Rationale

Negative moods and depression are common among alcoholics during the recovery process. Often, these moods are related to the actual depressant effects of alcohol or drugs or to the losses experienced in one’s life (e.g., family, job, finances) as a result of drinking.

Depression and negative moods related to these factors often get better during the course of treatment without any specific attention, as one is sober longer and begins to deal more effectively with the remaining life problems.

Some people, however, continue to experience problems with depression even after they have been clean and sober for fairly long periods of time. In such cases, it may be necessary to focus more directly on these negative moods.

Depression is a problem in its own right. However, it is a particular problem for the recovering alcoholic, since negative mood states, particularly depression, are a major reason for relapse and, thus, represent high-risk situations.

Returning to drinking is not an effective way to cope with depression and only serves to make the person more depressed in the long run.

There are many different ways to cope with depression and negative moods. Given the focus of the present therapy approach, negative moods can be dealt with effectively by changing the ways one thinks and behaves.

As such, many of the skills that have been learned to manage negative thoughts, to solve problems, and to increase pleasant activities can be used to deal with depression and its symptoms.

The best way to beat depression is to consider each symptom as a separate problem to be solved. The symptoms of depression are interrelated; improvement in one area leads to improvement in other areas.

[NOTE: Adapted from Emery 1981. © Simon and Schuster. Used with permission.]

Skill Guidelines

Depression has a number of causes and symptoms. Several different cognitive-behavioral approaches have been found helpful in dealing with depression of mild to moderate proportions.

Change your way of thinking about yourself and the world. One of the things that is most characteristic of depression is that the individual tends to view the world and the self through distorted and depressive perceptions.

The way one thinks affects how one feels. As such, it is important to look at the way you think and see if this contributes to your feeling sad and depressed.

The steps to changing your thinking, while not easy, are simple. First, become aware of your self-defeating thoughts; second, answer these with more realistic ones; and third, act on the new thoughts. If you use these three A’s, you can overcome the symptoms and causes of your depression.

Awareness. The first step in the process is to recognize the symptoms of your depression. Depressed people often miss or misinterpret symptoms of depression. Below are some ways you can become more aware of your symptoms:

Pay attention to your mood changes. When you start to feel sad, gloomy, ashamed, bored, lonely, or rejected, tune into what’s going on, to how you’re feeling. These are important clues to your thinking.

Own your feelings. If you are having trouble recognizing your feelings, start talking about them. Tell people how you are honestly feeling at any given moment.

Be alert to your body. This is a clue to your emotions. Notice your posture, your facial expression, how you are walking and moving.

Label your avoidance. Keep a lookout for people, places, and activities that you once enjoyed but are now avoiding. Forget about the reasons why you are avoiding them, just see when you do.

Watch for times when your confidence disappears. Are there times and places when you ask others for help? Ask yourself whether you were able to handle this on your own before. Remember, this loss of confidence can be a symptom of depression.

Look for activities that require great effort. Do you have to force yourself to make or return phone calls? Do you have trouble completing tasks around the house?

Become aware of trouble concentrating or making decisions. Do you vacillate over simple decisions or second guess yourself? These can be symptoms of depression.

The second level of awareness is catching the thoughts that come before your symptoms. These are called automatic negative thoughts. During depression, these automatic negative thoughts become stronger and drown out more sensible thoughts. Thoughts are used to monitor feelings and behavior. They are used to initiate action and anticipate events.

Your thoughts tell you what to do and how to feel. The chief characteristic of automatic negative thoughts is that they are generally wrong.

Automatic thoughts make you depressed; the more depressed you become, the more negative thoughts you will have and the more likely you are to believe them.

Below is a list of thinking errors or methods of distortion characteristic of depressed thoughts.

Thinking Errors

Type of error
 Examples
 
Personalizing
 Thinking all situations and events revolve around you. “Everyone was looking at me and wondering why I was there.”
 
Magnifying
 Blowing negative events out of proportion. “This is the worst thing that could happen to me.”
 
Minimizing
 Glossing over the saving and positive factors. Overlooking the fact that “nothing really bad happened.”
 
Either/or thinking
 “Either I’m a loser or a winner.” Not taking into account the full continuum.
 
Taking events out of context
 After a successful interview, focusing on one or two tough questions. “I blew the interview.”
 
Jumping to conclusions
 “I have a swollen gland. This must be cancer.”
 
Overgeneralizing
 “I always fail—I fail at everything I ever try.”
 
Self-blame
 “I’m no good.” Blaming total self rather than specific behaviors that can be changed.
 
