Overcoming Depression For Dummies

by Smith, Laura L.

  Therapist: That’s great about the distinction. Let’s come back to the quality of adult education training in a moment. Tell me, do stupid people normally get distinctions?

  Karol: Okay. So I got distinction in the internally marked unit, and, with support, I got a distinction on the externally marked one, too. But that was easy. The teachers simplified it all, and we had lots of extra language support. I know I can produce good results if I get lots of help and guidance, so that doesn’t count.

  Therapist: Wait a second. Please explain that to me. You just said you know your results really don’t count? Does this sound a bit like the thought distortion we spoke about earlier, when you discard positives? How can you show you understand how to help children to learn and get a distinction for your written work unless you’ve understood the principles and shown you’ve successfully applied them? And is anyone really able to do that if they actually are stupid?

  Karol: Okay. I take your point. Maybe I’m discounting important information. But I still handed in my first assignment late.

  Therapist: That’s true. You did. And that reminds me, where did you do your teaching assistant course?

  Karol: In Croydon. Why?

  Therapist: How long have you been in the UK?

  Karol: I came here three years ago, and I didn’t speak a word of English when I arrived. I got a lot of help with English at my secondary school but I still left without any A*-C grades. My teacher thought I might do well on a vocational course, so I applied to train as a teaching assistant. Why?

  Therapist: Is it just possible that English is a little more difficult for you than for some of the other students on your course, because you’ve only been in the UK for three years?

  Karol: I suppose so . . . but I’ve always been really good at everything I try to do.

  Therapist: And when you succeed, does that mean that’s because you’re just lucky or because you’re actually pretty bright?

  Karol: I suppose, sometimes, I’m quite bright.

  Therapist: By the way, didn’t you tell me that some of the other students you spoke to said they’d also found the first assignment really difficult and had to stay up really late completing it, so they could hand it in on time? And don’t most of them speak English as their first language? If that’s true, maybe you’re being a little hard on yourself, to say the least?

  Karol: Okay, I see your point. Maybe I am, as you say it, ignoring positive information and focusing on negatives. Perhaps a little more work in English? Maybe I should go to the learning centre and see if I can enroll on a Learndirect course to improve my English?

  Armed with this ammunition from his therapist, Karol develops a list of additional evidence for the prosecution. He’s looking for evidence against his negative thought which says that being given a verbal warning for failing to hand in work on time means he’s stupid and he’s never going to get onto the progression course and train as a teacher. His list of evidence for counter arguments to his negative thought is now growing, and includes the following:

  I did get a distinction for my Teaching Assistant award. Some members of my group got Merits and one only got a Pass.

  I usually succeed in most of what I do.

  Because I usually succeed, I probably go to pieces when I don’t, because I’m just not used to that.

  How can I expect to do really well on this access course if I’ve only been studying through the medium of English for three years? I just need some more guided practice and perhaps I can get some learning support this year.

  My mother’s always criticising me, and says I can’t do anything right. Just because she thinks I’m not cut out to be a teacher doesn’t mean I’m not going to be a good teacher. Actually, maybe she’s trying to get me to drop out of the course and go to work to help support the family. I plan to get an evening job when I’m managing my work better, and pay towards my board and keep, but not yet.

  I guess even very bright people do hand in work late sometimes. I think I do need to see the bigger picture.

  At first, most people find it difficult to come up with good evidence for disproving their thoughts. If that happens to you, try these tactics:

  Take your time. You can go back to the form over a period of several days if needed. The goal isn’t to feel better immediately, but to discover the skill of subjecting your thoughts to careful, objective analysis. And acquiring new skills takes time.

  Carefully review the evidence-gathering questions we list earlier in the section ‘Putting the thought on trial’. Think hard about each question and push yourself to find evidence that contradicts your negative thought.

  Consider seeking help from a professional therapist to get you started. Professionals can help you see that the vast majority of your negative moods are supported by thoughts that are actually groundless.

  After Karol fills in his Thoughts on Trial Form with his new evidence, he’s ready to reach a verdict. He declares, with the full support of his therapist, that his thought, ‘Getting this verbal warning means that I’m stupid and that I’m not good enough to train as a teacher’ is guilty of fraud and deception. He now sees that the thought causes him enormous shame and pain, but with little basis for doing so.

  Coming up with constructive alternative thoughts

  After finding the thoughts leading to your depressed feelings are guilty of inaccuracy, you need to develop an alternative view, a constructive alternative thought. These thoughts do require effort to put together. If a constructive alternative thought is based on falsehood it won’t stand up to scrutiny.

