Overcoming Depression

1. What is Depression?
   • This emotion can ensue from loss of any form resulting in self-devaluation. When depressed, people withdraw into themselves thus worsening their depressed state. You have a negative view of yourself, the world and the future. There is a loss of appetite, motivation, libido, interests, pleasure, decisiveness, sleep pattern may be poor and there may be suicidal thoughts.
   • Three causes of depression are:
     1. Self-blame – continually criticizing or despising yourself for your misfortunes in life
     2. Self-pity – feeling sorry for yourself over your lot in life
     3. Feeling sorry for the misfortunes of others e.g. famine
   • Sadness is a normal emotion resulting from realistic perceptions of loss – depression is an illness caused by negative, distorted thinking.
   • You need to develop a daily activity schedule to keep you busy thus countering your depression inducing thinking. You will be motivated to sustain the action which improves your energy and mood levels.
   • Identifying and challenging depressive thoughts and beliefs and taking action against these negative thoughts and beliefs will help you to overcome your feelings of helplessness and hopelessness so you can start to enjoy life once more.
   • Depression is a state of mood in which you will be aware of feeling far more than just low.
   • Depression is very common and has been prevalent for thousands of years.
   • Depression consists of a variety of symptoms. Sometimes emotions such as anxiety or anger which are common to depression can cause more trouble than the depression itself. You also may suffer guilt arising from a powerful urge to get away.
   • Depression can be uni-polar (suffering from only depression) or bipolar (manic-depression, swinging from both poles of mood – high and low).
   • Whether severe or less so, depression can be disturbing and have a crippling effect on your life.
   • The important thing to remember if you are feeling a failure, angry, trapped or think that life is not worth living, is that YOU ARE NOT ALONE.
   • There are many options available to those who are depressed, from some good drugs (anti-depressants) to many effective psychological treatments.

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2. The Biology of Depression
   • The physical and psychological levels of the body overlap so depression is caused by changes in body and mind.
   • There is a genetic risk of depression for some people but early life experiences can also lead to biological susceptibility.
   • Stress causes biological changes in the brain which can lead you to become increasingly focused on the negative, more fatigued and more stressed.
   • Learning to have more control over your life and thoughts can be helpful in numerous ways including allowing your brain chemistry an opportunity to recover.
   • Biological processes are related to the powerful state of mind that is depression. The brain is physically different when you are depressed from when you are well.
   • Just as grief can be the result of loss, depression can be switched on by problems you have in your life and how you come to view them.
   • Coping with the loss of a loved one, of being subordinated and/or defeated are all examples of mechanisms in the brain that evolved long ago. There are features of depression that seem to be connected to these mechanisms.
   • Unlovability, inferiority, defeat or entrapment, are examples of the sort of thinking that depression is inclined to concentrate your mind on.
   • Once depression is initiated, whether it is controlled or stays switched on is dependent to a powerful extent on your thinking.
     
   • Self attacking and self-supporting can increase or decrease stress respectively.

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3. Psychological and Social Factors
   • Depression is linked to negative thinking and a reduction in positive behaviour.
   • The quality of our relationships is connected to how good we feel in life. When depressed, relationships can often be viewed negatively.
   • Occurrences in early life can be a cause for difficulties in relationships.
   • We often form a number of latent negative beliefs about ourselves usually in childhood. Susceptibility to depression may arise due to these views.
   • When negative events take place these basic beliefs can be switched on again and you explain the events with your negative beliefs- e.g. “My marriage ended in divorce because of me – I am unlovable.”
   • Depression can result from not having a valued part in society. Our self-esteem is frequently derived from our social roles.
   • We require social environments which help our goals and pursuit of valuable social roles.
   • Depression should never be associated with personal frailty or inadequacy. It is due to over stressing ourselves and exhaustion which ensues leaving us feeling defeated.

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4. First Steps
   • Very occasionally depression arises from physical conditions that need to be screened out as soon as possible. The vast majority of depressions are not triggered by a physical condition.
   • Due to the variety in the forms and causes of depression it is necessary to set about dealing with depression in different ways.
   • Plan activities in steps – separate problems into basic steps and complete the steps one at a time.
   • You need to work out your own requirements – increase your social contacts or allow yourself personal space according to your needs. Attempt to have some positive activities in your life.
   • At times when relaxation is ineffective try increasing activity and distraction. Certain thoughts can be controlled in this way.
   • Learn to work within your own limits and avoid burnout.
   • You may seriously need to consider taking an anti-depressant to help you restart. Changes to your life style may be necessary (e.g. eat a healthy diet, take exercise, reduce your alcohol intake, try to get off stimulants and other drugs, try to come off tranquillizers with medical advice, learn how to relax, distract yourself).
   • Note the points above that you think are relevant to you.
   • Consider how you are treating your body and in what manner you are organizing your activities. Is it possible for you to plan to do things in steps?
   • Make a list of the positive things you would like to be a part of your life and think about ways that might realize some of these things.

