Improved appearance and/or fitness = Increased enjoyment and confidence
Not:
Improved appearance and/or fitness = Better, more worthwhile and valuable human being
Changing with time
We all change physically, emotionally, and perhaps spiritually and philosophically, as we grow older. Even if nothing exceptionally dramatic or notable happens to us, certain changes are inevitable. Our hair will grey; our facial features will adopt deep expressive wrinkles. Some of us actually even improve physically with age (not to mention in other, more pertinent, personality-based ways, such as mellowing or becoming more accepting), but in the main, we just get older - and it shows.
Being able to acknowledge, adapt to and accept the way your body's abilities and physical attributes change over time can help you to maintain a healthy body image for life. Being older doesn't equate to being ‘uglier' or ‘less useful'. It just means that you're naturally aging and your looks are changing. Your ability to climb up a mountain or dance the night away may diminish - but that's only natural and normal. Aging gracefully involves accepting the physical changes associated with getting older and adapting to new limitations whilst making the most of your capabilities. Many men and women come to terms with their changing appearances as they grow older and manage to maintain a healthy and robust body image. You can do the same if you apply a healthy attitude to growth, age and change. As humans we're not stagnant. We evolve and develop over time. No one can be defined absolutely on the basis of how they appear externally, however old they are.
So try to embrace rather than reject the ways in which your body and face change over time. Try to appreciate every smile line and worry wrinkle. They're the traces of a life fully lived.
Other events, such as accidents and illness, can also impact on your appearance and physical abilities. Adjusting to drastic or unpredicted changes to your face and body can be very difficult at any stage of life. Sometimes you may need some extra professional help. It can be inspiring to note that ordinary people do go on to lead satisfying lives even after serious accidents or illness. The actor Christopher Reeve (1952-2004) is probably one of the best-known examples of famous people who've suffered this type of adversity. Reeve, famous for playing the role of Superman in a whole series of films, became a quadriplegic in 1995 after being thrown from his horse during a sporting competition. He then lobbied on behalf of people with spinal cord injuries, and in support of human embryonic stem cell research.
Even if an accident or illness hasn't resulted in serious physical disability, comparatively minor issues, such as facial scarring or walking with a limp, can still be challenging. Adjusting to the loss of a limb, altered facial and bodily appearance due to an accident, loss of sight or hearing and diminished mobility in response to disease can have a profound impact on your personal sense of identity and on your overall body image. Happily, many people adapt to these sorts of difficulty and lead full, enriched lives. If you've experienced any of the difficulties discussed here and feel you'd like some extra support, seek some professional and expert help (see Chapter 21).
Chapter 12: Deconstructing and Demolishing Depression
In This Chapter
Understanding depression
Identifying thinking and behaviour patterns that keep your depression going
Recognising and reducing ruminative thinking
Confronting and solving practical problems
Using activity as an antidepressant
Getting your sleeping pattern back on track
Statistics show that as many as one in two people are estimated to experience depression at some point in their lives. Luckily, the problem is well-recognised and treatable.
If, for the past month, you've felt down, lacked energy, been pessimistic or hopeless about the future, and lost interest or enjoyment in doing things, then you may be suffering from depression. If you've also had difficulty concentrating, had a poor appetite, been waking early, and experienced a low mood, anxious thoughts or feelings of dread in the morning, then you're even more likely to be depressed. If you have three or more of these symptoms, your symptoms have been present for two weeks or more, and are intense enough to interrupt your usual day-to-day activities, then we recommend that you visit your doctor and investigate the possibility that you're suffering from depression.
Antidepressant medication can help to alleviate some of your depressive symptoms, although not every person diagnosed with depression needs to take medication. Depending on the severity of your depression, a course of CBT treatment may be enough to help you get better. CBT for the treatment of depression is well researched and the results show that it produces good outcomes. CBT and antidepressant medication are often used in conjunction to treat more severe forms of depression. Ask your doctor or psychiatrist to explain your medication and any possible side effects.
Antidepressant medications are often referred to as ‘SSRIs', which stands for selective serotonin reuptake inhibitors.
This chapter provides you with a guide to assess yourself for possible depression and offers some classic CBT strategies for defeating depression.
Understanding the Nature of Depression
The sort of depression we're talking about in this chapter is different to feeling down or blue in response to a bad event. We're talking about an illness now ranked as one of the most common reasons for people having to take time off work.
