How depression affects learning

how depression affects friendships and how depression affects your brain and how depression can affect a person
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Dr.KiaraSimpson,United States,Researcher
Published Date:05-07-2017
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SELF-CARE DEPRESSION PROGRAM 2ND EDITION ANTIDEPRESSANT SKILLS WORKBOOKINTRODUCTION epression is among the most painful and difficult of all human experiences. It robs those who have it of energy, interest, and the Dwill to make things better. It brings with it a profoundly negative view of the self, the world, and the future. During depression, it seems as though nothing can change, as though you will never get better. But depressed people do get better and depression some of the lifestyle choices associated with reducing does end. There are effective treatments and self-help depression are discussed in the Useful Information skills to deal with depression. Health care professionals section at the back of the book. Although medication- give depression treatments, but you can learn self-help based approaches are discussed briefly, most of our skills and apply them to your own life. This guide emphasis is on these other approaches: antidepressant teaches a set of antidepressant skills you can use to skills rather than antidepressant pills. manage depression. Sometimes the skills can be used on their own, when the depression isn’t too severe. We hope that the workbook will be helpful for you. But Sometimes they have to be used along with treatments reading it will not be enough. For the approaches to by professionals. work, you will have to put them into practice. We have tried to present all of the strategies in a clear, step-by- The emphasis in this book is on three steps: step format that will help you to work steadily toward reactivating your life; changing negative thinking your goals. habits; and solving problems as they arise. In addition, SELF-CARE DEPRESSION PROGRAM 1 ANTIDEPRESSANT SKILLS WORKBOOKINTRODUCTION Take a moment now to ask yourself three questions. Mark your answers on the scales below. On a scale of 0 to 100: How much of a negative effect has low mood had on my life? 050 100 NO EFFECT EXTREMELY NEGATIVE EFFECT How important is it to me to feel better? 050 100 NOT IMPORTANT AT ALL EXTREMELY IMPORTANT Am I willing to make getting better a priority in my life? 050 100 NOT A PRIORITY AT ALL EXTREMELY HIGH PRIORITY If you scored less than 50 on two or three scales, you may be considering change, but still feel uncertain. If that’s the case, read the workbook and think it over. If you scored 50 or more on two or three scales, you’re ready to change. You’ve had enough and you’re prepared to dedicate some time each day to getting better. Go to the next page and let’s get started . . . SELF-CARE DEPRESSION PROGRAM 2 ANTIDEPRESSANT SKILLS WORKBOOKWHAT IS DEPRESSION? ost times when you feel down, you’re not depressed. Feeling sad or low is a big part of life and can’t be avoided. When something goes wrong in Myour life, whether it’s an argument with your partner, conflict with your boss, or a physical illness, your mood might drop. Depression is not… Most times when you feel down, you’re not depressed. If you feel especially sad or irritable because of this Feeling sad or low is a big part of life and can’t be situation, maybe with poor sleep, not wanting to see avoided. When something goes wrong in your life, friends or family, eating too much or not enough – then whether it’s an argument with your partner, conflict you’re probably experiencing low mood. Low mood will with your boss, or a physical illness, your mood typically go away in a week or two, especially if there’s might drop. an improvement in the situation that started it. Depression is… But suppose it doesn’t go away and just gets worse. 2. if you have other problems like: You might be depressed: ■ big changes in weight or appetite; ■ not being able to sleep enough or sleeping 1. if your mood is very low or you have almost no too much; interest in your life almost everyday, and this ■ feeling that you are always restless or feeling goes on for weeks; AND slowed-down; ■ thinking that you are worthless or guilty; ■ feeling really tired much of the time; ■ feeling numb or empty; ■ having a lot of trouble concentrating or making decisions; ■ thinking about death or suicide. SELF-CARE DEPRESSION PROGRAM 3 ANTIDEPRESSANT SKILLS WORKBOOKM I L L D O D E W P R M E S O S I O M O N A J D O T R h D E F e P s R e a E S e S d n I l O i e N n s s g M g i s s e o e r a y s , d d o e s b n p t a e o ir , WHAT IS DEPRESSION? The two most common types of depression are called mild depression and major depression. Each of these includes the same kinds of problems (the mild kind. Your family physician, a psychiatrist ones we’ve listed above) but major depression is more or a psychologist can tell you whether you have severe. Usually, when a person gets depressed, it’s the a depression. FEELING OKAY