Overcoming Depression For Dummies

by Smith, Laura L.

  Why try, when I’m just going to fail . . .

  Of course you’re going to fail! Everyone fails. Bet you can’t think of anyone we know that doesn’t fail from time to time? So what’s the problem with this view? Depression refuses to acknowledge normality which is that no one succeeds at everything, every time. Depression invites all possible negative predictions, and failure is one of those predictions. But by starting off small, and breaking tasks into do-able steps, you can effectively minimise failure.

  A lazy person – that’s me!

  Labelling yourself lazy only makes getting started more difficult. The problem with labels is that they can grossly exaggerate and can stick. When you’re depressed, you really do feel tired and you have far less enthusiasm than usual for accomplishing necessary tasks.

  Psychologists know that people don’t succumb to depression as a result of laziness. Out of the thousands of studies we’ve seen on depression, we can’t think of a single one that shows laziness as a cause. Getting started on tasks when you’re feeling low is hard enough; don’t add the burden of guilt and shame by attaching the lazy label to yourself.

  One Step at a Time: Recording Activity

  Keeping an Activity Record is the best step you can take if you have severe depression and you’re neglecting important responsibilities or chores. The technique is straightforward and simple. (See Table 9-1 for a sample Activity Record.)

  1. Get out your notebook and list each day of the week in a column on the left-hand side of a page.

  You can also use a daily planner if you prefer.

  2. Identify and write down one previously neglected activity a day, for the coming week.

  Make your activity something small at first!

  3. After completing the activity, write down alongside it on the right-hand side of the page how the activity went and how you feel after finishing it.

  This exercise is about giving yourself credit for getting started, not on how brilliantly, or otherwise, the activity went.

  Is simply recording your activities going to increase your motivation? Surprisingly, yes. We find that any activity focuses attention and helps to get you moving. You also notice how much better you feel afterwards, which makes it even more likely that you’re going to tackle the next activity on your list for tomorrow, when you get there.

  Kathleen’s story gives you an example of how to keep an Activity Record. Kathleen is slowly sinking into depression. For the past month, she’s been spending most of her weekends in bed. Her mind is full of self-loathing. Although she somehow makes it into work most days, the minute she gets home, she collapses. Her diet consists of cold cereal and dry crisp bread, because she hasn’t the energy to do the shopping, or to prepare anything even if she buys it. What little fresh food there is invariably goes off before being eaten, and is slung out, making her feel even worse.

  Kathleen’s best friend, Becky, notices her worsening mood and weight loss. Becky is worried about Kathleen, so she pops round to see her. She asks Kathleen what she’s been eating, because she sees that the fridge is practically empty. Kathleen tells her, ‘Mainly just dry cereal.’ ‘And what are you going to do when you run out of cereal?’ Becky asks. Kathleen shrugs her shoulders and replies, ‘Dunno! Guess I’m just going to stop eating. I don’t really care.’

  Becky suggests that Kathleen starts an Activity Record and briefly explains how to do it. She says, ‘I’m going to pop round again in a couple of days. I expect to see food in the fridge. If you don’t start getting moving just a little, and if you’re not feeling better pretty soon, I’m taking you to your doctor.’

  Kathleen reluctantly agrees, because she knows that Becky’s not kidding. At first, Kathleen thinks that she can’t find the motivation even to start an Activity Record. She’s also convinced that she’s too lazy, and that even if she does make the attempt, she’s probably going to fail. However, Kathleen trusts Becky so she reckons that she has little to lose by giving the exercise a go. Table 9-1 shows Kathleen’s Activity Record for the first week. Notice that the Activity Record in Table 9-1 doesn’t include any huge projects.

  Table 9-1 Kathleen’s Activity Record

  Day

  Activity

  Outcome

  M

  Order a take-away from the local restaurant whose menu came through the door, and which says it includes delivery.

  Well, I did it. I didn’t feel like eating most of it, but I spoiled myself with a wicked chocolate dessert. It actually tasted pretty good.

  T

  Go to the corner shop and pick up a couple of things for dinner, and some cereal and milk just in case I really can’t face cooking.

  This was a lot harder. I didn’t want to go in, but at least there wasn’t much of a queue. When I got home, I didn’t cook, and just had the cereal. It did taste better with fresh milk than just dry.

  W

  Go to the bank. I’ve been putting that off for quite a few weeks.

  It felt surprisingly good to get that done. I even decided to microwave the food I bought yesterday. It wasn’t too bad at all.

  Th

  Go to the post office and get stamps so I can post the letters and bills off.