Specifically, depression has the following symptoms, usually lasting for at least two weeks:
Appetite variation, such as eating far less or more (‘comfort eating') than usual
Sleep disturbance, including having difficulty sleeping, wanting to sleep too much or experiencing early-morning wakefulness
Lack of concentration and poor memory
Irritability
Loss of libido
Loss of interest in activities previously enjoyed; engaging in these activities no longer produces pleasure
Social isolation and withdrawal from others
Self-neglect with respect to feeding or grooming
Neglecting to take care of your living environment
Decreased motivation and activity levels, often described as a feeling of lethargy
Feelings of hopelessness about the future and thinking bleak thoughts, such as ‘What's the point?'
Strong and enduring negative thoughts about yourself
Feelings of guilt
Inability to experience feelings of love, often described as a flattening of emotions or feeling numb
Suicidal thoughts, such as feeling that you no longer care whether you live or die
Another common form of depression is bipolar affective disorder, formerly called ‘manic depression'. People who have bipolar disorder experience periods of severe depression alternating with periods of hypomania (feelings of euphoria accompanied by impulsive and often risky behaviour). If you think that you have this disorder we advise you to seek an assessment from a psychiatrist. A psychiatrist will be able to prescribe appropriate medication and can refer you to a CBT therapist.
The techniques covered in this chapter for overcoming unipolar depression (depression that's not accompanied by periods of hypomania) are also useful for bipolar sufferers. Keeping up a consistent day-to-day level of activity is one of the main CBT strategies for managing bipolar affective disorder. You can use the techniques in the following sections, which cover improving the quality of your sleep, solving problems, scheduling your activities and interrupting rumination, to stabilise your mood and help you to minimise or avoid excessive highs and lows.
Looking at what Fuels Depression
Unfortunately, certain things that you do, in an attempt to alleviate your feelings of depression, may actually be making your symptoms worse. When people are depressed, they often make the mistake of doing what their mood dictates.
CBT helps depressed individuals learn to override their depressed mood and to do the opposite of what their
depression makes them feel like doing. Here are some of the main actions and thoughts that actually stoke depression:
Rumination: Getting hooked into a repetitive, cyclical process of negative thinking, repeatedly going over problems in the past or asking yourself unanswerable questions. (We discuss rumination in detail in the next section.)
Negative thinking: In depression, your negative thoughts about yourself are often based on beliefs that you're helpless and worthless. Thoughts about the world being an unsafe and undesirable place to live in are also a common feature of depression.
Inactivity: Feeling that you can't be bothered to do day-to-day tasks, not participating in activities that previously you enjoyed and staying in bed because you don't believe you can face the day.
Social withdrawal: Avoiding seeing other people and not interacting with the people around you.
Procrastination: Avoiding specific tasks, such as paying bills, booking appointments and making phone calls, because you think they're too difficult or scary to confront.
Shame: Feeling ashamed about your depression, and telling yourself that other people would judge you harshly if they knew how much your effectiveness and productivity had decreased.
Guilt: Feeling guilty about your depression, and overestimating the degree to which your low mood causes inconvenience and suffering for your loved ones.
Hopelessness: Thinking that you'll never feel better or that your situation will never improve.
Doing only what you feel like doing when you're depressed is likely to maintain or worsen your symptoms. Instead, try doing the opposite of what your depression directs you towards doing. For example, if you feel depressed and want to stay in bed all day avoiding phone calls and seeing friends, do the opposite. Try to make the colossal effort (and it can really feel colossal!) of getting up and dressed, answering the phone and going out of the house to meet friends. Doing so limits you ruminating on your bad feelings and thoughts, and forces your attention onto external things, such as other people and your environment.
Most people find that they feel better for having done something, even if they don't experience enjoyment from social interaction like they did before they became depressed.
Depression typically dulls your ability to glean enjoyment from previously enjoyed activities. Be patient with yourself and trust that your feelings of enjoyment can return over time. In the first instance, it's enough to simply do the things that you've been avoiding for the sake of it. Doing something is better than doing nothing. Don't put pressure on yourself to ‘have a good time' at this early stage in your recovery.
Going Round and Round in Your Head: Ruminative Thinking
Rumination is an integral process in maintaining your depression. Most people with depression are likely to engage in some rumination, even if they're not aware that they do.
