CHAPTER 2

Depression and Sadness

Depression is second to anxiety as the most commonly experienced emotional disturbance.

Depression can affect us all at some point or another; women have over twice the incidence of depression than men. This is thought to be due to hormonal influences throughout a woman’s life.

Here we will explore psychologically based depression as opposed to chemically or organically based depression.

Types of Depression

There are several different types of depression. They are usually distinguished by their dominant features, duration and severity of symptoms. Most of these kinds of depression are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM), an American Psychiatric Association publication.

The following three different kinds of depression are distinct depressive disorders described in the DSM. Sufferers experience significant distress and /or impairment of functioning, e.g. work, school, relationships and so on.

You can be depressed in a variety of different ways.

We can all experience depression because loss and failure are part of life. Whether we do or don’t is largely due to our beliefs, which can be healthy or unhealthy. Sadness is the healthy counterpart of debilitating depression.

Paul Hauck, an American psychologist, has observed that you can depress yourself in three ways:

Self denigration depression is triggered by holding rigid beliefs about autonomy, independence, success and freedom.

For example:

• I absolutely should be able to look after myself.
• I absolutely have to be independent.
• I should always succeed; the fact that I am not succeeding proves I am a total failure and worthless.

Self damning or denigration beliefs may also be related to holding rigid beliefs about acceptance or rejection by someone significant or by your community. For example, ‘I should not have been rejected. The fact that I have been proves I am bad, worthless’, and so on.

Self pity depression is based on thinking ‘Why Me?’, ‘Poor me’, ‘I don’t deserve this’. Self pity depression usually occurs after a loss such as losing a loved one, job or relationship. It is triggered by holding unhealthy demands that life must be comfortable, easy and hassle free.

Other pity depression occurs when you disturb yourself about people’s plight, pain and suffering and misfortune, creating demands such as ‘Injustice absolutely should not happen. People must not suffer so badly, it’s awful that they do.’

Anxiety about Depression

You can experience anxiety about becoming depressed or about remaining depressed forever.

You might think ‘I must never be depressed again; I couldn’t stand it. I must know for sure I will never be depressed again.’ This unhealthy belief will lead to anxiety about depression as well as unhelpful behaviours such as seeking constant reassurance.

The aim should be to experience concern about the future possibility of depression rather than anxiety.

Unhealthy Anger about Depression

If you hold a belief that depression is a sign of weakness then it is quite likely that you will feel unhealthy anger towards yourself for being depressed. Unhealthy anger is provoked by unhealthy beliefs about frustration or breaking of a personal rule.

For example, you may demand very high standards of performance from yourself at work. When you fail to meet those demands you can become depressed because you believe ‘I am a total failure.’ You can then feel angry with yourself for becoming depressed.

This unhealthy anger is triggered by holding an unhealthy belief about depression, e.g. ‘I should not be feeling depression as it proves I am weak’, leading to self defeating behaviours such as over drinking or shouting at others.

Guilt about Depression

If you hold an unhealthy belief that ‘I shouldn’t be depressed, it’s wrong as I have so much in my life to be grateful for’, you will feel guilt about the feeling of depression. At the heart of guilt is an unhealthy belief that ‘I should be grateful for what I’ve got. The fact that I am not means I am a bad person.’

Shame about Depression

Often when we are depressed we may hold a belief that ‘I shouldn’t be feeling depressed’ or reveal to others that we are depressed, for example, ‘If others know I’m depressed they will judge me as weak and I agree with them because depression is a sign of weakness.’ You may then pretend all is well or you may isolate yourself further to save face.

Feeling shame about depression or shame about having emotional problems is, unfortunately, very common.

Common Depression Triggers

The following are common triggers of depression – the list is not exhaustive. Depression is provoked by having an unhealthy belief about loss or failure. Tick the boxes that you think apply to you.

Tick the box to identify your depression triggers

Failure

Goals blocked

Loss of status

Loss of autonomy

Inability to do prized activities (disabilities)

Being dependent on others

Loss of choice

Loss of self control

Loss of approval

Rejection

Criticism/Disapproval

Loss of love

Negative evaluation from others

Losing connection with significant others

Being on one’s own

Loss of reputation or social standing

Loss of helping role

Hardship

Others’ misfortune

Others withdrawing support

Boredom

Loss of health/Illness/Heart attack

Unattractiveness

Unfairness

Bereavement/Death

Not having positive emotions

Others feeling angry with you

Financial

Specific thoughts

Not belonging

Failure to keep control

Limited choice

Other (write your own reason)

Am I Depressed or Sad?

