cognitive and behavioral techniques to overvome depression

Special Cognitive & Behavioral Techniques for overcoming depression :

Special Cognitive & Behavioral Techniques for overcoming depression Belal A El- Dabour & Mohammed K El- Dahdouh

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As your activity level gradually increases , your depression should gradually lift.

Evolution & Depression:

Evolution & Depression Nando Pelusi (2003) notes that most people find that overcoming their depression can prove especially challenging when they blame themselves and down themselves for being depressed . He suggests a two-step evolutionary perspective to eliminate self-blame and self-downing as a secondary aspect of depression .

First step:

First step Evoke a “contemporary” explanation for blame thinking. For example, if you catch yourself involved in secondary depressive thinking — where you think you should not be depressed, blame yourself for how you feel, then down yourself—think again. Telling yourself something like “I’m worthless if I’m depressed” does not change the depression and can deepen this state.

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Secondar y Depressive Belief Tw o Questi o n s to Chal l eng e Sec o nda r y Bel i ef Sam p le A nsw e rs to C hal l en g ing Questions “I must not b e depresse d . Feeling how I must not feel shows I ’m to blame and wo r thle s s.” When you feel depre s sed, where is t h e law that says yo u shoul d no t fe e l a s you do? A depres s ed mood is t h ere for a reason. Regardle s s of the rea s ons, however, y ou sti l l feel as y ou do. This acceptance v i ew is an intermediary step in cor r ecting secondary depressi v e thought. Wh y shoul d a ha b i t o f mind disappear by decree? A depre s sed mood pra c tical l y never changes by decree. But y ou can encourage y ourse l f to take steps to address your seconda r y depre s sive thinki n g—suc h a s tha t yo u should not feel dep r essed. Self - encou r agement, followed by action, can go far to el i minate distre s ses evo k ed by u nrealist i c decrees.

Second step:

Second step Evoke an “ultimate ” explanation for taking the onus of blame away from feeling depression . For example, feelings of depression among some people in northern climates could routinely occur a few months before the winter solstice . Preliminary feelings of depression could trigger a migration impulse to travel to a warmer climate.

COGNITIVE IMAGERY TECHNIQUES:

COGNITIVE IMAGERY TECHNIQUES Using Time Projection Doing Mental Rehearsals

Using Time Projection:

Using Time Projection When pessimism and gloom trump reason and optimism, you can act like a naysayer and negate whatever you accomplish in the present and deny there will be any positive future. Who wouldn’t feel hopeless and depressed under such circumstances? So if you take a test and get a high grade, you say this was a fluke. It was the failing grade that you got on your seventh-grade English test that attests to your true abilities.

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How might you shift from a pervasively gloomy point of view to one that is sprinkled with some optimism or, at least, a wait-and-see attitude ? There is no magical way to quickly shift from depressive thinking to a realistically optimistic outlook.

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Emeritus Arnold Lazarus (1971) suggests a time projection chiseling tool . If you are depressed by oppressing circumstances, ask yourself, “ What will I be doing in one, five, or ten years?” “ What positive things could happen?” “Does future offers opportunities?”.

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Knaus 1998 suggests a backward planning . If you see only doom for yourself, you are likely to filter out ideas that are inconsistent with that gloomy perspective, thus perpetuating the gloom. It is a typical tendency for people to engage in such filtering . “let’s pretend” sequence.

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Imagine that this is one year from now. You have overcome your depression . Think backward from that event. What happened just before your depression lifted ? What did you do to help make that happen? What steps did you take before the last step ? What decisions did you make in the beginning to start an antidepressant process in motion?

Doing Mental Rehearsals:

Doing Mental Rehearsals Mental rehearsals can help in areas of personal development . For example, you are alone and feeling isolated. You associate this condition with your depression. You’d prefer to have more contact with others . But , you find that you get tongue-tied when meeting with acquaintances. You don’t see yourself communicating well, and you believe that this is a partial reason for your sense of isolation. This represents a self-development opportunity . Suppose you lack confidence in your ability to engage people in small talk, and you’d prefer to more comfortably engage in informal conversations.