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5. Feelings and Thoughts
   • We interpret things that happen to us by many thoughts about what the event conveys to us.
   • These thoughts can be automatic and just enter your mind immediately with little or no effort.
   • You may spiral down into more intensely depressed feelings because one automatic thought can lead to another.
   • Our inner feelings, fantasies, what we notice about our body and past actions can contribute to negative thoughts as well as particular situations.
   • We can clarify our thoughts by asking ourselves questions.
   • Try not to dwell on these negative thoughts or you may spiral down into more deep intense depression.
   • Train yourself to identify the themes you tend to dwell on and become more aware of your automatic thoughts.
   • Make a habit of writing down your thoughts – this will enable you to become aware of your thinking.
   • Basic negative beliefs could be guiding your life and causing negative automatic thoughts. Until you gain knowledge of your automatic thoughts, you may be unaware of these basic beliefs.
   • Think about your thoughts and write them down in a notebook. Use three columns to separate triggering events, beliefs and key thoughts, and feelings.
   • Start by writing down anything that comes into your mind then learn to grasp your thoughts as your mood changes.
   • Clarify your thoughts by asking questions about how you see yourself as a person, how you think others see you and about implications, including for the future.
   • When you become familiar with grasping and writing down your thoughts, work on a fourth column – Challenging Your Thoughts. Continuing reading will help you do this.
   • Beware of negative thoughts such as “This is a waste of time – it won’t work for me.” Say to your self “Even if this does not help, what will I lose from trying?”
     

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6. Challenging Negative Feelings and Thoughts
   • To fight depression you need to be rational and compassionate.
   • Often we do not see that there is evidence for and against a negative belief.
   • Produce alternatives by considering a problem from a number of different viewpoints.
   • Try to recognize the key advantages and disadvantages of a situation. You can attempt to challenge a block that may be noted.
   • You can do experiments to obtain more evidence for and against your thoughts and beliefs; test things out and practice new skills. Design your experiment step by step to give yourself a chance of success.
   • Write down and look carefully at your negative thoughts about a specific set of circumstances.
   • Consider how you think when you are not depressed and what you might say to a friend in your position. Challenge and question the validity of your negative thoughts using a rational and compassionate approach.
   • In order to start to challenge your negative thoughts examine the evidence for and against your idea or belief and try producing alternatives to your negative thoughts and beliefs.
   • Focus on a particular problem and think about the pros and cons and the advantages and disadvantages of altering your circumstances.

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7. Types of Negative Thinking
   • The manner in which you think about things can cause your depression to increase rather than decrease.
   • When we are depressed the rational brain has less control over our feelings than the primitive emotional brain.
   • You should try to concentrate on and gain knowledge of your negative thoughts.
   • The types of negative thoughts that arise in depression include:
     • catastrophizing (predicting the very worst)
     • jumping to negative conclusions (interpreting things without evidence)
     • emotional reasoning (an over-reliance on feelings to guide judgments)
     • ‘I must’(these thoughts involve feelings of being compelled to do something)
     • disregarding and disbelieving the positives
     • disregarding and disbelieving others
     • increasing the strength of the negatives by dwelling on them,
     • all-or-nothing thinking (black-and-white thinking)
     • over generalizing (you notice something that is true and make generalizations about it)
   • It is possible to successfully challenge all these thoughts.
   • From the different types of negative thinking given above try to recognize the ones relevant to you.
   • As you record your thoughts try to become aware of the type of thinking you are employing. You need to get as much practice as possible at recognizing and challenging your thoughts.
   • Look closely at your negative thought monitoring record. Which type of depressive thinking is each thought an example of?
   • Note the sort of thought you are using and how to challenge it by being rational and compassionate.
   • Notice if these types of negative thoughts are entering your mind. Identify and question the validity of the thoughts as they do.
   • How might you assist a friend to challenge one of these types of thoughts e.g. jumping to conclusions? You need to be kind to yourself and take a middle view rather than extremes.
   • Concentrate on your abilities rather than what you are incapable of doing.
   • Ask “In what way am I taking care of myself?” “Are my thoughts assisting me in this?” Gradually increase your perceptions and understanding.

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8. How to Challenge Self-Attacking
   • We can self-attack/self-bully ourselves in many different ways without being aware of our actions. Some of these ways include self-criticism, personalization and self-blaming (You automatically tend to assume you are in the wrong or the cause of negative events), self-labelling, judging yourself rather than your behaviour and not seeing the two as different, self-attacking, self-hatred and social comparison.
   • If you are to beat your depression you need to examine these types of thinking. Are they reasonable and able to produce good results? Contemplate how you can cure them.
   • You need to sort out your relationship with yourself and concentrate on an inner cure before you start looking for a cure.
   • Consider the types of self-bullying thinking given above. Which of them are relevant to you? Familiarize yourself with the ways in which you bully yourself.
   • Write down your thoughts when something occurs and you feel bad about yourself. Note what you are stating about yourself and what it means to you.
   • Think about how you may be using the types of negative thinking given in Types of Negative Thinking.
   • Using your Thought Monitoring Record from Challenging Negative Feelings and Thoughts, concentrate on the fourth column, Challenging Your Thoughts, employing your rational and compassionate self to create counter views of yourself.
   • How would you prevent a friend from self-bullying? Make this relevant to yourself. Consider the information available and look for alternatives. How do you take care of yourself with these thoughts? Do these thoughts assist you to look after yourself? Gradually increase your perceptions and understanding.

