Psychology

Understanding &
managing depression
A workbook & guide
An introduction

Depression is a leading cause of disability worldwide, affecting over 300m people regardless of their culture,
age, gender, religion, race and economic status. There are many different reasons why an individual may become
depressed, many types of depression, many things that keep it going, and many things you can do to make things
better.

Depression is more than just feeling a bit sad and it is not something you can just snap out of. It is a mental health
disorder and it’s important to take it seriously and seek help.

In this booklet we look at some of the reasons why people become depressed, contributors to keeping that going,
and some ways of thinking and treatments that can help.

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 Psychology

Understanding depression
What is depression?
Most people feel sad or depressed at times. Sometimes you might feel low
for a number of reasons. People may say they are feeling depressed when
they are feeling down, but this does not always mean they have depression.
When intense sadness, including feelings of worthlessness, hopelessness
and helplessness, lasts for weeks or even months and interferes with your
everyday life, then it might be something more than sadness.

Depression, also called clinical depression or major depressive disorder, is

much more than simple unhappiness. It is a common and long-lasting
mood disorder that affects how you think, feel and behave and can lead
to a variety of emotional and physiological difficulties.

It differs from the everyday feelings of sadness in three main ways.

• Major depression is more intense.

• Major depression lasts longer (every day for two weeks or more).
• Major depression significantly interferes with everyday functioning.

Do I have symptoms of depression?

Everyone feels sad, lonely, or depressed at times. It is a normal reaction to
life’s struggles, big changes, loss, or damaged self-esteem. However, when
these experiences last for long periods of time, become overwhelming, and
cause physiological symptoms, they can interfere with your day-to-day life
and keep you from leading a healthy, functional and active life.

There are many signs and symptoms of depression, however, everyone is

different, and depression will affect people in different ways. Some of the
most common signs and symptoms of depression are listed overleaf.

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Common signs and symptoms of depression
Tick all boxes which regularly apply to you

How you might behave No one

g Not able to concentrate likes me
g Withdrawing from close family and friends
g No longer finding enjoyment in things that used to bring pleasure
g Not getting things done at school/work
g Relying on alcohol or sedatives

How you might think

g “I’m a failure”
g “No one likes me”
g “Things will never get better”
g “I’m worthless”
g “I can’t be bothered”
g “Others would be better off without me”

How you might feel

g Low/sad/unhappy
g Overwhelmed
g Low patience/irritable
I’m a failure!
g Upset
g Tearful
g Hopeless

How your body might respond

g Tiredness/lack of energy
g Poor memory
g Decreased pain tolerance
g Sleep problems
g Changes in appetite or weight

If you have ticked most of these boxes, you may be experiencing symptoms
of depression or low mood. However, these experiences are common
and most people feel some of these symptoms from time to time. If these
experiences are overwhelming and persistent (have lasted every day for
more than two weeks), seek help to discuss your concerns further.

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Common myths about depression

MYTH 1: You can simply MYTH 2: Talking about it MYTH 3: Others are better
‘snap out of it’ only makes it worse at dealing with their lives,
I’m just weak
Reality: No one chooses to be Reality: It is a common
depressed. Someone who is misconception that talking about Reality: On the surface it may
depressed can’t just shut it off or your feelings of depression will appear like everyone is coping
“suck it up”. If it was that simple, only reinforce the overwhelming better than you. This can be
no one would ever be depressed. feelings and keep you fixated due to the fact that people tend
Depression is a psychological, on negative life experiences. to hide when they can’t cope.
social, and biological condition. If In reality, being alone with your It may also be because when
you suspect you are experiencing thoughts can be much more you are feeling low, you tend to
depression, contact your GP or harmful than letting them out. compare yourself with people
make an appointment with an Talking to a supportive, empathic, who appear to be doing better,
experienced practitioner. and non-judgmental listener and not notice those who aren’t.
has been shown to help a lot of In reality, depression is not a
people. An accredited therapist sign of weakness or laziness. It
is best equipped to provide has social, psychological and
MYTH 4: Depression constructive support. biological origins and can be
is always triggered by treated in a variety of ways.
something bad happening Believing that you cannot cope
is a common symptom of
MYTH 5: Depression is depression and does not mean
Reality: Sometimes it is difficult
to understand how depression biological, there is nothing you are weak.
has developed. A lot of different you can do about it
factors can increase the
likelihood of someone developing Reality: Biology does play
depression, including traumatic a role in the development
events such as big life changes, of depression, but usually
loss, and accidents. However, alongside a combination of other
although traumatic events psychological and environmental
can be a potential trigger for factors. Even if it is partly
depression, they are not the biological, depression is treatable
root cause of it. Depression may and there are many things that
arise suddenly and inexplicably, can be done about it. By making
even when things seem to be changes in the way you think
going well. In almost every case, and behave, you may be able
an outsider like a therapist can to disrupt the vicious cycle of
help people identify possible depression. Additionally, talking
factors contributing to depression therapy does help many people
and help them to stop blaming and combining medication with
themselves for feeling that way. talking therapy is a common
treatment strategy for depression.

