Depression and

Low Mood
A self help guide
 Page

How can this guide help me? 3

What does research tell us about depression? 3

Signs and symptoms you may experience if you are 4

depressed?

How can I understand these feelings? 5

Can I recognise these gloomy thoughts? 6

What more should I know about gloomy negative thoughts? 7

How can I help myself? 10

Further help 15

Useful organisations 15-17

Useful books 18

References 19

Rate this guide 19

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These are the thoughts of two people who are depressed:

“I feel so alone, I never see my friends now, I guess they have dropped me. They
probably don’t like me – who would? There is no point in making any effort. It doesn’t pay
off... I just hate myself."

“I feel like crying all the time, I am so tired and can’t get interested in anything. In fact I
don’t even get started with jobs I should be doing, I can’t even do basic things that seem
so easy to other people...”

You may have had similar thoughts yourself. Depression is a very common problem and
many people feel low or down in the dumps at times. This is often due to life stresses
such as bereavement, money or housing problems or difficulties in relationships. For some
people the problem becomes much worse and gets in the way of normal life.

How can this guide help me?

It may seem that nothing can be done to help you feel better. But there are things that you
can do to make a difference. There is also further help you can get if the depression does
not seem to be getting any better.

This guide aims to help you cope with depression and begin to get better. The approach is
called Cognitive Behaviour Therapy (CBT). CBT uses methods that have been tried and
tested and found to be effective. It involves looking at the way you think about things and
what you do.

We have included pen and paper exercises in the booklet to help you begin to understand
and begin to deal with depression practically. You should find it helpful to complete these
exercises.

For more general information on depression see our booklet ‘Depression – an

information booklet’.

What does research tell us about depression?

Life is sometimes difficult and we know that factors such as low income, divorce or
relationship problems and loss of work can make people more likely to become depressed.
Research has helped us to understand depression more clearly. We now realise that
thoughts can also play an important role in depression. Changes in feelings may occur
gradually, but the way a person thinks about themselves when they are depressed is very
different from how they thought before. Perhaps you can think about some examples of
depressed thinking in yourself or in someone you know who has depression.

Here are a few examples:

 The successful business man who believes he is on the brink of bankruptcy.
 The caring mother who thinks she has lost interest in her children.
 The clever student who thinks he can’t concentrate and is stupid.
 The hard working man who thinks that he is useless because he has lost his job.
People who are depressed typically have such thoughts and at the time they believe them
to be true. When someone’s thoughts change like this, they also begin to experience
other changes.

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These are some of the signs or symptoms that you may experience if
you are depressed:
Emotions or feelings - (tick if you feel like this)
 Feeling sad, guilty, upset, numb or despairing 
 Losing interest and/or enjoyment in things 
 Crying a lot or unable to cry when a truly sad event occurs 
 Feeling alone even if you are in company 
 Feeling angry and irritable about the slightest thing 

Physical or Bodily Signs

 Tiredness 
 Lack of energy 
 Restlessness 
 Sleep problems 
 Feeling worse at a particular time of day - usually mornings 
 Changes in weight, appetite and eating 

Thoughts
 Losing confidence in yourself 
 Expecting the worst and having negative or gloomy thoughts 
 Thinking that everything seems hopeless 
 Thinking you hate yourself 
 Poor memory or concentration 
 Thoughts of suicide 

Behaviour
 Having difficulty in making decisions 
 Can’t be bothered to do everyday tasks 
 Putting things off 
 Not doing things you used to enjoy 
 Cutting yourself off from other people 

If you have ticked many of these boxes then you may be experiencing low mood or
depression.

When you’re depressed you may believe that you’re helpless and alone in the world; you
often blame yourself for all the shortcomings that you think you have. At the bottom of all
this you feel negative about yourself, about the world and about the future. So you tend to
lose interest in what’s going on around you and you don’t get any satisfaction out of the
things you used to enjoy. It can become hard to make decisions or to carry out little tasks
that you once did with no problem at all.

In Summary
Research now tells us that gloomy thoughts play an important role in depression. When
someone is depressed there are usually changes in the way they feel – their emotions,
how their body reacts, what they think and how they behave.

