10

Styles of depressive thinking: How to develop helpful styles

This chapter looks in more detail at the kinds of ways our thoughts can become problematic for us when we get depressed and how to work with them in a compassionate way. Depression can often be linked to difficult life situations: conflicts and problems in relationships, or at work, or with finances, or physical health, or feeling stuck in places we don’t want to be. Coping with these can be hard, but it can become even harder because as we become depressed, the way we think changes. Threat and loss-focused thoughts, interpretations and memories become much easier to bring to mind and dwell on. There is a shift to what is called a threat and loss (negative thinking) bias, and then we are on a downward spiral. 1 A typical spiral is outlined in Figure 10.1.

As our thinking follows a downward spiral, we start to look for evidence that confirms or fits our negative beliefs and feelings. We may start to remember other failures, and the feelings begin to spread out like a dark tide rolling in to cover the sands of our positive abilities. Such thoughts tend to lock in the depression, deepen it and make it more difficult to recover from (see page 101). They drive a vicious circle of feeling, thinking and behavior – and this gives us one route into disrupting the depressing spirals.

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Figure 10.1. A typical downward spiral.

Certain styles of depressive thinking are fairly common. Professor Beck, who started cognitive therapy, noted about six or seven types of negative (or as I prefer to called them ‘threat-focused’) thinking biases.2 We will explore some of them here. To work on our biases in a more balanced way, we have to (1) recognize them and (2) make an effort to bring our rational and compassionate minds to the problem. It is important to recognize that humans are often not that logical or rational – we can be, but we have to work at it. In fact a lot of research has shown that many of our ways of thinking about ourselves, other people, different groups, and our hopes for the future can become very biased and inaccurate – even at the best of times!2 So working for balance takes effort and training of our minds. Below we go though some typical biases that tend to appear with depression. We’ll start with jumping to conclusions because this is absolutely typical of the threat-focused and ‘better safe than sorry’ mind.

Jumping to conclusions

If we feel vulnerable to abandonment, or have the basic belief, ‘I can never be happy without a close relationship,’ it is natural that, at times, we may jump to the conclusion that others are about to leave us. This will often impel us to cling on to these relationships, unable to face up to our fear of being abandoned.

The part of our mind that focuses us on threats will tell us that we could not possibly cope with being alone. We might worry about how we think we could cope with everyday life, or we might worry about being overwhelmed by grief, feelings of loss and emptiness. Sometimes these feelings go back to childhood. If you have a fear of rejection or of losing a relationship, one way of helping might be to write down that fear and see if you can think of ways of coping with a break-up – if it occurs. Of course, the break-up may be painful: you can’t protect yourself from life’s painful things, but you can work out how to be supportive and compassionate to yourself in this time of difficulty. It’s hard but it can help us to actually shift our attention and think about how one could cope. For example, be understanding and kind to your distress: it is only natural to feel upset. We might consider how we could elicit help from friends, or remind ourselves that, before we had a relationship with this person, we had coped on our own; or that many people suffer the break-up of relationships and survive. There might even be advantages in learning to live alone for a while.

Putting thoughts into the minds of others

Another form of jumping to conclusions is called ‘mind reading’ or sometimes projection. We make assumptions about their thoughts and feelings. For example, we may automatically assume that people do not like us because they do not give sufficient cues of approval or liking us. In ‘mind reading’ we believe that we can intuitively know what others think.

The key point here is mindfully examining your thoughts rather than automatically assuming that your thoughts about what other people are feeling and thinking are accurate. Research has shown that some people struggle here. For example, parents may believe the annoying behaviors of their children are to wind them up; they take it personally. Or that disobedient children are showing that they don’t care about or respect the parent; again they take it personally. But they are reading intentions into their children that simply are not there. Young children are not thinking about ‘the mind of the parent’ at all. They are not thinking about how to ‘wind the parent up’ or cause them emotional upset – they are simply behaving in these ways to try to get what they want. It’s about them – the child – not the parent.

So the way we attribute intentions and feelings to other people’s behavior is important. When we get depressed we often think other people’s withholding, avoiding or ignoring behaviors are directed at us. Some men think that if their wives do not want to sleep with them when they want to it’s because they don’t love them enough – in reality there may be differences in sex drive, or timing or desire. Women may feel that if men don’t talk about feelings it’s because they don’t love them. In reality the man may have difficulties in talking about feelings in general. When people disappoint us it’s important to think that maybe it’s not really about ‘us’ or ‘me’ it’s about ‘them’. We have to find ways to be compassionately understanding and explore (take time to think about) the ‘minds of others’ in more detail.

Predicting the future

We often need to be able to predict the future, at least to a degree. We need to have some idea about what threats, opportunities and blocks lie ahead to know whether to put effort into things or not. How much energy and effort our brains devote to securing goals depends a great deal on whether we have an optimistic or a pessimistic view of the future. It may be highly disadvantageous to put in a lot of effort when the chances of success appear slim. The problem is that, as we become depressed, the brain veers too much to the conclusion that nothing will work, and continuously signals: ‘times are hard’. Depression says, ‘You can put a lot of effort into this but not get much in return. Close down and wait for better times’ (see Chapter 3). Getting out of depression may involve patience and a preparedness to think that the brain is being overly pessimistic about the future.

Emotional tolerance versus avoidance

Our brains have evolved over many millions of years to be able to have very strong emotions. One of our greatest difficulties is learning how to tolerate and come to terms with strong emotion. We can certainly look to how our thoughts may be making them stronger than they need be, but it’s also important to learn to tolerate the natural and normal power of our emotions; to recognize that there’s nothing wrong with us in having strong emotions. Rather it’s the way we deal with them, either by acting on them impulsively or by trying to get rid of them, avoid them, suppress them, or deny them that causes the difficulties.

A colleague told me a sad story he read in a local newspaper. A woman who was looking for her local Alcoholics Anonymous meeting got lost and couldn’t find the way there. She became upset, frustrated and anxious, so she sat in her car and drank a bottle of wine. She was picked up by the police well over the limit. She had simply not been able to tolerate the upset without wanting to turn off those intense feelings.

Another type of avoidance is the person who feels angry with a parent (say), but is frightened to acknowledge it or work through it. When anger arises she distracts herself or binge eats. Or a person may be frightened of (say) homosexual thoughts and feelings and so drinks to avoid them; or might drink to avoid feelings of loneliness or shame. We can run from all kinds of emotions. Our emotions can also stop us from doing things. Consider a socially anxious person who would love to go to university but the anxiety dictates their actions and they don’t go. Think about how often fears and worries stop you from doing things you really want to do. Sometimes we think about this in terms of confidence, but often it’s about our ability to tolerate emotions and act against that emotion. Most addictions, forms of self-harm, anxiety disorders, reckless and impulsive behavior and some depressions are linked to problems in tolerating emotions.

Given the problems we have with strong emotions and our ‘old brains’, distress tolerance is key to well-being. Compassion can be very helpful in how we learn to work with and tolerate strong emotions. Here are some ideas to have a go at.

Step 1: seeing the point of having a go

  • Make a commitment to learn to tolerate your emotions as something you want to learn to do.

  • Recognize the value of doing this; see how it will strengthen you.

  • Consider the value in giving up the short-term benefit of trying to avoid your emotions (e.g., by avoiding them, drinking or binge eating) in favour of the longer-term benefits of tolerance.

Step 2: what to do next

When you have agreed your motivation then these are some things to try:

Step 3: compassion focusing

  • With your soothing breathing rhythm, create a com passionate facial expression.

  • Imagine that you are a compassionate person who can tolerate strong emotion. See an image of yourself tolerating the emotions and being pleased afterwards.

  • Bring to mind your compassionate image and imagine talking out your emotion to your image.

  • Write a compassionate letter in your mind about your emotions or what you are feeling this moment.

In these exercises you are practising buying time, being with your emotion, and tolerating it. These are just some ideas and you may find others once you have committed yourself to learning to tolerate strong emotion. It’s not easy, but over time it will get easier for you. Regular practice of mindfulness and compassion work can actually help us become calmer inside. You may also have your own ways of working on this issue. For example although I am not religious myself, I know it can help some people. One woman thought about Jesus: ‘If he can tolerate that, I can tolerate this’. She did not use this to shame herself about her emotion (there are no ‘shoulds’ and ‘oughts’ here), rather it helped her feel ‘one with the suffering of Jesus’ and was very helpful to her. A person who was trying to control her urges to eat when hungry thought about starving children in the world. If they can tolerate that, she could tolerate her urges. It’s not unknown for actors to have severe nausea, even vomiting, on the first night of a play, but they work through it because they really want to act. The first step is really getting clear in your mind the advantage of learning toleration, of putting up with painful feelings.

Emotional reasoning

One of the reasons that we can have problems with emotion tolerance is because our emotions can be more powerful and long-lasting than they need to be. Strong feelings and emotions pull and push us into thinking in certain ways, and this can happen despite the fact that we know it is irrational. The problem is that, at times, we may not get our more rational and compassionate mind to help us. Given the strength of our emotions, we may take the view, ‘I feel it, therefore it must be true.’

Feelings are very unreliable sources of truth. For example, at the times of the Crusades, many Europeans ‘felt’ that God wanted them to kill Muslims – and they did. Throughout the ages, humans have done some terrible things because their feelings dictated it. As a general rule, if you are depressed, don’t trust your feelings – especially if they are highly critical and hostile to you. In Table 10.1 there are some typical ‘I feel it therefore it must be true’ ideas with some alternatives.

In their right place, feelings are enormously valuable, and indeed, they give meaning and vitality to life – we are not computers. But when we use feelings to do the work of our rational minds, we are liable to get into trouble. The strength of our feelings is not a good guide to reality or accuracy. See if you can come up with any other alternatives for the thoughts and ideas in Table 10.1.