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Different types of depression There are lots of different
subtypes of depression
including seasonal affective
You may have heard a number of different terms being used to describe disorder (SAD) which is caused
depression. Major depression is broken down into various subtypes, by the weather and lack of
each with a slightly different set of symptoms. Below are some of the daylight at certain times of the
most common subtypes of depression. year.

Dysthymia
Dysthymia is sometimes referred to as mild, chronic depression. It is
less severe than major depression and has fewer symptoms. People
with dysthymia experience a chronically low mood with some moderate
symptoms of depression, such as inability to sleep or sleeping
too much, low energy or fatigue, poor appetite or overeating, poor
concentration, low self-esteem, difficulty making decisions and feelings
of hopelessness. With dysthymia, these symptoms of depression can
linger for a long period of time often for two years or longer. While not as
severe as major depression, dysthymia can still interfere with person’s
day-to-day life and their relationships. Those who suffer from dysthymia
may also experience periods of major depression, this is known as
‘double depression’.

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Bipolar disorder
Depression also occurs in bipolar disorder, which was formerly known as
‘manic-depressive illness’. Bipolar disorder, like major depression, is a
mood disorder, however, it is characterised by episodes of mania as well
as episodes of depression. Episodes of mania can consist of inflated or
grandiose perception of one’s self, excessive involvement in activities
that can lead to painful consequences, less need for sleep, and a pattern
of racing thoughts and very rapid speech. While bipolar disorder and
depression share similar symptoms, they are separate disorders with
different treatments.

Seasonal affective disorder

Seasonal affective disorder (SAD) is a type of depression where mood
is affected by the weather and the time of the year. SAD is sometimes
referred to as ‘winter depression’ as symptoms usually occur and are
more severe during the winter, with the person feeling better during the
spring and summer. People struggling with SAD may experience several
symptoms, including low mood (which may last for months), increased
sleep, and increased appetite that is characterised by carbohydrate
cravings and weight gain. SAD is more common in northern climates as
there is a significant decrease in the hours of sunlight during winter. It
is common for people to experience mood changes during periods of
decreased sunlight, however, people with SAD experience symptoms
that are much more severe and interfere with their everyday life.

Post-natal depression
Post-natal depression refers to episodes of depression following
childbirth. Its onset may be related to hormonal changes, emotional
difficulties, and social circumstances. It is a very common condition that
affects one in ten women (and also some men) usually within one year
of having a baby. It is characterised by symptoms of depression that
persist for four weeks or more and interfere with emotional and social
functioning. People who have experienced depressive episodes before
pregnancy may be more vulnerable to developing post-natal depression.

Depression with psychosis

Sometimes depression can become so severe that a person loses touch
with reality and experiences psychosis. Psychosis is characterised by a
break with reality in which a person experiences delusions (beliefs that
have no basis in reality), or hallucinations (hearing or seeing things that
are not really there). Delusions and hallucinations may be paranoid in
nature or very critical and negative, which makes the depressive state
worse. The treatment involves both talking therapies and
antidepressant and antipsychotic medications.

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What causes depression?
There is no simple answer to what causes depression. It is important to
understand that depression is not caused by one thing. There are several
different factors that play a part in the onset of the condition. These
can be grouped into four main categories – life events, thinking styles,
lifestyle factors and biological reasons. Everyone has a certain level of
‘vulnerability’ or ‘risk’ factors. The more risk factors a person has, and
the greater the stress levels the person is experiencing, the greater is the
chance of experiencing a depressive episode.

