COPING WITH DEPRESSION

Depressed individuals often see themselves and their situation in a negative and pessimistic way. The depressed person often feels helpless, finds it difficult to enjoy formerly pleasurable activities, and feels hopeless about the future. They often have difficulty with making decisions, concentrating and taking action. Some people with depression feel irritable, sad and often like crying. Depression can also reveal itself through feeling increased physical discomfort, pain, boredom with work or school, alcoholism or drug addiction.

One form of psychological treatment for depression that has been found very effective is cognitive-behavior psychotherapy. Cognitive therapy has a focus on identifying the errors in thinking that depressed people often have and helping them substitute more accurate perceptions. Changing negative thoughts to more positive and realistic thoughts often will involve identifying distortions in cognition and correcting them. Counseling that encourages action toward solving problems and engaging in activities, exercise and relaxation are often helpful. The use of antidepressant medication is sometimes necessary.

Correcting Distortions in Thinking:

Like a scientist, you can learn to use your reasoning/cognitive powers to “test” the accuracy of your thinking and see whether it is accurate and realistic or an inaccurate interpretation.  In this way, you can keep from becoming upset at every experience that seems at first glance to be negative.

You can help yourself by:

Recognizing your negative thoughts

Correcting them and substituting more accurate and realistic thoughts.

Negative Opinion of Yourself: This notion is often brought about by comparing yourself with other people who seem to be more attractive or more successful or more capable or intelligent. You may consider yourself worthless and burdensome and not recognize more your positive qualities and strengths.

Self-Criticism and Self-Blame: You feel sad because you focus attention on your presumed shortcomings, you blame yourself for not doing a job as well as you think you should, for saying the wrong thing, or causing misfortune to others.  When things go badly, you are likely to decide it’s your own fault.  Even happy events may make you feel worse if you think, “I don’t deserve this.” Often, because your opinion of yourself is so low, you may make excessive demands on yourself.  You may require yourself to be a perfect housekeeper or an unfailingly devoted friend or an employee of unerring judgement.  You may run yourself down by thinking, “I should have done a better job.”

 Negative Interpretation of Events. You may find yourself responding in negative ways to situations that don’t bother you when you are not depressed.  If you have trouble finding a pencil, you may think, “Everything is difficult for me.”  When you spend a little money, you may feel blue, as if you have lost a large sum.  You may read disapproval into comments other people make or decide that they secretly dislike you - although they may act just as friendly as ever.

Negative Expectations of the Future. You may have fallen into the habit of thinking that you will never get over your feelings of distress or your problems and believe they will last forever. You tend to anticipate future failure and unhappiness as inevitable and may tell yourself it is futile to try to make your life go well.

Sense of Overwhelming Responsibilities. You have the same kind of jobs to do at home or at work that you have done many times before, but you now believe you are completely unable to do them or that it will take weeks or months before they are completed.  Or you tell yourself that you have so many things to do that there is no way of organizing the work. You may deny yourself rest or time to devote to personal interests because of what you see as pressing obligations coming at you from all sides.  You may even experience physical feelings that can accompany such thoughts - sensations of breathlessness, nausea or headaches.

How Do I Identify My Negative Thoughts?

 When you notice your mood changing or getting worse, ask yourself:

 What’s going through my mind right now: Your thoughts may be a reaction to something that happened quite recently, perhaps within the last hour or the last few minutes, or it may be a recollection of a past event.  It may even arise as an image or picture in your mind.  It is important to realize the following about your depressed thinking:

Negative thoughts tend to be automatic: They are not actually arrived at based on reason and logic - they just seem to happen.  These thoughts are based on the low opinion depressed people have of themselves, rather than on reality.

 The thoughts are unreasonable and serve no useful purpose: They make you feel worse, and they get in the way of attaining what you really want out of life.  You can learn to consider them carefully, and you will probably find that you have jumped to a conclusion that is not accurate. Even though these thoughts are unreasonable, they probably seem perfectly plausible at the time that you have them.  They are usually accepted as reasonable and correct, just like a realistic thought such as, “The telephone is ringing.  I should answer it.”

The more you believe these negative thoughts (that is, the more uncritical you are in accepting them), the worse you feel.  If you allow yourself to sink into the grip of these thoughts, you will find that you are interpreting everything in a negative way.  You will tend more and more to give up since everything seems hopeless.  

What Are Typical Thinking Errors?

 Exaggerating: You see certain events in an extreme way.   Problems and the possible harm they could cause are exaggerated.  At the same time, you underestimate your ability to deal with them.  You jump to conclusions without any evidence, and you believe your conclusion to be correct.  A man who invested his savings in a new house suspected that the house might have termites.  He immediately drew the conclusion that the house would fall apart and be worthless, his money squandered.  He was convinced that nothing could be done to save the house.

