METHODS FOR COPING WITH DEPRESSION

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Level IV: Cognitive Methods (chapter 14)

 Build a more positive self-concept. More and more evidence is accumulating that positive self-esteem is an antidote to depression. Examples of helpful action: make more positive self-evaluations by noting your successes, abilities, good morals, traits, and actions (Homme, 1965; Vasta, 1976). This is especially important for the depressed people who have a severe internal critic. You must challenge and silence your unreasonable critic. Also, personal pride comes from believing that your successes are due to skills and discipline you developed and utilized to meet a challenge. Being successful because you inherited wealth or a good brain doesn't build the ego as much as "coming up the hard way."

 If a person grew up in a non-rewarding, inattentive family, he/she may feel like an underdog and have little self-respect. Such people frequently drift towards "a bad crowd" and become antisocial because they gain some self-esteem in that way (Kleinke, 1991). They will probably need more than a shot of self-administered esteem-building cognition; they may need new social skills, educational-career-life plans, and a different peer environment. It takes courage to leave friends, especially if they are, for the moment, our only support system.

 See method #1 in chapter 14 for an extensive discussion of building self-esteem. It is very important. Evidence suggests that self-esteem buffers us from the onslaught of anxiety, guilt, depression, shame, criticism and other internal or external attacks.

 Challenge faulty perceptions, irrational ideas, automatic ideas, faulty conclusions, and excessive guilt. If your "automatic negative thoughts" slip by too quickly for you to notice (but they still cause sadness), try starting your search for the negative thoughts at the moment the emotions occur. Ask yourself, "What was I thinking when I got upset?" Or, "What was my view of the situation when I started to feel depressed?" These questions and the answers may help you uncover the well hidden self-blaming antecedent thoughts or interpretations of the situation. Write down your thoughts, then objectively ask:

 Examples:

 These methods, primarily from Beck and Ellis, involve detecting very primitive thoughts, checking their accuracy and replacing the harmful, inaccurate ideas with rational thinking (often based on observations of what really happens around us). Here are some more specific examples of methods:

 Tolerance training (challenging your irrational demands). Learn that you don't have to get what you want and that you can't always avoid unwanted outcomes. Challenge the "tyranny of the shoulds" or the "musts." Examples: "Everybody should like me" (that's impossible!). "I must have a lover" (learn to enjoy being alone for a while). "They shouldn't lie to me" (they have their problems). There are reasons for everything; learn them and accept reality. This is discussed more in cause #6 above and in methods #3 & #4 in chapter 14.

"Whether or not it is clear to you, the world is unfolding as it should."
-Desiderata

 Challenge false conclusions. The depressed person has been preprogrammed to think negatively and irrationally. This is not a conscious, intentional effort to come to negative conclusions; it is an automatic process. You just assume your negative thinking is right because you have always thought that way and no one has challenged your thinking. Now, you have to be your own challenger:

 If some relatively minor event (not like death or divorce) has gotten us down--and we have stayed down too long--we must examine our conclusions about that event. Remember that depressed people demand too much sometimes, get obsessed with a loss, blame themselves (no benefit of the doubt), let events get them down, and don't think they can do anything about the depression. That is the nature of depression and low self-esteem. They see no silver lining, no light at the end of the tunnel, no opportunity for growth in this crisis. They aren't thinking rationally (see cause #7 above).

 Avoid assuming responsibility for bad events and feeling guilt on and on. Recognize that it is unreasonable to assume that you are responsible for just the bad things in your life and not the good. Try to reduce your focus on your faults that may or may not have caused some loss in the past; instead, focus on your strengths that could improve your future. Likewise, guard against dwelling on and re-living the bad events and overlooking the good. Refer to #4 above. Flanigan (1996) offers advice about putting the past behind us and find self-forgiveness.

 Unlike Seligman's dogs, challenge your assumptions that you are helpless. Acquire Learned Optimism and the courage to "give it a try," and you are on your way to success, more friends, less depression, and better health (Seligman, 1991). In all the specific actions for coping with depression, optimism is important: to some degree, the effectiveness of all anti-depression methods is a function of how much the user believes in the methods (Kirsch, Mearns, & Catanzaro, 1990).

An optimist sees opportunity in every calamity; a pessimist sees calamity in every opportunity.

