Depression and Low Mood
Depression and Low Mood
www.cntw.nhs.uk/selfhelp
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These are the thoughts of two people who are
depressed:
“I feel like crying all the time, I am so tired and can’t get
interested in anything. In fact I don’t even do the things I used
to enjoy. I can’t even do basic things that seem so easy to other
people...”
This guide aims to help you cope with depression and begin to
get better. The approach is called Cognitive Behaviour Therapy
(CBT). CBT uses methods that have been tried and tested and
found to be effective. It involves looking at the way you think
about things and what you do.
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What is depression?
Depression is a common mental health problem. At least one in
ten people will experience depression at some time. In its
mildest form depression does not stop us from leading a normal
life, but the most severe depression can be extremely
distressing, with thoughts of death and suicide.
Thoughts
Losing confidence in yourself
Expecting the worst and having negative or gloomy
thoughts
Thinking that everything seems hopeless
Thinking you hate yourself
Poor memory or concentration
Thoughts of suicide
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Behaviour
Not making decisions
Can’t be bothered to do everyday tasks
Putting things off
Not doing things you used to enjoy
Avoiding seeing people
When you’re depressed you may feel hopeless and alone in the
world; you may blame yourself for all the faults you think you
have and feel pretty worthless. In short, you feel negative about
yourself, about the world and about the future. So you tend to
lose interest in what’s going on around you, you don’t get any
satisfaction out of the things you used to enjoy and you
withdraw even further into yourself. Eventually it can become
hard to make decisions or to carry out little tasks that you once
did no problem at all. People who are depressed often say they
don't recognise themselves they feel so different. The good
news is that there are many things that can help, and
people do recover from depression.
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Whatever the cause of a person's depression, there is
something that can help. But just as the causes can vary from
person to person, so can the treatment. Some people may need
medication, others may need to make some changes in their
life. For others becoming more active may be the key, whereas
others may really benefit from changing their thoughts.
Sometimes it might be all of these. As you can see depression
can be complex!
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someone isn't doing the things they enjoy and value, their mood
drops even more. And guess what? Yes, there is much more
space in the mind for more and more gloomy thoughts to flood
in!
In summary
No one cause for depression has been found, but it is likely that
early experiences, difficult circumstances, individual differences,
body chemistry, reduced activity and gloomy thoughts can all
play an important role in depression. When someone is
depressed there are usually changes in the way they feel, their
body chemistry, what they think and how they behave.
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people suffering from depression. Antidepressants work on the
chemicals in the brain to make you feel less depressed. They are
not addictive and once you begin to feel better, usually after quite
a few months, you can plan, with your doctor, to stop taking them.
This should not cause you any difficulty and your doctor will
gradually adjust and reduce the dose.
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people we care about makes our mood much worse. Don't
expect to enjoy things as you used to straight away. This will
come later, and gradually. Just do your best to do what you
can.
Positive steps
List things to do
Mix with people
Join in activities
Take exercise
Do things you enjoy and value
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usually enjoy. Work through your action list and tick off what
you’ve done. At the end of each day you’ll be able to look back
and see what you’ve achieved. Physical exercise and activity
can really help to lift your mood. Try and build a little in each
day. Classes are sometimes available to increase physical
activity for people with low mood. Your GP may be able to refer
you to these, or to other activities that may help your mood.
Mixing with friends, family, pets; anyone you feel close to, can
also help. In particular try to plan simple things you value, such
as walking in the countryside, being creative, listening to music.
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Try to fill in this action plan for a week, then continue with your
own similar plan
9am -
11am
11am -
1pm
1pm -
3pm
3pm -
5pm
5pm -
7pm
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events into your day and treat yourself. Each evening, spend a
few minutes jotting down two or three things you are grateful for
from the day. Some people find it helpful to have a nice
notebook especially for this. This is called a gratitude diary
and studies have shown improvements in mood from this
simple act.
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Try this way of problem solving yourself.
What is the problem? (write it down – be as specific as
possible):
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Try the following:
List all sorts of solutions. Remember how you may have
solved similar problems in the past. What would your
friends advise? Or how would you advise a friend with a
similar problem.
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Steps to tackle it:
Step 1: ……………………………………………………………
Step 2: ……………………………………………………………
Step 3: ……………………………………………………………
Step 4: ……………………………………………………………
Step 5: ……………………………………………………………
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Understanding depressive thinking
As we have said depression not only affects our behaviour but
also our thoughts. Sometimes negative thoughts can stop you
from doing the things that you would normally do. You might
say to yourself 'what's the point' 'I can't face it' and this will have
a real effect on your activity levels. As a result, you may then
get self-critical thoughts about being lazy, or irresponsible,
which make you feel even worse, and able to do less and less.
