If you feel ashamed of being ‘flat', about having nothing to say, or feel guilty about burdening your friends, then keeping to yourself may seem sensible. The problem is that the less you do and the fewer people you see, the less pleasure and satisfaction you'll get out of life, the less support you'll receive, and the more your problems will pile up and weigh heavy on your mind. Staying away from others may seem like the right thing to do when your mood is low. You may believe that you've got nothing to offer others. You may even have thoughts about being undeserving of friendship or love. However, the more you act on these destructive ideas, the more you reinforce them and convince yourself that they're true. Following your depressive tendency to isolate yourself can lead into true loneliness.
You don't necessarily have to talk about your low feelings when you see friends; in fact, it's often a good idea not to. Talking about superficial things and listening to what others have been up to can give you a welcome break from your own thoughts. Moreover, noticing that others treat you pretty normally can actually help you to feel a bit more ‘normal' rather than afflicted. Try not to worry about making interesting conversation and just allow yourself to absorb the company of those you're with.
A good rule of thumb for recovery from many psychological problems is: ‘if you want to feel normal again, you need to start acting as you would normally.'
Because depressive illness trains you to be such a skilled self-saboteur, you may end up doing negative self-comparisons when in company. Be wary of letting stealthy depressed thoughts such as ‘I should be getting on with my life like my friends are' or ‘Why can't I be happy like so and so?' take hold. Pretty much the worst time to try to self-evaluate is when you're depressed. So resist making comparisons and instead gently urge yourself to engage in social interaction.
Tackling inactivity
One of the best ways of starting to overcome depression is to gradually become more active, to steadily re-engage with other people, and to start tackling daily chores and other problems.
Use the activity schedule in Table 12-1 to start to plan each day with a realistic balance of activities and rest. Build up your activities gradually. If you've been in bed for days, getting out of the bedroom and sitting in a chair is a big move in the right direction. Remember: take it step by step. Using the activity schedule is really simple; it merely involves allocating a specific time to do a specific activity. You can photocopy the blank schedule in Table 12-1 and fill it in.
Don't overload your activity schedule, otherwise you may feel overwhelmed, sink back into inactivity, and probably berate yourself for being ineffective. It's crucial to realistically plan a gradual increase in activities, starting from where you are now, not from where you think you should be.
Dealing with the here and now: Solving problems
As with other aspects of your daily or weekly activities, you need to be steady and systematic in your attempts to deal with practical problems, such as paying bills, writing letters, and completing other tasks that can pile up when you're less active.
To get started, set aside a specific amount of time each day for dealing with neglected chores. Allocating your time can help things seem more manageable. Try the following problem-solving process:
1. Define your problem.
At the top of a sheet of paper, write down the problems you're struggling with. For example, you might consider problems with the following:
• Relationships
• Isolation
• Interests and hobbies
• Employment and education
• Financial issues
• Legal issues
• Housing
• Health
Apply the following steps to each of your identified problems. You may need to do Steps 2 to 5 on each of your different problems.
2. Brainstorm solutions to your problem.
Write down all the possible solutions you can think of. Consider the following questions to help you generate some solutions:
• How did you deal with similar problems in the past?
• How have other people coped with similar problems?
• How do you imagine you'd tackle the problem if you weren't feeling depressed?
• How do you think someone else would approach the problem?
• What resources (such as professionals and voluntary services) can you access for help with your problems?
3. Evaluate your solutions.
Review your ‘brainstormed' list. Select some of your most realistic seeming solutions, and list the pros and cons of each.
4. Try out a solution.
On the basis of your evaluation of pros and cons, choose a solution to try out.
You can easily feel overwhelmed when your mood is low. Even the best of solutions can seem too difficult. To deal with this, break down your solution into a series of smaller, more manageable steps. For example, if you're dealing with financial problems, your first step may be to ask friends to recommend an accountant, or to visit a financial consultant in your area. A second step may be to get your tax returns, proof of income and so on, together. A third step may be selecting an accountant, and contacting them for information about their fees and the services they provide.
5. Review.
After trying out a solution, review how much it has helped you to resolve your problem. Consider whether you need to take further steps, try another solution or move on to tackling another problem.
Taking care of yourself and your environment
One of the hallmarks of depression is neglecting yourself and your living environment, which in turn leaves you feeling more depressed.
Instead of allowing your depression to be mirrored in your appearance and your home, make an extra effort to spruce things up. Your environment can have an astounding effect on your mood, both positive and negative.