Magical thinking
 “Everything is bad because of my bad past deeds.”
 
Mind reading
 “Everyone there thought I was fat and ugly.”
 
Comparing
 Comparing self with someone else and ignoring all of the basic differences. “Cher has a better figure than mine.”
 
Catastrophizing
 Putting the worst possible construction on events. “I know something terrible happened.”

In addition to becoming aware of the typical thoughts associated with depression noted above, it is important for you to become aware of your characteristic automatic negative thoughts.

A number of steps can be taken to help you do this.

One way to become more aware of your thoughts is simply to count them. This will help you realize that they just appear—they are automatic and not a reflection of reality.

Give yourself a goal of collecting 50 negative thoughts. It seems like an impossible task, but it will prompt you to think hard and you are likely to come up with 5 to 10 such thoughts, even if you don’t make it to 50!

Use an instant replay technique. If you have some negative feelings and cannot quite catch the thoughts, replay the feelings over and over until you catch the thoughts. If you can remember what happened, imagine the event as if it were happening right now.

Look for the meaning of the situation. Ask yourself, “What is the significance of the situation… what are the consequences?” By doing this you can usually become aware of your thoughts.

Set aside a specific time to collect negative thoughts. You may find that setting aside a regular time may be helpful. During a half hour period, for example, write out some of the negative thoughts you had during the day. You might want to limit the thoughts to specific problems or situations.

Write out your thoughts. Putting your thoughts down on paper is one of the best ways to become aware of them. When writing them out, force yourself to go beyond the obvious thoughts that first come to mind.

Use the excuses you come up with to avoid collecting negative thoughts as cues to swing into action. This way the excuse can become an early warning signal.

Answering. Once you begin catching negative thoughts, you can begin answering them. The secret to answering negative thoughts is to realize there are different interpretations of any event and some are closer to reality than others.

When answering your thoughts, try to consider a wide range of possible interpretations, not just the negative ones.

If you are depressed, it is important to separate thoughts from facts, since you will have distorted thoughts, and when you believe and act on distorted thoughts, you become more depressed.

You must begin to question the assumptions involved in the thoughts. A good way to do this is to ask some serious questions of yourself and your automatic thoughts.

Here are 20 questions that you can use to generate answers to your negative thoughts:

What’s the evidence? Ask yourself, “Would this thought hold up in a court of law or is it circumstantial?” Just because the newspaper is late one day doesn’t mean you can’t count on anything. Give yourself a fair trial before you convict yourself.

Am I making a mistake in assuming what causes what? Determining causes is rarely simple. Example: Many women think they’re fat because they have no willpower. Scientists have been studying obesity for years and they don’t know what causes it.

They know the determinants are partly biological, social, cultural, psychological, familial, and economic. Saying lack of willpower causes obesity is an oversimplification. Specifics are difficult to pinpoint.

Am I confusing a thought with a fact? This can lead to trouble—especially if you call yourself names and then believe them as gospel.

There is an old story that makes this point: “How many legs would a dog have if you called the tail a leg? Five? Wrong. The answer is four. Calling a tail a leg doesn’t make it so.” Don’t be dogmatic about your thoughts—look for the facts.

Am I close enough to the situation to really know what’s happening? One woman said, “The bosses upstairs don’t like our department’s work and want to get rid of us.”

Who knows what they’re thinking upstairs? You’re not up there with them. You have to rely on what you know as fact. The woman’s worry turned out to be a false rumor.

Am I thinking in all-or-none terms? Do you see the world in either/or terms (“I’m ugly and everyone else is beautiful”)? Just about everything is in degrees and on a continuum.

Even a person’s gender is not always clear cut; some people’s hormonal makeup is such that it’s a tossup whether they’re male or female.

Am I using ultimatum words in my thinking? (“I always should be nice or no one will like me.”) You place unfair ultimatums on yourself with these words. This isn’t “just semantics,” but relates directly to how you feel and act.

Am I taking examples out of context? One student believed she’d been given a bad letter of recommendation. She thought the teacher said in the letter that she was narrow and rigid. When she reread the letter, she saw the teacher had written, “She has high principles.” It was really a positive letter, and she had taken this part out of context.

Am I being honest with myself? Am I trying to fool myself—denying the truth, making excuses, and misplacing the blame? One depressed woman, speeding on the freeway, thought, “I hope they catch me and put me in jail.” When she thought about it for a moment, she realized she didn’t really mean this.

Continued at
http://pubs.niaaa.nih.gov/publications/MATCHSeries3/elective.htm#10