TABLE 10.1 FEELINGS, NOT FACTS

Situation

I feel it, therefore it must be true

Alternative balancing ideas

Going to a party

I feel frightened, therefore this situation is dangerous and threatening

This is related to my shyness and confidence, not any actual danger – I can go a step at a time and be kind with my feelings.

Feeling anxious

I feel as if I will have a heart attack, therefore I will

This is understandable anxiety which can feel like this – but I have had these feelings many times before and it was anxiety not a heart attack.

Being accused of a minor fault

I feel guilty, therefore I am guilty and a bad person

It is understandable to be disappointed but there is so much more to me than that – feeling a bad person is maybe a reflection of my annoyance at being criticized. Learning to cope with criticism will strengthen me.

Losing my temper and shouting

I feel terrible when I get angry, therefore anger is terrible and I am bad and rejectable

Yep anger is not a nice feeling but it’s very much part of human nature – I did not design these feelings – and I am trying to understand and work with my anger.

Wanting to cry

I feel that, if I start crying, the flood gates will open and I will never stop; therefore I must stop myself from crying

It is easy to feel overwhelmed especially if one is not used to crying and being in touch with one’s pain – but crying does subside and I have shown myself to be effective in turning off my emotions if I really need to. Maybe a little at a time, and staying with my emotions might actually help me.

Feeling self-conscious when I cry

I feel ashamed when I cry, therefore crying is shameful and a sign of weakness

Crying is a very important human response built into our bodies. Crying is the display of our pain and is basic to our humanity. Other people have probably shamed me for crying so it is their shame I am feeling.

Making a mistake

I feel stupid, therefore I am stupid

Who hasn’t felt that awkward when one does something a bit thoughtless careless and daft – but one cannot sum up a complex self like this. My annoyance is probably driving this feeling and my compassion can actually get stronger if I used it right at these moments.

‘I must’

Over 2,500 years ago the Buddha said, ‘Our cravings are the source of our unhappiness.’ He also suggested that it is our attachment to things, our ‘must haves’ and ‘must bes’ and ‘others must be as I want them to be’ feelings and beliefs that lead to suffering – not least because life is not like this. All things are transitory and it is coming to terms with that and living in ‘this moment’ that matters. Look out for feelings that indicate you are ‘must-ing’ yourself. As we become depressed, and sometimes before, we can believe that we must do certain things or must live in a certain way or must have certain things, e.g., others’ approval, or achieve certain standards, e.g., weight loss.

By gaining control over our musts, ‘got to haves’ and cravings, we are gaining control over our emotional minds. Whatever your own particular ‘musts’, try to identify them and turn them into preferences. Recognize that reducing the strength of your cravings can set you free, or at least freer, and remember that there is often an irony in our ‘musts’. For example, at times we can be so needing of success and so fearful of failure that we may withdraw and not try at all. If you go to a party and feel that ‘everyone must like you,’ the chances are that you’ll be so anxious that you won’t enjoy it and even may not go. And if you do go, you may be so defensive that others won’t have a chance to get to know you.

Disbelieving and discounting the positive in personal efforts

If we have been threatened or experienced a major setback, we may need a lot of reassurance before trying again. This makes good evolutionary sense: it is adaptive to be wary and cautious. We even have a saying for it: ‘once bitten, twice shy.’

The problem is that in depression this same process can apply in an unhelpful way. If we have experienced a failure or setback, we may think we need to have a major success before we can re assure ourselves that we are back on track. Small successes may not be enough to convince us. However, getting out of depression often depends on small steps, not giant leaps. Typical automatic thoughts that can undermine this step-by-step approach are:

  • I used to do so much more when I was not depressed. Managing to do this one small thing today seems so insignificant.

  • Other people could take things like this in their stride.

  • Because it is such an effort for me, this proves that I am not making any headway.

  • Anyone could do that.

  • Small steps are all right for some people, but I want giant leaps and nothing else will do.

Remember what we have said about depression – your brain is working differently. Perhaps the levels of some of your brain chemicals have got a little too low. Perhaps you are exhausted. Therefore, you have to compare like with like. Other people may accomplish more – and so might you if you were not depressed – but you are. Given the way your brain is and the effort you have to make, you are really doing a lot if you achieve one small step. Think about it this way. If you had broken your leg and were learning to walk again, being able to go a few paces might be real progress. Depressed people often wish that they could show their injuries to others, but unfortunately that is not possible. But this does not mean that there is nothing physically different in your brain and body when you are depressed than when you are not.

If you can do things when you find them difficult to do, surely that is worth even more praise than being able to do them when they are easy to accomplish. We can learn to praise and appreciate our efforts, rather than the results.

A crucial thing to remember is that you are training and stimulating your brain. By focusing on small things that you can appreciate and give yourself praise for, you will stimulate important positive emotion areas of the brain. Although understandable, it is not helpful to keep dismissing these opportunities to stimulate your brain in a positive way. Try not to get caught up in debates with yourself about whether you deserve it, whether you should do more and so on. Focus on it as ‘physiotherapy for your brain’; exercising and stimulating key systems in your brain over and over again as often as you can.

Disbelieving the positive from others

Another area where we disbelieve the positive is when others are approving of us. To quote Groucho Marx, ‘I don’t want to belong to any club that will accept me as a member.’ Even being accepted is turned into a negative. Here are some other examples:

Rather than allowing himself to keep on thinking so negatively, Paul was encouraged to ask his boss about his report, especially the shaky areas. He didn’t get the response he expected. His boss said, ‘Yes, we knew those areas were unclear in your report, but then the whole area is unclear. In any case, some of the other things you said gave us some new ideas on how to approach the project.’ So Paul got some evidence about the report rather than continuing to rely on his own feelings about it.

From an evolutionary point of view, the part of us that is on the look-out for deceptions can become overactive, and we become very sensitive to the possibility of being deceived. Moreover, fear of deception works both ways. On the one hand, we can think that others are deceiving us with their supportive words and on the other, we can think that, if we do get praise, we have deceived them. Because deceptions are really threats, when we become depressed we can become very sensitive to them. But again we can try and generate balanced alternatives to these ideas. For example:

Even if people are mildly deceptive, does this matter? What harm can they do? I don’t have to insist that people are always completely straight. And life being life, some people are more deceptive than others. But I can live with that. To be honest I can be deceptive too – it is part of being human.

As a rule of thumb, it can be useful to take people at face value unless experience proves otherwise.

All-or-nothing

All-or-nothing thinking (sometimes also called either/or, polarized or black-and-white thinking) is typical when we are threatened. If we might be under a threat we often need to weigh this up quickly. Animals often need to jump to conclusions (e.g., whether to run from a sound in the bushes), and it is easier to jump to conclusions if the choices are clear – all-or-nothing. So our threat system can go for ‘better assume the worst’ and ‘better safe than sorry’. See if you can spot these in the list below.

  • My efforts are either a success or they are an abject failure.

  • I am/other people are either all good or all bad.

  • There is right and there is wrong, and nothing in between.

  • If I’m not perfect, I’m a failure.

  • You’re either a real man or you’re a wimp.

  • If you’re not with us, you’re against us.

  • If it doesn’t go exactly as I planned or hoped, it is a fiasco.

  • If you don’t always show me that you love me, you don’t love me at all.

All-or-nothing thinking is common for two reasons. First, we feel threatened by uncertainty. Indeed, some people can feel very threatened by this. They have to know for sure what is right and how to act and they may try to create the certainty they need by all-or-nothing thinking. Sometimes we may think that people who ‘know their own minds’ and can be clear on key issues are strong, and we admire them and try to be like them, but watch out. Hitler knew his own mind and was a very good example of an all-or-nothing thinker. Some apparently strong people may actually be quite rigid. Indeed, I have found that some depressed people admire those they see as strong individuals, but when you really explore this with them, they discover that the people they are admiring and trying to be like are neither strong nor compassionate. They are rather shallow, rigid, all-or-nothing thinkers who are always ready to give their opinions. A lovely motto someone gave me once was ‘indecision is the key to flexibility’.

There is nothing wrong with sitting on the fence for a while or seeing things as grey areas. Even though we may eventually have to come off the fence, at least we have given ourselves space to weigh up the evidence and let our rational minds do some work.

The other common reason why we go in for all-or-nothing thinking has to do with frustration and disappointment (see Chapter 21). How often have we thrown down our tools because we can’t get something to go right? When you get frustrated you tend to take a more extreme view. It is emotions that drive this view, so balancing of all-or-nothing thinking and our tendency to make extreme judgements of good/bad or success/failure can be very important in recovering from depression. The state of depression itself can reduce our tolerance of frustration and push us into all-or-nothing thinking, so we have to be aware of this and be careful not to let it get the better of us.

All-or-nothing thinking can be unpleasant for other people too. Tim talked about his mother who was depressed and how she found frustration very difficult. ‘Small things would set her off and then you would never know what mood she would be in.’ Tim could identify this as black-and-white and rigid thinking. ‘Things had to be just so and if they weren’t she’d get angry, anxious or withdraw.’ Tim understood that this related to various stresses in her life. Nonetheless, seeing this allowed Tim to reflect on himself and he decided he didn’t want to be like that. When he felt frustration mounting in him he would begin his soothing rhythm breathing, consider if his thoughts and feelings were rather black-and-white and practise being compassionate and tolerant in that context.

Overgeneralization

If one thing goes wrong, we can think and feel that everything is going to go wrong – our emotions go on a rollercoaster. When we overgeneralize like this, we see one setback or defeat as a never-ending pattern of defeats. Nothing will work; it will always be this way.

  • a student received a bad mark and had a heart-sink disappointment feeling and concluded, ‘I will never make it. My work is never good enough.’ (linked to anger, frustration and anxiety)

  • a friend had told Sue that she would come to her party, but then she forgot the date. Sue thought, ‘This is typical of how people always treat me. No one ever cares.’ (linked to anger, frustration and anxiety)

  • Dan broke up with his girlfriend and thought, ‘I will never be as happy again as I was with her. I will always be miserable without her.’ (linked to sadness)

So it’s important to be aware of the arising of feelings and meanings and the thoughts that tumble along with them.

