Am I missing something? Treatment Goals and Plans

Hi Starra I was waiting to give others a chance (I feel like I'm talking too much) but if you're going to get impatient :)... In one sense, yes, it is that easy: you define your goals and a treatment plan per goal, and then you put it into action. Fill out your Activity Schedule and do one or two Pleasant Activities a day and you're done. For this week. Whether you work on your goals one at a time or a few (or all) at a time is really up to what's most practical and works best for you. You'll get more homework from each session and each session builds on the previous ones, so you can't really skip through and still get full benefit from the program. It may seem slow at first, particularly if you're familiar with CBT and/or have been through other forms of therapy, but bear with it and the challenges will come. I suppose that my next question to you is (and I say this kindly -- it's hard to evoke tone online), if it's so easy to get to where you want to be, why aren't you there already? Just wondering if you are underestimating how much emotional energy it can take to do a few seeming simple things. If your work and the daily aftermath of it is what's holding you back, you may want to consider whether or not the goals that you have set are relevant enough to your current state of mind. Personally, and I know that you didn't ask this but I'll throw in my opinion anyway, I think that your goals are great. Ultimately, something in your worklife needs to change significantly, and that can be pretty daunting for most people. So looking after yourself and your relationship/s first is easier (you're control in these areas is usually greater) and of greater priority. If your job is gone, you can find another one. Not so easy to regain/repair your health and sense of well-being or your relationship with your husband if they go. Finally, in allowing you to feel success and feel better physically, you'll be able to address your work stuff with greater strength, perspective and judgment. Small goals, big impact. Sounds great. And don't denigrate simple -- simple is good :) Not sure what you mean by not being able to go back and look at the notes, so you may already know this -- in your Session Diary section, under the Your Progress tab, are the notes f

Am I missing something? Treatment Goals and Plans

3-5 goals, a treatment plan for each of them, schedule and do as many pleasant activities as you are able to (at least 2), and your activity schedule. Start working on your treatment plans and toward your goals as soon as you like -- it may take some time to embed the activities into habits. If it works for you, you can count the pleasant activities within your treatment plans as the pleasant activities for your homework. I think the point of scheduling pleasant activities is that many people struggling with depression find it quite difficult to either do or remember to do things that we enjoy. If that's not an issue for you, then don't worry about it. With any structured program for a large group of people, it can be tricky to maintain the structure and yet be flexible enough to account for individual differences from one person to another. Parts that are very meaningful and helpful for one person may be less so for another. You may find it helpful to look at the spirit or intention of the homework rather than the specific detail, and pulling it together into something that works for you :) And my apologies, you're right. The session notes aren't under Your Progress, they are under the Program Reference Tools tab. It can be a bit of a maze at times. Good luck :)

Dealing with the Medical Establishment.

I find that there is a layer still of old-school doctors -- caring perhaps, but dictatorial overall, and refuse to be questioned. Individual differences or the idea that a patient may come to them with some level of intelligence and/or self-awareness just doesn't feature in their view of the world. Patronizing and myopic to the point of dangerous are other descriptors that come to mind. A couple of examples (I have several more, but I'll restrain myself): My father had a stroke. He hated the medication he was being given -- his head felt confused enough already, he said, and he wanted to try alternative therapies. A naturopath suggested ginko biloba, and, though I'd read that it could be helpful for stroke victims, I encouraged him to ask his GP about possible interactions, etc. His GP said that this stuff was all just mumbo-jumbo, but that it wouldn't hurt him so go ahead and take whatever he liked. Dad's stroke was hemorrhagic and ginko is a blood thinner. Thankfully he had a few doctors/specialists that he was seeing, most of whom kept their knowledge up-to-date. A friend suffered a head injury such that she fell unconscious and was taken to hospital. She was discharged five days later with a diagnosis of hysteria and it went into her chart that she was being obstructive to her care. They didn't seem to worry about the fact that she was still vomiting, aphasic (thankfully temporarily), a walked like a drunken sailor. The obstructive bit came in because she was unwilling to sign forms that she could make no sense of (tough questions like: Do you have any metal in your body? she couldn't understand). No cognitive check, no MRI, no follow-up plan. I am astounded at the state of our medical community. One person out of how many have you seen in your years of therapy, etc says you're making it all up because you don't fit into his view of what people struggling with anxiety and depression should be like and what treatment they should respond to? I know that I'm simplifying it and there were no doubt other things that brought him to this conclusion, but it really doesn't seem to me as though he merits much credibility. I'd consider what he said, as there may be some kernels of truth somewhere in it, but please do put it into balance with what every other

Stress...

