Can anything be done? Understanding Depression and How to Overcome - - PDF document

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Can anything be done? Understanding Depression and How to Overcome - - PDF document

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20160204 Can anything be done? Understanding Depression and How to Overcome It Dr. Michelle Haring, R. Psych Director, NSSAC Overview What is depression? How do I know if I am depressed? Why do people get depressed? How is

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Can anything be done? Understanding Depression and How to Overcome It

  • Dr. Michelle Haring, R. Psych

Director, NSSAC

Overview

  • What is depression? How do I know if I am depressed?
  • Why do people get depressed?
  • How is depression treated?
  • What is cognitive‐behavioural therapy (CBT) and how

does it work?

  • What are some ways that I can apply CBT skills in my own

life?

  • How can I help a loved one with depression?
  • Where can I get more information and support?

Common Signs & Symptoms

  • f Depression
  • Feeling depressed, low, sad or empty most of the day,

nearly every day

  • Loss of interest or pleasure
  • Loss of motivation
  • Significant changes in weight or appetite
  • Sleep problems & other physical concerns
  • Feeling restless or feeling “slowed down”
  • Low energy/fatigue
  • Feeling worthless, guilty or like a “failure”
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Common Signs & Symptoms

  • f Depression
  • Social withdrawal
  • Irritability
  • Decreased sex drive
  • Tearfulness/crying
  • Problems with concentration, memory, decision‐making
  • Thoughts of death
  • These problems are upsetting or interfere with your

ability to work, take care of things at home, get along with other people, etc.

  • People with depression often have other problems such

as anxiety or health issues

What is Depression?

  • Approx. 1 in 8 Canadians (12.2%) will experience a

major depression at some point in their life

  • Approx 2x as many women as men will experience

depression

  • At any given point in time, 5% of Canadians will be

experiencing a major depression

  • Approx. 9000 people on the North Shore are

currently depressed

  • Canada’s fastest rising diagnosis, with diagnosis rates

likely to increase dramatically in next few years

Risk Factors for Depression

  • Family or personal history of major depression and/or

substance abuse

  • Recent loss (e.g., death of loved one or divorce)
  • Chronic health problems/pain
  • Stressful life events (interpersonal conflict, work stress)
  • Traumatic events
  • Major life changes (e.g., having a baby, moving to a new

city, new job)

  • Domestic abuse or violence
  • Other chronic stressors: unemployment, low income,etc
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A Model of Low Mood & Depression

Thoughts Emotions Physical Symptoms Behaviours

SITUATION

How is depression treated?

  • Depression can be treated effectively
  • Evidence‐based treatments include:

– Pharmacotherapy (medication) – Psychological treatment

  • Cognitive‐behavioural therapy (CBT)
  • Interpersonal psychotherapy (IPT)

How is depression treated?

  • The BAD NEWS: too few people are receiving

effective treatment

– Stigma & secrecy – Symptoms are overlooked or misdiagnosed by health professionals – Cost

  • The GOOD NEWS: you can apply key skills from

cognitive‐behavioural therapy (CBT) to help you to manage your mood

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What is CBT & how does it work?

  • Short term, problem‐focused psychological treatment
  • Effective for approximately 75% of people who complete

treatment

  • Offers some protection against future episodes of low

mood/depression

  • Targets current problems instead of family/childhood history
  • Teaches effective coping skills so you can manage your mood
  • Need to use skills consistently to make lasting improvements:

time & effort is required

A Model of Low Mood & Depression

Thoughts Emotions Physical Symptoms Behaviours

SITUATION

How CBT Works

  • Because thoughts, feelings, behaviours &

physical symptoms are interconnected. . .

  • . . .changes in one area lead to changes in the
  • thers
  • Making small, planned changes to behaviours

& thought patterns can gradually lead to big improvements in how we feel & function

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6 Key Tips for Managing Low Mood

  • Learn about low mood & effective treatment

approaches

  • Practice good self‐care
  • Set goals to get back to important activities
  • Replace unhelpful thoughts with more accurate

and helpful messages

  • Problem‐solve the situations that are contributing

to low mood

  • Seek support: connect with others who will

encourage you to make positive changes

Learning about Low Mood & Effective Treatments

  • … that’s what we’ve been doing tonight . . .

– What is low mood/depression? – What are the risk factors? – What treatment approaches have been shown to work? – What resources can I access in my community? – From what I’ve learned, what ideas can I apply/resources can I access to make improvements in my own life?

