The Depression Treatment Program: a Life Skills Learning Lab
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The Depression Treatment Program: A Life Skills Learning Lab Welcome to our learning lab! A wise person has observed, “The more important a life skill, the less likely we have received training for it.” When we get stuck in depression, for example, it’s likely that we’re experiencing some life circumstance that is challenging our coping skills—skills that may have worked previously, but are not “doing the job” currently. Our Learning Lab is designed to fill-in the skills gaps by providing training that many of us have earlier missed. Think of these skills as if they were tools, and you are being invited to develop or expand your toolkit. This workbook contains both exercises for developing your skills as well as providing additional information that you might read and review between sessions. Skills to be Developed Starts at page 1. BEHAVIORAL ACTIVATION: Gearing Up to Take Action ……………………… 5 2. MINDFULNESS: Being in the Present Moment ……………………………………. 9 3. COGNITIVE THERAPY PART I: Recognizing the Power of Thoughts ……. 12 4. COGNITIVE THERAPY PART II: Finding the Signals in Feelings ……………. 18 5. COGNITIVE THERAPY PART III: Untangling Your Thoughts ………………….. 25 6. ANXIETY: Reducing Worry and Sleep Problems …………….………………….. 32 7. DISTRESS TOLERANCE: Facing the Pain but Reducing the Suffering ….. 38 8. FORGIVENESS: Finding a Way to “Move On” …………….……………………….. 44 9. COMMUNICATION SKILLS: Managing Competing Wants and Needs .. 49 10. STRESS MANGEMENT: Integrating All the Skills Creatively ……………….. 55 Program Times: Tuesdays—10:30 to 12:00 and Thursdays—2:30 to 4:00 COMMON THREADS Although we introduce a new topic each session of the Depression Treatment Program, we hope you notice that there are a few “common threads” between each group. 1. MINDFULNESS: Mindfulness is the foundation on which each skill is built upon. We are asking you to practice being more intentionally aware of your thoughts about yourself, others and the world around you. Each session we will shine the spotlight on a different part of your experience and ask you to foster a deeper awareness and observation of that experience: your thoughts, emotions, physical symptoms and sensations, your words, and your actions. 2. RELAXATION PRACTICE: Every session, after check-in, we will guide you through a brief relaxation exercise during which we will provide a suggestion that prepares you to focus on the topic of the day. 3. FORMULA FOR DEPRESSION= Stress/Sadness + Powerlessness/Stuck: Each of the skills are designed to empower you and suggest ways you can begin to get “unstuck.” 4. PROBLEM SOLVING MODEL: With each problem that you encounter, imagine how a wise friend might suggest using the four options listed below. These options are always available to you, and you might want to consider how each might look based on your current circumstances. Action: Take action, make a change right now. Adapt: Adapt to the circumstances, reframe the problem, respond accordingly. Acceptance: Acknowledge what is and accept it, find peace, let go of resistance. Add to your Suffering: Keep responding as you are and demanding things to be different. Page 2 Life Skills Progress Chart We change when we focus on doing more of what we believe is helping us to feel better. Research indicates that when people identify some specific behavior or activity that has contributed to their feeling better—and then make a point of doing even more of that behavior or activity, they feel less anxious and depressed. In this Life Skills Learning Lab, we invite you to identify activities you have noticed to be contributing to your feeling better during the past week, and then to set a specific goal for doing more of those activities this coming week. For example, “I felt more energetic after having walked for 20 minutes in the morning on Tuesday and Thursday.” Specific goal: “This week I will walk for at least 20 minutes on five different mornings.” Change Record PHQ-9/ Behavior Change Goals Goals Session Date GDS Score (set at end of the previous session) Met? 1 / Showing up for the Orientation today 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / Page 3 DEPRESSION CYCLE Situation Trigger Manager asks me to come to office before I Thoughts about Moods go home I can’t think straight when I’m this worried. When I’m this moody, it’s hard to get along Depressive Thoughts with anyone. Why can’t I seem to “snap out No matter what I do, I can never please him. He’s found out that I’m behind on my of it”? I never get a break when I need it. project. This company is only interested in the “bottom line.” What if I lose this job? Thoughts Behaviors Feelings Biological Typical Feelings Typical Behaviors FEAR Monitor body responses Responses