Looking at the whole picture at once can lead to self-limitation because doing so can feel overwhelming. Focus on one small step at a time. For example, if we’d focused on writing this book as though it had to be finished in just one week, we’d stop writing instantly!
If you have a serious level of depression that includes thoughts of death and hopelessness, or you work on the strategies in this book for six weeks or longer without experiencing any success, please consult a professional for extra help.
Taking two steps forward, and one back
Many people who come to us for help with depression expect to improve, and that’s reasonable enough. But all too often they also expect swift, prompt progress that proceeds in a smooth, steady, upward fashion. The only problem with this second expectation is that we have yet to see it happen! Why?
To be honest, we’re not entirely sure why, but we do know that most people progress gradually, with many peaks and troughs along the way. It’s important not to expect your efforts to materialise as steady change. Change just doesn’t progress in that way. Your progress probably looks like Figure 3-1.
As you can see in Figure 3-1, progress includes both peaks and troughs. Like the stick figures in the chart, you’re going to go through various stages as you work to overcome your depression:
Standing on a peak: When you occupy this position, you’re more likely to form unrealistically positive expectations about how you’re progressing. You need to remind yourself that you are likely to experience both ups and downs.
Down in the trough: At this point, you may be tempted to think that you’ve never reached such a low ebb before. But the truth is, you may have made progress from where you began, but at these low points, it may be impossible to see the progress you’ve made. This is especially so if you were on a higher peak earlier. Try to resist making judgements about your progress when you’re on an inevitable downturn.
When you’re on your way up, you can assess your progress realistically, but you need to resist the temptation to predict too speedy a progression in the future. And when you’ve taken a dip, try not to then judge how you’ve been doing overall, because it won’t be possible at those times.
We want you to know that the predictable and inescapable downturns in the process of change have an advantage. What? Are we kidding? No, seriously, each dip, though unpleasant, can provide you with useful information about events that trigger your low moods. You can see what to do with such events in Chapters 5 and 6. The key lies in expecting these dips - not beating yourself up for experiencing the inevitable ups and downs inseparable from overcoming depression.
Transforming visions of failure into success
If you’re depressed, you’ve probably written hundreds of failure stories of doom and gloom. O.K., you may not have actually put the words on paper, but we bet your mind’s envisaged rejection, failure, wasted efforts, making a mess of things, and humiliation more times than you care to remember. And those images more than likely include rich details of your anticipated lack of skill along with a host of catastrophes that resulted from your expected failure.
Stories about potential failures can cause you to avoid making the effort at improving your depression. Basically, the stories become another form of self-limitation. So, how about considering something different?
Get out your notebook and a pen. Or, if you prefer, sit down in front of your computer. Write a story about how you just may succeed at something! Include details about how you’re going to approach the challenge, your plans, and the difficulties you anticipate.
Write down how you imagine you’re going to overcome those difficulties. Be sure to include any thoughts about your fears, but also include strategies for working your way through the fear. If you have trouble coming up with ideas for getting around the obstacles, ask yourself what someone else may do. Make your story long enough to include the specifics; don’t skimp.
Chapter 4
Finding Help for Depression
In This Chapter
Finding the right treatment
Helping yourself with self-help
Getting help through psychological therapy
Discussing medication with a professional
Are you feeling low? It’s a fair bet that, because you’re reading this book, you or someone you love is being hit by depression. Perhaps you’re just a bit down in the dumps, or even feeling like you really are at rock bottom? The good news is that there’s a whole range of different types of help available from a number of sources, ranging from bookshops to the therapist’s consulting room. The bad news is that the wealth of choice can be bewildering, especially when you find your thinking isn’t as clear as you’d like it to be. In this chapter, we untangle confusion by going through your options for getting help and giving you the means to make an informed decision about the huge array of options available.
We give you the necessary information on the three main ways for dealing with depression – self-help, psychological therapy, and medication – so that you can work out what’s best for you. And we help you understand the differences between various mental health professionals and identify whether you are well matched with the professional you choose.
Exploring the Self-Help Option
Everyone who’s dealing with depression can benefit from self-help. Self-help refers to efforts you make on your own, without professional assistance, to deal with your depression. You also have the option of ‘guided self-help’, where you carry out a lot of the work on your own, but have someone guide you through the various steps. Dozens of studies show the value of self-help for a variety of emotional, behavioural, and medical problems. Some of you may find that self-help alone is all you need. Others may need extra help if self-help alone isn’t enough.. However, self-help can powerfully boost the effectiveness of psychological therapy and/or medication.