Life events
It has been evidenced that early childhood trauma and losses (such as
death or separation of parents), or stressful adult life events (such as
divorce, loss of a job, death of a loved one, family conflict, retirement), Stressors such as loneliness,
can lead to the onset of depression. It is normal to feel low during these relationship issues and work
times and often the low mood passes naturally with time, but sometimes problems can increase the risk
the difficult feelings stick around for longer and become problematic. of depression
Experiencing several prolonged and severe difficult life events increases
the likelihood for a person to develop a depressive disorder.

Thinking styles
Cognitive theory suggests that the way we think and how we interpret
events and situations impacts how we feel and can lead to depression.
Some of the most common thinking patterns associated with depression
are overstressing the negative, taking the responsibility for bad things
happening in your life but not good ones, having inflexible rules about
how you should behave, thinking that you know what others are thinking
and that they are thinking badly of you. When we are depressed, we
commonly think about things in a negative manner and this has a
negative impact on our mood.

Lifestyle factors
Studies have shown that certain lifestyles, such as not engaging in
enough physical exercise, being over or underweight and having fewer
social relationships can increase the risk of experiencing depressive
symptoms. Sometimes a prolonged exposure to stress can lead to a
development of depression. These stressors can be ordinary things such
as ongoing problems at work, difficulties in a relationship, or loneliness.

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 Psychology

Biological reasons A genetic predisposition alone is

unlikely to cause depression
A family history of depression does not mean that all the relatives will
develop major depression. People with a family history of depression are
more vulnerable to developing depression at some stage in their lives,
however an increased vulnerability to the illness, does not necessarily lead
to depression itself. Therefore, a genetic predisposition alone is unlikely to
cause depression.

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What keeps depression going?
When someone is depressed, they experience many changes. Often, these
changes develop into a vicious cycle which keeps depression going and
makes it difficult to break out of. The vicious cycle of depression consists
of a combination of thoughts, feelings, behaviours, and bodily sensations.
The first step is understanding these changes and seeing how they fit
together into the cycle of depression.

To illustrate how the cycle works we will look at an example below. The
diagram shows how these different areas work together and affect each
other to keep depression going. We can see how Samantha’s thoughts
influence her behaviour, physiology and feelings.

Situation
Samantha makes a mistake at work
that costs her company a client

Thoughts
• I’m a failture
• I’m not good at anything
• Nothing will ever get better

Feelings Behaviour
• Sad • Stays in bed
• Upset • Can’t concentrate
• Hopeless • Withdrawing from friends

Physiology
• Tiredness and lack of energy
• Sleep problems
• Poor appetite

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As we can see above, a specific event triggered the cycle of negative thoughts. People who are depressed have a
tendency to interpret events in a negative fashion. The negative interpretation of events has been argued to be one of
the important factors of keeping depression going. When we are experiencing negative and self-critical thoughts, this
tends to have a negative impact on how we feel and how we behave.

In the above example, we can see how Samantha’s thoughts about being a failure and not good at anything led to
a change in her behaviour. She started staying in bed most of the time, had difficulty concentrating and began to
withdraw from her friends. This further fuelled her cycle of depression as it led to her feeling sad, upset, and hopeless
about the situation. Her body also reacted to all these changes and she experienced tiredness and lack of energy,
started having sleep problems and developed a poor appetite. Looking at this example more closely, we can see how
Samantha’s thoughts, behaviours, feelings and bodily sensations all interacted and combined to keep her depression
going.

TASK 1
Have a go at filling in the
diagram below with your own
experiences. Think about a Situation
recent situation when you
noticed a shift in your mood.
Identify what thoughts were
triggered by the situation and
how your behaviour, feelings and
bodily sensations were affected.
This may help you begin to Thoughts
understand your own patterns
and how different
areas interact.

Feelings Behaviour

Physiology

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Because all of these areas are connected and impact each other, the
vicious cycle of depression can be very difficult to manage. However, since
all of it is connected, changing one area can lead to changes in the other
areas and can eventually lead to a disruption of the vicious cycle.

