Depression

COPING WITH DEPRESSION

Aaron T Beck, M.D and Ruth L Greenburg A.B.

SIGNS OF DEPRESSION

“My wife left me because I wasn’t good enough for her.  I will never be able to get along without her”

“My hair is thinning.  I’m losing my looks. No one will care about me any more.”

“I am such a lousy secretary.  My boss just keeps me because he feels sorry for me.  Nothing I try to do ever turns out right.”

“I just can’t get myself to do any work around the house.  My marriage is falling apart.”

These are typical thoughts of people who are depressed.  While these notions seem to be correct on the surface, they actually show a change in the way a person has come to think about him/herself. Change – in thinking, feeling, and acting – is a key feature of depression.  Although the change may come gradually, the depressed person is different

from the way he/she was before the onset of his/her illness perhaps even the opposite of his/her usual self.  There are many examples of this change: the successful businessman who believes he is on the brink of bankruptcy, the devoted mother who wants to abandon her children, the gourmet who can’t stand food, the playboy who become disgusted with sex.  Instead of caring for himself he neglects himself and his appearance.  His instinct to survive may give a desire to end his life.  His drive to succeed may be replaced by passivity and withdrawal.

Recently a ten-year research project supported by the National Institute of Mental Health attempted to explain the persistence of these unpleasant feelings in depressed people.  These researchers found that an important factor is that the depressed person interprets many situations incorrectly.  What he/she thinks about what is happening around him/her affects how he/she feels.  In other words, the depressed person feels sad and lonely because he/she erroneously thinks he/she is inadequate and deserted.

A depressed patient, then, can be helped by changing the errors in thinking, rather than by concentrating on their depressed mood.

In our studies, we have found that regardless of their low opinions of themselves, depressed people perform just as well as normal subjects in a series of complex tasks.  In one study, we gave depressed patients a series of tests of increasing difficulty involving reading, comprehension and self-expression.  As the patients began to experience success, they became more optimistic.

Their mood and self-image improved.  Interestingly, they even performed better when they were later asked to try out other tests.

THINKING AND DEPRESSION

These findings suggest new approaches to treating depression and new ways in which the depressed person can learn to help himself/herself.

As a result of these studies, psychotherapists are now concerned with the kinds of statements that people make to themselves – that is, with what they think.  We have found that depressed people have continuous, unpleasant thoughts and that with each negative thought the depressed feeling increase.  Yet these thoughts are generally not based on real facts and make a person feel sad when there is no objective reason to feel that way.  The most obvious and typical sign of depression is a sad mood: gloomy, lonely, apathetic.  The depressed person may find himself/herself crying even when there is nothing to cry about or may find it impossible to cry when a truly sad event occurs.  He/she may have trouble sleeping or wake early in the morning, unable to return to sleep.  On the other hand, feeling constantly tired, he may sleep more than usual.  He/she may lose his appetite and lose weight, or eat more than he/she normally does and gain weight.

Typically the depressed person also sees him/herself in a very negative way.  He/she may believe that they are helpless and alone in the world and often blames themselves for trivial  faults and shortcomings.

He/she is pessimistic about him/herself, the world and about their future.  He/she loses interest in what is going on around them and don’t get satisfaction out of activities they used to enjoy.  Often he/she has trouble making decisions or getting themselves to carry out decisions they have made.

Some people may be depressed without showing the usual sad, moody, dejected feelings.  They may complain instead of physical discomfort or suffer from alcoholism or drug addiction.  When a person always seems tired or bored with what they are doing, they may actually be depressed.  When bright children do poorly in school over a period of time, this too may point to depression.  There is even evidence that the overly active child may be compensating for an underlying depression.

NEW UNDERSTANDING FROM RESEARCH

It is very common for depressed people to believe that they have lost something very important to them, although this is really not often the case.  The depressed person believes he/she is a “loser” and will always be a loser that he/she may be worthless and bad and perhaps not fit to live.  They may even attempt suicide.

Negative thoughts may keep the depressed patient from engaging in activities that will make them feel better.  As a result he/she is likely to experience harsh critical thoughts about them being “lazy” or “ Irresponsible” – which makes them feel worse.

In order to understand this faulty thinking, consider the following example.  Supposed you are walking down the street and you see a friend who completely ignores you.  Naturally you feel sad.  You may wonder why your friend has turned against you.  Later on you mention the incident to your friend, who tells you he was so pre-occupied at the time he didn’t even see you.  Normally, you would feel better and put the incident out your mind.  If you are depressed, however, you will probably believe that your friend has really rejected you.  You may not even ask him about it, allowing the mistake to go uncorrected.  Depressed persons make such mistakes over and over.  Infact they may misinterpret friendly overtures as rejections.  They tend to see the negative rather than the positive side of things.  And they do not check to determine whether they have made a mistake in interpreting events.