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How can I understand these feelings?
The way you think about things affects the way you feel, which affects the way you
behave. It is difficult to change the way you feel, but you can change the way you think
and the things you do.

When you are feeling depressed you might have negative thoughts a lot of the time. With
each negative thought the feelings of depression are likely to increase.

Sometimes negative thoughts can stop you from doing the things that you would normally
do. As a result, you may get critical thoughts about being lazy, or irresponsible, which
make you feel even worse. In other words, you get caught up in a vicious cycle.

For example:
Suppose you are walking down the street and you see a friend who appears to ignore you
completely. You might wonder why your friend has turned against you and you feel a little
sad. Later on, you mention the incident to your friend, who tells you that he was
preoccupied at the time and he didn’t even see you. Normally you would feel better and
put what happened out of your mind. But if you’re depressed, you probably believe your
friend has rejected you. You may not even ask him about the incident, and then the
mistake goes uncorrected. If you’re feeling depressed you’re more likely to make mistakes
like this over and over again.

The vicious cycle can look like this:

===Body

Actions

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 Has a similar cycle happened to you? Try and draw it out.

Can I recognise these gloomy thoughts?

When you are feeling low the gloomy thoughts may be so familiar and happen so often to
you that you just accept them as fact.

Gloomy thoughts are often about yourself; for example:

Do you have any gloomy thoughts about other things? - jot them down:
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These thoughts are sometimes about other things such as the world around you or the
future.

For example:

Do you have any gloomy thoughts about yourself? – jot them down:
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What more should I know about these gloomy negative thoughts?

We have given examples of the negative thoughts people have when they are depressed.
It is important to remember that you might still occasionally have some of these sorts of
thoughts when you are not depressed. The difference is that you would generally dismiss
them from your mind. When you are depressed, however, these thoughts are around all
the time. Let's look at these negative thoughts in more detail:

1. Negative thoughts tend to be automatic. They are not actually arrived at on the
basis of reason and logic, they just seem to pop up out of the blue.

2. Often the thoughts are unreasonable, and unrealistic. They serve no purpose. All
they do is make you feel bad and they get in the way of what you really want out of
life. If you think about them carefully, you will probably find that you have jumped to
a conclusion which is not necessarily correct. For example, thinking someone
doesn’t like you because they haven’t phoned recently.

3. Even though these thoughts are unreasonable they probably seem believable and
correct to you at the time.

4. The more you believe and accept negative thoughts, the worse you are likely to
feel. If you allow yourself to get into the grip of these thoughts, you find you are
viewing everything in a negative way.

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When people become depressed their thinking often changes. They may have some of
the following unhelpful thinking styles when they are feeling depressed:

1. Exaggerating the negative

This means we think things are much worse than they really are. For example you make a
small mistake at work and fear that you may be dismissed because of it. In other words
you jump to a gloomy conclusion and believe that it is likely to happen, or you may spend
a long time worrying that you have upset a friend only to find later she didn’t even
remember the comment.

Do you ever exaggerate the negative? Think back over the last two weeks and list:
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2. Overgeneralising
This is when we generalise from one small thing. For example, if one person doesn’t get
on with you, you may think “no one likes me” or if one of your many daily tasks hasn’t been
finished you think “I’ve achieved nothing – nothing has been done”.

In other words from one thing that has happened to you, you draw a negative conclusion
which is much bigger and covers all sorts of things.

Do you ever overgeneralise? Think back over the last two weeks and list examples:
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3. Ignoring the positive
People who are depressed tend to focus their thinking on negative or bad events and
ignore positive or good events. For example, you might have had a game of pool and
missed the shot once, but played well in general. After the game you just think about that
one missed shot and not the rest of the game played well, or you may have many good
friends who you have known for years but you concentrate and worry about one that has
fallen out with you rather than remembering all the other good friendships.

Do you sometimes ignore the positive? Jot down some examples from the last two
weeks:
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4. Taking things personally and being self critical

Often if our mood is low we blame ourselves for anything which goes wrong, even if things
have nothing to do with us in reality. For example, you go into a local shop and the
assistant who knows you is ‘off-hand’, your automatic thought is "she doesn’t like me...
have I done something wrong?”, but the most likely reason is that she’s tired or upset or
has had a ‘bad day’. In this example you have taken the blame personally. You may also
be self critical and put yourself down with thoughts such as “I am an idiot” “I never get
things right”.

