How to boost low self-esteem

November 13, 2015 by  
Filed under Anxiety, Depression, Home, Worry

Human beings are complex and complicated. When people come to my consulting room one of the first things I have to do is create a map of their internal psychological world.  When I create a psychological map I almost always find a problem with low self-esteem and therefore help to increase self-esteem is needed. This is especially true if a mood disorders such as depression accompanies anxiety and stress.

Low self-esteem

This video film outlines the three options/choices you have if you struggle with low self-esteem and it includes a startlingly simple question you can ask yourself that will basically tell you everything you need to know if you feel down or anxious.

I have had the video transcribed in case you want to also be able to read it. The transcript is below.

Let me see if I can make this issue more real so that it resonates with you. To determine if help with low self-esteem would be useful to you ask yourself this question… and this is a question I ask my clients repetitively. ‘What is the most negative belief you have about yourself’? Well sometimes people say, My feet are too big and I say, ‘no that’s not what it is.’

Commonly people say things like, I’m worthless, I’m disgusting, I’m no good, I’m unlovable, I’m a failure, I’m a fraud, I’m useless, I’m stupid. These are very negative beliefs to hold about yourself. And if you hold one of these beliefs it’s a very distressing thought to have. It’s a distressing piece of information to carry with you and it always causes a problem by decreasing your self-esteem.

If you recognize one of these negative beliefs as being applicable to you or if you ask yourself the question and you realize that you have a similar negative belief, then it’s difficult to live a fully satisfactory life. Once you have recognized your most negative belief you have basically given yourself three choices.

The first choice and the most commonly taken is to – ignore it. If you ignore your problems with low self- esteem you think it might go away. If you ignore it you can carry on as if it doesn’t exist. You can put it behind you and get on with your life. The trouble is that ignoring it won’t make it go away. It just puts it a little out of sight, so that you don’t have to look at it but it still always exerts its influence.

It’s like having another moon spinning around the earth exerting its gravitational force. Every now and then the extra moon and the current moon line up and we’re going to have massive gravitational forces disrupting life. You can ignore self-esteem issues, to a degree, for a period of time… maybe. And then it’s going to be distressing. It’s going to be upsetting. It’s going to cause things to go wrong. Ignoring it is a commonly adopted strategy but it’s not very useful.

The second most common choice when thinking about low self-esteem is to accept that your negative belief is true; accept that the most negative thing you believe about yourself is correct.

So, if I believed that my most negative belief is that I’m a failure, then I will accept as true that I am a failure. And commonly people who are depressed will sit in my consulting room and say, ‘I am a failure.’ ‘Like 100%?’ ‘Yes.’

That acceptance of the most negative belief that you have about yourself typically goes along with a substantial mood disorder and we can call it depression or anxiety depending on if it’s an anxiety provoking negative belief or a depressing one.

The first two options out of the three possible options are not very useful in the longer term and will definitely cause a problem at some point. The third choice is a bit more interesting, however. The third option when looking at low self esteem help is to ask yourself these questions:

‘Is my most negative belief about myself objectively accurate?’

‘Is my most negative belief about myself true?

‘Does my most negative belief about myself stand up to scrutiny?’

‘For instance if my most negative belief is that I’m a failure I would habitually say, ‘I am a failure.’

‘If I was doing my own therapy at the same time I would say, ‘do you work?’ ‘yes I do work.’

‘Do you hold down a job and get a salary?’ ‘Yes.’

‘Can you drive?’ ‘Yes.’

‘Are you able to maintain a relationship?’ ‘Yes.’

‘Are you interested in things?’ ‘Yes.’

‘Have you achieved any academic successes?’ ‘Yes.’

‘So are you really a failure?’

The question is this. When people say, ‘I am a failure.’ They don’t mean I have failed in being able to make a cheese sandwich they say, ‘I am a failure.’ This is a global interpretation of their whole being.

Looking at my most negative belief objectively can I sustain the view that ‘I am a total failure?’ No, I can’t and when people say, ‘I am a failure,’ which is a common thing for people to say, it’s hard for them to sustain it because it doesn’t match the evidence.
The evidence is not actually that they’re a failure. The case is that they feel a failure. And challenging this distorted emotion is part of the third choice.

There is usually a disconnection between your feelings of low self-esteem and reality. And you’ll find that this is true if you inspect it a little bit. There’s a disconnection between what you feel and what is demonstrably true based on the evidence of the world in which you live.