If you are depressed, many of your bad feelings are based on mistakes in thinking.  These mistakes relate to the way you think about yourself and to the way you judge things that happen to you.

Still, you have many skills and you may be good at solving problems in other areas.  In fact, you have solved problems all you life.  Like a scientist, you can learn to use your reasoning powers and your intellect to “ test out” your thinking and see whether or not it is realistic.  In this way, you can keep from becoming upset at every experience that seems at first glance to be unpleasant.  You can help yourself by (1) recognising your negative thoughts, and (2) correcting them and substituting more realistic thoughts.

CHECK LIST OF NEGATIVE THOUGHTS

Whenever you notice that you are feeling somewhat sadder, think back and try to recall what thought triggered or increased your feelings of sadness.   This thought may be a reaction to something that happened quite recently, perhaps within the last hour or last few minutes, or it may be a recollection of a past event.  The thought may contain one or more of the following themes.

1) 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: “ I am a much worse student than Mike”, “ I have failed as a parent”, “ I am totally lacking in judgement or wit”.  You may find that you have become preoccupied with these ideas about yourself, or dwell on incidents in the past when people seemed to dislike or despise you. You may consider yourself worthless and burdensome and assume that friends and relatives would be happy to be rid of you.

2) Self- Criticism and Self-Blame.  The depressed person feels sad because he/she focuses his attention on his/her presumed shortcomings, they blame themselves for not doing a job as well as they think they should, for saying the wrong thing or causing misfortune to others.  When things go badly, the depressed person is likely to decide it’s their own fault. Even happy events make you feel worse if you think, “ I don’t deserve this, and I am unworthy”. 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 unfailing devoted friend or a physician of unerring clinical judgement.  You may run yourself down by thinking “ I should have done a better job”.

3) Negative Interpretation of Events.   Over and over, 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 as friendly as ever.

4) 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. Or you may have negative anticipations whenever you try to do a specific job: “ I am sure to fail at this”.  A depressed woman would have a visual image of herself ruining dinner whenever she cooked for guests.  A man with a family to support pictured himself being fired by his employer for some mistake.  The depressed person tends to accept the future failure and unhappiness as inevitable and may tell him/herself it is futile to try to make their life go well.

5) “My responsibilities are overwhelming”.  You may have the same kind  of jobs to do at home at work that you have done many times before.  But you now believe you are completely unable to do them or 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 organising the work.  Some depressed patients deny themselves rest or time to devote to personal interests because of what they see as pressing obligations coming at them from all sides.  They may even experience physical feelings that accompany such thoughts – sensations of breathlessness, nausea or headaches.

WHAT YOU WOULD BETTER KNOW ABOUT NEGATIVE THOUGHTS

On the first page of this booklet, we gave examples of the thoughts of people in a depressed state.  A non- depressed person might occasionally have such thoughts but he/she generally dismisses them from their mind.  But the depressed person has them all the time – whenever he/she thinks about their own value or ability or what they are likely to get out of life.  These are some of the ways you can recognise depressed thinking:

 

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

 

2) 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.  If you consider them carefully, you will probably find that you have jumped to a conclusion that is really not accurate.  Your psychotherapist will be able to show you how unreasonable your thoughts are.

3) Even though these thoughts are unreasonable, they probably seem perfectly plausible at the time you have them. They are usually accepted as reasonable and correct, just like a realistic thought such as “ The telephone ringing – I should answer it”.

4) The more a person believes these negative thoughts (that is, the more uncritically he/she accept them), the worse they feel.

If you allow yourself to sink into the grip of these thoughts you will find you are interpreting everything in a negative way.  You will tend more and more to give up because everything seems hopeless.  But giving up is harmful – because depressed people often interpret the fact that they have given up as yet another sign of inferiority and failure.

You can help yourself by learning to recognise your negative thoughts and understanding why they are incorrect and illogical.  Check the characteristics listed below and see how well they fit your negative thoughts.

TYPICAL THINKING ERRORS

People who are not well or in pain are much more likely to feel irritated and angry than those who are healthy. So physical health can be a considerable factor in the anger equation.

Incorrect thinking leads to and aggravates depression.  You probably make one or more of the following errors.  Read these and see which apply.

1) Exaggerating.  You see certain events in an extreme way.  For example, if you are having some every day difficulty, you start to think that it will end up in disaster – you exaggerate problems and the possible harm they could cause.  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 suspects 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 nothing could be done to “save the house”.

