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I'm Depressed. I'm Overwhelmed. Where Do I Start?
by Monica A. Frank, Ph.D.

"So, where do you start? Anywhere. Just make it simple. And begin."

Although cognitive-behavioral therapy (CBT) is the most effective treatment for depression, it can add to the already present feeling of being overwhelmed because it involves effort. Many people with depression think "What do you not get about 'I can't do anything!'?" when the therapist presents them with CBT treatment methods for depression.

A common symptom of clinical depression is fatigue with the associated feature of lack of interest in normal activities. The individual with depression can feel overwhelmed with the simplest of tasks. Eating, brushing teeth, or showering can present major daily hurdles. The idea of the effort required by CBT can be daunting.

Which is why it is best to have a CBT specialist develop a plan. The therapist can assist by creating manageable steps and by using sessions for training exercises on using the methods of CBT. A CBT specialist provides specific tools and techniques to change thinking and behavior.

The Difference Between A CBT Specialist and a Therapist Who Claims to do CBT

1) CBT is not talk therapy. CBT involves learning how to use methods to reduce anxiety and depression that you can then implement yourself. Although talking about your problems does occur during the sessions, the focus is on "doing." CBT is directive and helps you to develop ways of managing your symptoms.

2) CBT doesn't just tell you how to think. Some clients have reported to me that they previously saw a CBT therapist and that it didn't help. Upon further inquiry, I found that the therapist just told them how they "should" think.

However, CBT is much more than telling someone how or what to think. CBT involves learning how to recognize irrational thinking patterns, understanding why these thoughts are irrational, and developing a believable rational alternative. The therapist may need to devote a great deal of time, especially if the client is severely depressed, to teaching each of these steps.

Learning how to develop a believable challenge is particularly crucial because it has to be something the individual can accept. Instead of telling someone what they "should" think, a CBT specialist provides them with possible alternatives and the logic behind these alternative rationales. Then they discuss whether it is an acceptable explanation or not. What may be acceptable to the therapist may not be a believable challenge for the client so the therapist needs to listen carefully to the client and develop an explanation that can work specifically for that client.

3) CBT provides training. A CBT specialist will help you learn the methods by determining what training you need and developing a plan for that training. For example, if I provide relaxation audios to a client, I will follow-up the next session to determine how the relaxation audio helped. If I find that it did not help, I determine the specific obstacles and address those obstacles. For some people with severe depression or anxiety, I may need to provide in-office relaxation training until they are able to use the audios. The same is true with the cognitive methods. If someone has difficulty with the reading materials, we may review the irrational thinking styles in the office and complete the cognitive diary together using examples they provide.

Thus, a CBT specialist will determine how much CBT the client can manage independently and how much assistance is required. People with depression often already feel inadequate so therapy should not contribute further to this feeling of inadequacy. Instead, it should help encourage by creating manageable goals and teaching how to achieve those goals.

Where Should You Start?

For someone so overwhelmed with depression that it is difficult to engage in basic daily activities, it is important to have a therapist guide you. The therapist can develop manageable goals and the steps to achieving those goals. In addition, the following provides some ways to make CBT less overwhelming when you are depressed:

1) Break goals down into smaller steps. Therapists know that the research indicates that if depressed individuals engage in activities they normally would find enjoyable, it can help reduce the depression. However, too often when people who have depression are told to be more active, it seems like an impossible task. It is similar to asking a sedentary person to start running a marathon. Therefore, break an activity down into smaller components that are more manageable. For instance, many of my clients tell me that normally they enjoy reading but no longer can focus or find it pleasurable. However, I do find that most of them can focus and read short magazine articles. By starting with something like reading the jokes in the Reader's Digest, they can build their ability to focus while obtaining some enjoyment.