At the heart of depression are unhealthy beliefs about real or perceived loss or failure.

Such unhealthy beliefs not only provoke depression but they have a consequence on how you think (cognitive consequences) and how you feel like behaving (action tendencies).

When you feel depressed, for example, your thoughts may be preoccupied with ‘if only’ and you may avoid friends and family and try to withdraw from the world.

Assess if you are depressed or sad by checking your cognitive consequences and action tendencies.

Look through the illustrations for the cognitive consequences and action tendencies and work out if you are depressed or sad. It is important to put yourself in the trigger situation.

It is easy to think that you don’t have unhealthy beliefs and thoughts when you are not triggered or when you are away from the problem. Imagine yourself in the situation that triggered your low mood and then work out if the emotion was depression or sadness.

Cognitive Consequences

Depression

You only see the negative aspects of the loss or failure.

Cognitive Consequences

Sadness

You can see both negative and positive aspects of the loss or failure.

Cognitive Consequences

Depression

You think of other losses and failures that you have experienced.

Cognitive Consequences

Sadness

You are less likely to think of other losses and failures than when you are depressed.

Cognitive Consequences

Depression

You think you are unable to help yourself (helplessness).

Cognitive Consequences

Sadness

You are able to help yourself.

Cognitive Consequences

Depression

You only see pain and blackness in the future (hopelessness).

Cognitive Consequences

Sadness

You can see the future with hope.

Action/Action Tendencies

Depression

You withdraw from reinforcements.

Action/Action Tendencies

Sadness

You are able to express your feelings about the loss or failure and talk to significant others.

Action/Action Tendencies

Depression

You withdraw into yourself.

Action/Action Tendencies

Sadness

You seek help and support after a period of mourning.

Action/Action Tendencies

Depression

You create an environment consistent with your feelings.

Action/Action Tendencies

Sadness

You maintain your environment regardless of your feelings.

Action/Action Tendencies

Depression

You attempt to terminate your feelings of depression in self destructive ways.

Action/Action Tendencies

Sadness

You do not terminate your feelings in self destructive ways.

Now … 

General Change or Philosophical Change for you?

General Change

Philosophical Change

Remember to take your time if you are choosing this route, as Philosophical Change is about changing your unhealthy beliefs over the long term.

Remember, depression is provoked by unhealthy beliefs about loss or failure. An unhealthy belief is made up of absolutist rigid beliefs in the form of a MUST, HAVE TO, NEED TO, GOT TO, ABSOLUTELY SHOULD, from which three further derivative disturbed beliefs come.

A rigid unhealthy belief, at B, is a demand about the most depressing aspect of an event – it is either a demand for it to absolutely happen or absolutely not happen.

For example, if what you are most depressed about is your depression, then the rigid belief is I absolutely should not be feeling depression. If what you are most depressed about is the end of a relationship, then the rigid belief is I absolutely should still have my relationship. The consequence of not having the rigid belief met is any or a combination of the three derivative beliefs.

For example:

Step 1

a. Choose a typical example of your depression problem.

b. Use the previous Common Depression Triggers table as a reference to pinpoint what you were most depressed about. You may have more than one trigger, which means you may have more than one depression provoking belief. Work on one belief at a time.

c. Express your answer to Question (b) above in the form of a ‘MUST’ or ‘ABSOLUTELY SHOULD’. (See previous examples.)

d. Identify the three derivative beliefs. (Awfulising, Low Frustration Tolerance (LFT), Self Damning. See page 5 as a reminder to what these mean.)

You may have all three derivatives or any combination of the three.

Remember to imagine yourself in the trigger situation when identifying these derivative beliefs.

Key: A = Awfulising, LFT = Low Frustration Tolerance, SD = Self Damning, OD = Other Damning

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Step 2

Question the validity of your unhealthy belief, using the following three criteria. Remember that an unhealthy belief is made up of the rigid belief and its derivatives. The disputing questions below are used on all of them.

a. Are they realistic or not and why?

b. Do they make sense or not and why?

c. Do they lead to helpful or unhelpful outcomes for me, and why?

