This chapter explores some other options for working against depressive thoughts and feelings and trying to change our brain states. It might be helpful to try some of the exercises in the previous chapters first, so that you have some experience of identifying your thoughts and generating alternatives, before you try the ideas here, so see how you go.
Flash cards
Flash cards can be used as reminders of the sort of useful things that you tell yourself when you are feeling depressed. To make a flash card, take a blank postcard or a similarly sized piece of paper. On one side, write down one of your most typical negative thoughts; then, on the other side, write down some key helpful alternatives to this. Repeat this exercise for the depressing or anxious thoughts you usually have.
For example, suppose that you have the thought: ‘I will never get better.’ On a day when you don’t feel quite so bad, write out this thought on one side of a card. On the other side, write down what you imagine you might say to a friend who had such a thought, or how you imagine someone who cares for you might speak to you. Remember, consider these ideas not with a cold mind but with as much
warmth and friendliness as you can muster – as if someone who cares about you is encouraging you to make your journey out of depression. Here are some alternatives to try:
This is a very distressing idea. However, it is very common for depressed people to think and feel like this so it is natural and normal to feel like this because I am depressed.
I can therefore just be mindful of this thought and feeling and see it as being produced by the depression. I can let the idea be there without running away trying to avoid it or dwelling on it and assuming it is true.
This is typical of all depression – it always looks on the dark side. I am one with others on this.
Because I feel like this, it does not make it true or a fact. The evidence is that people do recover from depression. I can be accepting of this thought, see it as an understandable thought – but not a fact. I can stand to the side of it.
Although I (understandably) want to feel really well right away, I might be trying to achieve too much. Maybe I could aim for a little improvement and work with that, step by step.
Focusing on the idea ‘I will never get better’, although understandable, will make me feel worse. It would therefore be preferable to focus on what I can do rather than what I can’t. How can I act against this belief and practise redirecting my attention and my behavior?
It could be a good idea to distract myself from dwelling on these thoughts, perhaps by listening
to the radio, taking myself out for a walk or doing some gardening. While doing this I will try to focus my attention mindfully on the activity.
If I learn to go step by step, I might learn to get more control over my depression. Let’s really give it a go and see how far we can get.
When you look at these ideas, how do they seem? Are there ways of discounting them running through your mind – as is typical in depression? Are you thinking, ‘Yes, but’, or ‘This might be okay for other people but not for me’ or ‘It’s too simple’? If you are having these thoughts, remember – this is the depression speaking. What have you got to lose by trying? How might you be kind and
understanding to your dismissive thoughts, but not let them decide your actions or take control? What happens if you read them through but focus on ‘hearing them in your mind’ in as kind and warm a way as you can? Why not have a go?
Let’s try another typical depression-maintaining thought that involves self-labelling: ‘I am a bad, weak or inadequate person for being depressed. I never thought it would happen to me.’ Your flash card might list some of the following:
There is nothing bad, weak or abnormal about me because I am depressed. Up to one in five people could have times when they feel like me.
Many celebrities and people in high places (film stars and politicians) have suffered from depression. Depression can’t be about weakness if all these people can get depressed, too.
Winston Churchill suffered from de pression, which he called his ‘black dog’, and he was hardly a weak person. It is to do with our brain design.
I would not speak to friends like this. I would try to understand and encourage them. Labelling them (and me) bad or weak does no good at all. It is just another form of bullying.
When I get depressed, I focus on all my bad points. This is usually to do with my frustration or disappointment. The time has come to learn to be kind and understanding of my setbacks and my frustrations.
You can carry your flash cards with you, in a pocket or handbag, and take them out to give you a boost and help. Some people find pinning cards up in particular places around the house can be beneficial. For example, a woman I know who wanted to lose weight and had trouble controlling her snacking put a card on her refrigerator. It read:
So you feel like a snack right now? But think about this. Do you really need it? Would you feel better if you resisted the urge?
Have a cup of tea instead. Hold on and you will be pleased with yourself tomorrow.
By reading this every time she was tempted to snack, she gained that little bit of extra control.
Compassionate cards
A slight variation of the above flash card idea is the following. Find a postcard or photograph that you really like, with a picture that gives a calm and soothing impression. One woman chose a picture of a mountain which she thought conveyed strength and calmness. Another chose to make her own card from some paintings and coloured paper. Choose any picture you like – it might even be one that makes you smile. Since you know what your depression thoughts are, you don’t need to write those.
