Overcoming Depression and Worry

The Main Contents

The Self-Help Information in the Article

Part One
The Causes of Depression

I don't go for this auto-cannibalism. Very damaging.
--Peter O'Toole, on psychoanalysis

A psychiatrist asks a lot of expensive questions your wife asks for nothing.
--Joey Adams

Helen thinks:

I know all my worrying is unhealthy really, but I can't seem to stop myself. It must be bad to spend hours lying on my bed every day like I do, just feeling upset about what's gone wrong. And as soon as I go to bed at night, I start mulling over the worries of the day again and all my problems, worrying and worrying about how bad things are without determining how to solve my problems. But I can't seem to help it or motivate myself to do things. But hopefully, there is a way to get better after all, like Alison says. I'll go to the library and see if I can get that book she mentioned out, and look on the Internet at those websites she suggested. ...

When the Brain Doesn't Seem to Work

[Later On] I'm glad I did that. Now this is interesting information.

It talks about relaxation, and why depressed people can feel so bad and find it difficult to sleep. It says that us depressed people can find it difficult to think of solutions to our problems because we get so emotional. It says that when we worry and worry, we can work ourselves up into such a state that the brain thinks things are getting towards crisis level, and a part of the brain called the amygdala floods the brain with so many emotional signals that it blocks the intelligent part of it from functioning, so we can find it much more difficult to solve problems or make decisions.

Oh, I wonder if that's why I have problems with such small things sometimes, like thinking it would be nice to have a sandwich, but not even being able to decide whether I want cheese or peanut butter, so I end up not having anything and going hungry. Or it's similar when I'm in a supermarket and holding two packets of soap powder, taking minutes deciding which one to buy. I feel as if my brain just isn't working sometimes. But maybe that's why.

The Reason it Happens

The information says that the process of flooding the brain with a lot of chemical signals that causes it to become full of emotion and blocks the intelligent side from reasoning much about things makes us depressed, and so we might wish it didn't happen. But it's designed for something different, for when people are in extreme situations that might be life threatening where they have to act quickly, where it's beneficial to have the intelligent part of the brain temporarily closed down, because we can't spend time deciding on things, because to stop and consider all our options before doing anything about the situation might stop us running away in time, and we need the extra emotional tension to motivate us to act quickly.

For instance, if we were in a country where there were wild animals on the loose and a tiger was coming, we'd need to just run away fast rather than stop and consider what was the best thing to do, because it could be eating us before we'd finished. So it's often best that the amygdala, the emotional side of the brain, takes over from the intelligent side when we need to do things in a hurry. It makes us react more quickly, because danger signals always reach it before they get to the intelligent side. That's why thinking clearly can become difficult under stress.

When it Happens at Inappropriate Times, like with Phobias

But the information says that the extreme emotional response is often brought about by inappropriate things. It can happen with anxiety and anger as well as with depression, and even with other emotions. For instance, a phobia of birds can be brought about after a child sees a bird fly into the house and a relative panicking instead of trying calmly to get it out. The child can learn to think they're helpless before birds and that birds can have unwanted control over them and so they're a threat. So whenever they see birds after that, their amygdala will send off danger signals without waiting for the intelligent part of the brain to decide whether there really is any danger or not. The emotional part leaps into gear, imagining it needs to do that, because if there was danger, it might be too late by the time it's allowed the person to think about it. So it does it quickly before the thinking part of the brain can decide what to do.

The signals the amygdala sends out are designed to put the body into "fight or flight" mode, so it can defend itself more effectively or run away faster. The heart beats faster to pump more blood to the limbs where it might be needed to add strength to the body's resistance to the supposed threat. Adrenaline's released into the system. Breathing becomes faster to enable more oxygen to be pumped into the bloodstream where it can go to the muscles to give them more energy. Since these responses are triggered off sometimes when they aren't actually needed, they cause the symptoms people think of as panic attacks.

That's why people with phobias can know their fear is irrational, but they might not know what they can do about it, since the fear comes on them automatically and suddenly. But they can re-train their brains to stop sending out the signals.

That's interesting, because I've had a few panic attacks. It doesn't talk about them much here, but it does recommend other information about those. Maybe I'll investigate it when I've read through all the material about depression.

When a Similar Thing Happens to Angry People

The information says that similar things happen to angry people. When someone allows themselves to fly into a rage, the emotional side of their brain floods it with so many signals that they can't think intelligently. It's the same fight or flight mechanism that works when they're scared of something, that'll give them the energy to attack someone or something or run faster if they need to. But it means that their possibly otherwise average or good reasoning abilities vanish, and their brain becomes stuck on one track - "I want ... I want ...! How dare you! If you don't stop, I'm going to do ..."! It says it's very difficult to have an intelligent conversation with a person in a temper.

Maybe that's why my old boyfriend seemed so unreasonable when he was angry.

When it Happens with Depressed People

It talks about that because it says that similar things happen with depressives. It says we'll often work ourselves up into a terrible state by worrying about things excessively. This will trigger the amygdala to flood the brain with so many danger signals that again, the intelligent side of it can't function. That's why we can so often think there's no hope, or our lives are ruined, and think the worst about things, instead of thinking through all the options we have in trying to solve our problems and seeing things as they really are, whereas when we're calmer, we can realise that there are actually quite a lot of things that could help us.

That's interesting, because when I'm really depressed, I'm convinced that the reality is that everything's hopeless and ruined. But I don't think like that when I'm not depressed.

The information says the next time we're in a similar situation to the one where our worry ended up making us feel so bad, the brain will remember that that type of situation triggered off the danger signals before and trigger them off again, so we'll get anxious and upset all the sooner. The system is designed to gear a person for action rather than thinking, which could take too long in a crisis where speedy action was necessary. In the case of depressives, the equivalent of the fight or flight response can be the urge to commit suicide to escape the situation.

What We Can Do About It

It says that depressed people need to calm down every time we notice we're beginning to work ourselves up into a state by the way we're thinking, so as to be able to allow the intelligent side of our brains to begin functioning properly again, so we can think of solutions to our problems. If we can calm down whenever we start to worry too much, we won't be endlessly tormenting ourselves by worrying without coming up with solutions, where we just make ourselves miserable and keep ourselves awake at might. The information says that a number of things can help us depressed people prevent the emotional side of our brains from flooding the rest with so many signals we can't think clearly. It says we can re-train our brains to react differently.

It says that relaxation exercises can help us do this. They can even help to prevent suicide, because if we're in an emotional state, our brains might be stuck in an unhealthy thought pattern where all they can think of is that everything's gone wrong. Relaxing can cause the emotional signals to subside, so the intelligent part of our brains can take control again, so we can find it much easier to start thinking things through intelligently, realising things might not be as bad as we think, and solving our problems again. It says that usually, there will be things we can do to make the situation that upset us so much better, but in our emotional state, we just won't be able to think of them. So we might think things are disastrous when they aren't really.

Lack of Motivation

It says that Depressed people are often unmotivated to do much, losing interest in doing things even if we loved to do them before.

Yes, that's true for me. I used to love doing gardening and cooking, but I just don't feel like doing those things now.

The information says we can solve the problem of lack of motivation quickly, when we learn to stop worrying so much and get a better sleep. That'll refresh us properly, so we'll feel like doing things again. It says it explains how we can do this.

Different Types of Sleep

But first, it says that the problem of feeling too unmotivated to do things happens partly because we don't have the energy. It says that that's a result of our worrying and the way it affects our sleep. It says there's more than one type of sleep, slow-wave sleep, which is the refreshing kind where minor damage to the body is healed, energy levels are topped up, and the brain gets refreshed, and REM sleep, where we dream.

It says depressed people have more dreaming sleep and less refreshing sleep than other people, and we start having long periods of dreaming sleep much earlier in the night than other people, before our energy levels have had a chance to be boosted much by the slow-wave sleep.

Worrying is the Reason Depressed People Have More Dreaming Sleep

It says that according to recent research, when a person dwells on things for hours, thinking about how bad they are, working themselves up into a state, not coming to any conclusions about what to actually do about the situation, which is a common depressive habit, emotional energy is stored in the brain. Because a solution to the problem hasn't been reached and given us relief, or we haven't got our feelings about it out of our systems during the day, the emotional energy doesn't have a chance to ebb away.

It says when a person finally gets to sleep and dreams, emotional energy is discharged by the brain trying to sort through the events of the previous day or two and release the emotional energy all the worry caused so the brain can be refreshed for the following day. It says that the reason why people dream is to sort through events and get rid of emotional energy.

Examples of Ways that Dreams can Release Emotional Energy

So someone who was made angry by something someone said but didn't express their feelings about it might dream about something connected with that, whereas someone who got their feelings out of their system wouldn't. If we planned to go somewhere and were really looking forward to it but then couldn't go for some reason, the feelings aroused by our having wanted to go will still be around in our brains waiting to be acted on. But if we don't act on them, they have to be discharged, which is what happens when we dream.
Similarly, if we had a craving to buy a cake from a shop we passed, but decided not to because we were trying to lose weight, the expectation that we'd enjoy it would still be around in the emotional part of our brain, even though we knew really that we weren't going to have it. So if we didn't satisfy the craving, the anticipation of eating the cake would be released from our system in some kind of metaphorical way when we were dreaming.

It says that cravings and other emotions can hang around in the brain even when we're not aware that they're still there.

The Reason Things Work That Way

It says things have to work that way, since if we kept having emotions that we didn't respond to and there was no way we could get them out of our systems, the brain would rewire itself to stop them affecting us in case they damaged us, and then they wouldn't be available to us when we needed them. So a tree might start falling down near us, for example, but it wouldn't alarm us, because we'd have been desensitised to the feeling of alarm to stop it hanging around in the brain and disturbing us, so we wouldn't bother getting out of the way and we might suffer dire consequences. So dreams are a harmless way we can get rid of stored emotions.

Other Reasons Emotional Energy can Build Up in the Brain

It says the things that can cause emotional energy to build up in the brain can even be things like watching something on the television that scares us, or something that makes us angry, even if it's just something that's happening to a character in a drama series who we can identify with. If we carry on thinking about it, we won't have got the emotions out of our systems before we go to bed, so they'll need to be discharged in our sleep.

Why Depressed People can Wake Up So Tired and Unmotivated

It says that the release of emotional energy is meant to clear the brain of it and so refresh it for the following day. But depressives have so much emotional energy stored in our brains by the time we go to sleep that we dream more than most people while the brain tries to discharge it. Discharging it takes up energy. It says that the brain can use up a large amount of energy when it's dreaming. So instead of refreshing us, it has so much work to do that by the morning, we're worn out instead, so we wake up still tired.

Well, I know I often wake up tired! I don't notice myself dreaming that much.
But it says that often, people can't remember what went on while they were in REM sleep, because dreams aren't usually meant to be remembered.

It says that sometimes, depressed people wake up tired a couple of hours before we want to, but can't get back to sleep, but that can be because the brain won't let us go back to sleep because it can't cope with any more dreaming sleep that would exhaust us even more, since the couple of hours before we wake up is usually when we have most of our dreaming sleep. It says it's as if the battery's flat.

It says that what prompts the brain to start and carry on dreaming every night is an electrical signal that fires off in the brain every so often before and during our dreams, a thing that tells our brains during the day when something new's happening, for instance if we suddenly hear something or see something different, or smell something we weren't expecting. Whenever we do that, the electrical signal fires off. It's part of the survival mechanism that alerts us to things that might possibly be danger signs, or just helps us alert ourselves to interesting things, so we can do something about them.

But so much energy has been discharged in dreaming sleep that the electrical signal doesn't fire off nearly as much as it should in the morning, so it doesn't perform its normal function of alerting us to what's going on around us so we can switch attention from one task to another, see what needs doing and get interested in different things. So it's difficult for us to motivate ourselves to get going, and hard to do things that require even small shifts in our attention, like getting dressed, making a phone call or eating properly.

Maybe that's one reason why I find it so difficult to get out of bed in the morning, and why I don't feel like doing anything when I do.