Rumination is a circular thought process in which you go over the same things again and again. Often, the focus is on how bad you feel or doubting that you can ever feel differently or better. Your rumination may also focus on trying to work out the root cause of your depression, or on the events that have contributed to you being depressed. You may ask yourself questions like the following, over and over again:
Why is this happening to me?
What could I have done to stop this happening?
If only x, y or z hadn't happened, I'd be okay.
Depression makes people feel compelled to ruminate. In a sense, rumination is like a faulty attempt to solve problems. Rumination is compelling because your depressed mood tells you that you must try to get to the bottom of why you feel bad. But rumination simply doesn't work: you end up trying to solve your depression by going over the same old ground and looking for answers inside the problem. You focus your attention on how depressed you feel, which leads to you feeling more depressed.
Fortunately, you can catch yourself going into a ruminative state by using the techniques we discuss in the following sections to interrupt the process.
Catching yourself in the act
Rumination is all-consuming. It will typically absorb you quite totally. You may look like you're simply staring blankly into space, but in your head your thoughts are going ten to the dozen. The key is to know when you're going into rumination, so you can take steps towards getting out of rumination.
Early warning signs of rumination taking hold include the following:
Getting stuck. You may be in the middle of doing something and find that you've stopped moving and are deep in thought. For example, you may be perching on the side of the bed for several minutes (or even much longer!) when actually you intended going for a shower.
Feeling low. Beware of times when your mood's at its lowest ebb: this is when you're most likely to engage in rumination. Most people ruminate at particular times of the day, more often than other times (although rumination can happen at any time).
Slowing down. You may be doing something and then start to move more slowly, like pausing in the aisle at the supermarket. You start to slow down because your concentration's heading elsewhere.
Getting repetitive. The same old thoughts and questions drift into your head, time and time again. You get a familiar niggling feeling that these vague questions must be answered.
The content of your ruminations isn't the problem - the process of rumination itself is. You don't need to do anything with your thoughts other than disengage from them, as we explain in the following section.
Arresting ruminations before they arrest you
Several different tricks can help you stop the rumination process. Try some of the following:
Get busy. Perhaps one of the most effective strategies you can adopt is to make your body and mind busy with something outside yourself. If you're vitally absorbed in an activity, you may find it harder to engage in rumination. These types of activity may include doing the housework with the radio on to hold your attention away from your internal thoughts, making a phone call, surfing the Internet, running errands, taking the dogs for a walk, and so on.
Work out. Hard aerobic exercise can exorcise those toxic thought processes. Be sure to exercise during the day or in the early morning, because exercising too near bedtime can disturb your sleep.
Get up and out. Rumination's more difficult when you're outside of your home or in the company of others. If you know that you're most vulnerable to ruminating at certain hours of the day, make sure that you schedule activities for these times.
Let your thoughts go. Practise letting your negative thoughts pass by and simply observe them like pictures across a television screen. Don't engage with your negative thoughts, judge them or try to answer any questions - just accept their existence and let them slip by. (Check out Chapter 5 for more on this technique.)
Get good at redirecting your attention. You can strengthen your attention muscles and deliberately focus on less depressing things. Try using task concentration training, a method of attending to external aspects of your environment, as it can successfully interrupt rumination. (See Chapter 5 for more on task concentration training.)
Be sceptical. Your depressed thoughts are a symptom of your depression, so try to take them with a sizable pinch of salt. You can resist the urge to ruminate about your depressed thoughts by deciding that they're neither true nor important. Even though they feel important and worthy of scrutiny - they aren't. You won't learn anything new about your depression by focusing on negative repetitive thoughts.
Keeping busy is a great technique for interrupting ruminative thinking. However, you can still end up ruminating while you're engaged in an activity. Be aware of paying attention to whatever you're doing. Be mindful of your actions when you're ironing, cleaning, stringing beads, weeding the garden, or whatever. Rumination can take hold during activities if you're acting mindlessly rather than mindfully (refer to Chapter 5 for more on this distinction).
Activating Yourself as an Antidepressant
Withdrawal and inactivity are the two
most fundamental maintaining factors in depression - they keep you in a vicious cycle of isolation and low mood. For example, to counteract feelings of fatigue, you may be tempted (very tempted) to spend more time in bed. Unfortunately, remaining in bed means more inactivity and less energy.
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