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9. The Effects of Negative Labels
   • We often identify our whole self with a single word/label/name-calling (weak, stupid, unlovable etc).
   • The labels may differ for individuals, but they are mostly negative judgments of us.
   • When we become focused on negative feelings and labels they can greatly affect our thoughts and feelings.
   • It can be useful to challenge these labels.
   • Consider the following labels and see if any are relevant to you-: bad, failure, hopeless, incompetent, loser, nuisance, ugly, unlovable, stupid, weak and worthless. There might be others that are relevant if these are not. Do you label yourself?
   • When did you first start labeling yourself? If it was caused by your depression you should disregard the label. If it was others, do you remember what was occurring at the time? What did they gain from labeling you in this way? Was it their way of diverting the blame from themselves or did they find you an easy target? You should tell yourself that the time has come to abandon these labels and think about doing so. They are unwanted and not necessary. Apart from the effort would anything prevent you from doing this? Think about the advantages and disadvantages.
   • Challenge these labels by being rational and compassionate. Explore other demanding tasks that may be useful. You have nothing to lose from attempting them to find out if they are of benefit. Keep in mind that in depression you tend to concentrate on the negatives.
   • You now need to focus on practicing the positives. The more you do this the better your mood will be and the less stress you will feel.

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10. Further Challenging Negative Thoughts
    • To help you focus on controlling negative thoughts use flash cards with the thoughts and alternatives. On one side of the card write down one of your negative thoughts and on the other write down some key challenges to this.
    • If you can identify your feelings but not your thoughts, give your feelings a voice – what would they say?
    • Sit in a mediator chair opposite two chairs placed together which are your internal bully and your inner helper or rational and compassionate self. Ask yourself what each would say respectively and write down your thoughts.
    • When you are depressed your internal images are often gloomy. Try to change the images so that they become more comforting and healing.
    • Explore some of your fundamental values and attitudes. Think about those that are no longer useful and try to change them by considering what values and attitudes you would convey to someone else. These will probably be your authentic values and attitudes.
    • “Life scripts” or typical roles give us all an identity. If you identify a life script that you would like to change, consider what you have to do to achieve this and how you would act differently if you had different values. Deal with the problem in steps.

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11. Coping With the Need for Approval
    • If you excessively seek approval, the needs of others will become more important than your own.
    • You can become trapped in seeking approval when the means of achieving approval becomes to be increasingly subordinate. You avoid your own needs and try to please others.
    • People can become subordinate to a way of life or to others.
    • Conflict over whether you live for yourself or for others can lead to a loss of identity. This is linked to loss of composure and reduced confidence due to lack of control over where your life is going.
    • Build your confidence by increasing the positives in your life and be serious about your own requirements and try not to criticize yourself.
    • In your relationships with others remember that approval has to go both ways.
    • Receiving a lot of criticisms and put downs is linked to mental ill-health. These can be verbal, non-verbal or even physical attacks. You may believe the bully or feel weak if you cannot deal with your adversary but the best option is to remove yourself from their presence or seek help from others.
    • You will need your Thought Monitoring Record from Challenging Negative Feelings and Thoughts. Try to recognize the types of negative thinking in the thoughts you note. See Types of Negative Thinking. Use your rational and compassionate mind to challenge the negative thinking.
    • How do you deal with approval? Are you able to accept the nice things said about you? If not, record your thoughts and challenge them.
    • What goes through your mind when you have made an effort and others do not notice? Do you think you are making too much of the circumstances? Are you feeling strongly self-critical? Challenge these thoughts with alternatives.
    • Do you feel you must please others? What would happen if you did not succumb to the wishes of others? Would you label yourself as selfish? Write down your thoughts and challenge them. What thoughts prevent you from being your own person? Is it possible that your thinking can consider both yours and the other person’s perspective.
    • Are you blaming yourself for being the target of a bully? Do you believe the bully? If so, think about how you can challenge this and how a sympathetic friend would talk to you.

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12. Feelings of Shame
    • Shame arises from a feeling that we are in some way different and inferior or bad. We all are capable of developing shame.
    • Shame occurs when we devalue ourselves for behaving in a way which attracts disapproval or ridicule
    • You may feel shame or be shamed by others.
    • Shame has emotional, behavioural and physiological components. These feelings may have been established in the past or present.
    • When you label yourself as e.g. inferior or bad, your shame increases.
    • Shame is felt when we want to feel good about ourselves but others will not allow this.
    • Your inner bully can make you feel shame and it is a bad idea to be restrained by your bully.
    • Shame can bring you to a standstill and you may spend much of your life hiding it or compensating for your shame.
    • In order to beat shame you need to admit the truth of the root of your shame with compassion for yourself and acknowledge that types of negative thinking e.g. all-or-nothing thinking, control the functioning of shame.
    • Write down the things you feel ashamed about and use your rational and compassionate mind to challenge them by finding alternatives to the shameful thoughts. For example: I am NOT a worthless person because ---------.
    • What is occurring when you feel ashamed? Imagine a friend is assisting you – take in their compassion and request what you require of them. How can you change to overcome your shame? How would you act if you felt less shame? Contemplate on taking measures to realize this.
    • Your fear of other people’s opinion will be reduced as you try to alter your behaviour. For example if you are dependent on wearing make-up to go out, try not wearing any. Examine and challenge your thoughts.
    • Attempt to be less formal with people. Increase your warmth toward them and concentrate less on what is visible.
    • Be the initiator in developing positive activities with other people.
    • You could try joining a group such as Alcoholics Anonymous – the self-empowerment skills they will teach you will be invaluable.
    • Keep a journal of your feelings of shame – this will give you emotional release.
    • Try to understand the child in you and accept and love that child.
    • Tell yourself each day about one good quality you possess. Do not listen to the shaming voice in your mind.
    • Recognize, stand up to or avoid people and situations that trigger your shame.