So on the one hand we have, this is what I know to be true and on the other hand we have this is how I feel. These are not the same things.
How you feel is what’s causing the most negative belief that you have about yourself to have energy.
What you feel is not always well calibrated to the world you live in and that is why either ignoring it or accepting it is the wrong solution to this problem of low self-esteem. The first two choices simple mean that nothing will change. How you feel will not change unless you challenge it and change it.

So what we have to do if there is a problem with low self-esteem and we want to change this is to take the third choice:. Use CBT Therapy to Help Low Self Esteem.

As part of getting self-esteem help you will need to examine your most negative belief about yourself. You have to examine its structure, you have to become interested in your problems with self-esteem and then challenge it and change it. We have to take this feeling of, I am disgusting, I am not good enough, I’m worthless, I’m unlovable, I’m a fraud, I’m a failure, I’m stupid, and we have to challenge this feeling to make it account for itself and bring it in line with what we know to be true because we can demonstrate it to be true.

I might not feel very clever but I’m not globally stupid. This negative belief is over generalized and De-contextualised. I might not feel good enough but the evidence is that I’m good enough in many domains of my life. Applying this acid test of reality is part of the process of cognitive behavioral therapy. This is CBT therapy.

When we challenge the feeling and we make it change to be more in line with what we know to be true. Because what we know to be true is…well… true.

Our feelings are not a good guide to reality in a lot of circumstances and in particularly when we have very negative beliefs and feelings about ourselves. So the third option of using CBT therapy to get self-esteem help means challenging and changing the most negative beliefs that we have about ourselves.

If we don’t challenge and change them they will continue to exert a powerful influence over us and they will distort and eventually ruin the course of our lives. It’s inevitable that they will do that because if you believe something very negative about yourself it will affect the course of your life. Now, my proposition is this, It doesn’t have to do that!

There are three choices that you can take, choice one is you can ignore it, choice two, you can accept it and choice three – challenge it and change it by using CBT for low self-esteem.

If you want to take option three there are many paths that will take you from where you are to where you want to get to, which I would anticipate is to feel good, to have a reasonable level of self-esteem and to be accurately calibrated to your skills and attributes and to the world around you. This gives you the best opportunity to achieve the best life that you can have.

If you want to engage with the third option which is boosting your self-esteem to move forward while adopting a proactive and constructive attitude to your mental health then please check out the CBT System Mood Control.

Depression, anxiety and stress are massively common human problems. The sad thing is they don’t have to be. We have within us the necessary tools and resources, with some guidance from a system like CBT (cognitive behavioral therapy) and Mood Control, to be able to resolve these. All we have to do is take the third choice.

Mood Control is a successful depression treatment and anxiety therapy that provides self-esteem help. Thanks for taking the time to watch and listen. I hope to see you on the inside of Mood Control and let’s get on this journey together.

Join Mood Control Today And Start To Feel Better

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Don’t go off the deep end…maybe

October 3, 2014 by  
Filed under Anxiety, Depression, Home

Just because you don’t know where you are, don’t go off the deep end! Or Sometimes you have to take the plunge! But how do you decide?

The only reliable way of making a decision that tells you what to do is by listening to who you are! That includes what your inner goals and desires are, what drives and motivates you and what you need in order to have a good and productive life.

You are your best guide to what is good for you but, as with advice from another person, you have to listen to it for it to have any effect.

It turns out that it can be pretty hard to listen to yourself and believe and accept what you find there. There is a lot of noise that gets in the way of your authentic inner voice.

But what is authentic anyway? How do you know your inner voice is authentic?

Here are the two keys to recognizing your authentic voice:-

Stop and listen to what you want.

So often we jump to what we think others want or expect from us that it can be hard to stop and pay attention to our own desires. If you’re the kind of person who cares deeply about other people then you’ll know what I mean by this. But, you are entitled to have your own desires and they don’t have to be compatible with those of the other people you mix with. You don’t have to conform all of the time. You are allowed to be yourself. It may be that one of the fundamental ingredients of a happy life is connection with your own desires.

Don’t take the story further

When you imagine something happening do you tend to elaborate it further and further until it turns into catastrophe or disaster? This is one of the basic components of worry. The ability to elaborate beyond the facts into a world full or hurt and pain takes you to places that don’t and never will exist. This propels you into fantasy outcomes that will never happen. You are going to need to stop doing this because it steals you from actual reality in the ‘here and now’ and puts you into your ‘head virtual reality fantasy generator’. This separates you from the world and your own needs within it. When you disconnect from ‘reality’ you become vulnerable to all sorts of terrible things…most of which will never happen. I like Mark Twain’s comment below.

