Overcoming Depression One step at a time
Part 1 Understanding Depression
Introduction
Read a chapter a week and do the exercises, this will take 8
weeks.
25% of people will experience depression in their lifetime
and depression has trebled since WW2.
Maybe this is because of a depressogenic society we rely
more on technology less on each other and have become alienated and isolated,
button pushers. At work we are human resources, to be played like a game of
chess, and we live in nuclear families divorced from our extended families.
End jobs, relationships, losing loved ones, moving house,
all put you at risk of depression.
Chapter 1 How depression works
Depression rarely has one cause, its complex, and it isn’t
necessary to determine the cause to end depression. With chemical imbalances it
isn’t clear if depression causes the chemical imbalance, vice versa or a
combination. The quickest way to remove
an influence from the past is change how you live in the present. Medication helps some people but not
everyone.
Depression isn’t a problem in you, but rather a problem
between you and life.
Depression is 5 of
1.
Sadness or depressed mood
2.
Loss of interest in things
3.
Significant weight change
4.
Sleep problems
5.
Feeling very restless or feeling very slowed
down
6.
Being tired all the time
7.
Having thoughts\feelings of worthlessness or
guilt
8.
Difficulty concentrating
9.
Having repeated thoughts of death or dying
Depression is a complex of
1.
Emotions=Sadness, feeling down
2.
Cognitions=thinking I’m worthless, there’s
something wrong with me, thinking about death
3.
Behaviours=inactivity, loss of interest in doing
things
4.
Physiology, sleep problems, eating problems, low
energy, depletion of serotonin
5.
Situations: loss of job, partner and loved one
Whilst you may feel depressed through a life event\vulnerabilities,
you stay depressed as you stop doing things that make you feel good.
Avoidance is used to stop people feeling worse. However this
is a short term gain and long term pain. You may see behavioural avoidance, e.g.
worrying about money is a way of avoiding feelings of loss or sadness.
Clients respond to BA saying sound like pull my socks up and
I’ve heard it before. Changing behaviour isn’t easy, behaviour becomes habit
and it’s done automatically, changing behaviour means taking some risk, maybe
experiencing different things, maybe doing something with an unknown outcome
and it also involves quite a few choices to find the right behaviour for the
right time. So it’s not easy!
Commonly people think that emotions cause behaviours, why
are you staying in, because I’m depressed.
However behaviour, doing something you enjoy will cause happiness, doing
something you don’t unhappiness.
Inside out
Taking medication, fixing something inside of you is an
inside out approach. If you take an outside
in you work on the principle that behaviour can cause emotion, if you take the
inside out you work on the principle that emotion causes behaviour, both are
true, but if you’re depressed you probably need to take the outside in
approach.
Chapter 2 Learn your patterns and start to change them
What are your behavioural patterns when depressed, worrying,
complaining, passivity?
Behavioural principles
1.
Most behaviour is automatic and occurs out of
consciousness
2.
Most of what you do is habit
3.
The first step to change behaviour is to
recognise it and its consequences.
So do an activity monitoring chart on an hour by hour basis
(no emotions), sell this on the fact that most behaviour is automatic and we
aren’t aware of it, and often don’t remember it. Many activities you enjoy when
you are not depressed may not be ones that you enjoy when you are depressed. It’s
possible when you start doing something you used to enjoy that you don’t
immediately start enjoying it, however if you stick with it will you refind
what you used to enjoy in it? Also notice about how different contexts and
different ways of doing the same thing have different effects, eating your
favourite food in a rush, vs. thinking I’ll treat myself, looking forward to
it, then eating it slowly. When you find the variations in depression, that can
give you indicators of what to increase. If you find a person has singular
emotions, try getting activities done that create other ones, go to a comedy
club, to a sad film. Also find out what it is about the situations that make a
decrease in depression. Have you stopped ruminating?
Step 1. Activity Monitoring chart
Step 2. Activity and Mood monitoring chart (add in as much
context as possible)
Step 3: look at chart and look to see what you can
understand
1.
