For motivated patients with good insight, I recommend cognitive behavioural therapy for mild to moderate depression and anxiety. It requires a high level of emotional intelligence – awareness of one’s emotional states – and flexible thinking – the ability to look at situations from different perspectives.
To be successful with cognitive behavioural therapy requires some humbleness because one must be able to release one’s attachment to patterns of thought, underlying assumptions and long held core beliefs that perpetuate negative moods.
I recommend to my patients, the book, “Mind Over Mood” by Padesky and Greenberger. I explain to them the concepts of CBT; just as our moods influence our behaviour and our thoughts, our thoughts can shape our moods. Negative thoughts and assumptions about ourselves, the world and the future underlie depressed moods. Catastrophic and “what if?” thinking that exaggerates danger and bad outcomes feed anxiety.
One of the first exercises I recommend from this book is the Activity Record. Each day for a week, you record what you are doing every hour. Beside this, you rate your mood on a numeric scale. This exercise is easier than it sounds. You would take out your single-page Activity Record at lunch time and review what you did and how you felt throughout the morning. You could do the same at dinner and at bedtime.
Before the week is over, most people recognize that their moods vary throughout the week and over the course of each day. Together, we look at patterns. Most people feel more depressed when they watch television and less depressed after vigorous exercise. A phone call can improve or worsen a bad mood depending on what was discussed and with whom one speaks.
Already after one week, you learn that you can influence your mood by how you spend your time. You may choose to spend less time watching television or doing other passive activities that make you feel down. You may spend more time talking with and hanging out with friends who give you a lift – and less time with those who are downers.
In general, when life feels random and out of your control, you will feel anxious. Over time, helplessness leads to hopelessness and depression. The ability to shape your own emotional states without drugs is empowering. It returns the locus of control to you.
Your happiness exercise: Even if you’re not feeling depressed, keep an Activity Record for one day. Pay attention to your moods throughout the day and how they vary depending on what you are doing and whom you are with. At the times you are feeling anxious, angry or sad, what were you thinking? When did you feel happiest? Will these insights shape your choices tomorrow?