Managing Your Depression (12 page)

2. Listen to relaxing music.

3. Go to gym.

4. Take bubble bath.

5. Watch funny movies.

What I will
not
do

1. Sit on couch all day.

2. Overeat junk food.

3. Not take a shower.

How other people can help me

1. Listen to me seriously.

2. Call to check on me.

3. Plan something to do.

Signature (patient)            ________________________________           Date      ___________

Signature (provider)         ________________________________           Date      ___________

ACTION PLAN FOR RELAPSE PREVENTION

My BASELINE

• Describe your baseline and what you need to do to maintain it
.

When I’m feeling well, I …

To stay well, every day I need to …

ACTION PLAN FOR RELAPSE PREVENTION

My TRIGGERS

• List events and situations that can increase your symptoms
.

My WARNING SIGNS

• List your personal signs, the noticeable changes in thoughts, feelings, behaviors, routine, or self-care that warn of an episode
.

Signature (patient)            ________________________________     Date      ___________

Signature (provider)         ________________________________     Date      ___________

ACTION PLAN FOR RELAPSE PREVENTION—PART
2

What I will do to cope, soothe, or distract myself

1.

2.

3.

4.

5.

What I will
not
do

1.

2.

3.

How other people can help me

1.

2.

3.

Signature (patient)              ________________________________     Date     ___________

Signature (provider)           ________________________________     Date     ___________

CHAPTER 6
Cognitive Behavioral Therapy

Thoughts, Feelings, and Behaviors

There is a close connection between our thoughts, feelings, and behaviors (actions). Each of these influences the others. For example, a certain thought may cause you to feel sad. This may then affect your behavior, causing you to cry and withdraw. You then feel more sad. Another thought may cause you to feel anxious, and consequently your behavior is jittery.

Cognitive behavioral therapy (CBT) is a kind of talk therapy (psychotherapy) that addresses this connection between your thoughts, feelings, and behaviors. In CBT you learn to identify and change thinking patterns that may be distorted, beliefs that are inaccurate, and behaviors that are unhelpful. CBT is a way to help you look at your thoughts and determine when you are thinking in a rational or an irrational way. You learn to monitor, challenge, and replace your negative thoughts with more realistic ones and to recognize the connection between your thoughts, feelings, and behaviors. CBT is particularly useful in depression, when your thoughts are often distorted, negative, and upsetting. If you can learn to be more aware of negative thoughts and feelings and respond to them using CBT, then you may be able to avoid a relapse or recurrence of your depression.

How You
Think
about and Interpret the World
Affects How You
Feel

• People experience the world as a series of events. These events can be positive, negative, or neutral.

• In your mind, you process and
interpret
these events and form thoughts about them. Interpretations are often based on individual beliefs and past experiences.

• Your thoughts give meaning to the event and create feelings about it.

• “Feelings” are created by your thoughts and interpretations of an event and not by the actual event. Thoughts and feelings are not facts.

An event can cause distress depending on how you interpret it in your mind. When you have an
accurate
understanding and interpretation of what is going on around you, your emotions will likely be in a normal range and not usually cause problems. If your thoughts about or interpretations of an event are inaccurate or distorted in some way, the emotions you experience may cause distress. This happens in depression. Challenging these distorted thoughts and interpretations with CBT can improve the way you feel.

What Are Distortions in Your Thoughts?

Distortions in your thoughts are errors in thinking that twist your interpretation of an event in different ways (see the examples in the next section). Many things can make you less accurate in your thinking and interpretation of events, contributing to thought distortions. For example, your thinking can be affected by

• lack of sleep

• poor or imbalanced diet

• substance abuse

• past experiences

• ideas about yourself and the world (your sense of self-worth)

• your mood (such as depression or anxiety)

Thought Distortions in Depression

Depression often causes people to view their experiences, themselves, and their future in a negative way. Negative events are often magnified, dominating your thinking. The depressed mind tends to interpret and twist things in a negative direction, causing negative thoughts. These thoughts happen automatically, not on purpose. When depressed, you are more likely to believe the biased or distorted thoughts, even though they are not an accurate reflection of reality. There is often little or no evidence to support them, and they are often extreme. However, these interpretations seem true and convincing when you’re in the midst of depression.

