Overcoming Depression For Dummies
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The more skills you acquire and master for handling depression, the less likely you’re going to experience relapse in the future. Continuing with psychological therapy or self-help for some months after your depression has gone away helps prevent relapse.
If you choose to treat your depression by using medication alone,, we suggest that you continue taking the medication for at least 6 to 12 months after overcoming your depression. Doing so helps to reduce your chances of relapse, although we highly recommend trying psychological therapy, such as cognitive therapy (see Part II), as well as medication. Alternatively, some people with a history of recurrent depression find that continuing with lifetime antidepressant medication provides them with reasonable protection against relapse (Refer to Chapter 15 for more information about medication).
Monitoring the signs
In Chapter 2, we review the many ways that depression affects your thoughts, behaviour, body, and relationships. If you’ve challenged and fought your depression, you no doubt know in what ways depression affects you. We suggest that you keep track of how you’re feeling by checking out the symptoms we discuss in the following exercise.
Carry out a weekly Depression Review. Choose a convenient time to schedule this activity into your calendar. We recommend continuing doing this review for at least a year after the depression lifts. In your Depression Review, rate yourself on the Happiness Depression scale (see the Introduction for a copy of this) and then ask yourself the following questions:
Have I been having negative or unhappy thoughts?
Have I started avoiding people or situations that make me feel uncomfortable?
What is my mood on a 1 to 100 point scale (extremely depressed to completely happy)? Has my mood dropped from its usual rating by more than 10 points and stayed lower for more than a day or two?
Am I having any noticeable problems with my appetite, sleep, or energy?
Have I been unusually hard on myself?
Have I been more irritable than usual?
Have I been having more guilty feelings?
Am I having problems with concentration?
If you answer yes to one or more of the questions above, beware! This list contains the early warning signs of possible depression. Of course, anyone can experience a few low thoughts, a little guilt, and difficulty concentrating but still not go on to develop full-blown depression. And we certainly don’t expect you to feel 100 per cent fulfilled every week of your life. But, if you’re having a lot of negative thoughts they can be warning signs of depression. Pay the signs serious attention, and start some form of treatment, including self-help, if your symptoms are mild, or life feels unsatisfacory.
Preparing a Prevention Plan
No one knows when or where a fire is going to break out. That’s why the law requires public buildings such as hospitals, shops, offices, schools to have a regular programme of fire safety drills. Having a fire prevention plan in place makes sure that you’re ready and know what to do in the event of fire. The result? Effective damage limitation.
A Prevention Plan for limiting the effects of depression does the same thing. In your Prevention Plan you vividly imagine potentially challenging times and events, and then explore how you could cope with them. Finally, you imagine yourself actually coping, and doing so in a productive manner.
None of us can predict what the future holds, which is perhaps a good thing, on the whole! However, you probably know what types of events have been difficult for you to handle in the past, and also have an inkling about what you fear about the future. Rather than pretend that your life is going to be a bed of roses, we suggest that you make a list of potentially distressing events that could happen to you at any time and that you fear could overwhelm your capacity for coping.
Here are a few possibilities:
Humiliation
Failing to meet a deadline
Financial reversals
Illness
Injury
Losing a loved one
Rejection
Next, choose just one item from your list. Imagine that event happening and finding a way of coping. When you make your Prevention Plan, use the questions in this list to help you come up with ideas on how you’re going to cope:
How would someone else handle this situation?
Have I dealt with something like this in the past? How did I do it?
How much effect is this event going to have on my life a year from now?
Is this event as awful as I’m making it out to be?
What creative ways can I find to deal with this challenge?
People often dread the future, because they assume they’re not going to be able to cope with what life throws at them. However, when you face your fears head-on you find that you can cut them down to size. That’s why we recommend that you develop a Prevention Plan that addresses the items on your list of worrying possibilities.
Robert recovered from his bout of depression about a month ago. He feels much better than he did, but he realises that he needs to take the problem of relapse seriously. He therefore monitors his early warning signs of depression (see the preceding ‘Monitoring the signs’ section) and realises that he’s starting to avoid certain people and situations. He knows that, in the past, he’s been over-sensitive about potential embarrassment and rejection.