“I’ve lived through some terrible things in my life, some of which actually happened.”

Mark Twain

Many of the terrible things we imagine never actually happen.

Many of the terrible things we imagine never actually happen.

Be prepared to say no to what you might not want.

Like many skills in life the skill of being able to discern what you want out of life is one that takes some practice to hone. Many people neglect putting enough effort into this for it to become a genuine life skill. Therefore the answer is to practice having an opinion, sometimes even if you don’t have a strong one.

Trying to please everyone is pointless as it only delays the time when you must be yourself and own your own desires.  Trying to please someone who does not have your best interests at heart (but their own) often ends up being abusive towards you.

Have an alternative already prepared.

I have coined a phrase that I think nicely sums up how we get ourselves into trouble. It is:-

‘Don’t take the path you don’t want to follow.’

What it means is that you need to stop putting attention into a life path that you don’t want to take leading to a destination you wouldn’t wish on yourself.  But do put effort into a life path you do want to take and which will yield a goal you can actively and positively work towards and achieve. Which translates to have a plan already worked out.

All of this means that you have choice. You can exercise choice in two ways. One way is to actively make a choice while the second is to passively accept the result of not making a choice.

You choose!

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Find out how to stop feeling bad

March 13, 2014 by  
Filed under Anxiety, Depression


The film below called self sabotage with the bad feelings generator explains everything in more detail. If you identify with anything that is written here then you will recognize the constant force of this process to pushing your happiness down.

If you suffer from worry, stress, anxiety or depression have you ever wondered why bad feelings never seem to end? It is as if there is a well of bad feelings and buckets of them just keep getting pulled up.  Or as I often think of it, it’s like there is a battery of bad feelings that gets recharged over night and then discharges bad feelings into your system throughout the day.

If this is your experience then you know how puzzling it can feel to have day after day of bad feelings without any obvious reason for them. So where does this constant streams of bad feelings come from?


Self sabotage

First let’s take a look at what self sabotage does to you.  No matter what you do it is never good enough. No matter what you experience it is never pleasurable enough, no matter what you try it never delivers what it should.

Are you always  struggling with some form of unfavorable comparison with what you achieve compared to what you feel you should have achieved? Do you struggle with how you should be compared to how you are? What ‘it’ should be like, and what you think others think about you, what you have failed to do compared to what you should have done.If so you have experienced the bad feelings generator in action.

The bad feelings generator is a process that continually makes comparison between your current state and a hypothetical alternative that is better in every way but is usually vague and ill defined.

The bad feelings generator

In my work with numerous clients over many years I have seen a pattern of thinking that seems to me to explain where the bad feelings generator is located and what it looks like. I think that this knowledge gives us a real opportunity to take a long hard look at the bad feelings generator and to really put some effort into  turning it down or even getting rid of it all together.

When you say to yourself ‘I should’, in that instant you are creating an internal dissatisfaction with yourself because in essence you are making yourself feel that you have failed in some way. You did not meet some internal high standard.

You may fool yourself into thinking that it is really only the act of encouraging yourself, or pushing yourself to do better but that is to misinterpret this process. the bad feelings generator only does what it says, it only creates dissatisfaction.  It never gives you action points or pointers to what you can improve your life. The bad feelings generator sabotages your quality of life and your happiness but gives you nothing of value in return. And, because it is simply a process that creates dissatisfaction there is never an end point. That is until you learn to accept yourself for who you are and what you are.


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The Depression Cure: Depression as a disease of civilisation

November 19, 2013 by  
Filed under Depression


Author of The Depression Cure, Dr Stephen S Ilardi has delivered a TED talk  in which he speaks of his theory of the origins of depression.

His arguments fit well with my own views and I believe that you’ll find it truly worthwhile taking the time to watch this video.

If you’ve followed my previous posts you’ll remember that I have written about the poor outcomes often seen from the use of antidepressant meds.

I often make the point that because depression is most noticeable by profound psychological disturbances and is most effectively treated by psychological interventions that it makes most sense, for most people, to consider depression a psychological problem.

The Depression Cure: We are hunters who no longer hunt

Dr Ilardi expounds his theory that human beings are evolved to live a hunter gatherer lifestyle. Most people now do not live like this anymore. As part of his research Dr Ilardi has looked at the lives of the aboriginal groups who rarely suffer from depression.