I am the master of my fate. I am the captain of my soul.
-William Henley

 Are optimists born? Maybe (watch a 1-year-old trying to walk). Certainly optimistic parents are a fortunate beginning, but even with pessimistic parents there is hope...(an optimist sees how change is possible). Until we are about 8 years old, we tend to be optimists. By mid-adolescence our thinking style is either optimistic or pessimistic and it tends to stay that way for the rest of our lives, unless we are persuaded or choose to change. Hope and self-direction are critically important factors in the outcome of human lives. Please pay attention if you are a pessimist. It's hard to become an optimist, requiring careful attention to every thought. The keys seem to be learning that (1) every failure is an opportunity to learn, (2) we can change, and (3) success depends on effort.

 If you do any of the following: set your goals too low (nurse's aide instead of MD), expect to fail or to be disliked, feel things aren't ever going to go well for you, believe you just don't have the ability or the personality needed to succeed, or have other pessimistic thoughts, then you need "learned optimism." How can you get rid of the negative, defeatist ideas? Well, you might be able to just ignore the pessimism. But if you have brainwashed yourself well, then you will have to question the validity of your pessimistic ideas. Most self-putdowns are wrong, especially in the sense that most people could accomplish a lot more than they do--they sell themselves short. So, attack those self-destructive thoughts by deciding to think clearly and objectively, like a wise adult, about your feelings.

 Look carefully at the typical pessimistic message: everything is terrible, always will be, and I'm to blame. This is close to Murphy's Law: Whatever can go wrong will. This is harmful, depressing crap you are feeding yourself! Recognize that these thoughts are a "left over" from an earlier time when things were going badly or someone was stuffing you with pessimistic thinking. Times have changed; the situation is different; you can be different. Rather than "nothing works out for me," how about "I'll try something new today." Rather than "he didn't want to play tennis with me--no one really likes me," how about "maybe he was busy," " maybe he isn't very good at tennis," or " I'll bet he'd like to do a lot of other things with me." For optimism it is important to have self-esteem and self-efficacy--faith in your ability to change things based on past experience (methods #1, #4 & #9 in chapter 14).

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 You Too Can Learn To Be Optimistic

 Pessimism provides an important explanation of depression and learned optimism provides a means of recovery from hopelessness and depression. In fact, being optimistic has many advantages. A recent book chapter written by Shatte, Reivich, Gillham & Seligman (1999) describes an experimental depression prevention program for children (Penn Optimism Program or POP). Depression and feeling helpless, in part, comes from using certain learned ways of explaining things. Example: a depressed child tends to blame him/herself for things going wrong ("I'm so dumb") and sees the cause--his/her dumbness--as stable and influencing almost everything ("I mess up all the time and always will"). Even though still self-blaming, the child who says, "I did poorly because I didn't study enough," is much more optimistic because a change is possible--a solution is available. An optimistic child often thinks troubles are caused by external factors which are changeable or avoidable and have limited influence, i.e. "I can avoid this minor problem." Not uncommonly, the explanations may involve external but untrue causes ("The teacher has it in for me" or "He meant to hit me") and need to be changed to more self-responsible thoughts ("I'd get better grades if I studied" or "Maybe I bumped him."). To start thinking more optimistically and accurately requires careful attention to and explicit instructions (from trainers or yourself) concerning the details of one's thoughts and reasoning. No easy educational/therapeutic/self-help task.

 In 12 weeks, the POP 2-hour groups of 10 to 12 depression at-risk children were taught (a manualized curriculum) to recognize how their interpretations of the causes of problems lead to their feeling depressed or optimistic, helpless, angry and so on. Then each child was given "reattribution training," i.e. they were taught to use an optimistic "explanatory style" rather than a pessimistic line of reasoning (see Cognitive and Rational-Emotional methods). In this program, the POP staff taught children to think of many alternative explanations--both optimistic and pessimistic--of behaviors and, then, to decide which causes are the more accurate explanations, asking others for feedback in the process. The training demonstrated that pessimism leads directly to "catastrophic thinking" about the future. To counter this, the POP children were asked to write out their predictions of the future ("I'm sad because my Dad will probably leave") and then check how realistic those expectations really are (How often do other parents fight? Does that mean they will divorce? If divorced, does that mean you wouldn't see Dad? Are some kids happier after divorce?). The children come to see that optimism is a necessary part of problem-solving too, because in order to find a solution one has to consider the more relevant, more useable, more powerful ways of influencing the problem situation. So, the POP program also trained children to identify the best ways of changing or accepting bad situations... that's realistic optimism.