  This wasn’t as hard as I thought it was going to be. Admittedly, I did have to force myself to do it, but I guess that’s okay.

  F

  Pay any remaining outstanding bills, and start looking at what can go onto direct debit.

  I was just too tired; I couldn’t get myself moving. Maybe the direct debit decisions are going to have to wait. I’ll try something less ambitious tomorrow.

  Sa

  Pay remaining bills. Do a supermarket shop.

  I’ve actually paid all my bills on time this month! What a relief. I really get so angry with myself when I keep on putting things off and results in exorbitant interest charges plus late penalty fees. I feel so good. And I actually did the supermarket shopping!

  Su

  Phone Becky with my report, before she checks up on me!

  I have to admit I felt pretty good telling Becky what I’ve done so far. I’ve a long way to go, but it’s a great start.

  When you develop your Activity Record, select small, manageable goals. None of them should take more than 20 or 30 minutes at first. After getting started, you can think about including slightly bigger tasks.

  Kathleen didn’t do everything she set out to do each day. So don’t worry if you also don’t complete everything. Celebrate your successes and forgive your failures. If you don’t complete an item, think about putting it onto the list for the next day. But if you still don’t do it the next day, then perhaps the task is more than you can handle right now. Put it to one side for the next week or so.

  If you find yourself unable to get started on your Activity Record, or don’t feel a little better after using the record for a couple of weeks, think about getting help from a professional.

  Conquering ‘Can’t’ Thoughts

  Your mind is constantly buzzing with thoughts about yourself, other people and about the future. Even if you’re not suffering from depression, many of your spontaneously occurring thoughts in no way reflect the reality of what has happened, is currently happening, and is going to happen. In the following section, we review specific ‘can’t’ thoughts and ways to defeat them. Throughout this book, and especially in Chapters 5, 6, and 7, you can find more information about the many ways that thoughts distort your view of the world, and what you can do to change the distortions.

  Depression can greatly magnify negative thoughts. One of the most common thoughts we hear from our clients when discussing the idea of taking action is, ‘Well, I’d really like to, but I just can’t.’ If you’ve ever had that thought, you most likely truly believe that you’re incapable – because of basic inadequacy, incompetence, or depression itself – and you’re genuinely convinced that taking action is beyond your ability. Read on to find out how to banish activity-sapping thoughts.

  T
hinking through your thoughts

  When you regularly tell yourself that you’re incapable of accomplishing specific tasks, we call this type of thinking ‘can’t do-itis’. Although this diagnosis may sound a bit fanciful, we assure you that its effects aren’t. Through repetition alone, ‘can’t do-itis’ can become a fixed belief that you eventually see as a fundamental truth. Consider the following common thoughts:

  I can’t remember a thing.

  I can’t think clearly.

  I can’t possibly clean out the shed; it’s just too much.

  I can’t concentrate on anything.

  I can’t motivate myself to do anything.

  I just can’t function any more.

  I can’t do anything right.

  Do they sound familiar? They do to us! On some days, can’t thoughts can just keep on going round and round in your head.

  Not that long ago, author Elaine was feeling a bit low, and heard herself saying through tears, ‘I just can’t face it!’ She then sniffed miserably and admitted, ‘Actually, I know that I can face it – but I really don’t want to!’ Having realised that she wasn’t unable to act, but was choosing not to, Elaine proceeded to break the task down into a number of smaller, less scary, potentially do-able chunks. Then she did just the first tiny bit of the task, successfully. Having disproved the ‘can’t do-itis’, Elaine was then able to tackle the next bit of the task, and so on.

  Perhaps you’re thinking that putting can’t thoughts to the test may work for the authors of this book, but it won’t work for you when you’re terribly depressed. If so, you may be interested to know that the majority of our depressed patients also think at first that the strategy isn’t going to help them. Nevertheless, when they try it, they almost always discover that testing out can’t thoughts helps.

  Testing out behavioural experiments

  You can prove once and for all that each of your can’t thoughts is false by showing evidence to the contrary. Here are some ideas you can use to test a few of the can’t thoughts we list in the section ‘Thinking through your thoughts’.

  I just can’t function any more. Breathing is practically all you have to do to disprove this idea! But as well as breathing you can further test yourself by getting out of bed, pouring yourself a glass of water, drinking a few sips, and doing a couple of small activities, such as brushing your hair or your teeth. If your ‘can’t thoughts’ start to interfere, focus and concentrate intently and solely on the movements of your body while you’re performing the task. Make a daily habit of disproving that you are incapable of moving: make an Activity Record that lists a new task each day (see ‘Taking One Step at a Time: Recording Activity’, earlier in this chapter).

