HOMEResource CentreTip SheetsDepressionManaging depression

Managing depression

Understand research, signs and what to do when you are feeling depressed.

Signs of feeling depressed

‘I just can’t get myself to do any work. My life is falling apart’, ‘My partner left me because I’m not good enough. I will never cope with being alone’, ‘I’m getting older. I’m losing my looks. No one will care about me anymore’, ‘I’m such a lousy (secretary, lawyer, housekeeper, supervisor, student, friend). My (boss, clients, spouse, friends) only keep me around because they feel sorry for me. NOTHING I try to do ever turns out right’.

These are typical thoughts of people who are depressed.

While these ideas may seem to be correct on the surface, they actually show a change in the way a person has come to think about him/herself.

CHANGE – in thinking, feeling, acting – is a key feature in depression.

Although the change may come on gradually, the depressed person is different from the way he was before the onset of the disorder.

There are many examples of this change; the successful businessman who believes he is on the verge of bankruptcy, the devoted mother who wants to run away from her children, the gourmet chef/cook who can’t stand food.

Instead of seeking pleasure, the depressed person avoids it. Instead of caring for him/herself, appearance is neglected.

The instinct to survive may give way to a desire to end life. The drive to succeed may be replaced by lack of energy and interest in life and withdrawal.

The most obvious and typical sign of depression is sad mood, gloomy, lonely and apathetic.

The depressed person may cry even when there is nothing to cry about, or may find it impossible to cry when a truly sad event occurs.

He/she may have trouble sleeping or wake early in the morning unable to return to sleep; or may feel constantly tired and sleep more than usual and gain or lose weight.

Typically, the depressed person also views him/herself in a very negative way, believing him/herself to be helpless and alone in the world and often blames him/herself for trivial faults and shortcomings.

Such persons are pessimistic about themselves, about the world, and about the future. Interest in what is going on around them is lost, and they don’t get satisfaction out of activities they used to enjoy.

They often have trouble making decisions or getting themselves to carry out decisions they have made.

Some people may be depressed without showing the usual sad, moody, dejected feeling.

They may complain instead of physical discomfort or drink alcohol excessively or take drugs.

When people seem tired and bored with what they are doing, they may actually be depressed.

When bright students begin to do poorly at school, this may be compensating for an underlying depression.

New understanding from research

It is very common for depressed people to believe that they have lost something very important to them, often though this is not really the case.

Depressed persons may believe they are losers, worthless and bad and perhaps not fit to live.

Research into depression over a ten-year period attempted to examine the persistence of these unpleasant feelings in depressed people.

It was found that an important factor is that depressed people interpret situations around them incorrectly. What they think is happening affects how they feel.

That is, the depressed person feels sad and lonely because she/he incorrectly thinks she/he is abandoned and deserted.

A depressed person can be helped by learning how to alter these errors in thinking, rather than concentrating on the depressed mood.

Studies by Aaron Beck and others in the USA found that regardless of their low opinion of themselves, depressed persons perform just as well as normal subjects on a series of complex tasks.

In one study depressed people were given a series of tests of increasing difficulty involving reading, comprehension and self-expression.

As they began to experience stress, they became more optimistic. Their mood and self-image improved. They even performed better when they were later asked to try other tests.

Thinking and depression

These and other similar findings suggested new approaches to treating depression and new ways for the depressed person to help him/herself.

Hence, therapists are now concerned with the statements that people make to themselves, that is, what they think. It was found that depressed people have continuous, unpleasant thought and that with each negative thought the depressed feeling increases.

Yet these thoughts are generally not based on real facts and make a person feel sad when there is no reason to feel that way.

The negative thoughts may be to keep depressed people from engaging in activities that will make them feel better.

As a result, they are likely to experience harsh, critical thoughts about being ‘lazy’ or ‘irresponsible’ – which makes them feel worse and worse.

In order to understand this faulty thinking, consider the following example; suppose you are walking down the street and you see a friend who appears to completely ignore you.

Naturally you feel sad. You may wonder why your friend has turned against you. Later, when you mention the incident to your friend he tells you that he was so preoccupied at the time that he didn’t even see you.

Normally, you will feel better and put the incident out of your mind. If you are depressed however, you will probably believe that you friend has really rejected you. You may not even ask him about it, allowing the mistake to go uncorrected.

Depressed people make such mistakes over and over again.

In fact, they may misinterpret friendly overtures as rejections. They tend to see the negative rather than the positive side of things. And they do not check to see if they have made a mistake in interpreting events.

