DAVID VEALE, FRCPsych, MD, BSc, MPhil, Dip CACP is a consultant psychiatrist in Cognitive Behavior Therapy at the South London and Maudsley NHS Foundation Trust and the Priory Hospital, North London. He is an Honorary Senior Lecturer at the Institute of Psychiatry, King’s College London. He is an accredited cognitive behavior therapist and President of the British Association of Behavioural and Cognitive Psychotherapies 2006–8. He has about 50 publications to his name, accessible through his website www.veale.co.uk. He has been helping people with depression and anxiety disorders for more than 15 years.

ROB WILLSON, BSc, MSc, Dip SBHS is a cognitive behavior therapist in private practice. He also works as a tutor at Goldsmiths College, University of London. He holds an honours degree in Psychology, an MSc in Rational Emotive Behaviour Therapy, and a Postgraduate Diploma in Social and Behavioural Health Studies. He has been involved in treating people with depression and anxiety for the past 12 years.

David Veale and Rob Willson are authors of Overcoming Obsessive Compulsive Disorder, also published by Robinson.

Other titles in the Overcoming series:

3-part self-help courses

Overcoming Anxiety Self-Help Course

Overcoming Bulimia Nervosa and Binge-Eating Self-Help Course

Overcoming Low Self-Esteem Self-Help Course

Overcoming Panic and Agoraphobia Self-Help Course

Overcoming Social Anxiety and Shyness Self-Help Course

Single-volume books

Overcoming Anger and Irritability

Overcoming Anorexia Nervosa

Overcoming Anxiety

Bulimia Nervosa and Binge-Eating

Overcoming Childhood Trauma

Overcoming Chronic Fatigue

Overcoming Chronic Pain

Overcoming Compulsive Gambling

Overcoming Depression

Overcoming Insomnia and Sleep Problems

Overcoming Low Self-Esteem

Overcoming Mood Swings

Overcoming Obsessive Compulsive Disorder

Overcoming Panic

Overcoming Paranoid and Suspicious Thoughts

Overcoming Problem Drinking

Overcoming Relationship Problems

Overcoming Sexual Problems

Overcoming Social Anxiety and Shyness

Overcoming Traumatic Stress

Overcoming Weight Problems

Overcoming Your Child’s Fears and Worries

Overcoming Your Smoking Habit

Copyright

Published by Robinson

ISBN: 978-1-47213-770-8

Copyright © 2007 David Veale and Rob Willson

The moral right of the author has been asserted.

‘Your Fitness Personality Profile’ (p.147) and ‘Fitness Personality Profile’ (p.148) copyright © 2005, James Gavin PhD and taken from Lifestyle Fitness Coaching, Human Kinetics Europe Ltd, 2005.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of the publisher. The publisher is not responsible for websites (or their content) that are not owned by the publisher.

The publisher is not responsible for websites (or their content) that are not owned by the publisher.

Robinson

Little, Brown Book Group

Carmelite House

50 Victoria Embankment

London EC4Y 0DZ

www.littlebrown.co.uk

www.hachette.co.uk

Contents

| About the Author
| Other titles in the Overcoming series:
| Copyright
| Note for practitioners
| Foreword by Professor Paul Gilbert
1 | What is Depression?
| Are you depressed?
| The effects of depression
| Common emotions in depression
| Types of depression
| Types of anxiety problems
| How common is depression?
2 | What Causes Depression?
| What makes a person vulnerable to depression?
| What can trigger depression?
| Understanding the psychological causes of depression
| Identifying your triggers and vulnerability
3 | A Psychological Understanding of Depression
| Thinking styles
| Putting aside ‘internal’ causes of depression
| When your solutions are the problem
| Avoid avoidance, escape from escaping
4 | Effective Treatments for Depression
| Recommended treatments for mild depression
| Recommended treatments for moderate to severe depression
| Treatments not recommended for depression
5 | How to Start Helping Yourself
| Rating the severity of your depression
| Defining your problem
| Assessing the effect of thoughts and actions
6 | Thinking About Thinking
| Watching your thoughts pass by
| Attention, attention
| Rumination, self-attacking thoughts and worry
7 | Activating Yourself
| Understand your values
| What are you avoiding?
| Planning your activities and setting goals
| The golden rules of behavioral activation
| Monitoring and reviewing your activity schedule
8 | Overcoming Obstacles to Activating Yourself
| Identifying your traps
9 | Understanding Self-harm and Suicide
| Deliberate self-harm
| Suicidal thoughts
| What to do if you are feeling suicidal
10 | Problem-solving
| Define your problem
| Brainstorm solutions
| Evaluate your solutions
| Try out a solution and review it
11 | Being Physically Active
| The importance of activity
| Matching activities to your personality
| How to keep yourself motivated
12 | Getting a Good Night’s Sleep
| Sleeping problems
| When sleep solutions are the problem
| How to get a good night’s sleep
| Medication for sleeping problems
13 | Your Diet and Your Mood
| The effect of a poor diet on your mood
| Food Diary
| Eating healthily
| EPA
14 | Sex and Drugs and Rock ’n’ Roll
| Sex
| Alcohol
| Coffee and caffeine-containing drinks
| Tobacco
| Illegal substances
| Stopping drink or drugs
| Compulsive shopping
| Gambling
15 | A Herbal Treatment for Depression: St John’s Wort
| Effectiveness of St John’s Wort
| What dose should I take?
| What side-effects can occur?
| What if I am taking other medication?
16 | A Guide to Medication for Depression
| Can I combine medication with a psychological treatment?
| SSRIs
| What side-effects occur with SSRIs?
| Other types of medication and physical treatments
| Stopping taking antidepressant medication
| Appendix 1 Am I Overweight?
| Appendix 2 Resources
| Appendix 3 Finding Professional Help
| Appendix 4 Further Reading
| Appendix 5 Blank Charts and Forms