Sometimes it is difficult for those with depression to take small steps because they believe that such steps are too insignificant and won't make a difference. However, most of the things people accomplish are based on small steps or goals. For instance, Tolkien wrote “The Lord of the Rings” averaging fewer than 250 words a day—that's about 25% of the words you just read in this article. Small steps truly can move mountains! Don't dismiss small steps but instead appreciate each step you take.

Another attitude of many people with depression is that they shouldn't have to develop goals, especially simple ones, to do something enjoyable. It seems absurd to them. However, depression takes away natural joy and, unfortunately, to combat the depression it is necessary to create steps to gain the simple pleasures back. This is a consequence of the depression and not a fault or weakness of the individual.

2) Do something that takes little effort. The tasks of CBT require effort. However, usually some method can be found for each individual that is manageable. That is why Excel At Life's apps have many different methods. Everyone does not need to use every method. Choose methods that work for you and don't take too much effort. But even many of those methods can be modified to make them easier to implement if they seem impossible to accomplish. For instance, reading an article can be overwhelming which is why Excel At Life is recording many of the popular articles. If you find reading difficult, you can listen to the article. However, sometimes it may even be difficult to focus on an audio article. In that case, I tell my clients to just turn it on. Even if they don't listen to the entire article, they may hear occasional snippets that are helpful.

The same is true with the relaxation audios. Instead of trying to relax (which can be difficult for some people with depression), just turn the audio on and have it play in the background. You may obtain some benefit and eventually be able to respond more to the relaxation.

3) Do something. Anything. Depression wins when you lose all interest in normal activities, and for some people, life itself. Anything you do helps to fight the depression. Instead of judging your activities as not good enough, give yourself credit for any step you take. Because every step is significant. Every time you do something, no matter what it is, you are fighting the depression and preventing it from winning. I have a client who finds it helpful to read the motivating statements on the initial screen of the “Depression CBT Self-Help Guide.” She turns the screen from portrait to landscape and back to read the different statements. This may seem like a simple activity, but it is potentially a very beneficial method she is using. As I have stated many times in my articles, the key to cognitive therapy is repetition. By rotating the screen of her tablet and reading the statements again and again, she is creating a new pathway in her brain. Eventually that new pathway can help her take more steps in her recovery.

So, where do you start? Anywhere. Just make it simple. And begin.

Specific Suggestions When Using “Depression CBT Self-Help Guide

When using Excel At Life's app there are several simple things you can do to get started. Once you start doing any of these it may become possible to start doing more. Don't worry about the outcome. Take one simple step.

1) Read the motivating statements. On the initial screen are a few statements that randomly display when the app is first turned on or when the screen is rotated. Reading those can help you begin to fight the depression.

2) Read more motivating statements. By selecting Menu (the three squares in the upper right corner), Settings, and Choose Statements and then Add Statements you will be able to read all of the statements that are used in the Cognitive Diary to help challenge depressive thoughts. Just reading through these can be a simple exercise to help with depression. However, if you want, you can also select the statements you find motivating to display on the initial screen. By doing so, the statements on the initial screen will be customized and more relevant to you.

3) Listen to an audio. As stated above, it can be helpful to just turn on an audio even if you can't focus completely. Start with the Depression Assistance audio and then try some of the others for relaxation.

4) Choose a picture. By selecting Menu, Settings, and Choose Design you can choose your own picture for the main screen. Choose something that normally makes you feel good when you see it.

5) Select daily points. From the initial screen, tap Points and then Select Points. Read through the list and choose simple activities that you can do. Even if you can only start with a couple points a day you may find yourself able to increase that over time. Although a little more complex, you can also add your own points to the list by selecting Menu, Settings, Customize Suggestions.

6) Read a suggestion. From the initial screen, tap Info and then Suggestions. Although there are 50 suggestions, you don't need to read them all at once. Just read one a day. Once you have been routinely doing some of these suggestions, you may find it possible to take on some of the more difficult methods in the app such as completing the Cognitive Diary.


Kindle Books by
Dr. Monica Frank

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