The Five Keys to Recovery from Depression

Getting Your Life Back
by Jesse H. Wright, M.D., Ph.D., Monica Ramirez Basco, Ph.D.

(Page 2 of 3)

Although each person's personal story is unique, there are some common themes that thread their way through the lives of most people who become depressed. The Five Keys are directed at these common clusters of problems. We'll introduce you to the Five Keys in this chapter and give an example of how Michelle used each of them to fight depression. As you read along, you may find some similarities in your own life. At the end of the chapter we will ask you to begin to think about how each of the Keys might help you overcome your depression.

      THE THINKING KEY

When you are feeling low, it is easy to slip into a negative style of thinking. Angry, upsetting, fearful or self-critical thoughts are some examples. They typically fuel your unhappiness and lead to actions that can make matters worse. If you find that you tend to get down on yourself, have excessive worry, or think pessimistically about the future, you can use the Thinking Key to learn methods to control your negative thoughts and solve problems more effectively. Research on the treatment of depression has shown that when your thought patterns become less negative and more accurate or rational, your mood brightens and your symptoms get better. If you can learn how to spot depressive thinking and change it in a healthy direction, you can take some very important steps toward getting your problems under control.

Did you notice that Michelle's thinking had a hopeless tone? The more she saw things this way, the worse she felt. To get back to a more balanced view of her self-worth and her prospects for the future, Michelle learned to spot her distorted thinking patterns and to correct her negativity when it was inaccurate. She also learned to take stock of the strengths and abilities she had forgotten that she possessed. As she mastered the methods offered in the Thinking Key, her natural optimism returned and she felt more hopeful about her future. You will learn to use these same techniques in Chapters 3 and 4.

      THE ACTION KEY

When you feel depressed, you can't help but act differently at home, at work, or in your relationships with others. You can lose interest and be less involved in your usual activities, develop negative habits, procrastinate, or show too much irritability. Jobs that might have been routine or effortless can become so difficult or unpleasant that you have to push yourself to get them done. You might even avoid some of your responsibilities altogether. If your actions have changed in any of these ways, you can use the techniques from the Action Key to learn to take pleasure in life again, cope more effectively with problems, and become more energetic. When you begin to act in positive ways, you will feel better about yourself, and your depression could start to fade away.

Michelle had several good opportunities to use the Action Key. For example, when she avoided her friends and dropped out of social activities she felt more lonely and isolated. As a result, her mood worsened, and she became even more depressed. This was unlike the old Michelle who had always enjoyed being with people. She used the Action Key to figure out how to begin acting more like her old self. Michelle's recovery plan included use of several of the self-help methods described in Chapters 5 and 6, such as learning how to experience pleasure again, combating fatigue and lack of motivation, organizing her day to be happier and more productive, and getting back her sense of humor. She started with small goals for change. But as she began to improve, Michelle was able to tackle more challenging problems like being assertive in handling the legal side of her divorce.

      THE BIOLOGY KEY

Scientific studies have provided convincing evidence that depression can be effectively relieved with biological treatments. In Chapters 7, 8, and 9 you'll find out how your brain chemistry is involved in producing depressive symptoms and how to promote recovery in two major ways: (1) modifying your life-style to stimulate healthy chemical processes in your body, and (2) using specific biological treatments such as antidepressants, herbal remedies, or light therapy. The Biology Key will help you decide whether or not to use medications or other biological interventions as part of your recovery plan. If you decide to take medication, you can learn how to limit the risk of side effects and get the most out of treatment.

The Biology Key was an important part of Michelle's recovery plan. She began taking an antidepressant medication early in her treatment. Both she and her doctor believed that the medication helped a great deal in relieving her symptoms. She also used techniques from the Biology Key to improve her sleeping and eating habits, and to get back into an exercise routine. As Michelle gradually got back into a healthy life style, she had more energy, and felt better about herself.

