Firstly it is important to remember to be kind and compassionate to yourself. It’s not easy to start/continue any self-help programme so give yourself a big pat on the back for your efforts so far for reading this!
This blog will explain a four-stage approach to help you deal with depression. The model is based on classic cognitive behavioural therapy, which by its very nature will look at both the cognitive or thinking component alongside the behavioural aspects of what you are doing.
Important initial point – Stay in control
In life, there are many challenges that come your way. If you look at these as either controllable or uncontrollable factors you give yourself a stronger base in which to deal with them.
Many of the things that contributed to feelings of depression may well be out of your control…things like what people do or say, a loss of someone close to you or work changes. It’s important to distinguish in your own mind what it is you can control and what you cannot. If you cannot control it, and there’s little you can do about it, then ask yourself why would you waste your precious time and energy on it? This will be draining and may well add fuel to fire of your depressed mood.
Remember the mantra ‘Control the controllables’
Stage 1: Education and understanding
Understanding depression is imperative before you can start to work on coping with it. As you take the time to explore what depression is and where it comes from, you begin to see ways in which you might best cope with it and allows you to take greater control over your low moods. It takes some serious effort, dedication, and hard work to improve the way you feel and it’s like anything in life – you get out what you put in.
Educating yourself on potential solutions and exploring all of these until you find the best ones for you at this time, is crucial. You can build your own toolbox of anti-depression strategies, each strategy might serve you best at a particular time and with specific challenges.
As stated in the last blog post It is important to remember that depression is an illness, not a sign of weakness or a character defect. There are many effective treatment options available.
Awareness and collecting information
As part of this education phase, it is important to keep a record of what you do and how you think. It doesn’t have to be complicated, often the very act of writing things down can help you feel better. As with many negative habits, they seem to creep up on us so slowly that we may not be aware of what we do – or don’t do. So this exercise is all about keeping track of your behaviours and thoughts. At the end of each day, write down a summary of the things you did – your behaviours and how you felt. As well as documenting behaviours it is also useful to record what you think and say to yourself, particularly those thoughts that lead to you feeling bad about yourself.
Then give yourself an overall mark for the day – how you feel from one to ten – where ten is great and 1 not good at all. By doing this for a period of time you will begin to see relationships between your activities and thoughts and the way you feel. You may find the more activities and socialising you do, the less depressed you feel.
A Healthy Diet
Eating healthily is just as important for maintaining your mental health as it is for preventing physical health problems.
When you’re feeling low, it’s easy to stop eating properly. You might binge on comfort foods such as sweets and cakes, or you might lose your appetite all together and not eat much at all. Again, you need to fight both of these extremes and attempt to maintain a reasonable and healthy diet. A healthy diet can make a significant difference in how quickly you recover from depression and can help lift your mood.
Depression can affect your sleep. If you’re having trouble here’s some tips:
- Set a standard bedtime and rising time. Your body operates on a sleep-wake cycle that works best when it is on a regular schedule. You will find it easier to fall asleep if you keep regular bed and rising times.
- Don’t go to bed too early. It may seem like a good idea, but if you never fall asleep until midnight, then don’t go to bed at 11 pm. If you want to start falling asleep earlier, do it gradually.
- Save your bedroom for sleep. If you can, avoid associating your bedroom with activities unrelated to sleep – like web browsing, going on phones and tablets and maybe social media, watching TV, doing work, exercising, talking on the phone and so on.
- Create a good sleeping environment – not too hot, not too cold, as dark as possible.
- If noise is a problem consider earplugs.
Avoid extended sleeping during the day. A 20-minute nap is fine if not too late in the day however any more may make it harder for you to fall asleep at bedtime.
- Prepare for sleep – Avoid strenuous activity, exercise, heavy meals and bright lights (including the blue light from devices) for at least an hour before going to bed.
- Focusing on your worries or on how much you need to sleep will only keep you awake – Practice deep breathing or other relaxation strategies when attempting to fall asleep.