Variations in mood
2.
Difficult\easier times during day
3.
Difficult\easier situations and activities
4.
Depression loops (When you attempt to cope with
depression but it makes it worse)
Step 4: Making strategic changes
1.
Identify situations\behaviours that depress you
2.
Establish current behaviours (presumably not functional)
3.
Establish behaviours that would reduce
depression (more functional)
4.
Select alternative behaviours and schedule them
into your week
5.
Adopt an experimental attitude, try the
alternative behaviour and see the results
6.
Evaluate results of experiment
a.
If it didn’t work what did you learn
b.
If it did work what did you learn
7.
Try new experiments
Depression can sometimes act as a devil on your shoulder
telling you how it won’t work, how you’re a failure etc. When you’re really
depressed it can be worth just letting him have his say (arguing with him can
just keeps him saying what he’s saying) and try the new behaviour anyway and
see what happens.
When you try new behaviour, become as fully involved in it
as possible. Focus on what you’re doing rather than things that have happened
in the past. So when you’re walking,
then walk, notice what’s going on around you, if you are ruminating while you
are walking, you are ruminating and just happen to be walking at the same time.
Also avoid evaluating the experiment
whilst it’s going on, immerse yourself in the activity and then check out the
experiment after. Also try the experiment more than once, good scientist always
repeat their experiments to be sure of their findings.
Part 2 Ending Depression
Chapter 3 Getting out of TRAPs and back on TRAC
The central aspect of avoidance, is what are the things you
need to get the life you want. Is what you are doing helping to get there, or
is it avoiding some difficulties you find in getting there.
There are two types of avoidance
Avoidance and escape behaviour
Escape behaviour gets you out of an unpleasant situation,
avoidance stops you getting into one. The difficulty with both of these is
whilst they may in the short term make you feel better as you don’t have the
unpleasant situation, if this is something you need to do, to make your life
more rewarding then the long term consequence is a less rewarding life. Whilst avoidance is natural and everyone does
it, it can make getting out of depression difficult. Avoidance can come out of our fight\flight
response that was useful in the preindustrial world, but not as useful in the
post industrial world.
Avoidance can be very subtle, so instead of working,
checking FB. Sometimes fatigue can be a way of avoiding difficult feelings.
Sometimes staying in bed is a way to avoid all the bad things that could happen
to them if they got up. Sometimes the
things that are avoided are the thoughts and feelings you will have if you do something.
So the avoidance may be thoughts\emotions\ or thinking behaviours.
Avoidance can be adaptive, e.g. avoiding dark streets, but
can be maladaptive if you don’t learn to solve your problems as it keeps the
problems alive, and decreases your confidence in your problem solving ability.
Avoiding things can also compound them, e.g. pink rabbit experiment. The
function of a behaviour is determined by its consequences (NB). To understand
avoidance look to understand the circumstance, does it feel difficult and what
are the consequences, have you solved a problem, made things better for
yourself in the long run or just in the short run, are there any unwanted
consequences.
TRAP
Trigger, this quite
often is an event, or a chain of events.
Types of Triggers
1.
Historical
2.
Current Internal\External
3.
Interpersonal
Triggers can be historical, i.e. someone shouting associated
with big danger, or an anniversary, or a song playing on the radio. Then there
are current triggers, so facing a difficult situation, could trigger anxiety,
or some loss could trigger sadness. There can be external triggers, things that
happen to you, or internal triggers, e.g. noticing your heart beating quickly,
or a thought, or an image, or worrying.
Response, usually
emotional, could be thoughts, so you get triggered to feel sad, or maybe you
start thinking how bad things are.
Avoidance Pattern.
This could be drinking or escape behaviour or safety
behaviour
Learning about avoidance
Step 1: list the things you avoid that are adaptive, and
maladaptive
Step 2: Learn your TRAP
Step 3: generate alternatives that are not knee jerk
responses
Step 4: Learn your TRAC
Facts about responses to triggers
1.