It says that because we can't get ourselves interested in things, we can feel as if everything's meaningless and not worth doing. Our energy levels will recover a bit during the day, but then if we start the worry cycle off all over again, probably with the extra worry about why we feel so tired and unmotivated to do even little things, we'll build up a whole new lot of emotional energy that needs discharging in our dreams, so the next morning, we'll feel just as exhausted again.

And the same thing can happen day after day.

It says that in the laboratory, it's been found that when depressed people have been woken up when they've started having REM sleep so they don't dream so much, they don't feel so depressed the next day.
Interesting.
But it says that when people are allowed to sleep normally again, they have more REM sleep than usual to make up for it, so they feel worse.

The Depressing Effects of Watching Television

It says that watching television can have the same exhausting effect on us, since so many things keep happening to grab our attention on the television that our electrical signals keep firing off until they use up all their energy. It says that research has found that people who watch it for long periods end up feeling tired and less able to concentrate. So it says it's not a good idea for people to watch a lot of television when we're depressed.

It says that exercise, on the other hand, or doing hobbies, can improve our mood.

Some Counselling Can be Harmful

It says that some counsellors think it's important to encourage depressed people to dwell on the bad things that have happened to us, to try and find out the cause of our depression. But dwelling on bad things will just make us worse, because of all the emotion it will cause us to build up that'll need deactivating at night during the dreaming sleep that'll tire us out.

It also says that dwelling on negative things familiarises the brain with doing that, so it comes more and more easily, and thinking of positive memories gets harder the less we do it, because the brain isn't used to it.

That's probably what happened to me, partly.

The Problems with the Kinds of Worries Depressed People Tend to Have

It says that a lot of the things depressed people worry about can't be deactivated during the day by us taking action, because the worries aren't about things that can be resolved in practical ways, like a person's anxiety over an exam could when they'd taken it, for example. It says the kind of worries depressed people have usually can't be deactivated like that, because they're much more vague, or they don't have obvious solutions.

For example, we can just brood for hours on things that happened in the past, or things that didn't happen that we wanted to happen, that we can't do anything about now. Or we can helplessly turn worries over and over in our heads about things that we think are far too complicated for us to know how to deal with.

Yes, I'm always doing that.

It says that as we get more and more upset, we might be full of exaggerated worries, like worrying about how we can possibly entertain a few guests who are coming to our home when we're so hopeless at everything we do; or worrying over whether the slight grumpiness of the love partner we've had for years means they're going to leave us, and that we just wouldn't be able to cope if they did; or whether people hate us because we must be making them miserable by being so miserable ourselves; or why we're so miserable all the time. We can think thought after thought like that that makes us even more convinced that things are hopeless, because we can't think clearly enough to get a balanced view on things, because the emotional part of our brain's blocking the intelligent side from functioning well because we're too worked up.

So we might have a stream of thoughts like,
"I always make a mess of things.
He's going to think I'm a failure.
This whole thing's bound to go wrong anyway.
And since the world's in such a terrible state, what's the point of trying?
Why should I even bother going on anymore?"

Yes, I know my thoughts can be a bit like that.

The information says that our thoughts just make us more and more upset. So they fill us with unexpressed emotion that has to be released from the system when we're dreaming. If we thought about our problems realistically and thought of solutions to them, and resolved to take action about them, or found solutions to them earlier in the day and took action then and there, the emotion would be deactivated while we were awake, so we wouldn't have to get rid of it in our sleep. But since we don't come up with solutions to our worries, that doesn't happen.

Getting a More Refreshing Sleep

It says that we can help ourselves to get a more refreshing sleep if we can spend the time that we'd normally spend worrying about things without actually deciding what to do about them doing relaxation exercises instead. It says they'll distract us from our upsetting thoughts so we don't spend the time worrying, because we're doing them instead, and they'll calm us down from the upset state we might have begun to get ourselves into. Then we won't be storing up so much emotional energy, so we won't dream so much because the brain doesn't have so much of it to discharge, and so we'll wake up more refreshed, and so more motivated to do the things we used to like to do before. It says that relaxation exercises might also put us in a better mood to sleep, so we'll get to sleep much more easily. Then we'll have more of the type of sleep that refreshes our bodies, and that'll be another reason we'll be more energetic the next day.

It describes several relaxation exercises we could do.

It suggests that when we start getting all emotional about something, it could help if we think, "Aha! I know what's happening! My Amygdala's flooding the rest of my brain with more emotional signals than I need. I can take control of this. I'm going to make them subside by doing some relaxation exercises! Then I'll be able to think more clearly about how to solve my problems."

Or if the minute we begin to feel ourselves becoming down, if we say to the emotional side of our brains, "This isn't what I need right now, thanks", the feelings might just go away if we've caught them before they get too bad.

I don't know about that. I'll have to try it.

But the information says that the more we do relaxation exercises, the slower we'll be to become all emotional in the first place.

Part Two
Relaxation Exercises

This art of resting the mind and the power of dismissing from it all care and worry is probably one of the secrets of energy in our great men.
--Captain J. A. Hadfield

The information says that if we can set aside a time every day to do some relaxation exercises, we might feel a lot of benefit, because they might make us feel calmer for some time afterwards. It says there are some easy ones that we'll probably be able to memorise and do whenever we're feeling a bit stressed, like breathing very slowly and evenly for several minutes. It says that that on its own can make people feel much calmer.

But it says that if we like, there are a variety of relaxation exercises we can do, and to help us remember them, we could read the ones they suggest onto a tape.

It says we should Try to make a quiet time for ourselves and do some relaxation exercises every day, for longer when we feel upset.

I think I'll try to set aside about half an hour, or even an hour or ninety minutes just for those before I go to bed each night. I often sit in front of television programmes that aren't really that good in the evenings, so missing them to do the relaxation exercises won't be that much of a sacrifice. Or if I go to bed and then do them, I might lull myself to sleep with them. That'll be good, since I usually do so much worrying at night, so it'll be nice to relax instead. I've got a tape recorder that turns itself off when the tape ends, so it won't matter if I fall asleep during any relaxation exercises I do after I've read them onto a tape.

I think I'll set a time in the afternoon to do a few as well when I'd normally be lying around on the bed feeling miserable.

It gives us some relaxation exercises to do, and recommends we spend several minutes on each one.

Contemplating Making a Relaxation Tape

I think it would be nice to make a relaxation tape, if there's a day soon where I don't feel too depressed to do anything. I could put together my favourite relaxation exercises from the list it gives, and then take a tape recorder outside if it's a nice day, and go somewhere where the birds are singing, so I can use that as a soothing background, and then I can read the relaxation exercises onto tape there.
Or I could go down to the beach one day and record some of the exercises with the sea in the background, or see if I can get a CD of the sounds of waves or other relaxing sounds from the library, and put it on in the background while I read the exercises onto tape.
I could do some with sea in the background, and some with birds in the background.

The Relaxation Exercises Themselves

OK.

I could practice this breathing exercise whenever I have a private moment or when I'm doing something that doesn't require all my attention, since I can do slow breathing while I'm doing other things. Maybe the more regularly I practice, the more relaxed I'll feel during the day.

More Instructions for the Breathing Exercise

It says the first few times we practice the breathing, it can help if we're somewhere comfortable where we won't be disturbed, with our clothes loose so they won't be uncomfortable and thus distracting. It recommends we sit comfortably with our hands resting side by side in our lap, or lie with our arms by our sides, or in whatever position feels most relaxed and comfortable, and it'll be good if we have our legs uncrossed, since our posture will be more relaxed then. It's also often best for most people to close the eyes.
Then it recommends that we become aware of the sensation of our arms, legs and head at rest.
It says it's good if we can breathe in and out about ten to twenty times, focusing our minds on slowly counting, rather than on any other thoughts.

It says we don't have to worry about doing the exercises it recommends exactly right. It says we should just do them in the way it feels best for us.

It says that when we're used to calming ourselves down by breathing slowly, we won't have to make sure we sit somewhere comfortable first; we can just breathe in that rhythm wherever we are, whatever position we're in, whenever we feel tense, or if we're finding it hard to make a simple decision, or if we want to cry, or whatever.

Anyway, back to what I'm going to read onto the tape:

Exercise 2: Focusing Entirely on your Breathing

Make time for yourself in a quiet place, and relax still further by banishing worrying thoughts from your mind by focusing entirely on your breathing. Again, breathe in through your nose, or through partly closed lips if your nose is blocked or something. Breathe out through partly closed lips as well. When you're used to counting when you breathe in and out, you'll be used to the rhythm and won't have to focus so much of your attention on counting. Instead, think of a single phrase when you breathe in, and another when you breathe out. For instance, when you breathe in, you could say to yourself, "I'm breathing in a nice, slow, cool breath", and when you breathe out, you could say to yourself, "I'm breathing out a nice, slow, steady, warm, relaxing breath".

Focus all your attention on your breathing and those words. If any other thoughts intrude, try to push them aside gently and focus entirely on the current breath you're breathing, so you don't start thinking worrying things.

Continue to breathe in and out slowly, saying "I'm breathing in a nice, slow, cool breath" and "I'm breathing out a nice, slow, steady, warm, relaxing breath", thinking about your breathing for four minutes. ...

OK.

Exercise 3: Muscle Relaxation

Lie down or sit in a comfortable chair. Breathe slowly and steadily for a few moments as instructed in exercise 1.

Try to focus on your breathing, and on thinking the word "Relax" as you breathe out, rather than on negative thoughts. [Pause]

Then between each couple of breaths, relax the muscles in each part of your body. Start with your facial muscles:

Tense the muscles in your forehead by raising your eyebrows high for a second or two, and then relax them. Notice how much more pleasant it feels when they're relaxed. [Pause]

Then screw up the rest of your face for a second or two so the other muscles become tense. Tense them up gently, then very slowly release the tension and take time to feel how nice the contrast is when they relax. Then take a couple more slow breaths, focusing your mind on your breathing again. [Pause]

Then gently tense your facial muscles one more time and relax them slowly, concentrating on the feel of them as they relax.

If you can't feel them relaxing, tense them up more tightly first. [Pause]

Tense the muscles in your jaw by biting your teeth together, and then relax them slowly. Feel the tension go out of them as they relax. [Pause]

Then tense the muscle in your tongue by pushing the tip against the roof of your mouth, and then slowly relax it. Feel the tension go out of it. Enjoy the sensation. [Pause]

Then tense the muscles in your lips, by pushing your lips together for a second or two. Then slowly relax them, feeling the tension go out of them. Focus on how relaxed they're beginning to feel while you let the tension go. [Pause]

Work your way down your body doing this technique:

Pull your shoulder muscles up towards your head and then very slowly let them relax. Focus your mind on how much more relaxed they're beginning to feel, and the contrast between the tension and how relaxed they are now. Luxuriate in the sensation.

Remember to take one or two slow breaths as well after every release of tension in each muscle. [Pause]

Then tense the muscles in your chest, by taking a deep breath and holding it for a few seconds. Then let it go slowly, feeling the tension go. Notice the relief. Then keep your breathing more relaxed as it was before. [Pause]

Then gently tense your arm muscles and relax them. Bend your left arm first as if you're trying to touch your left shoulder with your left hand. Relax it slowly, noticing and enjoying the contrast between the tension and the relaxation. [Pause]

Then gently tense your right arm by bending it up, and then gradually relax it, enjoying the sensation of gradual relaxation in it. [Pause]

Then straighten your left arm out and hold it tensely for a couple of seconds. Then very slowly let go of the tension. Focus your mind all the while on how much more relaxed it's beginning to feel now you're letting all the tension go. [Pause]

Then straighten your right arm out, tense it up, and then gradually relax it, noticing the increasing sensation of relaxation in it. [Pause]

Then clench your left fist, and then very slowly unclench it, feeling all the tension go out of it. Focus your mind on how much better it feels now it's relaxing. [Pause]

Then clench your right fist, and then unclench it very gradually, paying attention to the increasing sensation of relief and the ebbing away of tension in it as you unclench it. [Pause]

Then tense your stomach muscles gently by pulling your stomach in, and then relax it slowly. (Do this provided you haven't just eaten a big meal.) Remember to breathe in and out slowly and steadily a few times afterwards, while noticing how much better the muscles feel when they're relaxed. [Pause]

Then gently tense the muscles in your hips and lower back, by slightly arching your back and tensing your buttocks a bit. Hold the position for a second or two. Then gradually relax them, and enjoy the feeling of the tension draining away. [Pause]

Then tense your leg muscles gently:

First, straighten your left leg and point your toes downwards. Hold the position for a second or two, although be careful to do it gently if you're prone to getting cramp in your legs. Then very slowly bend your leg again and release the tension, focusing your mind on how good it feels to relax the muscles. [Pause]

Then straighten your right leg and hold it tense for a second or two, with your toes pointing downwards, and then relax it, gradually releasing the tension in it, focusing your mind on how much better it feels as it's relaxing. [Pause]

After a few more slow breaths, curl the toes on your left foot up tight, and then very slowly uncurl them, releasing the tension in them, luxuriating in the feeling of them relaxing, noticing how much better it feels. [Pause]

Then curl the toes up on your right foot, and then slowly release the tension in them, reflecting on how much nicer it feels when they're relaxing than when they're tense. [Pause]

If you notice that any part of your body has become tense again, just imagine it relaxing again, taking several seconds to move it around lazily and spend time noticing how good it feels to relax it. If your body's fully relaxed, just enjoy the sensation of relaxation for a while.