If you are depressed, many of your bad feelings are based on mistakes in your thinking.

These mistakes relate to the way you think about yourself and to the way you judge things that happen to you.

However, you have many skills and you may be good at solving problems in other areas of your life. In fact you have been solving problems all your life.

Like a scientist, you can learn to use your reasoning powers and your intellect to ‘test out’ your thinking and see if it is realistic. In this way, you can stop becoming upset by experiences that may seem at first glance to be unpleasant.

You can help yourself by:

Recognising your negative thoughts, and
Correcting them and substituting more realistic thoughts

Checklist of negative thoughts

Whenever you notice that you are feeling somewhat sadder, think back and try to recall what you thought and whether it triggered or increased the feeling of sadness.

This thought may be a reaction to something that happened quite recently, perhaps within the last hour or the last few minutes, or may be a recollection of a past event.

The thought may contain one or two of the following themes:

Negative opinion of yourself

This notion is often brought about by comparing yourself with people who seem more attractive or more successful or more capable or more intelligent:

‘I am a worse student than Mike’
‘I have failed as a parent’
‘I am totally lacking in judgment or wit’

You may find that you have become preoccupied with these ideas about yourself, or dwell on incidents in the past when people seemed to dislike you or you made a mistake.

You may consider yourself worthless and burdensome and assume that friends and relatives would be happy to be rid of you.

Self-criticism and self-blame

The depressed person feels sad because of the focus on attention on presumed faults and failings.

She/he blames him/herself for not doing a task as well as she/he thinks she/he should, for saying or doing the wrong thing or causing trouble for others.

When things go badly the depressed person see it as his/her fault and even happy or fun events can make them feel bad as they may think, ‘I don’t deserve this’, or ‘It should have been better’, or ‘Something bad is going to happen as I’m feeling so good (or relaxed)’.

Because your opinion of yourself is low, you may make excessive demands on yourself.

You may require yourself to be perfect in every way – a perfect housekeeper, friend, social entertainer etc.

You may run yourself down by thinking, ‘I should have done better’.

Negative interpretation of events

Over and over, you may find yourself responding in negative ways to situations that don’t bother you when you’re not depressed.

If you have trouble finding something you may think, ‘everything goes wrong for me’.

You may read disapproval into comments others make or the way they look at you, or decide secretly that they dislike you – although they act in as friendly a way as ever.

Negative expectations of the future

You may have fallen into the habit of thinking that you will never get over your feelings of distress or your problems and believe they will last forever.

Or you may have negative ideas when you try to do things. ‘I am sure I will fail at this’, or ‘this will turn out as badly as everything else’.

The depressed person tends to accept future failure and unhappiness as inevitable and may say that it is no use trying any more as nothing will change.

My responsibilities are overwhelming

You have the same kind of tasks to do at home, school or work that you have done many times before, but now you believe that you are completely unable to do them or that it will take weeks or months before they are completed.

Or you tell yourself that you have so many things to do that there is no way of organising the work.

Some people give themselves rest or time to devote to personal interests because of what they see as pressing obligations coming at them from all sides.

They may even experience physical feelings that can accompany such thought – breathlessness, shaking, anxiety, nausea or headaches.

What you need to know about negative thoughts

also have these thoughts at times but are able to dismiss them from their mind. The depressed person has them much of the time – particularly when she/he thinks about his/her own value as a person, or what is likely to come in life. You can recognise these aspects of depressive thinking.

Negative thoughts tend to be automatic. They just seem to happen without any logical thinking process. They are based on the low opinion depressed people have of themselves, rather than on reality.

The thoughts are unreasonable and have no useful purpose. They make you feel worse and they get in the way of your achieving and what you really want out of life.

If you consider them carefully, you will probably find that you have jumped to a conclusion that is not really accurate. Your therapist will be able to show you how unreasonable your negative thoughts are.

Even though these thoughts are unreasonable, they probably seem perfectly believable at the time. They are usually accepted as reasonable and correct, just like a reasonable thought such as “The telephone is ringing, I should answer it”.

The more a person believes these negative thoughts without any examination or criticism of them, the worse s/he feels.

If you allow yourself to sink into grip of these thoughts, you will find yourself interpreting everything in a negative way. You will tend to give up more and more since everything seems hopeless.

But giving up is harmful – because depressive people often interpret the fact that they have given up as yet another sign of inferiority or failure.

You can help yourself by learning to recognise your negative thoughts and understanding why they are incorrect and illogical. Check the characteristics listed above and see how they fit your negative thoughts.

