Introducing Cognitive Behavioural Therapy (Introducing...) (14 page)

Trigger for negative beliefs:

Losing her job. Linda’s underlying negative beliefs developed when she was quite young. However, up until now she’s coped by employing strategies to prevent what she viewed as her incompetence showing to other people. The problem came when losing her job triggered these negative beliefs and led to a series of negative interpretations of her situation. This then led into the vicious cycle of thoughts, emotions, physical feelings and behaviours which we looked at above.

How CBT can help you to tackle depression or low mood

The following ideas can help you improve your mood, whether you are suffering from long-term depression or just having a bad day. It is really important, though, to remember to ask for help if things are too much to manage alone. There is excellent help out there.
Chapter 9
will help you discover where to get this help.

Depression is incredibly common and sufferers are not alone. Ask for help if your depression is severe, if you are finding it impossible to begin to feel better or you have thoughts of ending your life.

Step 1: get active!

Try an experiment:

How would you rate your mood right now? On a scale of 0–10, where 0 is not low at all and 10 is the most depressed you have ever felt. Okay, write that down. When we feel very low, we don’t want to do anything at all. Often we find it hard to muster the energy to even get out of bed. However, if you’ve scored 1 or more, here’s the experiment: go out for a 5-minute walk, right now. Yes, even if it’s raining! It’s only 5 minutes, so you won’t melt … or drown!

While you are walking, think about your posture. Keep your head up and your back straight. Look around. Notice your environment, including any people. What can you see, hear and smell? Try making eye contact and smiling at anyone you see, even if you really don’t feel like it. If you find yourself caught up with negative thoughts like ‘I can’t do this’ or ‘I’m so tired’ try moving your attention back to everything around you. Walk briskly – faster than you feel like moving …

After 5 minutes rate your mood again. How is it now? How would it have been after those 5 minutes if you’d spent them sitting alone, brooding on your low mood? The chances are that you’ll find your mood has improved a little, or at least not become lower, which is what might have happened had you not got moving.

When our mood is low we naturally stop doing things we usually enjoy because we don’t
feel
like doing them. But the less we do, the less we feel like doing. Consequently we feel worse. So we do less still, feel even worse – and down the vicious spiral we go.

This is a basic principle of CBT for low mood. We need to look at our patterns of activity, reinstating things we have stopped doing or are avoiding. Sometimes this can involve a lot of effort – we may no longer enjoy things which we used to get a lot from, and simple things might take far more energy than before.

Let’s look at what happens to Linda when her mood becomes low and she stops doing things:

You can see how Linda is caught up in a negative spiral of thoughts and behaviours which maintain and worsen her low mood. Linda’s really stuck!

Using behavioural activation

So, how do we go about breaking this downward spiral? The answer is quite simple – start doing more. This is very easy to say and can be very difficult to do. However, if you approach this in a gentle, structured way you can gradually begin to reverse the spiral’s direction, travelling up instead of down. For a few days, try monitoring your activity and your mood. Use the mood scale of 0–10 you used earlier. But just before you move onto this next exercise, hold on a moment …

Um, you did go out for that 5-minute walk, didn’t you? If you didn’t, why not do it now before going any further? The experiment’s designed to show you how you really can reverse the spiral – but it won’t work if you don’t do it. Go on! Off you go!

Right – on with the next exercise …

Draw up an activity diary like this sample of Linda’s. For each period of the day Linda rates her mood (where 0 is not depressed at all and 5 is the worst she ever feels), her pleasure in the activity she is doing and the sense of achievement she gains from the activity (again, where 0 is none and 5 is the most she feels).

Try keeping a diary like this yourself for a week. It might look like a lot of work, but this exercise can provide you with a lot of very useful information about your mood.

After a few days, look at your diary. What do you notice? Most people find that even when they are depressed their mood fluctuates at different times of the day and with different activities. We also know that activities that give us pleasure or use our skills, giving us a sense of achievement, are important in helping us to maintain a better mood.

The next step is to start planning in activities. Use the diary sheet again. Each day plan what you are going to do. Make sure you build in some daily activities which give pleasure and a sense of achievement. These can be very small things – perhaps taking a bath, watching a favourite television programme or completing one small task you’d been meaning to do for ages. Planning and writing down your structure for each day will help you to stick to it, allowing you to monitor your mood and to see how increasing your activity affects it.

The 5-minute rule

When we are feeling really low and lethargic, drained of energy, it can be so hard to get moving. To do anything feels impossible. We can often overwhelm ourselves by thinking about everything that we have to do at once. We then get anxious and often decide there is no point in even starting. Use a ‘5-minute rule’. Just do something for 5 minutes. Don’t focus beyond 5 minutes. Just coax yourself to do this very small thing – then congratulate yourself for doing so. Remember that even just 5 minutes is better than nothing, and when you are depressed it can be the equivalent of an hour’s activity when your mood is good. At the end of 5 minutes, see how you feel.

Let’s see how behavioural activation helps Linda. Start from the bottom of the spiral and follow the arrows upwards.

We can see how gradually Linda begins to feel better and become more active. As this happens, her mood improves and the downward spiral is reversed.