Managing Your Depression (13 page)

How You
Think
and
Feel
also Affects How You
Act

Your interpretations of the events in your life cause emotions, and in response to these emotions, you also have an urge to act in a certain way. For example, when feeling miserable, you may choose to act angrily, stay in bed, cry, or drink too much alcohol. While some expression of emotion is okay, these are extreme negative behaviors that are not healthy for you.

Since you have the ability to act on your feelings, you also have
some
control over your emotions by choosing
how
to react and respond to them. The actions and decisions you make in response can intensify or lessen a particular feeling. Learning to modify your responses to intense emotion will decrease your level of distress. For example, instead of feeling extremely “enraged” or out of control in response to a troubling situation, you might feel sad or moderately angry. Work with your therapist to learn and practice this skill.

Should Statements

Should statements
are things you say that start off with the words “I should …” They reflect a rigid set of rules about how you and others must act, think, or feel. These statements take a
desire
and change it to a mandatory, inflexible standard, a moral imperative. When applied to the past, you can never meet that standard of perfection, so you end up feeling guilty, frustrated, or angry.

For example, “I should have been ______________” reflects a situation that can never be met.

Be aware of the “musts,” “oughts,” “shoulds,” and any “standards” you have that others do not share.

Ways to handle should statements:

1. Recognize the standards you cannot reach.

2. Recognize these statements as
desires
, not mandatory rules.

3. Replace thinking “I should
___________
” with

“I wish I ___________,”
or

“I would like ___________”

4. Practice doing this exercise when you catch yourself using a should statement.

Challenging and Changing Your Thoughts

Mood and Thought Monitoring Exercise

The Mood and Thought Monitoring Exercise is an effective CBT tool used to monitor and modify the negative thoughts and emotions that come with depression. In this exercise you will

• look at a particular situation that caused you to feel distress,

• identify the distortions in the thoughts that support those feelings of distress,

• challenge the negative, distorted thoughts, and

• replace them with a more accurate view.

This process, called
cognitive restructuring
, has been found to improve current levels of distress in people struggling with depression. The Mood and Thought Monitoring Exercise is an effective tool to use with your therapist or treatment team. The technique was originally presented by Dr. Aaron T. Beck as the “Daily Record of Dysfunctional Thoughts.” It has also been described in detail by Dr. David Burns, in his book
Feeling Good
. The exercise has been widely used clinically and adapted by many others since then.

Purpose of the Mood and Thought Monitoring Exercise

1. Self-assessment

• To increase your awareness of your thoughts, emotions, feelings, reactions, interpretations

• To understand how your thoughts, feelings, and actions (behaviors) are related and how they affect each other

• To understand what events led up to your current feelings

2. To change your problematic thinking

• Identify the thoughts that come automatically and support bad feelings (
automatic negative thoughts
) and replace them with a more accurate view of the situation.

• Identify ways to think differently about yourself and a situation, increase your awareness and perspective, and gain objectivity. Correct errors in your thinking.

How to Use the Mood and Thought Monitoring Exercise

Pick a recent personal experience to think about. Fill in the five columns on the Mood and Thought Monitoring Exercise form on
page 96
. Then reflect on your thoughts and emotions about the experience. This is not an easy task to do, and it may stir up the emotions you are now thinking about. Review the completed monitoring form with your therapist. Doing this exercise regularly will change your emotions in general, and in particular, those related to each experience. It will eventually improve your mood.

Fill in the Mood and Thought Monitoring Exercise form with your responses to these five steps.

1. Choose a recent situation or event that triggered distressed feelings in you and that is associated with one or more automatic negative thoughts.

2. Notice the emotions associated with that situation (such as sadness, anxiety, fear).

3. Identify the automatic negative thought(s) raised by that situation.

4. Identify the distortions in your thoughts (see Types of Distorted Thinking, on
page 90
). Replace the distorted, inaccurate thought with a realistic
alternative thought
(this
is called a Rational Response). The alternative thought you choose must be a fair and more accurate view of the situation. It has to be realistic, honest, and believable, and it should validate the emotion you are experiencing.

5. Notice the change in your emotions or in their intensity after you have replaced your thoughts with a more accurate, realistic view.

Example Responses to the Mood
and Thought Monitoring Exercise

A situation that triggered thoughts:
John did not return my telephone call when he said he would.

Emotions associated with this situation:
sadness, anger, rejection … at 100 percent intensity.

Automatic negative thoughts:
He hates me. He is angry with me. Everybody hates me. I’m a loser. I did something wrong. I’m not important enough.

Distortions in those thoughts:
polarized thinking, over-generalization, mind reading, catastrophizing.

Alternative thought:
John is my long-time friend, and he has never given me reason to think he hates me. There is no reason to think he is angry with me that I know of. Some people like me. I do some things right. There is no reason to think that I did something wrong to John. Maybe he is busy or out of town. Maybe he is sick or it slipped his mind.

Emotions after restructuring your thoughts:
sadness: 10 percent intensity; angry: 20 percent intensity;
rejected: 10 percent intensity

Notice how the restructured alternative thought has improved the intensity of the initial emotions from 100 percent to 10–20 percent.

 
MOOD AND THOUGHT MONITORING EXERCISE 

Use this form to monitor your mood when you are feeling unpleasant emotion or distress. The purpose is to identify the thoughts you have that support or contribute to the distressed feelings and to help you develop a more accurate view of the situation. Review the completed form with your therapist or treatment team.

More ways to challenge and change your Thinking

• Identify the distortions in your thinking. Use the Types of Distorted Thinking descriptions on
page 90
as a guide.

• Use the CBT Mood and Thought Monitoring Exercise to evaluate a situation associated with emotional distress. Substitute a more realistic thought or interpretation of an event for your distorted one.

• Examine the Evidence For and Against a negative thought, belief, or interpretation of an event.

– Gather evidence.

° Conduct your own “experiment” and gather evidence to check the accuracy of your thought.

° Ask others who know you well for their realistic, honest feedback.

° Seek out experiences that counteract the negative beliefs you have.

– Ask if your belief is inherently true or if it is an internalized message from your environment.

° If it is true, what is in your power to change?

• Examine the pros and cons of any thought, belief, decision, or action.

• When a thought or belief is upsetting you, look at whether your thought and reaction have more to do with events from long ago. Ask yourself:

– Where does this thought come from?

– Does it apply
now
, in the current situation?

• Separate your opinion and interpretation from fact. Interpretations often distort a situation negatively.

• Avoid making judgments or interpretations. Feelings and interpretations are not facts.

– Rely on the facts. Ask yourself: Is this an interpretation, or is it a
fact
?

• Replace should statements with less demanding language, such as “I would like it if …”

• Instead of assuming full responsibility and blame for a particular problem, consider other factors that might have contributed, that were outside your control.

• Use the same compassion in talking to yourself as you would give to others.

• Try thinking of things in the middle ground, or gray area, instead of at the extremes of black and white.

Evidence For and Against

When a thought, belief, or interpretation of an event is troubling, it is often helpful to examine the Evidence For and Against that thought. The evidence you gather will help you identify and change thoughts that are based on inaccurate assumptions.

Step 1. Identify a belief or thought that is negative or upsetting.

Step 2. Gather Evidence For and Against that thought.

• Collect specific evidence about that thought to check its accuracy

• Ask others who know you well for their realistic, honest feedback about that thought

• Seek out experiences that counteract your negative beliefs. This means that you go out and do something to see firsthand the evidence against your negative belief.

Step 3. Look at your list realistically and see where the evidence lies.

Ask yourself if your belief is inherently true or if it is an internalized message from your environment. If you find it is true, ask yourself what is in your power to change?