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In this mental rehearsal phase, you would do the following : Imagine a situation when you are with a person you want to act friendly toward. Create the scene in your mind where a brief conversation can take place . Imagine making small talk, asking “how is your family?” and “how are things going at work?” Imagine the rational thoughts you’d prefer to think.

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Imagine the feelings that would flow from such a rational perspective. Next , imagine yourself engaged in small talk with a specific person . Imagine communicating to different people you know in different locations. Imagine making passing conversation with friendly looking strangers at malls, grocery stores, and other places where people gather.

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If the conversation falls flat Communications are a two-way street. You can’t win them all Can you think of anything more reasonable than that? If so, use it Is it the sort of feeling that comes from acceptance? Is it the sort of feeling you associate with confidence? Try to conjure that feeling as you visualize yourself in a situation where a conversation “drops off.” If small talk stalls, what would be a rational way of viewing this drop off? Try viewing it this way: If you can accept that not all conversations go as planned, you’ll probably feel more relaxed about engaging in small talk. 16

BEHAVIORAL METHODS FOR CURBING DEPRESSION :

BEHAVIORAL METHODS FOR CURBING DEPRESSION When depressed, you may show little interest in the activities of daily living. You may experience more frequent feelings of anxiety, anger, or sadness. You may think more negative thoughts that relate to helplessness and hopelessness . In addressing depression from a behavioral angle, the idea is to decrease the frequency of depression-related behaviors while increasing the frequency of constructive behaviors . We’ll discuss a sampling of some behavioral methods to help defeat depression

Create a contingency contract with yourself to increase an activity :

Create a contingency contract with yourself to increase an activity The contract defines the priority activity, how you will structure the activity (dates, times), what you will do to work on the priority, and the type of rewards you will give yourself following the completion of specific phases of the activity. Write up the contract. Date it. Sign it. Follow it. Set up a penalty that you agree to impose on yourself if you fail to carry out the contract. Your penalty could be as simple as making a donation to some cause or political candidate that you do not like. Find someone who is willing to monitor your contract. His or her job will be to make sure that if you fail to carry out the con- tract, you will impose the penalty on yourself.

Create another contingency contract for an activity to decrease:

Create another contingency contract for an activity to decrease Activities to decrease can involve: sitting inactively in a corner, associating life with a painful experience, or avoiding contact with friendly people. By decreasing the frequency of such activities, you will increase positive activities. For example, by not sitting inactively in a corner, you may instead compose e-mail notes to friends . Instead of associating life with painful experiences, you can look for ways to contribute to relieving the despair of others, say, through volunteer work. Instead of avoiding contacts with others, you can make phone contacts, arrange for a luncheon, and so on.

Break the contracted activity into relatively smaller components:

Break the contracted activity into relatively smaller components Give yourself a reward following each phase. Although it is questionable whether you can really reward your own behavior, you can arrange a kind of self-reward with your monitor. You could, for instance, give away a sum of money to the monitor and then earn it Frequent rewards are likely to prove more motivational than one long-term reward. However, do include a desired bigger long-term reward following the completion of the project.

Use a penalty system to discourage negative behaviors.:

Use a penalty system to discourage negative behaviors. If you complain to your friends about how rotten you feel, this can be a turn off to them. Some may avoid you. If you set up an agreed self-penalty with your monitor, this will help you to decrease this behavior. For example, if you enjoy drinking coffee, you can ask your monitor to help you make sure you deprive yourself of drinking coffee for a day following a complaint session. If your monitor does his or her job, this will help you to avoid complaining.