All you need to do is write down your alternative compassionate thoughts (maybe like the ones we
tried above) on the back of the picture. When you are happy with this, then look at your picture, create a soothing rhythm in your breathing and adopt a kind facial expression. Read your alternatives, then flip the card and look at the picture and try to feel soothing and acceptance for you. Try that a couple of times. You can use your card when you’re feeling distressed – don’t forget that slight smile and kind facial expression because this will be stimulating muscles in your face and feeding back into your brain. With practice, you may find it helpful. As for all of these ways of working with your depression, try them out and see how you get on. Introduce you own ideas for working on your depressed brain state.
Preparing yourself for stressful situations
If you know that you have something stressful coming up, you can prepare for it in advance. You can use flash cards as reminders for coping. For example, suppose you are going to have people over for a meal. One response might be, ‘Oh God, it’s too much. I’ll never cope.’ You could write down some key coping thoughts before the event:
Maybe it won’t be as bad as I think. Let’s get the evidence.
I can break down what I have to do into small steps. Each small step might be ‘do-able’.
Filling my head with ‘can’t do’ thoughts is under standable but it would help if I refocus my attention and thoughts (see pages 190–195).
I can develop a plan of action. I can rehearse the relaxation skills while I’m doing it and see if that helps me.
I can learn to accept and tolerate my anxiety and feelings without running away. I can remind myself I have coped with these in the past. It’s the body getting into its anxiety routine. I understand that this is extremely unpleasant, but not dangerous.
I can focus my attention on what I’m doing. If I start to criticize myself, I’ll say ‘Look, I’m doing okay’ and really focus on that – and okay means ‘okay’, not necessarily marvellous.
When the guests arrive, I can give them drinks and ask them about themselves. People like to be asked things about themselves; the focus does not have to be on me.
If I feel tense during the meal, I can work on my relaxation. I can get up, go to the kitchen, or go outside for some air. I am not trapped here. I am free to go where I want – it’s my house.
I can deliberately practise imagining it going reasonably well, and feeling pleased, rather than only imagining it going badly. The aim is to show myself that I can cope and this is all I want to do right now. I will avoid all-or-nothing thinking (i.e. it has to be great or it’s a failure).
Each step of the way, I will focus on doing okay. I can do my best to keep my inner helper with me and praise myself for any small success.
Practise making a real commitment to change and take on the challenge. Think about and build an image in your mind of how you will feel when you do.
The aim of this kind of work is to help you to prepare for things that you might find difficult. The more you try focusing on coping, the easier it may get.
If emotions could speak
Some depressed people say that they do not have clear thoughts going through their minds, only
feelings. I remember once driving to work feeling rather down. At first, I could not focus on anything in particular, so I used the technique of, ‘If my feelings could speak, what would they say?’ I tried to get my ‘down’ feeling to tell me what was wrong. As I followed this idea, I found that I could begin to identify what my down feeling was about. It said, rather out of the blue, ‘Your life is going nowhere.
You’re getting old now and your chances have gone.’ As I followed this thought, I recognized that it had been triggered by playing cricket. Through my thirties, I had been too involved with work to play the game, which I had enjoyed in my youth, but had taken it up again in my mid-forties. Although I’d been a reasonable player when I was at university, I wasn’t now. Compared to the younger players, I was a lumbering oldie with a poor eye for the ball. I suddenly realized that I was grieving for my lost youth! If fact, my thoughts were not really accurate about what I was really feeling. I was not actually worried about my life going nowhere (I was doing quite well, in fact) but was upset about losing my youth. Sometimes our thoughts are not actually accurate reflections of our feelings. When we allow our feelings to speak freely, they can take us to some strange and interesting places.
So if you can’t identify thoughts but you can identify feelings, say to yourself, ‘If my feelings could speak, what would they say?’ Speak out loud the things that come into your mind; let the ideas flow.
As you allow your thoughts to flow, be aware of them but avoid trying to direct them anywhere. Be mindful. See what comes up, what passes through your mind when you focus on the feelings. Be prepared to draw a blank sometimes, or for thoughts not to make much sense. The idea here is to allow yourself to go on your own journey of guided discovery.
Speaking with different parts of ourselves
So far we have talked about having depressing thoughts, anxious thoughts, angry thoughts, rational thoughts, compassionate thoughts and so on. Sometimes it is helpful to think of these thoughts as if they represent different parts of ourselves, and use an approach that allows us to name these various
‘parts’ or types of thoughts (see pages 87–88). Self-critical thoughts can be called the ‘internal bully’, self-supportive thoughts can be named the ‘inner helper’, ‘compassionate image, friend or nurturer’
and so forth. If we give space to these inner selves (types of thoughts), it allows us to observe and listen to the different types of conversations going on inside us. The point is that we are not one-dimensional beings, and in many situations we can have a mixture of thoughts and feelings.