 In conjunction with or in addition to more optimistic reattribution training, the 5th and 6th graders in POP were taught several cognitive skills: assertiveness, negotiation, relaxation, anger and sadness control, how to deal with procrastination, social skills, and decision-making. The results were impressive. As intended, the 12-week treatment program resulted in more optimism when compared to a control group. More importantly, only twelve percent (12%) of the at-risk children in the treatment program had suffered moderate to severe depression by the end of the 24 month follow-up period. However, thirty-eight percent (38%) of the untreated matched control group had suffered depression. Apparently, teaching cognitive methods for increasing optimism and accuracy in thinking as well as a variety of other coping skills helps prevent depression. If a 12 week, 2-hour-a-week psychology class can reduce childhood depression in at-risk children by half or 2/3rds, surely the world needs to pay attention. _______________________________________________________________

 Whenever you have a self-defeating pessimistic thought, ask yourself these five questions: (1) Is it really true that you are helpless in this situation? How certain can you be that something unavoidable and awful is going to happen? Are you sure you couldn't get an A in math? Why couldn't you build your own house? What are the real chances of a catastrophe? (2) Is there another way to explain this event? Did he/she leave me for other reasons rather than my being boring? Find as many possible reasons as you can. (3) So what, even if it is partly true? Must it last forever? Must it mess up everything? Suppose he/she did think you were a little boring, there is a lot more to it than that. Besides, it won't be hard to become more interesting to someone else. (4) Is this pessimistic idea doing me harm right now? If so, put it aside. Of course, you must not hastily dismiss every pessimistic idea: it is wise to heed your negative feelings about many things, such as driving while drunk, getting into a fight, burning down your house for insurance, etc. In short, simply insist that the negative idea be rational and useful before it shuts down your life. (5) What is the best possible outcome I can hope for in this situation? Logically, what do I need to do to turn this crisis into an opportunity? Question the rational basis for your guilt (see guilt section above and method #4 in chapter 14).

Optimists, who try the hardest, believe success depends on effort, not on innate ability or luck or social class or looks. So, work harder and become an optimist. Be responsible and become proud.

Attribution retraining

 The depressed person is prone to believe "this bad situation will never get better," "it will ruin my whole life," and "it's all my fault." If those views of the situation were accurate, the person has a right to be depressed. However, these pessimistic views are never accurate.

 Changing your explanation of the situation can change your emotional reactions, obviously. If you shift your attributions so that you see yourself as less responsible for an unfortunate happening (divorce, failure, accident, thoughtless inconsiderate act), you should feel less guilty or depressed. If you change your attributions so that there is more hope of improving the situation in the future, even though you are held more responsible for the unwanted situation, you should feel less hopeless and more self-confident. For example, deciding "I'm going to have to work harder to succeed" is self-blaming for past failures, but it may be an accurate and hopeful assessment of the situation because you can work harder.

 Likewise, starting to see an unpleasant situation as being caused by temporary or easily changed causes is hopeful (as compared with unchangeable causes). Example: "My grades were low because I had the flu... (or) I tried to study in the living room where there is TV, stereo, and lots of activity." Also, if the cause of an unwanted situation influences very few other things (vs. a cause that disrupts almost everything), that is a happier situation. Example: being six foot seven inches tall may only keep you from being a fighter pilot but a bad temper may destroy many jobs and relationships. Finally, depressed people use several attributions that may at first seem unchangeable (low ability, bad luck, they're against me), but these causes can be seen as modifiable (learn skills, change luck, avoid or disarm enemies). There are so many ways to make changes, we should almost never feel powerless.

 For practice at changing your attributions (these are old thought patterns that don't change easily), try listing your weekly successes and explain them in terms of your personal traits and skills that are rather permanent and potentially useful in several areas of your life. This also keeps you from dwelling on your failures. Example: "My grades in math and social science went up because I learned to get myself organized every day, to enjoy studying these topics, and to use the SQRRR study method." (See #4 above)

 Successful self-help projects build confidence in your ability to make your world better (see self-efficacy in chapter 14). Sounds simple but much is involved: you must select some meaningful life goals, then acquire knowledge, skills, and role models so you can achieve these goals, and finally exert considerable effort so the achievement of the goals creates pride. Just saying "I can help myself" is not nearly as impactful as actually changing yourself (sort of like saying "I care for starving kids" and doing nothing versus saying "I care" and actually taking a hungry child on your lap and feeding him/her).

 Consider failure to be a sign you need to work harder or need more practice, rather than proof you are "a failure." Moreover, wise people have advised "learn from your mistakes" and "make mistakes--lots of mistakes--just don't make the same mistake twice." If we can take that attitude, i.e. "I'm just learning to master this situation," we could be much more tolerant of our failures. We don't have to succeed. Many great people have only made it by having the courage to face repeated failure: Lincoln, Van Gogh, Frank Lloyd Wright, Gertrude Stein...