Combining reading self-help with other tried and tested therapies may help to speed up your recovery.
Deciding whether self-help is for you
Before settling on self-help as the one and only way for you to overcome your depression ask yourself the following questions:
Am I having suicidal thoughts? If the answer is yes, then you do need to see a mental health professional (see the later section ‘Discovering who’s who in psychological therapies’). The mental health professional is likely to recommend psychological therapy, medication, or a combination of the two, in addition to self-help.
Is my depression seriously interfering with my life in areas such as work, relationships, sleep, appetite, or leisure? Once again, if the answer is yes, you may be suffering from a major depressive disorder (refer to Chapter 2 for more information on major depressive disorders), which means that you probably need more than just self-help.
If you answer ‘no’ to both of these questions, self-help may be exactly the right place to start. However, first ask yourself: ‘Do I have the desire and motivation to put into practice the advice I receive from self-help sources?’ We’re not talking about hours of daily study. But for it to work, self-help does require more than just one quick read through of an article or even a book. And you, like many other people, may find that you work better with guidance, reporting back on progress, and having help in understanding and overcoming setbacks.
With depression, it’s common to believe that if you do try and tackle it, you’re ‘bound to fail’. Working with a professional lets you borrow their belief that you can change, until you gather together enough evidence to establish your own beliefs. So if you can’t confidently answer ‘yes’ to the question of whether your own motivation is sufficiently robust, talk through your options with a mental health professional.
If you do make the decision to only use self-help, after having considered these points, then great. This book’s a pretty good starting point. As well as your self-help book you may want to explore extra self-help resources (see the following section). Work for a while at putting into practice w
hat you discover about yourself, and monitor your progress carefully. You can use the mood monitoring form (the ‘Mood Diary’) that we outline in Chapter 2 to keep track of your improvement.
If you don’t see progress through self-help after two months of effort, start exploring other sorts of help. If at any point you feel discouraged, begin to have suicidal thoughts, or your depression worsens, do seek help from a professional at once. See ‘Discovering who’s who in psychological therapy’, later in this chapter, for more information on mental health professionals.
Reviewing the resources
Choosing the right self-help approach depends on your personal preferences and style. The fact that you’re already reading this book suggests that the written word may appeal to you. The following list covers the most common self-help options (more options are listed in the Appendix):
Books: Dozens of books are available for helping you overcome depression. You’re probably going to find this is one of the clearest and easiest to follow, but do read through several different self-help books. Even though you may repeatedly see identical suggestions, the repetition helps you remember them. Also, each author has their own way of explaining theories, which can help your understanding. The best books for dealing with depression give you information about treatments that are known to work.
Books are a fairly inexpensive way of getting help - an obvious advantage. You can find or even order many of the books through your local library or via the Internet. Your GP may also be part of the ‘book prescription’ scheme, where your doctor helps you choose a book from a list of recommended self-help books and then ‘prescribes’ it for you. Self-help material also has the advantage of providing a huge amount of information that take a therapist many sessions to cover. And you can refer to the information as often as you need.
Make sure that the authors of any self-help book that you buy have the right professional qualifications and experience in helping others deal with depression. (We cover the subject of professional qualifications in the ‘Discovering who’s who in psychological therapy’ section, later in this chapter.)
Tapes, CDs, videos, and DVDs: For those who learn best by hearing or seeing, these can be really helpful. As with books, check out the author’s qualifications and experience and the effectiveness of the therapy.
Self-help groups: Self-help groups offer support and understanding. People with common problems gather in these groups (meeting up together, or as a ‘virtual group’ in a ‘chat room’ via the Internet) to share information and experiences. Members are able to help themselves and each other by sharing their feelings and experiences, and solving problems together. MIND, SANE, and the Depression Alliance are registered mental health charities that offer information concerning the availability of local support groups (See the Appendix for addresses). Often your library has a directory of community resources, as does the Internet.
Computerised Cognitive Behaviour Therapy (CCBT): This guided self-help programme ‘Beating the Blues’ for overcoming depression can help you overcome depression. Healthcare providers make CCBT available via your own computer or at centres.