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13. Coping With Guilt
    • Guilt arises from a responsibility for others. We focus on the harm or hurt we may have caused other people. It is often connected to fear and sadness.
    • Normal guilt occurs when we think we have done something wrong, and pathological guilt occurs when we have the additional belief that as a result we are a bad person.
    • We may resort to self-punishment because we feel that we deserve to be punished since we are a bad person. A common form of self-punishment is self-blame where we blame ourselves entirely for problems. We may take self-blame further and self-harm.
    • The problems of life naturally cause guilt which can restrain us but on the bright side, can enable us to acknowledge our damaging behaviour.
    • Guilt can trigger self-attacking and shame.
    • Guilt occurs when we feel we have not dealt adequately with people, had to turn down their requests or suffered a separation.
    • If you suffer guilt because you may think you are a burden or feel you have disappointed others, note that you do not choose to have your emotional problems. If your guilt makes you feel suicidal seek professional help.
    • Try to recognize your key guilt areas.
    • Let us consider how guilt can be both beneficial and detrimental to your well-being. Write down the ways in which recognizing your guilt helps you. Then think about the ways in which it is not of aid.
    • Confront and challenge your guilt by asking yourself the following questions: What am I trying to achieve by endeavouring to be pleasant? Am I taking on too much responsibility? Is this something I learned when young and need to alter now? What made me think this way and how might I alter my behaviour? Does my guilt make me submissive and unable to assert myself for fear of what others may think? What evidence is there for and against my guilt? What are the alternatives to my negative thoughts about guilt? What advice would I give a friend experiencing the same circumstances? How can I reduce and control my guilt?
    • It can be helpful to write a review of how you think you may have acquired your guilt and what you could do to challenge your guilty thoughts.
    • List the advantages and disadvantages of feeling guilty in a given situation.
    • How does guilt benefit your life? How is it detrimental to your well-being?
    • List all the factors that contribute to your problem.

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14. Managing Anger
    • We may get angry in circumstances when something of importance to us is harmed or is under threat of harm.
    • Anger is linked to feelings of frustration. People or things are not as we wish them to be.
    • Feelings of anger increase in depression and may be directed at yourself or other people. You may become excessively angry and explode or you may conceal your anger.
    • You may or may not be aware that your anger is associated with shame.
    • Consider whether you are over exaggerating the harm done or could be done.
    • Learn how to manage your anger, rather than letting it control you or blocking it out.
    • Brooding on angry thoughts turns on our fight/flight system making us feel more aroused. The chemicals released can do damage if they are not put to use.
    • Negative self-beliefs may prevent you from examining your anger and putting it to use assertively. Some examples are: Others are more powerful and I will never succeed in arguing against them. I am wicked and unlovable when angry. My parents taught me that anger is bad.
    • Think about the last time you were angry and write down some of your thoughts. Examine if you are using any of the types of negative thoughts e.g. all-or-nothing thinking. See Types of Negative Thinking.
    • Notice the danger signs if you tend to get excessively angry and tell yourself to keep your distance. Return to the issue when you feel more settled. Consider what was going through your mind and what the early feelings were – Did the anger build up and could you recognize the danger signals?
    • If you feel very angry stop any action and count to ten slowly, taking deep breaths. You need to draw your attention away from the cause of your anger. You could try leaving the room. In this way you maintain your calm and will have adequate control of yourself.
    • To deal with negative beliefs for avoiding anger make flash cards with your negative beliefs on one side and on the other, challenge them with alternatives. What are the pros and cons of altering your beliefs?
    • An exercise to release your anger and still maintain control, for those afraid of expressing their anger is to kneel by your bed and hit it with a rolled up newspaper, speaking or shouting your thoughts about your anger. Allow yourself to cry if you wish when your angry thoughts have diminished. Then lie on your bed and think to yourself that your anger is over and use calming imagery to soothe yourself. Note that you have been able to control your anger and need not fear it. When you feel more settled write down what you said or shouted when you were angry. Examine your thoughts for extremes that should be challenged.
    • See ‘Overcoming Anger’ in the Forward Counselling Advice Service.

