Overcoming Depression For Dummies
Page 16
Weighing the evidence
Designing alternative thoughts
Investigating your thought repair toolkit
You need skills to defeat your depression. You can start with the Thought Catcher we describe in Chapter 5. In this chapter, we build on the Thought Catcher, by explaining how you can examine your thoughts and perceptions using objective evidence. You can then use this new, more accurate evidence to create alternative constructive thoughts. And as well, we provide you with a well-stocked toolkit for repairing distorted thoughts, so that you can fix things and make yourself feel better.
After six months of thoroughly enjoyable retirement, George’s golf handicap has decreased by three strokes. He swings his number nine iron and grins as the ball flies down the fairway. He resists renting a golf-cart; walking the course is part of his exercise routine. But today, he notices an uncomfortable tightness in his chest, and then he feels nauseous and begins to sweat. He’s suddenly dizzy, and pain radiates from his chest down his right arm. He collapses on the grass.
Five weeks later, after successful heart bypass surgery, George sits at home. Feeling depressed and hopeless, he believes that life is never going to be the same. He can’t imagine ever being able to play golf again. His retirement is going be one of further illness, misery, and ever-increasing boredom.
His doctor refers him for a rehabilitation programme at the hospital’s physiotherapy gym, and predicts that George is going to be out on the golf course in just a few months. George cancels his rehabilitation appointments. He barely finds the energy to get dressed in the morning, let alone go to the gym. His dreams destroyed, George is nonetheless shocked when he finds himself contemplating suicide.
George experienced a triggering event (his heart attack) that set off a whole host of negative, even catastrophic, predictions about his future health and retirement. Unquestioningly following those thoughts led him directly into depression. However, the good news is that he can restructure his thoughts in ways that will make him feel better. He just needs to practise the series of skills we discuss in this chapter.
You need skills to defeat your depression. You can start with the Thought Catcher we describe in Chapter 5. In this chapter, we build on the Thought Catcher, by explaining how you can examine your thoughts and perceptions using objective evidence. You can then use this new, more accurate evidence to create alternative constructive thoughts. And as well, we provide you with a well-stocked toolkit for repairing distorted thoughts, so that you can fix things and make yourself feel better.
Taking Your Thoughts to Task
As we mention at the start of this chapter, the investigation of depressive thinking begins in Chapter 5 where we show you how to identify thoughts, emotions, and events relating to depression using a Thought Catcher. This allows you to record the events that trigger your emotions and explore the interpretations, or thoughts, you have about those events. This tool provides illustrations through various examples of how feelings naturally result from your thoughts. In Chapter 5, we also show you how thoughts can seriously distort reality.
Now, we take the Thought Catcher an important step further and show you how to put your depressive thoughts on trial through a process we call ‘Taking your Thoughts to Task’. The purpose of this process (which is also known as cognitive restructuring) is to restructure your thoughts and create accurate, believable alternatives. Although the idea of ‘Taking Your Thoughts to Task’ may appear to be a lighthearted concept being used to describe the restructuring process, keep in mind that the strategy is both serious and powerful.
We suggest that you use the ‘Taking your Thoughts to Task’ strategy frequently, regularly, and persistently. The good news is that you don’t have to spend huge amounts of time on the task. Devoting 10 to 20 minutes, 4 or 5 times a week, is going to give a noticeable boost to your mood within 8 to 12 weeks. And after your mood starts to lift, we suggest that you continue the work for at least another 8 weeks or so to ensure that your new ways of thinking have plenty of practice. As you become more skilled and find it easier, you’re likely to discover that you’re automatically monitoring all your thoughts, and putting the potentially negative ones to the test for accuracy.
Introducing the restructuring process
Here’s a brief summary of the ‘Taking Your Thoughts to Task’ process for you to review. We give you the complete rundown in the sections that follow.
1. Catching negative thoughts: This part of ‘Taking Your Thoughts to Task’ is made up of using a Thought Catcher to record all your thoughts, interpretations, or perceptions of the event that triggered your multitude of difficult feelings. You also rate the severity of the resulting feelings. (Go to Chapter 5 for more details about filling out a Thought Catcher.)
2. Putting the thought on trial: This step involves gathering evidence so that you can prosecute and defend the truthfulness of your thought. We ask you to carefully examine your thoughts and weigh up the evidence to decide if you should hold onto your thoughts because you judge them to be valid, or give them a life sentence because you decide that they aren’t valid and are guilty of making you feel unnecessarily depressed.