In Table 10.2 we can explore some typical balanced and compassionate alternatives for working on our tendencies for overgeneralization. Notice that we always start with being understanding and kind for the distress we feel.

TABLE 10.2 ALTERNATIVES TO DEPRESSING THOUGHTS

Depressing thought

Balanced and compassionate alternatives

Things will never work out for me

When I am upset it is typical for me to think like this – so I can be wise and kind to myself by recognizing it is my upset that is doing the thinking

 

‘Never’ and ‘always’ are big words. I have thought like this before and things did work out – at least to a degree

 

Let’s take some soothing rhythm breaths and slow myself down a bit and give myself some space to think

 

Now what would I like a really kind and compassionate person to say to me right now (really spend a moment on this idea and go with that)

 

Rather than just blanking out everything I could think that things might go okay

 

Predicting the future is a chancy business. Maybe I can learn how to make things go better. I don’t have to load the dice against myself

 

If a friend had a setback, I would not speak to them like this. Maybe I can learn to speak to myself as I might to a friend.

Egocentric thinking

In this situation, we have difficulty in believing that others have a different point of view from our own. The way we see things must be the way they see things – e.g., ‘I think I’m a failure, thus so must they.’ We discussed this on page 207, in the section ‘Putting thoughts into the minds of others’.

But there is another way we can be egocentric in our thinking. This is when we insist that others obey the same rules for living and have the same values as we do. Janet was very keen on birthdays and always remembered them. But her husband Eddie did not think in these terms; he liked to give small presents as surprises, out of the blue. One year, he forgot to buy a present for Janet’s birthday. She thought, ‘He knows how important birthdays are to me. I would never have forgotten his, so how could he forget mine? If he loved me, he would not have forgotten.’ But the fact was Eddie did not really know how important birthdays were to Janet because she had never told him. He was simply supposed to think the same way as Janet.

In therapy together with Janet, Eddie was surprised at how upset she had been and pointed out that he often brought her small surprise presents, which showed that he was thinking about her. He also mentioned to her – for the first time – that she rarely gave gifts except at birthdays, and to his way of thinking, this meant that she only thought about giving him something or surprising him once a year!

All of us have different life experiences and personalities, and our views and values differ, too. These differences can be a source of growth or conflict. It is because we are all different that there is such a rich and varied range of human beings. Unfortunately, at times we may downgrade people if they don’t think or behave like us. On the book stands today, you will find many books that address the fact that men and women tend to think differently about relationships and want different things out of them. This need not be a problem if we are upfront about our needs and wants and negotiate openly with our partners. It becomes a problem when we are not clear with them about our wants or we try to force other people to think as we do.

Dwelling and ruminating

As we noted on pages 113–4, dwelling and ruminating on the threats and losses in our lives can be a source of maintaining your brain in a state of threat and stress. All the ways of thinking noted above can feed into ‘dwelling and ruminating’. Some people also think that this is a way to solve problems and, if limited, thinking things through can of course be helpful. However, going over and over things that upset you or make you angry or anxious is not helpful. The steps are:

  • Practice noticing your ruminations when they start up.

  • Become mindful and notice the paths your thoughts tread – pull back to your observing kind and curious mode.

  • Make a commitment to gently refocus your attention – maybe with an activity or bring to mind a helpful image or something that is more likely to stimulate positive feelings in your brain.

KEY POINTS

  • The way we think about things can lead us further into depression rather than out of it.

  • When we are depressed, our brains change in such a way that we become very sensitive to various kinds of harm, threats and losses. It is (or was) adaptive for the brain to go for an ‘assume the worst’ and ‘better safe than sorry’ type of thinking when under threat. In these situations, control over our feelings is given more to the threat system in our brain and less control is given to the rational, kind and compassionate systems (see Chapters 2 and 3).

  • There are some typical types of thoughts that are encountered in depression. These include jumping to (negative) conclusions, emotional intolerance, ‘I must’, dismissing the positives, all-or-nothing thinking and overgeneralizing. We can try to work with these.

  • One way to help is to recognize the typical styles of depressive thinking and open our hearts to generating compassionate balanced alternatives; to deliberately switch our attention, thinking and behaving away from the threat system into a more balanced and compassionate system.

EXERCISES

Exercise 1

Review the different types of thinking outlined in this chapter. Consider which ones seem to apply to you (see Appendix 2 for a quick overview of some typical types of threat-focused thinking).

  • If you have written down your thoughts, consider which kind of depressive style each thought may be an example of – for instance, is it like jumping to conclusions, or emotional reasoning, or all-or-nothing thinking? You may find that one of the styles (e.g., all-or-nothing thinking) crops up in many different situations. That is certainly one of my styles when under stress.

  • Use your rational/compassionate mind to generate alternatives; think of questions to put to yourself. Do you have enough evidence for your view? Is this a balanced view? Would you put it to a friend like this? If you are to be really kind now, what would you think? Are you trying to force a certainty when none exists? Are you disbelieving the positives? Are you frightened of believing in the more balanced and compassionate alternatives?

  • Consider how you might help someone you like generate alternatives to, say, all-or-nothing thinking or jumping to conclusions. Practise being gentle with yourself rather than harsh and critical, and practise seeing things in grey rather than insisting on black and white.

  • Work on emotional balance and feeling tolerance as noted above.

  • Focus on what you can do rather than what you can’t. Have the motto, The secret of success is the ability to fail.’ (See Chapter 21 for further discussion of this motto.)

  • Ask, ‘How am I looking after myself? Do my thoughts help me care for myself?’ Slowly build on your insights.

KEY POINT

Always have a go at spending a few moments on your breathing and then trying to shift to the compassionate self or bring to mind your compassionate image (see Chapter 8). Once in that frame (even if only slightly) it might be easier to generate and think about compassionate alternatives.

It can also help to be mindful of your thoughts – note them in your mind and stand back from them – view them from the balcony as it were – watch the mind shift to black-and-white thinking or over-generalizing. It can seem odd and difficult at first, but with practice it can be very interesting. There is no forcing or trying to make yourself change your mind – just be open to the possibility for change and see what happens.

 

11

Writing things down: How to do it and why it can be helpful

Learning to write about your thoughts and feelings, especially to begin with, can be helpful. Here are some of the reasons why.

Thought forms

Thoughts forms offer ways of helping us to organize our thoughts and to distinguish between situations that trigger our feelings and moods, the kinds of thoughts and feelings that pour through our minds (often in a chaotic way), and then how we can refocus our attention on generating helpful alternatives. Thought forms are just useful guides to help our practice and develop our minds: see Appendix 1 for some ideas.

My advice here is: keep it simple. Use whatever kind of form suits you, rather than struggling with something that you find too complex – provided it does the job, of course. The most basic thought-alternative form is simply a page divided into two columns. You write your unhelpful, threat-focused thoughts in the left-hand column, and helpful, compassionate alternatives in the right-hand column. These depressive thoughts might be triggered by an event, or might come on as your mood dips. The key point is catching what these thoughts are and offering a balanced and compassionate alternative to them.

Table 11.1 shows an example of a completed form.

TABLE 11.1 COMPLETED THOUGHTS FORM

Depressing thoughts

Balanced alternative thoughts

Here I am just lying in bed again

I have to admit I am not feeling too good right now

Can’t see the point of getting up

Even though it will be a struggle, if I can try to gently encourage myself to get up and move around a bit this often helps

Things are bound to go wrong

If I can achieve a couple of things I’ll feel better

Nothing is worth doing anyway – I won’t enjoy it

Sure, I don’t enjoy things much because I am depressed – the trick is doing things to overcome depression. I know I can enjoy things when I am not depressed. So I will do my best to work against my depressed brain state

Degree of belief: 70%

Degree of belief: 40%

Rate your belief

You will see that at the bottom of each column in this example there is a figure for ‘degree of belief’ – that is, how much do you believe what you have written down? Some people find that if they rate how much they believe something this can be helpful for seeing that beliefs are not black and white, all-or-nothing. As time passes and you start to feel better you’ll be able to look back and see how the strength of your beliefs has changed with your recovery. Other people don’t find this particularly helpful, because they feel it is artificial in some way. Once again, find what works for you.

Make up your own column headings

You can make up your own column headings for different tasks. For example, sometimes it can be useful to write down in two columns (1) the reason why you believe and then (2) in the other column the reasons to change that view, or consider the advantages and disadvantages of a particular belief. You might prefer to label the two columns ‘what my threat- or loss-focused and/or self-attacking mind says’ and ‘what my rational and compassionate mind says’. For all these variations you can use the two-column format and simply change the headings to suit.

Adding more columns

In the thought forms given in Appendix 1 you will see other columns. In addition to the two noted above, we also have a column for writing down any critical events that might have triggered your distressing thoughts and a column for describing distressing feelings. This helps to give you a more complete picture; it will help your progress if you can be clear on what kinds of things tend to trigger your change of mood, arouse negative thoughts and feelings, or what those emotions and feelings actually are.

Rate change

It can sometimes be useful to rate the change in the strength of your beliefs and in your emotions after you have been through the exercise. For that, we might add a third column to the simple two-column form. Table 11.2 shows the same examples we used above, with the third column added on.

TABLE 11.2 CHANGING THOUGHTS

Depressing thoughts

Helpful thoughts that operate against the depression

How I feel now compared to before

Here I am just lying in bed again

I have to admit I am not feeling too good right now. Even though it will be a struggle, if I can gently encourage myself to get and move around a bit this often helps . . . (etc.)

Yes, I can see that this might be helpful and a way forward

Can’t see the point of getting up

Even though it will be a struggle, if I can try to gently encourage myself to get up and move around a bit this often helps.