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15. Assertiveness Training
    • The aim of assertive behaviour is to stand up for your legitimate rights and face others without putting yourself or them down.
    • Assertiveness training teaches you to increase the number and variety of situations in which you are assertive.
    • There are three types of interpersonal behaviour:
      1. Aggressive - you may be forceful in expressing your opinions, feelings and wants.
      2. Passive - your opinions, feelings and wants may be withheld completely or partly.
      3. Opinions, feelings and wants are stated with respect for the rights of others.
    • Make sure you are aware of your fundamental rights which include: asking for what you want; saying 'No' without guilt; not being perfect; being ignorant about something; being responsible for your actions; having your own perspective and emotions; being indecisive; choosing whether or not to deal with others' difficulties; expecting privacy, independence and success.
    • There are five steps to being assertive:
      1. What do you want? ;
      2. What is fair? ;
      3. Be clear in asking for it;
      4. Contemplate and be ready for the risks;
      5. Stay calm
    • Practice your arguments in advance and repeat yourself to get the message across. Be prepared to negotiate.
    • Think about situations in which you are not assertive and how you could change this and be assertive.
    • Write out a detailed description of problem scenes - note when and where the problem occurs; who is involved; what your difficulties are; how you handle it; your fear of what will happen if you are assertive; your goal.
    • To deal with a problem situation:
      1. Consider your rights and wants.
      2. Unless spontaneous action is required, arrange a mutually convenient time to discuss your problem with the other person.
      3. Define the problem as specifically as possible.
      4. Describe your feelings using 'I' messages, to give the other person an understanding of how important the issue is to you.
      5. Make your request in one or two simple but firm sentences.
      6. Give positive reinforcement to get what you want e.g. we'll be able to spend more time together. If this will be ineffective try negative reinforcement, describing the alternative way you will look after yourself if your wishes are not met.
    • You need to arrive at a workable compromise. Agree to review this after a specified length of time and if you are not both satisfied you can renegotiate.
    • Avoid being manipulated - techniques include:
      1. 'Broken Record' where you choose a concise assertive statement to say over and over to get your message across.
      2. Delay responding to a challenging statement until you are more prepared.
      3. Inviting criticism may reveal what is troubling the other person.
      4. When someone puts you down, acknowledge something you can agree with in their criticism and ignore the rest.
      5. You can change the focus, from discussing the topic to analyzing the interaction between the two of you.
    • In instances where you lack time you could use the short form assertiveness technique. Consider:
      1. Your thoughts - state the facts as: 'I think…'
      2. Your feelings - express as 'I' statements: 'I feel…'
      3. Your wants - specify behaviour change as: 'I want…'
    • You need to develop assertive body language. Practice the following basic rules in front of a mirror so that you learn how to apply them to problem situations:
      1. Maintain eye contact and an erect body posture.
      2. Speak clearly and firmly.
      3. Emphasize what you are saying with gestures and facial expressions.
    • Learn to listen assertively:
      1. Make sure you are both ready to listen.
      2. Listen giving the other person your full attention and ask them to clarify if necessary.
      3. Let the other person know you have heard what s/he has expressed to you.
    • Practice being more assertive in problem situations and consider how it makes you feel.
    • Role-playing is a good way to improve your assertiveness in a safe environment before trying it out in real life situations.

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16. Forgiveness
    • Focus on the meanings in your anger in order to be assertive. Concentrate on the hurt and important topics causing the disagreement rather than self attacking or hitting out.
    • Avoid spreading guilt, sulking, aggression and fearful retreating, since these are all non-assertive behaviours.
    • Try not to get angry with yourself for lack of assertiveness. This way you will stop your internal bully from taking control.
    • Reconciliation and forgiveness are crucial after a disagreement. You may have certain beliefs that prevent this – explore and try to alter them.
    • Forgiveness is assertive behaviour. You set yourself free from feeling victimized and wishing to avenge yourself.
    • Think about examples of assertive behaviour. Avoid attacking the other person. Clarify what you want to say and concentrate on a particular topic. Be willing to make exchanges and reach settlements by concessions on each side. This should not be seen as being weak. Try rehearsing what you want to say. This can be more productive than hasty action when angry.
    • If you have a problem of self-directed anger, practice saying assertive things to yourself.
    • Give yourself time to think in an argument. You could ask the other person to expand on their worries rather than rushing to take the defensive.
    • Acknowledge the other person’s view then give your own factual version. Try to avoid attacking each other.
    • You need to spend time forgiving others and live in the present not the past. Note the pros and cons of this and how it would help you. What is hindering you? Employ your rational and compassionate self to find alternatives to your negative beliefs.
    • If you feel unable to come to terms with your hurt you should seek help.
    • Try the Buddhist ‘loving kindness’ meditation. Go through a simple relaxation exercise to calm your breathing then imagine yourself as a person who needs loving kindness. Visualize yourself lying there with loving kindness directed at you. Let go of bad feelings and forgive yourself. Next imagine loving kindness directed at others. If they have hurt you, visualize forgiveness for them. This does not mean you should condone their behaviour but release yourself from damaging feelings.

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17. Frustration
    • Disappointment can be caused by things such as our feelings regarding our private life and obstruction to life goals.
    • When our ideals are unrealistic we can be set up for disappointment.
    • The frustration caused by disappointment frequently leads to thoughts that attack yourself (your internal bully) or others. You need to recognize these thoughts and challenge them.
    • As frustration increases you are likely to use types of negative thinking e.g. all-or-nothing thinking.
    • Try to set a boundary to the effects of disappointments on yourself so that you are not propelled into depression.
    • Make two columns – one for ideal thoughts and the other for actual thoughts. Write down these thoughts the last time you experienced anger and disappointment. Next note any thoughts created by this disappointment that attack yourself then any that attack others.
    • Consider if you use any types of negative thinking e.g. disregarding the positives, over-generalizing. See 8) Types of Negative Thinking.
    • How would you advise a friend who has suffered this disappointment? Is there evidence to support your ability to deal successfully with this?
    • Do not over look problems where you fail to differentiate between your behaviour and your ‘self’.
    • Examine the compelling force of ‘should’ and ‘must’ behaviour in your life. Does it create more pain? If so consider how it does so.
    • Are you ashamed at not attaining your ideals and hence feel disappointed?
    • Most importantly ask yourself are your ideals realistic?

