rk module 3 - this way up · module 3: tthhoouugghhtt rreeccoorrddiinngg crufad ic. org-h rk. 2...

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Lesson 2 Depression and Anxiety Program · CRUfADclinic.org · page 1 of 12

CRUfADclinic Patient Homework

Module 3:

TThhoouugghhtt rreeccoorrddiinngg

CRUfAD

clinic.org - hom

ework

http://www.stvincents.com.au/

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1. About Thoughts

As we have discussed, depression and anxiety are related to 3 types of symptoms- thoughts, behaviours and physical symptoms: This hand out is focussed on the role of thoughts in depression and anxiety.

What are thoughts?

Thoughts are mental events. They are the things you say in your mind about yourself, the world and other people. Without even noticing it, we have thousands of thoughts every day that help us give our own interpretation of the things that are going on in the world around us. They often help us to decide whether something is pleasant or nasty, good or bad, dangerous or safe. Thoughts can be experienced in the form of words, images, memories, imagined sounds or feelings, a sense of just “knowing”. They can be deliberate and obvious, or can come into mind spontaneously (that is, they just pop into your mind). They can last a short time (seconds), or stay around for longer .

Thoughts are important because they affect the way we feel

There are many different types of thoughts (negative, positive, neutral), and particular types of thoughts often lead to particular emotions. Let’s consider the following example.

1. Thoughts

2. Physical Symptoms

3. Behaviours

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Example 1: You have arranged to meet a friend for coffee at 3.00pm. It is now 3.15pm. You are waiting at the café, and your friend has not arrived.

3 people in the same situation may have entirely different thoughts and feelings.

Thought Feeling

Person 1 “Oh no, my friend must have been in an

accident” Anxious and Worried

Person 2 “My friend isn’t coming because they don’t like

me anymore. I’ve been stood up”

Angry, Hurt and Depressed

Person 3 “My friend has probably been held up at work

and will probably be here soon” Neutral

What would you think in this situation? ................................................................................................................................................................... Let’s consider another example:

Example 2: You are lying in bed one night and hear a loud thump outside.

Three different people in the same situation may have entirely different thoughts and feelings.

Thought Feeling

Person 1 “It must be a burglar” Anxious, Frightened

Person 2 “It was just the cat next door jumping down

from the fence” Neutral

Person 3 “It’s my neighbour deliberately trying to make

noise so I don’t sleep” Annoyed

These simple examples illustrate the way that we interpret a situation can have a big impact upon the way we feel. Often we assume that it is the situation itself that causes us to feel a certain way. In fact, it is the way we think about the situation that really affects the way we feel about it.

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Here are some other common examples of how different thoughts lead to different emotions:

Thought Feeling

I am a failure Depressed

I’m going crazy Frightened

People will judge me for being anxious Nervous

This treatment won’t work Hopeless

There is nothing I can do to feel better Helpless

She’s taken advantage of me Angry

He doesn’t understand Irritated, Lonely

I don’t need to be perfect Motivated

I can cope with my anxiety Relieved

I put in a good effort Happy, Proud

Why are thoughts important in depression and anxiety?

Our thoughts and the way we interpret particular situations are shaped through our present and past experiences, our knowledge, values, culture and upbringing. Because of this, and because they tend to occur automatically, they are very believable. The problem with this is that we assume that our thoughts are accurate, and never question whether they are true, accurate or valid. Unfortunately, when people become depressed and anxious, it can change the way they think. They often have lots of negative thoughts about their self (e.g., I’m a failure), other people (e.g., “other people judge me”), the world (e.g., “the world is a dangerous place”), and the future (e.g., “the future looks hopeless”). Depression and anxiety cause us to think about situations in a negative, catastrophic or pessimistic way. These negative thoughts are unhelpful because they can directly lower your mood, increase your anxiety, and contribute to the vicious cycle of depression and anxiety!

The good news is that unhelpful thinking can be changed... the first step in being able to change negative thinking is to recognise it!

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2. Common Thought Distortions

It can helpful to learn about some common unhelpful thinking styles (also called thought distortions), and to watch out for them in your own thinking. Most people experience these thinking styles from time to time, but often they become much worse in depression and anxiety. Please read through them now and see if you recognise any in your own thoughts:

Definition Examples

Black and White Thinking

This is the tendency to place all experiences in one of two opposite categories. You view situations as either black or white, and you don’t see the shades of grey in between.

I am a failure (or perfect)

She is a bad person (or good)

My life used to be perfect, now it’s a disaster

Catastrophising (Thinking the

Worst)

This is the tendency to think of something as being a disaster, when it actually isn’t. Your imagination creates images of disasters that have not happened and are unlikely to happen.