Create a list of positive things to look forward to experiencing.:

Create a list of positive things to look forward to experiencing. Admittedly , this step can prove challenging. When the future looks dismal, any positive expectation may seem like a meal of gruel. Nevertheless , the future can contain a rerun of a once favored movie. It is possible that you can purchase the antique chair you wanted at an upcoming auction. You may meet a favorite relative for lunch when that person comes to town. So , instead of negating things that the future may hold, look for ways to anticipate something out of the ordinary that can have value.

Try counting how many positive statements you make about yourself.:

Try counting how many positive statements you make about yourself. Include the number of positive statements about your future prospects that you make to yourself. Try to increase these and to decrease negative statements about yourself and negative statements about your future. Set up one or more rewards with your monitor for increasing the rate (number per day) of positives and decreasing the rate of negatives.

Pace yourself.:

Pace yourself. There is no universal law that says that you must operate like a dynamo, especially when depressed. During times when depression seems lighter, you may be in a better position to concentrate. That may be the time when you look closer into solving problems associated with depressive thinking. When depression deepens, doing mechanical activities can help disrupt the depression. These activities can include washing a car, moving furniture, weeding a garden, buying a quart of milk, or cleaning a bathtub.

Bottom line…:

Bottom line… Engaging in behavioral activities can help promote a sense of command over your own actions. When you use your muscles, you are simultaneously acting to change negative thoughts that say “you can’t do this; after all, you are depressed.”

CHART YOUR GOALS :

CHART YOUR GOALS Use the following chart to identify behaviors that you think are useful to increase, behaviors that you think are useful to decrease, and how you will reward yourself for progress in each area. Beha v iors t o Increase Reward s for Progr e ss Beha v iors t o Decre a se Reward s for Progr e ss Resolv i ng disagreements w i th family membe r s Watching tele v ision for one ho u r follow i ng each resol u tion Moping and complaining to fami l y members Watchin g bird s at bir d feede r fo r fifte e n minutes for each mope-free d ay

Premack’s Principle :

Premack’s Principle Finding ways to reward yourself can seem daunting when you feel depressed. You may want to disappear into the darkness rather than do something to get a reward which may seem meaningless at the time you get it. When depressed, reinforcing yourself for doing something constructive does not necessarily mean that you will repeat the behavior for which you were rewarded. However , establishing a routine where you break daily activities into achievable parts—and following each part with something that you might ordinarily do when you are not depressed—can help tip the balance in your favor.

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Psychologist David Premack’s (1965) principle is that any action that a person engages in frequently can serve as a reward to increase infrequent but desired behaviors. Frequent behaviors are usually readily available. When you are depressed, however, you can experience a dramatic behavioral shift where you drop some activities that are normally frequent, such as reading the newspaper or calling friends. Depressive thinking, perfectionist ruminations, angry preoccupations— all substitute for the normal activities of daily living. Nevertheless, it is possible to normalize your life by reengaging in high frequency behaviors that you previously enjoyed.

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Find something that you normally do or did that is or was pleasurable. Make doing this activity contingent upon doing something specific to deal with your depression. Suppose you decide to take one hour to write out your depressive thoughts so as to make them more visible. At the end of this time, do something that you normally find pleasing. It can be catching up on the news or drinking a cup of coffee . The Premack principle qualifies as a procrastination technology technique that can aid in defeating depressive thinking. Helps you act Provides reward , too.

USING PREMACK’S PRINCIPLE :

USING PREMACK’S PRINCIPLE The following chart describes two examples for using the Premack principle. Use the remaining spaces to fill in your own plan. Count e r-Depr e ssion A c ti v ity Positive Acti v ity That Y ou Ordinarily Do Though t l o g re c ordi n g. Read local n ews. Twenty m inutes que s tioning dep r essi v e ideas. Drink cup of c offee. 30

MAINTAIN ROUTINES:

MAINTAIN ROUTINES How you structure your life when depressed can make a difference. The Premack principle can be used to target specific areas where you want to increase the frequency of a certain behavior that can compete with a depression-related inactivity. Yet gradually rebuilding normal routines into your life and sticking with those basic routines can create a sense of structure, familiarity, and stability that eventually can help mute depression. This scheduling process can include assigning times for basic routines such as exercise , showering , eating , shopping , and sleeping .

