worcs session 2 understanding depressionmay2012

Choice, Responsiveness, Integration & Shared Care

Choice, Responsiveness,

Integration & Shared Care

Isaac Maddox HouseShrub Hill Road, WorcesterWR4 9RWTel: 01527 488 000

www.worcsmhp.nhs.uk|

Please make yourself comfortable and fill out a questionnaire…

Welcome to Managing Low Mood And Anxiety SESSION 2


Review of last week : Understanding the CB Model

Thoughts

Behaviour

Physical feelings Emotions

Situation/ environment


Homework Review

Identifying your own thoughts, feelings,physical symptoms, behaviours

What did you notice?

Setting goals


• Myths about depression

• What is Depression? – signs & symptoms

• Understanding depression using CB model

• Reversing the vicious cycle and increasing

activities (Behavioural Activation)

• Positive logs

Today’s Session: Understanding & Managing Depression and low mood


Changes in our mood and feeling low from time to time are normal parts of everyday life.

Sometimes these feelings may begin to last for a couple of weeks or more and begin to effect other areas of our life, how we feel physically and what we do.

What is Depression?


Myths About Depression‘If you get depression, you will always

be prone to it, and it will affect you for the rest of your life’

‘Depression is no different from getting the “blues” and this is

just a normal part of life’

‘People who have depression are just feeling

sorry for themselves ’

‘Depression can only be cured by medication’

‘People who say they are depressed just need to pull

themselves together’

‘Depression is not a real medical illness’

‘Depression is a normal part of getting older’


Depression….. •1 in 4 people have a mental health difficulty

•1 in 6 people experience depression (N.I.C.E)

•Affects any one, at any time

•One off or re-occurring episodes

•Different contributing factors

•3rd most common reason people see a GP (N.I.C.E.)

•Can be successfully treated and managed


Emotions

•Low•Anger•Irritable•Guilt•Shame•Anxious•Unhappy

• Stress • Sad• Lonely• Upset• Numb• Despair

• Down


• Expecting the worst to happen “Nothing is going to work out”

•Losing confidence in yourself “I won’t be able to do this”

•Gloomy thoughts “Nothing ever goes right for me”

•Everything seems hopeless “Its hopeless”

•Negativity towards yourself “I never get anything right”

•Negativity towards the world “No one can help me”

•Thoughts of self harm “Life isn’t worth living”

Thoughts


Physical Changes• Tearful• Loss of energy/lethargy• Sleeping more or Sleeping less• Changes in appetite• Changes in Weight• Difficulty concentrating• Problems With Memory• Reduced sex drive• Restlessness• Aches and pains


Behaviours• Difficulty making decisions• Putting things off / Procrastination• Not doing things you used to enjoy• Using food, cigarettes, alcohol, caffeine, drugs

etc to escape• Less self care E.g. Not getting dressed• Not answering the phone or opening letters• Staying in bed• Stop seeing friends/family • Not doing everyday tasks • Self harm• Rumination


• Genetics(you inherit genes that make you more likely to develop depression)

• Living environments/ Relationships (a family may have a high rate of depression because of the way people behave

towards each other, rather than because of the direct effect of genes)

• Biology/ Body• Difficult life experience

– Early experience– Life events

– Ongoing stress

Often, a combination of these factors are responsible

What can contribute to Depression?


When people are depressed they can feel physically unwell and may reduce the frequency and type of activities that they do

For example:

• Reduce interactions with friends, colleagues and family

• Make little effort to do things that they previously enjoyed

• Avoid necessary activities e.g. paying bills• Reduce or stop routine activities e.g. cleaning the house,

ironing, washing up.• Disrupted routines like meal times, the times they go to bed

and get up.


Life can often lack:

•A sense of achievement

•Feelings of enjoyment/pleasure

•A feeling of closeness to others


What are the benefits of increasing activity?


Increasing our activity levels can make an enormous impact on our mood by:

• Motivating us to do more • Esteem building- making us

feel better about ourselves• Making us feel less tired • Alternative focus- helps us

think about something other than focussing on our unhelpful thoughts

• Using up the adrenaline resources created by anger and anxiety

• Giving us a sense of achievement & enjoyment

• Being with other people • Stimulating the body to

produce natural anti-depressants


Understanding Depression: Vicious Cycle

DepressedMood

Increased guilt,hopelessness,ineffectiveness

Decreased activity,neglect of

responsibilities

Low energy, fatigue,decreased interest,Negative thinking


Patrick’s Story


Monday Tuesday Wednesday Thursday Friday6-7 Sleep Sleep Sleep

7-8 Sleep Sleep Sleep

8-9 Sleep Sleep Sleep

9-10 Sleep Sleep Drs appointment

10-11 TV - downstairs Sleep/TV

11-12 Eat TV

12-1 WatchTV

TV/ Eat

1-2 Shops

2-33-4 Sleep Eat

4-5 Sleep TV

5-6 Sleep/ Snack Games/ internet on

the computer6-7 Potter in the garden

7-88-9 TV Snooze

9-10 Eat Eat

10-11 Computer TV

11-12 Computer TV


• What do you notice about Patrick’s week?– Are there patterns in his sleep?– In his eating?– In the way he spends his day?

• What changes could he make?


Reversing the vicious cycle and increasing activity

CBT uses an intervention called Behavioural Activation to work on changing unhelpful behaviours.

Improved Depression

Increased Activity, Fair and Realistic

Thinking

Feeling hopeful, moreconfident, less guilty

Greater energy &motivation


Step One:What do you stop doing when you feel low?