- If you can’t stop worrying, sometimes getting up and making a list of your worries can help –remind yourself that you can address the problems on the list tomorrow.
- Are you a clock checker? It might help to turn your alarm clock around so that you can’t see the time.
- Remind yourself that everyone has a terrible night’s sleep sometimes – don’t get too stressed about it. People can very usually operate just fine the next day, even without a good night’s sleep.
- You probably slept more than you think!! Research shows that people – especially those with difficulty sleeping – tend to underestimate how much sleep they actually get.
Alcohol, cigarettes and other drugs
When life is getting you down, it is easy to try and ‘drown’ your sorrows or take other substances that might give you a momentary or short-term ‘feel-good’ factor. Alcohol itself is classified as a stringent depressant, so whilst it might make you feel good at the time of drinking, the evidence shows that longer-term it simply adds to your depressed mood. It’s a catch 22. You might feel so bad that you want to escape and drink might be your outlet… The drink makes you feel better for a while but the effect soon wears off.
The same applies to the momentary comfort some get from drugs and smoking without consideration for the long-term health consequences. With all these things the ‘hit’ doesn’t last that long and you may feel even worse when the effect wears off – leading to further and higher doses to get a similar hit. It’s not difficult to see how this can spiral out of control so be really mindful of taking any form of drug or excessive alcohol to try and help with your feelings.
Stage two: What are you actually doing?
The first blog on depression stated the psychological and physical symptoms of depression and it may be worth going back to give yourself a recap on these. These two components will form the basis for the rest of your action plan to feel better. When you are depressed, the hardest thing to do is to change the way you’re thinking and feeling – your psychology.
It is generally much easier to change your behaviours so the next steps in your action plan will be to look at what you do on a physical level and address that first. You’ll see that it is easier to choose to ‘do something’ like go for a walk than to try and ‘think yourself better’. By changing what you do – even if you still feel low doing it – you’ll start to slowly improve the way you think and feel and you can then look at starting the upward spiral.
Gradually get yourself moving even though you don’t feel like it. Sometimes, the less you feel like doing something, the more important it is to do it.
Just as an accumulation of stressors and life events lead to that negative and downward spiral, you’ll find that changing your behaviours and what you do can put you on an upward spiral. Once you learn how to change behaviour, then the psychology can follow and be easier to deal with.
A good way to approach your feelings is to commit to making a combination of approaches, which might include changing what you do, committing to speak to people and also challenging the way you think and talk to yourself.
You’ll find that each small component will contribute to you feeling better and on some days you might not want to take a specific action – maybe you don’t want to speak with anyone – but you’ll have a ‘toolbox’ of action points you can use as an when.
What are you up to?
The first phase of this behavioural stage is the information or data collection that we spoke about above.
Essentially, because when you get depressed you may not feel like doing anything, a sensible starting point is to look at what you are actually doing – write it down – make a list – like a personal diary. Try this for at least one week. Each time you write down an activity, you might give a mark out of ten for how beneficial it was to you. If you manage to accomplish such an activity, you should give yourself credit – even reward yourself in some way.
Once you’ve got a record of the things you do, the next phase is to actively programme in some more activity into your day. Your activity log/journal is a good place to start setting some future goals. Sometimes the thought of starting to get active can seem quite scary – like you don’t know where to start. So think of activities you either would like to do or just as importantly, activities you will commit to despite not wanting to. It doesn’t have to be anything spectacular. Start with simple things and things you might start doing by yourself before moving on to more interactive activities.
