Session 6: Depression Management
I. Review of Homework – Scheduling Fun Activities
II. Three Models of Depression
III. Self-Talk
IV. Strategies for Facilitating New Ways of Thinking
V. Homework – Thought Stopping Exercise
Reframing Worksheet
VI. Relaxation Technique – Rapid Induction Technique
Session 6: Depression Management
I. Review of Homework – Scheduling Fun Activities:
II. Three Models of Depression:
A. Biological Model: Depression due to changes in the body.
Biological Treatments:
1. Antidepressants are often used to replace low levels of serotonin, a substance found in the body that influences pain, sleep, and depression.

2. Exercise increases levels of endorphins in the body (chemical which helps fight pain and depression).
Behavioral Treatments:
Is based on the theory that the more we engage in pleasurable activities, the happier we will be.
C. Cognitive Model: Depression due to irrational thinking.
The rest of the session will be based on treatments generally from the cognitive model:

· All models can be going on at once.
· Treatments based on all of them have been demonstrated to be effective.
· Makes sense to implement the ones that fit you best and be open to trying several approaches.
III. Self-Talk
People talk to themselves all day with little awareness of it and it’s influence on anxiety, stress, and self-esteem. Self-talk is automatic and is carried out repeatedly.

When people are not sure why something is the way it is they start looking outside themselves for their unhappiness or other form of emotional distress. They have the impression that what is happening around them is what “makes” them feel the way they do. While it is likely that peoples thoughts and interpretations about a situation cause an emotional response.
Situation or
Emotional Response
Therefore, what a person thinks about a situation is likely the greatest factor influencing how they feel and respond. Each person has the choice to change the way they interpret and think about events.

Most people who engage in negative self-talk have been doing it for a long time and this internal negative self-talk often becomes a part of a person’s identity. The following is a list of common thinking distortions:
· All-or-Nothing Thinking. You see things in black or white categories. If your performance falls short of perfect, you see yourself as a total failure.

· Overgeneralization. You see a single negative event as a never-ending pattern of defeat.

· Mental Filter. You pick a single negative detail and dwell on it exclusively to that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.

· Disqualifying the Positive. You reject positive experiences by insisting that they don’t count for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

· Jumping into Conclusions. You make a negative interpretation even though there are no definite facts that convincingly support your conclusion.

A. Mind Reading - You arbitrarily conclude that someone is reacting negatively to you, and you don’t bother to check it out.

B. The Fortune Telling Error – You anticipate that things will turn out badly, and you will feel convinced that your prediction is an already an established fact.

· Magnification, Catastrophizing, or Minimization. You exaggerate the importance of things (such as failure, falling short of the mark, or someone else’s achievement), or you inappropriately shrink things until they appear tiny (your good and desirable qualities or someone else’s limitations).

· Emotional Reasoning. You assume that your negative emotions necessarily reflect the way things really are, “I feel it so it must be true.” · Should Statements. You try to motivate yourself with shoulds and shouldn’ts, as if you had to be whipped and punished before you could accomplish anything. “Musts” and “oughts” also fall into this faulty-thinking category.

· Labeling and Mislabeling. This is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself, “I am a loser.” Mislabeling involves describing an event with language that is highly colored and emotional loaded.

· Personalization. You see yourself as the cause of some problem, or take on someone’s opinion as having more value than it does.
IV. Strategies for Facilitating New Ways of Thinking:
Thought Stopping
Thought stopping involves concentrating on the unwanted thoughts, and after a short time, suddenly stopping and emptying the thoughts from your mind. The command “stop” or a loud noise is generally used to interrupt the unwanted or unpleasant thoughts.
Thought stopping is recommended when the problem is primarily cognitive. Specifically, when specific thoughts or images are repeatedly experienced as painful or leading to unpleasant emotional states.
The way we interpret situations or experiences is linked to irrational beliefs or negative self-talk. Reframing is a technique used to modify or change your view of a problem or a behavior. Reframing is accomplished by looking at problems, situations, or behaviors in a different manner.
V. Homework – Thought Stopping Exercise and Reframing Worksheet
The group leader should pass out the handouts entitled Thought Stopping Exercise and Reframing Worksheet. Handouts are located in Appendix ___. The group leader should go over both handouts with group members. He or she should also offer to answer any questions the group members might have.
List some negative statements that you tell yourself. For example, “I am not good enough or I will be devastated if I am not accepted.” Then identify which of the cognitive distortions listed above apply to the statements.

1. _________________________________________________________________________________

2. _________________________________________________________________________________

3. _________________________________________________________________________________

4. _________________________________________________________________________________

5. _________________________________________________________________________________

Johnson, S. L. (1997), Therapist’s Guide to Clinical Intervention The 1-2-3’s of Treatment Planning. San Diego, CA: Academic Press.
VI. Homework: Reframing Worksheet
VI. Relaxation Technique
Death of a Painkiller?
2009-12-22 15:37:24

When an advisory panel to the Food and Drug Administration (FDA) recommended a ban on acetaminophen-containing pain relievers in June 2009, the response was quick and angry. We were deluged with consumer calls, says FDA spokeswoman Karen Riley. Why the outcry? The panel had suggested that the FDA remove acetaminophen from all prescription drugs, including Percocet and Vicodin, two of the most popular painkillers in the world. The panel also advised lowering the amount of acetaminophen in over-the-counter medications like Tylenol from 500 milligrams to 325, which would cap the maximum daily dose at 2,600 milligrams. The reason: Every year, about 400 Americans die and 42,000 more visit the ER because of acetaminophen overdoses, which can lead to liver damage.

The Sound of Music Eases Pain
2009-12-22 14:55:35
Researchers at Glasgow Caledonian University in Scotland found that people who were listening to their favorite music felt less pain and could stand pain for a longer period.
Running Barefoot Eases Pain
2009-12-22 14:54:49
Scientists have found that those who run barefoot, or in minimal footwear, have a very different stride from their shoe-wearing peers. The sneaker-less tend to avoid "heel-striking," and instead land on the ball of the foot or the middle of the foot. By landing on the middle or front of the foot, barefoot runners have almost no impact collision, much less than most shod runners generate when they heel-strike.