Moodzone: Low mood and depression
NHS CHOICES MOODZONE
Low mood and depression www.nhs.uk/moodzone
I'm Dr Chris Williams, and I'm here to help you to help yourself
through a range of common life difficulties.
In this session, we're focusing on low mood and depression.
The aim is to help you look at the impact of low mood and depression
on different aspects of your own life.
We'll help you to understand how it creates a vicious circle
that can keep you feeling bad.
And we'll point out some practical things you can do
that can help make a difference.
You might want to get a pen and paper out as we go through things,
so that you can make notes and see how this approach fits your own life.
Low mood and depression are really common.
Between one-in-four and one-in-five people
experience significantly low mood at some time in their life,
so you're not alone.
Sometimes the symptoms are short-term and we can work them out over time.
But sometimes we can get stuck or feel down and stop enjoying things
for a number of weeks or months or even longer.
And when we get stuck in a period of low mood of depression,
it can do affect different aspects of our lives.
It can be hard to know what to do to improve things.
So, perhaps we can't sleep, or we feel low, or our confidence is gone.
We feel stressed out, or off our food and feel like pushing people away.
These are just some of the ways low mood can affect us.
What we need is a way of breaking things down
and working out how to change things.
And the great news is,
there are so many treatment options available for these problems,
such as cognitive behavioural therapy, CBT,
which is a popular and evidence-based form of talking therapy.
This module adopts this same CBT approach
and I'll use it to help you to understand how your thoughts
and feelings and behaviour all can act together to keep you feeling bad.
People often think about depression as just being low in mood,
but it's far more than that. It can affect every aspect of our lives.
Here's a typical example of someone experiencing and tackling low mood.
Dave had a job he really enjoyed, but when the recession hit,
there were redundancies and he lost his job.
He's now been feeling low for three months,
and has recently told his GP how he feels.
His doctor was really helpful and drew out a diagram to help Dave understand
how all his different symptoms fitted together and were affecting him.
To do this, his doctor asked him about how he was feeling
in five key areas of his life.
These help him think about the people and events around him
and the impact of all this on his thoughts, feelings,
physical symptoms and behaviour.
The aim of this so-called five areas assessment is to help Dave
to understand his situation better
and to spur him on to make some small changes
that can have a big impact on how he feels.
The first of the five areas is the people and events around us.
Let's use Dave's situation to think through how this applies to him.
Dave has lots of things going on around him that are causes of pressure.
He's lost his job,
he feels he hasn't got enough money to get through the month,
and also since losing his job, he's stopped seeing his friends as much
and feels he doesn't know anybody.
Plus, there are other things, too.
His friend's very unwell, and he's also having rows with his neighbours.
Hopefully, that gives you an idea of the sorts of things
that can go wrong around us.
And what Dave didn't know before his chat with his GP
is that the things going on around him can cause a vicious circle
that makes him feel worse inside.
Let's move on to look at the second of the five areas, Dave's thinking.
For the past three months, on and off, he's been saying to himself,
"Could I have done more, or worked harder?"
"What if I don't find a new job?"
"I'm too embarrassed to tell my friends and family
that I've been made redundant."
"A man shouldn't feel like this. I should be strong and confident."
And other unhelpful thoughts are common in depression.
These include self-critical things, like, "I'm hopeless."
"I've nothing to offer."
Or second-guessing what others around us think.
"People think I'm useless."
And blaming ourselves for things that aren't really our fault.
These are all unhelpful thoughts.
They often aren't true, but also dwelling on them makes us feel worse.
And that leads on to the third area, called "altered feelings".
Have you ever noticed that what we think can affect how we feel emotionally?
Because Dave's mind is so full of so many negative
and self-critical thoughts, he feels worse emotionally.
He feels down, guilty, fed up, angry and stressed.
He also notices one of the key symptoms seen in low mood,
life stops feeling enjoyable.
And how we feel can affect us physically.
And that is area four, altered physical feelings or sensations.
People are often surprised quite how physically exhausting low mood can be.
His low mood leaves Dave feeling physically exhausted.