Think about it. If you work in an office you might drive to work, sit at your desk in front of a computer all day and eat lunch while you work. Perhaps you work long hours and then don’t feel like cooking a healthy meal when you get in choosing instead to grab a takeaway. This has profound consequences on every aspect of our lives.

This lifestyle is nothing like the hunter gatherer lifestyle and yet our genetics haven’t changed much at all since then.

Therefore a complete reversal of this ever increasing tide of more depression probably requires a very different way of approaching our lives.

A different viewpoint, a different attitude and a set of different practices that respect our genetic heritage but are also manageable in the modern world.

This is what the Library Journal had to say about The Depression Cure:

“[Ilardi] presents his alternative approach based on cognitive-behavioral therapy with an anthropological twist . . . Research findings (including the author’s own study on the treatment’s efficacy) are translated into readable terms . . . The positive aspects of the TLC model are obvious, but Ilardi’s composite program—rooted in the hunter-gatherer way of life—is novel. Practical, straightforward, grounded in persuasive research, this book is recommended for anyone seeking an alternative approach to treating depression.”

I found this talk interesting. Let me know what you think.

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Are you dealing with stress and depression?

November 14, 2013 by  
Filed under Depression, Stress


Are you dealing with stress and depression? Is there a link between the two? Can stress actually cause depression? These are the questions our visitor Colin had for me. With Colin’s permission I’m sharing his letter with you and then I’ll answer his questions.

Dear Dr Purves

In May I relocated from London to York and took a new job with a housing company. For the previous three months I’d been commuting to London and staying there for the week, away from my wife and newborn child whom I missed terribly.

The move to York was supposed to make things better but things just went from bad to worse. The person who interviewed me for the post wasn’t the person I ended up working for and he took an instant dislike to me. I put up with his bullying as best as I could but it just got worse and worse. I was constantly stressed. He undermined everything I did so that I began to believe it was me. In my previous role I’d been trusted, liked and confident with my tasks but within a couple of months I felt like a different person. It was hard to relax even at home.

Then I got a call from my mother who lives in Scotland to say she’d been diagnosed with a brain tumour and they had to carry out more tests. I’m not  sure if there’s any relationship between how I was feeling before and what happened but I sunk in to an immediate depression.

I was tired and tearful all the time. I found it hard to get out of bed in the morning. I was snappy with my wife and I didn’t want to do anything. In six weeks I put on a stone in weight and I’m not tall so it looked even more. The weight gain made me feel even worse about myself and I withdrew even more.

I recently saw my GP who diagnosed me with depression and signed me off work. I’ve been referred to a CBT therapist now and am just waiting for my appointment to come through.

Is the fact that I was stressed at work before I found out about my mother’s health the reason I sunk so quickly in to depression or are they completely unrelated?

Many thanks


Dealing with stress and depression: What is stress?

Let’s start by looking at what stress is. In a nutshell it’s physical or mental stress on your body. Colin was certainly experiencing mental stress from his situation at work and as he himself identified was feeling stressed and uptight even when he was at home.

We all need a certain amount of stress in our lives but when it’s too much it begins to negatively impact us and our body. What’s actually going on in your body is that the stress causes higher levels of hormones such as cortisol and for example the amount of serotonin decreases. When your chemical balance is out of whack you can find yourself wanting eat more as Colin did or less. You might find you’re very sleepy or can’t get to sleep. And you may find yourself feeling tense and snappy as Colin reports. If this continues you can find yourself suffering from depression.

Dealing with stress and depression: What is depression?

If you are depressed you might feel sad or empty, experience a change in appetite or sleep, tired or even worthless. Colin reports feeling tired and tearful and gaining weight which are all typical symptoms of depression. When we refer to depression what we commonly mean is clinical depression or Major Depressive Disorder to give it its full diagnostic criteria name. You can learn more about what depression is on my clinical depression page.

Dealing with stress and depression: Is there a relation between the two?

There is a relationship between stress and depression. Colin was already susceptible to depression being stressed and unhappy at work before he learned that his mother was ill.

I would ask Colin if as a result of being stressed he had been making negative lifestyle changes. I wonder if he was already eating more unhealthy foods and exercising less? Changes such as these in stressed out people can mean that they are at greater risk of experiencing depression.