2)        Over generalising.  You make a broad general statement that emphasises the negative: “nobody likes me”. “ I am a complete failure”. “ I can never get what I want out of life”. If someone you know tells you off you think: “ I am losing all my friends”.

3) Ignoring the Positive.  You are impressed by and remember only negative events.  When a depressed woman was advised to keep a diary, she realised that positive events happen often but that she had a tendency not to pay attention to them and forget them.  Or she would tell herself that the good experiences were unimportant for one reason or another.

A man who for 4 weeks had been too depressed even to dress himself spent 8 hours painting in his bedroom.  When he finished, he was disgusted with himself for not getting exactly the results he wanted.  Fortunately, his wife was able to make him realise what remarkably fine work he had done.

On the other hand, you may tend to view some positive events as losses.  For example, a depressed young woman received a letter from her boyfriend, which she decided was a letter of rejection.  She broke off with him with great sadness.  Some time later, when she was no longer depressed, she read the letter again and realised no rejection was intended.  What she had received was not a rejection letter but a love letter.

WHAT TO DO

1)        The daily schedule.  Try to schedule activities to fill up every hour during the day.  (See special form for the weekly activity schedule).  Make a list of items you plan to attend to each day.  Start off with the easiest activity and then progress to the more difficult check off each as you complete it.  This schedule can also serve as a running record of your experiences of mastery and pleasure

2) “Mastery and Pleasure Method.”  You have more things going for you than you are usually aware of.  Write down all the events of the day and then label those that involve some mastery of the situation with the letter “M” and those that bring you some pleasure with the letter “P”.

3) The A.B.C of changing feelings.  Most depressed people believe that their life situation is so bad that it is natural for them to feel sad.  Actually your feelings are derived from what you think about and how you interpret what has happened to you.

If you think about a recent event that has upset and depressed you, you should be able to sort out these three parts of the problem:

A.       The event

B.       Your thoughts

C.       Your feelings

Most people are normally only aware of points A &C

A.       Suppose for example, your wife forgets your  birthday

B.       What is really making you unhappy is the meaning you attach to the events.

C. You feel hurt and disappointed and sad.

You think “My wife’s forgetfulness means she doesn’t love me anymore”. “ I have lost my appeal to her and to others”. You may then think that without her approval and admiration you can never be happy or satisfied.  Yet, it is quite possible that your wife was just busy or doesn’t share your enthusiasm for birthdays.  You have been suffering because of your unwarranted conclusion – not because of the event itself.

4) If you should happen to get a sad feeling, review your thoughts.  Try to remember what has been “passing through your mind”.  These thoughts may have been your “automatic” reaction to something that has just happened – the chance comment of a friend, receiving a bill in the mail the onset of stomach ache, a daydream, you will  probably find that these thoughts were very negative and that you believe them.

5)        Try to correct your thoughts by “answering” each of the negative statements you made to yourself with a more positive, balanced statement.  You will find that not only are you regarding life more realistically but also that you will feel better.

A housewife was feeling gloomy and neglected because none of her friends had telephoned her for a few days.  When she thought about it, she realised that Mary was in hospital and Jane out of town and Helen had really called.  She substituted this alternative explanation for the negative thought: “ I am neglected.” And began to feel better.

6) 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 is busy and thinks I am doing better than last week – so he doesn’t need to worry about me).

7) Solving difficult problems.  If a particular job you  have to 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 just do one step at a time.  Problems that seem unsolvable can be mastered by breaking them down into smaller 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 a difficulty.  We have labelled alternative ways of looking at and solving problems- “ Alternative Therapy”.

PSYCHOTHERAPY

Your psychotherapist can help you to identify and correct your unrealistic ideas and thinking that brings you to an erroneous conclusion about yourself and others.  He or she can also help you devise ways to deal more effectively with real, day-to-day problems.  With his or her guidance and your own effort, you will have a good chance to feel better.  And you can learn to respond with far less depression and misery when you encounter difficulties in the future.

Further Readings

Beck, Aaron T., Depression:  Causes and Treatment.  Phila:  University of Pennsylvania Press, 1972.

Beck, Aaron T., Cognitive Therapy and Emotional Disorders.  NY International Universities Press

National Numbers

MIND

Offers help and support , they hold group meetings where you can meet other people and will be offered help on ways to cope.

www.mind.org.uk

 

SAMARITANS

24 hr National Help line 116 123

This is run by volunteers who will give advice and a chance to speak to someone who understands how you feel.

www.samaritans.org

 

 

 

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