Sit or lie still for a minute or so, just breathing slowly and feeling the relaxation in your body, imagining you're sinking into something soft and comfortable.

If your mind wanders, gently bring it back to the relaxation exercise and focus on your breathing. [Pause for a minute]

OK.

For the next exercises, it says we're supposed to close our eyes. I suppose that's just to help us shut out distractions. At night I don't suppose it matters one way or the other.

Exercise 4: Imagining your Thoughts are Floating Away on Clouds

Notice your breathing, but don't try to regulate it for the following exercises.

With your eyes Closed, imagine you're lying on a soft carpet of long grass with little flowers like daisies in it all around you on a warm day, looking up at a clear blue sky. Try to empty your mind of all thoughts, so it becomes like the sky, clear and empty of clouds. If any thoughts that are the least bit disturbing do intrude into your mind, imagine breathing them out, and that then they form clouds that are blown away by your breath up and across the sky like they would be on a gentle breeze, till they disappear and your mind's clear again, like the sky.

Imagine this for three minutes. ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

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Exercise 5: Imagining your Thoughts are Blowing Away on Autumn Leaves

Imagine you're lying under a shady tree on a warm, sunny September day. Autumn leaves are rustling in the breeze all around you and you admire their colouring. A few birds are singing quietly. Try to empty your mind of all bad thoughts. If any negative thoughts enter your mind, imagine breathing them out, and that they land on fallen leaves and are blown away in the wind.

Imagine lying there peacefully enjoying the sights and sounds, and the feel of the soothing, cool, slightly scented breeze on your face, for four minutes. ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

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Exercise 6: Imagining your Thoughts are Floating Away on Leaves in a Stream

Close your eyes, and imagine you're lying by a clear little stream that's gently flowing along, on a warm, sunny Autumn day, with beautiful fruit trees all around you. Imagine watching leaves being carried down the stream on the current. Try and clear your mind of all negativity. If negative thoughts do enter your mind, imagine breathing them out and noticing them blow away and fall into the stream and being carried away on the current on the leaves. Imagine this for three minutes. ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

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Exercise 7: Day-Dreaming About a Holiday

Try to remember one of the best holidays or day trips you've ever been on. Close your eyes and spend three minutes imagining you're back there, enjoying the sights, sounds and feelings again. Imagine you're reliving the best bits, starting at the beginning and going through them at your own pace in your imagination as far as you can remember them, taking pleasure in them again. Try to make the day-dream as realistic as possible, imagining as many details as you can think of. Don't let any negative thoughts intrude. Gently push anything like that out of your mind, and just enjoy the day-dream. Try to imagine it as vividly as possible. ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

Exercise 8: Day-Dreaming About a Nice Place

Close your eyes, and imagine walking onto a clean, sandy beach on a warm Summer's day. [Pause for 20 seconds]

Imagine sitting in a comfortable deckchair that's been put there for you, and taking your shoes and socks off. You lie back in the comfortable chair. Imagine the feel of the warm sand beneath your feet. Imagine wiggling your toes, taking pleasure in the sensation of the warm sand brushing against them. [Pause for 30 seconds]

Children are playing, building sandcastles and paddling in the sea. You enjoy watching them as you relax in the warmth of the sun. [Pause for 30 seconds]

The sea's calm, and you enjoy listening to the quiet sound of the waves, looking at the clear blue water and the people paddling, swimming and surfing. You notice seagulls above, as a few fly past, calling to each other. [Pause for 30 seconds]

The sun's bright and warm. You hear the sound of children's laughter as they play together. You see some brightly-coloured seashells around you and think about how beautiful they look. You take several long, slow breaths, enjoying the smell of the sea air. You feel all the tension drain away from you and feel calm and peaceful. [Pause for 30 seconds]

Imagine yourself reclining in the chair enjoying the sunshine and the sights, sounds, smells and feel of the beach for another two minutes. If any negative thoughts intrude, don't worry about them, but just gently push them out of your mind and bring it back to the day-dream, thinking about it as vividly as you can. ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

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Exercise 9: Daydreaming About Another Nice Place

With your eyes closed, imagine walking down a path into a beautiful woodland on a warm day, with a gentle, soothing breeze rustling the leaves on the trees, and the sun shining through the tree tops. You can hear the birds chirping, and you can smell scented flowers and see them under the trees. You walk among the trees for a while, admiring their beauty, smelling their scent and listening to the rustling of dried leaves under your feet. [Pause for three minutes]

You walk back onto the path again and stroll lazily down it, taking in the sights, sounds and smells all around you. You see a few birds flying around, and enjoy the sunshine. [Pause for one minute]

After a while, you come to a clearing. There are moss-covered mounds of earth and flat rocks, and you sit down on one of them in the sunshine. A gentle little stream flows by. You listen to the soothing noise it's making and watch the clear water as it flows along over stones and little rocks. You feel warm and comfortable, enjoying the sunshine and the scented quiet atmosphere. Sometimes, you spot glimpses of cute little woodland animals as they play together. You take several long, slow breaths, feeling relaxed and peaceful. [Pause for three minutes]

You get up, walk slowly back along the path under the scented trees with the flowers underneath, and eventually come out of the wood. [Pause for two minutes] ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

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Exercise 10: Speaking Relaxing Words

Take several long, slow breaths. Try to clear your mind of all negative thoughts. Daydream a bit about relaxing places to get you in the mood if you like. [Pause for a minute]

Now repeat phrases to yourself a few times slowly to the rhythm of your breathing, like:

"I feel calm and relaxed." [Pause for twenty seconds]
"I feel peaceful and contented." [Pause for twenty seconds]
"I'm enjoying my time here relaxing." [Pause for twenty seconds]
"I feel satisfied and safe." [Pause for twenty seconds]
"I can feel all the tension leaving my body!" [Pause for twenty seconds]
"I feel nice and quiet." [Pause for twenty seconds]
"I'm taking long, slow breaths." [Pause for twenty seconds]
"I'm feeling very comfortable and contented." [Pause for twenty seconds]
"My mind is at peace." [Pause for twenty seconds]

Exercise 11: Thinking About Past Achievements

When you're feeling relaxed, close your eyes, and think about the things you've achieved in life, things that made you proud or pleased, or which other people have admired about you. Think right back to your earliest achievements as a child first if you can. Try and remember little successes you had when you were of school age, and then think forward through the years, thinking of each of the things you can remember that you know you've done well, or that other people have praised you for. Relive the experiences of success, going through the best moments in your mind again, imagining feeling the feelings you felt when you felt the sense of achievement all over again. Do this for four minutes. [Pause for four minutes]

Now ask yourself what good qualities you must have if you could achieve those things.

If the difficult times begin to come to your mind, ask yourself what the fact that you made it through them says about you. Think about the qualities you needed to succeed in making it through those times. Think about what that says about your capabilities.

Begin to think of yourself as a more positive and capable person, confident that you can succeed in and enjoy taking on new things. Imagine yourself achieving similar things to some of the best things you've achieved in the past in the future.

Do this for three minutes. [Pause for three minutes] ...

OK. Gently bring yourself back to the room. [Pause for fifteen seconds]

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Exercise 12: Imagining Doing Favourite Hobbies and Things You're Good At

Take several long, slow breaths, trying to focus your mind on your breathing rather than on thoughts about bad things in the past or worries about the future.

When you're feeling relaxed, imagine doing one of your favourite hobbies, or something you know you're good at. If you used to like swimming, for example, imagine yourself building up to it gradually first: getting your swimming things, leaving the house to go to the swimming pool, feeling pleased about going. Imagine a problem-free journey, and then imagine walking into the building, and getting changed while feeling the sense of anticipation as you look forward to it. Then imagine getting into the pool and beginning to swim. Imagine you're really enjoying the exercise. Think about all the enjoyable things and sensations you experience when you're out swimming, and try to imagine them as vividly as possible.

Do this for whatever hobby or interest you've chosen. [Pause for seven minutes]

OK. gently bring yourself back to the room, and make a plan to do the hobby you've just imagined enjoying, for real. For instance, if you've just imagined enjoying going swimming, set a time to go, sometime in the coming days.

I'll try to think of different hobbies or interests each time I listen to the tape, things I used to love to do when I felt motivated and energetic enough, and would ideally like to do again.

The information where I got these exercises says that imagining doing things is far more likely to motivate us to do them than just thinking about how we ought to do them will, because it engages the emotions, and if people feel pleasant emotions when they think about doing something, they're far more likely to want to do it.

Part Three
Stopping Ourselves Worrying and Thinking the Worst

Education is wonderful - it helps you worry about things all over the world.
--Joey Adams

Life's problems wouldn't be called "hurdles" if there wasn't a way to get over them.
--Author Unknown

An optimist thinks this is the best of all worlds. A pessimist fears the same may be true.
--Doug Larson

The information says that at times when we're relaxed, we're far more likely to be able to solve our problems, because we can think clearly about them. It says that depression isn't caused by bad life circumstances, but by the way we respond to them. It says that some people can have terrible things happen to them and perhaps be temporarily overwhelmed by them, but not go on to get depressed about them. It says that the reason some of us are more likely to get depressed about our life circumstances than others is because of the way we think about them. It says that we can make mistakes in our thinking that can make things seem even worse than they are, partly because the emotional part of the brain takes over when we worry too much so we can't think clearly enough about things, but partly because it's a habit we'll have got into anyway.

It says there are mistakes we can make in our thinking that we're so used to that we won't usually notice there's anything wrong with them, but we can learn to catch ourselves making the mistakes, and then we can challenge the faulty thinking with more healthy thoughts.

It says one type of mistake we can make in our thinking is called black-and-white thinking or all-or-nothing thinking. That's where we can think that things affect far more of our lives than they really do, and that things are wonderful or terrible with no in between, putting the worst interpretations on bad things.
So, for instance, if we over-sleep, we might think we won't have a chance to do anything useful with the rest of our day, when really it might just mean we have to reorganise things.
Or if someone we know passes by in the corridor without smiling, we might think they can't like us any more, whereas really, they might not have smiled because they were deep in thought about something, or they were a bit upset about something and didn't feel like smiling at anyone, or they were busy talking to someone else so might not really have noticed us or been preoccupied with the conversation.
Or if someone makes a suggestion to us about how we could do something a bit differently, we might jump to the conclusion that they're criticizing us and being nasty and get irritated with them, when really, they might have meant it in a nice way.
Or if one thing goes wrong, we can think the whole day's gone badly, forgetting all the good things that happened.
Or if one or two or a few parts of our lives are going badly, we might think our whole life's ruined, and there's nothing we can do to solve our problems, when that just isn't true.
And so on.

It says that a similar style of thinking is when we take things that go wrong personally, without considering all the other things that might have contributed to them going wrong. So, for example, if we cooked dinner and it didn't taste very nice, we might totally blame ourselves, rather than considering that a combination of things might have contributed to it, like that it may have stayed in the oven too long because the people it was made for turned up late, and the recipe instructions weren't that clear. We might worry about it for some time afterwards, criticizing ourselves for it, whereas other people might just apologise and then shrug it off and move on with their lives.