 

Things are bound to go wrong

If I can achieve a couple of things I’ll feel better

 

Nothing is worth doing anyway – I won’t enjoy it

Sure, I don’t enjoy things much because I am depressed – the trick is doing things to overcome depression. I know I can enjoy things when I am not depressed. So I will do my best to work against my depressed brain state

I feel maybe 5% less depressed by compassionately refocusing my thoughts

Try as best you can, with an encouraging, supportive (not bullying) tone in your mind to carry out your plan to get up and out of bed, move about and do something active, no matter how small. You might rate how you feel having done this, compared to how you were feeling before you started. Note the difference. You could even compare how you feel now with how you might feel if you had not done anything at all but stayed in bed. The point here is that the more you yourself see the value in these kinds of exercises the more you are likely to have a go.

Adapting the basic idea to suit yourself

Once you have got the basic idea of the importance of writing things down and slowing your thinking down, you are prepared to start working on your thoughts, feelings, and moods. However, the exact framework you choose to do this should be something you decide for yourself: it’s important that you are happy with the form you use.

Different forms will be useful for working on different things. I have started us off here with a fairly basic thought-recording form; but please tailor it to suit you. Experiment with these forms and try out designs of your own. However, always keep in mind the basic point of all this: that is, to help you stop hitting your brain with lots of negatives, to get a better perspective on things and start giving your brain a boost and some warmth.

Compassionate reframing

Ideas for generating alternatives are given in Chapters 9–11 and throughout this book. In Appendix 1 there are also various worked-out examples to offer you some more ideas – but these are only ideas. Sometimes it is helpful to take a few soothing rhythm breaths and focus on your compassionate self or image. You are trying to shift the position in your mind to where your thinking comes from – stepping into the compassionate frame of mind, as it were – and then from that position (or mind) starting to think about alternatives. You can also imagine compassionately trying to help someone, such as a friend you care for, to think in a different, more balanced way. How might you focus on strengths and courage, on coping and getting through? What would your voice tone be like? The key is to shift position. You will be very familiar with what your threat, loss and critical mind says, because that part of you will be active a lot of the time, but can you tune in to your compassionate mind, attend to it and develop it? Writing things down can give you the space and distance to start to do this.

Compassionate letter writing

There is now increasing evidence that writing about our feelings, expressing and exploring our feelings in writing (so-called expressive writing)1 can be very helpful for some people. Indeed, we can put into words on paper things we might struggle to think about in our heads or express to other people. We will explore some types of writing here so that you can see which one helps you.

Writing about oneself

Choose what you want to write about: your life in general, or a particularly difficult time in your life that you had trouble coming to terms with, or problems that you are experiencing right now. The idea here is to express your thoughts and feelings on paper, writing about what has happened or is happening to you. Imagine that you’re writing to a very compassionate person who completely understands what you feel.

Sometimes writing like this may stimulate different feelings in us. Again the key here is to go step by step and explore what is helpful to you. If you feel that there are things that you really don’t want to face on your own, be honest about that and think about whether you want to obtain professional help to guide and support you, or talk to a friend. Remember all these exercises are intended to be helps and guides for you, and you’ll need to judge just how helpful they are for you.

Another approach to writing is to begin to think about yourself and your feelings from different perspectives. Because we use different aspects of our minds when we write, we can sometimes find that in the process of writing, new insights and meanings emerge in our minds that help us clarify things. Practising doing this can help you access aspects of yourself that may help you understand your feelings better, learn how to tolerate them without fear or worry of acting them out, and perhaps tone down more depression-focused feelings and thoughts. But keep in mind what I have said many times before – this is an invitation, a ‘try it and see’.

Writing about yourself from another’s point of view

Sometimes it is useful to try shifting perspective on how we see ourselves. One way of doing this is to write a short letter about yourself, from the point of view of someone close to you who cares about you. I’m going to use the example of a fictitious person we will call Sue, but when you write your letter substitute your own name, of course. Such a letter might include:

  • I have known Sue for about twenty years. To me, he/she has been

  • I find Sue

  • I think Sue struggles with

  • I like Sue because

  • Sue’s strengths are

  • It would help Sue if she could

This exercise is designed to help you develop the habit of considering other perspectives on yourself. If you like, show what you have written to someone you are close to and trust, and see what they think.

Some people find this very helpful, others do not. One person noted that ‘I actually don’t know anybody that well who would be able to write in detail about me.’ So here you might want to imagine a friend, and what you would like them to say about you. If you find it is too easy to dismiss positives then you might want to try practising some of the imagery exercises we talked about in Chapter 8, or the behavioral work in Chapter 12.

Writing compassionately to yourself

In this exercise we are going to write about difficulties, but from the perspective of the compassionate part of ourselves. There are different ways you can write this letter. One way is to get your pen and paper and then spend a moment engaged with your soothing breathing rhythm. Feel your compassionate self. As you focus on it, feel yourself expanding slightly and feel stronger. Imagine you are a compassionate person who is wise, kind, warm and understanding. Consider your general manner, voice tone and the feelings that come with your ‘caring compassionate self’. Adopt a kindly facial expression. Feel the kindness in your face before moving on. Think about the qualities you would like your compassionate self to have. Spend time feeling and gently exploring what they are like when you focus on them. Remember it does not matter if you actually feel you are like this – but focus on the ideal you would like to be. Spend at least one minute – longer if possible – thinking about this and trying to feel in contact with those parts of yourself. Don’t worry if this is difficult, just do the best you can – have a go.

When we are in a compassionate frame of mind (even slightly), or in the frame of trying to help a friend or someone we care for, we try to use our personal experiences of life wisely. We know that life can be hard; we offer our strength and support; we try to be warm and not judgemental or condemning. Take a few breaths then sense that wise, understanding, compassionate part of you arise. This is the part of you that will write the letter. So we write this kind of letter from a compassionate point of view. If thoughts of ‘Am I doing it right?’ or ‘I can’t get much feeling here’ arise, note or observe these thoughts as normal comments our minds like to make, but refocus your attention and simply observe what happens as you write, as best you can. There is no right or wrong, only the effort of trying – it is the practice that helps. As you write, create as much emotional warmth and understanding as you can. You are practising writing these letters from your compassionate mind.

As you write your letter, allow yourself to understand and accept your distress. For example, your letter might start with

I am sad. I feel distressed; my distress is understandable because . . .

Note the reasons, realizing your distress makes sense. Then perhaps you could continue with

I would like me to know that . . .

For example, your letter might point out that as we become depressed, our depression or a distress state can come with a powerful set of thoughts and feelings – so how you see things right now may be the depression view on things. Given this, we can try and step to the side of the distress and write and focus on how best to cope. We can write

It might be helpful to consider . . .

A second way of doing this is to imagine your compassionate image writing to you, and imagining a dialogue with them and what they will say to you. For example, my compassionate image might say something like

Hi Paul

Gosh, the last few days have been tough. Isn’t it typical of life that problems arrive in groups rather than individually. It’s understandable why you’re feeling a bit down because . . . Hang in there because you are good at seeing these as the ups and downs of life, and that all things change, and you often say at least we are not in Iraq. So you have developed abilities for getting through this and tolerating the painful things.

You will note that the letter points to my strengths and my abilities. It doesn’t issue instructions such as, ‘You must see these things as the ups and downs of life.’ This is important in compassionate writing. You don’t want your compassionate letters to seem as if they are written by some smart bod who is giving you lots of advice. There has to be a real appreciation for your suffering, a real appreciation for your struggle and a real appreciation for your efforts at getting through. The compassion is a kind of arm round your shoulders, as well as refocusing your attention on what is helpful for you.

AN EXAMPLE

Here’s a letter from someone we’ll call Sally, about lying in bed feeling depressed. Before looking at this letter, let’s note an important point. In this letter we are going to refer to ‘you’ rather than ‘I’. Some people like to write their letters like that, as if writing to someone else. See what works for you but, over time, use ‘I’. You could read this letter and substitute ‘I’ for ‘you’.

Good morning Sally

Last few days have been tough for you so no wonder you want to hide away in bed. Sometimes we get to the point of shutdown, don’t we, and the thought of taking on things is overwhelming. You know you have been trying real hard, I mean you haven’t put your feet up with a gin and tonic and the daily paper. Understandably you feel exhausted. I guess the thing now is to work out what helps you. You’ve shown a lot of courage in the past in pushing yourself to do things that you find difficult. Lie in bed if you think that it can help you, of course, but watch out for critical Sally who could be critical about this. Also you often feel better if you get up, tough as it is. What about a cup of tea? You often like that first cup of tea. Okay, so let’s get up, move around a bit and get going and then see how we feel. Tough, but let’s try.

So you see the point here: it’s about understanding being helpful, having a really caring focus but at the same time working on what we need to do to help ourselves.

Writing as you at your best

Another way to write these letters is to imagine the part of yourself you like, the self you would like to aspire to more of the time (as long it’s not the aggressive kick myself past of course!). Then try to bring that ‘you’ to mind – recall ‘you at your best’, ‘you as you would like to be’ and then write from that part of you.

Guide to letter writing

When you have written your first few compassionate letters, go through them with an open mind and think whether they actually capture compassion for you. If they do, then see if you can spot the following qualities in your letter.

Depressed people can struggle with this to begin with, and are not very good at writing compassionate letters. Their letters tend to be rather full of finger-wagging advice. So we have to work and practise being compassionate. The point of these letters is not just to focus on difficult feelings but to help you reflect on your feelings and thoughts, be open with them, and develop a compassionate and balanced way of working with them. The letters should not offer advice or tell you what you should or should not do. It is not the advice you need, but the support to act on it.

Writing to others

Another way we can use letters is to express to ourselves our feelings about people. Usually these letters are not sent. If you feel you want to send them, it’s best to keep them for a week or two and think carefully before you do anything about it.