Changing Behaviours

  • It’s often easiest to start with changing behaviours

before tackling thoughts

  • As people become depressed, they tend to stop doing

things that are important for well‐being

  • Need a plan to gradually put these behaviours back

into your schedule

  • Key areas to address include self‐care & other

important “daily ingredients”

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Changing Behaviours: What to Target?

  • Key areas of self‐care include

– Diet – Exercise – Sleep – Limiting caffeine – Limiting drug & alcohol use

  • Other important areas to target include:

– Enjoyable activities – Activities that give you a sense of accomplishment – Connecting with others – Overcoming avoidance

Adapted from Antidepressant Skills Workbook by Bilsker & Paterson (2005)

How Do I Change My Behaviour?: Goal Setting

  • A simple yet powerful technique to begin forward

momentum

  • Choose one or two areas to begin with (getting more

exercise, seeing friends, doing something enjoyable, etc.)

  • Goals must be:

– Specific – Realistic (90% confident) – Scheduled

How Do I Change My Behaviour?: Goal Setting

  • Examples of goals

– Go for a walk to & from the community mailbox (10 mins) twice a week after work on Tuesdays & Thursdays – Call my sister for a 15 minute chat Sunday morning after church

  • Try to anticipate and problem‐solve around obstacles
  • Watch out for doing too much/trying too hard!

– Achieving goals builds motivation & momentum – Falling short of goals breeds discouragement and hopelessness

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The “trying too hard” problem

Motivation/Energy Expectations/Goals Try harder Try even harder, pick your self up by the bootstraps! Just do it, already! What’s the point? I always fail

Thinking Patterns Related to Low Mood & Depression

  • Unhelpful, unrealistic thinking is very common when we are

experiencing low mood or depression

  • This can be part of the reason why depression starts & can

keep it going

  • Characteristics of Depressive Thinking:

– Negative view of the self: self‐criticism – Negative view of the world/situation: focus on the negative/threatening parts – Negative view of the future: expect that things will not get better or that more bad things will happen

  • Everyone is prone to falling into “thinking traps” when we are

stressed, depressed or very tired

Does this sound familiar?

  • I’m a failure
  • People at work think I’m incompetent
  • I’m never going to find a partner
  • This pain is not going to get better
  • My family hates me
  • I always mess things up
  • The world is a harsh place
  • People are generally selfish & unkind
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Examples of Thinking Traps in Low Mood & Depression

THINKING TRAP EXAMPLE

All or Nothing Thinking Seeing things or people as right or wrong, good

  • r bad, perfect or terrible. A small mistake is a

total failure Catastrophizing Telling yourself that a minor negative event is/would be a complete disaster. Often accompanied by fears of not being able to cope Fortune Telling/Jumping to Conclusions Making predictions about what is going to happen, with little or no evidence Mindreading Thinking that you know what others are thinking, without any evidence

Examples of Thinking Traps in Low Mood & Depression

THINKING TRAP EXAMPLE

Negative Mental Filter Focusing on the negative parts of a situation and ignoring the positive parts of a situation Overgeneralization Making up a “rule” about how things are or will be based on one experience or event: “always” “never” “everybody” “Should” statements Telling yourself how you “should” or “must” act or feel Labelling Saying something very negative (and often unfair) about yourself or other people

Examples of Thinking Traps in Low Mood & Depression

THINKING TRAP EXAMPLE

Emotional Reasoning Thinking that bad feelings say something about how a situation actually is. Believing that your thoughts must be true or accurate because you “feel” strongly that they are, even if there is little or no evidence to support them Perfectionism Thinking that things or people are only right

  • r worthwhile if they are perfect

Personalization & Self‐ Blame Feeling overly responsible for other people’s behaviours and negative events, without considering other factors or people who may have influenced the situation

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Challenging Unhelpful Thinking Patterns: 4 Steps

STEP ONE: Recognize your unhelpful thinking

  • When you notice your mood has dropped, pay

attention to the thoughts that were going through your head when that happened

  • If you can, make a note of the thought and the

situation that triggered it

4 Steps adapted from Coping with Depression During Pregnancy and After the Birth: A cognitive‐behaviour therapy‐based self‐management guide for women by Haring & al., 2011

Techniques for Challenging Unhelpful Thoughts

Situation Unhelpful Thoughts After I tell my mom that it takes my baby 30 minutes to settle down, my mom calms my baby down in about 5 minutes Why can’t I ever settle her down that fast? I should know how to do that – she’s my baby. She probably thinks I’m a terrible mother

Challenging Unhelpful Thinking Patterns: 4 Steps

STEP TWO: Identify your “thinking traps”

  • Look at the thinking traps and see whether your

thinking falls into any of these categories. It is common to fall into more than one thinking trap.