Responses to triggers are often emotional
2.
Attempts to get rid of unpleasant feelings are
often unsuccessful, and take your eye off what you were trying to do
3.
Society often encourages you to get rid of bad
feelings
4.
The alternative is to feel what you feel and
carry on acting according to the goal that you have
Reactions
Whether an avoidance strategy is helpful depends on the
short and long term consequences.
Avoidance is a key process in maintaining anxiety and
depression. Fear is often a response that triggers avoidance, I just can’t face
the day because I know I’m going to feel miserable, i.e. I’m frightened of the
day. Sadness likewise triggers avoidance, where I’m sad, due to loss, and I
don’t want to engage with people. Anger too functions in the same way, it might
have been a prohibited emotion as a child so when felt it needs to be avoided.
Avoidance patterns
Procrastination as avoidance: when a task is difficult you
avoid doing it, until it becomes so pressing you have to. Some of the symptoms of depression can
function as avoidance, e.g. tiredness, negative thinking (you may use negative
thinking instead of responding assertively to others), complaining, moaning,
Rumination avoidance emotional\imaginal pain.
Numbing, spacing out can help avoid feelings of sadness.
Recognizing TRAPs
Man in a desert, drinks vodka, refreshed for a moment, then
dehydrated, then disorientated. Avoidance works the same way, short term
relief, long term pain.
Are you tired and need sleep as you have worn your
body\brain out, or are you tired and want to sleep to avoid painful feelings.
There is a difference between sleepy and fatigues, where the former is used
energy up need to replenish, the latter is ground down, down want to be awake
anymore, but it’s not tired. To tell the difference if you wake feeling
refreshed, it was worthwhile, if you wake feeling tired then it may well have
been fatigue.
How to get back on TRAC
Trigger
Response
Alternative coping response
If you expect to do something first time and it be
pleasurable\doable, if it’s not then you’re likely not to try it again, you’re
likely to avoid it.
Self-soothing as alternative coping
Self-soothing can be useful, as can avoidance, if you get
your resources back and approach what you need to. Self-soothing and avoidance
aren’t useful, where you reduce the unpleasant feeling, and don’t approach the
problem. There is also a big difference
between soothing and anesthetising. So does self-soothing make you able to
tolerate pain such that you can do what you need to, or does it remove the pain
and mean you don’t do what you need to?
Chapter 4 Taking ACTION: First Steps toward Change
·
Avoid criticising, shaming or blaming yourself
into change, you will feel coerced and resentful.
·
Just do it doesn’t work or you would have done
it
The best way to change is to firstly understand what you do
and how it makes you feel. In here you might see some things that you can
increase\decrease doing to improve mood. Likewise you can take things you are
doing and look for similar but more functional alternatives. This way change is
gentle and organic and related to what you are doing already.
Action=
Assess your mood and behaviour
Choose alternative behaviours
Try out alternatives
Integrate these changes into your life
Observe the results
Now evaluate
Common problems:
·
Inactivity
·
Lack of assertiveness
·
Worrying\self-criticism
·
Repeated conflicts
·
Too much work not enough play
Feeling hopeless may well be a symptom of depression rather
than a good predictor of the future.
Choosing Alternative behaviours
·
The goal is to take a choice rather act
automatically, so even if you only make something a little better that’s a good
move!
·
Make choices that are achievable, don’t set
yourself up to fail
Difficult with choosing?
·
Choices are not well defined, e.g. be optimistic
·
Fear of failing: if you have huge anxiety in
front of a new behaviour maybe you need to try a smaller target.
·
Try alternatives at least three times before
making a decision as to how useful or otherwise they are
·
Making a public or written commitment to change
often helps make that change
·
Trying new behaviour can make you feel awkward
·
Integrate change into your life, create a
routine that supports the new behaviour, a certain time that things happen,
certain things that happen before and after.