Do you sometimes take things personally when they probably have little to do
with you? Are you sometimes self critical? Give some examples from the last two
weeks:
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5. Mindreading
We sometimes believe we know what others are thinking and if our mood is low we may
expect that they are thinking badly of us. For example if a new friend is quiet you may think
“that is because she thinks I am boring”

Do you find that you ‘mindread’? Jot down some examples from the last two weeks:
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In Summary
When people are depressed they often have unhelpful thinking styles, leading to gloomy or
unhelpful thoughts about themselves, the world and the future. They exaggerate the
negative, overgeneralise bad events, ignore positives in their lives, mindread and can take
things personally. It is important to uncover gloomy thoughts and unhelpful thinking styles.

How can I help myself?

So far we have talked about how what we think affects the way we feel. We have looked at
particular ways of thinking which can lead to us getting depressed. In this section we will
look at practical steps to help to overcome depressive feelings and thoughts. Research
evidence tells us that increased activity is very helpful in overcoming depression.

Positive steps
 List things to do
 Mix with people
 Join in activities
 Take exercise
 Do things you enjoy

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1. Making a daily plan
When people are depressed they often don’t feel like doing anything, find it hard to decide
what to do each day and can end up doing very little.

Begin to tackle this by making a list of things you want to do. Then plan out an action list,
start off with the easiest task at first and don’t aim too high. Work through your action list
and tick off what you’ve done. At the end of the day you’ll be able to look back and see
what you’ve achieved. Physical exercise and activity can really help to lift your mood. Try
and build a little in each day. Mixing with friends, family and neighbours can also help.

List some exercise or activities which you could do. This can be as simple as a
brisk walk; or doing a crossword with a member of your family:
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Try to fill in this action plan – continue with similar plans

Mon Tues Wed Thurs Fri Sat Sun

9am - 11am

11am - 1pm

1pm - 3pm

3pm - 5pm

5pm - 7pm

2. Achievements and pleasure

When people are depressed they often forget what they’ve achieved and what they enjoy.
Most people have more things going for them than they are usually aware of. On your
daily action plan write down all events of the day, put a P next to those which have given
you pleasure and an A next to those activities where you felt you achieved something and
did well. Try not to be too modest; people who are depressed tend not to take credit for
their achievements. Try and build some pleasant events into your day each day - treat
yourself, it will help you.

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3. The ABC of changing feelings
Most people who are depressed think their lives are so awful that they have every right to
feel sad. In fact our feelings come from what we think about and how we make sense of
what has happened to us.

Try to think about a recent event which had upset and depressed you. You should be able
to sort out three parts of it:

A. The event.
B. Your thoughts about it.
C. Your feelings about it.

Most people are normally only aware of A and C. Let's look at an example:

Suppose someone at work criticises you for a piece of work you have done.

A. The event – criticism of your work.

B. Your thoughts – what are you thinking about? You may need to
concentrate to discover this.

C. Your feelings – hurt, embarrassed.

How depressing! No wonder you feel bad! The important point about trying to become
aware of these three stages A, B and C is that we can change what we think about an
event and therefore we can change how we feel about it.

4. Balancing
A useful technique to try is called balancing. When you have a negative, critical thought,
balance it out by making a more accurate and positive statement to yourself. For example:

The thought: “I’m no good at my job”, could be balanced with: “my boss said how much he
appreciated the piece of work I did yesterday”.

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5. The double column technique
Another thing you could do is write down your negative automatic thoughts in one column
– and, opposite each one, write down a more balanced positive thought. Like this:

Negative automatic thought: Balancing thought:

John hasn’t called, he doesn’t like me. He is very busy and thinks I am doing better
than I was last week, so he doesn’t need to
worry about me.

Later, it may be helpful to keep a diary of events, feelings and thoughts.

Try to keep a diary of events, feelings and thoughts. It may look a bit like the table
overleaf. Use the approaches described to gain more balanced thoughts. Look out for
unhelpful thinking styles.