Note for practitioners

If you are using this book with your client you should be aware that it is based on Behavioral Activation (BA) which is part of the family of Behavioral and Cognitive Psychotherapies and derived from the treatment manual, Depression in Context: Strategies for Guided Action by Martell et al (2001) (see Appendix 4.) There are differences between the standard activity scheduling of cognitive behavior therapy (CBT) and that of BA. BA is rooted in a contextual functional analysis of activities that are being avoided, or that have the function of avoidance (e.g. ruminating). This information then guides the choices in the activity scheduling. The aim is to help people develop a pattern of approach behaviors rather than avoidance. We have added elements of Acceptance and Commitment Therapy (ACT) by also encouraging activities that are in keeping with one’s valued directions in life. The distinctive feature of BA, ACT and newer approaches in CBT is the process of thinking (e.g. rumination, worry, self-attacking) rather than trying to change the content of a person’s thoughts. Thought records and identifying schemas and assumptions are therefore not used unless, for example, it is to identify and determine the helpfulness of one’s assumptions about ruminating or self-attacking. This book can be used in guided self-help for stepped care for mild to moderate depression, which in the future we hope to evaluate.

David Veale and Rob Willson

Foreword

Depression is a very common problem in the world today – and the number of reported cases is rising. It is estimated that 1 in 4 women and 1 in 7 men will have an episode of depression at some point in their lives, with many episodes beginning in early childhood and adolescence. Research has shown that in some communities, particularly the impoverished, depression can be even more widespread.

One of the difficulties with understanding depression is that it can vary depending upon the individual. Some people experience high levels of anxiety and a sense of dread; others experience elevated anger, frustration and irritability. Some eat more while others eat less. Most people suffering from depression have difficulty sleeping, but again, this can vary enormously from case to case. Despite these variations there are commonalities. For many, depression is seen as a state of exhaustion – you can feel physically, mentally and socially exhausted. This exhaustion can drain away positive feelings and interest in others and your environment. The combination of feelings of dread and fatigue, plus a negative outlook can make you want to hide away.

Over the centuries there have been many treatments for depression. More recent treatments include medications and specific psychological interventions. It is well known that depressed people’s negative thinking and predictions about others and their environment make them more likely to give up and thus spiral downwards into depression. Research was conducted to explore whether helping people directly to change their thinking, behavior and level of activities could be helpful. The answer was it definitely could. For instance, regular exercise can really help to combat depression. By gradually increasing your level of activity, focusing on small but important steps, you can start to reduce the effects of depression.

David Veale and Rob Willson have written Manage Your Mood to share with you some of the ways you can understand your thinking style and reorganize your daily routines and activities to help overcome your depression. By doing this you can start to take control of your life rather than battling on as before, simply keeping going, or just putting on a brave face.

Many of the ideas outlined in Manage Your Mood are derived from what are called behavioral approaches to problems. This works on the basic idea that in order for us to learn new tasks or overcome difficulties and anxieties skilful action is required, for example, if we are anxious about learning to drive, the best way to develop our skill and confidence is to get in a car and practise with an instructor. Think of how many difficulties you have overcome in life by actually going out and tackling your problem – even when anxious!

When it comes to depression, skilful action means:

Recognizing what was happening in your life that triggered depression. Sometimes it can be a life event such as the break-up of a relationship, or a combination of difficulties that just seemed to happen simultaneously. Some degree of depression may be a natural way we deal with things when we feel over loaded.

Noting the way a life event elicited certain, understandable but unhelpful, coping efforts and behaviors in you as you tried to adapt to the context and stressor. This will show you how depression is now piloting your life.

Recognizing how those behaviors (called ‘secondary problems’ such as avoidance and rumination) can themselves become sources of depression. For example, when feeling low you might start to avoid activities or people. Think back to the driving example. This does not mean that simply increasing activities is always the answer; much depends on how helpful you find the activities.

In Manage Your Mood, David Veale and Rob Willson outline which behaviors can make your depression unintentionally worse and what actions can be used to help. For example, hiding in bed and ruminating – while sometimes an understandable reaction – can allow the depression to deepen and ‘settle in’, making you feel much worse. In contrast, encouraging yourself to get up and do one or two things during the day can help a little and boost your confidence.

This book also contains strategies to help you develop plans to take on your depression, while factoring in the fatigue inherent in depression. Above all, David Veale and Rob Willson provide invaluable advice on how to be kind to yourself in order to get better. Manage Your Mood is not intended as an instant ‘cure’ for depression but instead provides a wealth of strategies for working with depression to overcome it and achieve your life goals. Written by two authors with many years of clinical experience and research, Manage Your Mood is necessary reading for anyone struggling to cope with depression.

Professor Paul Gilbert,
Professor of Clinical Psychology at the University of Derby and Head of
Specialty, Adult Mental Health for the Derbyshire Mental Health Trust