4 Steps adapted from Coping with Depression During Pregnancy and After the Birth: A cognitive‐behaviour therapy‐based self‐ management guide for women by Haring & al., 2011

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Techniques for Challenging Unhelpful Thoughts

Situation Unhelpful Thoughts Thinking Trap or Questions to Challenge this Thought After I tell my mom that it takes my baby 30 minutes to settle down, my mom calms my baby down in about 5 minutes Why can’t I ever settle her down that fast? I should know how to do that – she’s my baby. She probably thinks I’m a terrible mother Should statement Overgeneralizing Labelling

Challenging Unhelpful Thinking Patterns: 4 Steps

STEP THREE: Challenge the unhelpful thinking and replace it with more healthy thinking

  • Use “challenging questions” to help you to come up with

an alternative thought that is more realistic & helpful

  • If someone I really care about knew I was thinking this

thought, what would they say to me?

  • If someone I really care about was in this situation and had

this thought, what would I tell them?

  • Is this thought helpful right now? Is there another way of

thinking about this situation that would have better results?

  • Have I confused a thought or feeling with a fact?
  • What evidence do I have that supports this thought? What

evidence do I have that does not support this thought?

Questions adapted from Greenberger & Padesky (1995), Burns (1999), Bilsker & Paterson (2005)

Challenging Unhelpful Thinking Patterns: 4 Steps

“Challenging questions” continued

  • Am I blaming myself for something over which I do not have

complete control?

  • What’s a less extreme/more fair way of looking at the

situation? Are there shades of grey that I am ignoring?

  • When I have felt this way in the past, what did I think about
  • r do that helped me feel better?
  • Five years from now, if look back at this situation, will I look

at it any differently?

  • Are there any small things that contradict my thoughts that I

might be discounting as not important?

Questions adapted from Greenberger & Padesky (1995), Burns (1999), Bilsker & Paterson (2005)

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Techniques for Challenging Unhelpful Thoughts

Situation Unhelpful Thoughts Thinking Trap or Questions to Challenge this Thought Healthier Thoughts After I tell my mom that it takes my baby 30 minutes to settle down, my mom calms my baby down in about 5 minutes Why can’t I ever settle her down that fast? I should know how to do that – she’s my baby. She probably thinks I’m a terrible mother Should statement Overgeneralizing Labelling My baby takes different amounts of time to settle on different days. Sometimes she settles fast for me. It isn’t fair to call myself a terrible mother – I have learned a lot since she was born and I do a lot to care for her which takes effort and love.

Challenging Unhelpful Thinking Patterns: 4 Steps

STEP FOUR: Make healthier thinking a habit

  • Learning to catch and challenge your unhelpful thoughts and

replace them with more helpful thoughts is a SKILL

  • It takes time & practice to become confident and comfortable

with this new skill

  • PRACTICE as much as you can – it will come easier to quickly

recognize and let go of unhelpful thinking when it happens

  • Sometimes “coping cards” can be helpful
  • For more information about Healthy Thinking, see the Healthy

Thinking Wellness module at www.heretohelp.bc.ca

Problem Solving

  • Low mood and problems go hand‐in‐hand
  • Sometimes problems are what trigger the low mood in the

first place (e.g., financial problems, conflict with a coworker)

  • Other times, problems have begun as a consequence of the

symptoms of low mood ‐ low motivation & energy, concentration & decision making difficulties (e.g., mounting debt because not opening & paying bills, poor social support because new to the community, etc.)

  • Learning and applying problem‐solving skills can help you to

manage the situations that are contributing to your low mood/depression

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Problem‐Solving Steps

Identify and Define Problem Select and Formulate Goal Brainstorm potential solutions Consider pros and cons Choose best solution Implement and Evaluate

Problem‐Solving Tips

  • Be specific about the problem/chunk it down

– “I have financial problems” vs. “I can’t pay the minimum balance on my credit card”

  • For more information about problem solving,

see the Problem Solving Wellness module at www.heretohelp.bc.ca

Seek Support

  • Speak Up: many people who are experiencing

depression pull back from others & don’t seek support

  • Connect with others who will encourage your efforts to

make positive changes

  • Seek professional support from your family physician
  • r other health care professional
  • Be persistent in asking for the support you need:

emotional support, social network support, practical support, informational support

  • For more information about social support, see the

Social Support Wellness module at www.heretohelp.bc.ca

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How can I support a loved one with depression?