·
People have shown that disruptions to routine
can put you at risk of mood disorders
·
You only know how to do a new behaviour after
practising it a while, imagine the first time you rode a bicycle.
Difficulty integrating change
·
Too many changes, start slowly and integrate
things, then add another, so each one is bedded in
·
Trouble following through, i.e. great idea, but
not implemented. Then what are the obstacles, how can they be addressed.
Observe the results
·
Before doing the new behaviour, note your mood
before doing it, how you feel during the experiment and your mood directly
after it is over, and how you feel during the rest of the day
Choices
·
We have a lot more choices than we are aware of,
look to see what yours are, minute, by minute, hour by hour
Chapter 5 Stop worrying about your inner child and develop your outer adult
The idea here is that understanding why you are depressed,
through what has happened to you, what your character is, can sometimes be
unhelpful to overcoming depression. Looking for causes doesn’t lead to
solutions. This approach can lead to
worrying and rumination. A clearer approach is to find out what is keeping you
depressed.
Reasons why we think
·
To fix a problem
·
To hold onto negative thoughts about past events
as otherwise it would let people off the hook
·
As a way to avoid doing things
·
As a way to avoid what’s happening in the
present
So what you need to work out is what is the function, what
is the purpose of my current thinking.
Ways to describe ruminating
1.
Over thinking
2.
Brooding
3.
Worrying
4.
Obsessing
5.
Stewing about a problem
How to deal with ruminating
Step 1: Establish what your rumination topics are
Step 2: Notice the impact of ruminating on your mood and how
you think
Step 3: CBA on rumination
Step 4: Establish if rumination helps you solve problems
(your focus changes to yourself not the problem)
Step 5: Do an ABC on ruminating
Step 6: See if there are things you are avoiding doing by
ruminating
When you ruminate, you cut yourself off from the world. This
prevents you getting pleasure from the world, getting opportunities and
information. All of these factors can lead to depression. Rumination can also
highlight things, make them seem as if they are present, so bad things you have
done or have happened to you, will seem like they are continuing in the
present.
Distinction between problem solving and ruminating. The
former you only think about the problem, long enough to solve it, or to
evaluate choice, or to work out how to implement. The latter is abstract and
evaluative.
Distinction between experiencing and ruminating. The former
experiences the emotion, the latter thinks about it and its consequences. If you actively feel the emotion it tends to
pass reasonably quickly, if you brood about it then it can last a long time.
Treatment for rumination
1.
Recognise when it happens (You’re ruminating
when: you think without solving problems, you think over and over negative
thoughts etc., the process of thinking makes you feel more depressed)
a.
2 minute rule
i.
Continue thinking for 2 minutes
ii.
Ask yourself:
1.
Have I made progress to solving a problem
2.
Do I understand more about the problem
3.
Do I feel less self-critical, less depressed
than I did before
2.
RCA=Rumination cue to Action
a.
Notice your ruminating
b.
Generate a list of alternative activities
3.
Attending to experience: when you fully immerse
yourself in a task you spend less time thinking about yourself
a.
Listen to sounds
b.
Smell the smells
c.
Feel the feeling
d.
Look at the sights
Part 3 Activation as an approach to your daily life
Chapter 6 Make changes one step at a time
Depression you become shut down, have low energy, no
motivation and don’t take pleasure in the things that you used to do. A person
with a broken jaw used to enjoy steak, whilst it’s healing how can they enjoy
steak. The thoughts around having no motivation are what’s the point, its
hopeless etc. Depression has been
evolutionarily adaptive as it has helped us shutdown whilst we heal, or it can
be adaptive as it means that the current course of action isn’t adaptive, so
for instance challenging a boss where you won’t win and if he leaves you it
would create greater harm than good.
Some theorists say depression is a result of interpersonal relationships
(Klerman 1984), so loss of personal relationships leads to depression. When
depressed it’s difficult to improve relationships or to create them. So take the outside in approach, write a plan
for how to get the relationships that you want.
With any goal it has component parts.