Dealing with stress and depression: Getting better

So you know how you got here. Now what should you do? I’m glad Colin’s been referred to a CBT therapist as cognitive-behavioural therapy (CBT therapy) is a highly successful way to treat depression. While Colin is waiting for his appointment to come through there are plenty of free CBT exercises available which he could use to get started.

Waits to see CBT therapists can be lengthy depending on where you live.  If you find yourself on a waiting list and would prefer to get started sooner another option is to embark on a computerised CBT program such as Mood Control or Blues Begone which you can fit in to your lifestyle.

Dealing with stress and depression: Other treatments

There are lifestyle changes you can make   and natural treatments for depression which you can also try.

Best of luck dealing with stress and depression.

I hope you’ve found this post helpful.

Dr Purves

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Postpartum Depression Facts

November 7, 2013 by  
Filed under Depression

Do you  know the postpartum depression facts? This week I received a message from Penny who suspects her daughter has signs of postpartum depression. Penny kindly gave me permission to share her letter with you.


Dear Dr Purves

My daughter Karla gave birth to her son six weeks ago and I’m concerned that she has signs of postpartum depression.

She’s 25 and this is her third child. The first two were girls and she was fine with both of those. She has a supportive, loving partner and whilst money is tight they’re OK. There’s no apparent reason for her to be unhappy. It was her partner who called me because he is worried about her.

Karla seems happy one minute and then she bursts in to tears over nothing. For example Paul’s parents were coming down from Scotland to meet the baby. She was wiping down the sides in the kitchen and when she’d finished she burst in to tears because she’d missed a bit.

She doesn’t seem to care about her appearance. I know it can be hard to get showered and dressed when you have a newborn but she’s not even interested in leaving her pyjamas.

I’ve noticed that she often seems really distant. If I or anyone ask her a question she sometimes seems to struggle to formulate her words.

I asked her what was going on and she said she felt completely overwhelmed and empty. She said she didn’t feel anything for the baby.

I’ve heard of the baby blues, in fact I experienced that myself, but it only last a few days and was much closer to when the baby was born. If anything Karla seems to be getting worse not better.


Postpartum depression facts: Baby Blues v Postpartum Depression

Penny recalls having Baby Blues herself but postpartum depression, also known as postnatal depression, is different.

Let’s start with the Baby Blues. The Baby Blues usually kicks in a few days after giving birth. You can find yourself feeling irritable or crying over nothing and this is most likely down to your hormone levels. New mothers often report having symptoms of the Baby Blues on the third and/or fifth day after giving birth. There’s a lot to deal with initially.


You’ve been through labour, you’re most likely to be sleep deprived and you’re now a mum with a lot resting on you… and of course hormones. But Baby Blues is short lived. Symptoms can last merely hours or a few days .

If your symptoms persist or get worse as Karla’s mother reports hers are then you should see a doctor because you may have postpartum depression. Rest assured there is plenty of postpartum depression help available if your doctor does diagnose you with this condition.

Postpartum Depression Facts: About

The bare bones postpartum depression facts and symptoms are as follows:

As with general depression the signs of postpartum depression can include low mood, sadness, tiredness, finding it hard to sleep, loss of interest in things you used to enjoy, lack or increase in appetite,  or considering suicide.

Postpartum Depression Facts: You’re not alone

What Penny and Karla need to know is that according to the Royal College of Psychiatrists 10 to 15% of women having babies will experience postpartum depression.

Some celebrities with postpartum depression have been especially publicised. Actress Brooke Sheilds’ battle is well documented and was particularly severe. She penned the book Down Came the Rain: A Mother’s Story of Depression and Recovery about her struggle.

Everyone’s experience of postpartum depression is different. Brooke reports hearing voices, feeling rage and self-hatred. Very severe postpartum depression known as postpartum psychosis which may include delusions, rapid mood swings and hallucinations affects 1 in 1000 women.

Brooke says, “It has nothing to do with your love for [your children]. … It is something that is in your body, the loss of estrogen, the amount of hormones. … Pay attention to the feelings that you’re feeling and talk about it and ask your doctor. … Find out what medicine’s available. You don’t have to be miserable.”

Postpartum Depression Facts: Cause

Why is this happening to me? It’s common for women to wonder why they are experiencing postpartum depression.

So, what are the causes of postpartum depression? The cause is likely coming from a combination of things. Don’t underestimate the stress of being responsible for a newborn or the hormonal changes which will be going on in your body. If you add to these circumstances relationship issues or losing your job, for example, it’s a lot to deal with.