I have to agree with Ava, Casey. I find it more than a little depressing and de-motivating to think that I am now and forever predisposed to depressive episodes because of permanent changes in brain chemicals, particularly when the suggestion comes alongside the suggestion that we can change the way we think, feel, behave. I don't disagree with the statement that how we feel is related to chemicals in the brain, but the same experts who say this (except for drug companies, but that's another post) also say that the relationship is two-way. And isn't the point of this program to change the way we think and behave in order to change the way we feel, which would then change our brain chemicals in a positive way? I actually believe that I'm building/rebuilding my coping mechanisms and that I will come through this better equipped to deal with life's stressors than many people because of that, and I don't think that that is my ostrich speaking. Technically, we need a certain amount of stress in order to move. We each have a different threshold, though, for when stress moves from positive and motivating to negative and depressing. That threshold is determined by any number of things -- genetics, personality style, life experiences, ways we've learned to cope, how many other stressors we're facing at the time... Our world is becoming more and more stressful and the more we learn about the things that affect our personal thresholds and how to strengthen our ability to cope, deal, let go, the better. I'm reading a book currently called "Perfect Madness -- Motherhood in the Age of Anxiety". As well as being an interesting read, I think it's a great title that can, unfortunately, be applied to much of life these days. "A Tough Climb -- Leadership in the Age of Anxiety"... "Scattered Minds -- Education in the Age of Anxiety"... It's no wonder so many of us are cracking under the pressure. And I don't find it helpful, or accurate, to suggest that once we're cracked, we're broken.

Stress...

Thank you Danielle, for your clarification. From my perspective, however, of all the helpful information that is in this post, the suggestion that one depressive episode puts us at higher risk for another is the one piece that is unhelpful and not entirely true. I'm curious as to why you feel that this is an important point to get across when there is a large and growing amount of evidence to show that people can and do overcome a major depressive episode and never experience another. It doesn't happen without work -- I came across a Jay Leno quip: "They came out with a new weight loss drug this week. Thank God! I was afraid I was going to have to watch my diet and exercise!" -- and hard work at that, but to say that anybody who experiences depression is forever predisposed regardless of the work that they've put in...? That sounds like all-or-nothing thinking to me, or perhaps over-generalization? I think that it's time to bring out a Thought Record and look at the evidence that this is true as compared to the evidence that this is not true, and develop some alternative thoughts that are more in line with the evidence. :)

procrastination/motivation - please help!!

Hi capa -- wow, someone like me. I guess that we're never as unique in our vices as we think. You're going to hate me saying this (how many times have you heard it before?), but I've found the only way I can get myself going is to do one small bit. I choose a small part that I enjoy doing and/or that has a right or wrong element to it, like a chart, diagram, the references, the title page, or I set a small amount of time, say 15 minutes, to work and then somehow convince myself to do it. Often the looming deadline would be stress enough for me to actually write the paper, but if that's past a few times and your profs are being understanding... well I'd be up the creek in that situation. It's as if something inside me wants to know how far I can push these caring people who believe I can do it before they'll give up on me. As if I actually want them to give up on me to confirm my belief that I'll never be good enough. Crazy, eh? Setting deadlines before the actual deadlines or having someone call every day or every few hours to check on progress may help. One time, someone actually stood behind me as I worked to make sure that I didn't stop. Talk about anxiety!!! Ultimately, I suppose, it's challenging that voice inside you that's telling you that you cannot begin. You can, you just don't want to, or are afraid to for whatever reason. You have the strength inside you to resist that tempting voice, to calm that panicked being. You wouldn't be almost finished grad school if you were unable to do the work, so pull out that strength. You know that it doesn't have to be perfect, that you just have to get something -- anything -- in so that they aren't forced to give you zero. Actually, sorry, ultimately it's realizing that this moment you are in is only one in a lifetime of moments. If you're getting to crisis level over this, step away. It's a piece of paper. Yes, it would be good if you could just get it done now, but pay attention to the cost to yourself and your health. (Your doctor may be able to get you a break or a longer extension so that you can find your footing again.) I realize that I'm making it sound very simple when I'm sure there are so many complex issues and expectations tied to your schooling that stepping away for a bit isn't