SELF-CARE DEPRESSION PROGRAM 4 ANTIDEPRESSANT SKILLS WORKBOOK c o i l t a g o o n u e s g s . o e V n a e s r n y d o o h n m a . F r e e d e l t t i o n h g i g n u n e t m g b o o u r h t e a o m f p p t ty . p h e e l n o e w d m . o o d .WHAT IS DEPRESSION? A few observations about depression . . . ■ Depression is hard to diagnose on your own. time, and more than 15% of adults will be depressed Our moods affect our judgment of ourselves. So it’s at some time in their lives. often hard to judge whether we are really depressed. Usually it takes a trained professional to make ■ Depression is not a sign of weakness. the diagnosis. Many capable, intelligent, and extremely accomplished people have been depressed. ■ If you have depression, you are not alone. Being depressed does not mean that you have More than 4% of adults are depressed at any given a “weak personality” or a character flaw. If you think you have depression . . . If you think that you have depression, it is important professional. This can be your family physician, a that you find help. The skills in this workbook are psychologist, psychiatrist or other mental health meant to help you with your depression, but you professional. They can help you with a number of shouldn’t have to do it alone. Getting another opinion different treatments for depression. A good thing from someone you trust can help you understand your about these treatments is that they work well problems or put them in perspective. If you continue alongside skills you learn from this workbook. to feel depressed, seek the help of a health care If you feel like hurting yourself . . . For many people, depression makes life seem hopeless appointment, there are a number of crisis lines, staffed and unmanageable. Most depressed people feel this way 24/7, that you should call. Go to your yellow pages and from time to time. For a small number of individuals look under Crisis Centres to find the numbers in your this feeling of hopelessness gets so strong that they area. You might also visit the Emergency Room at your begin to think that life itself is not worth living. If local hospital. this happens to you or someone you know, it’s time to get help. Find a health care professional to help you Remember, things can get better. get past these feelings. If you can’t wait for an SELF-CARE DEPRESSION PROGRAM 5 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? People become depressed for a wide variety of reasons. Research has identified a number of factors associated these areas of your life can play a role in the develop- with causing and continuing the depressed state. The ment of depression, and depression itself can have diagram below shows the five major factors: situation; an impact on all of them. On the following pages we thoughts; emotion; physiology; and action. Each of consider each of these factors in more detail. SITUATION • loss • isolation • conflict • stress ACTION • social withdrawal THOUGHTS • reduced activity • negative thinking level habits • poor self-care • harsh self-criticism • unfair & unrealistic EMOTION PHYSIOLOGY • discouragement • altered sleep • sadness • low energy • despair • changes in brain • numbness chemistry • anxiety SELF-CARE DEPRESSION PROGRAM 6 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Situation Depression is often triggered by very stressful life situa- ■ Stress related to your physical health. This is tions. If your attempts to cope with these situations by especially true for health problems that are chronic, improving or accepting them have not been successful, cause a lot of pain or disability, and only get partly you may begin to feel overwhelmed and hopeless. Then better with treatment. Some physical illnesses or the risk of a depressive episode increases. Some situa- their treatments can trigger depression by their tions that can be associated with depression include: effects on the body. For example, hypothyroidism (a condition in which the thyroid gland secretes ■ Major life events, particularly involving loss. Events too little thyroid hormone) is often associated such as the death of a loved one, moving, divorce, with fatigue and depression. financial setbacks, or job loss are major disruptions in one’s life. That doesn’t mean people only get depressed when things are going badly. Some people get depressed ■ Lack of contact with other people. Social isolation when their life has been going smoothly: depression is a significant risk factor for depression. just seems to come out of nowhere Antidepressant skills like the ones taught in this book are just as ■ Relationship conflict. Times of conflict in useful for these people. personal relationships, whether marital or family, are extremely stressful and can contribute to the onset of depression. ■ Stress related to your job. This can take the form of employment uncertainty (not knowing whether your job will continue), friction with supervisors and co-workers, or overwork (human beings were never designed to work 16 hours a