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18. Competitiveness and Perfectionism
    • Most of our problems arise from failing, so learning how to fail without attacking yourself is useful in gaining more control over your mood. Without realizing it, because of the pressure to succeed, we can become competitive and perfectionist people who are daunted by the thought of failure.
    • Perfectionism leads to frequent disappointments which results in feeling low.
    • Perfectionism can lead to competitiveness when we want to be seen as superior and wish to avoid inferiority.
    • To find out in which areas of your life your competitiveness lies ask yourself which areas of your life you would not settle for being average and which concern you regarding what others possess, are achieving or doing.
    • A problem with perfectionism is that you evaluate yourself on the products of your activities and disregard your efforts.
    • Competitiveness and perfectionism can be directed at our self or at others or we may feel it is expected of us.
    • Another problem with competitiveness and perfectionism is that your internal bully often directs frustration and anger toward yourself.
    • You may become self-centered from perfectionism and competitiveness if you let your inner bully take control.
    • You may experience frustrative anger, anxiety or guilt at not succeeding, because of your negative thinking styles.
    • As a result self-attacking or attacking others may increase, leading to you feeling more low.
    • You need to consider how you cope with yourself and others when you cannot meet your ideal standards.
    • In order to identify your competitiveness and perfectionism think about an occasion when you did not succeed at something. What were your ideals regarding the matter? What were you hoping to achieve and why would that have been good? Were you afraid of inferiority or were you seeking superiority? Were you attempting to attain your own ideals or those dictated by others? Was your objective to gain the favour of others? Are you success orientated or do you try to avoid failure?
    • Praise yourself for even your little successes.
    • Examine your actions when you fail. Do you attack yourself or others? What do you say in these circumstances? Do you accept failure, if so why? Write these down to make things clearer for yourself. Next explore if you use types of negative thinking e.g. all-or-nothing thinking.
    • Learn how to fail so that you need not fear achieving success. Use your rational and compassionate mind to ask yourself firstly how you would advise a friend, then what you wish them to say to you. Can you find alternatives to challenge your negative thoughts and feelings?
    • Try to break things up into a manageable size and proceed in steps concentrating on your achievements rather than what you have been unable to do.
    • Set realistic standards, become tolerant of others’ mistakes and learn to identify what is ‘good enough’ and accept it.
    • Is your life pleasurable or do you not enjoy things? Can you complete one task today? Consider how you might obtain help from others?
    • Learn to accept yourself thus gaining confidence and enjoy your success.

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19. Problem-Solving
    • Problems of any sort can cause distress to a depressed person.
    • The problem-solving approach can be useful in these cases. You learn to focus your thinking and find solutions to your problem instead of becoming frustrated. There are six steps in problem-solving:
      
      
      1. Define the Problem – Be specific and try to break the problem into more manageable tasks. Do one task at a time. Choose your task and specify your goal.
      2. List Solutions – Try to write down as many ideas, to solve your problem, as you can.
      3. Evaluate the Pros and Cons of Each Solution – Consider your solutions and reject the unsuitable ones. List the remaining solutions in order of usefulness.
      4. Selecting a Solution and Planning Action - Choose your first solution and decide how you will put it into action. Rehearse your task and make sure you have a back-up plan in case your task does not go as planned.
      5. Do it - Attempt your solution.
      6. Review the Result of the Solution – If your solution is successful try to understand why it was so. If your solution is unsuccessful try to comprehend why it did not work. Praise yourself for having tried and choose your next solution from your list.

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20. Stress Awareness Training
    • You need to monitor your stress and become familiar with what sets it off and the feelings, thinking and actions associated with the anxiety. You can do this by keeping a diary. When you feel anxious note the date and time. What was the event? Rate your distress 1-10 (1 is no distress and 10 is extreme panic). What caused your anxiety? What was your response to cope with the problem? Re-rate your distress.
    • After two weeks of monitoring your stress levels you should become aware of what triggers your distress, your bodily feelings and thoughts when distressed, how your distress levels vary with different situations, what you tend to do when distressed and what is the best way for you to cope with your distress.
    • Make two lists – one of short-term only coping strategies and the other of long-term coping strategies. You can refer to these when you feel stressed. Try to incorporate more of the long-term strategies into your set of coping techniques and attempt to gradually abandon your short-term methods.
    • Avoid turning to stimulants such as alcohol, caffeine and nicotine as coping methods. These have unpleasant effects in the long-term.
    • Study your diary to determine what drives your cycles of distress. Is it bodily, psychological, behavioural or social?

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21. Dealing With Bodily Experiences: Controlling Your Breathing
    • Hyperventilation – faster breathing occurs in response to exertion and stress. In the long-term this can be uncomfortable and cause unpleasant physical symptoms which trigger more anxiety and more hyperventilation. Another cycle of stress is set up and can result in a panic attack.
    • You can rectify hyperventilation by learning to control your breathing.
    • First practice lying down and later sitting or standing. Place one hand on your stomach and the other on your chest. Breathe in slowly through your nose until your lungs are full then exhale slowly through your nose. Breathing in and out counts as one breath – aim to take 8-12 breaths a minute.
    • In order to be effective you need to practice this exercise repeatedly.

