Unhelpful thinking in depression

There are certain types of unhelpful thinking in depression that are particularly negative, keep repeating themselves and seem totally believable at the time. For example, someone having a difficult day with pain levels may start to think ‘I feel useless.’ This thought can then lead on to another thought: ‘I am a useless person.’

This example shows how a person can draw conclusions based on how they feel, rather than on the actual situation. This type of extreme thinking or belief on a high pain level day can easily make you feel depressed.

ACTION 1: IDENTIFYING UNHELPFUL THINKING STYLES

Think about the last time your mood changed and you felt depressed or low. Recall what went through your mind and in the right hand column of the table below circle the unhelpful thoughts that you noticed.

ACTION 2: UNDERSTANDING HOW TO CHALLENGE UNHELPFUL THOUGHTS

When you feel unpleasant moods or emotions, notice what you are thinking.

Ask yourself: ‘What went through my mind as I started to feel down or depressed?’

Moods can be affected by what you are thinking, and what you believe, about a situation. The table below shows an example of how thoughts and beliefs affected Maria’s mood. When Maria noticed the unhelpful thoughts that had occurred during her mood change she realized she had been biased against herself, and her thinking style had been extreme, black and white, ‘all or nothing’. She decided to challenge these unhelpful thoughts in Steps D and E (see the ‘Challenging Thoughts Worksheet’ on p. 207).

The effect of looking for a realistic response on Maria’s mood was that she then assessed herself as feeling more cheerful, less sad and more hopeful.

HOW CAN ‘CHALLENGING THOUGHTS’ HELP DEPRESSED MOODS?

Challenging unhelpful thinking and beliefs can be useful in lessening moods and chronic pain. It is not simply ‘positive thinking’. It is about noticing thoughts that do not help in the present situation. They lead to unpleasant feelings of more depression and less pleasure. On the next page is a Challenging Thoughts Worksheet. This shows how new responses to a situation can improve the way you feel and think about it. Use this Challenging Thoughts Worksheet to spot and challenge thoughts that lead to unpleasant emotions or mood changes. Use a rating scale to check if challenging your thoughts led to an improvement in mood.

ACTION 3: HOW TO USE THE CHALLENGING THOUGHTS WORKSHEET

STEP A (‘SOMETHING HAPPENS’)

Write down in your notebook what happened, who was there and what you noticed.

Sometimes unpleasant feelings are more easily noticed than thoughts.

So you may need to use Step C (‘I feel and do something’) first, then go back to Step A.

STEP B (‘I TELL MYSELF’)

Record what your thoughts or beliefs were, and what you said to yourself.

Then check out your unhelpful thoughts, using the unhelpful thoughts list on p. 200.

STEP C (‘I FEEL AND DO SOMETHING’)

Record how you felt and what you did. Rate feelings (0–10)

STEP D (‘I ASK SOME USEFUL, REALISTIC QUESTIONS’)

Use the ‘Thought challenging questions’ (see below) to challenge the thoughts you had in Step B.

Try to imagine different ways of seeing the situation.

See whether this changes your thoughts in a realistic, helpful way in Step E.

STEP E (‘WHAT WILL I SAY TO MYSELF AND WHAT WILL I DO IN FUTURE?’)

Record what you could or will say to yourself, using the results of the thought challenge in Step D to help you.

THOUGHT CHALLENGING QUESTIONS FOR STEP D

Step D – Ask myself:

What is the evidence for and against this thought?

If my best friend were in this situation, what would I say to him or her?

Am I confusing thoughts with fact?

Am I:

jumping to conclusions?

‘mind reading’?

thinking in ‘all or nothing’ terms?

using words which are extreme or exaggerated (like ‘always’, ‘never’, ‘mustn’t’, ‘should’, ‘forever’, ‘can’t’ and ‘every single time’ . . .)

Use the ‘Unhelpful thinking style list’ on p. 202 to help you with this step.

Am I:

•   condemning myself as a person on the basis of this event?

•   expecting myself to be perfect?

•   concentrating on my weaknesses and forgetting my strengths?

•   making judgements based on feelings rather than facts?

•   focusing on factors that are irrelevant?

•   paying attention to the negative side of things?

Finally, check what effect your realistic responses have on your mood level.

Note: Feedback from people who have used these Challenging Thoughts Worksheets suggests that it’s worth trying them on at least three occasions when you are feeling depressed. It is really helpful to use the sheets until the thought challenge method becomes easy to do and a regular part of your life.

OTHER WAYS TO MANAGE DEPRESSION

Tick those ways you might try:

   Shifting attention and practising mindfulness (see Chapter 15).

   Increasing pleasurable activities. Rewarding yourself is a very useful way to help lessen depression. Try and do one pleasurable activity each day and then reward yourself for the effort (see Chapter 7).

   Changing unhelpful behaviors. Doing things that give you a sense of satisfaction or enjoyment. Plan activities day by day (see Chapters 6 and 8). Leave out or change unhelpful ones, like getting up late in the day.

   Becoming more physically active (see Chapter 9).