Level I
Behavior
Lynn Rehm (1981) has developed a self-control treatment
program for depression based on Kanfer's model of self-monitoring,
self-evaluation, and self-reinforcement. The first five steps summarize Rehm's
methods:
Although depression frequently seems (to the depressed
person) to come from nowhere, i.e. isn't related to daily events, that isn't
true in most cases. The Lewinsohn research has clearly shown that positive
events or activities lead to positive moods; negative events to depression
(Grosscup & Lewinsohn, 1980). The depressed person must become aware that this
is true in his/her life too. So rate your mood on a 1 to 10 scale and keep a log
or a diary every day of positive events and activities. It is likely that your
mood will reflect what is happening in your life.
As we have seen, depressed people tend to focus on negative
events and overlook positive ones. They don't know they are doing this. So, it
is important that they "give careful recording a try and see what happens." Look
for and record all pleasant events and activities, even small, trivial,
seemingly unimportant pleasant events. It is vital that you learn, again, to see
the beauty, feel the warmth, and smell the roses. Don't forget ordinary things:
a cup of coffee, a walk, seeing a bird, reading a book, helping someone,
watching kids go to school, watching the news, reading an advice column, going
shopping, listening to music, making yourself attractive, visiting a neighbor,
completing a chore, calling a friend, daydreaming, playing with children,
expressing an opinion, getting a long kiss, getting or giving a compliment,
etc., etc. Record in your diary (3 or 4 times each day, otherwise you'll forget
them) a brief description of these pleasant events.
After about a week, plot your daily mood rating and number of
pleasant events for that same day on the same graph. See if your mood doesn't go
up and down according to how many pleasant events occurred that day. If so, this
is a powerful argument to increase the number of pleasant events in your life
and to appreciate the nice things that happen.
This is a simplified version of a "behavioral analysis" in
which one would look for the antecedents and consequences of good and bad moods.
The objective is to find cause and effect relationships that can be used to
increase happiness and reduce sadness. I would recommend a behavioral analysis
because it explores the causes of the depression as well as the sources of
satisfaction.
Like procrastinators, when we become depressed we tend to
focus on the past or to see primarily the immediate consequences, not the
long-term results of what we are doing now. We hurt, so we focus on immediate
relief, disregarding activities that might be stressful but very important to
our future, like getting training for a new career. To increase your awareness
of the effects of your activities, do one "outcome analysis " each day of some
activity, i.e. estimate the short and long-term, both positive and negative,
outcomes. Examples:
|
Activity
|
Effect or Outcome
|
|
|
Immediate
|
Delayed
|
|
Watch soaps on TV
|
+Distracting. Fun.
+I can tell others about show.
|
|
|
|
-May upset me.
|
-Shows won't be remembered
-I wasted valuable time.
|
|
|
|
|
|
Take a hard class
|
+Interesting.
+Meet people.
+Get ideas for current job.
|
+Career advancement.
+Adds hours toward a degree.
|
|
|
-Stressful.
-Takes time & money.
|
-May be unemployed so class wouldn't help.
|
The objectives are:
to encourage realistic, long-range planning
to see the lasting consequences--or the wastefulness--of
certain daily activities
to make some important but uncomfortable activities more
tolerable today because they pay off tomorrow.
This is important for all of us to do, but it is even more
important and difficult for a pessimistic person with low self-esteem to do.
Earlier we learned that global thinking (or end goal
wishing), e.g. "I need to get better grades," overlooks the necessary details of
how to get there. Also, unrealistic, perfectionist expectations, e.g. "I'll get
all A's," may lead to disappointment and self-criticism. Thus, it is important
to learn to have a plan, to set realistic goals and sub-goals, and to have some
success experiences. It is important to be satisfied with small gains. So,
decide on some practical, possible, important self-help project--dieting,
increased socializing, more detailed and prompt record keeping at work, learning
to play tennis, spending more time alone with spouse, or whatever. Then, for
each project goal, set several clear, explicit, attainable sub-goals (small
steps), perhaps things you could do every day or every few hours. Schedule the
time, give it priority, and be sure you are successful. Record your progress in
a diary, along with the positive outcomes.
When discouraged, we feel at fault when things go wrong and
"just lucky" when things go well. Rehm has an exercise to help you realize your
contribution to success and reduce your responsibility for failure:
Think of an important recent event and describe it.
In what ways were other people, chance, luck (good or bad),
or fate responsible for this event?
In what ways were you (your efforts, skills, abilities,
experience, appearance, etc. or lack thereof) responsible for this event?
What percentage of the responsibility for this event was
attributable to you?
Do this for several events, including both positive and
negative ones. You have almost always worked for positive events and against
depressing events. So, if you do not think you are truly responsible for more
than 50% of the pleasant events, reconsider your explanation of those events and
see if you aren't causing more positive things than you thought. Factually based
confidence in your self-control is a powerful antidote to pessimism and
helplessness (remember depressed people underestimate their problem-solving
ability).
Usually others or circumstances or just bad luck cause
unpleasant events (the exception to this general rule is when our
passive-dependency is the cause). So, if you see yourself as responsible for
negative events--over 50% of the time--go back and see if others and chance
aren't more responsible. If your passivity is the problem. Ideally, you will
come to believe (accurately) that your general, stable abilities and traits,
e.g. intelligence, personality, organizational, and communication skills, etc.,
cause good things to happen and uncontrollable, temporary external factors that
you are not responsible for produce the downers. (You are correct if you are
thinking this fits better in level IV.