Going for a walk at the same time every morning could be a great starting point. Doing an activity at the same time every day helps with your commitment and motivation. Try to notice and savour the walk and really take in the sights and sounds. Really take notice of the houses, the colour of the doors, flowers, any animals you see and so on. By really being in the present your mind will start to build an element of ‘positivity’ rather than dwelling on what makes you feel low. Savouring things and being grateful for things in your life are both shown to be beneficial in terms of your happiness and well being. When feeling depressed it’s so easy to just focus on what is going wrong and let the good things in life pass you by. By taking a little time to appreciate what you have, rather than what you don’t, to focus on the certainty rather than the uncertainty, can be highly rewarding. Why not go to a coffee bar to reward yourself for the walk. If you are alone it can be nice to have other people around you; you don’t have to talk or socialise but a simple smile to the person serving you and a ‘how’s your day’ can lift your own mood. People watching can also be fascinating too or bring a book and relax.
Looking after yourself
When people feel low they tend to stop caring too much about their appearance, or even simply forget to care! Your personal care might deteriorate a little, simple things like getting up and dressed, washing and putting make up on can make such a difference and stop a potential downward spiral.
Small duties and chores
When feeling down it is also easy to put off jobs aside like housework, food shopping, paying bills – set yourself a list and tick these off as letting these small things build-up will make them seem overwhelming and make you feel worse.
Research findings suggest that exercise may be just as effective as antidepressants at reducing the symptoms of depression. Sometimes the improvement in mood happens quickly, and for others, it takes a few weeks of regular exercise (three to four times a week, for about 20 minutes at a time). Being physically active can lift your mood, reduce stress and anxiety, encourage the release of endorphins and even improve self-esteem. It doesn’t mean you have to run a marathon, a brisk walk should also help! Exercise will also be a good distraction from negative thoughts and it can improve your social interaction too.
Exercise can improve your energy level, improve physical well being, burn off stress and provide a sense of achievement.
Here are some tips for starting an exercise program:
- Pick activities that you really enjoy. Some people prefer vigorous exercise, like running or fast walking.
Other people enjoy exercise, like weight training or yoga. It doesn’t matter what you pick – all exercise has been shown to have a positive effect on mood. Sometimes people are most successful at sticking with an exercise routine if they pick several activities and rotate.
- Frequency is more important that duration.
Regular short periods of exercise are better than infrequent or irregular long periods.
- Remember – nothing changes overnight.
Use your goal-setting skills when you are developing an exercise programme – start small and build up over time.
Now you’ve considered all the activities available each evening try scheduling three activities for the following day, that you’re not currently doing; one self-care activity, one chore and then importantly one interest or hobby activity.
Schedule these into specific times of the next day. Remember to make it doable, be specific and don’t change your mind – however you feel on the day – an example might be to get up at 8 every morning, shower and go for a walk for 20 minutes. Put your activities in the diary at the end of the day. At first, you might not feel any better but that’s when you remind yourself you’re actually being proactive and doing something positive and it could take a little time. Remember, when people are depressed, they tend to focus on the things they haven’t done, and ignore or downplay the things they have managed to do. Deliberately remind yourself that you did it – it counts, even more so when you feel low.
After a week of doing these activities, review the situation.
Ask yourself the following questions:
- Do I feel better and if so what made me feel better?
- Did I feel a little better when I was doing things?
- Am I doing more?
- Do I want to keep doing these things?
- Do I want to do them more often?
- Can I add another activity?
If you had some difficulty achieving your goal, what got in the way? Don’t beat yourself up over not doing something…it’s ok, As your energy comes back, you will be able to do more. The most important thing is to start moving, no matter how slowly.
Stage three: Don’t be a hermit
We’re social animals and relating to others is one of our basic psychological needs. When you’re depressed it might feel far from a need – it might be something you want to avoid altogether. So how do you start? What if you really don’t want to socialise? Then the first stage would be to …
When you’re feeling low one of the last things you might want to do is talk. Keeping yourself to yourself might feel like the best thing to do. You believe that no one wants to listen to your worries and problems.
Take a moment to think of a good friend. How would you feel if you found out they’d been feeling really low and didn’t feel they could share their problems with you. You’d probably feel a little upset yourself, maybe even offended that they felt they couldn’t share their problems with you.