The purpose of this letter is again to articulate your feelings. You can write about your needs or sadness, disappointment or anger, or how you want to be loved or things you find it difficult to express. The point about writing these things down is that we think in a different way when we write.

Writing can help in ways that allow us to make sense of things and come to terms with them in a different way. For example, Kim felt very angry with her mother who was a career woman. As a child, Kim had been looked after by a number of different nannies. For some years Kim felt under pressure to tell her mother what she felt. She also felt she couldn’t have a genuine relationship with her mother until she cleared the air, and that she was being weak in not speaking honestly. However, we talked about this and the importance of taking the pressure off herself ‘to prove herself’ and confront her mother. She wrote some moving letters that were never sent, and at the end of the process felt that a lot of the pressure to confront her mother had gone. In a strange way this actually made it easier for her to think about having a conversation with her mother about the key issues. Kim came to see that the degree of anger she felt blocked her in many ways, because it was less about anger and more about wanting recognition from her mother that was important. The writing helped with the anger and then Kim was able to think about how to have a quieter conversation about the sadness in Kim’s life because of the effects of her mother’s career.

Grief

Sometimes if we are grieving it can help if we write letters to the dead person, saying goodbye or whatever else we want to say. Goodbye letters can sometimes be quite emotional but also helpful in articulating and expressing our feelings.

As with all these exercises, take one step at a time and only do things that are helpful for you, or that you can see will be helpful if you stick with them. If you feel you grief is overwhelming then this might be a time to think about professional help from a counsellor or psychotherapist. Or simply take very small steps, but do it reasonably often, and build up.

Forgiveness

The last 10 years have seen a lot of research on forgiveness.2 However, there is a lot of misunderstanding about it. Forgiveness is about letting go of our anger. The person we forgive we may never like, never want to see. We might never condone their actions. Forgiveness is simply putting down our weapons and our desire for vengeance, and walking away. We say, ‘It ends here.’ Of course there may be a lot of thoughts such as, ‘I must not let them get away with it,’ ‘It is too unfair’, ‘I am weak if I do not pursue this,’ ‘If I were a proper person I would do something about this.’ The problem is that living with anger often isn’t going anywhere and that is very depressing. The only person we are hurting is ourselves and our brain, because we are constantly stimulating threat systems in our brain. Anger that is unhelpful like this simply makes us feel powerless.

Forgiveness is a way in which you can bring peace to your mind. We could fill a whole book looking at how to work on forgiveness.2 If you go on to the Internet you will be able to explore lots of sites on forgiveness. Check them out and see what works for you; some are interesting and helpful, and some not. But at a straightforward level, forgiveness letters are simply ways to help you acknowledge your anger and upset and forgive, let go, move on, walk away. As one patient told me:

I realized I had spent a lot of my life hating my mother and yet also wanting her to love me. She just wasn’t up to it. When I realized that actually she was quite a damaged person and simply wasn’t up to being as I wanted her to be, I felt more sorry for her and able to forgive her. To be honest I pulled back quite a bit and I think she would like me to have seen her more, but I found a comfortable distance for me. Recognizing this and letting go of my anger and my need set me free. And you know, wherever she is now (she died a few years ago), I genuinely hope she’s happy.

Importantly, keep in mind that the point of these letters is not to stir up difficult emotions but to be compassionate about them and learn how to think about them in compassionate and balanced ways.

Gratitude and appreciation

So far we have rather focused on writing about difficult things. However research has also shown that it’s very helpful if we can spend some time thinking about things we appreciate, like and feel gratitude for.3 When we are depressed it can be quite difficult to have feelings of gratitude. Nonetheless if we focus on those feelings it will stimulate parts of the brain that are associated with positive antidepressant feelings. You can start by thinking of a person or key phase in your life, or someone who is showing you some kindness no matter how small, and think about gratitude. The feeling of gratitude is not a grudging or a belittling feeling at all, but a feeling of pleasure and joy that the other person was there and helped you in some way.

Gratitude is not associated with a feeling of obligation. The moment we feel obligated by somebody else’s kindness it is difficult to feel gratitude. Focus on the behavior. One patient noted that although there were things that angered her about her husband, just focusing on her gratitude for him helped her feel more balanced and happier.

The same goes for appreciation. Take your pen and a fresh sheet of paper, and write about the things you appreciate and like in your life. They might be quite small things like the first cup of tea of the day; the blue of a summer sky; certain tele vision programs; the warmth of your bed; a relationship; or part of your job – absolutely anything that gives you feelings of appreciation and liking. Notice how we often let these pass. Bear in mind why you are doing this as an exercise – it is to balance up your systems and to stimulate part of your brain that will help you counteract the feelings of depression. Recall that depression will force you into a corner of your mind so that you always have to walk on the shadowy side of the street, so we have to practise refocusing.

KEY POINTS

  • To combat depression, we can call on different parts and abilities of ourselves: our rational minds and our compassionate/friendly minds. Writing helps us slow down and think in different ways.

  • By calling on these aspects of our minds and trying to activate them, we are making our brains work in certain ways that can counteract depression.

  • We can learn to write about our difficulties reflectively and with compassion by putting ourselves in the compassionate frame of mind when we write. This can take practice. Using a letter-writing approach can be helpful.

EXERCISES

Exercise 1

Write down your depression thoughts about a particular situation. Look at them carefully.

As you think about alternative ideas, take a rational/compassionate approach. Try thinking about what you might say to a friend who is in a similar situation. You might also consider how you think when you are not depressed.

To begin to generate alternative thoughts, look back at the ideas on pages 187 9 and focus on:

  • What is it helpful to attend to (e.g., from memory or in your current situation). Remember the old saying ‘is the glass half full or half empty?’ – practise attending to the half-full aspects too.

  • What is a fair, logical or reasonable way to think and reason?

  • What would be the helpful and supportive things to do in this situation?

Exercise 2

Write some compassionate letters for yourself, or engage in writing that expresses your feelings.

Even if you don’t have much faith in the alternatives you think of at first, the act of trying to generate them is an important first step. As with all exercises it is what you think will be helpful to you that is key, because different people find different things helpful. Make sure that all of your efforts to help yourself meet the ‘friend and compassion test’. This means that any of your alternative thoughts are considerate, helpful behaviors that you would be prepared and pleased to offer to friends and that you can see are evidence of compassion. Logic and common sense is not always useful to us; it’s when we feel it is helpful in our hearts that matters.

 

12

Changing your behavior: A compassionate approach

As we saw in earlier chapters, the depressed brain state can be a kind of ‘go to the back of the cave and stay there’ state. We want to pull the covers over our head and wish the world would go away. When we feel like this it helps to take a compassionate approach: in other words, to be very understanding of such feelings but also to think what might be triggering this feeling and how to break out of it. Maybe we have been working too hard and are exhausted, or maybe life events, setbacks and conflicts have taken the wind out of our sails. Sometimes a mild depression tells us we are exhausted and we really need to find a way to slow down and get some rest, let our bodies recuperate. Humans are like other animals – we need chill-out time. It is amazing how, when people take longish breaks from work, they often say they feel themselves slowing down, and the pace of life is easier. We must admit to ourselves that, through no fault of our own, we are living in a ‘rush rush, hurry hurry’ society where we can get rather exhausted. Learning to take time out, respect our body and rest it as much as possible is important, and I agree – it is easier said than done. In particular, one of the problems of being a single parent is the sheer workload, and demands that can be exhausting. If burnout and exhaustion are behind the depression, it’s important to see this and to address it in appropriate ways – without blaming oneself for being tired!

However, as we get depressed we can also stop doing various activities and disengage, and this adds to a depression cycle rather than helping it. We find resting is not helpful. When we are depressed, daily activities can seem overwhelming. In these situations it can be very useful to operate against the pull of depression. We need to encourage ourselves to do more not less, but the emphasis is on encouraging not bullying ourselves. This helps us to activate our drive system. It helps if we organize activities in such a way that they can be approached step by step. In the last 10 years or so therapies for depression have been developed which focus specifically on changing behavior.1 There are also self-help books dedicated to this type of ‘change your behavior, change your mood’ approach.2 It’s important, though, that you see this as helping you, not just as putting on a mask and carrying on regardless.

Tasks and goals

When therapists are trained, they are often taught to focus on three things: the bonds and relationships between patient and therapist; the tasks that need to be undertaken; and the goals and aims of the therapy. In helping yourself to get out of depression, you can take the same approach. The bonds and relationship you have with yourself have been the focus of earlier chapters, so now let’s look at tasks and goals.

Tasks

Often, as we move forward out of depression, there are various tasks that we can set for ourselves on our step-by-step journey. Here are some examples:

These are not easy things to do, so you may have to work hard. When we are depressed our thoughts and feelings are very dismissive – they may say things like, ‘This won’t work for me; don’t be silly; I can’t do it; can’t be bothered; I’m too angry; it’s too difficult’. These are all very common thoughts. The way to deal with them is to expect them, to notice them, but focus on the task anyway. If you put a certain time aside, e.g., five minutes, plan to focus your time on the task. You might also think about whether this feeling is actually linked to angry rebellion and you are really saying, ‘Oh, sod it. I just don’t want to do it, so why should I!’ If that is true, then honestly acknowledge it – be compassionate and understanding of such feelings, but then take a breath and think about how to actually help yourself move forward. Think also that there may have been many times in life when you predicted that things would not work out but they did.

Goals and commitments

Having small and achievable goals can be helpful as these are the things you want to achieve. At first, depressed people usually just want to feel better. But this large goal needs to be broken down into smaller ones. These smaller goals might be:

  • To do a little more each day.

  • To be more assertive with some other person(s).

  • To spend more time on something I enjoy.

  • To join a club or charity where I can get involved with other people and feel useful.

  • To spend more (or maybe less) time with my children.

The most important commitment is to put effort into transforming your depression by training your mind in helpful, compassionate actions. You do this in the knowledge that:

  • The way our brains have evolved over many millions of years can be very tough on us and give a host of unpleasant feelings and moods.