Event Feeling or Thoughts in your Other more balanced

emotion mind thoughts
Example

A neighbour Low and She doesn’t like She’s probably got

ignored me depressed me, no one does. something on her mind – I
am jumping to a conclusion
that she doesn’t like me.
Your example

6. Try and remember details

Research tells us that the person who is depressed doesn’t remember details of events
but tends to think in general statements, such as “I’ve never been any good at anything”.
Try and train yourself to remember specific details so that good times and experiences are
easy to recall. A daily diary can help you to do this. Make lists of actual achievements
and good aspects of yourself such as “I’m always on time”, “I helped my friend on
Tuesday” or “My partner complimented me on my work last week”. Listing past
achievements and pleasurable activities in detail can also be helpful.

In Summary
Using a daily plan, mastery and achievement notes and keeping a diary of automatic
thoughts and more balanced thoughts can help you to fight depression and the gloomy
thoughts that go with it.

7. Solving difficult problems

Sometimes we feel overwhelmed by the very complicated and difficult things we have to
do. One thing which helps with this sort of problem is to write down each of the steps
which you have to take in order to complete the job – then tackle one step at a time.

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Problem solving can seem more difficult when you feel depressed. If you have a
particularly difficult problem, try and look back to times when you may have successfully
solved similar problems and use the same approach. Or ask a friend what they would do in
a similar situation. Be clear. Write down all your possible options. Use ‘brainstorming’–
where even apparently silly solutions are written down to be considered. Choose the best
approach.

Try this way of problem solving yourself.

What is the problem? (write it down – be as specific as possible):
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Try the following:

List all sorts of solutions (brainstorming). Remember how you may have solved
similar problems in the past. What would your friends advise? Or how would you
advise a friend with a similar problem.
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Choose the best of the above. (write it down)

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Steps to tackle it:

Step 1: …………………………………………………………………………………………

Step 2: …………………………………………………………………………………………

Step 3: …………………………………………………………………………………………

Step 4: …………………………………………………………………………………………

Step 5: …………………………………………………………………………………………

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8. Long term beliefs
Sometimes people have long held views about themselves that are very self critical – for
example, “I’m not a very clever person” or “I’m not a very lovable person”. These beliefs
are often a product of our past experience and may hold no truth in present reality. Try to
challenge this self criticism, stop knocking yourself down and look for evidence that
disproves the beliefs. What would you say to a good friend if they held that belief about
themselves?

9. Particularly stressful times

Many people experience a difficult time in their lives which can be linked with events that
they cannot change, for example bereavement, or several bereavements over a short
period, unemployment, longstanding illness, chronic financial problems or isolation.
Sometimes several of these events happen together and depression can result. In time,
most people bounce back, but it may be hard to do this without help.

10. Further help

We hope you will use the exercises suggested in this booklet. They should help you to
begin to overcome your depression and get back in control of your thoughts and your life.

If you feel that you are making little progress then other help is available to aid you in
overcoming your problem.

Your family doctor is the best person to talk to first. They may suggest a talking treatment
or antidepressant tablets or both. They may suggest you see a mental health worker who
can offer expert help with your problems. If you feel so depressed that thoughts of
harming yourself have been in your mind then visit your doctor as soon as possible and
talk about how you are feeling.

Where can I find extra help?

If you think you may be depressed, your GP is the best person to talk to in the first
instance. They will have information about local services which may be able to help. Help
may also be obtained from your practice nurse or health visitor based at your GP practice.

Useful organisations
 Association for Post Natal Illness
Tel: 0207 386 0868
www.apni.org
145 Dawes Road, London, SW6 7EB
For women who are experiencing depression following the birth of their baby.
 Bipolar UK
Tel: 020 7931 6480
www.bipolaruk.org.uk
11 Belgrave Road, London, SW1V 1RB
Works to enable people affected by bipolar disorder to take control of their lives.
 British Association for Counselling and Psychotherapy
Tel: 01455 883 316
www.bacp.co.uk
BACP House, 15 St John’s Business Park, Lutterworth, Leicestershire, LE17 4HB
Offers an information service providing contacts for counselling in England and Wales.