Include bathing, laundry, tidying and cleaning as part of your weekly activity schedule.
Getting a Good Night's Sleep
Good night, sleep tight, don't let the bedbugs bite!
Sleep disturbance, in one form or another, can often accompany depression. Here are some tips you can use to improve your chances of greeting the sandman:
Get some exercise. We cannot overstate the benefits of taking regular exercise. Exercise is good for your mood and good for your sleeping. You can take vigorous exercise during the day or even first thing in the morning to get your endorphins (‘feel good' chemicals in your brain) charging. If you want to take some exercise in the evenings to help you wind down and de-stress, keep it gentle and not too close to your bedtime. A stroll, or an easy cycle ride, is an ideal choice.
Establish a schedule. Getting up at the same time every day and avoiding daytime naps can help you get your sleeping back on track. Catnapping may be very tempting, but ultimately it interferes with your bedtime and can actually lower your mood. If you know that you get the urge for a siesta around the same time every day, make plans to be out of the house at this time. Make yourself busy to keep yourself awake.
Avoid lying in bed awake. If you find dropping off to sleep difficult, don't lie in bed tossing and turning. Get out of bed and do something - ideally, something boring like sorting laundry or reading a book on a subject you find dull, drinking something warm and low-in-caffeine, such as milk or cocoa - until you feel ready for sleep. Try to stay up until your eyelids start to feel heavy. The same applies if you wake in the middle of the night and can't get back to sleep easily. Don't stay in bed for longer than ten minutes trying to get back to sleep. Get up and do something like the above ideas, then get back into bed only when you feel sleepy.
Watch your caffeine and stimulant intake. Avoid caffeinated drinks from mid- to late afternoon. Caffeine can stay in your system for a long time. Remember that, as well as tea and coffee, many soft drinks, chocolate (although not so much) and various energy drinks contain caffeine. Even some herbal teas contain stimulants, such as matte and guarana.
Establish
a bedtime routine. Going through the same pre-bedtime procedures each night can help your mind realise that it's getting near to shutdown time. Your routine may include having a warm bath, listening to a soothing radio programme, having a warm, milky drink, or whatever works for you. Sometimes, having a very light, easily digestible snack before bedtime is a good idea to prevent sleep disturbance associated with going to bed hungry.
Setting realistic sleep expectations
During the day and while you try to fall asleep, you may well have thoughts like ‘I'll never be able to get to sleep', or ‘I'm in for another night of waking up every two hours'. Understandably, you may have these expectations if your sleep has been disturbed for some time, but such thinking is likely to perpetuate your sleep disturbance. Be aware of your worrying thoughts about sleep problems, such as ‘I'll never be able to cope on such little sleep', or ‘I've got to get some sleep tonight'. Trying to force yourself to go to sleep is rarely successful, and doing so contradicts the concept of relaxation because you're making an effort to sleep.
Although it may sound like a tall order, try to take the attitude that you can cope with very little, or poor-quality, sleep. Also, answer back your sleep expectations by briefly telling yourself that you don't know for definite how you may sleep tonight and that you're just going to see how it goes.
Making your bedroom oh so cosy
Your bedroom should be used for sleeping and nothing else, apart from sex. When you're trying to settle your sleep pattern, you should avoid even reading in bed. The idea is to help your fatigued mind build helpful, sleep-inducing associations with your boudoir. So, you definitely don't want to be watching telly, working on your laptop, talking on the phone, eating or engaging in any other activity in bed, apart from slumbering or making sweet lurve.
Take care to make your bed and bedroom a relaxing, soothing place to be. Get yourself some very nice bed linen, remove clutter from the room, maybe put out some candles, hang some relaxing pictures on the walls, and make the temperature right for you. Smells can carry strong associations, so consider using a pleasant fabric softener on your linen or a special-purpose pillow spray. Just the smell of a soothing fabric softener on your linen can be enough for you to associate your bed with sleeping.
You can buy several natural essential oils from herbalists and health food shops that are thought to have relaxing properties. Try having an aromatherapy massage, or add essential oils to your bath, heat them in a burner to fragrance your room or sprinkle them diluted on your bedclothes. Consider trying some of the following oils:
Chamomile
Clary sage
Geranium and rose geranium
Lavender (always popular)
Palma rosa (also said to be good for depression)
Ylang ylang (also claimed to have an aphrodisiac effect)
Always get advice from a qualified herbalist about how to use essential oils correctly and safely. Most good quality health food shops may either have some qualified staff or be able to recommend a herbalist or aroma therapist. Undiluted essential oils are very strong, and you shouldn't apply them directly to your skin. If you're taking medication, are pregnant or have any allergies or medical conditions, you should always consult your doctor before using any aromatherapy or herbal remedies.