“IF WE CHANGE HOW WE THINK OR BEHAVE WE CAN CHANGE HOW

WE FEEL”

Recognising negative thoughts

When someone is depressed, they tend to think in a certain way. Often,
depressed individuals see themselves in a negative light and their
self-confidence and self-worth become very low. They also normally have
a critical way of thinking about others and the future. If you have been
experiencing depression for a long period of time, it can often feel as
though you are looking at the world through a ‘gloomy’ lens. It is important
to remember that these thoughts can occur occasionally, even when you
are not depressed. The difference is that you can generally dismiss these
thoughts, however, when you are depressed, these thoughts are around all
the time.

___________________________________________________________________
Do you have any
negative thoughts
___________________________________________________________________ about yourself?
Write them down
here.
___________________________________________________________________

___________________________________________________________________
If you have any
negative thoughts
___________________________________________________________________ about others and
the future? Write
them down here.
___________________________________________________________________

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Some facts about the negative thoughts

They are usually automatic, they just happen and are often not based on
reason or logic. They are often unrealistic and unreasonable. They often
serve no purpose and all they do is make you feel bad and get in the way of
you living your life.

• Although these thoughts are unreasonable, they often seem and feel
reasonable when you are experiencing them.
• The more you believe and accept negative thoughts as truths, the worse
you will likely feel. When we get ‘sucked into’ negative thinking, we tend
to view everything in a negative light.

When people become depressed, their thinking changes, and it often falls
into a negative thinking pattern. People use these thinking patterns as an
automatic habit and are often not aware of having them. However, when
you are constantly and consistently using the same unhelpful thinking
style, it can cause a great deal of emotional distress. Being aware of these
patterns can help you recognise them when they are happening in the
moment. Below are some of the most common unhelpful thinking patterns.

Black and white thinking

When feeling low we might fall into the pattern of only seeing one extreme
or the other. You are either wrong or right, good or bad. There are no
in-betweens and no shades of grey. This can often leave you feeling as
though you are never good enough which can contribute to low mood.
Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down examples of your
own black and white
thinking.
___________________________________________________________________

Overgeneralisation
When we overgeneralise, we take one example from the past or present
and, based on that isolated incident, we assume all other experiences
will follow a similar pattern in the future. If you use statements such
as “I never …”, “Everyone …”, “You always …”, then you are probably
overgeneralising.

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Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down examples of when
you overgeneralised.
___________________________________________________________________

Mental filter
This thinking pattern is a sort of a ‘tunnel vision’, a process of ‘filtering in’
and ‘filtering out’ certain information. It often involves ignoring the positive
parts and focusing solely on the negative elements of a situation, colouring
the whole experience by a single negative detail.

Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down examples when
you applied a mental
filter.
___________________________________________________________________

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Catastrophising
This is a common thinking pattern which accompanies low mood. When we
are catastrophising, we tend to ‘blow things out of proportion’ and view the
situation as horrible, awful, or unfixable, even though in the bigger scheme
of things, the problem itself might be quite small or easily fixable.

Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down examples when
you catastrophised.
___________________________________________________________________

Jumping to conclusions
When we are feeling low it is common to spend time thinking about
the future and predicting what could go wrong. We also tend to make
assumptions about what someone else is thinking, without having any
evidence to support them. In the end most of our assumptions and
predictions don’t happen and we have wasted time and energy being
worried and upset about them.

Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the
last two weeks and
___________________________________________________________________ write down examples
when you jumped to
conclusions.
___________________________________________________________________

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Personalisation
When we are depressed, we often take things to heart. This thinking pattern
involves blaming yourself for everything that goes wrong or could go wrong.
You might be taking 100% responsibility for things that you are only partly
responsible or not responsible for at all.

Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down examples of times
when you personalised
a situation.
___________________________________________________________________

‘Should’ing and ‘must’ing:

We often imagine how things should or must be, rather than accepting them
as they are. By saying “I should …” or “I must” we can put unreasonable
pressure or demands on ourselves and others. Although these statements
are not always unhelpful (e.g. “I should not drink and drive”), they
sometimes create unrealistic expectations.

Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down examples of your
own ‘should’ing and
‘must’ing.
___________________________________________________________________

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 Psychology

Labelling
When we are feeling low, we often label ourselves in a negative way.
We might make global statements based on our behaviour in one
specific situation. When we label ourselves in negative ways such as
“I’m not worthy”, “I’m a failure”, “I’m stupid”, it negatively impacts our
self-confidence and mood.

Do you recognise this thinking pattern?