Or if a relationship breaks up, we might take all the blame, worrying over whether we were perhaps not affectionate enough, or too affectionate, and that maybe we didn't give the other person enough space; or whether we just aren't lovable enough. Or we might agonize about what we must have done wrong, not considering that there were probably faults on both sides, and that it might have had quite a lot to do with habits or attitudes the other person had, or that we just might not have been compatible, having different interests, aims in life and attitudes to things, perhaps, so we weren't a good match.

Or if a boss at work says our department's been performing badly, we might immediately start worrying that it's our own inadequate work that's let the side down, and even if we know of someone else who's obviously not working hard enough, we might still expect to be the one who gets the blame.

Or if we lose our job because the company we've been working for has been doing badly, we might blame ourselves for choosing that company of all companies to go and get a job with, even though we couldn't really have known things would turn out the way they did.

It says that another kind of mistake us depressive people can make in our thinking is to think things going wrong in one part of our lives will affect the whole of them. So, for instance, if a marriage or romantic relationship fails, we might be sure our whole life is ruined, and so we might start thinking there isn't any point in bothering to go on, so we'll stop thinking our job's worthwhile even though we enjoyed it before, and we might stop taking pleasure and interest in our children's achievements, if we have any kids, because we might think there's little point in bothering, since life's just a mess.

Or if we lose our job or don't get one we really want, we might think our whole life's a failure, so we might not think it's worth looking for another job.

Or if we developed a serious disability, like losing an arm or our sight, we might think there was no chance of us ever being able to do anything worthwhile or be happy again, and think all the time about what we've lost, instead of beginning to plan for the future and investigate what we could still do.

It says that depressives also assume things will be bad permanently, instead of seeing things as temporary setbacks, which they often are. So, for instance, if we lost a job or didn't get one we really wanted, we might think, "I'll never find another one!" So we'd think things were much worse than they really were and wouldn't see the point in doing things that might make them better.

Or if a relationship ended or our love partner died, we might think, "I'll never ever find another person who I could love or who would love me".

Or if we had our heart set on buying a certain house, but someone else got it instead, we might think we could never be happy again, despite the good things we still had in life, and other nice houses we might come across.

Or if we failed an important exam, we might think the whole of our life was badly affected. So we might not take pride in other things we had achieved, because we might think that since we were failures, there wasn't any point in trying to achieve anything else, or that we couldn't have done that well in the things we thought we'd achieved after all.

So it asks us to bring to mind the bad things that have happened in our lives recently and ask ourselves if we've been thinking of them in a similar way, attributing far more significance to them than we should have really, or taking the blame for them when things weren't really all our fault.

Yes, I think I do do things like that, especially with Anthony my boyfriend who's studying miles away. Whenever he says he isn't going to come and see me because something else has come up, or if we have an argument, I do always think it must mean he can't like me any more, and that he might never want to see me again, whereas I usually find out that that isn't true in the end. I'll think through the other things that have made me depressed recently to see if I'm taking the same kinds of attitudes.

It says that when we start getting upset because we're taking things too personally or thinking things have far more and long-lasting effects on our lives than they really do, we can worry about them far more than we should, and so we get far more emotional about them than we need to, and that keeps turning on the "fight or flight" system run by the emotional part of our brains that stops us thinking more clearly. So we have less and less chance of being able to think sensibly the more we work ourselves up into a state by worrying because we've attributed far more significance to things than we should.

So, for example, we might end up boiling with resentment over something that wasn't really that bad, or full of anxiety over something fairly trivial, thinking we've got no confidence at all and we're hopeless, when that's not really true. But we might think like that because we just can't think logically enough to get things in their proper perspective.

So we can carry on making ourselves feel worse and worse, magnifying the importance of bad things. So, for instance, a relationship that isn't perfect in almost every way might seem no good at all when our "fight or flight" mechanism begins to shut down our logical thinking; or if things aren't going our way, we might think they've gone disastrously. It says that the same mechanism can be what's behind excessive jealousy. We just won't be able to think reasonably enough to get things in their true perspective, since we'll have worked ourselves up to the point where we can't think rationally.

It says the fact that we can work ourselves up into the state where the emotional part of the brain doesn't allow us to think clearly is the reason why some people can end up slumped on the floor in floods of tears because they can't even think clearly enough to work out a sensible way of going about doing something even as simple as finding a can-opener to open a tin.

It says we can stop the process of working ourselves up into a state before it gets that far. Besides relaxation techniques and doing things that'll distract us from our worries so we're too busy to think about them, there's another thing we can do. It says that normally when we're worrying, we might not notice the individual depressive thoughts as they go by, but it can help if we keep stopping our thinking in its tracks, perhaps by saying, Stop! to ourselves firmly when we notice ourselves worrying; and then we can make a deliberate effort to think back over what we've just been thinking, and challenge it. It gives several examples of the depressive thoughts we might have and suggestions for the kinds of more realistic things we could decide to think instead.

So, for instance, if we notice we've just thought that we always do things wrong, we could discipline ourselves to stop and think, "Is that really true?" And then we might think something like, "No. Actually, what's really happened is that I've done one thing wrong today; but I did it right the time before. And there are lots of other things I do right. This won't take long to put right."

Similarly, if we catch ourselves thinking a friend's better than us at everything, we might stop to reflect that that isn't really true; they just beat us at a game today.

Other examples might be things like:

• Our marriage break-up was all my fault.
  No, we both did things that made the relationship worse.
• I'll never get over this!
  This is upsetting, but it'll pass. Everything does.
• I should do this.
  Why?
• I ought to be like that.
  Why?
• I just Have to get him/her back.
  Not necessarily. If I can't, at some point, I'll probably find someone else who's right for me.
• I can't cope.
  Actually, I've worked on some of this problem and got it sorted out, so I think I can work on the rest and solve it if I put my mind to it. And there are several things I managed to cope with in the past even though they were difficult. So if I could do that, I'm sure I can cope with this really. I'll see if I can think about what the fact I coped before and the way I did it says about what abilities I might have to cope this time.
• I'm just not good enough.
  I'm doing my best. And I know that with more planning and practice, I could find ways to be better.
• Oh, it's all too much! I just can't decide!
  I'll calm myself down with some slow, even breathing for a minute, and then I should have a clearer head, and it might be easier to decide then.

It says another way of taking our focus off our worrying thoughts is first to tell ourselves to stop, perhaps saying it firmly to ourselves, and then making a very deliberate effort to distract ourselves with things we'll enjoy, and that'll engage the part of the brain responsible for more sophisticated thinking than the emotional part of the brain does, perhaps by doing puzzles or crossword puzzles, or reading a book we find interesting and might get absorbed enough in to forget our worries for a while.

It says another thing we can do to deal with negative thoughts is to think of alternative viewpoints on things, so for instance if we think we're no good, we can list all the things that prove we've done things in the past that prove we are worthwhile after all. So if we catch ourselves thinking something negative about ourselves or someone else, we can try to think of three or four possible alternative explanations for why things have happened, not to let people off the hook for their behaviour, but just to help us see that we might be making a mistake to put the worst possible interpretations on things, which is a common habit among depressed people. So, for example, we might think depressive thoughts and answers to them like:

• I'm too trusting. It'll be far better if I never have another relationship again.
  I may have made a mistake in trusting one or two people, but that doesn't mean everyone's untrustworthy. I can be a bit more cautious and still have another relationship.
• My husband doesn't love me. He never hugs me.
  Some people just don't show emotion openly. He does smile at me a lot. He does things to please me, and he does seem to like being with me.
• I always do what's required of me at work, but my boss never compliments me. He can't think I'm good enough despite my best efforts.
  Maybe he never compliments anyone. And if I can continue to do well all the time despite the fact that I never get praised for it, that must mean I'm a conscientious worker and good at disciplining myself.
• She's always complaining that there are things wrong with me and our relationship. She can't want me around.
  Maybe she'd like a better relationship with me, but she's just going about trying to get one the wrong way, not realising that criticizing me only antagonises me.

It says that when we're depressed, the emotional side of the brain clouds our thinking so much that we not only think things are even worse than they are, but we think bad things must be going to go on forever, because we can't see past them, whereas in reality, things change all the time. So it says it can help if we try to catch ourselves thinking like that, and challenge our negative thoughts that make us think things will be as bad as they are forever with ones that give us more hope that things can change. So the types of thoughts we might have and answers we might make to them might go something like:

• I'll never have a relationship that works.
  Just because the one I've just had didn't work out, it doesn't mean I'll never have one that does. Next time, I might find someone who's more suitable for me.
• Nothing ever works for me.
  I've tried a few things that haven't worked, or haven't worked yet, but maybe something will soon.
• I can't bear it any more.
  I've reached the point where it's important for me to make changes.
• I won't ever be able to forgive him.
  At the moment I'm finding it very difficult to cope with my hurt feelings.
• I can't see a way forward.
  Up until now, I haven't been able to find a way through this.

It says depressed people can often lie awake, thinking up frightening possibilities about things that might happen, making ourselves feel worse and worse, when often, most of the things we're worrying might happen never will.
Or we can endlessly think over relationships or other things that went wrong, thinking over and over about what we should have done and said that could have made things turn out differently.

It says that when we're worrying about bad things happening when they might never happen, it can be good if we stop ourselves, ask ourselves what evidence we have for thinking they might happen to us, ask ourselves what good it does to worry about whether they could, and list as many reasons as we can think of why we'd be better off not worrying about them.

It says sometimes, when we really think about what we've just been worrying about, it can turn out to be so irrational as to be unrealistic, and sometimes even laughable, and then the worries can lose their power.

It recommends that we don't let worries from one part of our lives ruin other parts. So, for instance, if we're angry because something's gone wrong at work, it can be good if we keep that problem for work, and don't let it make us miserable during a friend's barbecue, for instance. Or we should try not to let an argument with our husband or wife ruin our working day. We can plan to worry about them at a set time of day.

It says that if we try to recognise the parts of our lives that are working despite the fact that parts aren't working so well, it can give us strength and confidence, since we'll know that some things are going right.

It says one way to stop ourselves worrying is to set a time late on in the day, making it our 'worry half hour', and deciding to do all our worrying then. So if a worry comes to mind at another time of day, we can tell ourselves we'll put off worrying about it till our next worry half hour, and then find something else to do to take our minds off it. It suggests we note things down in a notebook if we worry we'll forget them before our next worry half hour.

It says we can help motivate ourselves to stop worrying if we remember that Today's worry is tomorrow's depression. It says that if we can stop worrying most of the time, we might very well feel better within a week, or in a couple of days even, since our sleep will improve, and we won't be working ourselves up into an emotional state where we can't think clearly. It says that the more we notice an improvement, the more motivated we'll be to carry on.

Part Four
Finding Things to Amuse us

I dip my pen in the blackest ink, because I'm not afraid of falling into my inkpot.
--Ralph Waldo Emerson

It says it can help our mood a lot during the day if we can find things to laugh about and amuse ourselves. It says that even smiling can make us feel better, even putting on a smile, since it says that doing that makes us feel more like smiling for real.

Hmmm! I wonder.

It recommends we try to think back to the funniest things that have ever happened to us, and relive them in our minds so we'll enjoy them all over again.

And it suggests we actively try to find things that'll make us laugh, like collecting funny cartoons, getting comedy tapes out of the library, or reading a funny book.

It says laughing can get us out of the mind-set where we think everything's hopeless, because once our emotional state gets defused, we can think more clearly.