Following someone’s dramatic self-harm or even suicide close friends often say – we had no idea? They never said anything…So don’t be afraid to share and speak. Sharing a problem either with a friend or trusted colleague, or even a support group can not only give you help, but also an insight into the issues you might be going through. It’s also nice to hear you’re not alone in feeling this way and many others have and do go through periods of depression and come out the other side. Their personal experiences might even help you or at least give you some comfort.
You might prefer to talk to someone anonymously and there are plenty of telephone support lines like the Samaritans where you can call someone at any time.
Remember – a problem shared really is a problem halved.
If you’re okay with talking on the phone, the next part of your action plan will be face-to-face engagement. This could be with family, friends or social or even support groups.
Involvement with family and friends.
Even if you don’t feel in a good place at the moment, you could decide to invite a friend to do something together – even if it’s just going for a coffee. You might feel that you don’t want to talk much, so simply going out and listening could be a good starting point. The thing is to get out and be with someone you like or trust.
Next, you may decide to go out for a longer period, perhaps to a city centre to walk around, window shop or have lunch together, maybe visit a museum or a show. By increasing the frequency of your interactions and then extending the duration, you’ll be distracting yourself and this should help the negative spiral.
Social or support group
If you don’t have the option or don’t feel like socialising with friends and family, a great option is to join some sort of social or support group. There are so many options available from walking groups to dedicated support groups and you can find details of your local groups online. One of the benefits of joining these groups is that you may feel safer chatting with someone new. Another great benefit is that most groups meet at set times every week or even every day and adding that structure to your life will definitely help.
This could also be done in addition to your involvement with friends and family. The more active you can be and the more time you spend with others the better.
Volunteer groups or charity organisation can be beneficial in getting you re-activated and re-energised. Helping others been shown to be very cathartic and rewarding in itself. Helping people who may be less fortunate than yourself will help to put things back in perspective.
Remember, whatever you choose to do, try to really engage and savour what you’re doing, don’t just go through the motions.
Stage Four: Thinking Errors
Negative or irrational thinking and depression
People are often affected in totally different ways to similar or even the same events. Their response or reaction is directly related to the way they interpret the event – their perception of what happened. Imagine a scenario where a tennis player is playing and sees her coach start to talk to her parents – she might think straight away that they’re discussing a shot she just missed and perhaps how she might lose matches after such an error – she starts worrying and misses the next few shots and eventually the match.
When speaking with her parents after she asks what they were talking about and they say the coach asked if they’d watched a programme on TV the previous night – the girl is distraught!
Now, imagine another player seeing the same thing and thinking that the coach is telling the parents how well she has trained and overcome errors in her session this week. She is more energised and goes on to win the match comfortably. In this scenario, the event experienced was exactly the same however there was a totally different outcome because of the different assumptions the players made. How many times have you jumped to the wrong conclusion when something happens to you – this is a classic thinking error – If you are going to make an assumption make it the positive one – you’ll feel much better for it even if the assumption was wrong!
Negative Thoughts and Depressed Mood
When people feel depressed they have particular ways of thinking about themselves, others and the world. Negative events are given much more significance than positive ones and the positive ones are often ignored pretty much completely. Most of the time the thoughts are totally unrealistic and things seem much worse than they actually are.
This unfair and unrealistic thinking affects the way we make sense of events and situations. For example: Thinking in a very critical fashion, judging ourselves in a harsh and unfair manner. The bad things we have done are very obvious, and we have a hard time remembering anything good about ourselves. Typified with self-talk such as “I am so useless, I’m just a complete failure”. These unhelpful thoughts are also automatic; they seem to appear out of nowhere and are not the result of reasoning or decision making. Sometimes they are so automatic they are difficult to spot. Unfortunately, these thoughts can also seem very believable – and so there seems to be very little reason to doubt them.