3. Coming up with constructive alternative thoughts: You take this step if you find the evidence shows that the thought isn’t valid. You develop an alternative thought that seems believable, but that isn’t unrealistically positive. These thoughts often include an element of the original negative thought, but they include credible, positive information as well.
4. Evaluating your alternative thoughts: Finally, you test out your restructured, alternative thoughts for a period. It’s important to discover if your new alternatives actually feel better than your previous, depressive thoughts. Therefore, this step asks you to rate how you feel when you think of the new thought versus the earlier one.
Persistence is key to ‘Taking Your Thoughts to Task’, and overcoming negative, depressive thoughts. Practise regularly and keep at it until your feelings of depression start to lift – and then continue practising some more! Be aware that improvements take time. But if things get worse instead of better, consider seeking professional help.
You are likely to get the best results from the ‘Taking your Thoughts to Task’ techniques by writing everything down. Taking a shortcut by simply following the techniques ‘in your head’ is a great boost to the work you do on paper, but it can’t stand alone. Don’t underestimate the power of the written word. Writing all the elements down in a notebook helps you utilise the objective part of your mind, which you need for this task. Writing things down increases your chance of both remembering, and even believing them. Also, keeping a written record allows you to regularly review your thought records.
We’re not suggesting with the ‘Taking your Thoughts to Task’ process that negative thoughts and feelings have no validity and have to be banished entirely. Before we go any further we need to clear up any possible misconceptions. Consider the following points:
Negative thoughts often (though not always) do have a grain of truth. Acknowledging this truth is important, because denial isn’t useful. When things are truly bad and difficult, you’re better off finding ways to cope than attempting to rationalise and trying to fool yourself.
Sadness isn’t the same as depression. Loss and adversity will make you unhappy, and it’s inevitable when such events occur you are going to feel sad. The death of a loved one, loss of a job, severe illness, financial problems, and physical disabilities all present serious challenges and emotional upheaval, and can give rise to profound sadness or even despair.
Typically, reactions to losses don’t cause a deterioration in your basic sense of self-worth, and they do ease over time. It can take a very long time, but the feelings do get better eventually. Refer to Chapter 2 to find out more about the difference between grief and depression.
Catching negative thoughts
It’s important to capture any suspiciously negative thought, before you can put it on trial.
Think of a time when you felt strong negative feelings such as sadness, despair, guilt, or shame. Where did these feelings begin? A Thought Catcher can tell you by uncovering the links between events, thoughts, and feelings. A Thought Catcher shows you that most of the time, your unpleasant emotions come from the thoughts or interpretations you make in response to events that have happened to you.
To understand the relationship between thoughts, feelings, and events, you need to record your thoughts, plus the events that occurred before them, and also the feelings that followed. Rating the intensity of those feelings in order to find out just how much your thoughts are disturbing you is also a good idea. Refer to Chapter 5 for more information about Thought Catchers and the connections between events, feelings, and thoughts.
Karol’s story shows you how to take your thinking to task. We follow Karol throughout this chapter to show you how the process works. First, he identifies his negative thoughts.
Karol, the son of migrant EU workers, wants to train as a teacher in Britain. After successfully completing a teaching assistant’s course he commences an access to further education course. His place on a teacher training course at a local university depends on successful completion of this course.
Initial euphoria at the start of the course rapidly gives way to low mood and he reluctantly seeks help after feeling seriously depressed for a month. He isn’t sure how his depression started, but he feels it’s affecting his sleep, energy, interests, and concentration. He’s starting to be late for classes and is given a verbal warning that his place on the course may be terminated after he hands in his first assignment late. At the strong urging of one of his friends, Karol arranges an appointment with the college student counsellor. The counsellor uses a cognitive behavioural therapy approach, as advocated by government guidelines. It has the longest and best established track record for treating depression, and also helps prevent relapse.
The counsellor asks Karol to start noticing the times when he feels especially sad, depressed, and/or upset. Then he asks him to record these feelings on a Thought Catcher that he gives to Karol. After Karol completes the form, the therapist suggests that Karol underlines the most troubling, upsetting thought – the one that stirs up the most difficult emotions. Table 6-1 shows one of Karol’s records.
Table 6-1 Karol’s Thought Catcher
Feelings (0 to 100)
Events
Negative Thoughts (or Interpretations)
Shame (90)
Guilt (80)
Despair (85)
I handed in my first assignment late and the lecturer threatened to chuck me off the course in front of the whole class. My parents are working so hard to pay for me to train as a teacher and this is how I repay them! I really found it difficult to do the coursework but all the others managed it. Maybe I’m just stupid. I’m not cut out to do be a teacher.