day, either in an occupation or around home). SELF-CARE DEPRESSION PROGRAM 7 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Thoughts Each of us is affected differently by outside events, anticipates feeling miserable, and sees the other people depending on how we think about those events. as judgmental and rejecting. Each person’s thoughts Imagine two people walking into a party. One person determine how the event is experienced. Research is naturally outgoing, anticipates enjoying herself a evidence has shown that depressed individuals often great deal, and sees the group of partygoers as friendly have distorted ways of thinking about the world that and receptive. The other dreads social gatherings, can trigger or worsen the experience of depression. SELF-CARE DEPRESSION PROGRAM 8 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Distorted ways of thinking These ways of thinking often start in childhood. Some Unrealistic, negative thoughts people grew up in families where only negative and about the situation. critical comments were made. In other families, You see the situation in an unrealistically pessimistic children were discouraged from saying positive things way, emphasizing its negative or threatening aspects about themselves and rewarded for being self-critical. and ignoring more positive or promising aspects. Whether these negative thinking styles are caused by the depression or started in childhood, they have Unfair, negative thoughts about yourself. enormous influence on your experience of the world. You think about yourself in a very critical fashion, judging yourself in a harsh and unfair manner. Not surprisingly, these ways of thinking about the world increase the negative impact of difficult life Unrealistic, negative thoughts situations and predispose people to emotional pain. about the future. A person with depressive thinking can become You anticipate a future that is bleak and disappointing, discouraged or hopeless even when things are exaggerating the likelihood of very negative outcomes. going well. Taken together, we call this the Negative Triad: thinking in an unfair and unrealistic, negative way about your current situation, yourself, and your future. SELF-CARE DEPRESSION PROGRAM 9 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Emotion Depression often begins with feelings of discouragement Remember that depressed people interpret the world in and sadness after unsuccessful attempts to deal with an unrealistically pessimistic way and judge themselves a difficult life situation. However, as the depression in a harsh and unfair manner. The emotions they feel continues, these feelings of unhappiness give way to are based in large part on this negative way of inter- more severe and painful kinds of emotional experience. preting their lives. If their thoughts about the world The depressed individual is overcome by a sense of are unrealistic and negative, then their emotions will despair, a pervasive mood of hopeless misery. A feeling also be unrealistic and negative. of intense anxiety (physical tension, worry, and a sense of impending doom) often accompanies these It may be hard to think about emotions as unrealistic. depressed feelings. But imagine a person who firmly believes that airplane travel is extremely dangerous and that planes are falling Some depressed people experience a general sense of out of the sky frequently. That person will feel very emotional numbness, an inability to feel anything. It frightened when flying. This fear, however, is based is as though the psychological pain has become so on a false belief about airplane safety and is, therefore, intense that your mind simply switches off your unrealistic and inappropriate to the situation. Similarly, emotions, like a circuit breaker. depressed individuals often have beliefs about the world and themselves that are unrealistic and lead to unrealistic, negative emotions. SELF-CARE DEPRESSION PROGRAM 10 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Physiology Depression is accompanied by a variety of physical One theory of depression is that it is caused by changes symptoms. One of the most powerful physical changes in brain function, a “chemical imbalance”. There is accompanying depression is impaired sleep. Usually, research showing that, for some depressed people, this involves an inability to get enough sleep, whether certain neurochemicals in the brain are less active. because the person has difficulty falling asleep, repeat- It is unclear, however, whether these changes in brain edly wakes during the night, or awakens much too early. chemistry commonly cause depression. All we know is Sometimes the person may sleep too much, caused by that depression is often associated with changes in a desire simply to hide away in sleep or a fatigue so brain chemistry. pervasive that there never seems to be enough sleep. When sleep is “non-restorative” – that is, the person The physiological changes of depression make it harder does not awake feeling refreshed and