The common thinking errors
- Filtering – you only look at the bad, never the good. Your focus is on everything that doesn’t go your way and you totally ignore all the things that do. You may single out a negative detail and dwell on it, ignoring any good things you have done. You may see only your weaknesses and mistakes, and disregard your strengths and accomplishments.
- Overgeneralisation – one negative event is the beginning of a never-ending pattern. If you fail the first time, you will fail every time. If you have difficulty with one friend, nobody likes you. If something went wrong everything is going to go wrong – It’s the “I’m having a bad day scenario” when its 9 o clock in the morning and a couple of things haven’t gone your way- or “this match is going to be awful after making an error in the first minute of a 2hr match
- All or nothing thinking – you see things as black and white with nothing in between. You are either fat or thin, smart or stupid, depressed or happy, and so on. Gradual progress is never enough – only a complete change will do. “Who cares if I only did half of it? It’s still not finished!”
- Catastrophising – a small disappointment is a disaster. For example, after making a mistaken comment at a meeting, you think you made a complete fool of yourself and it was a complete disaster. As a result, you react to the imagined catastrophe – you believe that everyone at work thinks you are stupid and you may lose your job, rather than to the little event (the mistaken comment) that in fact not many people noticed and even if they did was no big deal, they’ve all done similar and actually felt pleased it wasn’t them again and felt for you!
- Labelling – you talk to yourself in a harsh way, calling yourself names like “stupid”, “idiot” or “failure”. You feel like these labels sum you up. In fact, many sportspeople will label themselves as rubbish and call themselves names that they wouldn’t accept from anyone else. The crazy thing is people start living up to their own label – so if you’re going to label yourself make it a good label!
- Mind reading – you feel you know what others are thinking of you, and it’s always bad. As a result, you react to what you imagine they are thinking without bothering to ask – as in the tennis player’s interpretation of what their parents and coach were discussing.
- Fortune Telling – you know what the future will bring, and it’s usually negative. Nothing will work out, so why bother trying? Result: You bring about the future you fear.
- Disqualifying the positive – anything positive about you or anything positive that happens is discounted. For example, “I did manage to get some things done, but anyone could have done that”, or “I enjoyed going out, but I felt depressed again afterward”. It’s those belittling comments that ultimately will make the person feel less about themselves.
- Personalisation – If something bad happens, it must have been your fault. Other more likely causes are ignored.
- Perfectionism -it’s only good enough if it’s perfect. And because it’s never perfect, you are never satisfied and can never take pride in anything.
- Shoulds and oughts –you know how you should be and how the world should be – but you are not, and neither is the world. “I should not upset people”. “I ought to have achieved more than this.” Result: You are constantly disappointed and angry with yourself and everyone around you.
Whether negative thinking starts before depression or is caused by depression, it can have a very big influence on your experience of the world. Negative thinking increases the negative impact of difficult and challenging life situations and can make people more sensitive to emotional pain. So how can you minimise or eliminate your negative thought? Here’s our three-step guide:
STEP 1 Awareness – Recognising your negative thoughts – & the ABC strategy:
Self-awareness is a crucial first element in change and self-improvement. Negative thinking can be so habitual, quick and automatic that people don’t even realise they’re doing it. It’s important, therefore, to learn to become aware of negative thinking as it occurs. This takes some effort and it is a useful exercise when you have these thoughts to first acknowledge them and then start to challenge them. A really useful strategy to help to identify negative thinking is to fill out a thought diary over the course of a week. Every time your mood sinks a little further, ask yourself:
What was going through my mind just then?
Write it down!! Then make a note of the emotions you were feeling. Keep recording your thoughts – maybe you’ll notice patterns and the same kind of thought happening over and over again – you might want to put a mark beside thoughts that keep repeating themselves.
Another useful strategy and one you will brave to employ is to simply ask some people close to you how often you use negative talk – which will reflect your negative thoughts – what they say may surprise you and help you become more aware.
When you start to become aware of unhelpful thinking, you may feel tempted to attack yourself.
“How could I think such stupid thoughts?”
Don’t – these thoughts are more common than you expect – simply learn to deal with them and change your mindset.
Remember, depression causes you to criticise yourself, and recognising unhelpful thinking gives you one more way to beat yourself up. Instead, remind yourself that unhelpful patterns of thinking may have been learned over a long period of time and the habit may take some effort to break.
The ABC Strategy
A useful way to approach these thoughts is what we call the A-B-C process.
A stands for Activation or Activity that brings a thought on. Someone says something to you don’t like for example – or you mess up at something you value.
The B is the Belief about what happens – so in the case here it could be “no one likes me’ or “I always mess up when it counts”
and C is the Consequence of that thinking – so you end up feeling bad, sad, weepy or any other negative mood because of the meaning you attached to the thought.
STEP 2 – Dispute or Challenge
As a progression to the ABC strategy, you can start using D as a disputation on your meaning. The reason we call these types of thoughts irrational is just that – they are irrational and if you dispute or challenge them you will learn how futile they can be and eventually stop having them – or at least when you do have them you will be in a better place to not let them affect you.
Challenging negative thinking requires deliberate re-thinking of the situation that got you upset.
Again keeping some form of a diary of your thoughts and responses is useful here – particularly if you add how a situation – or more precisely your perception of the meaning of that situation – made you feel – as before you don’t need to write it down but it could be very useful to do so.
An important technique is reframing – Think about the situation and try to come up with a different explanation or a different idea about it. Sometimes this is as simple as reminding yourself you don’t have enough information to know for certain what is happening! This process is similar to having an argument with yourself – fight back against your negative thinking by giving yourself a chance to think fairly and realistically about what has happened. Ask yourself ‘what would my friend say in this situation, if it happened to them?’
And remember the words of the great Greek Philosopher EPICTETUS who famously said –
It’s not what happens to you – its how you react to it..
Here are some questions that might help you come up with more fair and realistic thoughts:
Testing the Reality of Negative Automatic Thoughts
- What evidence do I have for this thought? Would most people say that it supports your negative thought? If not, what conclusion could you draw instead?
- Is there an alternate way of looking at this?
- Is there an alternate explanation?
- What is a less extreme way of looking at this situation?
- How would somebody else think about this situation? How would someone else react?
- Maybe I need to ask around and find out.
- What would I tell somebody else if they were worried about this (We are often much more realistic about other people than ourselves.)
- Am I setting myself an unrealistic or unobtainable standard? What would be more reasonable?
- Am I forgetting relevant facts?
- Am I over-focusing on irrelevant facts?
- Am I thinking in all-or-nothing terms?
- Am I over-estimating my responsibility in this situation?
- Am I over-estimating how much control I have in this situation?
- What if this happens? What would be so bad about that?
- How will things be in X months/years time?
- Am I overestimating how likely this event is?
- Am I underestimating how well I can deal with this problem/situation?
It is not enough to come up with a rational, fair, and realistic thought just once. Negative thinking gets repeated over and over – it is a habit that is hard to break. More balanced thinking will help you feel better, but it will take dedicated and purposeful practice.
Unlike negative thinking, it is not automatic, at least not at first. It usually takes practice before getting the hang of more realistic thinking and you can start seeing a more balanced and realistic picture of yourself and your experiences.
STEP 3: Preparing for “trigger” situations.
There will be some situations in your life that are quite likely to trigger unhelpful thoughts. If you can be prepared for these it will be easier to deal with them at the time. Deliberately start rehearsing your fair and realistic thinking. You will have to tell yourself how to look at the situation – almost as though you were giving advice to a friend. If the unhelpful thinking starts – respond! Fight back! You may feel as though you are having an argument with yourself, but that is okay – every time you talk back to your unhelpful thinking, it gets weaker and your fair and realistic thinking gets stronger.