 Watch for and change your overly negative, unquestioned, self-blaming thoughts. Example: "I got a 'C' because I'm stupid" (no, because I didn't study enough or have good study methods. I can't judge my ability to do school work until I put my best efforts to an extensive and fair test).

 Observe the relationship between your thoughts and mood; prove that "illogical thoughts cause my depression, not my stupidity, looks, or badness...and I can change those damned thoughts." Also note expectations and outcome: if you expect little or nothing of yourself, you'll probably do poorly. If you expect to do impossibly well, you'll certainly fail. Your ambitions need to be challenging but realistic.

 Guard against self-handicapping (discussed in chapter 4). This is where you claim to have a handicap, perhaps "I'm sick," "I was up all night," "I have test phobia," "I didn't prepare," "I'm nervous and shy," "I've had a bad experience," "I'm on medication," etc. These handicaps are designed to excuse a poor performance (if that is the outcome); thus, prepared-in-advance handicaps reduce our motivation to do well. It is true that no one will be able to tell how able or disabled we are as long as there is no accurate test of our ability. That's the real pay off. But there are costs: we never get to know ourselves, we are likely to feel inadequate (we know we haven't tried), and we get little pride from always being handicapped.

 Guidance. If you have no purpose, if you are bored, if you feel worthless or guilty or irresponsible, you need a guiding, inspiring philosophy of life. See chapter 3 quick. A meaningful life needs to have a purpose that firmly guides what you do every day. Life's purpose doesn't have to be grandiose or religious, but it should increase the good in the world and reduce the bad; it should make you proud. Self-esteem and self-efficacy also involve wanting to learn, mastering challenges, and developing skills and competencies. Your 2 1/2 pound brain is a fantastic organ. Don't waste it.

 Lowering your aspirations. Disappointments could be reduced by lowering your aspirations and/or just accepting reality ("that's just the way the ball bounced"). See 29b. Guard against frequent obsessions with personal faults, such as being only average in intelligence, being small and skinny, being tall, being "ordinary" looking, having ugly ears, being shy, not catching jokes, and so on. Many of these worries are not correctable or don't really matter; other worries can be changed, but they aren't solved by just feeling depressed about the problem.

 Determinism or humanism. A deterministic view of how the world operates can make one more tolerant of oneself, more accepting of others, and more hopeful of the future (method #4 in chapter 14). Self-acceptance may also come from a humanistic viewpoint in which each person is intrinsically respected, valued, and loved. Each human is different and makes an important unique contribution to the world (Jampolsky, 1979; Buscaglia, 1972).

 Religion. Finding comfort in a religion and acceptance in support groups has helped many people overcome depression. Every community has several religious communities. There are many self-help groups (or you can start one). There are also televangelists, many religious writers, and spiritually oriented psychologists, such as Jampolsky (1985) and Peck (1993). See the discussion of self-help groups in chapter 5 and religion in chapter 14.

 Look to the future. Sometimes the heavy weight of today's burden is lightened by asking: What will life be like next month? in six months? in a year? in five years? in ten years? All things change. Given a more distant perspective, there may be less gloom and more hope.

 Talk yourself up. As with anger, we can learn to interpose positive thoughts or self-instructions between the disturbing event and our emotional reaction so that the sadness is reduced. For instance, as discussed in chapter 14, suppose you have just been told by your boy/girlfriend that they want to terminate the relationship. How can you reduce the pain and depression? The pain can't be avoided but it may be dulled and shortened a little. Look for positive aspects: "At least a decision has been made" and "It's good that I found out now about her/his being unsatisfied, rather than after we were married." Look for your good points: "I'm proud of how I handled the relationship" and "I didn't try to just be what he/she wanted; I want someone to love the real me." Look for support from others: "All my friends will support me; some didn't think he/she was a good choice for me any way." Look for a positive future: "I will be a better companion in the future and I know a lot more about what I want in a relationship."

What seems nasty, painful, or evil, can become a source of beauty, joy and strength, if faced with an open mind. Every moment is a golden one for him/her who has the vision to recognize it as such.
-Henry Miller

 If a loss can be anticipated (like a death), realistically facing the situation, discussing it with others, and emotionally "working through" the loss can reduce the impact. Also, if the loss can be seen as less personal ("it's not my fault") and less catastrophic, it should be less depressing and you will probably have a quicker recovery.

 Note: obviously some of the behavioral and emotional suggestions given above are partly cognitive in nature too.


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