ACTing against Depression
Acceptance and commitment therapy (ACT), founded by Stephen Hayes, is one of the ‘third wave' developments in cognitive therapy. Basically, ACT is a newer approach to treating depression but still largely based on core cognitive therapy principles. ACT differs in some pertinent ways from standard CBT. The chief difference is that, instead of challenging your negative thoughts directly, you're encouraged to observe them without judgement and let them pass naturally. We touched on this concept earlier on in this chapter (also see Chapter 5 for more on allowing thoughts to pass).
In addition to tolerating and non-judgementally observing negative thoughts, ACT focuses on commitment to personal values. According to ACT, people who recognise their values (and pursue action to reflect those values) avoid depression. (We look at value-based living in Chapter 18.)
The following three sections expand on some basic principles involved in recovery from depression found both in CBT and ACT.
Practising acceptance
The feeling of depression, and the thoughts that go with it, are undeniably deeply unpleasant and unwelcome. We've never met anyone who said they elected to become depressed. You may conclude that you're basically miserable, a ‘misery guts' or a fundamentally negative person based on your depression. We find that this is rarely the case. Being depressed is not the same as holding a cynical and pervasively negative view of the world generally. In fact, the opposite is typically the case. If you're depressed, one of the things you may find hardest to accept is the change from being a positive person who enjoys life to one who feels utterly defeated and devoid of enjoyment. People who are depressed sometimes express feeling that they no longer recognise themselves.
Because symptoms of depression frequently run so counter to your understanding of your natural temperament, they can be uniquely difficult to accept. We're not suggesting that you learn to like being depressed - that would be crazy. But it can help to accept your depression for what it is - an illness. Thankfully, depression is usually temporary (even if it does last for a long while) and is not a change of personality. Your personality is still in tact; your depression is merely masking it. Unwittingly, you may be putting extra pressure on yourself by issuing demands such as ‘I must not feel this way', ‘this is intolerable' or ‘I have to get better now!' Such demands (though understandable) just reinforce your bad feelings and build bigger obstacles to recovery. They're rather like banging your head against a wall. Try practising these types of accepting attitude instead:
‘I hate being depressed but unfortunately I'm not immune to depression.'
‘Depression is very hard to bear but I am tolerating these unpleasant feelings.'
‘I want to get better now but I can't bully myself out of depression so I will be patient but determined.'
Give yourself credit for coping even though you may feel like you're not. You are coping; it's just not easy.
Considering compassion
You can't bully yourself out of depression. If that strategy worked, we'd have far fewer clients. Giving yourself a hard time for being low is literally kicking yourself when you're down. So many depressed people both berate and refuse to look after themselves because doing so's part of an insidious cycle. See Figure 12-1.
When you're ill, you want to get well again. That involves looking after yourself, both mentally and physically. When you have flu or some other physical illness, you probably don't tell yourself that you should never have become ill in the first place, or that you're weak and pathetic because you've done so. Depression is a different ball game, as Figure 12-1illustrates. An essential part of recovery is offering yourself compassion instead of criticism. Try these tips for being kind to yourself:
Give yourself credit for your efforts to act against depression. Instead of telling yourself that you should be doing more, start from where you are now. If yesterday you didn't get out of bed and today you did - that's significant progress. The next step may be going to the shops or answering your telephone. Focus on your small daily improvements instead of benchmarking yourself against where you ultimately want to be.
Compliment and kindly cajole yourself. Depression inevitably invites you to think of yourself in negative ways and call yourself bad names. Stop yourself from verbalising or mentally constructing self-directed insults. Instead, deliberately call to mind your good points and encourage yourself to do more through the use of praise. Be nice!
Be wary of false friends. Using illicit drugs, alcohol or food to alleviate your feelings and thoughts can grant you a brief respite - but at a high cost. You're likely to feel far worse when you ‘come down' from drugs and alcohol or after an eating binge. You may end up
with a dependency that prolongs a period of depression which may otherwise shortly relent. Alcohol and drug use can also interfere with the effectiveness of antidepressant medication. See Chapter 10 for more information about addictions.
Cognitive Behavioural Therapy For Dummies Page 21