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 British Association for Behavioural and Cognitive Psychotherapies
Tel: 0161 705 4304
www.babcp.com
Imperial House, Hornby Street, Bury, BL9 5BN
The lead organisation for CBT in the UK.
 CRUSE Bereavement Line
Tel: 0844 477 9400
www.crusebereavementcare.org.uk
PO Box 800, Richmond, Surrey, TW9 2RG
Helpline for bereaved people and those caring for bereaved people.
 Depression Alliance
Tel: 0845 123 23 20
www.depressionalliance.org/
20 Great Dover Street, London, SE1 4LX
Information, support and understanding for people who suffer with depression, and for
relatives who want to help. Self-help groups, information, and raising awareness for
depression.
 Depression UK
www.depressionuk.org/
c/o Self Help Nottingham, Ormiston House,
32-36 Pelham Street, Nottingham, NG1 2EG
A national mutual support group for people suffering from depression although does
not provide a helpline.
 Mental Health Matters
Tel: 0191 516 3500
www.mentalhealthmatters.com
Avalon House, St Catherines Court, Sunderland Enterprise Park, Sunderland, SR5 3XJ
A national organisation which provides support and information on employment,
housing, community support and psychological services.
 Mind Infoline
Tel: 0300 123 3393
www.mind.org.uk
15-19 Broadway, Stratford, London, E15 4BQ
Provides information on a range of topics including types of mental distress, where to
get help, drug and alternative treatments and advocacy. Also provides details of help
and support for people in their own area.
Helpline available Mon - Fri, 9am - 5pm.
 NHS Choices – Your health, your choices
www.nhs.uk
Information about conditions, treatments, local services and healthy lives.
 PALS – Patient Advice and Liaison Service
www.pals.nhs.uk
Provides information and advice about local NHS services and support organisations
and helps sort out any problems with NHS services.
 Rethink
Helpline: 0300 500 0927
www.rethink.org
89 Albert Embankment, London, SE1 7TP
Provides information and a helpline for anyone affected by mental health problems.

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 Relate
Tel: 0300 100 1234
www.relate.org.uk
Premier House, Carolina Court, Lakeside, Doncaster, DN4 5RA
Help with marital or relationship problems.
 Samaritans
Tel: 08457 90 90 90
www.samaritans.org
Email:[email protected]
Freepost: RSRB-KKBY-CYJK, Chris, PO Box 9090, Stirling, FK8 2SA
Provides confidential support for anyone in a crisis.
 SANELine
Tel: 0845 767 8000
www.sane.org.uk
1st Floor Cityside House, 40 Adler Street, London, E1 1EE
Offers practical information, crisis care and emotional support. Helpline available 6pm -
11pm (local rate).
 Young Minds
Tel: 020 7089 5050
Suite 11, Baden Place, Crosby Row, London, SE1 1YW
www.youngminds.org.uk/
A national organisation committed to improving the mental health of all children and
young people under 25.

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Useful books
 Feeling good: the new mood therapy
David Burns
HarperCollins 2000
A drug-free guide to curing anxiety, guilt, pessimism, procrastination, low self-esteem,
and other depressive disorders uses scientifically tested methods to improve mood and
stave off the blues.
 Overcoming depression: a guide to recovery with a complete self-help
programme (3rd edition)
Paul Gilbert
Constable and Robinson 2009
A self-help guide using Cognitive Behavioural Techniques, this book is full of step-by-
step suggestions, case examples and practical ideas for gaining control over
depression and low mood.
 Dealing with depression (2nd revised edition)
Kathy Nairne and Gerrilyn Smith
The Women’s Press 1998
This is a practical guide for sufferers of depression and those who know someone who
is depressed. It identifies the causes of depression and the many forms it may take,
explores ways of coping and recovering, and evaluates the help available.
 Depression: the way out of your prison
Dorothy Rowe
Taylor and Francis 2003
Gives us a way of understanding our depression which matches our experience and
which enables us to take charge of our life and change it.
 Mind over mood
Christine Padesky and Dennis Greenberger.
Guilford 1995
Draws on the authors' extensive experience as clinicians and teachers of cognitive
therapy to help clients successfully understand and improve their moods, alter their
behaviour, and enhance their relationships.
 Overcoming depression and low mood: a five areas approach
(3rd revised edition)
Chris Williams
Hodder Education 2012
Overcoming Depression and Low Mood is a series of short self-help workbooks for use
by people experiencing low mood and depression. Developed in liaison with a wide
range of experts, the course provides access to the proven Cognitive Behaviour
Therapy (CBT) approach. Providing accessible information and teaching key life skills
the workbooks provide a practical and effective way of improving how you feel.
 Anxiety and depression: a practical guide to recovery
Robert Priest
Ebury Press 1996
Robert Priest has written this book especially to provide help for those feeling anxious
and depressed. In particular, he covers the practical self-help methods to reduce stress
and offers an explanation of the causes and effects of anxiety and depression.