rested – it to cope with life problems or even to follow the steps becomes harder to face the day and deal with problems. of a depression management program like this one. Depressed people often feel that they lack energy and Antidepressant medication can often be quite helpful are exhausted by everyday activities. in restoring sleep and regaining your sense of physical energy. It can allow you to actively learn and try out the new skills needed to overcome depression. SELF-CARE DEPRESSION PROGRAM 11 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Action Depression usually has a significant impact on a person’s behaviour. Here are some of the main areas affected: Not doing rewarding activities. Hobbies, crafts, sports, reading, and travel may all suffer. Depressed people often feel too tired or unmotivated to pursue these activities, and the less they participate in them, the less they feel able to do so. Most depressed people suffer from anhedonia, reduced ability to have fun or get enjoyment from things. Why would you go to the movies, engage in hobbies, or do the things you used to enjoy if you didn’t think you would enjoy them? Inactivity becomes a habit. As a result, the depressed person no longer receives the personal satisfaction provided by these activities, further contributing to the sense of discouragement. Not taking care of yourself. Activities designed to maintain one’s body and appearance are frequently neglected. Depressed individuals may take less care in personal grooming or dress than usual. In addition, exercise is often reduced, whether this involves formal fitness activities such as jogging or simply walking around the neighbourhood. Eliminating exercise contributes to depression by removing a powerful source of physical well-being and increased self- esteem. As well, the depressed person often has disrupted eating habits, whether this means inadequate intake (“forgetting to eat”) related to a lack of appetite, or overeating as a form of self comfort. SELF-CARE DEPRESSION PROGRAM 12 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAUSES DEPRESSION? Not doing small duties. A depressed person often neglects or procrastinates doing small, necessary duties, like running errands, taking out the garbage, cleaning house, or caring for the garden. Failing to complete these chores adds to the depressed person’s sense of inadequacy and lack of control over life. It also creates friction with others and places further stress on relationships. Withdrawing from family and friends. Social invitations are refused, phone calls are ignored, and habitual get-togethers with family or friends somehow just don’t happen. Social isolation is a strong contributor to depressed mood, taking you away from the warmth and sense of connection to others, basic to all of us. Depressed people often believe that others have no interest in their company, given how miserable or emotionally flat they are feeling. SELF-CARE DEPRESSION PROGRAM 13 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAN YOU DO ABOUT DEPRESSION? MILD DEPRESSION ■ Talking to family and trusted friends about how ■ Speak to a family physician, psychiatrist or psycholo- you’ve been feeling is usually a good thing to do. gist. A professional can help you figure out what’s They can help you figure out solutions to some of the been going on and can make useful suggestions. problems you’ve been dealing with; besides, just ■ In some cases, antidepressant medications can be knowing that people care about you is helpful. helpful in overcoming Mild Depression. But for most ■ Write about problems you’re facing, your feelings and individuals with Mild Depression, the answer does not thoughts, and possible solutions. This can help you lie in medication. understand what you’re going through and what choices you have. Learning and practicing the antidepressant skills in this guide is likely to be very helpful in overcoming Mild Depression. SELF-CARE DEPRESSION PROGRAM 14 ANTIDEPRESSANT SKILLS WORKBOOKWHAT CAN YOU DO ABOUT DEPRESSION? MAJOR DEPRESSION In addition to the actions described previously… (CBT). CBT is a talking therapy that teaches new skills for thinking and acting more effectively. This guide is ■ Definitely see your family physician if you think based on CBT methods. you might be this depressed. Major Depression is a ■ Yet another effective treatment is interpersonal serious problem and should be diagnosed by a family therapy (IPT), a talking therapy that teaches new physician, psychiatrist or psychologist. skills for dealing with partners, friends and family. ■ Antidepressant medications are the most commonly ■ For long-lasting or recurrent depression, the most prescribed treatments for Major Depression and are powerful approach is to combine antidepressant usually effective. medication with one of these kinds of talking ■ An equally effective treatment for most cases of therapy. Major Depression is Cognitive Behavioural Therapy Learning and practicing the antidepressant skills in this guide