Let’s assume your unhealthy belief was as follows:

Go ahead and dispute your unhealthy belief or beliefs.

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Step 3

a. Change your unhealthy belief and work out the healthy version by removing the rigidity and replacing it with the preference belief.

b. Remember to negate your unhealthy demand. For example, ‘I prefer not to be depressed but it doesn’t mean that I must not be.’

c. Identify the derivative beliefs. (Anti-awfulising, High Frustration Tolerance (HFT), Self/Other/World Acceptance. See page 7 as a reminder to what these mean.) Use the examples below as a guide.

d. Remember, preference beliefs are flexible, make sense and lead to a helpful outcome.

Key: A = Awfulising, LFT = Low Frustration Tolerance, SD = Self Damning, OD = Other Damning, AA = Anti Awfulising, HFT = High Frustration Tolerance, SA = Self Acceptance, OA = Other Acceptance

Go ahead and rewrite your beliefs in a healthy way.

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Step 4

Dispute your healthy beliefs using the same criteria used in disputing the unhealthy beliefs – this keeps it fair and you are more likely to persuade yourself to commit to changing them if you dispute the unhealthy and the healthy beliefs in exactly the same way.

Remember that a healthy belief is made up of a preference belief and its three balanced derivatives or a combination of them. The disputing questions below are used on all of them.

Go ahead and dispute your healthy belief and its balanced derivatives.

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Step 5

In order to change your depression provoking belief to a healthy sadness provoking one, you need to think in accordance with your healthy belief and take constructive actions. The illustrations demonstrate the thinking (cognitive consequences) and action tendencies of sadness. The constructive actions are based on the action tendencies of sadness.

• Think and act in accordance with your healthy belief repeatedly and consistently in a forceful manner until eventually your emotional state changes from depression to sadness.
• Remember your emotion of depression will change – the new way of thinking and the new actions you will implement will feel uncomfortable initially but this is completely natural. You are changing an old habit of unhealthy thinking and old habitual depressive behaviours. It takes a few weeks of repetitions done consistently and forcefully.
• The behavioural goals you set for yourself need to be challenging but not overwhelming. If you overwhelm yourself then it defeats the object of the exercise.
• Start with imagining yourself thinking and acting in a healthy manner whilst being in the trigger situation until you think you are ready to challenge yourself in real life. For example, imagining yourself going out and meeting up with friends is a good start but at some point you will need to take action and make the arrangements and go and meet your friends and then continue until you achieve your desired goal.
• Recite your healthy belief in your head daily and particularly when you are imagining yourself in the trigger situation. This mental rehearsal will help you to remember it when you deliberately face the trigger situation in real life.
• Once you achieve your desired goal, whatever it is, then maintain the helpful thinking and actions. For example, if you are able to get to that big social event and then make no further arrangements to socialise you may begin to feel isolated again, so make efforts even when you don’t feel like it.
• Review how you did, each time you challenge yourself, and then work out what you can do differently or better the next time. Then do it. Do not demand perfection from yourself. The process of moving from depression to sadness is uncomfortable and uneven. Some days you will make bigger strides when you challenge yourself and other days you will make small strides or even take a step back. The important thing is to accept that this can happen and then bring your focus back to what you are doing and continue with it.
• Remember, you didn’t learn to drive a car, ride a bicycle or learn to read overnight, it takes repetition and focus and consistency.

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Chapter 2 – Depression – Takeaway Tips

• To overcome depression, it is important to work with vigilance on self acceptance. Dispute your self damning beliefs energetically.
• Ensure you have good sleep hygiene and maintain regular routines. Go to bed at a reasonable hour in the evening and get up at a reasonable hour in the morning.
• Take regular exercise, ideally on a daily basis – this helps raise your energy levels.
• Eat regularly. It helps maintain a constant state of energy.
• Involve yourself in regular activities you enjoy. Read helpful, inspiring books, these help you keep a wider perspective on life rather than the narrow focus you tend to develop when you feel depressed.
• Challenge yourself but do not overwhelm yourself as you face your depression triggers.