Websites: You can find a huge range of resources relating to depression on the Internet. Putting ‘depression resources’ into a search engine yielded over one and a quarter million hits! You can take part in recovery programmes (see www.livinglifetothefull.com), check out the NICE guidelines for people with depression (www.nice.org.uk), join chat rooms, download articles, buy products, sign up for computer programmes, and even pay for a therapist offering help by providing advice through email or phone consultations.
We only list tried and tested websites in the Appendix to this book. You need to bear in mind that there is little quality control for what is on offer on the Internet. As well as finding well qualified practitioners who can help you, you’ll undoubtedly discover many unqualified, though well-meaning individuals offering you advice, plus outright frauds who also market their products and ideas online.
Confidence tricksters abound on the Internet, offering you all kinds of merchandise that promise prompt relief from depression with little or no effort. Buyer beware! No miracle cures exist for depression.
Many people aren’t lucky enough to find the best option to deal with their depression by chance alone. And believing everything you’re told also isn’t the answer. You are most likely to succeed by carefully evaluating all options for help to find your best choice.
Pursuing Psychological Therapy
Psychological therapy involves working with a therapist using psychological techniques to ease emotional problems. Psychological therapy covers many different approaches, and a wide range of professionals practise these therapies. It can be pretty daunting working out what’s likely to be the best source of help for you from this mind-boggling array of options.
But don’t start getting depressed about it! In this section, we give you the information you need to find your way through the maze. First, we discuss the types of psychological therapy that have been shown to be effective in treating depression, then tell you how to understand who’s who within the mental health professionals, and finally look at finding and working with a therapist.
Uncovering what works: The effective psychological therapies
You may decide you want to read through the thousands of articles available that discuss the effectiveness of psychological therapy for treating depression. However, you’d probably rather not, so we’ve gone ahead and done some research for you. But new studies are continually being reported, so we do advise you to keep an open mind about the possibility of adding to this list in the future.
The following therapies are proved to be effective and to produce excellent results within a reasonable timeframe:
Cognitive behavioural therapy (CBT): CBT is made up of two types of therapy: cognitive and behaviour. Cognitive therapy operates on the understanding that the ways in which people think about, perceive, and interpret events plays a central role in how they feel (Part II covers this therapy). Behaviour therapy focuses on helping you to change behaviours like finding activities that you positively enjoy and also introducing you to problem solving (Chapters 9 to 12 cover behaviour therapy). Some therapists practise cognitive therapy and behaviour therapy separately, but nowadays most take the combined approach of CBT.
Studies show that changing your way of thinking helps you in overcoming depression. It has also been shown that changing your behaviour can improve the way you feel and ease depression.
For the treatment of depression, no psychological therapy has received as much support as CBT. In fact, the UK Government recently committed £170 million to making CBT treatment available to enable more people to overcome emotional problems (especially depression and anxiety).
Research shows that CBT works equally well as medication for treating depression, and that CBT provides a degree of protection against relapse – something that medication doesn’t always do.
Interpersonal therapy (IPT): This type of therapy helps people identify and modify problems in their relationships, both past and present. Like CBT, this approach has also been shown to ease depression about as well as taking medication. Sometimes this method of therapy delves into issues involving loss, grief, and major changes in a person’s life, such as retirement or divorce. The IPT approach also includes examining and understanding the relationship between the therapist and client. You can discover how to relate to the therapist in ways that may help you understand what you are doing, and how to improve other relationships. Part IV looks at strategies, such as learning to deal with loss, that are drawn in part from IPT.
Most people aren’t aware of how many different types of therapy exist. Here are just a few others: psychoanalysis, client-centered therapy, transactional analysis, Gestalt therapy, hypnosis, eye movement desensitisation reprocessing (popularly referred to as EMDR), and Hakomi therapy.
Indeed the United Kingdom Council for Psychotherapy (UKCP), which accredits
Organisations offering training and practice in the various forms of Psychotherapy, has 80 Member Organisations. They divide into 7 main sections. Even the section titles themselves can be confusing to some professionals, let alone to people who do not work in the field!
We will not go into these in any depth, but list them here to give you an idea of the range:
Analytical psychology – psychoanalytic and psychodynamic
Cognitive behavioural
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