Routine activities

Get upShaveBrush hair

Pleasurable activities

Exercise – gymPub with DarrenRead a magazineWatch a film

Necessary activities

Check e-mails/ answer e-mailsOpen postRespond to post


Step Two: Make a hierarchy of activities

Put your lists in order of difficulty, mixing up the different routine, pleasurable and necessary activities

THE MOSTDIFFICULT

• Pub with Darren• Go to the gym• • •

MEDIUM DIFFICULTY

• Respond to e-mails• Respond to post/ bills• Open post• •

THE EASIEST• Shave• Brush hair• Check e-mails• Read a magazine•Watch a film


Step Three: Plan Activities• Start with the easiest activities• Small regular activities are better to begin with• Build them up gradually• Detail precisely: what, where, when and who

with. Keep it S.M.A.R.T• Plan a reward

‘Act according to your schedule rather than your mood’

‘You may not feel like doing something but it may help to take a step away from your feelings and do it anyway’


Activities ScheduleMon Tues Wed Thurs Fri Sat Sun

Morning WhenWhatWith who

ShaveBrush hair

ShaveBrush hair

ShaveBrush hair

ShaveBrush hair

ShaveBrush hair

ShaveBrush hair

ShaveBrush hair

WhenWhatWith who

Open post

Sort bills

Open post

Afternoon WhenWhatWith who

Read mag. At home for 30 mins

Watch a film

Read magazines

WhenWhatWith who

Check e-mails

Check e-mails

Evening WhenWhatWith who

Watch film with Darren


STEP FOUR: Review Progress

• Remember progress may be sporadic and may not always go completely to plan.

• Give time for reflection.

• Problem-solve any difficulties experienced.


• Not everyone experiencing low mood notices a reduction in activities…Some people may feel overwhelmed by the amount of things they have to do and this may be highlighted when reviewing your weekly record.

• You might need to look at using the record to bring more balance to your daily activities.

• We look at this more in future sessions on Stress Management


The Core Principles of Behavioural Activation

Principle 1: The key to changing how we feel is changing what we do.

Principle 2: The clues to figuring out what will be antidepressant for a particular person lie in what they used to do and enjoy.

Principle 3: Structure & schedule activities that follow a plan, not a mood.

Principle 4: Change will be easier when starting small.

Principle 5: Take on activities that are naturally reinforcing.

Principle 6: Use a problem-solving approach, and recognize that all results are useful.

Principle 7: Don’t just talk, do!

Principle 8: Troubleshoot possible and actual barriers to activation.


Action before motivation!

Don’t wait for the “motivation”, take action and the rest will follow.


“If you do what you’ve always done, you’ll get what you’ve

always got”

Deciding to change...


Making changes – what are the costs & benefits

Staying the same (no change) – what are the costs & benefits

Motivation...


Imagine your life 6 months from now and that nothing has changed; you have not taken steps to address yourproblems. Consider how you would feel, what you would do and the impact on your life.

Group Activity

What are the costs and benefits of not making changes and staying the same?

Motivation – staying the same


Imagine your life 6 months from now and that you havemade changes; you have taken steps to address yourproblems. Consider how you would feel, what you would do and the impact on your life.

Group Activity

What are the costs and benefits of making changes?

Motivation – making changes


•When we feel low in mood, we often focus on the things that we haven’t done.

•We “filter out” and ignore the positive things such as what we have been doing.

•It is like we are wearing a pair of “gloomy specs”.

Mental Filter


For example, if someone criticizes you, you’re more likely to accept it as true. But if someone pays you a compliment, you manage to discount the positive comment completely.

Then, without meaning to, you are quite likely to forget it happened at all. So all that is remembered are the negative things, and the general picture that gets built up is overwhelmingly negative.

Mental Filter


This technique can help breakdown focus on the negatives which in turn can help reduce some of the negative feelings.

Positive Log


• Use a notebook that you like the look of.

• Ensure it is a size that you can carry around with you.

• Fill in anything positive as it happens. Do not wait till the end of the day.

•Things you managed to get done•Something you do goes to plan•Something you go goes better than expected•You do something worthwhile•Somebody contacts you•Somebody compliments you

• At the end of the day read the whole notebook.

How to use a positive log...


The aim is to develop a more fair, realistic and positive view of yourself and your situation.

This may be quite hard at first, and the things being recorded may seem silly or trivial.

It is important to write them down anyway.

Over time, you may realise that there are more positive experiences that you once noticed – and many that you previously ignored


Negative ThinkingDepressed mood also leads to an increase in negative thoughts, which then go on to worsen our mood further.

• We will focus on the unhelpful thinking styles associated with both depression and anxiety in Session 5.

Problem SolvingWhen feeling low, problem solving ability can reduce severely. This is because of feeling tired & lacking energy, concentration problems, loss of confidence in decision making, low motivation

• Dealing with problems make us feel more effective, hopeful and encouraged. We will focus on Active Problem Solving in Session 6


Lastly...

Reward yourself for your accomplishments and any positive changes you notice about yourself.

Finding a way to give yourself positive rewards is important as when you are treated well, you feel better.


• What depression is and how it affects you physically, cognitively and behaviorally.

• The significance of inactivity in the cycle of depression and how to reverse this cycle using Behavioral Activation.

• The role of a negative focus in depression and how a positive log can help.

Session Summary


• Follow the Behavioural activation steps 1-3 and plan your weekly diary in advance.

• What do you notice? Are there any links between how you feel and what you are doing?

At home...

• Practice keeping a positive log.


Any Questions?

worcs session 2 understanding depressionmay2012

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