A Plan for Recovery

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

(Page 3 of 3)

Problem Solving — Getting Started

How do you feel when you look at your problem list? Do you have a sense of accomplishment that you have made some progress in recognizing things that can be changed? Are you optimistic that something can be done to turn your situation around? Or do you feel a bit overwhelmed? It's a normal reaction to see a list of problems and to think that the road ahead will be difficult. But, one of the big pluses of accurately identifying problems is that you'll have a much better chance of finding solutions if you know exactly what is bothering you.

When we begin therapy with our patients, we usually ask them to pick one or two problems they can work on right away. Even before they have had a chance to learn everything they would like to know about the Five Keys, we want them to feel a sense of accomplishment. The program described in this book is similar to therapy in that it takes time to fully understand your problems, organize a plan for recovery, and implement the plan. However, there are some basic problem-solving techniques that you can use now to tackle some of your difficulties and begin to get some relief. Here's how to get started.

Review your problem list and rate each item for its degree of difficulty using the scale in the box below. A score of 1 suggests that it would be fairly easy to make some headway toward managing the problem. A score of 5 suggests that it would be extremely difficult for you to make any significant progress toward solving this problem at this time.

If all your items are rated a 4 or 5, you're probably only thinking about the big changes you have to make. Add to your list the smaller challenges, problems, and annoyances that need attention. Try to place them under the Key you think might be most helpful. Don't worry about matching the problem and the Key exactly. There will be plenty of guidance ahead on how to best approach your various problems. Of the problems you rated as 1, 2, or 3 in difficulty, choose one or two that you think you could make some progress on in the next few weeks. Circle these in your notebook. Next, make a list of ideas for managing the problems. These may be things you have thought about doing, but have not had the time or energy to try. Choose the solution that you think has the greatest chance of success and give it a try. You'll find that if you can make a small amount of progress, it can lighten the emotional burden you carry on your shoulders.

Michelle used this same problem solving exercise early in her therapy. When she was asked to rate her initial problem list for degree of difficulty, she gave them all a score of 4 except for "becoming distant from the kids," which she thought would be easier to change. She gave that problem a rating of 2. Because Michelle had some excellent ideas on positive changes that could be made and was ready to take some action to improve the situation with her children, we decided that this would be a good place to start.

Michelle's plan for beginning to do things differently with her children included the following: (1) Try to have an evening meal together with children at least four times a week, (2) After dinner, talk with kids about school or the other things that are going on in their lives, (3) Spend some time helping with homework or reading to children each weekday. In the past, Michelle had done many of these things routinely. So, when she spotted the problem and started to do something about it, she began to feel encouraged.

Try to follow Michelle's lead in using problem solving to get started toward recovery. If you can take at least one step in a positive direction now, it should boost your optimism and help prepare you to use the Five Keys to overcome depression.

A Plan for Recovery

This initial effort to solve a few problems is just the beginning of an overall plan for feeling better and getting your life back on track. In the next chapter you will start to build your Personal Plan for Recovery by measuring your symptoms, setting workable goals for improving your life, and figuring out what strengths you have to battle depression. As you read further you will learn about each of the Five Keys and will discover new ways to control your symptoms, solve your problems, and reach your goals.

Sometimes progress can be slow at first, but your efforts should pay off as you put in more time and effort. If you start to feel discouraged along the way, skip ahead to Chapter 6 and read about ways to increase your patience and persistence. Michelle was so upset when she began treatment that she had a hard time staying motivated. Her logical mind told her that she had the ability to make things better for herself, but her sad and anxious emotions kept undermining her confidence. To make herself hang in there even when she wanted to give up, Michelle learned to rely on two of her greatest strengths — her ability to dig in and work hard even when she dreaded the task, and the support of her friends. When she felt like throwing up her hands and giving in to her misery, Michelle called her two best friends to ask for help. They did their best to encourage Michelle by reminding her of her usual tenacious spirit and the successes she had in the past. If that didn't work, Michelle told herself, "I've just got to do it. I don't have the luxury of giving up on myself. My kids need me. I have to at least give it a try."

After she overcame depression, we asked Michelle to tell about how she got better. "If you keep working at it, you can find a way to conquer depression. For me, it was learning how to stop thinking so negatively and acting so lost and helpless — and using a medication that really helped. My family and friends were terrific. They stuck by me when I needed them. In the beginning I thought it would be impossible, but I did learn to solve my problems."

Michelle eventually realized that there could be many ways to lead a satisfying life without being married to her husband. Michelle's long-term goal was to get beyond the divorce to reach the point where her life had clear direction and purpose again. She was optimistic that better days would be ahead.

Hope for Getting Your Life Back

What do you think your chances are of getting better? Do you believe that there will be answers to your problems? Do you have a hopeful attitude about the future? Hopefulness can be one of the most significant influences on your progress toward recovery. People with a hopeful view about change are usually willing to try new things. But if you suffer from hopelessness, you may give up too easily or not give good ideas an opportunity to work.

Think for a moment about the effect of hope on your behavior. If you don't believe that any of your efforts are likely to make a difference, how hard will you try to change? On the other hand, would you act differently if you had faith in yourself to get beyond your difficulties, or even reach a higher plane in life? While a positive mental attitude is clearly helpful, it can be hard to come by when you are feeling down. There can be a "vicious cycle" in depression in which you lose your desire to take action. When you do less to get out of your rut, to spend time with those who love you, and to solve your problems, it is easy to become more discouraged about the future. Hopelessness feeds the depression, which slows you down even more.

The way out of depression is just the opposite. A "positive cycle" can develop when you find some reasons for hope, and either change your attitude or change your actions. After you take some positive steps, your mood lifts and your energy starts to return. You'll probably find that it's hard to make yourself feel more hopeful until you have a reason to feel that way. So you will have to take a few steps toward fixing your problems before your optimism returns.

For some people, this positive cycle keeps going even after the depression goes away because they have developed new skills, healthier habits, and better attitudes. These positive life changes help them to be stronger overall than they were before and to find greater meaning and purpose in their lives. Jeff, the teacher described earlier in this chapter, was able to lead a much more fulfilling life after he stopped comparing himself with others and began to pay full attention to family relationships and the other things that really counted for him.

We want to stop now to ask you these very important questions: What gives you hope? What keeps you going? Each of us has a unique response to these questions. But some of the common answers we have heard are: "My family, I would never want to leave them," "I know I can get better," "I really love life when I'm feeling well," "For me... I have lots of things I still want to do," "My faith keeps me going," and "I have a contribution to make in life."

Take some time now to write out answers to these two questions in your notebook. Try to think of as many reasons as you can. You can use the examples above to get you going with ideas. If you have trouble thinking of reasons for hope or what keeps you going, here are some things you can do:

Ways to Stimulate Hope for Recovery

1. Get started — do the problem-solving exercise outlined in this chapter.

2. Learn about the treatment of depression by reading this book or talking with a doctor or therapist — recognize that depression is a common illness that responds very well to therapy.

3. Ask someone you know well about your situation. If they are supportive and tell you that things will get better, try your best to believe them.

4. Remember that depression makes you focus on the negative and sometimes miss the positive. You can fight hopelessness by paying more attention to the positive things that happen in your life. These could be small things like seeing your children smile, finding a good parking space, or taking time to savor a special meal; or bigger things like completing a project, getting a raise, or making a new friend.

As you work through the exercises in the rest of the book, you should be able to identify more reasons to have hope for the future. For most people there are numerous possibilities for coping with difficulties and finding ways to get their lives back. After you write down your current reasons for hope, you can go on to find out more about how the Five Keys can be used to target your problems and find solutions.

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.