So Robert decides to make a Prevention Plan. In his mind’s eye he imagines himself asking Brenda, whom he finds very attractive, to go out on a date. He then imagines her refusing, in no uncertain, even downright hurtful terms. Here’s how Robert answers his coping questions:
How would someone else handle this situation? ‘Actually, I bet this happens to people all the time. I guess the key is to accept the rejection, ask myself if there’s anything I can take away from the event, and move on. It’s not like the rejection is going to be plastered all over my forehead for everyone to see.’
Have I ever dealt with something like this in the past? How did I do it? ‘I’ve been turned down before, and I did get through it. Though I didn’t like it, I argued with myself and decided that it was really her loss, not mine.’
How much effect is this event going to have on my life a year from now? ‘Well, putting it that way, and given how many fish there are in the sea, I guess the answer has to be not much at all.’
Is this event as awful as I’m making it out to be? ‘No. I guess I’ve been telling myself that it’s awful, and that it means I’m a total reject. But let’s face it: just having those thoughts doesn’t make them true.’
What creative ways can I find to deal with this challenge? ‘Maybe I could try out that new speed-dating service where you meet something like 20 people in an hour. I may meet somebody interesting, and even if I don’t, maybe I can find a way of dealing with rejection by getting loads of practice.’ Robert’s Prevention Plan helps him to realise that his ability to cope with feared situations is greater than he’s led himself believe. He then imagines getting turned down and dealing with the rejection many times. After realising that he can deal with this problem, he asks Brenda out.
Prevention Plans are most effective if you first read about cognitive therapy, in Part II. Cognitive therapy helps you understand how to tackle difficult events using logical, reasoned ways of thinking. Working out your Prevention Plan provides extra practice in using this type of thinking.
All too often, people suffering from depression also struggle with exaggerated feelings of anxiety and worry about future events. Anxiety can be lurking in the background of your depression. If you suffer from both anxiety and depression, we recommend that you read Overcoming Anxiety For Dummies by Elaine Iljon Foreman, Laura Smith, and Charles Elliott (Wiley). Dealing with your anxiety, helps you to make a much more effective Prevention Plan to ward off a relapse.
Achieving wellbeing: More than simply defeating depression
If you work hard on overcoming depression and seriously search for solutions, you’re likely to be successful. But given
that you also stand a good chance of defeating your depression, why stop there?
You may no longer be feeling depressed, but are you achieving a solid sense of wellbeing? If not, Dr Giovanni Fava at the University of Bologna has been investigating strategies for preventing relapse and encouraging wellbeing and feelings of satisfaction in your daily life. We review three of his techniques.
Chapters 18 and 19 give you lots more information for increasing your overall sense of wellbeing. Reading these chapters can help you enhance your resilience and ability to prevent relapse.
Monitoring your wellbeing
Some people say they hardly ever experience real feelings of satisfaction or wellbeing, even when they have never suffered from depression. However, when asked to monitor their wellbeing, they usually discover that certain types of situations and events give them greater satisfaction than others. This discovery often inspires them to get much more involved in doing things that are satisfying and enjoyable.
Find the time to think about the activities that feel satisfying to you. Write them down in a notebook. Then record the thoughts you have in response to those events, as well as how much satisfaction they give you. Rate the intensity of your satisfaction on a scale of 0 to 100. You can use the Satisfaction Tracker to help you identify which activities improve your sense of wellbeing (see Table 17-2 for an example). Then you can use that information to increase those activities, thereby increasing your overall satisfaction.
Alan no longer feels depressed, but he doesn’t feel he’s actually enjoying many things either. His therapist suggests that he use a Satisfaction Tracker to get a better idea of what kinds of situations increase his sense of wellbeing. Table 17-2 shows what Alan discovers when he records the level of the satisfaction he experiences when he takes part in specific events.
Table 17-2 Alan’s Satisfaction Tracker
Situation
Satisfying Thoughts
Satisfaction Level (0 = none; 100 = total)
Taking the dog to the park.
I love watching my dog run!
60
Going to a party.
I like talking with some of my friends.
40
Showing off my new car to Linda.
I think she might like me.
35
Washing and polishing my new car.
I feel great when I take good care of things.