  • That is absolutely not our fault – we did not design our brain, choose our genes, or how our early relationships shape us.

  • But it is up to us to try as best we can to work with our minds to change our mental states.

Commitment is linked to the value we put on things. For example, if I ask you not to express your anger for a week, or to go out even if you’re depressed, you might be uncertain. What about if I offered you £10? Okay £100? Not enough? Okay £1 million. Of course I can’t do that, but think about it – if there is a really big payoff you might put a lot of effort into something. We have to be honest about this. Like a person training to get physically fit, some days will be harder than others – but the clear goal keeps them going. For working on a depressed state of mind, focus on how it will help you to get better and really make that your goal – think of all the benefits – imagine (and see) yourself as ‘feeling better’ and what you are doing now you are better. It is easy to let these slip from one’s mind when it gets tough. It can be useful to set yourself a couple of goals at the beginning of each day or week. Start by setting small goals – the smaller, the better. If things are difficult or you don’t reach your goals, ask yourself some questions.

  • Were the goals too ambitious?

  • Could I have broken them down further?

  • Did I run into unexpected problems?

  • Did I put enough effort into achieving them?

  • In my heart of hearts, did I think that achieving them wouldn’t really help?

  • If it did not go as I wanted, am I being compassionate with myself?

Behavioral experiments

Many therapists encourage us to try what we call behavioral experiments. This means trying out different things, keeping an eye on what works for us, how we might do things differently to make them work better for us, and tailoring them to our needs. This does not mean doing things simply because we’re told to, but trying to see the point of what we’re doing. For example, if you want to get physically fit you might go to the gym and really push yourself even though it’s not entirely comfortable. You learn what works for you and put up with the discomfort because you understand what you’re trying to achieve. Indeed, the discomfort may actually inspire you because you feel it is helping you move forward in your goal of ‘getting fitter and stronger’. We can approach depression like this too.

Take staying in bed. If staying in bed helps you feel better, all well and good, but often in depression it does not. We simply use bed, not to rest and regenerate our energies, but to hide away from the world. Then we feel guilty and attack ourselves for not doing the things we have to do. When you are lying in bed, you may tend to brood on your problems. Although bed can seem like a safe place to be, it can actually make you feel much worse in the long run. The most important step is to try to get up and plan to do one positive thing each day. Remember, your brain is telling you that you can’t do things and to give up trying. You will slowly show that part of yourself that you can do things, bit by bit.

Occasionally, however, because depressed people often bully themselves out of bed with thoughts such as, ‘Get up, you lazy bum, how can you just lie there?’, it can be useful to try the opposite tack. This is to learn to stay in bed for a while, at least one day a week, and enjoy it – read a magazine or listen to the radio and allow yourself to feel the pleasure of it. To practise being able to lie in bed without feeling guilty can be helpful for some people. Imagine that you are exercising that pleasure area of your brain, which really needs exercise.

Designing experiments

It is useful to work on and against our depressive ideas by setting experiments: that is, testing things out and rehearsing new skills. A useful motto here is, ‘Challenging but not overwhelming’. Remember – design your experiments – things to have a go at – to take you forward step by step, rather than rushing into something that has a high risk of failure. Don’t worry if the steps seem too small. If things go a bit pear-shaped, remember it was just an experiment and think about how to learn from it.

Experiments don’t always work out as we hope they will. When I was a shy young student at college, a good friend encouraged me to ask a woman to dance at our college dance. It was noisy, but I got my request across. She turned to her friend, looked at me, looked back at her friend, laughed – and they both got up and walked to the bar! Oh dear. On another occasion I had learned some assertiveness and was in a shop queue when an older man pushed to the front of the queue. People were irritated. I need to do something here, I thought. I’m a psychologist and an assertive one. I left my position at the back and said to the man, quite kindly I thought, ‘Excuse me, look, I’m sorry but there is a queue.’ He looked at me and then said, ‘Why don’t you eff off, you four-eyed git, before I smash your face in.’ My response was of course to say, ‘Absolutely – look – I’m off right now!’ So even the best-intended plans don’t always work out!

If we try things and they don’t work out, we can try to find out why. Was there anything about it that was a success? For ex ample, you did try and you can learn to cope with these setbacks and try again in the future. One can learn not to be so fearful of failing or rejection – it is unpleasant but nothing more. My college friend thought it was funny that the girls walked off but said, ‘That’s typical, you’ve just got to keep trying. Somewhere in the hall a girl will want to dance with you, you’ve just got to find her. On attempt 252 maybe.’

We also need to think whether we were attempting too much. Were our expectations too high? In the case of tackling the aggressive man the answer is probably yes – he was a big fellow, and I am by nature a coward. Did your negative thoughts overwhelm you? Did you really put the effort into it that you needed to?

People can generate and write down alternative thoughts and ideas and behaviors. They may be very casual about it and just look at the words without thinking their meaning through, or trying to put feelings of kindness and understanding into those alternatives. In the back of our minds might be a thought, ‘This approach can’t work.’ So we stack the experiment against ourselves before we begin.

So we may need to use the courageous part of our compassionate mind to tell ourselves in a friendly, supportive way:

Look, I know this is hard, and yes, it is a shit being depressed, but let’s not stack things against myself. Let’s give it a fair go. After all, what have I got to lose? If I were helping a friend, I’d know how tough it is but I’d also encourage them to give it a go. Let’s go through this step by step.

Getting out of depression takes effort, and this is especially true if you are trying to help yourself. It is the same with getting physically fit. It would be no good putting on your trainers and running to the garden gate and back – you have to push yourself more than that (assuming you don’t live in a stately home where the garden gate is a mile away). It is very understandable to find this tough going, and it may be that there are times when we need some extra help from friends or professionals. There’s no point in berating ourselves if we’ve tried our best and have found it too hard.

Blocks to becoming active

To become more active, it helps to decide on a specific activity and the time you are going to do it. For example, go shopping at 10 a.m. on Tuesday. Visit a friend at 2.30 on Wednesday afternoon. When the time comes, go for it. Each day, do some things that invite you to operate against depression. Make a plan for the week, and when you get to the time do whatever it is you’ve chosen to do. Try to engage in each activity in a spirit of encouragement and support.

You may well have some extremely understandable but unhelpful or irritable thoughts: ‘Nothing I do to help myself will help me – so it is not worth trying.’ If you do, be compassionate and shift to your compassionate self (see pages 149–155). Recognize that all over the world depressed people think like this, because that is how the depressed mind thinks- so it is perfectly understandable to think like this. But it is only one possible pattern in your mind, so consider also:

  • Am I defeating myself before I start? Probably if I am honest. Huff.

  • Let’s get helpful here and try to be supportive.

  • Do I really have enough evidence to say this or that can’t work, or is this just how I feel about it?

  • What have I got to lose by trying? If I put effort into this and it doesn’t work out, I’ll certainly be no worse off and might have gained something.

  • If I try, at least I’ll know I made the effort even if things don’t work out.

  • I can go one step at a time. If I break my problems down into smaller ones, they may not seem so overwhelming. I don’t have to try to do too much at once.

  • I may feel better if I try to do something rather than nothing.

  • I can praise myself for effort.

Now try this. Spend a moment on your soothing breathing rhythm and connect with your compassionate self, no matter how minimally (see pages 149–55) Read through these ideas (on page 253) with as much warmth, care and concern as you can, and as if you really wanted to help a friend. How do they seem to you now?

Learning how to do things we don’t want to do

To reach our goals in life we often have to do things we don’t want to. People who want to be successful at sport, playing an instrument or passing exams have to practise and study even when they don’t want to. Many of us feel very anxious when we start learning to drive a car. When I started, my leg shook so much I could hardly push in the clutch! However, we accept those things – because of our goal to be able to drive and be mobile. And of course there are many small things that we may not want to do such as getting up to go to school or college, studying for exams, going to work, or getting the children up and out for school. Even making the effort to socialize can seem like a hurdle.

Step 1: Develop your vision

When engaging in disliked activities, focus on the benefits of doing them (rather than the difficulties), and think about how you will feel if you complete a task. Think how your actions can take you nearer to your goals, while avoiding things won’t actually help you get better – although you may temporarily feel less anxious (or whatever).

Karen felt tired and a little anxious about going to the shops. So she created in her mind a vision of herself coming home with the bags of food and making something enjoyable to eat with the family and tried to hold that in mind while doing the shopping. She saw that as an achievement. It really helps if we can think of a goal and commit ourselves to it. Otherwise what’s the point of engaging in difficulties unless you can really see the benefits and focus on those? That’s true for all things in life, of course.

Sue kept in mind how good she would feel in a few months when she had left her husband and worked through his threats. ‘It was keeping that vision of being free and living alone, doing my own things, that helped get me through and take difficult decisions,’ she said.

Step 2: Develop the feelings of support and helpfulness

Focus on creating inside you feelings that will help you. When engaging with activities you’re not too keen on, spend a moment really trying to contact and create within you your compassionate self. Then take yourself gently by the hand and engage in the activity. When we talk about getting up to do things, this is not to bully you out of bed or into doing things but to encourage you to get up, because lying there and brooding on problems may only make you feel worse. Getting up and doing things takes you closer to your goal of recovery. But test it out, try it a few times and see how you go. Think about how you can make this ‘acting against your depression’ with kindness more effective for you once you understand the value of doing it.