I should never have enrolled on this course in the first place. I couldn’t do the work on time because I’m thick. I’ll never get a place on a teacher training course. I really worked hard and without learning support I couldn’t do it on time and now they’re going to chuck me off the course. I look like an idiot to the whole class.
Karol diligently records the specifics of his unpleasant event and carefully rates his feelings. He looks closely at the thoughts instantly passing through his mind after being given the verbal warning. At first, all he comes up with is the thought that it was a mistake to take the course in the first place. However, when he considers the implications for his future and what he thinks passing the access course really means to him, he finds more information to write down under his negative thoughts column. Finally, he reviews his various thoughts and decides that the thought that troubles him the most is the thought triggering feelings of shame, guilt, and despair at being thrown off the course and getting an F grade in the exam, meaning that he’s a failure and that he’ll never be a teacher.
Putting the thought on trial
After identifying your particularly troubling thought, put it on trial. You are both the lawyer for the prosecution, and for the defence. Your job is to prepare both sides of the case. The depressed mind usually has no difficulty coming up with evidence for the defence of the negative thought (that is, evidence in support of the thought). You’re likely to have more trouble coming up with evidence for the prosecution (evidence disproving or making the negative thought useless).
We have a list of evidence-gathering questions to help you prepare the case against the troubling thought (witnesses for the prosecution!):
Do I have any experiences or evidence from my life that contradicts my thoughts in any way?
Have I had thoughts like these in the past that didn’t work out as I predicted they would?
Is this event really as awful as I’m letting myself believe that it is?
Is this negative thought illogical or distorted in any way? (Refer to Chapter 5 for a list of common thought distortions.)
Am I ignoring any evidence that disputes this thought?
Is my thought based on facts or my own critical judgements?
What evidence is there to support the thought – or is it just another of those troublesome negative automatic thoughts?
Using a Thoughts on Trial Form (see Table 6-2 for a sample), record the evidence both for and against your problematic thought in your notebook. Divide the page into two columns: ‘Defence’ (evidence that supports your thought) and ‘Prosecution’ (evidence against the validity of your thought).
Now we return to Karol to show you how this process works in practice. Karol’s counsellor suggests that he puts on trial his upsetting, negative thought (that an F grade in the exam means he’s stupid). To do so, he asks Karol to play two roles – first the defence lawyer and then the prosecutor.
Next, the counsellor gives Karol a Thoughts on Trial Form and asks him to fill the form in carefully. Table 6-2 shows what Karol returns to his counsellor after working on both sides of the case.
Table 6-2 Karol’s Thoughts on Trial Form
Accused thought: The verbal warning means I’ll be chucked out and never become a teacher.
Defence: Evidence in Support of Thought
Prosecution: Evidence Disproving Thought
I’ve been given a verbal warning. If I get a written warning next time, I could be asked to leave the course.
Well, I suppose one late piece of work and a verbal warning doesn’t have to mean that I’ll be late with the next assignment.
If I get given a written warning, I’m one step away from being thrown off the course.
If I give the work in on time, I won’t get a written warning.
I’m not cut out to be a teacher if I can’t hand in the coursework on time without support.
I’m sure that even bright students find it difficult to do the assignments and submit them on time.
This was only my first assignment. If I couldn’t hand that in on time, I’m bound to hand the next one in late and I bet the work will be even harder.
My mother said that I’m just lazy and maybe I’m not cut out to be a teacher. What she really means is that I’m stupid.
As you can see, the defence case for Karol’s thought is stronger than the initial case for the prosecution. Karol’s obviously struggling to develop a convincing case for the prosecution, to find against the negative thought.
Here’s a dialogue between Karol and his counsellor showing how a few of the right questions can make all the difference. Note that the counsellor asks questions, but it’s Karol who has to come up with the answers. This technique is known as Socratic questioning, (after the famous philosopher, Socrates) and is key to the way a good therapist helps you find your own evidence and answers.
Therapist: So, Karol, you were given a verbal warning for handing in your fist assignment late and concluded that you’re stupid and you’re never going to be a teacher, is that right?
Karol: Well, yes. What else could it mean?
Thera
pist: Think hard about this. Can you come up with any evidence that suggests you’re actually quite bright? Anything at all?
Karol: I suppose so. I did get a distinction for my teaching assistant award. But it was an ESOL course and we all got English language support. Anyway, I didn’t do my course at a college – I trained at an adult education centre and their standards were lower.