Maintaining Progress

Red Flags

We all have ‘red flags”: very early warning signs, often unique to us and our particular experiences, that indicate the danger of potential negative changes, or of the depression or anxiety returning. These can vary significantly from person to person, but an example might include noticing the return of negative self-talk, where our internal dialogue becomes once again self-critical, lacking in any compassion we might have worked at building.

Identifying Depressed Thinking

Tackling depressed thinking is one of the most effective things you can do to build up longer-term resistance to depression. The first step in this is learning how to identify your own patterns of depressed thinking.

The Depression Habit Spiral

The negative and pessimistic habits of thought that depression brings have an effect on your behaviour, brain chemicals and mood, reinforcing a downward depression habit spiral. By identifying and tackling these depressed thinking habits you can break into the depression habit spiral and turn it around.

Steps to Take:

Step 1: Understand what depressed thinking is

Understand what we mean by ‘depressed thinking’ and the explanations of the main types of depressed thinking, including those which relate to anxiety and anger spirals.

Step 2: Become a detective on yourself.

We all have an ‘internal running commentary’ of thoughts. Spend a day, or even a week, ‘tuning in’ to your internal running commentary. You may be surprised at how negative and critical it is. Start to notice which thoughts make you feel particularly low.

Step 3: Keep a thought diary

Keeping a thought diary is the foundation for understanding how your thoughts affect your feelings. A good way to identify your unhelpful thoughts is to write them down in the ‘ABC’ format:

• A stands for Activating Event
  Record any event or situation in which you experienced a strong negative emotion
• B stands for Beliefs
  Ask yourself what you were thinking of when the event occurred and what was going through your mind at the time; write down all these thoughts and underline the one that best describes the situation – in CBT this is called a ‘hot thought’; rate how much you believe this hot thought on a scale from 0 to 100
• C stands for Consequences
  Write down your feelings at the time, and rate the intensity of the one that best associates with your hot thought, using a scale of 0 to 100; also rate any actions you undertook as a result of the activating event

Step 4: Learn how to uncover depressed thinking

When you are identifying beliefs, it is important to uncover the unhelpful thoughts underlying the initial response to the activating event. Ask yourself why you thought or felt something, or what is bad about the thing you identified. Write everything down no matter how silly or embarrassing it seems.

For example, if you noted that you felt upset when you saw your friend talking to someone else, you can ask what made you upset (“I thought she looked happy speaking to the other person and she always looks worried when she’s speaking to me”) and what’s bad about that (“she might be getting fed up with me”), and what does that say about me (“I’m a burden and I’ll end up with no friends”). Keep going until you have identified all the different thoughts and feelings that you can think of.

Step 5: Identify the types of depressed thinking

Look at the thoughts you have uncovered and start to see if you can identify some of the different types of depressed thinking that you know about, including: mental filtering or ‘tunnel vision’, all-or-nothing thinking, emotional reasoning, personalisation and self-bullying, jumping to conclusions, control freakery, catastrophising, and so on.

Challenging Depressed Thinking

Following on from identifying your depressed thinking habits, you are in a position to start the work of challenging them. Challenging depressed thinking is vital for building resistance to depression.

Testing the Validity of Your Beliefs

Challenging depressed thinking is about becoming a detective to find the evidence to test the validity of your beliefs, and then using reasoning skills to modify them and develop more helpful attitudes in their place.

‘Defusing’ From Your Thoughts

It can also be helpful to realise that it isn’t possible to prevent unhelpful thoughts from occurring. Once you have done what you can to challenge your thoughts and have reduced your level of belief in them, you can learn to just notice unhelpful thoughts when they arise and ‘let them go’ without attaching any energy to them.

Questions to Ask Yourself

Use the following list of questions to help you test the validity of your thoughts and bring a wider perspective to bear. It is useful to consider whether other people would agree with your beliefs or whether there is hard evidence to support them:

• What’s the evidence for this perspective?
• What evidence is there for a different point of view?
• How did I get into the habit of thinking this way? (Take into account personal history and also evaluate wider social and cultural influences)
• What other explanations could there be?
• How realistic are my expectations and beliefs?
• Is it helpful for me to see things this way?
• What would be a more positive way to see this?
• What would I say to a friend if they were thinking this?

