Managing Your Depression (14 page)

 
UNDERSTANDING THE ORIGINS OF YOUR THOUGHTS 

Sometimes the thoughts that bother us come from situations long ago, but the thoughts stay with us, even though they no longer apply. Spending time reacting to old thoughts does not help your current situation.

Ask whether your distressed thought or reaction applies to the current situation or to events in your past. Does it apply now? If it does not apply now, try to put it aside.

Pleasure and Mastery

Add some Pleasure and Mastery activities to your week, even if you don’t feel like it or don’t feel that you deserve it. It is not enough to eliminate negative experiences from your life. You also need to have positive and pleasurable experiences. Pleasurable activities will help decrease the chance of your depression symptoms getting worse. They are a way to help yourself, part of your Relapse Prevention plan.

Create a list of pleasurable activities that you like to do, or used to like to do. Choose to do some of these regularly, and add them to your schedule.

Next, list activities you like that challenge you, that provide you with a feeling of competence and effectiveness. They should be a little difficult for you to do (such as overcoming an obstacle or learning a new skill). These are called Mastery activities. Choose to do some of these on a regular basis, and add them to your schedule.

Pleasurable Experiences

We each have our own preferences for pleasurable activities. Here are some examples:

What is pleasurable for me?

 
PLEASURE AND MASTERY 

Pleasure Activities

• Things I like (or used to like) to do …

Mastery Activities

• Things I like (or used to like) to do that challenge me and give a sense of competence and accomplishment …

CHAPTER 7
Strategies to Get You through the Tough Times

The life skills described in this chapter can help you through some of the rough times. A few of the approaches are a review from previous chapters, included here as a reminder because they can be difficult to remember and do when depressed. You will learn strategies for Coping and Stress, Mindfulness, and Distress Tolerance. In addition, there is an overview of Communication Skills, with recommendations for Dealing with Family and Friends and Talking with Your Doctor, as well as Tips for Family and Friends.

Coping and Stress

Stress is an emotionally and physically disturbing condition you may have in response to challenging life events. When you are suffering from depression, dealing with stress can be more difficult. It can also make your depression worse and contribute to relapse, or a return of symptoms.

Stress can come from events inside or outside you. The causes and intensity of stress may vary from person to person, but common causes include:

• real events in life (positive or negative, e.g., marriage, divorce, birth, job, finances, a major loss)

• relationships

• an illness

• change (of any kind)

• your environment

• overload of responsibilities

• an unresolved conflict

• a situation not under your control

• uncertainty while waiting on an unknown outcome

You can actively take steps to lessen the effects of stress and decrease your vulnerability to stressors. This is called
coping
. When you manage stress using effective Coping Strategies, you decrease the negative effect that stress has on your depression.

Coping Strategies include ways to prevent and prepare for stress as well as skills for managing it when it occurs:

1. Maintain a regular schedule and structure of activities. This includes optimizing your sleep, diet and nutrition, exercise, and self-care.

2. Manage the little daily stressors.

• Prioritize your responsibilities and activities.

• Keep yourself organized.

• Maintain a schedule but don’t overschedule, and adjust as needed.

• Break down large or complex tasks into smaller pieces that are more manageable.

• Keep a to-do list and a daily reminders list.

• Write things down in a notebook, including healthcare-related questions and instructions.

• Use a daily pillbox for your medications, to keep track of when you took them.

• Develop a system that you like and that works for you to manage the mail, bills, and housekeeping.

• Avoid overstimulation.

• Be mindful, in this moment.

3. Use CBT strategies. An event can cause stress depending on how you interpret it in your mind. Usually we interpret events based on individual beliefs and past experiences.
Sometimes we also interpret events with distortions in our thinking. Challenging these distorted thoughts and interpretations using cognitive behavioral therapy can affect the way you feel and respond and can improve your level of stress.

• Use the CBT exercises (see
chapter 6
).

• Keep a journal of your thoughts and feelings.

• Identify the sources of your stress. This will help you respond to it in a more effective way, when you know what you are dealing with.

• Be assertive in your communication—this helps you to feel in control of your situation.

• Keep your perspective.

4. Use problem-solving strategies.

• Speak with someone (a friend, therapist) for help as you work out a problem.

• Get accurate information about the problem to make an informed decision.

• Evaluate and define the situation realistically.

• Consider your options and the alternatives.

• List the pros and cons of your options.

• Seek additional assistance as needed.

5. Distract and refocus your attention.

• Occupy your mind with other thoughts and activities: puzzles, reading, hobbies, sports, gardening, or other things you like to do.

• Volunteer your time; reach out to others.

• Replace your current emotion with another (e.g., by watching a movie or reading a book that is funny or scary).

• Leave the situation aside mentally for a while.

Coping Strategies

Try any of these examples of Coping Strategies to find what works for you. The more familiar you are with your options, the easier it will be to remember them during stressful times or an episode of depression or mania.

• Ask for help.

• Don’t give up.

• Do the best with what you have available to you now.

• Focus on what matters.

• Seek a solution to the problem.

• Seek out the facts. Identify and challenge any inaccurate assumptions and interpretations.

• List your options.

• Examine the Evidence For and Against.

• Try an alternative approach, a different way of thinking.

• Anticipate, think, and plan ahead.

• Be active, not passive.