Overcoming Depression: A Step-by-Step Approach to Gaining Control Over Depression

416 Pages·2001·16.78 MB·English

by  Paul Gilbert

Overcoming Depression
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O V E R C O M I NG
D E P R E S S I ON
A Step-by-Step Approach
to Gaining Control over Depression
SECOND EDITION
Paul Gilbert
OXTORD
UNIVERSITY PRESS
2O01
To my family
OXPORD
VNIVERSITY PRESS
Oxford New York
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and associated companies in
Berlin Ibadan
Copyright © 1997,2001 by Paul Gilbert
First published in the UK by Constable & Robinson Ltd.
First issued as an Oxford University Press paperback, 1999
Published by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise,
without the prior permission of Oxford University Press.
Library of Congress Cataloguing-in-Publication Data
Gilbert, Paul.
Overcoming depression: a step-by-step approach
to gaining control over depression / Paul Gilbert.—second ed.
p. cm-
Includes bibliographical references and index.
ISBN 0-19-514311-6
1. Depression, Mental. 2. Cognitive therapy. I. Title.
RC537 .G534 2001
616.85'27—dc21
9 7 5 3 1 0 2 4 6*
Printed in the United States of America
Contents
Acknowledgments vii
Foreword ix
Introduction xiii
Preface to the Revised Edition xvii
Preface to the First Edition xix
PART I: Understanding Depression
1 What is Depression? 3
2 Causes of Depression: Biology and Stress 12
3 Causes of Depression:
How Evolution May Have Shaped Depression 29
4 Causes of Depression:
Early Life, Psychological and Social Aspects 48 ,
PART II: Learning How to Cope
5 Initial Steps 69
6 Thoughts and Feelings 84
7 Challenging Negative Thoughts and Feelings 99
8 Styles of Negative Thinking 121
9 Self-Bullying and How to Challenge it 139
10 Calling Ourselves Names:
How Negative Labels Affect Us 156
11 Further Methods to Challenge
Negative Thoughts 171
PART III: Special Problems Associated with Depression
12 Approval, Subordination and Bullying 187
13 Confronting Shame 210
14 Coping with Guilt and Caring Too Much 234
15 Coping with Anger 263
16 From Anger to Assertiveness and Forgiveness 284
17 Dealing with Frustration, Disappointment
and Lost Ideals 302
18 Perfectionism and Competitiveness,
or How the Secret of Success is the Ability to Fail 320
19 Summing Up 343
Appendix 1: Monitoring
and Challenging Your Thoughts 348
Appendix 2: Quick Guides 355
Appendix 3: Antidepressants 363
Appendix 4: Useful Books and Addresses 369
Index 374
Extra Monitoring Sheets 383
Acknowledgments
Many people have contributed enormously to the writing of
this book. At times depressed people read some chapters and
gave very important feedback and views of their own. Sadly, in
order to protect confidentiality, I cannot name them but my
heart-felt thanks goes out to them. They have saved me from
some insensitivities and obscurities and have helped clarify cer-
tain points. I am also indebted to the many depressed people
who have shared their stories with me and shown me the many
faces of depression.
Many colleagues have, over the years, shared discussions on
treating depression. Steven Allan, my research colleague, needs
special mention for his preparedness to read the whole book and
spend many evenings discussing ideas, and for sharing his thera-
peutic experience. Special thanks also go to Professor M. Perrez
for his encouragement and many helpful comments on the text.
Other colleagues who have read sections include Ken Goss, Liza
Monaghan, Phil Brewin and Mia Gregory. To all these I owe my
thanks.
I also owe my thanks to those who tried to educate me. Profes-
sor Ivy Blackburn started me off in cognitive therapy many years
ago. Dr William Hughes introduced me to psychoanalytic ap-
proaches, Dr E. MacAdam to family therapy and Dr H. Ghadiali
to group therapy from a Jungian perspective. Special thanks go to
Dr John Price who has had a deep impact on my thinking about
depression, especially in regard to some of the theories outlined
here. He has also shared many therapeutic ideas with me. His
theories on depression, put forward in the 19605 and 19705, are
VI1
Overcoming Depression
now gaining research evidence. He deserves credit for being one
of the first to see depression as a state of defeat.
I am forever amazed at the patience of my own family. Jean
7
Hannah and James all allowed me the time to write but also res-
cued me from over-involvement. I have no doubt at all that much
of my current contentment with life resides in their loving sup-
port - not to mention the tea and sympathy.
I would also like to thank Professor Peter Cooper for asking me
to write this book and as editor giving me the freedom to write it as
I saw best. Gratitude also to Mark Crean of Robinson Publishing
for his encouragement and hard work on the manuscript. Special
thanks must go to the original copy-editor, Nancy Duin, who toiled
with my English. Of course, any confusions, bad spellings and
other annoying things are obviously my responsibility. For these I
apologize in advance.
Vlll
Foreword
Many, perhaps the majority, of those who go to see their family
doctor have some type of psychological problem which makes them
anxious or unhappy. There may be a fairly obvious reason for
this - the loneliness of widowhood or the stresses of bringing up a
family - or it may be that their mental state is part of their
personality, something they were born with or a reaction to trau-
matic experiences in their lives. Despite being so common, I soon
discovered after starting in general practice over ten years ago that
this type of mental disturbance (usually described as a neurosis to
distinguish it from the psychosis of those with a serious mental
illness like schizophrenia) is particularly difficult to deal with. What
are the options? Well, there are always drugs - minor tranquillizers,
antidepressants and sleeping pills. It is certainly easy enough to
write a prescription and more often than not the patient feels a lot
better as a result, but there is no getting away from the fact that
drugs are a chemical fix. Sometimes this is all that is necessary to
tide someone over a difficult period, but more usually the same
old problems recur when the drugs are discontinued.
The alternatives to drugs are the 'talking therapies' ranging from
psychoanalysis to counselling that seek to sort out the underlying
cause of anxiety or unhappiness. Psychoanalysis is out of the ques-
tion for many, being too prolonged - often lasting for years - and
too expensive. Counselling certainly can be helpful for no other
reason than that unburdening one's soul to a sympathetic listener
is invariably therapeutic. But once the counselling sessions were
over, I got the impression it was only a matter of time before the
psychological distress reappeared.
IX