Working on blocks to helpful compassionate behavior

Compassionate behavior is aimed to help you grow, develop, nurture and overcome difficulties in your life. It is very easy for us to view compassion and kindness as being about giving in, about not pushing ourselves, and sometimes it can be this. I am all for making life as easy as possible if it helps me. But we need to be wise about this because if we are honest sometimes backing off, giving in, or taking the easier route is going to make life much more difficult; that’s not compassionate. David Veale and Rob Willson in their book Manage Your Mood have identified a number of obstacles to working on helpful and compassionate behavior.2

Doing things only when you feel motivated to do them

Sometimes that works, and there are times when we feel like doing things and times when we don’t, but be honest with yourself if it’s just avoidance. Will there actually be a time in the near future when you know you will be motivated? Maybe it is useful to act against this lack of motivation. Learn how you can do things even when you’re not motivated because then you are free from the ‘whimsies’ of your motivational system. Learning to do things in an unmotivated way can be a useful skill.2

Waiting to feel better

If you are feeling very tired, then it is a good idea to check with your family doctor whether there could be a physical reason for your tiredness. Tiredness is one of the most common symptoms that present to family doctors today, so ensure you get the evidence that your tiredness is indeed related to your depression. Sometimes if you are recovering from a physical illness or you have been exhausted, waiting to feel better and allowing your body to recuperate is helpful. But at other times simply waiting to feel better is not helpful and the way to feel better is actually to do more things. For example, there is no point in saying, ‘I will ride my bike or get fit when I feel fit and energized’. The reason for doing these things is because I don’t feel fit and it is the doing of those things that makes me fit and energized (hopefully!). We must not put the cart before the horse.

Waiting for medication to work

You might think, ‘My doctor told me I need medication; indeed this book has talked about depressed brain states, so I just need to wait for the medication to work.’ Sometimes this can be helpful, but we can also change our brain states through our activities. Your medication will not retrain you, teach you, or help you build up your coping skills – only you can do that. These skills we are discussing here can help you now and in the future to put control back in your own hands. Your medication might work better if you also work against your depression.

When I have more confidence I will do more

This is also a ‘cart before the horse’ issue.2 Think of any activity such as learning to drive. What comes first, confidence or your anxious practice? Confidence comes from the doing, not the other way round. If you have had confidence and have lost it I’m afraid the same applies; we regain confidence through the doing.

Frankly I can’t be bothered

Who hasn’t felt that from time to time? But in depression, sadly, it can be for most of the time. As I noted briefly above, if we’re honest sometimes these feelings can be tinged with anger or, ‘Why should I, it’s too much effort.’ We might feel angry with people around us, and fed up, and it’s easy to withdraw from them. One of the difficulties for some depressed people is recognizing just how much anger or resentment interferes with their lives in all kinds of ways. Here again the trick is to act against that anger, and not to allow your anger to dominate your behavior, by giving up or withdrawing. Acknowledge your anger honestly and then think of some activities that would help you. Be honest if you tend to ‘cut off your nose to spite your face’. This is actually rather common, so there is nothing to feel ashamed about once you’re honest about it. Keep in mind to be honest but also kind about these thoughts and feelings – they are all very human things, really.

Breaking down large tasks into smaller ones

Depressed brain states can tone down some of our thinking abilities. The depressed brain state interferes with our planning and straight thinking abilities, so we have to plan things in different ways than we might normally do. Suppose you have to go shopping. It would be natural for a depressed person to think about all the hassles before they start, feel overwhelmed, and not go. Okay, we know that is how depression thinks so how can we act against it? One way is to practise the step-by-step approach and focus on one step at a time.

So first look in your cupboards and make a list of what you need. When you’ve done this, give yourself some praise. Think of a phrase that’s fun for you, such as, ‘Okey-dokey – done’ or, ‘Okay, that’s cool – I’ve done step one.’ Keep an eye open for angry thoughts like, ‘But this is so simple I should be able to do it easily.’ Well, if you weren’t depressed you would, just as if you didn’t have the flu you could probably run easily, and if you didn’t have a broken leg you could probably walk upstairs easily. The brain state of depression makes our daily activities difficult, so acting against it is hard work. Keep in mind that after all, you are one step further ahead than you were before you made the list.

Next, get your bags and other things together to go to the shops. On the way, focus on the fact that you are now prepared for shopping. Again notice the various thoughts that can pop into your mind about how difficult this is, how tired you feel, how you probably will forget something. Keep in mind that we expect those thoughts because that’s how depression thinks. Be mindful and notice the thoughts, recognize them as expected and natural, and then refocus your attention on your activity and intention. To the best of your ability, be kind and gentle with those intrusive thoughts and feelings.

When in a shop, work your way slowly around until you have everything on your list. Oh, they have run out of a key thing you wanted? Note your frustration, recognize it as natural, be kind to it and then refocus your attention on how best to cope with that annoyance and the thing you wanted not being in this shop. Notice if depression gives you a stream of thoughts ‘I knew this would happen; it is typical; what a useless shop; why does this always happen to me!’ And of course we don’t need to feel depressed to have those thoughts! Again be mindful – notice them, smile at them and return your attention to the task at hand – be kind to these thoughts – don’t fight with them or try to stop yourself having them. Remind yourself that millions of people throughout the world are probably having the same thoughts as you.

We have used shopping as an example, but of course you can use any activity you like. Here are the steps:

As with most things in life, practice helps.

Planning positive activities

Often, when we feel depressed, we think we have to do all the boring things first. Sometimes, boring chores are unavoidable, but it will really help you if you also plan to do some positive activities – simple rewards that give (or used to give) you pleasure. For example, if you like sitting in the garden with a book, going to visit a friend, taking a walk, or swimming, then plan to do these activities.

Sometimes depressed people are poor at including positive activities in their plans for the day. All their time is spent struggling to get on top of the boring chores of life. They may feel guilty going out and, say, leaving the washing up undone. But we need to have positive activities. If we don’t, it is like drawing on a bank account without putting anything into it. The positive things you do can be seen as depositing money in your account. Each time you do something that gives you pleasure, no matter how small that pleasure is, think to yourself: that’s a bit more in my positive account. Another way to think about it is stimulating these emotion systems inside of you. They need to be ‘worked’, like muscles do. If we don’t stimulate our positive emotion systems then we are not stimulating the cells in those systems and eventually they might not be able to give us the positive feelings we want. This is why we can think about what we are doing as a kind of physiotherapy for our brains.

If you think like this it will help you get around blocks to doing positive things, such as thoughts like ‘I do not deserve this’, ‘I am being selfish’, or ‘I must attend to other things first’. We may have grown up being told we deserve this or don’t deserve that. But this is not about deserving, it is about exercising your body and brain to help them work more effectively for you. You can always choose not to do positive things once you are free to.

In Chapter 7 we explored focusing on things you like and enjoy, and learning to appreciate things. To start with these are often small things such as your first cup of tea of the day. Learning to train our attention to focus on pleasures is important. For example, you might like walking, but even though it is a beautiful day, because you are not practising focusing your attention on it, your mind is full of your problems and how you are not feeling so good. When engaging with positive activities, focus your attention on what you are enjoying, no matter how small that experience of enjoyment is. Have a go for a while and see what happens for you.

Coping with boredom

Some depressions are related to boredom. Through no fault of our own our lives have become repetitive and boring. Sometimes this appears unavoidable. However, again the key issue here is to diagnose boredom and then take steps to challenge it.

One of my patients had gradually slipped into a lifestyle that involved going to work, coming home, watching TV and going to bed, having given up meeting friends and planning activities with them. Slowly, step by step, he began to think of things he would like to do, and then tried to see if he could do at least some of them. One thing was joining the local football club and getting involved as a social member. At first he found making the effort to get to meetings tiresome, but he got to know a few people and that encouraged him. Another was joining a local charity group and helping with fund-raising.

A recent patient experienced life as rather meaningless, but had the idea that somehow life should be meaningful all by itself. But meaning is something we need to create, and we do this through our activities and commitment to goals. Finding things you can do to help others can often make life meaningful. Meaning rarely comes from simply wanting to pursue pleasures.

Women who feel trapped at home with young children are particularly vulnerable to boredom and lack of adult company. We are a highly sociable species, and sharing and talking with others is important for our well-being. Again, the main thing for people in this situation is for them to recognize that they are bored and begin to explore ways of getting out more and developing new contacts. They could perhaps contact mother-and-baby groups, and ask their friends about other activities. If social anxiety is a problem, people who are depressed like this could try to do a little more each day in making outside contacts and/or contact their family doctor to ask if there are any local groups who might be able to help them with social anxiety and getting out more. The reasons that we may have fallen into a lifestyle where we are not stimulating our positive emotion systems enough may not be our fault at all, but we will have to try to take control over the situation, step by step.

Increasing activity and distraction

Sometimes, when people feel very depressed or uptight, they can also feel agitated. At these times, trying to relax does not work. Their mind won’t settle down to it. Then they need to distract themselves with a physical activity. Any kind of activity – digging the garden, jogging, aerobic exercises, decorating and so on – can be helpful. Physical activity can be especially useful if you are tense with anger or frustration.

Creating personal space

Occasionally there may be a problem in creating ‘personal space’– that is, time to be spent on oneself. We can feel so overwhelmed by the needs of others (e.g., the family) that we allow no ‘space’ for ourselves. We become over-stimulated and want to run away. If you find that you need time on your own, don’t feel bad about it but see it as important to think about. Talk to those close to you and explain this. Make it clear that this is not a rejection of them: rather, it is a positive choice on your part to be more in touch with yourself.

Many people feel guilty if they feel a need to be alone doing the things that interest and are important to them, but it is important to negotiate these needs with loved ones. Most importantly, do not assume that there is anything wrong with you for wanting space or that there is necessarily anything wrong with your relationships. Relationships can become claustrophobic from time to time. If you know that there is space for you within your close relationships, this may help to reduce possible resentments and urges to run away. Keep in mind that we humans evolved into small groups living in the open. Thousands of years ago we would not be trapped in a house with one person or children. It is very natural for us to want to spend time alone. Carol found that wherever she went in the house sooner or later one of the family would have a request: ‘Where’s my shirt?, ‘Where are you, mum?’ She couldn’t even get any peace in the loo! It helped to explain to her family that she needed rest time and this would be helpful to her.