Overgeneralizing:  You make a broad, general statement that a problem in one area will affect other unrelated issues. For example, bad judgment in one investment means all of them are bad. Your judgement will be poor in all decision making.  

Ignoring the Positive:  You remember only negative rather than positive events and things that you have done.  

 What Can I do To Get Moving Again?

 The Daily Schedule: Try to schedule activities to fill up every hour during the day.  Make a list of items you plan to do each day.  Start off with the easiest activity and then progress to the more difficult.  Check off each activity as you complete it.  This schedule can also serve as a running record of your experiences of accomplishment and satisfaction.

 Sense of Accomplishment and Pleasure: You have more things “going for you” than you are usually aware of.  On your activity schedule, label activities that involved some accomplishment with the letter “A” and those that brought you some pleasure with the letter “P”.

Solving Difficult Problems: If a particular job you must do seems to be very complex and burdensome, try writing down each of the steps that you have to take in order to accomplish the job and then do just one step at a time.  Problems that seem unsolvable can be mastered by breaking them up into smaller, more manageable units. If you feel frozen into only one approach to a problem and are not making any progress, try to write down different, alternative ways of tackling the problem.  Ask other people how they might handle such difficulty.

What Can I Do To Deal With My Negative Thinking?

 Most depressed people believe that their life situation is so bad that it is natural for them to feel sad.  Your feelings are derived from what you think about and how you interpret what has happened to you.  If you think carefully about a recent event that has upset and depressed you, you should be able to sort out three parts of the problem:

* The event

* Your thoughts

* Your feelings

Most people are normally aware of only the event and their feelings. Suppose, for example, your husband forgets your birthday.  You feel hurt and disappointed and sad.  But what really makes you unhappy is the meaning you attach to the events. You think, “His forgetfulness means he doesn’t love me anymore.  I have lost my appeal to him and to others.”  You may then think that without his approval and admiration you can never be happy or satisfied.  Yet, it is quite possible that your husband was just busy or is generally forgetful.  You have been suffering because of your unwarranted conclusion - not because of the event itself.

 When you feel sad, review your thoughts:  Try to remember what has been “passing through your mind.”  These thoughts may be your “automatic” reaction to something that just happened - the chance comment of a friend, receiving a bill in the mail, the onset of a stomachache, or remembering an event.  You will probably find that these thoughts are very negative and that you believe them a great deal.

A homemaker was feeling gloomy and neglected because none of her friends had telephoned for a few days.  When she thought about it, she realized that Mary was in the hospital, Jane was out of town, and Helen had already called.  She substituted this alternative explanation for the negative thought: “Everyone has neglected me,” and began to feel better.

Try to correct your thoughts by “answering” each of the negative statements you make to yourself with more realistic, balanced statements. You will find that not only are you regarding life more realistically but also that you feel better.  To evaluate your negative thinking, ask yourself the following questions:

What is evidence that my thought is true?

What is the evidence that my thought is not true or not completely true?

Is there an alternative explanation for what has happened?

What’s the worst that could happen and how could I cope if it did?

What’s the best that could happen?

What’s the most realistic outcome?

What would I tell a friend if he or she were in my position?

 What’s the effect of my believing my negative thought?

 What could be the effect of thinking about this more realistically?

What should I do now?

 The Double Column Technique: Write down your unreasonable automatic thoughts in one column and your answers to the automatic thoughts opposite these.  (Example: “John has not called.  He doesn’t love me.”  Answer: “He didn’t call me this week, but the last time we were together he was very affectionate, and he has told me he cared in the past.  He may be very busy this week and may think I’m doing better than I am.  The worst that could happen is we’d break up, which would be very hard, but I’d survive.  The best thing that could happen is that he’ll call very soon.  The most realistic outcome is that he’ll call sometime this week I would tell my friend Donna that she shouldn’t worry but just call him.  The effect of believing he doesn’t love me is that I feel miserable and unmotivated to do anything.  The effect of changing my thinking would be that I’d feel more hopeful.  I should just call him by the end of the day if he doesn’t call me.”

Using mindfulness to cope with negative experiences (thoughts, feelings, events):

Becoming more mindful of breathing, body sensations and routine daily activities allows us to be to become observers of our thoughts and feelings and then more accepting of them.  This results in less distressing feelings, and increases our ability to enjoy our lives. With mindfulness, even the most disturbing sensations, feelings, thoughts, and experiences, can be viewed from a wider perspective as passing events in the mind, rather than as "us", or as being necessarily true.  

When we are more practiced in using mindfulness, we can use it in times of intense distress, by becoming mindful of the actual experience as an observer, using mindful breathing and focusing our attention on the breathing we can listen to the distressing thoughts mindfully, recognizing them as merely thoughts, breathing with them, allowing them to happen without believing them or arguing with them.  If thoughts are too strong or loud, then we can move our attention to our breath, the body, or to sounds around us.