is likely to help in overcoming Major Depression. BUT remember that the skills taught in this guide will not be enough by themselves to fix something this serious. If you have a Major Depression, you should seek professional help. SELF-CARE DEPRESSION PROGRAM 15 ANTIDEPRESSANT SKILLS WORKBOOKMORE ABOUT MEDICATION edication is quite helpful in a number of cases. Many of those who take antidepressant medication experience a lift in mood and a reduction in other symptoms (such as loss of appetite or Mdifficulty concentrating). But medication is seldom a complete treatment for can give you the energy and mood lift you need to mood problems: it is also important to make changes make changes (such as starting a regular exercise in how you think about and handle your life. Don’t use program, learning assertiveness skills, or defining medication as a way of allowing you to keep living an and working toward your life goals). unhealthy or unfulfilling lifestyle. Instead, medication SELF-CARE DEPRESSION PROGRAM 16 ANTIDEPRESSANT SKILLS WORKBOOKMORE ABOUT MEDICATION Here are some additional points about medication: Different medications work Certain people benefit from taking for different people. medication for a long time. It can take time to find a medication (or a combination For some people, antidepressant medication continues of medications) that works well for a person without to have beneficial effects over the long term. Most too many side effects. Side effects may include sleep people take medication for a while in order to get difficulty, change in appetite and loss of sexual desire. the strength to make positive changes, then gradually stop using it. Never stop taking medication suddenly. Some people have unpleasant reactions to discontinuing It can be tempting to stop taking a antidepressant medications. If you wish to stop a medication as soon as you get the medication, consult with your prescribing physician. level of improvement you want. Usually you will stop in stages by gradually taking The result is often a rapid return of the problem. It less over time. is generally best to stay on the medication until your mood has been steady for a while. Reductions in medication may then be done gradually while your mood is monitored. SELF-CARE DEPRESSION PROGRAM 17 ANTIDEPRESSANT SKILLS WORKBOOKANTIDEPRESSANT SKILLS n this section, you will learn three skills that can stop your mood from sliding down, lessen your depression and help prevent it from happening Iagain. The skills are: ■ ■ Reactivating Your Life Thinking Realistically Solving Problems We will explain how each of these skills helps fight Depression involves all areas of your life: your depression and show you in a step-by-step way how emotions, thoughts, actions, physical functioning, and to use the skill. It’s best to think about these skills life situation (including social support, family relation- the way you would if you were learning a new job or a ships, employment, finances, and so on). Each of new sport: practice is very important. Some people find these areas is connected to all the others. As a result, it helpful to share this guide with a spouse, trusted changes in one area produce changes in the others. friend, counsellor or family member – this person can When depression first develops, negative changes in help you keep practicing even when you feel low energy one cause the others to get worse as well. But when or unmotivated. If there’s no one like that, then keep you are working on getting better, changing one area practicing the antidepressant skills. As you work through leads to improvements in the others. The goal of treat- the skills, it will gradually get easier and the result is ment is to get all areas of your life spiraling upward, worth it. each producing positive change that improves the others. SELF-CARE DEPRESSION PROGRAM 18 ANTIDEPRESSANT SKILLS WORKBOOKREACTIVATING YOUR LIFE uring depression, most people don’t do the things that normally keep Dtheir mood positive. But if you stop taking care of yourself or doing the Depression leads to inactivity, but inactivity makes things you normally like, your life becomes more dull depression worse. What seems like a good coping strategy and depressing. Although it can feel as though you actually tends to maintain or intensify depression. The are comforting yourself by being less active, in fact solution: don’t wait until you feel like doing more. you are probably helping the depression get worse. Waiting actually makes it less likely that you will get In other words: better. And don’t wait until you feel motivated – as you get better, you will regain a sense of motivation. Action starts first, motivation kicks in later. Setting goals to increase your activity level is a powerful method for managing depression. DEPRESSION INACTIVITY The aim is to gradually get yourself moving even though you might not feel like it. These are the steps to gradually reactivating your life. SELF-CARE DEPRESSION PROGRAM 19 ANTIDEPRESSANT SKILLS WORKBOOK