Feeling Alone and Frustrated

Hi Fluffy Betrayal is a huge thing to deal with! I'm glad that you found this website as well, and glad that you don't feel so alone anymore. There doesn't seem to be much pain or frustration expressed here that someone else doesn't relate to -- sad, but reassuring to know that there are other people who struggle at times as well. For me, the huge anger for the betrayal itself was one thing, but then the deep resentment that the betrayer seemed to be getting off scot-free while I'm left in pain and anguish to pick up the pieces created even more anger, focussed and unfocussed, at the unfairness of the world. Then I would get angry with myself for not being able to just let go of it -- forgive and forget, get on with my life -- as easily as the people around me seem to think I should. There's a theory that depression can result from repressed anger, so I've been trying to figure out constructive ways to release my anger. Talking helps a little; screaming into a pillow helps somewhat; beating up a punching bag helps a lot. I know that taking it up with him isn't going to help at all because what I really want is for him to say he's sorry, show remorse, ask for my forgiveness, and, realistically, that's just not going to happen. I suppose it comes down to keeping in mind that we can't change other people's behaviour, only our own responses to it. Allow yourself to be angry -- you have every right to be so regardless of what your friends and family might say -- and find a way that works for you to get that anger out of you. When you do that, you take back the power you're giving him to hurt you and cause you more pain. If you don't get the anger out, it will seep out anyway and in ways that may not be very positive or constructive. I go to a self-help group as well, and I get a great deal out of the sharing of experiences, empathy and wisdom. I think you're doing the right things to get yourself through this -- just give yourself the time to heal as well.

Why does negative self talk feel comforting?

I'm sorry I've been quiet for so long. It's good to know that other people are getting something from this discussion -- I've certainly gained a lot, both from Ava's insights and from writing my thoughts down. I'll echo Ava in saying thanks for the positive feedback. Is it affirmations that your counselor is getting you do, Chula? I suppose that they're based on the idea that repetition leads to learning, but my inner critic has a heyday with them, too, if they are eons away from my actual beliefs. I think affirmations can work sometimes, but I'm dubious when it comes to the convoluted core beliefs that we've developed, embedded, and fiercely protected over the years because they are our safe place. Perhaps it is that simple: memorize new, positive beliefs to replace the old, wonky ones, but what comes to mind is a double-exposed photo -- the original image is still there, distorting the new image. I like your summary, Ava. I think of it as protecting my inner child, but that may be because I'm a mother. I don't know if you have kids, but the instinct to protect them is the strongest one I have. Do you know, though, as I write this I realize that I don't think I give my inner child as much credit as I do my daughters for strength and resilience. It's my inner child who's world is defined by those core beliefs, and perhaps I've been refusing to really examine them because I don't want to tear apart her world. But as you said earlier, maybe she is more resilient than I think. We all have different analogies that are meaningful -- thanks, Ava, for helping me to frame mine more clearly. I think I can work on my core beliefs now. I'm going to start another thread about belonging and fit, following on from another part of our discussion. You, me, several others here and in another self-help group (face-to-face) that I participate in have mentioned something about being out-of-synch with their environments and I wonder why. Perhaps it will dud, but even so... I'm glad that you got a break from your drill sergeant, Ava. Now you know how you can shut him up!:)

Is it ever enough

Hi Chula So many people here are experiencing a similar lack of understanding from partners, friends and family, myself included, though Im not really sure what would help. As Danielle suggested, encouraging your girlfriend to read up about depression, or even perhaps participate in a support group for families of people with depression may help. If you havent already asked her to help you in small but specific ways to achieve your goals, that may also help. If you want to work out and get fitter, perhaps you could ask her to pull you out for a walk after dinner every evening? Wanting to help someone you care about but not knowing what to do is such a helpless feeling. From some of your other posts, it sounds a bit as though you are pushing her away even though she's the love of your life. I'm just wondering, because I do this, whether or not you are having a hard time accepting her love? If you don't believe yourself to be lovable or deserving of happiness, do you mistrust her love and so you continually "test" it? Perhaps not. It does sound, though, as if she wants to help you but doesn't know how -- help her.:)

breakup in the midst of trying to get better

Hi capa It sounds to me as though you still have your optimism -- sad as you are about the break-up, you still see the opportunity. I think you're absolutely right to focus your energy on getting yourself back on track -- you'll then have more strength to work on mending the relationship. As to what will help at this moment to deal with the additional pain and hurt, I'll echo Danielle: be extra kind to yourself, and allow yourself to feel the loss. Perhaps putting the worry off to the side to deal with later might help as well. Then one small step at a time to get yourself moving forward again. Easy to say, hard to do, but I think you have a good attitude -- that and your optimism will help you through this. Curious