Typical thinking errors

Incorrect thinking leads to and worsens depression. You probably make one or more of the following thinking errors. Read this and see which apply:

Exaggerating

You see certain events in an extreme way.

For example, if you are having some everyday difficulty, you start to think that it will end up as a disaster and you exaggerate problems and the possible harm they could cause.

At the same time you underestimate your ability to deal with them.

You jump to conclusions without any evidence and you believe your conclusion to be correct.

A man who invests his savings in a house suspected that he house might have termites.

He immediately came to the conclusion that the house would fall apart and is worthless, his money lost. He was convinced that nothing could be done to save the house.

Overgeneralising

You make a broad general statement that emphasises the negative: ‘nobody likes me’, ‘I am a complete failure’, ‘I can never get what I want out of life’, ‘I will never make any real friends’, ‘I am losing all my friends’.

Ignoring the positive

You are impressed by and remember only negative events.

When a depressed woman was advised to keep a diary, she realised that positive events happen often but she had a tendency not to pay attention to them or to forget about them.

Or she would tell herself that good experiences were unimportant for some reason.

On the other hand, you may see some positive events as losses because you did not pay proper attention to the details and jumped to conclusions.

For example, a young woman received a letter from her boyfriend, which she read as a rejection. She broke off with him but later when she re-read the letter she realised that no rejection was intended.

What to do

The daily schedule

Try to schedule activities to fill up the spare hours of your day.

Use a weekly Activity Schedule with each hour of each day marked off into boxes. Make a list of items you plan to attend to each day.

Start with the easiest and progress to the more difficult. Check off each activity as you complete it. This schedule can also serve as a record of your experiences of mastery and satisfaction.

‘Mastery and pleasure’ method

You have more things going for you than you are usually aware of.

Write down all of the events of the day and then label those that involve some mastery (that is, you could do a task you didn’t think you could) of the situation with the letter ‘M’, and those that bring you pleasure with a letter ‘P’.

The ABC of changing events

Most depressed people believe that their life situation is so bad that it is natural for them to feel upset or sad.

Actually, your feelings come from what you think about how you interpret what has happened to you.

If you think carefully about a recent event that has upset and/or depressed you, you should be able to sort out three parts to the problem:

a) The event
b) Your thoughts
c) Your feelings

Most people are only aware of points (a) and (c).

Suppose your family forgets your birthday. You feel hurt, disappointed and sad. What is really making you unhappy is the meaning you attached to this event. You think, ‘my family’s forgetfulness means they don’t love you anymore’.

You may feel you are ‘unlovable’ and then think that without their approval you can never be happy and satisfied.

Yet, it is quite possibly that your family were too busy or just do not share your enthusiasm for birthdays.

You suffer because of your unrealistic conclusions – not because of the event itself.

Review your thoughts

If you should get a bad feeling review your thoughts.

Try to remember what has been passing through your mind.

These thoughts may have been your automatic reaction to something that happened – the chance comment of a friend, the arrival of a bill, the start of a stomach ache, a daydream.

You will probably find that these thoughts were very negative and that you believe them.

Try to correct your thoughts

Do this by answering each of the negative statements you made yourself with a more positive, balanced statement.

You will find that not only are you regarding life more realistically but that you feel better.

A housewife felt gloomy and neglected because none of her friends had called her.

When she thought about it she realised that Mary was in hospital, Jane was out of town, and Helen had called.

She substituted this alternative explanation for the negative thought, and began to feel better.

The double column technique

Write down unreasonable automatic thoughts on one side of the page and your answers on the opposite side.

Example: John has not called, he doesn’t care about me anymore.

Answer: He has been very busy and thinks I am doing better than last week, so he need not worry about me.

Solving difficult problems

If a particular job you have to do seems to be very complex and burdensome, try writing down each of the steps you will have to take to accomplish the task, and then take them one step at a time.

Problems that seem unsolvable can be mastered by breaking them into smaller manageable bits. If you feel stuck in only one approach and are not making progress, try to write down different ways of tackling the problem.

Ask other people how they handled that type of difficulty.

Psychotherapy

You therapist can help you to identify and correct your unrealistic ideas and thinking that brings you to wrong conclusions about yourself and others and help you to plan ways of dealing more effectively with real, day-to-day problems.

With guidance and your own efforts, you will have a good chance to feel better. And you can learn to respond with far less depression or anxiety when you meet problems in the future.

For more support make an appointment with your GP and visit: