Depression lies. Lately it has been making me feel like a failure, a reject, someone who breaks all she touches, that maybe I have much to offer but that the world isn’t interested. But it’s not the truth. The lies are powerful, but ultimately truth holds a greater power.
Since I last wrote on the subject I have been to my doctor, been diagnosed with mild depression and as a result been offered counselling, and referred to a self-help group for learning to manage anxiety and depression. I’ve also been reading a book with a friend, which has given me some really helpful insights and ways of dealing with my illness. I want to share what I’m learning as I figure the more information is out there for people, the more we can overcome this stuff. I hope I can help demystify the treatment process a bit, and share the things I’ve found helpful.*
Despite my really pretty low level symptoms, my doctor listened when I described them, took me seriously and told me that what I was saying sounded important. Low level as they are, the symptoms were still enough to be diagnosable and worth referring for treatment, and catching it at this early stage should stop it becoming worse. It’s SO worth knowing the symptoms of mental illness, so you know when to seek help; you don’t have to just accept these symptoms as normal and suffer in silence, there is help, and as with so many illnesses, treating it early gives the best prospects of recovery.
So. My self-help group is basically a training course, teaching a group of us a set of techniques called Cognitive Behavioural Therapy, which basically aim to break the vicious cycles of self-destructive thoughts and behaviours our illnesses can lead us into. This is the main recommended treatment for mild depression and anxiety, and one of the most effective too for mental illness in general. It is front-led, and somewhat death-by-powerpoint, but as a result, none of us have to share anything personal or talk about our illness or circumstances at all unless we want to. I’m currently almost half way through the CBT course, and am already seeing some things change.
One of the most significant changes is actually that I’ve seen a massive change in the confidence of other participants. The first session I found heart-breaking; we were a room full of beautiful, broken souls, and so many were evidently completely unaware that they were not alone. People were surprised to hear that mental illnesses like theirs affect a quarter of people at any one time, and stories emerged of feelings of isolation, worries that they were ‘crazy’ or would be seen that way, years spent trying to just cope with the way they were feeling, unaware that there was help available, or that ‘help’ did not necessarily mean scary drugs and certainly did not mean being locked up, and all sorts of feelings of guilt, weakness or inadequacy in coming to this group. I realised how incredibly, unusually blessed I am to be surrounded by so many friends, family and colleagues who are open about their health and help to raise awareness and share solidarity with each other; as a result, I have experienced none of this. Four weeks in, people are no longer trying to sneak into the clinic unseen; they are talking more freely about their experiences, they are beginning to see how normal and common their experiences are, to speak of their illnesses as illnesses and not weaknesses, and there’s a general sense of solidarity, strength and pride breaking through. It’s lovely! Openness makes such a difference! Breaking stigma is one of our greatest weapons against mental illness, so please do what you can to open up the conversation around you; it truly makes a difference.
Anyway; back to the content. We have so far been learning techniques to help us improve our sleep patterns, calm us down when anxious, break cycles of destructive thinking, and motivate ourselves into getting active again when depression tries to shut us down, paralyse us into inaction, stop us enjoying the things we used to, or to regain control of tasks that seem overwhelming.
Sleep – sleep problems can be a cause and symptom of depression and anxiety, and tackling them can help recovery. Caffeine, alcohol, sugar, smoking, eating too soon before bed, physical discomfort, exercising not enough and/or too soon before bed, lying awake, and using the bed for things other than sleep and sex, especially involving screens, are all detrimental to sleep. Apparently the amount of sleep we get is far less important than its quality, so it isn’t about going to bed or getting up at particular times so much as retraining ourselves to sleep well when we do sleep. We were advised to learn the difference between feeling fatigued and feeling sleepy – literally ready to fall asleep – and only go to bed when we are genuinely sleepy, and to get up and go somewhere away from the bedroom if we find ourselves lying awake, until we feel sleepy again. Keeping a sleep diary for a couple of weeks (no longer, don’t get too hung up on it) can help identify patterns.
Calming techniques – we were taught a breathing exercise to help us to calm down when feeling anxious. Instead of breathing quickly and shallow, it helps slow our breathing down and deepen it. Putting one hand on our chest and one on our belly we can feel the difference between breathing deeply and shallowly. When we are breathing deeply, from the diaphragm, our belly should move more than our chest, so focus on this. Count as you breathe in – maybe to four but whatever feels natural – hold the breath in for a second or two, then let the breath out slowly as you count a little longer – maybe to six, but again whatever feels natural. Focussing on breathing can help calm the mind in itself, but so does the deep breathing itself. We also learnt a relaxation technique where in your mind you think about each part of the body in turn, noticing how it feels, tensing the muscles there and then consciously relaxing them again, working down the body until we’ve noticed and relaxed all areas we’ve had tensed up.
Thought Challenging – healthy or unhealthy, we all have negative thoughts pass through our minds regularly. But when we are ill, they come at us more frequently, we lose resilience to them, and we can find ourselves in unhealthy thought spirals. Firstly, we learnt the difference between a thought and a feeling, which sounds obvious until you consider how often we might say ‘I feel…’ when describing something we actually think (for example ‘I feel stupid’). A thought you can rephrase into an ‘I think…’ statement (‘I think I am stupid’), and someone could call into question, whereas a physical or emotional feeling (‘I feel sad/hot/sick…’) no one can argue with. Secondly we learnt the different types of unhelpful thought patterns we might find ourselves in, so that we can learn to spot them. These include: Thinking in very black and white terms (that things can’t be partly good, only all good or all bad), Overgeneralising (thinking something is always the case), Taking things personally (eg thinking it must be your fault), Mind reading (thinking you know what someone else is thinking or coming up with reasons why something has happened), Fearing the worst, fixed ‘Shoulds’ that induce guilt, Focussing on the negative whilst ignoring the positive, or even Disqualifying the positive (eg putting down a compliment paid to you rather than accepting it), making Negative predictions that can be self-fulfilling (such as ‘I won’t enjoy myself’), and Mistaking feelings for facts. We were encouraged to keep a diary, noting down the negative thoughts we’d had as they come at us, to rate how bad they made us feel and how much we believed them, and through that, to identify the really problematic one that we’d most like to tackle. For me – ‘I think I’m a failure’. It should also help identify triggering situations. Finally, we challenge the thought. We were taught to put the thought on trial, to list the concrete, factual evidence for and against that thought really being true. Usually that will result in a list of points both for and against it. And from this, we can then work out a more rational statement to replace the original thought with; not an unrealistically positive statement, but a more true one, taking into account both sides of the facts. Identifying, analysing, challenging our thoughts and learning to believe the replacement thought more than the original negative thought will take practise, but I’m finding even beginning to practise is helping disrupt the unhelpful thought spirals that lead to my low moods.
Motivation – depression can easily demotivate us from doing anything; it feels like a weight pressing down on us, making even straightforward activity hard work, making us tired or overwhelmed, taking away enjoyment from things we used to enjoy doing, and adding anxiety to social situations that can make us avoid others. However, the truth is that withdrawing from activity is one of the very worst things to do; it perpetuates and deepens the illness in a vicious cycle and can lead to it becoming really serious. Breaking that cycle takes a lot of effort, but is vital to recovery. The first thing we were advised was that motivation doesn’t necessarily precede activity; activity itself is often what causes motivation to increase. The technique we were taught to regain motivation I have to admit caused me a lot of anxiety even thinking about it, as it sounds like the to-do list from hell – but I do think it makes sense in breaking the paralysing effects of depression, so I’m going to persevere with making it work:
We were taught to list all our routine tasks (everyday things like showering and cooking for example), our necessary tasks (like work, paying bills, and for me at present, freecycling all the junk that’s in our garden), and pleasurable activities (including things we used to enjoy doing but are currently finding difficult, such as social activities or hobbies). The next step is to rate them in terms of how easy or difficult we are currently finding each task, breaking down those we’ve rated hardest into the smallest chunks we can, and then re-rating those chunks for difficulty. Then we are to plan out our weeks, scheduling in the tasks for really specific times so we don’t put them off, making sure we plan in a good balance of routine, necessary and pleasurable activities, and crucially, starting small. They emphasised the need to not try to take on too much to start with, but concentrate on the tasks we’ve rated as easiest, and also not to get carried away if we achieve something and feel good, and be tempted to do too much more, overdo it, and then feel low on energy the following day. Finally, at the end of the week, we were advised to review the week’s plan before planning our next week; what worked, what didn’t, had we taken on too much, could we do a bit more..?
Discussing this in the group after we’d given it a go for a couple of weeks, we found that breaking down the tasks as much as possible, and celebrating and rewarding small victories rather than beating ourselves up for stuff we hadn’t managed to do were really important, and I confessed that I’d found it hard to do with a rather chaotic lifestyle; I’ve been trying to apply the principle to smaller blocks of time, maybe a day or half day at a time, planning my time so I don’t get stuck on the sofa feeling low and overwhelmed but making sure I deliberately planned in little tasks to all my time, and keeping a good balance between routine, necessary and pleasurable activities. I now have a book in which I’ve started noting down small victories, things I found difficult on the low days but did anyway, which is encouraging.
At the same time, I have been reading a book with a friend called ‘Loving God With All Your Mind’. This is a book written by Elizabeth George, a Christian who discovered a similar treatment for depression and anxiety via the Bible. Having struggled with depression and anxiety for many years, she suddenly made a breakthrough after reading the words of Phil 4:8; ‘…think about what is true and honourable, right and pure, beautiful and respected. If anything is good and worthy of praise, think about these things.’ She suddenly had a revelation that actually the way she was thinking did not match up to these criteria. The more she examined her thoughts, held them up against these virtues, and questioned ‘but is it true?’, the more she began to break her destructive thought patterns and head towards recovery.
Truth in particular is an important one; it is so easy to begin to believe or worry about untruths, about ourselves, about others, and certainly about God. Some of my own are that I am a failure, that others are better than me at everything, and feeling surplus to requirements, even to the extent of doubting whether God has a use and a plan for me. There’s a little truth behind some of this; but are these things really true..? Honestly, no.
The technique is remarkably similar to that recommended under CBT, and has helped many people overcome depression and anxiety. Learn to identify the negative thoughts underlying your low feelings, and ask yourself ‘but is it true?’. I’ve been doing this a lot over the last few weeks, and although it’s early days, I know it is already helping a little. I’m still getting into negative thought spirals that mean sometimes I just cannot lift myself out of a real low, but just beginning to ask the question, is it true, is already starting to interrupt the vicious cycle a little, and causing me to focus on what I do know to be true in fact, even if I don’t necessarily feel it at the time. Good stuff. I’m only part way into the book so I can’t say whether the whole book is helpful or not as yet, but certainly I recommend these first few chapters, and exploring how this Biblical advice could help you.
We so easily lose sight of what is actually, really, true. Bringing ourselves back into a true perspective is tough when we’re ill, and takes a lot of time and practise. But at the end of the day I do believe the truth will set us free.
(2nd half of this post here, featuring my notes on what we learnt about panic attacks and managing worry.)
*I figure it is in the interests of the NHS to have this shared widely to potentially help others on the way to recovery and thereby possibly help reduce pressure on the overstretched service – though please do still go to professionals for help. What you won’t get from online advice is the chance to ask questions and advice of professional therapists, share difficulties you find when using these techniques, tips for making them work for you, and the sense of solidarity from being part of a group and learning with others in the same position.