Introducing Cognitive Behavioural Therapy (Introducing...) (13 page)

Lapses are inevitable – but you are never back to square one, given what you have learned and achieved so far. Build on this. Use lapses as an opportunity to learn more about how to change your habit, and to maintain the change for a bit longer … until the next time! Then go back to the top of this paragraph!

6. Dealing with depression

Depression is a prison where you are both the suffering prisoner and the cruel jailer
.

Dorothy Rowe

‘Depressed’ is a word which we often use in everyday language to describe our mood when we feel low, out of sorts or just generally not at our best. For those who experience true depression, however, it’s very different indeed. If you are depressed, the way in which you view and experience the world can change beyond recognition. Simple tasks become like climbing Everest, and the smallest of setbacks can feel like the end of the world. People have described the experience of being depressed as ‘like wading through treacle’ or like seeing the world through dark glasses, where colours become shades of grey. Winston Churchill described his depression as being like an enormous black dog which followed him everywhere, weighing him down.

Everyone feels low from time to time – it’s completely normal. Arguably part of what makes us human is the way in which we experience a range of emotions in response to life’s events. To feel sad in response to losses or disappointments or simply just to have a ‘bad day’ is something which we all experience, and usually just accept. Generally, when we feel this way we are able to identify roughly why we feel as we do. Usually the feeling passes reasonably quickly, or we do something to cheer ourselves up. It’s important not to label normal sadness as pathological in some way.

However, for some people, low mood persists for weeks, months or even years with very little relief. It may be accompanied by other distressing symptoms, such as changes in appetite and sleep patterns, fatigue, physical aches and pains or feelings of worthlessness, helplessness and alienation from those around. Studies suggest that 1 in 5 of us will experience depression at some point in our lives. The experience of depression often brings other difficult emotions like guilt, shame or anger with it.

Symptoms of depression

Do you recognize any of these?

• Prolonged depressed mood
  
• Thoughts of hopelessness and worthlessness
  
• Changes in appetite – eating too much or too little
  
• Changes in sleep pattern – sleeping too much or too little
  
• Tiredness and fatigue
  
• Physical aches and pains
  
• Restlessness or agitation
  
• Feeling physically slowed down
  
• Thoughts of self-harm or even suicide
  
• Difficulties with concentration, memory and attention.
  

It’s a pretty gloomy picture. However, there’s some good news in all this gloom. We now recognize and understand depression far better than just a few years ago. The stigma surrounding this and other mental health problems is slowly reducing. Sufferers often feel more able to talk about what they have experienced and to share their trials and their coping strategies. A recent campaign, ‘Time to Change’, highlighted the importance of challenging the stigma surrounding mental health problems like depression. It drew on the stories of famous people such as Stephen Fry, Alistair Campbell and Ruby Wax, demonstrating that
depression can and does happen to anyone
. But the very best news of all is that there are now many tried and tested treatments which have helped millions of people throughout the world. These include medication, talking therapies of many kinds, complementary or alternative therapies and community or social activities. CBT is one of the ways in which people with depression can be helped to get better, and evidence shows that it’s one of the most effective.

When does ‘normal’ low mood become depression?

If you experience a difficult life event, such as a bereavement or other loss, such as redundancy, it would be unusual not to experience some low mood. These feelings may last some time, making it difficult to judge what might be considered ‘normal’ for such a situation. Often what you need most is time, support and care from those close to you. Most of us recover over time from such difficulties. However, for some people events like these can trigger a more lasting and pervasive depression. Usually you are considered depressed and perhaps needing help if you have had psychological and physical symptoms of depression on most days, over several weeks.

The following questions might help you think about whether or not you may be experiencing depression. Think about how you have felt over the past 2 weeks. Have you regularly experienced any of the following:

• Feeling very sad or irritable?
  
• A loss of interest in things that you previously enjoyed?
  
• Feelings of guilt or feeling bad about yourself?
  
• Being unable to concentrate, remember things or make decisions?
  
• Changes in your weight or appetite?
  
• Changes in your sleep pattern?
  
• Fatigue or feeling drained of energy?
  
• A feeling of restlessness or decreased activity which has been noticed by other people?
  
• Feeling that your situation is hopeless or that you are worthless?
  
• Thoughts of death or suicide?
  

If you have been experiencing more than 5 of these symptoms on most days over the past 2 weeks then you may well be depressed. If you think you are depressed it is a very good idea to talk to your doctor and explore the options for treatment. Self-help using the ideas suggested in this book can be an important part of treatment but should be undertaken in conjunction with professional help.

Suicidal thoughts or ideas

It can be very frightening if you or someone close to you experiences thoughts of suicide or self-harm. We don’t often talk about these things but they are much more common than you might think. During bad times, huge numbers of us may have thoughts like wishing we could just go to sleep and never wake up, or that we’d never been born. There is a huge difference between having these kinds of thoughts and actually devising a plan to harm yourself. If your thoughts start to turn to plans, it’s a good indication that professional help is needed. In a crisis, your GP or hospital A&E department are good starting points to find help. Research shows that depression is linked to chemical changes in the brain, making it very difficult for you to think in a clear, positive or healthy way. It is so important that we all get help and support at times of crisis, and don’t act on depressed thinking.

How CBT can help us to understand low mood and depression

If you’ve been depressed, you’ll probably recognize how the ‘five areas’ model of CBT can help you to understand what’s happening to you. Here’s an example of this:

The ‘five areas’ model of CBT

Case study – Linda

Linda is made redundant. The company is going through troubled times and Linda was the last to join so it’s easy for them to let her go. However, Linda has always experienced low self-esteem and worries about her competency at work. This dates back to experiences of being bullied at school. Losing her job brought back feelings of not being good enough, and she tells herself that the company’s been looking for any excuse to get rid of her. She feels ashamed, choosing not to talk to friends and family about it because she’s sure they’ll agree with her thoughts, and judge her. This means she’s not hearing other points of view about her problems and finds it impossible to see any other interpretations of what’s happening. Linda feels exhausted and drained of energy, stops going out and spends a lot of time in bed or alone, dwelling on negative thoughts. At first, avoiding people and social events brings some relief. She tells herself she needs the rest because she was so tired. However, over time, rather than the tiredness lifting, Linda begins to feel less and less motivated, ever more lethargic and weary, and her mood worsens.

What causes depression?

There is no single cause for depression. People talk about depression as a ‘chemical imbalance’ in the brain and research shows that certain brain chemicals change in people in a depressed mood. However, for most people the cause of depression is a complex mix of biological (chemical), psychological (thinking and feeling) and social (life) factors.

CBT suggests that certain early experiences and life events (such as trauma in childhood, early losses, bereavement or bullying) can make us more vulnerable to developing depression later. This is because such experiences lead us to develop underlying negative beliefs about ourselves, other people and the way the world works. Let’s look at how Linda’s depression may have developed:

Early experiences:

Bullied at school. Laughed at by other children.

Not well supported by parents – told she was being ‘weak’ and should just ‘ignore it’.

Negative beliefs:

I’m weak and can’t look after myself
.

I’m incompetent
.

Other people are likely to hurt me
.

The world is unfair
.

Strategies for managing the negative beliefs:

She avoids getting close to people. She sets really high standards for herself and works harder to avoid people realizing that she is incompetent.