      THE RELATIONSHIP KEY

Research studies have repeatedly proven what common sense tells us — relationship problems can be stressful and depressing. The Relationship Key focuses on teaching you how to identify problems in your relationships and take action toward making improvements. Even if your relationships are strong, you can use the methods in the Relationship Key to improve your communication, resolve conflict, eliminate resentments, and create more intimacy. Positive and caring relationships can be a tremendous help when you are trying to recover from depression. There are several things you can do to help create and nurture loving and supportive connections with others.

A crisis in her marriage was the main trigger for Michelle's depression. In Michelle's case it was too late to save her marriage. Instead, she needed to grieve the loss and find a way to strengthen the other important relationships in her life. Techniques from the Relationship Key (described in Chapters 10 and 11) helped her cope with her loss, focus on positive elements of her life independent of her marriage, and set positive goals for the future. One of her greatest assets was her close relationship with her children and friends. As Michelle succeeded at re-building these relationships, the feeling of emptiness that initially fed her depression disappeared.

      THE SPIRITUALITY KEY

Lack of a sense of meaning in your life or feeling spiritually empty can be a breeding ground for despair. Drawing strength from having a purpose and being committed to your core values and beliefs can help you face depression and work on putting your life back together. The Spirituality Key will help you find meaning in your daily existence, and perhaps strengthen your faith, by teaching you ways to rediscover your lost spirituality, calm your mind, and open your heart. Elements of spirituality that cut across cultures and religious faiths and practices are discussed along with suggestions for defining your own sense of spirituality.

The Spirituality Key was a big help to Michelle in overcoming her depression. It helped her to regain hope for the future, brought her back to her faith community, and strengthened her sense of purpose. Michelle's divorce and subsequent depression, though seemingly life shattering, gave her an opportunity to redefine herself, reevaluate her beliefs, and rediscover the things outside her marriage that gave her life meaning. We hope that these same methods that are offered in Chapters 12 and 13 will help in fighting off your depression and in adding new dimensions to your life.

Are you getting some ideas about how the Five Keys to Recovery might apply to you? The following table summarizes the problems that can be addressed by each Key. Read through the list and think about which Keys you might want to learn how to use.

My Story — The Beginning

The exercises in this book are geared toward helping you develop a skill, sort out your feelings, set goals for recovery, and work toward making improvements. It can be easy to read through a book like this and think about how the various methods might be helpful to you. It is a different story altogether to put these ideas into action so that they begin to work. Therefore, we encourage you to not rush through reading the book, but to take time to complete those self-help exercises that might be applicable to the problems you are facing.

The first exercise will be to begin telling your own story. Take out your notebook and write out your answers to the following questions. Using Michelle's story as a guide, fill in as many details as you can.
Exercise 1.1

My Story — The Beginning

Open your notebook and title this exercise "My Story — The Beginning." The goal is to think about how your depression began, what has made it get worse or better, and how you might begin to change.

1. When did your depression begin?

2. What symptoms or problems bother you the most?

3. What seems to trigger your depression?

4. What usually seems to help?

5. How has your life changed since you have become depressed?

6. What have you started doing since you have been depressed?

7. What have you stopped doing since you have been depressed?

8. What ideas do you have now for changes that could be made to improve your situation?

Here's the next step. Go back over your story and circle all of the difficulties you are experiencing that could possibly be addressed with one of the Five Keys. You will find some clues in the table on page 8 called the "Five Keys to Recovery from Depression." On the next page of your notebook, summarize your observations by making a heading for each Key and listing the things you circled in your story. Try to match the problems with the Key. Title this exercise "My Problem List."

Copyright © 2001 by Jesse Wright and Monica Ramirez Basco

About the Author

Jesse H. Wright, M.D., Ph.D., is professor of psychiatry at the University of Louisville and medical director of the Norton Psychiatric Center. He developed the first multimedia program for computer-assisted therapy of depression and is the founding president of the Academy of Cognitive Therapy. He lives in Louisville, Kentucky.

Dr. Monica Basco is an internationally recognized expert in cognitive-behavior therapy and a founding fellow of the Academy of Cognitive Therapy. She has lectured throughout North America as well as in South America and Europe and has been training psychologists and physicians for the past 12 years. She is the author of three books, numerous research and magazine articles, and has appeared on several radio and television shows including the Oprah Winfrey Show.