ANGER Avoid confrontations GUILT Seek reassurances SADNESS Procrastinate HURT Typical Physiological Responses Heart beats faster. Blood pressure goes up. Begin to sweat, Chest gets “tight.” Stomach churns. Feel tingling or numbness in fingers. Page 4 Skill 1: Behavioral Activation How is this skill related to depression? Generally, when we become depressed, our whole world slows down. We lose momentum, and many of our daily routines get dropped or become more sporadic. Unfortunately, the less active we are, the more depressed we become—and the less motivated we are to be active. Our feelings, thoughts and behaviors are all negatively affected when we become depressed, and it’s hard to change any of these for the better. However, behaviors are easier to change than either thoughts or feelings. So it’s helpful to begin by noticing how we are already subtly changing our behaviors just by “showing up” for this session and engaging with others in the session activities. What’s the BIG IDEA? Behavioral activation is a powerful “antidepressant” with few negative side effects except for some sore muscles if exercise is involved. Perhaps you’ve never thought of taking a walk around the neighborhood as a form of protest but. .when you take the simple step of becoming more active, you are protesting against the notion that you are powerless or stuck. How might I notice if I’m “getting” the BIG IDEA? You might just find yourself walking around the block, or in the mall, or through a park. Do that a few times and you’re likely to notice that you have a tad more energy, or that you’re noticing some interesting things as you walk. Who knows what wildly positive things could happen from there! You might start working out in the yard, return to a favorite hobby or clean your closets. Who knows? Page 5 Behaviors That Often Change When Depressed Take a few moments to briefly describe yourself when you are being your “typical self” compared to when you are experiencing a depressive episode Behavior Typical Self Depressed Self Bathing ___________________________ _________________________ Sleeping ___________________________ _________________________ Exercising ___________________________ _________________________ Weight ___________________________ _________________________ Socializing ___________________________ _________________________ Eating ___________________________ _________________________ Sex ___________________________ _________________________ Hobbies ___________________________ _________________________ Drugs/Alcohol ___________________________ _________________________ Coffee ___________________________ _________________________ Clothing Style ___________________________ _________________________ Finances ___________________________ _________________________ Attitude toward change ___________________________ _________________________ Impulse Control ___________________________ _________________________ Lying ___________________________ _________________________ Anger episodes ___________________________ _________________________ Internet /video games ___________________________ _________________________ Spending time alone ___________________________ _________________________ T.V. ___________________________ _________________________ Before going further, write down a couple of thoughts about completing this exercise. ______________________________________________________________________________ ______________________________________________________________________________ Page 6 Daily Activities For Managing Moods Below we’ve listed many suggestions for behavioral activation. In the blank provided, rate on a scale of 0 -10 (10 being most difficult) how difficult it would be for you to engage in this activity 3 times per week. Set a daily schedule with regular times for sleeping, eating, personal hygiene, and other activities. ____ Increase pleasurable and constructive activities. Call a friend, spend a few minutes doing a hobby, or do part of a chore that needs to be done. ____ Take time to relax. Set a time each day to let go of your worries and just “be with yourself.” You can learn skills like progressive muscle relaxation, meditation, visualization, or many others that can help you with this. Make a time when no one can interrupt you – this is your time. ____ Exercise. For best results, exercise outdoors in natural light. Mornings are often helpful because exercise stimulates energy for the day ahead. ____ Social Contact. Make time for contact with a friend, a family member, neighbors, or acquaintances. ____ Practice Skills Introduced in Group Sessions. Read the extra pages included in the workbook, and fill-in the blank forms provided for extra practice. ____ Here are some extra tips that are also helpful to keep in mind Practice Good nutrition. Limit your intake of