___________________________________________________________________
Think back over the last
two weeks and write
___________________________________________________________________ down some instances
when you labelled
___________________________________________________________________
yourself.

Recognising unhelpful behaviours

Reduced self-care
When feeling depressed, the first thing that often falls by the wayside is our
motivation to look after ourselves. Simple tasks such as washing ourselves
and looking after our appearance can become difficult. We may stop being
physically active, spend more time in our beds, and stop eating properly.
When we don’t look after ourselves, it negatively affects our self-esteem
and self-confidence, thus our thoughts tend to become even more
self-critical than usual. This again creates a vicious cycle as we tend to feel
bad about ourselves and feel physically unwell, which in turn decreases our
motivation to take care of ourselves.

Withdrawal from family and friends

Another big behavioural change that occurs when we are feeling depressed,
is that we start refusing invitations, we stop answering and returning phone
calls, and we spend less time with our close family and friends. Social
isolation is an important factor in keeping depression going as it takes
away the connection with others and the belief that we are not alone in this.
Thoughts play an important role in this behaviour as, due to our depression,
we might think that we are a burden to others or that they don’t want to be
spending time with us. It again creates a vicious cycle as our behaviour can
in turn push people away and put a strain on relationships.

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Less involvement in rewarding activities “We may no longer
When we are feeling depressed, two of the main symptoms are lack of experience the
energy and lack of motivation. They keep depression going as they lead to
a decrease in engagement in activities such as hobbies, walking, sports,
enjoyment or pleasure
reading, or playing with children. It keeps the cycle of depression going that we used to
as the less we participate in these activities, the less we feel able to do
so, and the worse we feel. We may no longer experience the enjoyment
receive by engaging
or pleasure that we used to receive by engaging in these activities. This in in activities”
turn can lead to more negative emotions and thoughts such as feeling low
and thinking that we are useless.

Problems with everyday tasks

Due to low mood and a lack of energy or motivation, we find it more
difficult to do everyday tasks. Things such as doing the dishes, taking the
rubbish out, cleaning the house, and running errands take more energy
and effort for us to complete. We might even put them off and not do them
until the number of unfinished tasks becomes overwhelming. This again
creates a vicious cycle that keeps our depression going as it can lead to
more negative emotions and self-critical thoughts such as ‘I am useless’ or
‘I can’t do anything right’.

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Treatment of depression
The good news is that we can do something about these thoughts,
feelings, and behaviours to change the vicious cycle of depression. Some
people may be able to deal with depression on their own, without any
treatment at all. However, for many people, getting some help in tackling
this condition can be very useful. The first step to getting treatment is to
see your GP. Your GP will ask you some questions to assess whether they
think you have depression. They will talk with you about possible treatment
options or they may refer you to a counselling service. The two main
approaches to tackling depression are talking therapies and medication.
These may be used individually or in combination.

Talking therapies
The aim of talking therapy is to relieve psychological distress through Talking therapies can help you better
expressing your feelings and discussing your thoughts with a therapist. It understand your own difficulties
will help you better understand your own difficulties and guide you as you
begin to identify and plan different ways and strategies for overcoming
depression. There are many different types of talking therapy, however,
all of them involve talking to a trained therapist. They may be delivered
one-to-one or in a group, with your family, or with your partner. They may
be delivered face-to-face, online or over the phone. For some difficulties
and conditions, one therapy may be more suitable than another and,
overall, different styles of therapy suit different people.

Research has found the following therapies to be effective in treating

depression:

• Cognitive-Behavioural Therapy or CBT

• Counselling
• Psychodynamic Therapy
• Mindfulness Based Therapy
• Interpersonal Therapy
• Problem-Solving Therapy
• Behaviour Activation

It is important to understand that, whichever model of therapy is used,

it normally takes some time before you begin to notice any changes.
However, don’t let that discourage you as research has shown these
therapies to be effective and they have helped many people.

Our ‘Services’ page has more detail about these therapies and information
on how to access them.

Visit [Link]/therapy-coaching-wellbeing-services

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Medication
Another approach to treating depression is with the use of medication.
When you talk to your GP about your depression, they may prescribe
antidepressant medication. Antidepressants may be used on their own or
in combination with a talking therapy. There are many different types of
antidepressant and different people find different medication helpful.

