Coping with Depression. Guide to what works – a subjective review

This is a subjective review of:

Coping with Depression. A guide to what works for patients carers and professionals
by Dr Costas Papageorgiou, Dr Hannah Goring and Dr Justin Haslam

Coping with DepressionAfter a brief introduction the book starts with a chapter by an unnamed patient of theirs whose health problems were attributed to repeated cycles of depression, the cause of which ultimately lay with suppressed issues after an unhappy childhood (can relate to the guy somewhat!) and goes on to describe the treatment he had to help him overcome it without more relapses.

The next chapter looks briefly at some of the types of depression like SAD and Dysthymia (the closest to mine), though Manic (bi-polar) Depression is covered in a separate book of its own in the series, as is OCD. Subsequent chapters look at facts and figures and a long look at medications* and other treatments.

*I used to be on a SNRI’s like Venlafaxine myself (Efexor in the States). Helped the mood swings enough that my family could tell when I’d forgotten to take them! Didn’t get to the root cause mind, nor did counselling and later CBT on their own – which is why I’m back where I am, only a far worse this time, which is saying a lot.


Chapter 5: ‘Changing how you feel by changing how you behave

This is where I found it starting getting helpful. For instance:

Activity scheduling

For example, your charts might reveal that you tend to feel particularly depressed in the mornings, and that this is linked with lying in bed and dwelling on problems

Yep, that’s about the size of it, but then I can get up, dwell some more, and am still doing it at 2am or 3am 🙁

The idea is to keep busy, active as much as possible, but I can tell you while it does work for a spell, if your depression is bad enough motivating yourself to do anything at all (including eating or even drinking fluids) is hard and the least thing or memory or comment can undo you. Depression really sucks!

Looking at avoidance (which is what I invariably do with issues) it continues:

… However, painful feelings are in fact a normal and natural part of human experience, and our attempts to avoid these emotions do not make them go away but can actually make them worse

A sentence or two later it adds:

Similarly, avoiding anxiety and stress may lead to increased stress in the long run as it does not allow you to deal with the source of the stress

This is probably the worst I’m guilty of and is a major contribution to my cycles of depression. I’m not good with personal confrontation which I’ve identified as largely bring due to a childhood where confrontation of any sort could lead to another trip to ‘Accident and Emergency’ after he tripped again, such a clumsy child. My childhood probably wasn’t all bad, but the bad bits – at least the ones I can remember – had the psychiatric nurse helping me the other week genuinely horrified. As he says, the safety checks weren’t in place in those days.

Then:

Learning to accept and tolerate difficult emotions and feelings is therefore an important part of working on avoidance

It does continue on that vein but it’s about the size of it and I do concur, up to a point. In my case that point being – after reading Susan Jeffers ‘Feel the Fear and do it anyway‘ – that I’m finding I can now handle the fears and feelings of new conflicts, but I’ve a lot of other, older issues that will take a much more work.

Rumination. Yer, I do that a lot too. As they say, doesn’t help.


Chapter 6: ‘Changing how you feel by changing what you think

This chapter looks at CBT (cognitive behaviour therapy). This can work well from self-help books on their own, but not for all.

I had some success with this form of therapy from Dr Michael Scott a consultant psychologist specialising in PTSD. Even read most of his books, helped him with that website and with others like [ Simply Effective CBT ]. (If you are reading this doc, you still need to update more often :P).

However, for myself, while I understand all the concepts and theory behind MOOD charts, Thought Records and the rest, I’m resistant to it. Don’t let me put you off though, I’ve more issues than Readers Digest!

Anyway, back to this particular book and chapter.
It explains fairly well how it’s not the event or situation that’s the issue, but how you think about it at the time. It gives a few examples, including the following:

It’s snowed in the night.
You could think about going sledging with your children and feel happy.
Or you could feel it may stop you meeting your friends and feel sad.
Or you could worry that you might skid and crash your car tie yourself in knots feeling anxious and scared at the mere thought of it.

There’s a variety of forms but in general you have a MOOD* chart and keep a record of your first thought, then you have to think more about whether you really do feel that way and put in a reconsidered opinion, THEN you decide what to do or how you truly feel. It’s basically training yourself not to get wrapped up – trapped – in the thing that’s causing the depression, anxiety and/or stress.

*(MOOD: Monitor mood, Observed thought, Objective (re-evaluated) thought and Deciding what to do.)

Might scan this in but there’s a completed example of a ‘thought record’ in the appendix where a student feels really depressed at the thought of a class but re-evaluates his (or her) unfounded worries and decides it’s not as bad as they thought.

Ooh, this is interesting. The sections on Beck’s theory of depression and on ‘negative automatic thoughts‘ are good. It’s worth getting the book just for this and for the following part on types of thinking biases. Nothing new to me as such there, but it’s given me a bit to think about. If you are depressed it might be useful and it explores negative selective thinking. *nods*

It is important to get into the habit of actually writing down your thoughts, rather than simply trying to respond to them in your head, because writing them down can help bring a sense of perspective over them.