Part Five
When Things Remind us of Bad Things in the Past

If you are still being hurt by an event that happened to you at twelve, it is the thought that is hurting you now.
--James Hillman

Have you ever been at sea in a dense fog, when it seemed as if a tangible white darkness shut you in and the great ship, tense and anxious, groped her way toward the shore with plummet and sounding-line, and you waited with beating heart for something to happen? I was like that ship before my education began, only I was without compass or sounding line, and no way of knowing how near the harbor was. "Light! Give me light!" was the wordless cry of my soul, and the light of love shone on me in that very hour.
--Helen Keller

Nothing is permanent in this wicked world - not even our troubles.
--Charlie Chaplin

Similarities Between Present and Past Things that Can Make us Depressed

It says that sometimes, we can have problems like being anxious about things we don't really need to be anxious about or getting depressed by the mention of someone's name or something, because of things that happened in the past. But they don't mean we need to bring up the past in detail in counselling to experience the emotions fully in order to heal or anything like that. They mean that the emotional part of our brain's making faulty associations between things that are happening in the present or that might, and things that happened in the past, so we get the bad feelings we had then.

It says that when it connects things that are happening now to things that happened in the past, it's called pattern matching. It's a useful function most of the time, because for instance, it means that when we see a piece of furniture or a relative's face, we'll probably recognise it without having to consciously work out what it is, because the brain will make an association between it and all the memories it has stored of such things from before, so we can recognise it much more quickly. It does the same thing with experiences, to help us make sense of them. For example, if a friend we hadn't spoken to for years phoned us, we might not have a clue who they were and what they were talking about at first, till our brain remembered them.

But it says the process can cause problems sometimes if we've had bad experiences, because the brain makes snap associations between past and present things, when things that are happening in the present that might be totally harmless have some kind of connection to bad things that happened in the past. So it gives us the feelings we had then.

So, for instance, if we keep having a compulsion to be hostile to a particular person for no good reason really, it might be because they remind us of someone who bullied us once in the past, perhaps just because they have the same hair colour. Or we might keep feeling insecure in relationships, because something about our partner or the feelings we get with them makes our brain connect the relationship with one that went bad. Or we might be fearful of speaking in public, because our brain makes a connection between that and a time at school when a teacher made us stand up in front of the class and humiliated us in front of everyone by asking us questions we couldn't possibly have known the answers to, and mocking us when we didn't, which drained our confidence for speaking in public in front of anyone, even though most people might be more friendly.

So it says we should ask ourselves what the things we have difficulty with remind us of. Then we can break the connections in our mind by reassuring ourselves that the current situation's different.

For instance, if we find ourselves feeling insecure in relationships for no apparent reason, but thinking back, we can remember a relationship that made us insecure, we can write down a list of as many ways we can think of in which the person we're having a relationship with now is different from the person we had the relationship with that made us insecure in relationships. For instance, they might compliment us more, not keep losing their temper like the other partner did, enjoy being with children unlike the other partner, share many more important interests with us, or whatever, and so on.

Or if we have a fear of public speaking and we remember that we first started to feel like that after a bad experience with a teacher, we can write down a list of as many ways we can think of in which we're better equipped to deal with the situation now than we were then, like being far better able to stand up for ourselves and knowing a lot more things, and the ways the audience is different, like if most of them are likely to be more friendly.

If we realise that we feel hostile to a person only because they remind us of someone else in ways that don't really mean they're likely to be just as bad, we can think of all the ways they're different, or if we don't know them well enough, remind ourselves that we don't and reflect that they might be very different.

It says doing things like that can help the brain stop associating things that might actually benefit us with bad things.

Past Traumatic Memories

It does say that if the past memories the brain's associating the things with are traumatic, we might need help so we can start to think of them in ways that don't upset us.

How to Turn Fear of Failure into Anticipation of Success

It says that a fear of failure can sometimes be the source of people's depression, because it stops us doing things we want to do and so limits our chances in life, and it might go back to just one bad incident in the past. But we can help ourselves get over it by imagining ourselves succeeding at things we want to do. It says that just as depression is caused to a large extent by the misuse of the imagination, where we can fantasize about all kinds of ways our life could be bleak and meaningless in the future and how we could fail at everything we try, the imagination can also be a very helpful tool in getting us out of depression if we use it well. If we imagine ourselves failing, it can reinforce the faulty connection our brain has made between us failing once and the likelihood of us failing again, so we can become even more sure that we'll fail. The more we imagine failing, the more we'll be convincing ourselves that we'll fail.

But it can work the other way around as well. If we imagine ourselves succeeding at things, it can break the association the brain has made between us failing once and the likelihood of us failing again, so we can get more optimistic about succeeding.

It says the imagination's very powerful; it's what enables inventors to think up new things. It says that some people think they haven't got any imagination worth speaking of, but it doesn't need to be good enough to invent things or anything like that. It only needs to be good enough to do what people ask it to do every day already. For instance, when we're absorbed in a good story, we might imagine the scene. Adverts on the television are in effect often asking us to imagine how good we'd feel if we had the products they're selling. If we're tempted to drop some litter on the floor outside, we might stop because we imagine what might happen if a policeman saw us. So we really use our imagination all the time, and it says we depressed people must have good imaginations to get ourselves into the state we do, imagining all kinds of horrible possibilities to convince ourselves that our future will be miserable. So it says that just as we can imagine everyday things, we can learn to imagine succeeding in life.

It says it works best if we do relaxation techniques first. Then we can imagine going through the thing we're worried about failing from start to finish, imagining it as realistically as we can, starting off by imagining feeling confident, or if it's something like an exam, just a little anxious perhaps to motivate ourselves to keep alert and want to succeed.
Then, we can imagine going through the event, perhaps finding it a bit of a challenge, but succeeding in the end, and feeling pleased with ourselves.

We can draw on memories of when we did succeed in doing similar things, to help us imagine what it would be like.

We can also bring to mind every similar thing we can remember that we did where we did succeed, and relive them at a leisurely pace in our minds. We could relive successful events several times till we feel more confident.

Then we can do what's necessary in practical terms that will enable us to succeed, hopefully without all the doubts and anxiety that keep telling us we won't.
And we'll have raised our expectations of success, which will make us more confident, so we'll think it's worth trying harder, so we're more likely to succeed.

It says that going through things in our imagination like that first can also give us good practice, which is another reason we can be more likely to succeed. For instance, if we're worried about going to social events, we could imagine going to one, walking into the room smiling and feeling calm and pleased to be there, and then we could imagine talking to different people, thinking up ways to open conversations, and questions to ask. That'll help us think of more to say when we do go there.

One Reason for a Sudden Drop in Mood

It says that sometimes, when we suddenly become depressed but we can't work out why it happened, it can be because of the pattern matching process, because a smell or sound or image very briefly brings to mind something unpleasant, like an incident that happened before when the smell was around, or something that happened at around the same time as we heard the sound once, and so on. We might not be conscious of the match our brain's making, because it's done it so quickly we're not really conscious of even having thought it, but if we ask ourselves what was going on at the time we began to feel depressed, we might be able to work it out.

If we can work it out, we can think of as many ways as we can of how our circumstances now are different from the ones the smell or sound or image reminds us of. For instance, if we realise that a smell we've just noticed reminds us of our mother's cooking, and that depresses us, and thinking about it, we realise it's probably because it reminds us that she belittled us a lot and made us feel worthless while we were trying to help her in the kitchen, we can tell ourselves that we know better than to believe the kind of thing she said now, and we could list several things that prove we're not worthless. And we can remind ourselves that we can stand up better to criticism now and so we could defend ourselves instead of just believing it.

Another thing we can do to raise our mood is to remind ourselves of everything that's going right in our lives at the moment, perhaps listing all the things we can think of, and reminding ourselves that our depression only resulted from a momentary faulty connection made by the brain, that doesn't necessarily mean that the same things are happening or might happen now as happened before.

Or to give another example, if we see a picture that brings on the depression because it's like one in a grandparent's house, and we realise it reminds us that they're becoming more and more ill and there doesn't seem to be anything we can do, we can make a deliberate effort to go into problem-solving mode, and try to plan ways of making things as easy as possible for them and us.

Part Six
Handling Other People's Negative Criticisms of us

A setback is the opportunity to begin again more intelligently.
--Henry Ford

Success is 99 percent failure.
--Soichiro Honda (founder of Honda Motor Corporation)

I have not failed. I've just found 10,000 ways that won't work.
--Thomas Edison

Success consists of getting up just one more time than you fall.
--Oliver Goldsmith

It says it's important not to just take in the negative things that other people say to us, but to challenge them in our minds. It says that people can sometimes carelessly say horrible things they don't really mean when they're annoyed, like telling us we're clumsy when what they really mean is that they thought one thing we did was clumsy. They can go away and forget all about what they said, but we can keep thinking about it long afterwards, and if we're not careful, it can damage our self-image. It says that children can be especially badly affected, because they're more likely to believe what people say.

It says we'll feel better about ourselves if we stand up for ourselves when people make careless exaggerated comments about us. So, for instance, conversations might go:

• Them: You spilled that drink! You're so clumsy and stupid.
  Us: Spilling a drink doesn't mean I'm generally clumsy or stupid. Sorry; the reason I spilled it was because I was trying to do something else at the same time as reaching for it. Perhaps that was a bad idea; I won't do it next time. (or whatever the cause was)
• Them: Why haven't you finished that report? You're so irresponsible (or slow or long-winded)!
  Us: I couldn't finish the report before now, because I needed to include information in it that wasn't available to me when I started.
  Or perhaps:
  I know it's important to get it finished, but I couldn't give it my full attention because I had another urgent deadline to meet.

It says that whether or not our explanation is accepted, if we stand up for ourselves, firmly but without being rude, we're bound to feel better about ourselves.

Part Seven
How Some Drugs, Food, Exercise and Alcohol can Affect our Mood

The sun is nature's Prozac.
--Astrid Alauda, 1990

It's official: Music lifts depression. Many studies have shown that music has a marked effect on mood and self-esteem. Music is a direct route to the emotional realm.
--Jonathan G. Zuess, (Wisdom of Depression)

A lot of what passes for depression these days is nothing more than a body saying that it needs work.
--Geoffrey Norman

A vigorous five-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world.
--Paul Dudley White

Some Prescription Drugs can Cause Depression

I've just read that depression isn't necessarily all caused by psychological things. I've found an article that says that some drugs can lead to depression in some people, particularly certain drugs for heart problems, high cholesterol, epilepsy and migraine.

But it says that there are alternative drugs people can take if there depression's being caused by the medication they're on, so they'll just need to consult their doctor about whether they ought to change it.

How Depression Affects the Immune System

It says that when we're depressed, a stress hormone is released called cortisol, which can stop the immune system from functioning as efficiently as it should after a while. So when we get over our depression, we might well find it easier to fight off colds and other infections.

Exercise Can Help Lift the Mood

It says that exercise can be very good for us when we're depressed. It says the reason is that it increases blood flow to the brain, and raises levels of brain chemicals like serotonin and dopamine which lift our mood. It says if we exercise outdoors, it can be even better, because we get the benefit of natural light, which also raises serotonin levels.

It says that some people are convinced that depression's the result of a chemical imbalance, where for some biological reason, serotonin and dopamine aren't high enough. But in reality, they can fluctuate from minute to minute, and the more depressive thoughts we get, the lower they become, making us feel even worse. But we can raise the levels in various ways.

It says some people have claimed that exercise can cure depression better than antidepressants, and now scientists have found that exercise can play a big part in lifting even major depression among people who'd been in-patients in psychiatric hospitals and who antidepressants haven't worked for. Scientists also found that a twice-weekly exercise class could significantly alleviate depression among the elderly people they studied, when they could be persuaded to do it.

It says this is the problem - that when people are depressed, they just won't feel like exercising or doing anything else.
I know I don't.
But it says that it'll be the depression deceiving us into feeling as if we won't enjoy it and we'd rather stay indoors lying on the bed brooding or something. It says that once we understand how quickly our mood can be lifted when we switch our thoughts away from the exaggerated thinking that's making us so worried and depressed, we'll be more sure that we will feel better after exercise.

It suggests we start off with something small, like a short walk, if we'd prefer. It says to make it more enjoyable and distracting from worrying thoughts, we could make a point of paying attention to our surroundings, maybe setting ourselves little tasks, like having a go at counting fifteen different types of flowers and plants while we're out, or different kinds of trees or cars or people's coats, or anything we like the idea of.

It recommends we carry a notebook with us for recording how good a mood we're in, and as soon as we get back to our door, we write down how good it is on a scale of 1 to 10, with 1 being the worst it could be and 10 being the best. We could write down what number we estimate it to be before we start as well, and then If it's higher when we finish, it'll hopefully encourage us to go out next time.