In other words, you get caught up in a vicious cycle which looks
something like this:
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Has a similar cycle happened to you? Try and draw it out.
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What do gloomy, depressive thoughts look like?
Suppose you are walking down the street and you see a friend
who appears to ignore you completely. Normally this wouldn't
bother you too much. You might wonder why your friend didn't
speak and feel a little disappointed maybe. Next time you see
them you might mention the incident to your friend, and they
might tell you that they were preoccupied at the time and didn’t
even see you. If you’re depressed, you probably believe your
friend has rejected you. ”They don't like me. What have I done
to upset them?” may pass through your mind. You may not
even ask about the incident, and then the mistake goes
uncorrected. The next time you spot your friend, perhaps you
ignore them and walk straight by. If you’re feeling depressed
you’re more likely to make mistakes like this over and over
again.
Gloomy thoughts are often about yourself, and are usually self
critical; for example:
“I’m no good”
“People don’t like me”
“I’m a bad mixer”
“I look ugly”
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Do you have any gloomy thoughts about yourself? – jot
them down:
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For example:
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Do you have any gloomy thoughts about other things? –
jot them down:
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1. Catastrophising
This means we think things are much worse than they really are
by jumping to the worst conclusion. For example you make a
small mistake at work and fear that you may be dismissed
because of it, or you may spend a long time worrying that you
have upset and lost a friend by something you have said only to
find later they didn’t even remember the comment.
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Do you ever catastrophise? Think back over the last two
weeks and list:
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2. Over-generalising
This is when we generalise from one small thing. For example,
if someone isn't friendly to you, you may think “No one likes me,
I'm a waste of space” or if one of your daily tasks hasn’t been
finished you may think “I’ve achieved nothing, today has been
pointless”.
In other words from one thing that has happened to you, you
draw a negative conclusion which is much bigger and covers all
sorts of things.
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3. Ignoring the positive
People who are depressed tend to focus their thinking on
negative or bad events and ignore positive or good events. For
example, you might have had a game of pool and missed the
shot once, but played well in general. After the game you just
think about that one missed shot and not the rest of the game
played well. Or you may have many good friends who you have
known for years but you concentrate and worry about one that
has fallen out with you rather than remembering all the other
good friendships.
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“Are you sometimes self critical?”Jot down some
examples from the last two weeks
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Do you find that you ‘mind read’ or 'fortune tell'? Jot down
some examples from the last two weeks:
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Did any of these look familiar? If so, don't worry. Once you have
begun to recognise them in yourself, there is plenty you can do
to stop depressed thoughts affecting your mood. The following
simple techniques might help:
A. The event.
B. Your thoughts about it.
C. Your feelings about it.
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is that you can change what you think about an event and
therefore you can change how you feel about it.
2. Balancing
A useful technique to try is called balancing. When you have a
negative, critical thought, balance it out by making a more
accurate and positive statement to yourself. For example:
Negative Positive
thought thought
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Feeling or Thoughts in Other more
Event
emotion your mind balanced thoughts
Example
Your
example
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a good friend if they held that belief about themselves? Again
writing things down can be really helpful. Improving your self-
esteem is very important to recovering from depression.
6. Dealing with rumination
When people are depressed they may ruminate. That means
they go over an upsetting thought again and again without
finding a solution. This can become an unhelpful habit. One
way of dealing with this is to try and notice what’s going on
when this sort of thinking starts, and try to do something
different. So for example, if the rumination is bad when sitting
watching TV, then try to do something else, such as: getting
active, practicing relaxation, reading or doing a puzzle. If you
can interrupt the habit, then you may be able to reduce the time
given to these unhelpful ruminations.
Sit comfortably, with your eyes closed or lowered and your back
straight.
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Bring your attention to your breathing. Don't try and change it.
Just notice what it feels like.
Notice where you feel the breath. In your nose and your throat
and your chest. Notice your chest and stomach rising with the
in-breath, and falling with the out-breath. Just as though you
were observing a wave, coming in and going out.
Thoughts will come into your mind, and that’s okay, because
that’s just what the mind does. Just notice those thoughts, then
bring your attention back to your breathing. You may notice
sounds, physical feelings, and emotions, but again, just bring
your attention back to your breathing.
Whenever you notice that your attention has drifted off and is
becoming caught up in thoughts or feelings, simply note this
without judgement, and then gently bring your attention back to
your breathing. Thoughts will enter your awareness, and your
attention will follow them. No matter how many times this
happens, just keep bringing your attention back to your
breathing. The more you can practice this exercise the more it
will help you not to get caught up in your negative thoughts.
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Further help
We hope you will use the exercises suggested in this booklet.
They should help you to begin to overcome your depression
and get back in control of your thoughts, your depression and
your life.