  • It can be really difficult to watch a loved one struggle

with low mood or depression, fortunately, many excellent resources are available

  • Here’s what isn’t helpful . . .
  • Try harder
  • Pick yourself up by the bootstraps
  • You know it will make you feel better
  • Keep pushing, you can do it
  • Give it your all, 110%
  • If you loved us, you would do this
  • Stop feeling sorry for yourself and make a

change

Just change your behaviour!

  • Depression is bigger than you; you can help, but

you can’t make it go away

  • Treat your loved one like an adult
  • Encourage, but know when to back off; do not

apply pressure

  • Your loved one did not choose to have this problem and cannot “just stop”

being depressed

  • Be positive & reinforce their efforts
  • Treatment takes time & tremendous effort by your loved one
  • Do not ignore problems for fear that it may upset

your loved one

So what can I do to help?

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So what can I do to help?

  • Educate yourself about depression & help your

loved one find resources

  • Let your loved one know that effective treatments

are available & support his or her efforts to find a treatment that works

  • Consider having a joint session with your loved
  • ne’s mental health professional to find out what

you can do to support his or her efforts to make progress

  • Look after yourself, keep up with self‐care,

recreational & social activities

  • Take pressures off of yourself
  • Seek your own support from friends/family
  • Consider joining a family support group
  • Find ways of getting away from the situation

Make sure to care for yourself!

Keep Going!

  • Learning to better manage your mood and to improve

your life takes time & effort

  • Remember that all of us feel low and/or depressed from

time to time

  • In many cases, applying the skills we’ve reviewed so far

will help you begin to feel better

  • For more information about depression & its treatment,

consider the following excellent resources…

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Where can I get more information and support?

  • Some helpful books*:

Mind Over Mood: Change How You Feel By Changing the Way You Think Greenberger & Padesky (1995) Overcoming Depression and Low Mood: A Five Areas Approach: 4th Edition Williams (2014)

Where can I get more information and support?

  • Some helpful books*, cont’d

Overcoming Depression: A Self‐Help Guide Using Cognitive‐Behavioural Techniques Gilbert (2009) *All of these books are available at the Capilano

Branch of the North Vancouver Public Library In Edgemont Village

Where can I get more information and support?

  • Free Online Resources:

– Antidepressant Skills Workbook by Bilsker & Paterson: http://www.comh.ca/antidepressant‐skills/adult, available in multiple languages & as an audiobook – Coping with Depression During Pregnancy & Following the Birth: A Cognitive‐Behavior Therapy‐Based Self‐Management Guide for Women by Haring et al: www.bcmhsus.ca/resources/adult‐ resources – Wellness Modules at www.heretohelp.bc.ca: covers topics such as social support, problem‐solving, getting a good night’s sleep, eating and living well, healthy thinking and more

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Where can I get more information and support?

  • Mood Disorders Association of BC: www.mdabc.net
  • MoodGym Training Program: A free online self‐help

program that teaches CBT‐based skills to manage

  • anxiety. (Australian National University):

https://moodgym.anu.edu.au/welcome

Where can I get more information and support?

  • BounceBack: Reclaim Your Health
  • CBT‐based guided self‐help for people with mild to

moderate depression (with or without anxiety)

  • Funded by the BC Ministry of Health Services to be

accessible throughout the province

  • Family physician referral required
  • See www.bouncebackbc.ca for more information

Where can I get more information and support?

  • BounceBack: Reclaim Your Health
  • 2 components:
  • Living Life to the Full DVD
  • Telephone‐delivered Coaching to help participants

complete a structured CBT workbook‐based mood improvement program

  • Workbooks cover topics such as: practical problem‐

solving, challenging extreme & unhelpful thinking,

  • vercoming reduced activity and avoidance
  • See www.bouncebackbc.ca for more information
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Final Thoughts

Remember that effective treatments for low mood & depression are available, so don’t give up! Encourage others to be understanding and supportive of people with low mood & depression Thank‐you!