  I can’t remember a thing. We have our colleague, Dr Steve Hayes, to thank for this idea. Try remembering this number sequence – 1, 2, 3. Now pretend that we’re offering you a million pounds (don’t forget that we said ‘pretend!’) if you can remember ‘1, 2, 3’. We’re willing to bet that if a million pounds were really on the table, you’d remember that sequence a few minutes from now. (If not, we suggest that you see your doctor, because something other than depression may be going on.)

  If you can pass this test, you can probably find many more examples of things you can remember. And if you can remember something – anything – then you can you use this to disprove your ‘can’t thought’. At the same time, please realise that depression does cause a certain amount of difficulty with memory. If you want more help with your memory, flick to Chapter 8.

  I can’t possibly clean out the shed; it’s just too much. Start by cleaning out one very small corner of your shed. After getting that done, consider cleaning another small area the next day. Perhaps in a few more days you can tackle two or three small spaces. That’s how seemingly impossible tasks get done – one small bit at a time.

  When you’re depressed, your mind can sabotage your efforts to improve how you’re feeling by focusing on the whole task facing you – making it feel as though you must get the task done in one go. For example, if you picture all the miles you’re going to walk in the coming year, and you believe that you must walk the entire distance today, we bet you probably won’t even feel like starting.

  Break tasks down into very small, achievable chunks. You can conquer ‘can’t do-itis’ by identifying a small bit of whatever it is that you think you can’t do, and then going ahead and doing just that.

  Checking Out Your Negative Predictions

  Your mind can sabotage your plans for taking action in another clever way – by assuming that catastrophes are a certainty. When depression takes hold, these negative predictions seem increasingly believable and horrible. You may feel as though your horoscope consistently says, ‘Today is absolutely not the day for trying new things. Retreat, withdraw, and stay passive. Don’t take any action.’ And your ‘horror-scope’ never gets updated.

  If you’re hearing similar dire predictions from your mind’s fortune-teller, perhaps it’s time to test out such misguided advice.

  If you get stuck when it comes to tackling important tasks, try using our Negating Negative Predictions technique, to conquer your catastrophising. Use this technique initially for just one week. You may find that it helps you to get moving and also helps in shifting your depression. Take the following steps and check out the sample chart in Table 9-2.

  1. For each day of the week, write down one or two tasks you’ve been avoiding.

  Try to think of small, do-able projects. If you choose a larger project, break it down into small pieces to be tackled over a certain period. Then do it just one bit at a time.

  2. Make a stress prediction for each task.

  Predict (on a 0 to 100 point scale) how much stress you think that the task is going to cause you. For example, do you reckon that paying the bills is going to feel incredibly difficult? If so, you may want to predict the stress factor as 70 or even above.

  3. Make a boost prediction for each task.

  Rate (on a 0 to 100 point scale) how much of a boost you reckon you’re getting in terms of satisfaction, confidence, and a lifting of your mood when you’ve completed the task. For example, if you think that paying bills is going to result in a mild to modest boost in satisfaction, mood, or confidence, you may want to rate the expected boost at around 25 to 40.

  4. Record the outcome (or your actual experience) on your chart for both the stress and boost categories.

  After finishing the task, write down how much stress and aggravation you actually experienced from doing the project, plus how much of a boost you got in terms of increasing your feelings of satisfaction, confidence, and improvement in your mood.

  Amelia, a university professor, has been depressed for the past month. She starts arriving to work late and sinking on to the sofa the moment she gets home. She eventually drags herself upstairs to bed after a night spent watching what she calls mindless TV. Important tasks, such as preparing lectures, marking exam papers, paying bills, and shopping, start mounting. Amelia decides to try the Negating Negative Predictions technique. Table 9-2 shows you her chart.

  As you can see in Table 9-2, Amelia consistently predicted that her activities would involve more stress and hassle than she actually experienced. The stress was only as great as she expected in one case – and that was because the lawnmower kept cutting out. Although not every task gave her a huge boost in satisfaction, confidence, and mood, the kick that she experienced was always far greater than she imagined it was going to be. After one week, Amelia still felt depressed, but she at least experienced a small lift in her mood from the exercise. And that lift made it easier to take on new tasks.

  If you’re like most other people with depression, you’re likely to experience results similar to Amelia’s. You find yourself predicting activities to be more stressful and less rewarding than you actually find them to be. Why not try out the Negating Negative Predictions exercise for two weeks?