  Overly positive spins and simplistic dismissals of negative thoughts look very different from reasoned, alternative, restructured thoughts. An overly positive spin is an inappropriate attempt to make a bad event or situation seem like a good thing (politicians are pretty good at positive spins). And simplistic dismissals are ineffective attempts to minimise the meaning of unpleasant events by denying them and saying they aren’t so (this isn’t convincing!).

  Here are examples of Karol’s three types of ineffective replacement thoughts, followed by the later more effective restructured alternatives.

  Unrealistic optimism: Okay, so I handed the work in late. Next time I’ll work harder. I don’t need any help – I just need to put in more effort and I’m bound to do really well from now on.

  Overly positive spin: One verbal warning for late work will only show up on my college record, so the university need never know. I’ll still get onto the teacher training course and that’s all that matters.

  Simplistic dismissal: So what? A verbal warning is meaningless. I know I’m bright and I can do the work without any outside help.

  Restructured alternative thought: A verbal warning doesn’t mean that I’m stupid; I’ve too much evidence to show otherwise. If I hand everything in on time from now on, and I manage to get good grades, I can still get a good reference from one of my tutors, and I should be able to pass the course and get my place to train as a teacher. Handing the work in late has helped me to understand that I still need some support and to work on my English. It’s really a good thing because I need really good English if I am going to be a successful I’m intelligent enough to try to access the help and support I need.

  After putting your thoughts on trial and going through the painstaking work of finding them guilty, don’t next replace them with other equally false, negative alternatives. Rather, continue designing a new perspective based on reason, logic, and solid evidence. Develop a perspective that’s a realistic, accurate interpretation of what’s occurred in your life, and base any future predictions on this.

  Such reflective interpretations include any partial truth contained in your negative thoughts. For example, Karol realised that a verbal warning is significant but it does not show that he is stupid. These interpretations are most effective if they include realistic positive information. In Karol’s case, that means including the recognition of his intelligence.

  Evalu
ating your alternative thoughts

  If you find your thoughts guilty of deception, and restructure them using constructive alternative thoughts, you’ve made a great start. But the exercise is only useful if it actually does you some good!

  We suggest that after putting your thoughts on trial and constructing alternatives you then rate the outcome. How? Simple. List the feelings you originally rated as arising from your negative thoughts. Then re-rate those feelings to see if they change.

  Karol wrote down each of his feelings and found that:

  Shame went from 90 to 55.

  Guilt went from 80 to 40.

  Despair went from 85 to 65.

  These ratings show that Karol’s work on restructuring his thoughts substantially changed his feelings. However, the difficult feelings didn’t go away entirely. And the reality is that you too can expect that some unpleasant feelings are likely to stay with you. You may have to practise this exercise a lot before you find your feelings diminishing to the point that they feel unimportant.

  But what if the feelings stay the same or, get even worse? This outcome occurs occasionally, so try not to panic. Consider the following possibilities instead:

  You’ve identified the wrong event. To check out this possibility, ask yourself what else was going on around the time you experienced the troubling feeling. Possibly, the event you really need to identify was a daydream, image, or thought that had just floated through your mind, and you failed to notice it. If you’re able to capture another triggering event that is more likely to have started the downhill slide, start again, and go through the whole ‘Taking your Thoughts to Task’ process once more.

  You’ve caught the wrong thoughts. It may be that you’ve put a thought on trial that’s less upsetting to you than another thought about the event. For example, if you’re feeling ashamed and inadequate after missing a pass while playing football with your friends, perhaps you thought it was because you were a bit slow to react. So you subject the thought about slow reactions to the ‘Taking your Thoughts to Task’ process, but find you feel no better after making it ineffective and coming up with a constructive alternative thought.

  But maybe the event involves additional, more troubling thoughts. As well as thinking that you were slow to react, perhaps you were troubled by seeing how upset your teammates were, and by thinking that you’ve horribly disappointed them and let the side down. If so, you need to take the more disturbing thought through the ‘Taking your Thoughts to Task’ process. If you don’t benefit from ‘Taking your Thoughts to Task’, be sure to ask yourself if you have additional, more troubling thoughts to catch and put on trial.

  You may have additional thoughts that you need to deal with. We suggested that you to take your most disturbing thought to task. However, you may want to take remaining thoughts through the same process. Do so with any such thoughts if they seem to arouse a lot of unpleasant emotion.