Some of the most common types of antidepressant that you may be

prescribed are:

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)
• Tricyclics and Tricyclic-Related drugs
• Monoamine Oxidase Inhibitors (MAOIs)

Your GP should be able to discuss the treatment plan and all the benefits
and possible side effects with you prior to you making an informed
decision on whether or not you want to try antidepressants. Once you start
the course of medication, it is important to talk to your GP before you stop
taking them, because stopping suddenly can be difficult to cope with and
can be dangerous.

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How can I help myself? Strategies for overcoming low

mood and depression
When you are feeling depressed, you may blame yourself for all the
shortcomings that you think you have, and you may believe that you are • Learn how to challenge
helpless and alone in this world. those unhelpful thoughts
and beliefs and find more
Beneath these thoughts and feelings is a strong negative belief about helpful and balanced
yourself, the world, and the future. This negative belief creates a vicious alternatives.
cycle of depression as it leads to a loss of satisfaction in things you used to • Incorporate strategies that
enjoy and a lack of interest in what’s happening around you. As this cycle help you become more
continues, it can become harder to make decisions and to do the little active in a meaningful way.
tasks that used to be easy to do. • Learn to be kinder to
yourself and to notice
The good news is that there are a number of strategies that you can use to your good qualities and
overcome low mood and depression. See right for more about strategies. achievements.

Challenging unhelpful thoughts

Step 1

Recognising your negative thoughts

As discussed earlier in the section ‘Recognising negative thoughts’ (see

page 11), negative thinking plays an important role in the maintenance of
depression. It happens quickly and automatically, meaning that we are
often not even aware that we are doing it. Therefore, the first important step
is to become aware of our negative thinking as it occurs in the moment.

A good tool that you can use to help you become more aware of your
thoughts is a Thought Diary (see the example overleaf). Use a thought diary
over the course of a week to write down your negative automatic thoughts.
The best way to catch these thoughts is to notice when there is a change
in how you are feeling and then ask yourself: “What was going through my
mind just then?”. Then write it all down. Write the situation that occurred,
make a note of the feelings you were having and rate how strongly you felt
them. Write down the thoughts that you were having and see if you can
identify any of the unhelpful thinking styles that we covered in the section
‘Recognising negative thoughts’. Keep recording your thoughts and you
may start to notice a pattern.

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Situation Feeling/emotion Thought
Where were you? What happened? What did you feel? Rate how What thoughts or images went
strongly you felt the emotion. through your mind?
e.g. I passed by a friend on the street Sad 100% They don’t like me (jumping to
and they saw me but just walked Lonely - 90% conclusions).
past me and didn’t say hi to me. No one likes me (generalisation).
It’s because I’m a horrible person
and people don’t want to spend time
with me (personalisation).

As you will start to become more aware of your thoughts, you will increase your ability to separate yourself from your
thoughts and recognise them for what they are: just thoughts. They are not facts and they are often not based in
reality. With increased self-awareness, you will increase the space between the negative automatic thought and the
automatic reaction and create more room for a conscious response to your thoughts. Once you create more space,
you will be better able to challenge these thoughts and find more helpful alternatives.

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Step 2
Learning to challenge these negative thoughts and replace them with a
more helpful and balanced alternative

Once you become more aware of your negative automatic thoughts, the
next step is to start challenging them. Remember, the goal is not to only
think ‘happy thoughts’, the goal is to think more accurate and helpful
thoughts. Although with time our thinking can become biased, it is within
our power to start challenging and changing how we think. The most
common strategy to challenging our unhelpful thoughts is to examine them
and to see how accurate they are and how fair we are to ourselves. Use the
table on the next page as a guide.

1. Write down the situation, feelings and the unhelpful thought that was
triggered and that you want to examine. Only work on one thought at a
time.

2. Write down how strongly you believe that thought right now? (0% = not
at all, 100% = completely).

3. Write down all the reasons why that thought might be true. Ask yourself
‘What is the evidence that supports this thought?’

4. Make a list of all the reasons why this thought might not be 100% true all
of the time. You might find it helpful to ask yourself:

• What facts or evidence is there that shows that this thought isn’t
completely true? If a friend thought this about themselves, what would
I say to them? Is there another way of seeing it?
• When was the last time I had a similar thought and it wasn’t true?
What is the bigger picture? If I looked back on this thought in 15
years’ time what would I say to myself?