65
Clearing out the shed.
It feels good to do things I’ve been putting off.
65
Alan discovers that there are quite a few more activities than he originally thought that give him satisfaction. He sees that taking the dog out and doing particular chores are surprisingly gratifying. He also likes catching up with Ken. He decides to make a point of scheduling in one satisfying chore, going out to lunch with a friend, and taking his dog to the park each week. But Alan notes that his satisfaction isn’t as high as he would have expected on two items – going to a party and showing off his new car. This discovery leads him to the next strategy for enhancing his wellbeing.
Interrupting the interrupters
If you start monitoring your satisfaction with different situations as Alan did in Table 17-2, you’re likely to discover that some activities are less satisfying than others. Look closely at your thoughts about such events. First, consider any thoughts you have that involve feeling good about the event. Then ask yourself if you’ve noticed any thoughts that interrupt that sense of satisfaction. We call those thoughts ‘interrupters’ – these are any thoughts that lessen and take the shine off your enjoyment of a positive activity.
For example, in Table 17-3 Annette tracks her satisfying activities in the same way as Alan in Table 17-2. She then chooses a few activities that she didn’t find as satisfying as she’d expected. Table 17-3 shows what her interrupters are:
Table 17-3 Annette’s Interrupters
Event
Satisfying Thought
Interrupter
Volunteering at the homeless shelter.
I like contributing something to society.
But then I thought that I really should be working on my school project: I’m never going to get it done.
Going to a party.
I think Kevin might like me.
Then I thought that he’s probably already got a girlfriend, and he’s just being polite.
Can you how Annette’s interrupting thoughts manage to lessen her sense of wellbeing and satisfaction? If you’re not feeling as satisfied as you’d expect with events try tracking your interrupters as Annette did. Then ask yourself the following questions about those disruptive thoughts:
What evidence do I have that supports or disproves these interrupting thoughts?
If a friend of mine told me that she had this interrupting thought, would I agree it was reasonable, or see it as self-defeating?
Do I have experiences in my life that may disprove this interrupting thought?
Is this interrupting thought distorted in any way?
Can I come up with an alternative to this interrupting thought that may be more accurate and help me feel better?
When Annette puts her interrupters to these questions, she finds she can think up more satisfying alternatives. You too are likely to discover that looking closely at your interrupters pays dividends. When you answer the preceding questions, you’re going to call those interrupting thoughts into question and come up with more satisfying alternatives. You’ll find it helpful to keep track of this information in your notebook.
The strategy of challenging interrupters may be familiar if you’ve read Part II, which discusses cognitive therapy. In Part II, you find many more strategies for tackling problematic thinking. The main difference here is that you track satisfying events rather than disturbing, depressing ones. You then record which thoughts interfere with that satisfaction.
Changing your lifestyle
A third useful strategy for increasing your overall sense of wellbeing and lessening the likelihood of relapse is by looking closely at your lifestyle. Ask yourself these Lifestyle Analysis questions:
Am I spending my time doing things that make me feel good, or do I merely switch off and escape by doing things like watching too much TV or overdoing the alcohol?
Am I working longer hours than necessary?
Am I driving myself scatty with self-imposed standards of perfectionism that cause unnecessary pressure for me?
Do I take reasonable holidays and breaks?
Do I take part in a reasonable amount of recreation?
Are there things I’ve always wanted to do that I haven’t got round to doing? If so, what are they, and what’s stopping me?
Take time out to examine your life. Think about the way you spend your time. Does it reflect your priorities? If not, think about using your time differently. If you feel trapped and unable to make these changes, read Chapter 12. Discover a creative way of sidestepping your mind’s trap.
Reining in Relapse When It Recurs
Sometimes depression returns despite all your efforts to fend it off. What do you do in this case? First, you need to know what real relapse looks like. (To find out what’s a genuine relapse see the ‘Reaching your verdict: Relapse versus low mood’ section, earlier in this chapter.) Then if you decide that you’re experiencing a relapse, take steps to deal with it.
The very first step in dealing with relapse is to seek professional help. If you’ve never been to your GP, a psychological therapist, or psychiatrist before, make sure you go now, because self-help on its own isn’t enough when dealing with recurrent depression.