  You came up with an unbelievable reflective replacement thought. Ask yourself if your replacement thought is too much like the overly positive spin or the simplistic dismissal we discuss in the ‘Coming up with constructive alternative thoughts’ section, earlier in this chapter. Develop a constructive alternative thought that is truly believable.

  You sense that you don’t want to change your feeling about the situation. If this concern applies to you, you may want to read Chapter 3, which deals with breaking barriers to change. You may well discover that certain beliefs are indeed blocking your way towards feeling better. If so, it’s helpful to work on those beliefs first.

  If after working through the ‘Taking Your Thought to Task’ process, as well as the potential change-blocking beliefs in Chapter 3, and you’re still struggling to feel better after a number of weeks, please seek professional help. Get help sooner if you feel hopeless and helpless and can’t shift those feelings fairly quickly. This self-help book can still be used alongside therapy, but you shouldn’t try to just use it on its own if you are experiencing dark and gloomy thoughts.

  Following a model example

  We introduce this chapter with a story about George and his bypass surgery, and we now want to end his story on an up note. Recalling George’s progress gives another example for you on how to complete the ‘Taking your Thoughts to Task’ process.

  George’s cardiologist recently attended a conference featuring discussions about how often depression follows heart attacks and even increases the likelihood of additional heart problems. The cardiologist follows this up and after more research on cognitive therapy, suggests to George that he see a counsellor. George agrees, and after his first session with his counsellor, George decides to put his thoughts on trial. Here’s how George makes the most out of the ‘Taking your Thoughts to Task’ techniques.

  First, George fills out a Thought Catcher form, as seen in Table 6-3.

  Table 6-3 George’s Thought Catcher

  Feelings (0 to 100)

  Events

  Negative Automatic Thoughts (or Interpretations)

  Despair (85)

  Hopelessness (85)

  Heart attack, bypass surgery, hospitalisation, and the prospect of lengthy rehabilitation

  I’m old. I’ll never recover from this heart attack. Rehabilitation sounds really heavy going. I can barely get out of bed. And I can never be happy not playing golf again.

  George’s thoughts that trigger the most despair and hopelessness include the idea that he’s never going to recover and that he can never be happy without playing golf again. He analyses these thoughts with a Thoughts on Trial Form, you can see in Table 6-4. To do so, he thinks about the evidence-gathering questions (see the section ‘Putting the thought on trial’, earlier in this chapter, for the list of questions).

  Table 6-4 George’s Thoughts on Trial Form

  Thoughts suspected of being negative: I’m old. I’m never recover from this heart attack. And I can never be happy not playing golf again.

  Defence: Evidence in Support of Thought

  Prosecution: Evidence Disproving Thought

  I’ve seen good friends fade away and die after a heart attack.

  I guess I’ve also seen people get a lot better after bypass surgery and live a number of good, active years.

  Rehabilitation takes months, and that’s even assuming it’s going to work.

  I’ve thought things looked pretty awful in the past, and they improved. I was convinced I’d never get over losing my wife. It sure was tough, and I still miss her, but I actually have felt happy occasionally since then.

  I don’t have the energy for rehabilitation; maybe I’ll go along to it when I feel a bit better.

  I suppose maybe I’m ignoring my doctor’s prognosis; he predicts I’m going to recover.

  If I don’t get better, I’m never going to play golf again.

  Maybe I’m trying to reach conclusions based on how I feel rather than on the facts.

  They say that energy increases once you just start moving, and that the body deteriorates when you lie around. Maybe that’s really so.

  Although it’s true that I’m never going to play golf again if I don’t get better, I’ll certainly never get better at all if I don’t get moving.

  Even if I don’t play golf again, I do know some friends who seem pretty content, despite their physical limitations.

  Based on George’s Thoughts on Trial Form, he comes up with a restructured thought: ‘The odds are pretty good that, with work, I can recover from this bypass surgery. It won’t be easy, but it sure beats the alternative. And if I don’t recover to the extent that I hope, I can still find some interesting things to do.’

  Finally, George rates the results from his new constructive alternative thoughts by re-rating his feelings:

  Despair was at 85; now it’s at 30.

  Hopelessness was at 85, now it’s at 10.

  George continues working with the ‘Taking your Thoughts to Task’ process for several months. He recovers from his surgery and does play gol
f again. His handicap never gets quite as low as before, but he feels good about the outcome, and enjoys his retirement for a further two decades.