Some examples of automatic negative thoughts are

• “I’m a loser.”

• “I can’t do anything right.”

• “Nothing is ever going to change.”

These examples are extreme generalizations that are not true. It is the depression talking. When you remove the distortion in these thoughts and take a more accurate view of them, you can then replace the distorted thoughts with more accurate, alternative thoughts, such as

• “I’m not perfect, but I do some things right.”

• “Some things in my life do get better.”

So when you are depressed, it is important to look at whether your thoughts are distorted in some way (see
pages 90
–91). The way to do this is to look carefully at the facts of a situation and challenge any inaccurate interpretations of them. When the distorted thought is replaced with an accurate one, the upsetting emotion will eventually be replaced by a more realistic emotion. This is not easy to do, especially during an episode of depression, when you are viewing the world through a seemingly believable but distorted lens. You may not be able to notice the inaccuracies in your thoughts, which seem so convincing. The following sections will show you how to identify the different types of distortions in your thinking and how you can learn to challenge them.

Types of Distorted Thinking

Distortions in thinking, called
cognitive distortions
, are common in depression. A person’s perception or interpretation of an event can be distorted, twisted, or inaccurate in some of the following ways.

Filtering:
focusing on and magnifying the negative details while ignoring (filtering out) all the positive aspects of a situation. When you filter your thoughts, you often reject or minimize positive experiences and insist they “don’t count.” Dwelling on the negative distorts your view of reality.

Polarized, or All-or-Nothing, Thinking:
thinking of things at one extreme or the other, in black or white, good or bad, all-or-nothing categories. For example, if something you do is not perfect, you see yourself as a “total” failure, at the worst extreme.

Overgeneralizing:
making a general conclusion based on a single event or piece of evidence. When you overgeneralize, you see single negative events as permanent and often use the words “always” and “never.” If something bad happens, you expect it to happen again.

Global Labeling:
generalizing one or two qualities into a negative overall (global) judgment and applying a label. This is an extreme form of overgeneralization. An example is when you label yourself a “loser” based on one less-than-perfect behavior.

Jumping to Conclusions:
immediately interpreting things in a negative way without having the facts to support your conclusion.

Mind Reading:
concluding that you “know” what others are feeling, why they act a certain way, or how they feel about you, without their saying so.

Fortune Telling:
believing you “know” how future things will turn out without any supporting evidence.

Catastrophizing:
expecting the worst, a disaster. This type of thinking often includes “What if.” scenarios.

Minimizing:
discounting the positive aspects of yourself or your actions, insisting they “don’t count.”

Personalizing:
thinking that everything people say or do is a reaction to you personally or assuming total responsibility and blaming yourself for events out of your control.

Blaming:
holding other people responsible for your pain or the opposite, blaming yourself as the source of every problem.

Emotional Reasoning:
believing that what you feel
must
automatically be true, that negative emotions reflect the true picture. For example, if you
feel
stupid, then you must
be
stupid.

Being Right:
being continually on trial and defensive, having to prove that your feelings, opinions, and actions are right. Being wrong is unthinkable. When you think in this way, you will do anything to prove yourself right.

Reward Fallacy:
expecting that all your sacrifice and self-denial will pay off, then feeling bitter and resentful when that does not happen.

Source:
Adapted in part from David Burns,
Feeling Good: The New Mood Therapy
(New York: Avon, 1980), table 3-1, pp. 42–43.

Cognitive behavioral therapy uses a series of exercises to challenge and replace the negative and distorted thoughts that accompany depression. The CBT Mood and Thought Monitoring exercise on
page 96
is an effective tool for identifying the automatic distortions in your thoughts that support feelings of distress. When you practice doing this exercise, you can learn to more easily replace the distorted thought with a more accurate, realistic view. This will in turn decrease your level of distress. If this exercise is too difficult for you to do right now, at least remind yourself that you are depressed and that your thoughts may not be accurate at this time.