practice.
The following organisations and help lines may also be useful:
Association for Post Natal Illness - for women who are experiencing depression following the birth of their baby
145 Dawes Road, London, SE6 7EB
Tel: 0207 386 0868
Cruse Bereavement Care - for bereaved people and those caring for bereaved people.
Tel: 0844 477 9400
Mind InfoLine
Tel: 0845 766 0163
National Debt Line. Help for anyone in debt or concerned they may fall into debt.
Tel: 0808 808 4000
Relate - help with marital or relationship problems
Tel: 0845 456 1310
Samaritans
Confidential support for anyone in a crisis
Tel: 08457 90 90 90
Some useful books which you may like to buy or borrow from your local library:
David Burns (1980) Feeling Good, The New Mood Therapy.
New AmericanLibrary. New York
Paul Gilbert (1999) Overcoming Depression
Kathy Naime and Gerrilyn Smith (1994). Dealing with Depression.
The Women’s Press.
Dorothy Rowe (1993). Depression: The Way Out of Your Prison.
Routledge.
Christine Padesky and Dennis Greenberger (1995)
Mind over Mood Guilford
© EMIS and PiP 2008 Updated: 22 May 2008
