Overcoming Depression For Dummies
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GPs: Most people go to their GP as the first port of call when they have what they think might be a medical, emotional, or a mental health problem. Your GP may then refer you to a specialist in a particular area, depending on what they think is likely to be the problem. Talking to your GP about symptoms of depression can be a very good way to start your treatment. GPs are responsible for more than 60 per cent of the prescriptions given for emotional disorders.
If you have told your GP about your depression and she doesn’t offer any help, follow up, or onward referral, you may want to consider changing your GP. Remember, you do have the right, as well as the need, to access effective help.
Psychiatrists: Psychiatrists receive more extensive training in the biological treatments of depression than any other prescribing group of professionals (see ‘Discovering who’s who in psychological therapy’ earlier in this chapter, for more information.) Psychiatrists regularly see patients with depression and other emotional disorders and have a lot of experience with the tricky side effects and drug interaction issues involved with antidepressant medication.
Professionals who don’t prescribe
The majority of mental health professionals aren’t licensed to prescribe antidepressant or any other medication, although they may have received some training and education about the use and effects of drugs.,. They include counsellors, physiologists, social workers, occupational therapists, psychotherapists and nurses (see the earlier ‘Discovering who’s who in psychological therapy’ for details of these professionals).
Pharmacists aren’t allowed to give you prescription drugs without a doctor’s prescription. However, pharmacists can advise you on the purchase of over-the-counter medications and complementary therapies (see Chapter 16), if you have a mild, uncomplicated form of depression (refer to Chapter 2 for more information about the different types of depression).
If you decide to take medication and also receive psychological therapy from another therapist, encourage your therapist to talk to the health care professional who is prescribing your medication. Good communication ensures that both professionals work together and head in the same direction, and that there is nothing conflicting in your treatment that may possibly harm your therapeutic progress.
Part II
Seeing Things More Clearly: Cognitive Therapy
In this part . . .
Cognitive therapy is the most widely researched approach to the treatment of depression. This research has consistently shown that cognitive therapy alleviates depression as well as, or better than, any other strategy in this book. For most of you who are battling depression, cognitive therapy will be one of your main weapons.
In the chapters that follow, we give you an understanding of the connections between depression and habitual ways of thinking. You can discover how depression distorts thinking. We also provide you with the tools to smooth ruffled thinking. Digging deeper, you can unearth the core beliefs that may be fertilising your depressive thinking. We provide ways to deal with troublesome beliefs. Finally, depression often interferes with memory, so we show you what you can do to manage this problem.
Chapter 5
Uncovering Underlying Thought Processes
In This Chapter
Introducing cognitive therapy
Understanding the connection between thoughts and feelings
Checking out what you are thinking and feeling
Exploring the four main types of distorted thinking
Have you ever been caught in a traffic jam? Horrible, right? Some people respond to traffic snarl ups by thumping on the steering wheel and muttering choice obscenities. Others turn up the radio and relax to soothing music. What’s the difference? The angry people have angry thoughts: ‘I just hate getting stuck in traffic. People today just don’t know how to drive! I can’t stand being late!’ Those who are more laid back have thoughts like, ‘No sense in getting upset by things I can’t control. I’ll get there when I get there. Actually, it’s quite nice to get the chance to listen to music.’
The way you think about or interpret events greatly affects the way you feel about them. In this chapter, we discuss the relationship between events and the thoughts and feelings that follow them. We also show you how to keep track of your thoughts and feelings, making you aware of how they influence your life. Then we look at how misperceptions, misjudgements, blame, and negative feelings distort thinking, feeding and deepening depression. And finally, we give you the tools and for dealing with those disturbing distortions to your thinking.
Thinking about Cognitive Therapy
Cognitive therapy, and the later development of cognitive behavioural therapy, are by far the most widely researched psychological treatments for depression. Studies repeatedly show that cognitive therapy lifts depression and reduces relapse.
Cognitive therapy is one of the psychological therapies. All psychological therapies involve working on your own, or with a therapist using psychological techniques to reduce emotional problems. Cognitive therapy primarily uses techniques designed to change your way of thinking, making you feel better.
A major idea underpinning cognitive therapy is the interconnected nature of feelings (which we also refer to as emotions) and thoughts. Thoughts strongly influence feelings, and vice versa. Both play an important role in the development and maintenance of depression.