Self-depreciating people feel that giving themselves overt
self-rewards--going out for dinner--is being selfish, and they think giving
themselves covert self-rewards--"I really handled that well"--is shameful
bragging. These attitudes become barriers to using some of the most powerful
self-control tools, such as self-reinforcement and self-praise. Rehm recommended
making a list of assets--true positive traits. Read it frequently and add
accomplishments to it. Make another list of possible rewards, and use them in
self-help projects. Depressed people need more good things in their lives.
Get active. Actually, research has shown that we do fewer fun
things when we feel low, but simply doing more pleasant activities is no
guaranteed cure-all (Biglan & Dow, 1981). Yet, actions do change feelings.
Increase your activity level, get out of bed (or your chair or house), find
interesting, fun things to do but, more importantly, undertake profitable,
beneficial activities that solve problems, improve your situation or future, and
replace sad thoughts. Start with easier tasks, work up to harder ones. Reward
your progress.
Several therapists recommend that every major activity on
your daily schedule be rated for "mastery" (how well you did it) and for
"pleasure." From these rating we can learn a lot, e.g. that we are getting more
pleasure than we thought out of life, that we can do many things pretty well,
that many activities are satisfying even though we aren't very good at them, and
so on. You may have to push yourself to be active. A book by McGrath (1994),
stressing converting depression's dissatisfactions into motivation to
self-improve, could also prod you into constructive action. Examples: feeling
like a victim may lead to correcting the situation, anguish about aging may
encourage exercising, a poor evaluation may inspire us to learn more, etc. Deep
depression makes it very hard to get active (in those cases medication may be
needed).
Exercise promises long-lasting results. In just the last
couple of years, there have been a couple of interesting studies showing that an
aerobic exercise program--stationary cycling or treadmill--for 30 minutes 3
times a week reduced major depression as much or more than medication (Zoloft).
After 16 weeks, the remission rate was 60% for both groups, but at follow up
after another 6 months the exercise group had a higher recovery rate (than the
drug group) and they were less likely to relapse (8% vs. 38% in the Zoloft
group). The subjects in this study were middle-aged or older (Babyak, et al,
2000). Be sure to check with your doctor first, but exercise would be good for
you in many ways, not just with depression. Seriously consider this. Even more
recently, other studies report that daily exercise reduces depression by 1/3 or
1/2 within 10 days, that is faster than most people respond to anti-depressive
medications.
Avoid unpleasant, depressing situations. Take a vacation, get
complete rest and lots of sleep (just for a week or two--not for months). Our
interpersonal situation powerfully influences our happiness and depression.
Barnett and Gotlib (1988) found that introversion, loneliness, dependency, and
marital problems often precede the onset of depression. Avoid losses and these
conditions if you can (of course, it can be a joy to lose a lousy marriage).
Try to change your depressing environments --working
conditions, family interactions, stressful relationships and so on. Our mood
reflects our surroundings.
Reduce the negative thoughts that characterize depressed
people: self-criticism ("I'm really messing up"), pessimistic expectations ("It
won't get any better"), low self-esteem ("I'm a failure"), and hopelessness
("There's nothing I can do"). How do you stop or limit these depressing
thoughts, memories, or fantasies? Try using thought-stopping, paradoxical
intention (massed practice) or punishment. Or restrict unwanted sad thoughts to
specific times or places, e.g. a "depression" chair; then reduce the time spent
in the chair (see McLean, 1976). Or reward stopping negative thoughts; replace
them with pleasant fantasies (Tharp, Watson & Kaya, 1974).
Make an effort to have a lot more positive thoughts:
satisfaction with life ("Living is a wonderful experience"), self praise ("I am
thoughtful--my friends like that"), optimism ("Things will get better"),
self-confidence ("I can handle this situation"), and respect from others ("They
think I should be the boss"). Even if you don't feel like saying these things
every hour, say them anyway. They will become part of your thinking.
Ask others to model for you how they control depressing
thoughts and guilt producing ideas. What self-instructions do they use to "get
out of a bad mood?" Practice talking to yourself out loud, then silently.
Become aware of any payoffs for depression or self-putdowns.
Reduce these reinforcements: don't complain or display sadness, ask others to
ignore your sadness (but interact with you more during good times). Remember
excessive talking about your depression may sometimes make you more depressed
(don't use this as an excuse for not seeking help).
Act happier. Practice smiling more, speaking in a less whiny
voice, standing up straight with chest out, dressing up more and expressing
compliments, feeling self-satisfaction, and acting as though the future will be
better. Acting happier can change our mood.
Become a better self-helper. Become a better self-helper as
you work on a variety of personal problems (Rehm, 1981). Learning to master a
life--your life--is not easy. Read self-help books. Prove to yourself that you
can change your environment, your behavior, your mood, and so on. Recognize your
increased ability...but know your limitations. Both knowledge of useful
psychology and self-confidence are important. Feeling in control of life is an
important part of enjoying life.
Atonement. Figure out a way to make up to others or to
society for the things you have done wrong (see discussion of guilt above).
Develop marital contracts. Develop marital contracts that
provide each partner with a reward for changing in ways requested by the mate.
Seek support. Self-Help or Support Groups, Marriage
Enrichment Programs, Parents Without Partners, Integrity Groups, Singles Groups,
Emotions Anonymous, The Compassionate Friends (for bereaved parents), Neurotics
Anonymous, Recovery, Inc., Theos Foundation (for widows), Widowed Persons,
encounter groups, group therapy, church groups, or local groups of people in
similar circumstances. Use the phone book and/or Mental Health Center to find
the appropriate group for you.