Karla would have been more at risk of developing postpartum depression if any of the following apply to her. And if I had the opportunity to meet with Karla I would ask her the following:

  • Have you previously suffered from depression or had any other mental health issues?
  • Did you feel depressed or anxious at any point when you were pregnant?
  • Have you experienced any additional stressful events?

Postpartum Depression Facts: Treatment

If you suspect that you have postpartum depression then your first port of call should be your GP. I would advise Penny to speak to her daughter and encourage her to have a chat with her health visitor or doctor who will come up with a treatment plan. As with general depression you can recover from postpartum depression and the same options apply.

Exercise is a natural mood booster and something you can do for yourself. Put your baby in the pram and get walking. It doesn’t have to be vigorous exercise to make a difference. Just do something.

Your doctor may prescribe you an antidepressant and suggest a course of cognitive-behavioural therapy.

Cognitive behavioural therapy (CBT therapy) is a talking therapy which is used widely in the treatment of depression and anxiety. It will help you challenge and change your thoughts. You can either undertake a course of therapy face to face with a therapist or use a computerised CBT course which you can access through your computer such as Mood Control or Blues Begone which has been used by the NHS.

And that brings us to the end of postpartum depression facts which I hope you’ve found useful.

Wishing you a good journey.

Dr Purves

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Is there a cure against depression and low mood?

October 28, 2013 by  
Filed under Depression


Rumination and negative beliefs ruin your mental health

*** Newsflash ***

Not everyone believes there is a cure against depression and low mood. A correspondent kindly sent me this quote attributed to Stephen Fry:

“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.

“Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.”

I am a great fan of Stephen Fry and as such I have time and respect for his opinion. But I have a fundamental disagreement with the first paragraph of his statement. It just seems too fatalistic. It seems to suggest that depression is what it is and that is all there is to it!

There are three fundamental reasons I can offer to disagree with Stephen’s quote:

Cure against depression and low mood: Many people overcome depression

Firstly, I have spent a considerable number of years helping people overcome depression and I have overwhelmingly found that following face to face CBT therapy people recover from depression. Indeed, this is so common that it is my expectation that recovery will occur and if for some reason it does not then I am surprised. This will give you an indication of the rate of success generally seen in practice.


Cure against depression and low mood: Computerized CBT cures depression

Secondly, it is even the case that computerised CBT (cCBT) programs like Blues Begone and Mood Control cure depression. It my recent posts and publications you may have seen the headline that 61% of users of Blues Begone are cured of depression without having any human therapist input.

Cure against depression and low mood: Rumination and self critical thought predicts depression

And thirdly, the BBC offered a slice of data that illustrates the role of thinking processes in the development, maintenance and relapse of depression. Collaborating with the University of Liverpool the BBC administered a questionnaire to a huge population sample of 32,827 people from 172 countries making it the biggest study of its kind ever undertaken in the UK.

Cure against depression and low mood: The BBC reported:

“We found that people who didn’t ruminate or blame themselves for their difficulties had much lower levels of depression and anxiety, even if they’d experienced many negative events in their lives”. “Dwelling on negative thoughts and self blame has previously been recognized as important when it comes to mental health, but not to the extent this study has shown.

“Rumination and self-blame have long been accepted by health professionals as part of the problems that can lead to depression and anxiety – the two most common mental health problems in the UK, according to the Mental Health Foundation.”

These findings suggest that rumination and self blame are both crucial psychological pathways to depression and anxiety. I acknowledge that rumination and self blame can become habits of thought and as such can take on a power that is hard to break. But it can be broken through challenge.

Everyone who has recovered from depression has challenged and broken free of the hold of negative thinking, self criticism and rumination. Although the habit of rumination needs to be carefully monitored and challenged whenever it rises up again.

Furthermore evidence from other research has shown that one of the best predictors of relapse in depression is rumination. So a dangerous foe to be guarded against, for sure!

There is nothing inevitable about rumination. Nor is there any force on earth that states ‘you must blame yourself’. These are things that we all do but it is the quantity and the sheer self destructiveness of the rumination and self blame that seem to be the tipping point into depression and anxiety.

These are processes that we can all learn to control and in so doing gain better control over our mental health.

I understand the reasons for the more fatalistic viewpoint with respect to mental health issues and that it may help remove some of the stigma associated with mental health problems. It reduces the power of the narrative that someone who suffers from depression is simply not trying hard enough to feel better or that depression is caused but not managing your psychology well enough. But if a client were to say to me ‘I am depressed and there is nothing that can be done about it’, I would say ‘let’s agree to keep an open mind about it and see if this turns out to be the case.’  Because most of the time it doesn’t.