My anxiety will kill me

What if... happens?

I made a mistake...I will lose my job!

Over-estimating the Risk

This is the tendency to over-estimate the likelihood of something bad happening.

My partner will have an accident

I’m 100% likely to have a panic attack

Under-estimating Ability

This is the tendency to underestimate your ability to cope.

I won’t manage

I can’t cope

Mind Reading This is the tendency to assume what other people are thinking, without asking them.

He thinks I’m stupid

She thinks I’m going crazy

She doesn’t like me

Taking Things Personally

This is the tendency to take responsibility and blame ourselves for anything unpleasant or negative, which in fact we were not primarily responsible for.

It’s my fault

I made her worry

Fortune Telling

This is the tendency to anticipate that events will turn out badly, and to consider this prediction to be an already-established fact.

This will be a disaster

Things always turn out badly

I’ll fail my exam

Filtering

This is like looking through dark glasses, ignoring anything positive or realistic, rejecting positive experiences because they “don’t count” for some reason, and paying attention to negative information. It makes you focus on a detail taken out of context, and ignore other more important aspects of the situation.

Ignoring your strengths

Dismissing achievements as “good luck”

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Setting Unrealistic Standards

This is the tendency to set high and unattainable expectations of yourself and other people.

I should be doing better

I have to be 100%, everything else is not good enough

I should do it perfectly

Labelling The tendency to be quick to judge and condemn yourself. You assign global negative traits to yourself and others.

I am worthless

I am weak and inadequate

He’s a loser

Jumping to Conclusions

Drawing a conclusion without having any evidence to support the conclusion, or drawing a conclusion even when the evidence is contrary to the conclusion.

I have a sore throat..it must be cancer

Emotional Reasoning

This is the tendency to assume that your negative emotions reflect the way things really are.

I feel bad, so things must be going badly

I feel depressed, therefore my marriage is not working

I feel fat, therefore I’m fat

We know that it can often be very difficult to change these negative thoughts, especially when you’re ruminating or worrying. In fact, if you are prone to these types of thinking habits, it’s quite likely that you’re judging yourself right now for thinking these things (e.g., “I shouldn’t think this way,” “There is something seriously wrong with me for thinking this,” “I have a pessimistic personality”). In this course we will teach you strategies to change your relationship with these thoughts. You will learn the technique of thought challenging soon, which helps you to make accurate judgments about how realistic your thinking is, and can be helpful in being able to change unhelpful thoughts. However, first you need to be aware of what negative thoughts come to mind, especially when you are feeling depressed and/or anxious.

Tips for Identifying Thoughts

One of your homework tasks for this week is to begin writing down your thoughts whenever you experience a sudden mood change (e.g., a drop in mood or an increase in anxiety), and then see if you can spot any unhelpful thinking patterns (thought distortions). The Thought Monitoring Worksheet (located at the end of this Summary) takes you through this process. Make sure to make a few copies of the Thought Monitoring Sheet and fill it out whenever you can. Some people find it helpful to write down the instructions in a notebook and carry this around with them throughout the day. That way they can write down their thoughts straight away, whenever they notice a drop in their mood.

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What You Should Know:

At first, many people find it difficult to identify their thoughts, especially when they feel very overwhelmed, anxious or depressed. At first it is really helpful to start by practicing noticing your thoughts at times when you are less anxious or depressed (e.g., after the event that made you anxious). We have provided a list below of some common unhelpful thoughts that often occur in depression and anxiety. If you have difficulty identifying negative thinking at first, this might help give you some ideas to look out for! Tick the ones that apply to you.

Common Unhelpful Thoughts (what I think to myself)

About myself:

I’m worthless/ I’m a failure

I’m a loser

I’m alone

It’s all my fault

I can’t cope

I will never be able to do this right

I’m not good enough

About other people

They think I’m stupid

Everyone will know I am not coping

They think I’m weak

People will judge me for being anxious

I have nothing interesting to say, people will think I’m boring

No one understands what I’m going through

About anxiety and depression

I’m always going to be anxious

I can’t concentrate and it’s ruining my whole life

I’ll never feel better

Things will be awful if I’m not 100%

I will never be normal

The world is a dangerous place

I’ll never be what I used to be

My life used to be perfect before I was anxious and depressed

About my thoughts

If I worry too much it’ll make me crazy

There is something seriously wrong with me

I’m different. No one else thinks this way

I could lose control over my thoughts

About the future

The future is bleak

There’s no point trying

I’ll only mess up again

Bad things will happen

This is hopeless

This treatment won’t work

I’ll be paralysed by anxiety

If I don’t plan ahead I’ll fail

Other:

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Thought Observation Exercise

Another way of getting better at identifying your thoughts is to do a “thought observation exercise.” You have probably done this already without even realising it. Think back to when you first tried controlled breathing. What went through your mind? Often we find that many people notice thoughts like “I’m not doing it properly” or “It’s not working” or “I’m feeling more anxious – this must be making it worse!” Now we are going to try another strategy that is similar to controlled breathing that helps you learn to notice, identify and observe your thoughts.