5. Go back and read the original thought, all of the evidence for it, and all
of the evidence against it. Do this out loud if you can.

6. Say to yourself “Given all of the evidence, is there a more balanced way REMEMBER, it is not enough to
of thinking about the situation? Is there a more helpful way of thinking about challenge your thoughts and come
myself or this situation? Have I been judging myself harshly? Is there a up with an alternative thought just
fairer, more balanced way of summing this up? What could I do differently once. Negative thinking has likely
that would be more effective in the future?” been in place for a long time, so it
is an old habit that will take some
7. Write down your new, more balanced thought and rate how strongly you practice to break. More balanced
believe the new thought and your old thought right now (0-100%). Do you thinking will help you feel better, but
notice any difference? it will take some time and effort.

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 Situation/ Feelings Unhelpful Facts that Facts that Alternative, Outcome
Trigger Thought support the provide more balanced Re-rate
Rate how unhelpful evidence perspective thoughts
much you thought against the
believe the unhelpful
thought thought

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 Psychology

Step 3
Preparing for ‘triggering’ situations

The last step is to identify the situations that are triggering and prepare
for them in advance. Look back at some of the negative thoughts you
identified for yourself.

My triggering situations:

__________________________________________________________________
Try to identify some
of your most common
__________________________________________________________________ triggering situations.
Write them down here.
__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

After you’ve identified your triggers, rehearse your helpful and balanced
thinking. When you notice unhelpful thinking, stop, take a breath, and
respond consciously. Don’t let your automatic thoughts take over, respond
to them and challenge them with examples given above. Every time you
engage in this exercise, your unhelpful thinking will get weaker and your
ability to find more balanced and helpful alternatives will get stronger.

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 Becoming more active can lead
to an improvement in mood and
overall wellbeing

Getting active
When we feel depressed, our motivation to engage in everyday activities
normally decreases. You may even stop doing activities that used to bring
you joy. In the short-term, you might feel a sense of relief for not having to
do difficult tasks, which can lead you to do even less. With time you may
end up doing very little which can lower your mood and self-confidence
even more and keep the depression cycle going.

Becoming more active in a meaningful and gradual way can lead to an

improvement in your mood and overall wellbeing. Learning how to be more
active can help you create a daily routine which will increase your sense of
enjoyment and achievement. One helpful way of doing this is by using an
activity planner which can help you do more of the things you have to do,
as well as the things you would like to do.

Step 1: Understand your cycle

Use the Activity Diary tool on the next page to record what you are doing
during the week. Each time you write down the activity, give it a rating
on a scale of 0 to 10 for Enjoyment (E), for the Achievement (A) and for
Connectedness to others (C). Once you finish recording your activities over
a week, you can have a look through it and see for yourself what you are
actually doing and enjoying. You may realise that you are mostly engaging
in activities that give you a sense of achievement and not engaging in
enough activities that give you a sense of enjoyment, or maybe you realise
that you are doing very little and not enjoying yourself at all.

Once you have an overview of your baseline activities, you can ask yourself
what activities need to increase or decrease. As we note in the section
‘Recognising Unhelpful Behaviours’, there are four main activities that we
tend to engage in less when we are depressed.

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 Psychology

Activity diary

Morning Afternoon Evening

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Page 26
Step 2: Make your own personalised list of activities
Self-care
Examples: washing your face, brushing your teeth, getting out of bed and
dressed each morning, taking a bath, having a healthy meal, going for a
walk.

Your examples:

__________________________________________________________________
Write down some ways
you could look after
__________________________________________________________________ yourself.

Connecting with family and friends

Examples: calling a friend, replying to a text message, joining a family meal,
attending a social group.

Your examples:

__________________________________________________________________
Write down some
examples of how you
__________________________________________________________________ could connect with
family and friends.
Rewarding activities
Examples: reading a book, playing a game, listening to music, playing an
instrument, gardening, doing yoga, meditating.

Your examples:

__________________________________________________________________
Write down some
ways you could reward
__________________________________________________________________ yourself.

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 Psychology

Everyday tasks
Examples: making the bed, doing the dishes, opening letters, paying the
bills, keeping the house tidy, food shopping.

Your examples:

__________________________________________________________________
Write down some
examples of tasks you
__________________________________________________________________ need to do each day.