Making Checklists:

Making Checklists To start, put your priority daily activities on a list. Then order them according to the sequence that you plan to do them in. You can structure your time to make normal high-probability behaviors follow those that you want to encourage in yourself. Checking off the activities that you complete signals an accomplishment and a sense of control . You can assign a fixed time for each activity of daily living, such as exercise starting at 8:30 A.M. As you complete the items on the list, check them off.

Using a Weekly Planner:

Using a Weekly Planner Routine & time Saturday Sunday Monday Tuesday Wednesday Thursday Friday

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The above planner makes sense for redundant activities that you can do daily. You can use different colors to signal different levels of accomplishment. As items get crossed out, this observation can feel rewarding. But even when depression trumps any feeling of reward, remember that you are still acting in a way that can bring long-term relief from depression. When you commit yourself to establish and maintain daily routines , plan for lapses . If you lapse, start again .

Project by Project:

Project by Project If your project is to recognize and defeat depressive thinking, you can combine this with the Premack principle . For example, follow one hour of reviewing key areas of this book with a normal activity of daily living, such as showering.

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Depression is a wild card in any routine scheduling program. Depression retards normal activities. So it is wise to see the schedule as an experiment. As you engage in this experiment, you are likely to come across stumbling blocks, delays, and other interferences that can be identified and worked at along the way. The time it takes you to recognize and address such depressive interferences is the time it takes.

Strategic Delays and Procrastination:

Strategic Delays and Procrastination Unlike procrastination , where you impulsively put off a relevant activity, delays can be strategic . When depressed , some activities on your list might best be put off. Suppose you feel stressed by your current job and want to get another. You are able to plod through the day on the job, but you really don’t like what you do. When depressed, your mood will be downtrodden. If you decide to put off a job search because of a lack of energy and enthusiasm, waiting until you get over feeling depressed can be a strategic choice . Procrastination would be putting off dealing with the depression or putting off the job search once depression passes.

GET MODERATE EXERCISE:

GET MODERATE EXERCISE Exercise is among the top of the list of antidepressant activities. Understandably , exercise can be challenging to start and to maintain, even when you are not depressed. Building exercise into your routine often involves a struggle that comes at a time of high pessimism and low energy. But you can have an added incentive when depressed. You are not only acting to get into better shape—good for general health reasons—but also to alleviate a distressful depressive state.

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To get the benefits from exercise, you have to decide to do it. N ext , you’ll need to put one foot before the other to get the process started. Expect to stumble in this area at first, but do try to persist Sometimes exercising with a group or buddy can serve as an incentive to continue. Looking beyond depression can be a remarkably effective way to start, then to sustain, an exercise program. For example, imagine it is sixteen weeks from now. If you could get relief from depression within sixteen weeks, would you exercise for that purpose only?

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Are there any short-term benefits that can serve as an immediate incentive to start an exercise program? You can normally experience an improved mood for a time following either aerobic or anaerobic exercise. For example, immediately following twenty-five minutes of treadmill walking, women with major depressions experienced less automatic depressive thinking and a better mood. Following this exercise routine, people with the greater degree of depression tended to experience the greatest magnitude of positive change.

What Is Moderate Exercise?:

Moderate exercise activities include jogging in place , walking on treadmills , climbing stairs , swimming , walking , bicycling , rowing , or light weight lifting . You can work on your own, with a group, or at a health facility with exercise equipment and professional instruction. You are moderately exercising when you raise and maintain your heart rate 20 to 30 beats above your normal level. If your normal heart rate is 80 beats per minute,100 to 110 beats per minute can be your target range. The amount of time for exercising involves sustaining an approximate 105-beat rate for between twenty to thirty minutes. A reasonable frequency is to exercise every other day. But there is some evidence that exercise is cumulative. You can break exercise sessions into five-minute segments and spread the effort throughout the day. What Is Moderate Exercise ?