But the story doesn’t end there. Physical factors can also play a role in depression. Factors such as fatigue, illness, and changes in blood chemistry can lower your mood, which, in turn, prepares the ground for the development of depressing thoughts.
For example, Colin tosses and turns through a third night. He’s not sure what’s causing his recent bout of insomnia, but every time he feels he’s about to fall asleep, another part of his body itches, or his position becomes uncomfortable. Colin’s day begins with a long rush-hour drive; irritability overtakes his usual calm acceptance. His tiredness worsens his growing worry. He starts to think, ‘What’s wrong with me? I’m not going to be able to get through another day. I feel awful. I can’t focus. I’m going to lose my job.’
Colin’s thoughts have begun to spiral downwards. Why? Too many consecutive nights of poor sleep bring on fatigue and accompanying negative thoughts. One good night of sleep just may allow Colin to return to normal. Or not. Sometimes, a physical event can start a train of negative thoughts and feelings that may then hang around for quite a while.
No one knows how to determine which of the three ingredients (feelings, thoughts, or physical factors) triggers depression for any particular person. But the good news is that you can interrupt the cycle of depression in various ways, using cognitive therapy, no matter what started the downward spiral. The goal of cognitive therapy is to help you be fully aware of your negative thinking when it occurs, and then to actively reframe those thoughts into more realistic terms. After you’ve done so over a period of time, your depression is likely to lift.
Research shows that cognitive therapy can be as effective as medication in treating depression. And, surprising as it may seem, like medication, cognitive therapy too has positive effects on brain chemistry, which is one of the physical ingredients of depression. But therapy doesn’t have to be an either/or proposition. Deciding whether one, two or all of the therapy options of medication, cognitive therapy, and behaviour therapy (see Part III for information on behaviour therapy) are right for you is complicated. We discuss the issue of combining medication with psychological therapy in more detail in Chapter 15.
Monitoring Thoughts and Feelings, and Relating Them to Life Events
A core element of cognitive therapy (see the preceding section ‘Thinking about Cognitive Therapy’) involves increasing your awareness of the links between thoughts, feelings, and events in your life. In this section, we show you how to become aware of your feelings about events and to examine the thoughts that go with them.
Some people genuinely are hardly aware of their feelings. Others have diffic
ulty detecting their thoughts. We help you to recognise and identify feelings, and we explain how to work out what you’re thinking. You may think that you already know what your feelings and thoughts are, but they aren’t always that obvious. After you’ve got the hang of clearly identifying feelings and thoughts, you can then see the links between your thoughts, feelings, and the events that lead to them, plus keep track of them using a ‘Thought Catcher’.
And once you see how events, thoughts, and feelings interconnect, you can then analyse your thoughts to spot the typical distortions that depression inevitably causes. We show you how in the ‘Unearthing Distortions in Thinking’ section, later in this chapter.
Feeling comfortably numb
Believe it or not, experiencing a full-blown severe depression but remaining unaware of your sad feelings is actually possible. People sometimes try to suppress, deny, and/or avoid unpleasant feelings. They try to feel better by cutting themselves off from their emotions so that they feel comfortably numb. This strategy makes a certain degree of sense, but the problem is that you can’t successfully block out all feeling. Denying and/or suppressing feelings doesn’t work, and in the long run, only makes things worse.
Trying to squash your feelings down inside you is like putting a lid on a pressure cooker, and then adding extra weights. To your horror the lid then blows off, and all the contents overflow. Research shows that denial and repression (conscious or unconscious attempts to avoid thinking about uncomfortable emotions and thoughts) are linked to poor emotional health, whereas expressing feelings improves both your physical and mental health.
When people find that denial and repression don’t get rid of unpleasant feelings, they sometimes turn to other strategies, such as immersing themselves in their work, binge eating or even abusing drugs and/or alcohol. (Be warned by the old adage: I tried to drown my sorrows, but they just learned to swim!) Unfortunately, avoiding unpleasant and unwanted feelings by trying to distract yourself through excessive work or by taking drugs or excessive eating and drinking only gives fleeting, temporary relief. In the end, these solutions worsen your difficulties, and you dig yourself deeper into depression’s hole. And remember what they say – when you find yourself in a hole, stop digging!
Many people (with and without depression) find it difficult to be aware of their feelings. But even if you often don’t know what you’re feeling, or others say that you’re out of touch with your feelings, you can change all this.