Sit comfortably in a chair with your eyes closed

Put your hand on your belly (stomach)

Breath in and out normally without trying to change it in any way, and as you do, pay attention to the rise and fall of your stomach

Notice what goes through your mind during this exercise. It's ok and natural for thoughts to arise, and for your attention to follow them. If you notice that your attention gets captured by your thoughts, bring your attention back to your hand rising and falling on your belly as you breathe in and out.

Note. Set a timer for 3 minutes. After the exercise, ask yourself what went through your mind, what were you thinking about, and were there any thoughts, images, or sensations that you noticed.

Monitoring Rumination and Worry

People with depression and anxiety are prone to engaging in rumination and worry. Although everyone worries and ruminates from time to time (that is, they are normal just like emotions), these thoughts become more intense and difficult to manage when you feel depressed and anxious! Sometimes you may not realise you have gotten stuck in your thoughts. Along with other behaviours, physical symptoms and thought symptoms associated with depression and anxiety, it is important to learn identify when rumination and worry occur. You might only become aware that you have been ruminating or worrying when you start to feel more depressed or anxious. Therefore, if you notice your mood change, it might be because you have been worrying or ruminating. Sometimes people with depression and anxiety find that they ruminate and worry more frequently at particular times of day or in certain situations. Tick those that apply to you. If you’re unsure, spend the next week taking note of when repetitive thinking occurs:

At night before you go to sleep

In the morning as soon as you wake up

At work

Before you enter a particular situation (e.g., social situation)

After you have been in a particular situation (e.g., social situation)

When you are feeling down

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When you are feeling anxious

Around particular people

Other........................................................

Here are some more questions that you can ask yourself to find out when you are more prone to ruminate and worry:

1. Is there a particular time of day when you’re more likely to engage in repetitive thinking? (e.g., late at night while you’re lying in bed?)

2. Is there a particular activity which triggers it (i.e., which occurred just before you started ruminating and worrying) e.g., do you find yourself worrying before social events?

3. Are there particular people who trigger it?

4. Are there particular topics or themes you repeatedly think about?

5. Are there particular thoughts you find it hard to get unstuck from?

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Thought Monitoring Form: Liz’s Example

1. Situation

What is the situation that is upsetting you? What has happened?

Going over my lesson summary

1. Cognitions/Thoughts

What are your thoughts about this situation? What is going through your mind?

I haven’t done the things I planned. What is bad about that?

I’m not good at this.

The therapy won’t work. What does this say about you?

I’m lazy.

I won’t get better.

I’ll be anxious and depressed forever.

2. Feelings

How do you feel? E.g. angry, sad, happy, surprised, ashamed, scared, guilty, joyful, anxious, disgusted, annoyed, delighted. *Rate strength of feeling (0-100)

Sad (90)

Ashamed (80)

3. Take a step back!

Look at your Thoughts. Can you see any Unhelpful Thinking Patterns? Fill in your own Thought Monitoring Form on the next page

Unhelpful Thinking Patterns

Black and white thinking Disqualifying the positive Harsh judgement Catastrophising Fortune telling Personalisation Mind reading

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Thought Monitoring Form: Your Copy

4. Situation

What is the situation that is upsetting you? What has happened?

5. Thoughts

What are your thoughts about this situation? What is going through your mind? What is bad about that? What does this say about you?

6. Feelings

How do you feel? E.g. angry, sad, happy, surprised, ashamed, scared, guilty, joyful, anxious, disgusted, annoyed, delighted *Rate strength of feeling (0-100)

7. Take a step back!

Look at your Thoughts. Can you see any Unhelpful Thinking Patterns? NOTE: Use this form to help you to monitor your own thoughts.

Unhelpful Thinking Patterns (tick the ones that apply)

□ Black and white thinking □ Disqualifying the positive □ Harsh judgement □ Personalisation □ Fortune telling □ Catastrophising □ Mind reading

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