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22. Dealing With Bodily Experiences: Relaxation
    • You need to develop relaxation into a skill you can use when you feel muscular tension due to stress.
    • Try to develop a routine and practice your relaxation exercises. Start by lying down and later you can try sitting or standing. Control your breathing.
    • Record your experiences noting the date and time. Rate your distress before the relaxation exercise, 1-10 (1 is tense and 10 is very relaxed). Which exercise did you use? Rate your distress afterwards. Make notes of the sort of day it was, your preoccupations etc.
    • Below are three exercises – only move to the next one when you are fully relaxed after a routine.
    • Progressive Muscular Relaxation (PMR) – Breathe slowly and regularly as you focus on different parts of the body: feet – tense your feet then relax and repeat; legs – straighten your legs then relax and repeat; abdomen – tense your abdomen then relax and repeat; back – arc your back then relax and repeat; shoulders/neck – bring your shoulders up and in and press your head back. Relax and repeat; arms – stretch out your arms and hands. Relax and repeat; face – tense your face and bite hard then relax and repeat; whole body – tense your whole body then relax and repeat.
    • After the routine if you still feel tense then repeat it then when you are relaxed think of something calming to relax your mind. Get up slowly and gently.
    • You should practice PMR twice a day until you feel relaxed after the exercise.
    • Shortened PMR – You can miss out the tensing and go straight to relaxing the different muscles. When you have achieved this you can progress to using the routine at other times and places.
    • Simple Relaxation Routine – Identify a word, object or scene you find calming. Sit comfortably and close your eyes. Be aware of your breathing as you inhale through your nose. As you exhale, think about your calming mental image. Continue this until you feel relaxed. You should practice this exercise frequently.
    • When you have learned to relax using the three exercises you can start to use the skills throughout the day. Use something to remind you regularly to relax. Apply your relaxation skills whenever you need to use them in response to physical tension.

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23. Dealing With Psychological Aspects: Distraction
    • A cycle of mounting anxiety is set off by alarming thoughts and images. You can break this cycle by distracting yourself.
    • Physical Exercise – If you keep active you are less likely to be preoccupied by worrying thoughts.
    • Refocusing – Distract yourself by focusing on things around you e.g. listening to others’ conversations or studying how someone is dressed.
    • Mental Exercise – Formulate a phrase, picture or mental exercise that distracts you e.g. redesign your home, imagine your dream home in detail or recite poetry.
    • Develop a set of distraction techniques for different occasions that are suited to your needs e.g. If you get stressed at interviews then physical distraction will not be helpful.
    • Make two columns – in one write down the situation causing anxiety and in the other your chosen distraction method.
    • Practice your distraction techniques when you are not anxious and try to catch your anxiety at an early stage.

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24. Managing Your Time
    • Good time management requires being aware of:
      1. Your needs and strengths – list these opposite each other.
      2. Your standard procedure – find out how you use your time at present by keeping a record of how you spend your time. From the record you will be able to work out the best way of working. Try to get a balance of work tasks and include breaks.
      3. Your priorities – identify and rank in order of priority the different areas of your life. Consider the time you allocate to each and what is realistic and necessary. Perhaps others are making demands of you that you need to be more assertive about?
      4. Setting reasonable goals – keep in mind the important areas of your life when pursuing goals. Clearly define your goals so you know when you have achieved them. Some goals will need to be broken down into more manageable steps.
    • Once you know the above you can draw up a new more efficient schedule. Use an organizer and list long-term (within six months), medium-term (within a month) and short-term (within a week) goals. Set aside time each day to organize. Try to do a ‘To do’ list of prioritized tasks every day. Plan flexibly and review every month.
    • Delegating – giving over responsibility with authority, to others for appropriate tasks, is part of good time management.

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25. Sleep Management
    • The length of sleep necessary varies from person to person.
    • Worrying will prevent you from sleeping.
    • You need less sleep as you get older.
    • Sleep is affected by mood, stress, food, alcohol, exercise and medicines.
    • In the long-term, sleeping tablets are not helpful and can be addictive.
    • You can manage your sleep problems by changing your behaviour rather than resorting to medication.
    • Keep a sleep diary for several nights to ascertain if you have a problem. Note the date and anything that might affect your ability to sleep e.g. your activity before retiring. If you have waking episodes, note your activity to restore sleep. Was it helpful? Next day note the number of hours of sleep you managed to get and rate how alert you feel 1-10 (1 is dull and sleepy and 10 is very alert). Rate your performance that day 1-10 (1 is poor performance and 10 is performed well). If you do have a problem the following suggestions might be helpful:
      1. Analyze your sleep diary to see if poor sleep is due to stress and is likely to get better as this eases; are there behaviours which result in poor sleep that you could change?; identify helpful and unhelpful ways of coping and avoid the latter.
      2. Introduce pleasant smells into your sleeping environment to help you relax e.g. potpourri or lavender oil.
      3. Try to relax an hour or two before you go to bed. Keep your daily stress low and seek counselling or the support of friends if you feel the need. Exercise during the day. Avoid caffeine, nicotine and alcohol and try a warm milk drink before bed. Make sure you are not hungry before retiring as this will keep you awake. · Ensure you have a quiet bedroom and a comfortable bed and have emptied your bladder before trying to sleep. Use your bed only for sleeping and set an alarm so you wake regularly each day. Avoid naps during the day.
      4. If you sleepwalk you are advised to discuss this with your doctor as it can be dangerous.
    • To cope with disturbing dreams you could try:
      1. Constructing a positive ending to your disturbing dream and mentally practicing this alternative ending several times before sleeping;
      2. Practicing beforehand what you might say if the dream occurs;
      3. Keep water and a towel by your bedside to wash your face with if you wake up sweating - this will help you re-orientate;
      4. Keep a notepad and pencil within reach so you can record your dreams but beware of reading too much into their interpretation.
    • Relaxed Breathing Method:
      You could try the following method of relaxed breathing to ease tension and promote sleep:
      1. Ensure you have some time to yourself and push your worries to one side;
      2. Sit or lie comfortably and close your eyes with your arms by your side;
      3. Concentrate on breathing naturally;
      4. Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed;
      5. Count back from 10 then open your eyes and feel how relaxed you are now. Slowly get up and resume normal activities.