He also isn't feeling hungry any more and has lost some weight.
He's tired and feels run down.
He also aches all over and has headaches.
Other physical sensations can include feeling sick, palpitations, pain,
losing your sex drive and noticing a churning stomach.
And all these things, the altered thoughts and feelings
and physical symptoms all add up to affect what Dave does,
his behaviour and activity levels.
And that's the fifth and final area of the five areas assessment.
And this creates a vicious circle where the worse Dave feels, the less he does.
The less he does, the worse he feels.
He starts to stop looking for jobs and stays inside much of the day.
Because he feels guilty that he hasn't got a job,
he's also stopped visiting his family.
And when his sister calls him,
he shouts at her when she asks how things are going looking for work.
He's also stopped cooking meals, something that he had a keen interest in
and enjoyed doing before.
Finally, Dave's avoiding phone calls from his friends
and is cutting himself off from another important possible source of support.
Other common unhelpful behaviours include drinking too much, oversleeping,
comfort eating and putting important things off,
like paying bills or doing the housework.
And all of these can worsen how we feel.
The good news is that this vicious circle spins both ways.
And that by making a positive change in one area,
things may change in the others, too.
So, for example, Dave and his GP both agree
that his altered behaviour's a good place to start making changes.
As a small first step, Dave therefore decides to say yes to an invitation
to go to his friend's for Sunday lunch.
He also decides he'll start speaking to his friends and family
on the phone again. And will really listen to how they are.
He also cooks himself a meal and really enjoys it.
He does all these things bit by bit over the next few days,
so the activities are realistic, small and achievable.
They're all things that get him going again,
will give him a sense of pleasure and achievement or closeness to others.
Dave had a great day at the lunch,
and then came home and chatted to his family to tell them more about it.
Did this help you understand how you're feeling right now?
Why not work through your own five areas assessment,
and see if there are any changes you can make to help you feel better.
Writing this down is a good idea.
So firstly, what's going on in your life?
Are there any pressures or problems?
Secondly, what's been going through your mind recently?
Any thoughts, or memories, or pictures,
or predictions about what will happen in future?
Thirdly, how does this make you feel emotionally?
Low or sad, anxious, guilty, ashamed or angry?
Fourthly, have you noticed that you've been feeling different physically?
And finally, fifthly, have you stopped doing things you used to enjoy?
Are you avoiding anything?
Or have you started doing new things that are becoming unhelpful?
What impact has this altered activity had on how you're feeling?
Are you trapped in a vicious circle. And if so, here's how to get out of it.
Firstly, your thinking.
Watch out for upsetting thoughts that worsen how you feel emotionally,
or physically, or affect would you do.
These are often just a thinking habit, rather than actually being true.
So, sometimes just noticing the pattern
will help you take a step back and change things.
There's more about this in the unhelpful thinking session.
Secondly, physical symptoms.
If you notice new symptoms that concern you,
get them checked out by your doctor to find out what's happening.
If low mood or stress is worsening things,
try our anxiety control training,
and learn key skills in how to relax your body and mind.
And thirdly, in your behaviour,
getting going again is one of the best things you can do.
Planning things that give you a sense of achievement, pleasure
and closeness to others and make sure you re-establish a structure to your day
by getting up and going to bed at a reasonable time
and eat three reasonable meals a day.
And say "yes". Negative thoughts tell you to say "no" and decline invitations,
so watch out for saying no to things or avoiding things because you feel scared.
The more you avoid things, the more it saps your confidence
and that vicious circle starts spinning again.
And here are some more don'ts.
Don't drink too much, or eat too much to block how you feel,
or push people away, or hide away or isolate yourself.
Making changes can really help boost your mood and help you feel better,
which in turn will really help you tackle whatever life's throwing at you.
So, go on, go for it, and live your life to the full.
You've made a great start here by completing this session.
Check out the others in the Moodzone series,
which you may also find helpful.
They cover things such as anxiety, unhelpful thinking
and practical problem-solving.
Thank you for listening.
Thank you. For more like this visit: www.nhs.uk/moodzone