Cure against depression and low mood: A friend is always a good thing

I agree that steadfast friendship is a restorative that is to be welcomed wherever it is found.


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What Clinical Depression Treatments are available?

October 16, 2013 by  
Filed under Depression

We recently received this letter from one of our visitors who’s looking for clinical depression treatments and we  felt it offered a good opportunity to talk about depression treatments in general:


Dear Dr Purves

 I’m 25 years old and today when I saw my doctor he told me I have clinical depression. I wasn’t exactly surprised as I’ve had bouts of depression lasting a few months at a time over the past few years.

 I often feel anxious as well as depressed and don’t want to leave the house and this often makes me late for work. I hate my job but the pay is good and I can’t afford to leave.  I haven’t the energy to put any effort in to friendships and many have fallen by the wayside. I just don’t enjoy anything anymore. I feel flat all the time.

 My doctor talked to me about different clinical depression treatments. He said he wanted to put me on antidepressants and arrange for me to see a therapist. I’ve had antidepressants before and they didn’t work. I also had a couple of sessions with a counsellor a long time ago but found them a complete waste of time. Is there anything else I could try that might actually work?



Clinical depression treatments: Antidepressants

Research has shown that antidepressants aren’t that helpful in cases of mild to moderate depression and the latest guidance from the National institute for Health and Clinical excellence (NICE) is that doctors should only prescribe them for the more serious cases. Some GPs adhere to this but some are giving them out for the mild cases.

From what you’ve said you sound as if you have a moderate case of depression. However, I would suggest that you talk this over with your doctor as he will fully understand your case. If you do have a severe case of depression then antidepressants do have their place as part of your treatment plan. Your doctor is in the best place to advise you.

Clinical depression treatments: Cognitive-behavioural therapy (CBT Therapy)

I’m sorry that you didn’t get on well with your counselling. Counselling can be very helpful if you have a problem that you need help solving. Counsellors don’t tell you what to do but provide you with practical advice.

clinical depression treatments - therapy
Treatments which include cognitive-behavioural therapy techniques tend to be really successful and NICE recommends that therapy is offered to patients with depression. It’s likely this is what your doctor has in mind when he says he wants you to see a therapist and I’d encourage you to give it a try.

In a nutshell CBT therapy is a talking therapy which helps you to make sense of your thoughts and behaviours. It will teach you how to go about replacing your negative thoughts with positive ones and change your actions.

If you don’t like the idea of having face to face therapy you could try computerised CBT (cCBT) which is just as successful. Basically you undertake a course of treatment in the comfort of your own home on your own computer. Blues Begone and Mood Control are two such treatments.

Clinical depression treatments: Lifestyle changes

As part of your treatment plan you might like to consider introducing regular exercise. I’m sure you know about the general health benefits of exercise but it’s also a great mood booster. It doesn’t matter what you do as long as you get moving.

Clinical depression treatments - exercise
I have clients who walk and others who have become involved in team sports such as five-a-side football. The key is to do something you enjoy. I know you’re feeling flat at the moment so enjoy might be a strong word but choose something you can tolerate and go from there. If it’s a 15 minute walk then start there. Try to build exercise in to your daily routine.

Clinical depression treatments: Self help support groups

Depression can be isolating. As you mentioned you don’t feel you have the energy to put in to friendships at the moment and as a result have lost friends. Some of my clients have felt that their friends didn’t understand what they were going through and others have deliberately distanced themselves feeling they were no fun to be around anymore.

If this is how you’re feeling then you might benefit from joining a support group for people with depression and talking to people who understand where you’re coming from.

There is a list of self help groups on the Depression Alliance website


Clinical depression treatments: Other treatments

If depression is severe and you haven’t responded to any of the above treatments there are some other options available which your doctor may suggest.

Electroconvulsive therapy (ECT) is one. It passes electrical currents through your brain.

Another option for severe depression is Vagus nerve stimulation which involves having an implant to control the brain’s mood centre.

And there’s Transcranial magnetic stimulation which involves holding an electromagnetic coil to your head.

Clinical depression treatments: Conclusion

As your depression appears to be moderate I hope that you will respond well to treatment. All depression is treatable to some extent and most of it to a great extent. I would urge you to participate actively in your own recovery.

