The warning signs of depression
Reading based Psychologist Dr David Purves from Berkshire Psychology Service outlines the warning signs of depression. If you believe you struggle with low mood then please read this report. Depression is usually a treatable illness. The first thing to do is gather good information.
Depression is a word that covers a wide range of mental health problems but the main characteristic is a loss of good, positive feelings and an accompanying loss of interest or enjoyment in things, people and activities. Often the first people to see the warning signs of depression are those closest to the sufferer.
It may seem a paradox but there can be value and even comfort in knowing and naming a problem. If you know and name you also have access to the knowledge based that has accumulated on how to understand and treat that problem. And this is a necessary precursor to being able to move forward. Knowledge and an attitude of action towards the problem of low mood and depression is a very positive first step in starting to feel better. Let's map the warning signs of depression onto a CBT understanding of low mood and depression.
Understanding the CBT understanding of depression
We will now develop the very important fact that thoughts, feelings and behaviors are linked in creating your low mood. Indeed, there is a constant interplay between your thoughts, feelings and behaviours.
If you think negative thoughts about yourself you will feel negative emotions.
And, if you feel low you will find more opportunities to undermine yourself creating even more negative thoughts.
This two way relationship always works in this way.
In addition, if you think negative thoughts about yourself and feel down you will do less of the things that previously helped sustain your good mood (behaviors). You will go out less, keep in touch with friends less and, get less pleasure from what you do try. Reducing your activity repertoire only depresses you further.
Despite having the warning signs of depression: How can I control my emotions?
It is very hard to directly control your emotions, sometimes you feel low and at other times you feel better.
It can be hard to know why your mood fluctuates as it does and finding these missing links takes time and effort.
It is very common for people with depressed mood to say, ‘I wake up and I do not know why I feel down’.
But, you may also not know that you can change how you feel.
Indeed, how you feel often has little to do with ‘who you are’ (your personal identity) and more to do with an habitual negative way of thinking that has somehow gotten out of control (balance).
It can be very hard to pull yourself out of a low mood simply by willing yourself to feel better.
But, research has shown that a very effective way of reversing low mood is to pay more attention to the thoughts that accompany the mood and to challenge them for accuracy.
What both clinical and research experience tells us, and what it is often possible to identify for yourself, is that the thoughts you have lead to the mood you experience.
What you really need to understand is that you cannot have good and positive thoughts yet feel down.
You always have thoughts that flow in the same direction as the mood you experience. While you cannot easily control your mood you can much more easily control your thoughts.
This is the principle of the cognitive aspect of cognitive behaviour therapy (CBT). If you control/manage your thoughts then you can much more easily control your mood.
Physical symptoms are often noteworthy warning signs of depression
Negative thoughts and feelings often give rise to troubling physical symptoms, such as those below.
- feelings of stress
- feelings of fear or dread
- numbness (which means there are no feelings that you can recognize)
- fear of people
- fear of challenges
- unexplained pain
- irritable bowel
Physical symptoms can often seem unrelated to your negative thoughts or mood. You may find that you have an upset stomach or pain that seems to have no good reason for being there. Alternatively, if you have been injured the pain seems to be worse on some days and leads to you feeling hopeless and even helpless to combat it. You may find that you experience headaches that leave you unable to attempt any activity at all.
Whatever your experience of physical symptoms these are often linked to the way that you think about yourself and hence how you feel about yourself.
The bottom line is this:
When you think negative thoughts and feel low your body responds by being more troublesome!
The important point is this:
How your body reacts, how you feel, how you think and what you do are all interrelated.
When one is down they are all troublesome.
When one is up they are all more manageable. These big four aspects of your experience are all intimately connected and cannot be experienced separately.
Mike's Story of depression
Mike had been feeling down about his work. He was behind in processing applications and he thought that his boss was now watching him for mistakes. These feelings made it harder for him to concentrate and do a good job. On Tuesday night, Mike had trouble going to sleep because he was worrying that
In the morning, Mike slept through his alarm clock and when his wife Julia questioned something he did he just lost it!