It’s all about seeing these automatic negative thoughts, recognising them, challenging and banishing the unreal elements of them. They also add that diving into ‘positive thinking’ doesn’t work, need to be level-headed over it all. One step at a time. I rather concur here too. Positive Affirmative books have their place, even here, but to play with their analogies, trying to con your subconscious that the world is rose-tinted when you are wearing grey tinted glasses isn’t going to wash.

A measure of my level of depression, I guess. There’s a good section on ‘behavioural experiments‘ that takes the idea of testing the water. You think it might not be worth trying but you don’t know until you try. My logical side is saying, ‘Yep, fair call, good point there mate’ and the devil on my other shoulder is shouting, ‘Sucker, you know they are setting you up for a fail, just don’t even bother, you know it will end bad’

*mutter* Sooner I see the psychiatrists the better. Need to push the boundaries and banish my daemons.

(addenda)
Mindsets

Mindsets or ‘Thinking biases’ are also known as ‘thinking errors’ and ‘cognitive distortions’.
Beck and associates listed ten of these filters:

  • Overgenerisation
    One failing overrules all passes mentality
  • Mental filter
    Negative selective thinking in any situation. Personally I think everyone with depression can drop into this one
  • All-or-Nothing, Black-White, Dichotomous thinking
    Only seeing extremes. Again, fairly stereotype for depression, seeing the very worst.
    I know I’m terrible for that. Had a few discussion with my consultant psychologist over that. He kept using the traffic light analogy, but I point-blank refused to acknowledge the amber light. It was red or it was green – and it was nearly always red. I do keep his lessons in mind years later, but I still can’t often see the middle light.
  • Self-blame, personalization
    Everything is your fault, even if it’s not.
  • Jumping to conclusions
    Again, fairly typical for people with depression and invariably in the negative, without evidence to substantiate the conclusion, belief or feeling.
  • magnification and minimisation, catastrophizing
    Blowing things completely out of proportion if they are negative and completely dismissing them if they are in your favour. One example is seeing a minor prang as you going to lose your driver’s licence. Or ignoring your good points (say perfect teeth) and magnifying your imperfections (say a mole on your toe that no-one sees anyway).
  • Emotional reasoning
    Treating feelings as cast iron facts and in doing so making them happen. I think they mean it more specifically, but I reckon it applies greatly to most people with depression ‘cos you think wrong-headed.
  • Disqualifying the positive
    Same again really, where you discount any positive events or experiences in your life.
    I know I struggle to remember good things in my past ‘cos I’ve let the bad memories drown them out.
  • ‘Should’ statements
    Unrealistic and exaggerated expectations for your own performance.
    “I ought to do this”
    “I must feel this”
    These lead to feelings of guilt and anger when we fail to live up to our standards
  • Labelling and name-calling
    An extreme form of overgeneralisation with emotionally loaded language to put yourself down, like “I’m such an idiot” “I’m a complete failure”

Chapter 7: Changing for how feel by changing your unhelpful assumptions.

This pretty much follows on, looking at unhelpful assumptions that according to Becks are as much a part of an individual’s identity as being male or female. Again appears to form when you are young and it’s these that lead to the previously covered automatic negativity.

From my understanding it’s quite insidious, laying in wait almost. In the example given the man’s father had told him if you don’t do your best you’ll get nowhere in life, so he does his best and goes on in the world. Then maybe 30 years later he misses out on a promotion and BAM, down goes his house of cards.

Not all unhelpful assumptions are so bland though. If you grow up being told you are worthless and should never have been born then your parent(s) (or peers or siblings or bosses or…) have cruelly brainwashed you into accepting a life of depression, misery and low self-esteem. It doesn’t make the cruel things others say about you true!

Individuals with depression are likely to see their unhelpful assumptions as facts rather than views or opinions that they have formed earlier on in life as a result of their experiences

Often though it appears that these assumptions aren’t in the leave bit obvious and require considerable insight and exploration from the patient and doctor to unearth. Not sure I actually know what my own are. I know what, when, where and why most of my major issues lie or began, but those are on a one by one event. There again, I blocked out most of my childhood so I dunno :(.

Must have read this chapter a few times now mind and I’m still struggling to solidly clarify the definition. It does appear to be an, if not the underlying factor in cyclic depression, but it’s evasive.

*Looks at the example of the ‘downward arrow technique’ and applies it to one my own issues.*
OK, get that and see how it could work, in some cases.
The example starts with a negative automatic thought (I’m not going to be able to do the task properly) and hammers it with ‘So what’ until it spits out ‘I am not good enough’, the root unhelpful assumption being that if it’s not perfect it’s not good enough.

Ultimately, I think that chapter should be dealt with as one on one with a trained psychologist, only worked on one of my issues and it’s messing with my head now.


Chapter 8: Changing how you feel by how you relate

This one covers something called IPT, Interpersonal Psychotherapy. ok, not going here. I get this chapter and I’m not in a place to deal with in. Avoidance issues or no, soloing this at present is not a good idea. Should have acted on a suggestion put by one or three of my previous consultant psychologists. *sighs* And then the other issues raise their ugly heads.

Wishing won’t make it so. ***** it. And getting really agitated now.

“MEDIC!”


Final chapter, 9 : Feeling well, staying well: preventing relapse and recurrence of depression

Just a recap, really.

.

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