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Depression Treatment and Symptoms

September 25, 2013 by  
Filed under Depression

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Why mental defeat creeps up on you

When you’re thinking about depression treatment and symptoms you’ll recognise that sometimes you feel like giving up and letting everything just drop. This is a normal reaction when things feel overwhelming. But sometimes when we are faced with circumstances that feel beyond our control this need to let go of everything can get out of control and turn into mental defeat.

Depression treatment and symptoms

Depression treatment and symptoms: Mental defeat

Mental defeat is often seen in clinical cases of post traumatic stress disorder (PTSD) where it is a whole body response to overwhelming fear, and the threat of death. The survivor often cannot shake off the belief that there is nothing they can do to protect themselves. This leaves them with an ever present sense of vulnerability and threat. Mental defeat is not limited to PTSD however, a recent study into chronic pain revealed that mental defeat is correlated with how distressing chronic pain is felt to be.

Depression treatment and symptoms: Psychological coping

One of the core elements of psychological coping is the belief that you have the necessary means to get through your present troubles with your identity intact. However when mental defeat creeps up on you it attacks your sense of self; leaving you wondering if you can truly manage, while suspecting you cannot. This delicate balance on the edge of coping is both distressing and debilitating. Chronic pain can often leave sufferers with an intense psychological reaction to pain feeling like it has taken away their autonomy and identity.

Depression treatment and symptoms - On the edge

Depression treatment and symptoms: The study of mental defeat in chronic pain

Mental defeat was measured by agreement or otherwise with statements like these:

because of the pain I felt destroyed as a person’

‘I felt humiliated and that I was losing my sense of inner dignity’.

The study used questionnaires to assess mental defeat, pain, distress, and disability in a sample of Hong Kong Chinese. The results are also considered to be relevant to European chronic pain sufferers. Three groups of chronic pain sufferers were compared. When the pain levels of the groups was statistically controlled for the results showed that those volunteers who also scored higher on measures of mental defeat showed more poor functioning and distress, over and above the effects of pain severity.

Depression treatment and symptoms: Mental defeat is linked to depression and anxiety

Those volunteers who scored higher in mental defeat also scored higher on measures of depression and anxiety. They were also much more likely to seek specialist treatment for chronic pain.

Mental defeat is pernicious and can creep up on anyone. It has long been recognised that depression elevates the impact of pain and causes the feeling of mental defeat to be stronger and more persistent.

Chronic pain is a real problem in our modern society, with some estimates putting the incidence of chronic pain in the community as high as 46.5%. So there is a real need to provide psychological interventions and treatment strategies that help defuse the mental defeat that creeps in with chronic pain.

Depression treatment and symptoms: My CBT therapy tools for tackling mental defeat

Depression Treatment and Symptoms - Tools to tackle it

  1. To see the pain as an enemy is to open the path to victimisation. If you give the pain control over your identity then you are in a struggle you cannot win. The pain is not your enemy it is simply an experience you are having. Therefore accept the pain and don’t think of it as an intruder, an enemy or a life spoiler.
  2. Don’t fight pain with rejection or avoidance. Of course you must minimise the effects of pain by careful management but don’t refuse to accept its existence. This only places you in an oppositional place where you cannot win. I have had many clients who started out saying things like:

‘I can’t accept the pain’ I didn’t ask for it, it has robbed me of my life I won’t let it defeat me.

These are understandable sentiments but they are not usually conducive to a good outcome. Don’t fight the existence of the pain but do manage it as well as you are able.

  1. Do allow the pain to flow and ebb. Accept that it is there and is a part of you right now. Although intend that it will diminish as your engagement with it diminishes.  Pain feeds off your attention, anger, avoidance and disability. When you stop feeding pain it loses strength. Stop feeding it your negative emotions.
  2. Depression increases the burden of pain by as much as 15%. Imagine if you could have 15% less pain by changing your mental attitude. This is the goal, as you turn mental defeat, depression, anxiety and the feelings of helplessness that accompany mental defeat away you reduce your burden of pain. This in turn helps empower you to accept the pain you have; reducing further your anger over it. This further decreases your burden of pain and you become someone who has pain but is not defeated by pain.
  3. In the end mental defeat is a forlorn attempt to fight yourself. It just never works. Use a different strategy and you will get a different outcome. And along the way you will become empowered once again.


Mental Defeat Predicts Distress and Disability in Hong Kong Chinese with Chronic Pain (2013) Tang NKShum SHLeung PWChen PPSalkovskis PM.

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