If you feel that you are making little progress then as mentioned
other help may be available to aid you in overcoming your
problem, and your family doctor is usually the best person to
talk to.
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Useful organisations
Association for Post Natal Illness
Tel: 0207 386 0868
Email: info@apni.org
www.apni.org
For women who are experiencing depression following the
birth of their baby.
Bipolar UK
Tel: 0333 323 3880
Email: info@bipolaruk.org.uk
www.bipolaruk.org.uk
Works to enable people affected by bipolar disorder to take
control of their lives.
British Association for Counselling and Psychotherapy
Tel: 01455 883 300
Email: bacp@bacp.co.uk
www.bacp.co.uk
Offers an information service providing contacts for
counselling in England and Wales.
British Association for Behavioural and Cognitive
Psychotherapies
Email: babcp@babcp.com
www.babcp.com
Information and advice for people about behavioural and
cognitive psychotherapy (CBT).
CRUSE Bereavement Care
Helpline: 0808 808 1677
www.cruse.org.uk
Helpline for bereaved people and those caring for bereaved
people.
Depression UK
Email: info@depressionuk.org
www.depressionuk.org
A national mutual support group for people suffering from
depression although does not provide a helpline.
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Healthwatch
www.healthwatch.co.uk
Healthwatch England is the independent consumer champion
for health and social care in England. Working with local
Healthwatch networks, we ensure that the voices of
consumers and those who use services reach the ears of the
decision makers.
Mental Health Matters
Tel: 0191 516 3500
www.mhm.org.uk
Email: info@mhm.org.uk
A national organisation which provides support and
information on employment, housing, community support and
psychological services.
Mind Infoline
Tel: 0300 123 3393
Text: 86463
Email: info@mind.org.uk
www.mind.org.uk
Provides information on a range of topics including types of
mental distress, where to get help, drug and alternative
treatments and advocacy. Also provides details of help and
support for people in their own area.
Helpline available Mon - Fri, 9am - 6pm.
The NHS website
www.nhs.uk
Information about conditions, treatments, local services and
healthy lives.
Relate
Tel: 0300 100 1234
www.relate.org.uk
Help with marital or relationship problems.
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Rethink
Advice service: 0300 500 0927
Email: advice@rethink.org
www.rethink.org
Provides information and a helpline for anyone affected by
mental health problems.
Samaritans
Tel: 116 123
www.samaritans.org
Email:jo@samaritans.org
Freepost RSRB-KKBY-CYJK, PO Box 9090, Stirling, FK8 2SA
Provides confidential support for anyone in a crisis.
SANE
SANEline: 0300 304 7000
www.sane.org.uk
Offers practical information, crisis care and emotional
support.
Young Minds
Tel: 020 7089 5050
Parent helpline: 0808 802 5544
YoungMinds Crisis Messenger: for free 24/7 support across
the UK if you are experiencing a mental health crisis, text YM
to 85258
www.youngminds.org.uk/
A national organisation committed to improving the mental
health of all children and young people under 25.
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Useful books
Feeling good: the new mood therapy
David Burns
HarperCollins 2005
A drug-free guide to curing anxiety, guilt, pessimism,
procrastination, low self-esteem, and other depressive
disorders uses scientifically tested methods to improve mood
and stave off the blues.
Overcoming depression: a guide to recovery with a
complete self-help programme (3rd edition)
Paul Gilbert
Constable and Robinson 2009
A self-help guide using Cognitive Behavioural Techniques,
this book is full of step-by-step suggestions, case examples
and practical ideas for gaining control over depression and
low mood.
Dealing with depression (2nd revised edition)
Kathy Nairne and Gerrilyn Smith
The Women’s Press 1998
This is a practical guide for sufferers of depression and those
who know someone who is depressed. It identifies the
causes of depression and the many forms it may take,
explores ways of coping and recovering, and evaluates the
help available.
The mindful way through depression: Freeing yourself
from chronic unhappiness
Mark Williams, John D. Teasdale, Zindel V. Segal, Jon
Kabat-Zinn
Guilford Press 2007
This is a self help book all about how mindfulness meditation
can help depression. It includes a CD of guided meditations.
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Mind over mood (2nd edition)
Christine Padesky and Dennis Greenberger
Guilford Press 2015
Draws on the authors' extensive experience as clinicians and
teachers of cognitive therapy to help clients successfully
understand and improve their moods, alter their behaviour,
and enhance their relationships.
Overcoming depression and low mood: a five areas
approach (4rd revised edition)
Chris Williams
Taylor and Francis 2015
Overcoming Depression and Low Mood is a series of short
self-help workbooks for use by people experiencing low
mood and depression. Developed in liaison with a wide range
of experts, the course provides access to the proven
Cognitive Behaviour Therapy approach. Providing accessible
information and teaching key life skills the workbooks provide
a practical and effective way of improving how you feel.