If you start concentrating on your bodily sensations, we think you’re likely to find the words to describe what you’re feeling. It may take you a little time, but paying attention to what your body’s telling you helps you in identifying your feelings, and enables you to move on to the next stage.. This is when you link your feelings to your thoughts, which then prepares you for the important Thought Catcher exercise we describe in the ‘Designing your Thought Catcher’ section, later in this chapter. You can start becoming aware of your bodily sensations by paying attention to the following:
Muscle tension
Your breathing (Is it fast, slow, deep, or shallow?)
A sense of heaviness in your chest
Dizziness
Posture (Are you relaxed, rigid, or stiff?)
Nausea
Feeling that your throat is constricted
Discomfort of any type
Put aside five minutes a day to actively focus on all of your bodily sensations. Try to think of words which describe the feelings, and which capture your complete physical and mental state. A few suggestions to start you off might be:
Afraid
Anxious
Apprehensive
Despondent
Disturbed
Embarrassed
Frustrated
Guilty
Heavy
Inadequate
Insecure
Low
Melancholic
Miserable
Morose
Nervous
Obsessed
Sad
Shaky
Sombre
Tense
Worried
Some people are fully aware of just how low and distressed they feel. But though they feel all the emotions, if anyone asked them about what they’re thinking in response to events, they may say, ‘Absolutely nothing. My mind’s a blank. I just feel terrible.’ If this describes you, read the next section.
Exposing underlying thoughts
When first coming across cognitive therapy, some people say with total conviction, ‘But I never have any negative thoughts!’ If this is your reaction, we believe you and know that you may not hear specific words and sentences running through your mind as do many people. However, when we say ‘negative thoughts’, we’re referring to thoughts in a broader sense. Consider thoughts as your interpretations or perceptions of the important events in your life. They’re the way you see or understand what’s happening. Thoughts are the meanings you consciously or unconsciously assign to what’s going on around you.
You may not be aware of an actual conversation going on in your head when something happens to you, but people do look for the meaning of events they experience. If you feel a sudden rush of feelings, try asking what event immediately preceded the feelings and then think about your perception or interpretation of the event.
For example, if someone says to you, ‘You look amazing,’ you may not be aware of any particular thoughts. But ask yourself how you interpreted that event. Did you hear the message as a positive statement about your clothes, or that you look in pretty good shape? Alternatively, was the comment sarcastic, meaning that your outfit is totally wrong for you, or that you sure have gained weight? Or perhaps you heard the statement and thought that the person was merely trying to be polite. Those interpretations are part of your thoughts, and they all result in different feelings about the comment.
You may find these questions useful for helping you identify your thoughts about events:
What meaning does the event have for you in your life?
What worries you about the event?
What implications does it have for your future?
What do you think the event may mean about you?
What went through your mind as you noticed the event?
Designing your Thought Catcher
You can use the Thought Catcher when you experience troubling feelings. It can help you follow through and understand the connections between your thoughts, feelings, and the events that trigger them. Also, the Thought Catcher can help you become more aware of the types of events that bother you and prepare you to confront and overcome any problematic thoughts.
Start a new page in your notebook, and divide it into three columns. In each column, fill in the following information (see Table 5-1 for a sample):
Feelings: Use this first column to write down negative feelings (not thoughts) and rate them on a 1 (very mild) to 100 (extremely severe) scale. People often notice their feelings before anything else, even though thoughts have usually preceded the feelings, so focus first on what you’re feeling. Sometimes you notice yourself experiencing more than one feeling. Record all the unpleasant feelings - they are the key to what depression is all about.
Events: Use the second column to write down the event that preceded or triggered the feeling. Such events are usually things that happen to a person, but sometimes they involve a daydream or image that floats into the mind. If you notice the event before you become aware of the feeling, feel free to fill out the event first. But events do precede feelings. So if you become aware of any feelings, stop and ask yourself what happened just before. Only occasionally is the feeling going to emerge more than half an hour after the event. In most cases, the feeling arises almost immediately.
When writing down the event, try to be as specific as possible: Include where you were, who was there, and what happened.
Negative Automatic Thoughts (NATS): Use the third column to record the thoughts or interp
retations you have about the event – , your understanding of what happened. These thoughts generally occur automatically without careful, conscious reflection, and are usually negative in some way, which is why they are called Negative Automatic Thoughts. Be sure to take time and reflect on the whole range of reactions and interpretations you have.