It says that we need to choose exercise we enjoy doing to carry on being motivated to do it. It recommends we don't do things like long-distance running on our own that'll give us lots of opportunity to think worrying thoughts while we're doing it, but says that it might be best to do something we enjoy as part of a team or group if possible, or something like a walk with a friend that ends up in a cafe where we can have a chat and relax.

It says things like that will meet several of the needs that are common to people: our need for exercise, our need to focus our attention outwards onto other things instead of constantly focusing it on our worries, and a need we have for contact with other people.

Food that Can Help Lift the Mood

It says the food we eat's very important as well. In fact, it says it's so important it can even change the way we think and feel. It says the right food can improve our mood and give us the energy to be motivated to make changes.

It says it's best not to have excessive sugar in the diet, but to keep blood sugar levels lower by eating more healthy snacks instead, like nuts, fruit and chopped vegetables. It says a healthy diet that's good for the brain can include wholegrain cereals and other whole foods like lentils, beans, nuts, seeds, fresh fruit and vegetables; eggs in moderation, and fish like herring, mackerel or fresh tuna. It says that omega-3 fish oil might be especially important in keeping away depression, and it's possible to buy supplements of it, such as one called Eye Q, which it says is particularly purified. But it says that taking supplements while on antidepressants might make serotonin levels go too high, since both things will be increasing them, so that can cause unpleasant side effects. So it says that anyone on antidepressants ought to speak to their doctor before taking dietary supplements.

It says that pregnant women and women who might get pregnant in the future might benefit especially from eating oily fish or taking fish oil supplements, since their stores of Omega-3 oil are being or might be used up by a baby as well as by them, since it helps in the growth of the brain; so they might be at slightly greater risk of becoming depressed. But it does say that when eating fish itself, it might be best not to eat more than two portions a week, because of the danger of contamination by pollutants from the sea.

Alcohol Can Make Depression Worse

It says that though we can get the impression that alcohol helps us, it's actually a depressant, so after it makes us feel better at first, we can feel worse after a while. If we think that means we need to drink more, we can become addicted to it, and that will cause more problems for us that'll make us more depressed. It says an addiction can fool us into believing we're getting all our needs met, when in reality it's making our lives more chaotic, so we're less likely to be getting them met. It's just an unhealthy substitute.

Part Eight
What to Do when Grieving Causes Depression

It says one thing that can trigger off depression is grieving. It says it's natural and healthy to grieve in itself, not only for people we've lost, but for anything we were attached to, like an important job, a pet, a house we were deeply attached to, and so on. It says we get extra feelings of sadness when we grieve because the brain triggers off a biological program that brings the memories back to mind so we can deal with them and register the fact that the past is past, so we don't have expectations of things carrying on the way they were.

It says the process can go horribly wrong if we start fantasizing about how terrible life will be now without whoever or whatever we've lost. The more we do that, the more we can get the impression that life is cruel and unfair, and the more we can seriously damage our mood.

Yes, I started doing that after my first boyfriend Adrian died.

It says that grief can turn into clinical depression if that kind of thing happens. It says that one guideline for distinguishing between grief and clinical depression is that when people are still obsessing about the fact that they've lost the person or animal or thing they've lost three months after the loss, and perhaps are feeling suicidal, that's moved beyond normal grieving.

It says one thing that can deepen depression and hinder recovery is if the grieving person does things like turning the room of the person they're grieving for into a kind of religious shrine, or keeping their belongings laid out in exactly the same way as they were the day they died, or making a special point of kissing their photograph every morning and evening. It says doing that kind of thing keeps people in the grieving process and can lead to depression.

It says the best way to grieve is to accept sad feelings as they come up, recognise them as the brain's way of helping us process the fact that the loved one's no longer with us, and let the feelings pass without adding to them or making them worse by having fantasies about how terrible life will be now.

It says there are some other things we can do to help ourselves recover. It says that one thing is that gradually, in our own time, we should get rid of the person's belongings. It suggests we could give clothes to charity shops, and ask friends and relatives if they'd like to choose something to remember the person by. It recommends we don't end up with any of their belongings in a place we'll see them often and be reminded of the person, so we can move on to new things.

It recommends that next, while we're still grieving, we pick one morning or afternoon a week, perhaps one that has special significance for us, and resolve to do all our grieving then. And then the rest of the week, we should try to live as normally as possible. If a thought of the one we've lost comes into our minds the rest of the week, we can gently push it out of our minds, telling ourselves we're going to think about it in our special grieving time. Then we can shift the focus of our attention onto other things.

And we should try to live our lives as normally as possible when it isn't our grieving time, taking up activities we used to enjoy again, like perhaps taking the children or grandchildren to the park, for those who have them, helping in a charity shop, going out for entertainment with a social group, or whatever we used to like doing, to keep ourselves involved with life. It asks us to consider whether the person we lost loved us, and if they did, whether they'd want us to make ourselves miserable over them. It says if they would wish the best for us, we owe it to them to try to make the best of the fact that we're still alive. And it says that by being with other people, we could be increasing the enjoyment of life of the ones we're with as well.

It says the more we go out and mix with other people and do new things we enjoy, the less depressed we'll feel. And if we can learn a new skill at the same time, we might feel more valued. So we could perhaps go to an evening class we like the sound of, learn to cook new things, go to some kind of craft class where we could do painting or pottery or something, or a range of things like that. It suggests we look into assertiveness training if we think we could do with it. It says that local colleges run courses sometimes, and we'd be both meeting new people there and learning something it would help us to put to use, so we'll stop being so lonely and become more confident in our abilities, if we need to do that.

It suggests we get a bit of paper and note down all the things we think we just might be interested in doing, no matter how unlikely they seem at first. It says a friend could help us. Then we could work towards fulfilling some of the ideas we come up with.

Part Nine
Getting Emotional Needs Met

The Emotional Needs we Have

The information says depression is a sign that all our needs aren't being met. After all, we wouldn't continually worry so much if they were. It says that everyone has basic emotional needs that have to be met to a certain extent, at least sometimes in our lives, for us to be mentally healthy. It says these needs include:

• Security: We need to feel as if we have a safe territory around us, so we can live our lives without fear as far as possible, and enjoy privacy whenever we need to.
• Control: We need to feel as if we're in control of our lives and that we're free to make our own decisions about what we do in them, at least to some extent. The more interests and activities we're involved in, the more we can maintain that sense of control, because then, if we lose control of one part of our lives, for instance if we lose a job, we'll at least know we can determine what we do in other parts of our lives.
• Attention: We need to receive some from others, at least sometimes; and we also need to give it.
• Emotional connection to others: That can include friendship or emotional intimacy. It means that we ought to have at least one person who will understand us, who we can share our hopes, dreams and ideas with. It says for some people, talking to a pet can fulfil their need for emotional connection, but many people need more than that.
• Connection to the wider community: It says we need to feel as if we're part of something bigger than ourselves. That could include working for a cause or charity, or being part of a team - anything that takes our focus off ourselves, and gives us a sense of belonging and purpose in life.
• Paying attention to the mind-body connection: We can succumb to mental illness more easily if we don't take care to eat healthily and exercise, and if we don't sleep enough.
• A sense of meaning, goals in life and purpose: We need to be physically or mentally challenged a bit, by having problems to solve. If we don't occupy our imaginations with things that stimulate them and challenge them to invent creative solutions to things, they can be under-used, and can focus on things that are unhealthy and create problems for us, like magnifying little concerns out of all proportion, till we see them as major problems. On the other hand, if we use our imagination in creative ways, focusing it outward on something interesting rather than on ourselves, we can feel satisfaction when it manages to find solutions to the challenges we've set it.
• A sense of status: We need to feel we have some importance in life or in the community, not necessarily a position of importance to a whole community; it could be our status as a mother or father. But we need to feel that at least someone values us.
• We need to have a sense of competence or achievement: That'll make sure we don't suffer from low self-esteem. We can achieve this by investigating and learning new things and improving the skills we already have. That will increase our sense of purpose in life, and make us more confident that we're reasonably talented so we can feel good about ourselves.

Fulfilling Our Needs

It says that some activities can fulfil several needs at the same time. For example, maybe doing voluntary work as part of a team would solve the need for attention, emotional connection with others, stimulation of the imagination, creativity, belonging and a sense of our value and meaning in life all at once.

It says that research has shown that if one of our needs isn't met over a long period of time, it can significantly affect our mental health.

But it says the needs have to be fulfilled in a balanced way. For example, too much attention could be as bad as not enough, or thinking we need to fulfil our need for attention and so spending our time getting it at the expense of spending it doing something that will fulfil our need for meaning in life can leave us feeling empty and worthless in the end. Or too much security could make us unpractised at dealing with difficulties and so incompetent to deal with new challenges.

It says we might not know how to go about getting all our needs met, or we might lack the skills to, and so that's something we can find ways to work on. For instance, some people don't feel confident enough to go out in public, but there are self-help materials around that can give them ideas about how to build it up.

It says that sometimes, the reason we might not be getting all our needs met is because of something traumatic that happened once. For instance, people who were badly bullied at school might not have the confidence to mix with other people because of that, so they won't be getting their needs for attention and emotional connection to others met. And if they're fearful about mixing with other people, they might worry and worry about it until they get depressed, since it's worry that causes depression. So if they can get over their fear of being with other people, their depression will go away as well, unless there are other worrying things going on in their lives as well. There are ways of getting over fears of things like that, and they'll hopefully find some good ones if they look for them.

Or it says that other things might have damaged our abilities to get all our needs met. For instance, people whose parents neglected them might crave closeness with others, but not know how to trust them. So they'll need to find out about techniques for building up trust before they can get their need for intimacy met.
Or people might find connection to others difficult because they might not have had much opportunity to develop social skills for some reason, like making small talk, giving and receiving compliments with ease, or showing interest in another person. So they might have to work on those before they can get their needs for connection met. But they can be reassured that there are self-help books and articles around that can give advice on such things.

It suggests that to help us work out what needs on the list aren't being met in our lives, we should go through them slowly one by one, thinking about them. But it says we should be careful to try to see things in a balanced way, not letting our depression influence us to think that nothing's going right and none of our needs is being met, since there might be several parts of our lives that are going right, or could be very easily if we just changed something small, but we might be letting one or two bad things make us feel bad about the rest. It says that if we find it hard to think of what's going right for us, so we can't distinguish between our negative view of everything and what's genuinely not right, we could get a friend to help us.

It suggests we think back to what happened just before we started to become depressed, to work out what triggered the depression off, and that might help us work out what need we're most missing out on. For instance, if the depression started after we were burgled, it'll mean we need to do things that will give us back a sense of security and control again, like perhaps having a burglar alarm installed if possible and fitting window locks, among other things.

So when we've worked out what needs we have that aren't being fulfilled, we can investigate ways of getting them met. It says that no one's life will be ideal, so we can't expect to work out how everything could be perfect, but we might be able to work out changes we could make that could make quite a difference.

It says it might be best to consider the needs one by one, working out what to do about each one in turn before we think about the rest. Or if we can't think of what to do about one of them, it's best to go onto the next one in case we just brood on it till it makes us depressed. We can always come back to it.

Working Out What Needs Aren't Being Met

It goes through the needs one by one, asking us to try to work out what we might be missing out on:

Security: It says that first, we can consider whether anything, at home, work or anywhere else, makes us feel fearful, vulnerable, worried, lacking in confidence or insecure.

Emotional connection to others: Then, it suggests we consider whether there is anyone in our life who's important to us, and who we're important to, and anyone we can have fun and be ourselves with, and share our hopes and fears with.
And it asks whether we've been grieving over anyone for a long time, whether we've had a relationship break-up, or whether we've lost touch with friends.

The mind-body connection: It asks whether we're eating healthily, getting enough exercise and sleeping well.

Connection to the wider community: It asks if we have connections to people outside our close friends and family, for instance whether we're involved in any community activities, clubs, charity or voluntary work, helping neighbours or others, college classes, sports, or that kind of thing. It asks whether anything has meant we've had to give things like that up, like perhaps a newborn baby, a disability or illness, or whether we've given things we enjoyed up because of our depression.