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Moderate exercise can reduce fatigue , increase energy , boost your immune system , and reduce symptoms of depression . This partially depends on your health , physical condition , gender , and age .

BEHAVIORAL TECHNIQUES FOR SLEEP PROBLEMS :

BEHAVIORAL TECHNIQUES FOR SLEEP PROBLEMS When your depression feels severe, you’ll feel fatigue, yet you may have trouble sleeping. About 90 percent of those with a major depression have fitful sleep patterns. Insomnia , awakening in the middle of the night (middle insomnia), interrupted sleep, paradoxical dreaming, and early morning awakening are common signs of depression . Disruption in sleep patterns is normally a psychobiological issue with a strong biological component, as described in the following list.

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The rapid eye movement (REM) phase of sleep is associated with dreaming. When the latency for this stage of sleep is short, relative to nondepressed sleepers, it is associated with depression. Negative, fitful dreams are called paradoxical : sleep loses some of its normal benefits. As depression starts to lift, there is a change in dream patterns from more negative dreams during the first half of sleep to fewer negative dreams during the second half of sleep Some who also suffer from anxiety might have difficulty falling asleep.

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Restorative sleep correlates with reductions in a depressed mood, depressive thinking, and other common symptoms of depression. Some sleep medications can prove productive. However, if you’ve tried medication to restore sleep without significant success, here are some cognitive and behavioral methods that you can try for restoring healthy sleep patterns.

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Follow a regular sleep schedule. Go to bed just when you are likely to feel sleepy. Give your body cues associated with sleep, such as listening to a favorite soothing song about fifteen minutes before you are scheduled to retire. If you routinely fall asleep on the couch while watching TV, then awaken a few hours later and stay awake for the next several hours, you need to change the routine . Do something active where you will stay awake until a regular bedtime.

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Spend about a half hour in direct daylight each day. In the morning, go out in the sun for about fifteen minutes. This can help set your sleep-time clock. Do moderate exercises (aerobics, for example) during the afternoon every day. Since it takes a few hours for the body to go back to normal, avoid exercising two to four hours before you go to bed . Avoid ingesting coffee, cola, tea, or chocolate seven hours before your regular bedtime.

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If you smoke, refrain from doing so several hours before going to bed. (Because of demonstrated health risks, it is a good idea to stop permanently.) Associate your bed with sleeping. Avoid reading or watching television in bed or doing work in bed. Take a warm bath about two hours before sleeping. This can be relaxing as well . The two-hour time gives your body ample time to cool down before sleeping . Reduce controllable external noises that can serve as distractions to sleep. Try using white noise to muffle outside sounds that can’t be eliminated. A white noise may be a low-volume sound from a non-operating television channel.

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Relax… If you relax your body during periods of interrupted sleep, you will do better than if you worry about how well you are doing trying to fall asleep. Your body will gain some benefit. Some experts advise sleeping with your head facing north. The theory is the pineal gland responds to magnetic forces with increases in melatonin production. (I’m unconvinced that this makes any difference, but turning your head north can’t hurt.) If you are inclined to watch a clock to see when you awaken, use one without an illuminated dial or light. You are less likely to preoccupy yourself with how much sleep time you might be losing.

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If you have difficulty sleeping because you reflect on the trials and tribulations of the day, this is a signal that you can profit from resolving daily conflicts as they arise. There is a significant scientific literature on the relationship between sleep problems and negative content of thought. One direction of this thought is worry over lack of sleep and anxiety about performing less well following interrupted sleep. Worry is distracting and anxiety creates arousal. Challenging negative thinking related to sleep can help alleviate those tensions .