He shouted. She thought he was over-reacting. He then left the house without shaving or tidying himself up, he missed his breakfast; all day at work Mike felt out of sorts and conspicuous.
Stress at work is a common cause of depression
This case is not at all untypical of someone who is feeling strain from work or some other place, and that strain is expressed at home maybe towards someone who might not be responsible for causing it in the first place. Perhaps you've been there yourself?
You are sensitive to how other people treat you.
It is a social world where you interact with other people in differing situations.
While you are sensitive to the ways that other people treat you, you also interpret the world around you in line with the ways you think about yourself and how the world works.
It is obvious that the social environment, or context, in which you live directly impacts on how you think, feel and act.
This was clearly the case for Mike.
The context of his work stress was enough to make him feel uncertain and watched and spoil the quality of his home life. Later when Mike went to his regular therapy session, to help combat his depression, he was able to describe what he was thinking and feeling and how this affected his behaviour on Wednesday morning.
Mike said that his work had been much less enjoyable lately. A new boss had made things that he normally felt were easy, now quite stressful. This made him question a lot of things he previously took for granted.
Clearly, this was not a comfortable situation for Mike.
So on Wednesday morning, all of this was on his mind. All of the stress and strain that Mike’s job was taking on him made it difficult to sleep and left him feeling drained. This in turn lowered his resistance to further stressors, such as a last minute job at work, or an offhand comment from a colleague.
Your Thoughts can be depressive
What can you do if you think you have depression warning signs?
It is not always easy to identify the thoughts you have about things when you are actually doing them. It is much easier to look back on situations and identify them later. But if you try hard enough it is often possible to find some key negative thoughts that influence your mood and behaviour.
Mike could identify one thought that really increased his stress levels: "If I don't get to work on time my boss will think I am a failure again."
Your emotions are the direct experience of depression
Mike felt a complex set of emotions on Wednesday morning, but one feeling that he was able to identify was that he was irritated or maybe even angry at his wife for making him late (although she was not to blame).
He later recognized and felt sorry about his outburst.
Although, feeling guilty about this actually did not help Mike.
Your behaviours really affect depression
A combination of all of the above led Mike to act the way he did.
The cumulative effect of his job stress (context), his poor sleep and stressed state (physical sensations), the belief that his boss would think of him as a failure (thought), the outburst of anger (emotion), made him leave the house
He may have felt a sense of righteous indignation when the front door slammed.Yet, for the rest of the day, unshaven, he felt conspicuous and worse than the day before.
His actions did not help to solve his perceived problem, in fact in his mind it just made it worse.
It is not hard to imagine how he would feel when he went back home again on Wednesday night!
Mapping the forces of depression
We can map out the forces that led to Mike acting as he did.
How it all interacts
We can think of physical sensations, thoughts, feelings, and behaviours as all interacting within the context of the environment. These factors are pictured above in the ‘Map of Forces’.
The important point to gain from this example is that for Mike’s all five of these factors interacted to lead to his self-defeating actions. They were all linked together.
It is usual to have one main factor with all of the others interacting with it in some way. So when one thing changes all others also change to accommodate it.
This has to happen because the whole system is connected.
This means that if Mike wanted to change some aspect of his life he would have some choice in deciding where to place his efforts and gain the change he wanted.
This is equally true for you!
Even if you have the warning signs of depression you can change any aspect of the five domains outlined above and then every other aspect must change in some way to react to the deliberate effort you have made.
So what's the best treatment for depression?
The cognitive behaviour therapy method of treatment of depression generally focuses on three aspects of your experience that are more under your conscious control than the other two.
The things you have the most control over are:
The context of depression
You can change aspects of you work experience, your home experience, your relationship with a partner or with other members of your family.
Doing one thing differently affects everything else; remember this: subtle and small changes only need to be made at first.
Thoughts related to depression
You may not feel that you have much control over negative and self-defeating thoughts but you can learn to take much more conscious control over these.