Using all of these questions, you can re-evaluate your thought and replace it with a more balanced, helpful belief. You can return to your ABC record and re-rate the intensity of the emotion that you first identified. If you challenged the thought successfully you should feel the negative emotion less intensely.

Find Out More

The strategies described here come from something called ‘cognitive-behavioural therapy’ (CBT). Find out more about this effective form of therapy by:

• Reading the excellent book ‘Overcoming Depression: a self-help guide using cognitive behavioural techniques’ by Paul Gilbert
• Practising this strategy using the best-selling workbook ‘Mind Over Mood’, or see if your institution makes available online support and self-help packages
• Finding a counsellor or psychologist who is trained to help you learn these techniques. You might want to look at the following websites for professional organisations to help you locate the right person for you. Or, seek support through your institution’s well-being or student support team, who often provide counselling free of charge:

British Association for Counselling and Psychotherapy (www.bacp.co.uk)

United Kingdom Council for Psychotherapy (https://www.psychotherapy.org.uk/)

British Association for Cognitive and Behavioural Psychotherapies (http://www.babcp.com)

British Psychological Society (http://www.bps.org.uk/bpslegacy/dcp)

Modifying Stress Levels

How we habitually deal with stress plays an important role in our vulnerability to depression. Learning how to modify our stress levels is a vital part of protecting ourselves from depression.

Managing Stress Better

Stress itself cannot be avoided, and our basic stress response has evolved as part of the way in which we protect ourselves. Managing stress better means understanding how to use the stress response effectively to deal with problems constructively.

Planning and Practical Action

The most important first step for managing stress levels is to focus on what you can practically do to keep stress under control. Basic planning and time management can make an enormous difference to stress levels. There is lots of detailed advice provided by universities and colleges, and student organisations, for planning your student life effectively. Try these tips as a starting point:

• Get a good quality planner or diary with enough space to record all your commitments
• Use the planner to record all your study commitments and deadlines
• Take some time to plan out your week so that you assign realistic blocks of time to study, leisure, work, and exercise. This is especially important if your course involves a lot of independent study and fewer organised contact hours
• Make a start on your assignments in plenty of time. Starting is the hardest part, so plan to just make a very small step as your starting point (getting a book out of the library, for example)
• Or if the writing part is what you find hard to start, then jot down some random thoughts and sentences straight away without thinking too hard about it – once you have something down on the page, it is easier to shape a plan for going forward from there

Problem Solving

Of course not all stresses can be ‘planned away’, and there will be problems and difficulties that inevitably cause you stress and anxiety. If you notice that you are feeling stressed or anxious, the first thing to do is establish whether you are worrying about a real, current problem that you have an element of control over. For example, you may have some unpaid bills but not enough money, or your essay may be due at the end of the week and you haven’t started yet. Use the following problem-solving process to tackle problems like this:

1. Identify the problem clearly and specifically
2. Make a list of all the possible solutions, including those you don’t like
3. Only once you have a full list of possible options, start eliminating the ones that are unreasonable or less desirable
4. Put the remaining ideas in order of preference and evaluate the top 3 or 4 for their advantages and disadvantages
5. Decide on a plan and implement it
6. Evaluate whether it has helped and return to previous steps if more needs to be done

Change Attitude Towards Control

However, there are many things which we cannot control. Stress, anxiety and anger spirals take place when our normal stress response goes into overdrive. Sometimes this happens because we have unrealistic expectations about the level of control that we are able to exert in our lives.

Having a constructive approach to control in life is like riding a bicycle – if you don’t try to steer and never use the brakes, you give yourself a pretty dangerous ride. However, if you brake too hard (wanting to impose too much control) you’ll probably get thrown over the handlebars! If you let yourself balance without thinking about it too hard, and use the brakes and gears appropriately, the bike becomes an extension of your body and riding it can feel almost effortless.

Try to practise ‘going with the flow’ of life in the same way, putting effort in when needed, freewheeling when there’s a downhill stretch and ‘putting the brakes on’ gently and in good time without panicking.