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Wakefulness can come about from telling yourself something like “I’ve got to fall asleep, I’ve got to fall asleep.” Should this “command to sleep” process occur, question the demand that you have to fall asleep. Explore the possibility that the worst thing that is likely to happen is that you’ll feel tired the next day, and how is that so bad?

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Teach yourself to defuse negative thinking that can contribute to disrupted sleep patterns. For example, learning to decrease cognitive distortion through rational examination can, over time, reduce the frequency and intensity of thoughts that promote depressive arousal and disrupted sleep patterns. If you have difficulty falling asleep because you anticipate a negative occurrence tomorrow, flip things around and concentrate on best outcomes . When you are unable to sleep, a tested behavioral approach is to get out of bed.The idea is to avoid associating the bed with wakefulness. Return when you are ready to sleep. Count backwards from one thousand by threes.

BEHAVIORAL TECHNIQUES FOR SAD :

BEHAVIORAL TECHNIQUES FOR SAD Seasonal affective disorder commonly occurs in northern climates at around the time the days grow short. In addition to defusing the depressive thinking that ordinarily accompanies this form of depression, light therapy can help reduce SAD effects. There are specialized lighting systems for treating SAD. Research shows that florescent light bulbs with an intensity about ten to twenty times as bright as ordinary inside light is a therapeutic level. Light therapy procedures produce about a 75 percent remission rate. Changes may be notable between three days and two weeks of daily exposure to extra light. In some cases, people obtain the same effects of light therapy by going out for a walk on a sunny morning. The use of light has promise as a general way to curb depression.

A VALUES APPROACH FOR DEFEATING DEPRESSION :

A VALUES APPROACH FOR DEFEATING DEPRESSION What is this thing called “value”? Values are core beliefs that represent what is important to you. They can be what you believe is right or wrong ; what is ethical and moral . Values sometimes appear in the form of abstract ideas such as integrity, responsibility, freedom, and friendship . However you label or define your values, they are matters of importance to you . Your values can occur in combination to give direction to your life. One value direction is to contribute your gifts, engage in appealing activities, and remove barriers that stand in the way of such valued activities. Following this combined value direction, you are likely to address depression if it gets in the way of the expression of your values.

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Values serve as organizing principles around which we can structure a significant part of life. Whether you feel depressed or not, if you value responsibility, you are likely to organize your activities around responsible steps to address depression. When the pull of responsibility dominates the pull of a depressive retreat, you are more likely to act responsibly even when the going feels sluggish and slow. Thus, exercising responsibility is an establishment of control that opposes helplessness thinking .

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Your family and social experience help shape your beliefs and values. When you are depressed, many positive beliefs and values can become subservient to depressive beliefs. Nevertheless , even when depressed, you can reactivate values that you believe are functional. You can pick new values to pit against depressive thinking, moods, and behavior. For example, you can promote responsibility over withdrawal. Thus, you act to counter the pull of depression because “it is the responsible thing to do.” The following exercise shows how the value of responsibility applies to social situations (external) and self-development (internal) factors.

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EXERCISING YOUR VALUES: First , list what you believe are important social rules and regulations that you believe are important responsibilities to follow, and then list what you anticipate from expressing these values. These values can involve paying bills on time or volunteering to help disadvantaged children learn literacy skills. Next, list the values that represent what you think is important from a self-development perspective, and then list what you anticipate from expressing these values . consider if there is a relationship between what you value that is external and the values that you hold that are internal. You may come to see that the value of responsibility intersects with both external and internal directed actions. Externa l value s t o f o llow: Ant i cip a t e d re s ults for fo l lowing the va l ue: Int e rnal v alu e s to f ollow: Ant i cip a t e d re s ults for fo l lowing the va l ue:

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By setting upon a path paved with desirable values, you can leapfrog over many false beliefs and apprehensions. That’s because your values define what’s important to you . Many decisions will then fall into values categories, which can simplify the choices that you make and reduce much uncertainty and indecisiveness that so often accompany depression.

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