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References
 Depression: The treatment and management of depression in adults.
NICE clinical guideline 90. National Institute for Health and Clinical Excellence.
October 09
 The six cycles maintenance model; Growing a ‘Vicious Flower’ for depression. Moorey,
S. 2010, Behavioural and Cognitive Psychotherapy. 38 pp 173-184
 Cognitive therapy and the Emotional Disorders. Beck A.T. 1976 New York Guildford
Press
 Overcoming Depression: A self help guide using cognitive behavioural techniques.
Gilbert, P. 2000 Robinson Press.
 Rumination and prospective changes in depressive symptoms. Grassia, M. and Gibb,
B.E. 2008 Journal of social and Clinical Psychology, 27, pp 931-948
 Contemporary behavioural activation treatments for depression: procedures, principles
and progress. Hopko, D.R., Lejuez, C.W., Ruggiero, K.J. and Eifert, G.H. 2003 Clinical
psychology Review, 23, 699-717

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 Support your NHS
Join our NHS Foundation Trust

Northumberland, Tyne and Wear NHS Foundation

Trust provides a range of mental health, learning
disability and specialist services for a large part of the
North East of England and beyond. You may not think
these services have very much to do with you, but
mental health problems affect 1 in 4 people and there
are a growing number of people with both learning and
other disabilities.
As a member of our Foundation Trust you can be as
active as you like, from just receiving regular
information about the trust to getting involved in issues
that you care about. It’s free to join. Please complete
and return the Membership Application Form.

20
Support your NHS
Join our NHS Foundation Trust
Get Involved – Sign up to become a Northumberland, Tyne and Wear
NHS Foundation Trust member and choose a self-help guide for free
from the list overleaf.
 ntw.nhs.uk/getinvolved
 0191 223 2468
 FREEPOST NTW MEMBERSHIP
Membership is completely free and as a member you can:
 Give your views on the Trust’s plans and any issues that interest you
 Vote in the Governor Elections or stand as a Governor yourself
 Receive regular information about the Trust

Membership Application Form

Public  *Service User  *Carer  (please  only one)
*Service User/Carer I currently use or have cared for someone who has
used, the following service in the last four years: (please  service used below)
 Adult  Neuro Disability  Older People’s
 Children and Young People’s
 Learning Disability

Mr  Mrs  Miss  Ms  Other: ……………………………

First name: ………………………….. Surname: ………….…………….
Address:……………………………………………………………………….
Postcode: …….……….………... Date of birth: ……………………………

How would you like us to contact you? (please /complete)

Post  Email  …….…………………………………………………
Tel  …………………………… Mobile  …………………..…….

Signed: ……………………………….....…. Date: ……………….…

Please send me a free copy of=

Free self help guide
(choose from the list overleaf)
21
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Written by Dr Lesley Maunder and Lorna Cameron, Consultant
Clinical Psychologists, The Newcastle upon Tyne Hospitals NHS
Foundation Trust. This guide has been developed from an earlier
manual by Sheila Sharkey and Kevin Gibson.

Many thanks to local voluntary sector groups, service users and

healthcare staff who have contributed to the review of this guide.

Further information about the content, reference sources or

production of this leaflet can be obtained from the Patient Information
Centre.

This information can be made available in a range of formats on

request (eg Braille, audio, larger print, easy read, BSL or other
languages). Please contact the Patient Information Centre
Tel: 0191 223 2545

Published by Northumberland, Tyne and Wear NHS Foundation Trust

2015 Copyright PIC/90/0313 March 2013 V2
Review date 2016

www.ntw.nhs.uk/pic Follow us on Twitter @ntwnhs