Status: Then it asks if we're comfortable with our status in society, for example, if we feel good about ourselves and the way we think other people see us, whether we feel appreciated or rewarded in some way for what we do, or whether we feel we should have achieved more in life, or feel resentful towards others for having more than us, or whether we long for things we haven't got.

Competence or achievement: Then it asks whether we have a sense of competence and achievement, for example, whether we're satisfied with what we do, or whether we find life boring or lacking the opportunities it once had or that we'd like, or whether we find it too difficult to cope with.

Control: Then it asks whether we feel we have control over our lives and freedom to do what we want within satisfactory limits. It asks whether we have enough responsibilities to feel we have control over something, or whether we have too many and can't cope. It asks whether we have enough control over our lives to be able to take the decisions that really matter to us, or whether someone else has too much power or influence over us. It asks whether we've recently lost control over important things, perhaps because of illness, or a new person at work or elsewhere who wants authority over us or is being difficult.
But it asks whether we feel we ought to be able to control things that realistically, we can't, like whether people we care about and are trying to encourage do well in exams, and whether we get upset with ourselves if they don't.

Attention: It asks whether we're getting our need for attention met in a healthy way. For instance, we should consider whether we spend too much time alone, whether we feel too shy to appear in public much or put ourselves forward for anything, or feel that people we meet at social events aren't going to be interested in us.

It asks us to consider whether we spend time with someone who's overpowering and steals the limelight and saps our energy, or whether we seek attention in unhealthy ways, like doing things we wouldn't normally do, such as engaging in politics just because someone we want to be with does.
It asks how much sincere attention and interest we show other people, and whether we're genuinely interested in them, or just in how their actions and opinions affect us.
It asks whether we get attention by being depressed.

Meaning, goals in life and purpose: Then it asks whether we're being challenged in a positive way by the work we do or other things in our lives. It asks us to consider whether we have activities that interest us where we're learning new things and developing new skills, where we have to put our brains or bodies to work. It says even retired people benefit from that kind of thing, since keeping the brain going and doing new things gives us a sense of meaning and satisfaction.
It asks whether we do things for other people who need us, and whether we have a commitment to something bigger than ourselves, like a cause, a community activity, a sport, a school, or something else that'll give us purpose in life because we're working towards something we believe in.

It says that asking ourselves questions like that might very well uncover the cause of our depression, and with some people, it might turn out to be very simple to put right. For instance, if they've stopped going out socially because they lost their confidence after something happened, but they were always confident before, gradually going to more and more things again and learning a few conversational skills to boost their confidence might help them out of their depression completely. It says that all our worries and exaggerated thinking might have clouded things so we can't think of the original cause of our depression till we question ourselves in the way it suggests to find out what we need to do in life to help us over the real problems in our lives.

It says that when we've realised what's missing in our lives, it'll be easier to know what we need to do or to stop doing to get our needs met, so then we can start making plans to organise things so as to do that.

Changing Things Little by Little

It says we should set goals for ourselves, to change our lives little bit by little bit, not too ambitiously so things might not work out and we just get more depressed, but in little stages that we're fairly confident we can achieve. But the goals should be things that help us work towards putting pleasure and meaning back in our lives.

So it says that if we decide we need to do more exercise, for example, it would be best to start off by doing a short brisk walk every day at a time we set, rather than to attempt something major like a twice-daily energetic work-out at the gym that might exhaust us and so make us feel discouraged so we give up.
Or if we want to boost our self-esteem, being too ambitious, like deciding to lose weight, give up smoking and drinking and go for a much better job all at once will probably be too much to cope with all in one go, so it's best to pace ourselves.
It says that taking little steps at first that we're successful at will encourage us to take bigger ones, so we can take bigger and bigger ones with more confidence and enthusiasm. It says that as far as boosting self-esteem goes, one idea might be to take on a bit of charity work that'll make us feel sure we're contributing something valuable, and where we'll probably come to feel appreciated.

Depression Can Make People Ignore Other People's Needs

The trouble with going out and meeting more people for me is that people have got fed up with me in the end. Maybe I get too demanding or clingy. I know I get attached to people, and then come to rely on them for attention and don't like it when they stop wanting to see so much of me. Maybe I need to learn to stop doing that.

The information says that depression can drive other people away from us in the end, because we get so wrapped up in ourselves and our feelings and distorted thoughts about the way things have affected us that we become almost completely selfish; we stop caring about the needs and feelings of others, unless it's to feel bad about not thinking of them. It says we can get like that even if we're caring people when we're not depressed.

But if we get called selfish when we're depressed, at least we'll know it's the depression making us like that, and we're not necessarily always selfish.
That's reassuring, because I have been called that before.

The Attraction of Pessimism

Another thing is that I'm not sure I'd want to go out more, in case things went wrong.

But it says that depressives are habitually pessimistic, only focusing on what could go wrong, and pessimism can have its attractions, because we might think it keeps us safe because it prevents us from doing anything where we might end up experiencing feelings of disappointment or upset because things have gone wrong or haven't worked out for the best for us. But since there's a risk of that happening with most things, it means we'll be missing out on a lot of things that could actually work out well and be very rewarding and pleasing. So when we get over our pessimism, we might actually find a lot of pleasure in life we wouldn't have done if we were trying to protect ourselves against disappointment and upset by being pessimistic, feeling sure things would go badly all the time, when they probably won't really.

Yes, I suppose that's probably true.

What to Take into Consideration When Working Out our Goals for Change

It says our goals should be concrete rather than vague, because if they're too vague, we won't know how to work out steps to work towards achieving them. So, for instance, they couldn't be things like, "I want to be happier", or, "I want to be less of a burden to others". It says that if those are the only types of things we can think of at first, we can work out how to turn them into goals we can think through how to achieve if we ask ourselves to imagine what it would be like if we were happier or less of a burden, what we'd be doing differently. So we could ask ourselves questions like:

• "If I woke up in the morning and wasn't depressed any more, what, realistically, might have changed?
• What would be the first sign that things were different?
• What would I be doing differently when I got up?
• How would things be different as I went through the day?
• What would I be doing to contribute to making them so different?
• What would other people notice me doing differently?"

So the same kind of thing could happen to us if we start off with just a few small goals, and work up to bigger ones as we feel better and better.

It says our goals must be positive. It says it doesn't work to try to focus on not doing something, like trying to concentrate on not worrying, since we would need something to do to replace it if we were going to stop it. Just trying to concentrate on not worrying would mean worrying was on our minds all the time because we were so busy thinking about not doing it, so that in itself would turn into a worry that would be just as bad as our other ones. So we ought to focus on something positive that will distract us from worrying instead, an activity that will take our attention and that we'll be too interested in to want to spend the time worrying.

It says our goals should be tailored to helping us meet the needs that aren't being met in our lives at the moment. It says all depressed people withdraw from social activities and social contact, because we just don't feel like being with people at the time, or don't want them to see us while we're depressed. But it says that while that might give us a bit of short-term relief when we think we won't have the pressure of being with them, we can withdraw more and more from social contact, and that just makes us feel worse and worse, because we're spending more time worrying instead of doing things that will distract us. So it recommends we think about all the things we used to enjoy, and start to gradually work up to doing more and more of them again.

It says that if we were good at things once, we'll probably still have the skills. Even if they're a bit rusty, it shouldn't take too long to get them back again the way they were. And it says that if we can think of anything new we're interested in, we should try to pluck up the courage to try it, since if we enjoy it, it'll absorb us and stop us spending the time worrying, and help us realise life can still be enjoyable.

Building Up Social Contacts Again

It makes several suggestions as to how we could start building up our social contacts again, and asks us to consider whether any of them is appropriate:

• Calling a friend we've thought about calling for ages and suggesting we meet up.
• Going out for a walk or a meal with our partner or someone close.
• Taking our children to the park, and joining in their games.
  Well, I haven't got children, but I have enjoyed playing with other people's before.
• Inviting a friend or two for a meal at our house.
• Taking up an activity again that we used to enjoy, like dancing, swimming, sport, painting, gardening, amateur dramatics, or whatever we liked.
• Walking the dog with a neighbour rather than on our own, or walking ours when the neighbour walks theirs.
  Well, I haven't got a dog, but I have got a couple of neighbours who have. Maybe I could go out walking for exercise where they go, and say hello to them.
• Going to the cinema or theatre with a friend or partner.
• Meeting up for a relaxed chat with work colleagues after work.
  Well, I don't work, but when I start to get better, I'll start looking for a job, maybe just a part-time one to start with, and then I'll see.
• Booking a holiday somewhere where we'll meet new people and explore new places.
• Getting involved in charity work where we'll be in direct contact with people, such as visiting old people's homes to do things to cheer them up, working with disabled children, or serving food at a soup kitchen for homeless people.
• Going to an evening class or going on an activity weekend, where we'll meet new people.

It says we should start off with just one or two things like that, and build up slowly, so we don't take up too much in one go and then feel we can't cope with all the extra commitment.

It says it's important to do things that benefit other people, not just ourselves, to give us more fulfilment and satisfaction that we have meaning and purpose and value in life.

Needs that are More Difficult to Meet

It says it might take a lot more than that to fulfil some of our needs. For instance, if someone's feeling insecure at work because they're being bullied there, it might be best for them to look into ways of trying to stop it, or seeking alternative employment.

It says that when we've worked out what the real reasons are for us being unhappy, we should think each one through and list the options we have for improving the situation. For instance, if we were unhappy because we were caring for an elderly person who was always criticizing us and didn't like us going out, we could write down a list of options that could make the situation better for us, like standing up to them more; arranging with neighbours, friends and family a scheme where they could come and sit with the person for a while while we went out, in return for a favour we could think up to do them; finding out about respite care, where the elderly person could go for a few days to give us a break, and so on. It suggests we discuss possible solutions to our problems with someone we trust.

It gives an example of how we can work on the goal of taking back control of our lives, if we don't think we have enough. It says sometimes we can't control events, like having to move house because of a relationship break-up, having to start using a wheelchair or whatever, but we can control our responses to them. If we're fantasizing about terrible things that just might happen in the future or feeling self-pity for hours about all the things we can no longer do and anxiety because we're worrying over and over again about how our lives will be affected, we'll make ourselves feel really bad. But if we calm ourselves down with relaxation techniques, and then think through logically what we can do to make life as easy as possible given the circumstances, we'll end up feeling much better.

It suggests we make a note of each problem separately, and then work on them one by one, thinking of at least one practical step we can take to start improving each situation. It gives a few examples, suggesting that if debt is a problem, for instance, we could decide to go for advice on what to do to make payments easier to a debt counsellor at a citizens' advice bureau; or if the problem that's restricting our lives is having to deal with very naughty children, we could decide to find a parenting class to go to in the hope of learning how to cope with them better.

It says the brain's designed to solve problems, so the act of working out how to solve our problems will make us feel better than we did before in itself.

Making Sure Goals Are Appropriate

It says our goals must be appropriate. For instance, if we had lost a limb, lost a husband or wife to someone else or if they'd died, or lost our youth, it clearly wouldn't be practical to want them restored to us; but we might be able to work around the loss to still bring happiness and fulfilment back into our lives. For instance, losing a loved one might have made us grief-stricken, but if after some time, we feel we're just making ourselves feel worse and worse by dwelling on it, being with other people should cut down our loneliness and distract us from all the brooding we'd do if we were on our own, so it should make us feel better. So we can think about ways to go about meeting more people.

Making Difficult Decisions

It says some people get depressed because they have to make a difficult decision, and all their options seem so difficult that they don't know what to do. It says that it's best to put off making decisions in that kind of circumstance, because it may be that as we gather more information over time, the best option to take will become clearer to us. It says that in the meantime, it's best to do things that will stop us falling into unhealthy depressive thinking, like keeping busy with worthwhile things, meeting other people, being active, and eating properly. It says that things change all the time, so things will often happen that will make the best course of action clearer to us.