Knowing your limits

Depressed people can become exhausted from overwork and then can’t cope with the demands placed upon them. They notice that they were failing and becoming overwhelmed, feel ashamed about their failings and become more depressed. Most depressed people are real battlers but sometimes they allow themselves to over-extend because they can’t say ‘no’. To be frank that is not helpful to you. I have certainly got caught in that one too.

Think of ways that you might replenish yourself, but most importantly, don’t criticize yourself for feeling burned out. Acknowledge it honestly and think through steps that might help. Are there enough positive things in your life? Can you do anything to increase them? Can you speak with others about your feelings and seek their help? Can you take time out or pass on some of the chores? Burnout can occur if we have not created enough personal space. Limits are personal things and they vary from person to person and change from time to time and situation to situation.

Looking after our bodies

Dealing with sleep difficulties

Sleep varies from person to person. My daughter and I have never been particularly good sleepers, whereas my wife and my son can fall asleep almost anywhere. In addition, the ease of getting to sleep and our need for sleep change as we grow older, so our sleep patterns are personal to us. Although it’s annoying, try not to worry about not getting enough sleep. Famously, Margaret Thatcher only slept for four hours a night! Sleep problems can take various forms. Some people find it difficult to fall asleep, others wake up after being asleep for an hour or two. Other people wake up in the early hours, and there are also those who sleep extremely lightly.

Think of sleep as another behavior that needs managing. A milky drink before bed may help. Make sure that your bed is comfortable and the room well ventilated. Plan for sleep. Don’t do what I used to, which was to work late into the night and then find I couldn’t sleep because my head was buzzing with the things I had been working on. In planning for sleep, think about relaxing (and try to relax) half an hour to an hour before bedtime. Listen to relaxing music or do a relaxation exercise. If possible, read a book that takes you out of yourself (but not one that scares you or is particularly mentally involving). Avoid arousing (exciting or scary) TV programs. If appropriate, ask your partner for a soothing massage. Take gentle exercise during the day.

Among the things to avoid is alcohol. Having a drink (or two) may seem helpful, but usually isn’t. It leads to disturbed sleep patterns, and you may wake early in the morning with mild (and, if you drink heavily, not so mild) withdrawal symptoms. Catnaps during the day can disrupt night sleep. If I sleep for longer than 15 minutes during the afternoon it can really mess up my night’s sleep. If you wake early, get up and avoid lying in bed, ruminating on your difficulties. As a poor sleeper, if I wake early I tend to get up and work. Of course, at times this leaves me feeling tired, but I have come to accept this as my style. If your sleep pattern is very disturbed, you may find an antidepressant helpful. Some people have found that going without sleep for a whole night and not catnapping the next day can help lift their mood, but this is best done under supervision. There are some good self-help books on the market for sleep problems. Do discuss with your family doctor though, because sometimes tiredness and not sleeping can be linked to things like anaemia (or other physical reason) and a dose of iron tablets might help.3

Body work

An important aspect of compassionate behavior is looking after, nurturing and caring for your body. Your body is like a garden, and to function well it needs looking after. It can become exhausted and needs pampering. Learn to care for your body and treat it with respect. Teach it how to relax, exercise it and feed it good things – not junk food and high-sugar foods, especially if you are depressed.

I always advise trying to find a sympathetic family doctor with whom you can have a frank and open discussion about your depression. In 1992 the Royal College of Psychiatrists in Britain mounted a ‘Defeat Depression’ campaign to increase the awareness and skill of family doctors in this area of psychological problems.

Very occasionally, depression can arise from a number of physical conditions. These include:

  • problems with the thyroid gland

  • anaemia

  • diabetes

  • chronic fatigue syndrome (CFS; also known as ME)

  • vitamin deficiency (e.g., B12)

  • hormone problems

  • stroke

  • complications with other medications.

It is important to have these and other things screened out as soon as possible. However, one should also recognize that most depressions are not triggered by a major physical condition, although there may be more subtle problems.3

Changing the way you treat your body

Eat a healthy diet and drink plenty

People who are depressed often have a very poor diet. Work out a balanced diet including fresh fruit and vegetables and a high percentage of carbohydrate (e.g., pasta, bread, potatoes). This is because these foods release their energy slowly and may help to boost certain chemicals in the brain that are depleted when we are depressed. You may wish to take advice on this.4

There is increasing evidence that weight loss itself can affect various brain chemicals. Consider if your depression came on or got worse as you lost weight. Some research has also shown that eating large amounts of sugar and other refined foods might increase irritability in some people, so try cutting out cakes and other sweet things.

Some people like to take extra vitamins. The evidence for these helping depression is not clear, but provided you are not doing yourself any harm (e.g., too much vitamin A can damage your liver), these may work as a placebo if nothing else – that is, you may become less depressed simply because you believe in the vitamins, not because they have actually had a direct effect on your brain chemistry. A sympathetic family doctor will advise you on this.

We often don’t drink nearly enough and so toxins can build up in our bodies making them feel sluggish. The ideal is two litres a day so that your urine is fairly clear but don’t drink too much too quickly. Drinking water can also help weight loss. Again it is very useful to talk to your doctor about this. If anxious, avoid the stimulating caffeine drinks of coffee and even tea, and try green teas.

Supplements

Because depression is so common in our societies, the Internet is full of remedies. These include things like omega-3 fatty acids, folic acid, S-adenosyl methionine (SAM-e), St John’s wort and many others. Evidence that some of these may be helpful is gradually accumulating.

The problem is that the quality of products obtained via the Internet can’t be guaranteed. Some of these supplements can interact with medication or have side effects. So if you want to explore them you will need to discuss things with a qualified person, usually your family doctor or a nutritionist. Provided you obtain appropriate professional advice, then experimenting and seeing what works can be helpful.

As with much in this area, we desperately need more research. We also know that people can have very individual responses to all kinds of medications and supplements. What is helpful for one person may not be helpful for another, because biologically we are all slightly different. Evidence tells us that many people pursue the alternative therapies for depression, but if you choose to explore this path, tread cautiously.3

Taking exercise

There is increasing evidence that exercise can be very beneficial for mild to moderate depressions because it tends to boost the production of certain chemicals in the brain. A patient of mine who had a bipolar illness (and was taking lithium and an anti-depressant) found that if he woke up in the morning feeling down, a vigorous swim in the local pool helped to lift his mood. When we become depressed we tend to do less, and if you can encourage yourself to take exercise, this can be helpful. It may give you a sense of achievement, in addition to being good for you and boosting certain brain chemicals.

Reducing your alcohol intake

Alcohol can have a depressant effect, and it is usually helpful to reduce your intake, especially if you tend to drink to control your moods. Sometimes people use alcohol to get to sleep; as we have seen, this can be detrimental. Altogether, alcohol is a bad way of managing stress and depression.

Stimulants and other drugs

If you are taking stimulants, try to stop. This applies even to mild stimulants such as coffee. Occasionally, I’ve found that some of my depressed patients drink vast amounts of strong coffee, sometimes more than 10 cups a day. Many stimulants can have depressant or anxiety-increasing side effects.

If you are using illicit drugs, try to get off them as they will not be doing your body any good. Some cannabis smokers lose motivation and become depressed and apathetic, and if there is an underlying sensitivity, it can also lead to more serious mental health problems. In fact, abuse of all drugs, including painkillers, needs to be considered here. If you are taking a lot of painkillers, you should see your family doctor and plan to reduce your intake.

Tranquillizers

Taking the odd tranquillizer from time to time can be helpful. However, if you have been using tranquillizers for a long time, you should think about coming off them. You must not come off them too quickly, however, but rather reduce your intake slowly. It is important to obtain medical advice from your family doctor, who might refer you to a psychiatric nurse or psychologist. There are also self-help groups and books to help with tranquillizer withdrawal.

Learning to relax

Sometimes this is easier said than done. Have a look back at pages 130–2 for some suggestions. There are also a variety of books and self-help tapes on relaxation on the market, as well as classes and groups. Explore these and see if you can find one that suits you.

Overview

Compassionate behavior means engaging the world in a certain kind of way, which often means acting against our depressed feelings For this we can develop compassionate courage. We also need to treat our bodies carefully; after all, they are the foundation for many of our feeling states. I suspect that in the years to come we will learn much more about the relationship between our diets, various additives in our food, the chemicals in the atmosphere and how these effect our moods. But we can try our own experiments. Provided you discuss with your family doctor or a qualified professional then you may want to experiment to see if certain types of change in eating, exercise or supplements help you. My view about depression is that it affects mind and body and we should treat them both kindly.

KEY POINTS

  • There are many forms and causes of depression.

  • Because of these differences we need to have a variety of different approaches to depression.

  • It can be helpful to plan activities step by step. Break problems or tasks down into simple steps and follow them one at a time.

  • Include some positive activities in your life. At times, you may need to increase your social contacts, at other times reduce them to create personal space. Much of this is about working out your own needs.

  • The type of thoughts we have can affect the way our brains work. Sometimes, certain thoughts can be controlled by distraction.

  • Don’t assume that you have to become an inexhaustible supplier of good works. No one can be. Learn to work out your limits. If you think that there are very few things you can’t cope with, the chances are that you are not working within your own limits.

  • Finally, treatment often needs to be aimed at how our bodies are working. It may require us to take seriously the possibility of using an antidepressant to help us get going again. We may need to change our lifestyles (e.g., take more exercise, improve our diets, cut out the coffee, learn how to relax, distract ourselves).

EXERCISES

Exercise 1

  • Make a list of the points in this chapter that you think are relevant to you.

  • Clarify in your mind:
    – How are you treating your body?
    – How do you organize your activities? Can you plan to do things step by step?

Exercise 2

Make a list of the positive things you would like to include in your life. These can be quite simple: for example

  • I would like to see my friends more.

  • I would like to go to the movies more.

  • I would like to have more time to myself.

Consider ways that might make some of these things happen.