The Happiness Trap
Russ Harris
Robinson 2008
Offers techniques using mindfulness skills to enable you to
experience a full and happy life and to overcome depression
and anxiety.
The happiness trap pocketbook: an illustrated guide on
how to stop struggling and start living
Russ Harris
Robinson 2014
Dr Harris joins forces with acclaimed illustrator and self-help
author, Bev Aislett, to produce this illustrated, engaging and
genuinely helpful guide to breaking free of 'the happiness
trap' and finding a true sense of wellbeing.
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An introduction to coping with depression (2nd ed)
Lee Brosan and Brenda Hogan
Robinson 2018
Written by experienced practitioners, this introductory book
explains what depression is and how it makes you feel. It will
help you to understand your symptoms and is ideal as an
immediate coping strategy and as a preliminary to fuller therapy.
Reasons to stay alive
Matt Haig
Canongate 2016
A true story of how the author came through crisis, triumphed
over an illness that almost destroyed him and learned to live
again. A moving, funny and joyous exploration of how to live
better, love better and feel more alive.
The recovery letters: addressed to people experiencing
depression
Olivia Sagan and James Withey
Jessica Kingsley 2017
A series of letters written by people recovering from
depression, addressed to those currently affected by a
mental health condition. Interspersed with motivating quotes
and additional resources as well as new material written
specifically for the book. This powerful collection of personal
letters from people with first-hand experiences of depression
will serve as a comforting resource for anyone on the journey
to recovery.
Overcoming mood swings: a self-help guide using
cognitive behavioural techniques
Jan Scott
Robinson 2010
This book is a self-help manual for those who have
experienced mood swings and gives background information
on depression and mania. The author uses tried and tested
practical techniques that will help people identify and manage
their mood more effectively, and achieve a more stable
emotional state. Contains a complete self-help programme
and monitoring sheets.
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CBT cognitive behavioural therapy: your toolkit to
modify mood, overcome obstructions and improve life
Elaine Iljon Foreman and Clair Pollard
Icon Books 2016
Using the same tools employed by CBT practitioners, this
book is full of activities and experiments to explore and
challenge, stories and exercises to provide perspective, and
a clear framework to encourage and guide you. The authors’
friendly and supportive approach will help you learn to
manage recurrences of negative thinking and behaviours,
and to develop strong coping strategies.
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Mind your head
Juno Dawson
Hot Key Books 2016
Covers topics from anxiety and depression to addiction, self-
harm and personality disorders with added information and
support from clinical psychologist Dr Olivia Hewitt. Juno and
Olivia talk clearly and supportively about a range of issues
facing young people's mental health - whether fleeting or
long-term - and how to manage them.
Mindfulness downloads
Franticworld.com Mindfulness: Finding Peace in a Frantic
World – Free meditations and mindfulness resources.
www.headspace.com – A free taster of mindfulness, with an
opt-in to buy further sessions
www.freemindfulness.org – A collection of free to download
meditations
References
A full list of references is available on request by emailing
pic@cntw.nhs.uk
Share your thoughts with other people and let them know what
you think of this guide at www.cntw.nhs.uk/selfhelp
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Join our NHS Foundation Trust
Cumbria, Northumberland, Tyne and Wear NHS
Foundation Trust provides a range of mental health,
learning disability and specialist services for a large part
of the North East of England, North Cumbria and beyond.
You may not think these services have very much to do
with you, but mental health problems affect 1 in 4 people
and there are a growing number of people with both
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As a member of our Foundation Trust you can be as
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Receive regular information about the Trust
Please complete and return the Membership application
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Join our NHS Foundation Trust
Sign up to become a Cumbria, Northumberland, Tyne and Wear NHS
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FREEPOST CNTW MEMBERSHIP
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Mental Health
Self Help Guides
• Abuse
• Alcohol and You
• Anxiety
• Bereavement
• Controlling Anger
• Depression and Low Mood
• Depression and Low Mood - a guide for partners
• Domestic Abuse
• Eating Disorders
• Food for Thought
• Health Anxiety
• Hearing Voices and Disturbing Beliefs
• Obsessions and Compulsions
• Panic
• Post Traumatic Stress
• Postnatal Depression
• Self Harm
• Social Anxiety
• Sleeping Problems
• Stress
• Plus 3 guides for prisoners
• Anxiety
• Depression and Low Mood
• Post Traumatic Stress
www.cntw.nhs.uk/selfhelp
Also available in BSL, easy read and audio format
cntwnhs @cntwnhs
Written by Dr Lesley Maunder and Lorna Cameron, Consultant
Clinical Psychologists. This guide has been developed from an
earlier manual by Sheila Sharkey and Kevin Gibson.