Sometimes we can learn to pay attention to what different parts of us are saying by using different chairs. For example, sitting in one chair we become one part (e.g., the angry self, or anxious, sad or critical self). We give full voice to the thoughts, concerns and feelings. Then we get up, take a few steps and a soothing breath and sit in a facing chair and become the wise, compassionate self who has listened intently, is understanding and helpful. Pay close attention to the thoughts that flow here. If not much comes then imagine speaking to someone else for a moment – someone you care for – and also make a note to practise becoming the compassionate self more often.
Something else you might find helpful is a ‘playful’ style, playing each part as if you were trying to win an Oscar. This is not at all easy when we are depressed, but this does not mean we cannot be playful and take our inner thoughts less seriously.
A word of caution – if your self-critical side is not only your own disappointment and put-downs but also reminds you of someone who was very hurtful or harmful to you, then your compassionate side needs to be assertive and stand up to the ‘voice from the past’. This can be tough and may need to be worked though with help or a therapist. As always, only go with these exercises insofar as you
find them helpful to you (see page 303).
Changing depressive images
When we are depressed, we often feel as if we are in a deep hole or pit and our internal images are very dark and harsh. Because this internal world can blacken our lives, it is sometimes helpful to work with these images directly. If you feel in a deep hole, imagine a ladder coming down to you and that you are climbing out, rung by rung. Practise the imagery before sleeping. It would be nice to jump out in one go, but that’s only possible for a superman or superwoman and I have yet to meet one of those. Each time you succeed at something, that’s one more rung up the ladder.
If your inner image is dark, try imagining getting some light in by installing some windows, or build a door and get out. Try not to accept the image passively, but start to change it so that it becomes more healing.
Carol had thought about getting out of a difficult relationship and coping on her own, but her
internal image was always of living in some dark, cold place that nobody ever visited and which she never left. She thought that some of her dark images might have had their origins in being left in a cot in a dark room as a child. By focusing on one of these images and using active imagination (i.e.
moving into the image), it became clear how dark this image of being out of the relationship actually was. Then it became possible for her to explore and change the image. She imagined what she could do in this place to change it, how she would like her own place to look, how she might decorate it, what pictures she might put on the walls, what flowers she might buy, what friends she might invite around, and so on.
The key thing about images is that, once you have a sense of them, you can work on how you would like them to change. Avoid simply bringing the image to mind and then feeling worse because you are not working to change it. It is changing the image that is important.
Sometimes people enjoy painting. People who are depressed tend to paint dark pictures, but it can be helpful to paint healing ones. Think about the kinds of images that are healing. These may be of a country scene, or of water – a seascape, for instance. Again the key idea is to acknowledge the dark images but also to introduce light and healing.
Changing values
We learn some of our values and attitudes because important people in our lives have told us that some values are good or punished us if we did not conform to them. Our attitudes towards sex, religion or the expression of anger are often learned in this way. Sometimes we adopt values by copying others, even those in society in general. For example, there is concern today that thinness is so highly valued as a female trait that many young women are getting caught in over-restrictive diets that can spiral into eating and weight problems. We take certain of these values into ourselves (i.e. we internalize them) and they become our own values and the ways that we judge ourselves.
Getting out of depression sometimes means that we have to reexamine our values and our attitudes.
This may be enormously difficult and painful because we may lose our sense of who we are and have to accept new risks. To make matters worse, we may feel a great sense of disloyalty in changing our values from the ones our parents have given us. Sometimes we cling to values that are quite harmful to us because, in the back of our minds, we still hope to succeed with them and make our parents (or
others) proud of us.
Sam had a high need to achieve and do well because his father had told him that only achievement counts in the world. Sam knew that his style of pushing to achieve, achieve, achieve and his intense self-criticisms were doing him no good, and he also worked out that the voice of his inner critic sounded very much like his father. And yet, despite this insight, he could not let go of the idea, ‘If I don’t achieve anything, I am worthless.’ For him to give up these values required him to give up the idea that he would, one day, get it right and prove himself. That had always been his hope, and to
Sam had a high need to achieve and do well because his father had told him that only achievement counts in the world. Sam knew that his style of pushing to achieve, achieve, achieve and his intense self-criticisms were doing him no good, and he also worked out that the voice of his inner critic sounded very much like his father. And yet, despite this insight, he could not let go of the idea, ‘If I don’t achieve anything, I am worthless.’ For him to give up these values required him to give up the idea that he would, one day, get it right and prove himself. That had always been his hope, and to