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26. Dealing With Interpersonal Relationships
    • Interpersonal relationships may have caused depression or may be preventing you from recovering – in any event interpersonal relationships will be affected by depression.
    • You need to understand your personal relationships and be able to deal with them effectively.
    • Draw interpersonal maps – one for before you developed depression and the other for afterwards:
      1. How your interpersonal relationships are at present;
      2. How your interpersonal relationships might be now if you did not suffer from your emotional problem;
      3. How your interpersonal relationships will be in 10 years if you continue to suffer from your emotional problem;
      4. How you would ideally like your interpersonal relationships to be.
    • These will summarize all your relationships and allow you to recognize any changes you may desire.
    • List all your important relationships and put yourself in the middle of the map in a circle.
    • Place each person’s name in a circle on the map, around you in the middle – the closer the relationship to you, the closer the circle to you.
    • Join these circle’s to you in the middle with an arrow outward if it is you mainly giving; an arrow inward if you are mainly receiving; a two-way arrow if giving and receiving is balanced; a question mark if you are unsure.
    • You could also draw maps for how you would ideally like your interpersonal relationships to be; how your interpersonal relationships might be now without depression; how your interpersonal relationships will be in 10 years if you still have depression.
    • Examine these maps noting any differences and set yourself goals to make any desired changes to your relationships.
    • For each relationship ask yourself:
      • who initiates and terminates contact;
      • are you happy with how often you see this person? ;
      • who decides what to do or what to talk about? ;
      • is there a balance between giving and receiving? ;
      • do you want to alter the relationship in anyway?
    • Consider questions such as:
      • who could I confide in and get advice from? ;
      • who would be there for me if I fell ill? ;
      • who would lend me money at very short notice?
    • Next time you have contact with each person, examine the relationship – participate and observe. Were your predictions correct? – If not, what was different?
    • When you have a complete picture of your relationships, think about how you maintain them and in what way you want to change your relationships.
    • Two important reasons for making changes are:
      1. A balanced and supportive social network is necessary for your well-being;
      2. By altering your relationships but avoiding being controlling, you may increase your sense of control.
    • Start by making small changes and monitoring progress. You could also try discussing what you have learned about the relationship with the individual.

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27. Removing The Obstacles To Intimacy
    • Record and examine closely the things that prevent you from achieving intimacy with someone. Note your thoughts and reactions when you distance yourself from a friend or end a relationship and make an analysis e.g. are you overgeneralising?
    • Social inadequacy can be an obstacle to intimacy. Apply your assertiveness skills to your social and work life and observe how socially skilled people handle situations in particular difficult ones. Rehearse your social behaviours so that you are comfortable with them.
    • Try to grasp your anxious thoughts, examine them closely and if required, challenge them. What are your anxious thoughts? Is your outlook biased – are there misjudgments? Consider the evidence to support and discount your thoughts.
    • See ‘Overcoming Social Phobia’ in the Forward Counselling Advice Service.
    • It is possible to become over-intimate and make ourselves vulnerable to exploitation. Trust can be given in a series of stages and you can fluctuate as to how much you trust someone.
    • Communication is necessary for all relationships. Record the feelings which threaten your relationship (e.g. jealousy) and grasp the automatic thoughts. Analyze them and find alternative ways of dealing with the situation.

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28. Conclusion
    • Ask for help if you require it.
    • Proceed in steps
    • Break problems down so you can manage them more easily.
    • Increase the positive activities in your life.
    • Pay more consideration to and try to become more knowledgeable about the thoughts and ideas that enter your mind when depressed.
    • Recognize the types of negative thinking you may be using.
    • Write down your thoughts to make them clearer.
    • Recognize the key themes in your depression e.g. your shame and high ideals.
    • Acquire the ability to use your rational and compassionate self to challenge and look for alternatives to your negative thoughts.
    • Expect to have your progress halted and to suffer failure at achieving what you desire, occasionally.
    • The way forward is to have compassion for yourself and the courage and determination to face your difficulties and alter your behaviour being a genuine friend to yourself.

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