Keeping a Record of Any Improvements and Drops in our Mood

It says one way of encouraging ourselves in our activities can be if we monitor how our feelings are improving over time. We can get a notebook, and write down how we're feeling after each activity, or every few hours, on a scale of 1 to 10, with 1 being the worst we could possibly feel, and 10 being the best. It says that if we don't feel at our worst the first time we write a number in the notebook, we should write one down when we do, perhaps at the time of day we feel at our worst, with the number, and the date and time. We can call the lowest number our baseline. That'll be the worst we know we can be, so we can be encouraged when we write higher numbers because we'll know they're an improvement on it. It says that if we feel better than that the first time we write a number, when we do write the lower one, we'll already know it's possible to rise above it, so that might encourage us.

It recommends we carry our notebook with us, and whenever we've just done an activity we decided to do when we were working out our goals, like meeting friends or doing a sport, or gardening or something, we write another number on the 1 to 10 scale in our notebook according to how we feel, along with the date and time, and the activity we've just done. It says it's best if we write it as soon as we finish the activity, rather than waiting till we get home and depressive thinking might have set in again. It says that exercise and being with friends boosts the mood, so we're likely to feel quite a bit better just afterwards. It says it could even be a 6 or a 7. It says that if it's only a 2, it'll still be a 100 % increase on how we were feeling before, so it'll still be quite some improvement.

It says that as we get used to going out more and begin to look forward to it, our mood will probably rise further and further up the scale. And writing down what activities we've just done each time will help us to remember what activities boost it most, so we might decide to do more of them.

It says that if our mood slips back again, we shouldn't worry. It might actually be something we can turn to our benefit, because it'll be telling us something about what we need to improve about our lives. So we can ask ourselves what it was that made ourselves feel worse, and what we can do to stop it happening again. We can try to work out what makes our mood go up or down, so we know what to do more of and perhaps what to do less of, or what to think about more so we can try to change things.

It says that another good thing to do can be to write numbers down according to how we feel at set times during the day, to help us work out what makes us feel better, and what lowers our mood and saps our energy. So, for instance, we might work out that a phone call where a relative criticized us was what sent us into depression, because it started us dwelling on how useless we think we are. Or a phone call from a friend who encouraged us to do something we were thinking about doing may have made our mood rise. Once we've worked out things like that, we can do things to help our mood rise or stop it sinking more. For instance, we can work out strategies to stop criticism getting to us so much, perhaps standing up for ourselves more on the phone, or making a point of reflecting afterwards that the criticism is exaggerated or untrue or whatever, so we don't need to take it that seriously.

Actually, I started feeling depressed the other day after ruminating on something that annoyed me, and I'd been going to draw some pictures to go on the wall in Alison's baby's bedroom, and I'd been looking forward to it before. But I stopped feeling like doing it when I started feeling depressed. But I got a cup of tea and started doing it anyway, and it wasn't long before I felt much, much better.

So now I know to try and stop myself thinking about the thing that annoyed me so much, and that even if I don't really feel like doing something productive, I might start feeling much better once I start.

Part Ten
Encouraging Ourselves by Thinking about Past Achievements

What a man thinks of himself, that it is which determines, or rather indicates his fate.
--Henry David Thoreau

The greatest discovery of my generation is that a human being can alter his life by altering his attitudes.
--William James

I have learned to use the word impossible with the greatest caution.
--Wernher von Braun

Don't cry when the sun is gone, because the tears won't let you see the stars.
--Violeta Parra

The information says that sometimes, people can think of depression as something that comes in and overwhelms us, turning us into a mass of misery. But we don't have to think of ourselves as if we're our depression. It says depression's caused by a misuse of the imagination, often started when we go into the all-or-nothing thinking style after stressful events, coupled with a withdrawal from life. That means we can control our depression by doing different things, so it can be helpful to think of it as something separate from ourselves, something we can master once we know how.

It says that one thing that can make us more cheerful and confident is if we think about all the things we've achieved in the past, that show us we will be capable of succeeding in the future. For instance:

• it could be having a long-term relationship, which might have broken down, but staying with someone for that long at least tells us we're capable of forming lasting relationships.
  I'm not sure that one applies to me yet. Mine haven't lasted all that long so far. Well, not long enough to really call them long-term anyway, I don't think. Then again, that wasn't really my fault, so I shouldn't think of it as meaning I'm no good at achieving that kind of thing.
• Or caring for anyone else, like children, relatives or in a job, tells us that we're capable of being caring, even though depression will have made us selfish. It means we weren't always like that, and we can change.
  Well, I don't think I've done anything like that yet either. But I think I'll start doing little acts of caring for others, like looking after Alison's baby more when she goes out for an hour or two. I do enjoy that, and I know he likes me.
• Holding down a job will mean we had the talents to be able to stay there.
  Well, I've had little jobs in the past, but now I haven't got one, and I've never had one for that long, so I don't think that really applies to me yet either. But when I recover from my depression, who knows.
• Any educational achievements, or any skills we've learned, like driving, learning a musical instrument, or doing anything creative, mean we have the dedication needed to stick at things, so we'll know it's still there.
  Well, I have done things like that, so maybe they do show I have good qualities.
• Keeping a home for years will have taken skills.

So it can help if we think of things like that and anything else we can think of that shows us we can succeed at things, and ask ourselves what those things say about us.

It says we can write down all the skills and qualities we can think of that we've demonstrated in the past, and this will prove to us that we have the ability to do worthwhile things in the future, and build up our confidence. Then we can read the list from time to time to cheer ourselves up and remind ourselves of them.

It says that we can use things we've achieved or done in the past as inspiration to improve our lives now.

For instance, if we're in a relationship that's going badly, it might be difficult to imagine that it could ever have been going well, because the bitter feelings we have now might be at the front of our minds, but it can help us improve the relationship if we sit down with our partner and think back to when our relationship first started, and try to remember what attracted us to each other in the first place, and what activities we used to enjoy doing together. Then, we could perhaps start to do them again.

I could try that with my boyfriend Anthony, since we've been arguing quite a bit lately.

It says that sometimes, even things we think of as negative could be put to positive use. For instance, someone who's a bit obsessive about writing things down could use that to write down their list of skills and qualities meticulously, and to keep a specially good check on their moods, writing down when they feel better and worse, to help them work out how to take control of their moods better.

Part Eleven
For Anyone who Wants to Withdraw from Anti-Depressants

It says that if we want to withdraw from antidepressants because we've decided we'd prefer to manage without them, we'll need to do that gradually, because stopping them abruptly can give us unpleasant or even dangerous withdrawal effects. So it recommends we ask our doctors to put us on a gradual programme of withdrawal. It says some people don't like the idea of speaking to their doctor about it in case the doctor thinks their new positive attitude is a result of the drug and doesn't want them to come off the medication. But it encourages us to keep asking for what we want if we come up against that attitude, saying it's our right to come off medication if we like. It says that if we explain to the doctor what's really caused our new more positive attitude, they might be more understanding. It says most of them will be keen for us to get better by whatever way helps.

Part Twelve
What to Do when we Start to Feel Down Again After we've Recovered from Depression

Allowing Brief Low Spells

It says it'll be natural that sometimes, after we've recovered from depression in general, our lives will be more stressful than usual and so sometimes we might wake up feeling depressed and less energetic than usual. It says when that happens, it's important to recognise that the feeling will only be temporary.

It says that sometimes, we can give it permission to be there for a while, but only if we put a time limit on it, like perhaps the rest of the day. It says that if most of our needs are being met, what usually happens is that it will lift during the day by itself, possibly in the next few hours, because we might get a phone call from a friend, we might become absorbed in something challenging at work, and so on, so we won't have to make a deliberate effort to lift it.

But it says that if that doesn't happen, we should do the things we know will help shift it, like going for a walk, doing other exercise, phoning a friend, going somewhere where we'll be with other people, and so on.

But we'll know we won't have to worry we need to shift our mood straightaway.

What to Do when the Depression Seems to be Coming Back

It says that sometimes, we might think we're doing really well, feeling much more positive than we used to and participating more in life, but then suddenly, we might start feeling depressed all over again for no apparent reason.

It says that when that happens, we won't need to worry, because it'll just be because when people have been depressed for some time, their nervous system has been hyperactive for a long time, and it takes a while for it to calm down and stop responding dramatically to minor stresses.

It gives an example of how if a relative asks to stay for the weekend, our brain might quickly associate it with a time when they came before and we didn't get on, and we might get all emotional and not know what to do, feeling convinced we can't cope.

It says at times like that, we should take immediate action to calm ourselves down by relaxing ourselves. It recommends we do the controlled slow breathing to do that. It says when we're calm, the emotional part of our brain will stop sending the signals that are making us feel overwhelmed, and the rational side of our brains will take over again. Then we can think about what it was that caused us to get depressed again, perhaps asking ourselves what happened just before our mood changed to work out what it was. When we've realised what it was, we can think through the situation and decide what to do, perhaps by challenging our negative thoughts, or by working out a way of handling the situation that'll make things easier for us.

So for instance, with a relative whose visit we're not looking forward to, we could perhaps think of things we'll both enjoy to take up quite a lot of our time, and think through how we could share the chores with them so we're not lumbered with all the extra housework.

It says we should keep alert for warning signs that we might be slipping back into depression again. It says it won't come back all by itself, but responding to life stresses in the old unhealthy ways can trigger it off again, and when we're used to thinking extra negatively about things, it'll be easy to slip back into it, like focusing excessively on anger, anxiety or guilt.

So it says that if we notice we're beginning to lose interest in things, not wanting to see friends or participate in leisure activities any more, feeling a bit empty or uneasy, or starting to find it difficult to get out of bed for no good reason, we should strongly suspect that depression's coming on, and so we'll know to take the steps we've learned about to ward it off. It says we should stick to leisure activities even if we're less motivated to go to them, since we'll probably feel better when we do, and withdrawing from them again will make us begin to feel worse. It says at the same time, we should try to work out what made our mood slump, and when we're feeling calm, try to work out what to do about stresses in our lives. And at the same time, it can be good if we try to pick up on the negative thoughts we're having and counter them with more reasonable ones, and keep ourselves distracted from them by doing interesting things or keeping ourselves busy.

Notes and Links

The Backstory

The Way Things Are Before They Begin to Improve

The Reasons Helen Became Depressed

Helen has been depressed on-and-off for years. Her parents were both pessimists and never gave her any confidence that she could succeed in life. So she developed a pessimistic personality as well. This made her prone to depression, but her depression got worse after her first boyfriend Adrian died of a very rare heart condition. She was extremely upset, but after a while she got another boyfriend, who she moved in with. But he became abusive, and her neighbours intimidated her because they invited people around at weekends who did antisocial and potentially dangerous things, like threw fireworks over the fence into her garden, and she was convinced they took drugs , and she worried they might become aggressive if she complained.

She split up with her boyfriend and moved to another area, but she was very upset about the way things had turned out. Now she often falls deep into depression. Especially at night, she finds herself brooding over what happened, and worrying and worrying about her future and making herself miserable. This makes it difficult for her to sleep at night. Then she feels tired and depressed in the morning, and feels as if she doesn't want to get up because she just can't face the day.

She's unemployed, because she doesn't think she could cope with a job. She has a new boyfriend who she's attached to, but he's studying in another part of the country and doesn't see her as much as she'd like, and she feels insecure that she'll lose him, or that he'll turn out like the one she lived with. Every time they have an argument or he says he'll come and see her but then tells her he's had to change his plans and put the visit off, she spirals down into a terrible depression where she's certain everything's hopeless and nothing will ever work out, and perhaps it would be best to commit suicide to end the misery.

She has had counselling for her depression, but it made her feel worse rather than better, and she ended up feeling even more suicidal, because the counsellor encouraged her to talk about all the things that had gone wrong in her past, and so it brought them all to mind again, and when she went back to her house on her own, she just spent more time worrying and brooding over them, making herself more upset still.

When Things Begin to Look Up

One day, a friend, Alison, tells Helen that there are techniques people can use to get over depression quickly. She recommends a book she's sure will be helpful and a few websites. On her better days, Helen looks at them.

She finds that the more she learns, the more optimistic she becomes; and as she becomes more and more motivated to make changes in her life and understands more about what can be done, her depression improves more and more.