EVENT: My medication isn't helping my depression

EMOTIONS: despair, grief, defeated

DISTRESS RATING: 9--Feeling desperate

THOUGHTS: “I've tried everything for my depression. Nothing seems to help. It is so hard to do anything. I'll never get my life back on track. My future is hopeless. I'm just weak and useless.”

CAN YOU IDENTIFY THE IRRATIONAL THINKING IN THIS EXAMPLE? There are at least 3 irrational beliefs.

HOW CAN YOU CHANGE THE THINKING? What is another way of thinking about the situation that won't cause the feelings of despair, grief, and defeat?

ANSWER:

Irrational Beliefs:
1) Negative Labeling of Self. The most serious issue in this person's thinking is the negative labeling of himself. He has an illness like someone with cancer, chronic pain, or high blood pressure--a chronic problem that requires ongoing treatment and attention. However, he labels himself as "weak and useless." Such a label blames himself for the depression which can only serve to make him feel worse. He is not at fault for the depression but he does have to deal with it. Just as those with chronic pain who recognize they are not going to get rid of the pain have to learn how they can live their life as fully as possible with the pain, this person needs to focus in the same way. He has been trying to get rid of the depression which is a fine goal early on in the treatment of depression. However, for some people the depression may be chronic. In this case, he needs to grieve the losses caused by the depression (energy, motivation, physical well-being) but determine how he can live his life.

2) Catastrophizing. He assumes that his entire future is hopeless based upon how he feels now. However, the nature of depression, even without treatment, is that it waxes and wanes meaning that it doesn't stay at the same level of severity all the time. Also, the problem with hopelessness about the future is that it creates a self-fulfilling prophecy. A person who believes the future is hopeless is more likely to give up which will create more negative outcomes. In addition, the catastrophizing is looking at the unforeseeable future rather than the immediate future. Such a perspective can be bleak for someone with depression but there are so many unknowns. However, the immediate future can focus on more knowable tasks or goals. For instance, "Can I get out of bed and take a shower?" For someone with depression that can seem like an impossible task because it is connected to this hopeless perspective of the future: "What does it matter if I get out of bed? My life won't be any better." However, if they can narrow their perspective to just the task at hand, it can become more manageable: "The only thing I need to focus on right now is getting out of bed. I don't need to focus on my entire future."

3) Generalizing. As discussed with the catastrophizing, this person is making assumptions about his future based upon the present. However, the problem with generalizing is that if anything changes in the present, the assumption is likely to become inaccurate. For instance, if he focuses on setting smaller, more present-focused goals, he is changing his approach. He is focusing in a more mindful way on the present and re-focusing from the hopelessness of the future. Doing this potentially changes the outcome. It may not make his depression go away, but it can allow him to learn how to live with it similar to how a person with chronic pain can learn to live with the pain. The depression itself does not prevent the living of life or even the enjoyment of life. It is the feelings of hopelessness and despair that does that. In fact, typically with those who are depressed, if asked in advance "Do you think you would enjoy X (reading a book, taking a walk, talking to a friend, etc.)?" they would say "No. Nothing is enjoyable." However, if you ask them during the activity if it was enjoyable, often they will respond positively. Therefore, the generalizing prevents them from engaging in activities that could be uplifting because they believe that their feelings will remain the same.

The important thing is to keep in mind that depression and emotion are two different things. Depression is an illness that causes the physical system to have a lowered functioning so that the body itself feels weak and fatigued. This leads to other symptoms such as disinterest in usual activities or not eating properly which further affects the functioning of the system, and finally, leads to the feelings of failure and hopelessness. So these emotions may result from the depression but are not part of the depression. For example, someone with cancer may feel hopeless. However, the cancer doesn't cause hopelessness (some people may feel the opposite) but the hopelessness can be a consequence of the cancer. This distinction between the illness of depression and emotion is important because it allows a person to recognize that a full range of emotions is still possible. The depression doesn't prevent enjoyment or pleasure. It just interferes.

How Can This Thinking Be Changed?
"I have depression. Even though I have to deal with the unpleasantness of depression and I have every right to grieve how it affects my life, I also need to keep in mind that I can still have pleasant things in my life. Besides, I don't know this is my entire future. I'm making an assumption based upon how I feel right now. Instead of focusing on the far future, I will focus on the more immediate and finding ways to live with the depression. When the hopeless thoughts about the future come into my mind, I will focus back to the present and what I can do now."