Making and maintaining friends
Write down a list of casual acquaintances and mark those who
you’d like to develop into friends
Choose a couple of people to call or write to
Have a cup of coffee with one person
Invite family or friends over for a meal
When you choose what you want to do, break it down into
small steps
Having a difficult conversation
Avoiding conflict will keep it going, getting angry and
attacking someone is unlikely to help either. For a difficult conversation best
to make a plan so you don’t act from emotions which may be quite high. Only set goals that are in your control, so
if your partner hurt your feelings by being late, the most you can do is tell
them how you felt
Types of human interaction
1.
Be physically around people
2.
Emails etc.
3.
Brief interactions in public, stores etc.
4.
Symbolic greeting, nodding head
5.
Offering a token, I’m going for coffee would you
like one
6.
Ask for a favour
7.
Share what you have in common
8.
Make small talk: social axel grease, eases you
in to something more significant
If you haven’t got much to say, as you haven’t done much
because you’ve been depressed, ask about what the other has been up to, take interest
in them.
If little tasks feel overwhelming and you can’t do them,
then this can leave you with a feeling of failure. Break the tasks down into
baby steps and do one. If that’s too much, break them down even more. So get a
list of tasks to do, and when you do one, just concentrate on the one in hand.
If you find tasks difficult, rate them on your own current
suds scale, not what you should be like when you’re not depressed, or how other
people think you are, how it is for you. This then can get you to do your
component tasks easiest one first.
Chapter 7 Free yourself from mood dependence
If you wait until you don’t feel depressed, so you have
motivation and energy to do things, then you could wait quite a long time. So
you can either do small things, or do things you normally do, but do them in a
different way, then you can get the enjoyment from the small thing or the
normal thing and this will start to change your mood.
In the west we think mood determines, even controls
behaviour, but there are other things, our goals, our thoughts and rules can
override emotions. Think of a behaviour you can’t do, how much would you have
to be offered to do that. So you can override your emotions if it is important
enough to you. Mood and emotion influence behaviour but don’t control it. Also
sometimes emotions can be wrong, you feel anxious but actually there’s nothing
to be scared of.
When you are depressed or anxious it can be more helpful to
operate according to a plan. You might
feel like you can’t do anything but test it out see what you can do, and
remember the 1000000 incentive, that you could do it if the reward was big
enough. Physical problems can stop you doing things, but depression does make
your pain feel worse, so again test out and see what you are capable of. If you
are ill and you say you couldn’t cope with x how much is it your cold telling
you, how much is it depression.
It might feel awkward to act according to your goals rather
than your mood. Like you are being fake. However you are being true to your
goals, your desires it’s just it might feel a bit awkward with your mood. But
then that will change. Does your mood
define you, or do your goals, or a bit of both? Just imagine what it would feel
like if you had a broken arm, then the cast came off, how would it feel say
eating or driving, how would it feel if you continued doing it.
Sometimes setting goals can be difficult as you think what’s
the point I will never achieve them, but this is just mood dependent thinking. A good goal is one that you have influence
over and one that you value.
As you make long term goals, mark them down as realistic and
desirable. This will help you prioritise your goals. Long term goals are
achieved by a collection of short term goals.
If you find it hard to achieve your goals, finding that you
are being forced to achieve them, but you don’t feel like it, remind yourself
that it is you that values them, that you will be missing out if you don’t
achieve them.
Studies show that how we act affects how we feel, the test
was to try to keep a pencil between your upper lip and your nose, people which
forces the lower part of the face to smile. People who did this reported a
better mood than people who did not.
If you want to feel different, act different. So how would
you be acting if you had motivation, how would you be acting if you weren’t depressed?
Act like that and let the mood follow your behaviour.
Chapter 8 Build the life you want
Chances of depression returning increase after every episode
of MDD. Each change you make, makes a new history for the future. The past can seem to be causing the present
as the feelings associated with past events are almost as strong at the
original feelings. We react differently to our past experiences, some we have
been influenced by and vow never to repeat, e.g. some of the ways our parents
acted. Words, thoughts, smells, sounds,
physical feelings can all be evocative of emotions, through their association
with past events.