The important point about negative thoughts is that they seem to occur automatically.
In CBT they are actually called automatic negative thoughts (ANTs) because they come to mind so readily. Actually, the ability of ANTs to pop into your mind increases dramatically as your mood gets lower. ANTs are usually personally negative and are always inaccurate. They are the worst possible interpretation of anything! Consequently, they are very good at being depressing.
The behaviour of depression
When you think about something you have done and you feel you failed at it, you are less likely to do that activity again. This makes sense and as a general rule is probably a good thing. It means that you tend to focus your efforts into areas where you may have more ability.When you feel low however, you have a tendency to misinterpret signals from the world around you.
You may feel bad about something you have not done, when actually everything is the same as it was previously.
To quote Mark Twain, ‘I have suffered many misfortunes in my life, most of which did not happen.’
You generalise from specific examples to more general ones and feel defeated.
You see obstacles where previously you saw opportunities.
You feel overwhelmed (feeling), tell yourself that ‘it is too hard’ (thought) and do not bother to try (behaviour)!
One of the depression warning signs and a very important and serious consequence of depression is that your activity level decreases.
Does this make you feel better or worse?
The answer is always worse!
As you decrease your level of activity the opportunities to interact with the world and to test the reality of your negative thoughts reduce. Hence the negative thoughts about yourself seem to gain in strength and validity. You actually behave as if you believed the negative things you think and say about yourself. Hence depression!
The three main areas where you can start to recognize and change the aspects of your experience that create low mood. Have been outlined. If the first instance it is hugely important to get an assessment by an expert. Thereafter there is a reliable and effective path out of depression. All you have to do is take the steps as they are explained and laid out for you.
Dr David Purves and Berkshire Psychology Service provides a complete cognitive behavioral therapy treatment program. Dr Purves provides you with all the tools you need to help you create the life you want and to take more control over depression.
An anti-depressant tool to use now
Here is a tool that you can use to start the battle against the falsehoods your brain creates to depress your mood and spoil your experience of life. The most fundamental step in defeating depression is recognizing the negative thoughts themselves and then challenging them to account for their accuracy.
If you've identified with some of the depression warning signs. Start to overcome depression here:-
- Take a piece of A4 paper and at the top write the most damaging negative thought you have about yourself in black ink. This works well if it is the thought that really drags your mood down. Examples that are common are: I am a fraud, useless, odd, damaged, unlovable, etc. Make sure there is only one thought here. If you have more than one thought that comes to mind put the others on different sheets of paper for later on.
- Now you need to rate how much you believe this thought, the best thing to do is to rate how true it feels to you at this very moment in time the scale is ‘0’ not at all true and ‘10’ as true as it can possibly be.
- Next use the rest of the paper to make a list of as many reasons as you can find that show the thought to be untrue and use a coloured pen for this. Examples might be: I have friends, I can complete tasks, I try hard, I do my best, I am not responsible for others, I can manage my money, I can listen to people, I can read a book, I can play, I can cook, I have been successful before, I passed my driving test (note: that examples do not have to be substantial they only have to disconfirm the negative thought).
- Use as much of the paper as you can, spread out, write things even if you don’t fully believe them. Use your imagination, allow yourself to go back in memory and find examples that disconfirm the negative thought. Things have not always been as they are now; remember the way things are when you feel better. Give yourself over to a flight of fancy, allow yourself to be liberated for a moment from the negative thought and create the alternatives to it. Really challenge the negative thought, find as many alternatives to it as you are able.
- After you have spent no less than 10 minutes challenging the negative thought re-rate how true it feels 0....10 once again. The rating of how true the thought feels is likely to changed and even gone down from the previous score. The less true something feels the less bothersome it is to you.
What you have demonstrated is that the way you think about something determines how you feel about it. Change the thought and you change the feeling. This is the key to using CBT therapy to change your life. It is not a trivial enterprise; it is one of the most important things you can do to ensure a good life. But it really works.