Step 3: Now make your own activity diary

Use the Activity Diary overleaf and schedule your week ahead of time. Start
by first writing down all the activities you have to do, such as attending
appointments, running errands, doing housework. This will show you the
time you have left that is free. Then plan other activities that you would like
to do. Give yourself space to be busy or to take time to relax. You may find
it helpful to use your list above to plan in some time for an activity from
each of the four groups. Aim to have a good balance of all three areas:
achievement, enjoyment, and connectedness to others.

Page 28
 Activity diary

Morning Afternoon Evening

Monday

Tuesday

Wednesday

Thursday

Page 29
Friday

Saturday

Sunday
 Psychology

Learning self-compassion
When we are depressed, we often get caught up in self-criticism, self-hate
and feel shame. This is due to our biased mind that ignores the positive
messages and amplifies the negative ones. For example, if someone
criticises you, you may remember that for days or even weeks and believe
it to be true. But if someone says something nice about you, you might
disregard them by thinking to yourself that they didn’t really mean it.
However, this is something that you have learned to do and whatever
has been learned, can also be unlearned. So, let’s learn to be kinder to
ourselves.

Step 1: Keep track of the good things

Keep a journal and start writing down all the good things that happen in
your life. This will help you create a more balanced and realistic picture of
your situation and challenge the negative bias that your mind is trapped
in.

Some possible things to include:

• When you get something done.
• When something that you do goes according to plan.
• When you do something worthwhile.
• When you do something that goes better than you expected.
• When someone compliments you.

Step 2: Reward yourself Write down the good things that

happen in your life
Remind yourself that dealing with depression is a hard and draining task.
Things are more difficult when you are depressed and trying to change
your thoughts and behaviour is hard work. So, it is important to reward
yourself for all the hard work you have been doing. Think about what
things would bring you joy and do them unapologetically.

Step 3: Create a more positive image of yourself

When you are depressed it is difficult to see yourself in a positive light.
Moreover, societally we have been taught to be humble and to not ‘brag’.
That is why it can be extremely difficult to recognise your positives. Look
at the list of positive traits below and write down a rating for yourself on a
scale of zero to two. Zero means you have none of that quality, one means
you have a little of that quality, and three means you have quite a bit of
that quality.

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 Kind Mature Versatile
Gentle Creative Educated
Strong Consistent Willing
Resilient Appreciative Experienced
Caring Capable Efficient
Assertive Quick Open-minded
Hard-working Sensitive Logical
Reliable Perceptive Serious
Honest Patient Supportive
practical Thoughtful Resourceful
Responsible Fit Realistic
Loyal Trustworthy Funny
Motivated Shows iniative Punctual
Friendly Humane Warm

If you can think of any qualities that are not on the list, add them in the
spare boxes above.

__________________________________________________________________
Go through the list
and write down all the
__________________________________________________________________ qualities you ranked
with a one or a two.
__________________________________________________________________

You may have written down quite a few of the positive qualities or you may
have written down only a few. If there are only a few, it is a start to you
building up a more positive picture of yourself. Write down this list on a
piece of paper or a card and look at it as often as possible, especially when
you are feeling low. Keep adding to it, ask friends and family what they think
your good qualities are. The more you look at your list, the more you will
remind yourself of your positive qualities, the more open you will be to the
evidence for them, and the more you will believe them.

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 Psychology

Summary of key points

• Everyone feels sad sometimes, that does not necessarily mean that
you have depression. Once these feelings become overwhelming
and persistent, then it might be more serious.

• Depression is a serious and common mental health condition, and

not something you can just ‘snap out of’.

• There are many different types of depression. You should consult

your GP if you suspect you might be suffering from any of them.

• There are many different treatments for depression, the most

commonly used are talking therapies and antidepressant medication.
These may be used alone or as a combined approach.

• The vicious cycle of depression is maintained by a combination of

thoughts, feelings, behaviours, and bodily sensations. Changing one
area can lead to changes in the other areas and eventually lead to a
disruption of the vicious cycle.

Key steps in overcoming depression

Three things that you can do for yourself if you are feeling low or
experiencing depression are:

• Challenge unhelpful thoughts and find more balanced alternatives.

• Incorporate strategies that help you become more active in a

meaningful way.

• Learn to be kinder to yourself.

Page 32
 Psychology
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