When you recognise yourself doing things that imitate people
in your life, that you don’t like, try altering them, doing the opposite. Again for behaviours that you respect from
people in your life, try imitating them, find out exactly what they did, and do
it for yourself. It’s much easier to do
something positive, rather than stop something negative. Replace things don’t
stop them, nature abhors a vacuum.
Problem solving is a great antidote to depression.
What is the problem, is a useful question as it promotes you
finding a solution, why I have this problem less so as the cause of the problem
isn’t necessarily useful to finding a solution, well, especially with mental
health difficulties. Making problems
more concrete helps us solve them.
Problem solving:
1.
Define the problem concretely what is the
problem
2.
Brain storm solutions
3.
Give pros and cons for each solution, short and
long term consequences, resources required etc.
4.
Choose best solution, or create an amalgamation
of the solutions to get the best solution
5.
Implement solution
6.
Test outcomes
Some problems have no solutions, we will die and our friends
with. With problems such as these then acceptance is needed. Again some problems you haven’t got control
over so you may need to accept. Life has
suffering, happiness and joy. Only accepting the joy in life is not accepting
life.
The kindness of others, a support network, helps you with
the adversities of life. Self-soothing
is useful in the absence of companionship, the hot bath, the lovingly cooked
meal. Self-soothing is different to
self-anaesthesia. Self-soothing is
engaging in life and treating yourself well, as a valued person.
Chapter 9 Tying it all together
Forms
Activity Monitoring
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Activity and Mood Monitoring
In each box write down the activities that you engaged in
during the hour and how you felt. Rate your feeling on a scale of 1 to 10 with
1 being the least intensity of feeling and 10 being the most.
Time
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Finding the behaviours that make you feel bad, and an alternative
Look back over the activity and mood monitoring charts that
you completed over the last week. Choose one or two situations and
corresponding behaviours that seemed to make your mood worse. If you mood was
steadily depressed with little variation, pick a situation and behaviour that
clearly did nothing to improve your mood and could be changed. Try to find
behaviours that occur somewhat regularly during your week. You’re looking for
regular patterns that can be changed. In the spaces below, fill in the days of
the week and time of day, the situations in which the behaviours occur, and
your current behaviours in the situations. For now, leave blank the space for
alternative behaviours. As with the activity and mood monitoring chart, try to
be as detailed as possible.
Day(s) of week and time of
day:_______________________________________________________
Situation:__________________________________________________________________________
Current
behaviour:__________________________________________________________________
Alternative
behaviour_______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Day(s) of week and time of
day:_______________________________________________________
Situation:__________________________________________________________________________
Current behaviour:__________________________________________________________________
Alternative behaviour_______________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
TRAP Worksheet
Instruction: Fill in the blanks for four different TRAPS
that you find yourself in
TRAP 1
Circumstance:______________________________________________________________________
Trigger:____________________________________________________________________________
Response:__________________________________________________________________________
Avoidance
Pattern:__________________________________________________________________
Consequences:______________________________________________________________________
TRAP 2
Circumstance:______________________________________________________________________
Trigger:____________________________________________________________________________
Response:__________________________________________________________________________
Avoidance
Pattern:__________________________________________________________________
Consequences:______________________________________________________________________
TRAP 3
Circumstance:______________________________________________________________________
Trigger:____________________________________________________________________________
Response:__________________________________________________________________________
Avoidance
Pattern:__________________________________________________________________
Consequences:______________________________________________________________________
TRAP 4
Circumstance:______________________________________________________________________
Trigger:____________________________________________________________________________
Response:__________________________________________________________________________
Avoidance
Pattern:__________________________________________________________________
Consequences:______________________________________________________________________
TRAC Worksheet
Instruction: Fill in the blanks for TRACS that you could use
TRAC 1
Circumstance:______________________________________________________________________
Trigger:____________________________________________________________________________
Response:__________________________________________________________________________
Possible alternative Coping
