Low mood and dpafu

In this section we look at low mood associated with DPAFU, and not low mood in its own right. If you think you may be suffering from depression, our advice would be to consult your GP and/or a good self-help guide, for example Overcoming Depression by Paul Gilbert (2000) or Mind Over Mood by Dennis Greenberger and Christine Padesky (1995). There are numerous others and a quick visit to the self-help section of a bookshop or an Internet search will give you lots of other possibilities.

Like any other chronic condition, DPAFU can get you down and often leads to feelings of hopelessness about the future (we saw this with Alexi’s case history, see page 19). You may wonder whether you’ll ever feel well again, which of course is likely to lower your mood. Some people also feel helpless because they believe there’s very little that can be done to make things better. Low mood doesn’t just mean you feel sad; it can affect you on a variety of levels. It can leave you with disturbed sleep, a feeling of exhaustion, irritableness, poor appetite and constant worry. It can make you avoid other people and make you much more prone to cognitive errors (see page 42). People think many of these sensations or symptoms are caused by DPAFU. But low mood and DPAFU aren’t one and the same, although there is little doubt that they are related.

Research has shown that we’re all sometimes liable to negative automatic thoughts and the cognitive errors they generally involve. Most of the time, the impact cognitive errors have on our mood, physical reactions and behaviors is minimal. By and large, they do little damage and go unnoticed. But they may become more frequent, prominent, and distressing – perhaps following a critical incident, the onset of another condition or as a reaction to an event in our lives. In the negative cycle that follows, the depressed person believes that nothing they do will make them feel better so they no longer bother to try. There is a general feeling of despondency. Hence the old expression that the glass is half empty.

It is these very negative thought-behavior-mood cycles that people with DPAFU often find themselves caught up in. The way to address low mood is initially to recognize it. Is your mood a cause of DPAFU or a consequence? Are you depressed irrespective of the DPAFU? The first question is very difficult to answer. For some people, low mood will have followed the onset of the DPAFU. You will then need to become aware of the thoughts you have about DPAFU. We know that depression often occurs as a result of perceived loss. Are you grieving for the loss of your old self? Do you feel that you have no control over the sensations of DPAFU and that the situation is hopeless? Do you believe that the DPAFU is a result of, or has caused, irreversible brain damage and that there is nothing you can do about it? All these thoughts and feelings may exaggerate feelings of helplessness. Either way, these are negative thoughts that you can list in a thought record (see page 101). Remember to gather evidence to support or refute your beliefs.

By drawing on CBT models, you can guide your treatment and devise your own self-help program. You can work to change any one of the five systems outlined earlier in Figure 5.1 (see page 47). For instance, you can change:

 

•   how you think (through the use of thought records);

•   how you feel physically (you can tackle issues like sleep, diet and exercise or use antidepressant medication);

•   change your environment (for example, by going away on holiday);

•   how you feel emotionally (this can be difficult and virtually impossible to control to demand, although making changes to the other systems will help);

•   how you behave (the easiest thing to change when we are feeling low).

To change your behavior, start by getting some idea of how your activities are connected to your mood. You can do this by recognizing the amount of pleasure and the sense of achievement you get from the activity. To do this you will need to complete an activity diary. This is similar to the hourly diary described on page 73. Each hour of the day you write down what you were doing (your activity) and how you were feeling (your mood). Next you rate how much pleasure you were getting from your activity and the degree to which you felt any sense of achievement. Rate pleasure and achievement from 0–100 per cent, with 0 meaning none at all and 100 meaning the most possible. Complete the blank version on page 132 to get some idea of where you are at now. Once you’ve established your current level or baseline of activity, you can then schedule in more activities that give you a sense of both pleasure and achievement. Have a look at the example below. This will help you complete one yourself for every day of the week. What does the example mean to you? What patterns can you see?

You’ll see from this example that there is clearly a link between what we do and our mood. Having lunch with a friend brought the most positive mood, and also gave the greatest sense of achievement for that day. Often when you’re doing one activity, such as watching television you may also be going over things in your mind. Be aware of these thoughts and record them in your thought record. Again, notice when you’re doing things that seem to give you little pleasure. It may be that the situation or activity provokes such anxiety that any sense of pleasure is lost or diminished.

Once you’ve completed your own activity diary (using Table 6.19 overleaf) for one week, you’ll be able to look back over your ratings and ask yourself a series of questions:

 

•   Did my mood change over the week? If so, from what to what?

•   Was there a link between the things I did and how I felt?

•   What activities give me pleasure and/or a sense of achievement?

•   Are there certain days, times or situations that make my mood better or worse?

•   Are there themes or patterns that I have only just become aware of?

•   What are the sorts of activities I can increase because they make me feel better and decrease because they make me feel worse?

As you begin to address these questions, a plan of action may become clearer. The key to success at this level is to turn each activity into an experiment. Don’t avoid an activity because you think you won’t enjoy it. Invariably it’s the negative thought patterns or the cognitive errors that are making you feel anxious and stopping you from doing something. Complete a thought record both before you do something and after the event. Now compare how you predicted it would go, and how much pleasure and achievement you thought you’d get, with how it actually went by completing the same ratings. If they’re the same, try again but think about the feelings you had before the activity and how they might have influenced the final outcome. For example, if you believed that you wouldn’t enjoy going to the pub with your friends because your DPAFU would be worse in a confined space and smoky atmosphere, the chances are that you’d be right as you would have paid so much attention to the atmosphere, your feelings of DPAFU and how right you were that you wouldn’t enjoy the activity. You’d fail to notice the positive aspects, such as being with your friends. It’s also worth reading through the section on managing anxiety. This will help you see whether anticipating events, or ruminating on them, lowers your mood.

It is clear from talking to people who suffer with DPAFU that they do begin to avoid social situations and being with other people. To start with, this can be in very subtle ways. Eventually though you can end up avoiding other people as much as possible. People often explain that they feel unconnected to, or unreal around, other people. They may also worry that people will think they’re somehow odd. Social isolation affects mood in a number of ways: lowering your mood and reducing your self-esteem and/or self-confidence. Not being around people also confirms your belief that you are ‘odd’ and that others will see that there is something wrong with you. It also reinforces your disconnectedness from others. Again, these ideas become a negative and circular argument.

You can apply the same strategies to low mood or depression as you do to your DPAFU. First, identify all the things you believe that DPAFU sensations stop you from doing and the things it makes you do more of. Then think about how much pleasure, stress, distress or satisfaction each one gives you. It may seem obvious that you wouldn’t want to repeat the things that made you feel bad, but what about the things you used to enjoy and/or gave you a positive feeling? An example might be going to the cinema. Maybe you’ve stopped going because it made some of the sensations associated with DPAFU worse. But this may have been at the expense of going out with a good friend on a regular basis. Begin to schedule these activities back into your life gradually. But be careful not to overdo things all at once; this may leave you feeling exhausted or overwhelmed.

When you begin to recognize how you’re feeling, you can begin to link the thoughts, feelings and behaviors that accompany each mood and you’ll begin to notice the impact your thought patterns have on your mood and behavior.