behaviours:__________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Choose One alternative to
Try:_________________________________________________________
__________________________________________________________________________________
Commit to a time to try
it:_____________________________________________________________
Consequences:______________________________________________________________________
TRAC 2
Circumstance:______________________________________________________________________
Trigger:____________________________________________________________________________
Response:__________________________________________________________________________
Possible alternative Coping
behaviours:__________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Choose One alternative to
Try:_________________________________________________________
__________________________________________________________________________________
Commit to a time to try
it:_____________________________________________________________
Consequences:______________________________________________________________________
Behaviours to change
Select at least two
behaviours that you feel reasonably confident you could change. Write down the
situation and behaviours in the spaces provided below. Then, for each
behaviour, think of as many possible alternative behaviours as you can and
write them down as options. Don’t worry about results right now. At this point,
you’re simply thinking of alternatives. Once you have a number of alternatives
for each behaviour, write down how difficult each one would be. Use a scale of
1 (not at all difficult) to 5 (extremely difficult). Then estimate how helpful
the alternative is likely to be in shifting your mood in a positive direction.
Again use a scale of 1 (not at all helpful) to 5 (extremely helpful).
1.
Situation:__________________________________________________________________
Behaviour to change:
__________________________________________________________
Option A:
__________________________________________________________________
Difficulty (1-5):
_______________________________________________________________
Helpfulness (1-5):
____________________________________________________________
Option B:
__________________________________________________________________
Difficulty (1-5):
_______________________________________________________________
Helpfulness (1-5):
____________________________________________________________
Option C:
__________________________________________________________________
Difficulty (1-5):
_______________________________________________________________
Helpfulness (1-5):
____________________________________________________________
2.
Situation:__________________________________________________________________
Behaviour to change:
__________________________________________________________
Option A: __________________________________________________________________
Difficulty (1-5):
_______________________________________________________________
Helpfulness (1-5):
____________________________________________________________
Option B: __________________________________________________________________
Difficulty (1-5):
_______________________________________________________________
Helpfulness (1-5):
____________________________________________________________
Option C:
__________________________________________________________________
Difficulty (1-5):
_______________________________________________________________
Helpfulness (1-5):
____________________________________________________________
Monitoring Rumination
Over the next week, see if you can recognise and label
rumination when it occurs .Use the rule above to help you recognise brooding,
obsessing, or other ruminating behaviour. When you do recognise it, say to yourself:
“This is ruminating”. You will be surprised at how powerful it can be to simply
increase your awareness of what you’re doing. You will probably find that
labelling rumination will help you control it.
Use the space below to monitor ruminating when it happens.
In the first column, record the situation in which you observed yourself ruminating.
In the second column record exactly what you were ruminating about. In the
third column identify the consequences of ruminating. An example of how to monitor episodes of
ruminating is provided in the first row.
|
Situation
|
Rumination
|
Consequences
|
1
|
Driving to work on Monday
|
I’m stuck in a bad relationship. I’ll
never be happy or fulfilled in my file.
|
Felt more depressed. Almost didn’t
stop at a red light
|
2.
|
|
|
|
3.
|
|
|
|
4.
|
|
|
|
5.
|
|
|
|
Short term goal planning worksheet
1.
Short-term goal:______________________________________________________________
___________________________________________________________________________
2.
Steps toward the goal:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
3.
Order of the steps:
a.
_____________________________________________________________________
b.
_____________________________________________________________________
c.
_____________________________________________________________________
d.
_____________________________________________________________________
e.
_____________________________________________________________________
f.
_____________________________________________________________________
g.
_____________________________________________________________________
h.
_____________________________________________________________________
i.
_____________________________________________________________________
4. Initial
commitment to step 1:____________________________________________________
___________________________________________________________________________
___________________________________________________________________________