Overcoming Depression and Low Mood A Five Areas

Approach, Fourth Edition - 4th Edition

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Contents
Introduction ix

Part 1: Understanding why you feel as you do 1

Starting out ... and how to keep going if you feel stuck 3
Understanding why you feel as you do 21

Part 2: Making Changes 45

Practical problem solving 47

Being assertive 73

Building relationships with your family and friends 91

Information for families and friends – how can you offer the best support? 111

Doing things that boost how you feel 135

Using exercise to boost how you feel 161

Helpful things you can do 177

Unhelpful things you do 203

Noticing extreme and unhelpful thinking 235

Changing extreme and unhelpful thinking 257

Overcoming sleep problems 281

Alcohol, drugs and you 303

Understanding and using antidepressant medication 321

Planning for the future 335

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Buying the books in bulk: Bulk copies of the book are available at discounted rates
direct from the publisher and also from www.fiveareas.com

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Introduction
Welcome to the fourth edition of Overcoming Depression and Low Mood: A Five Areas
Approach. It’s been good to hear from so many people who have benefitted from
using this resource. Hopefully, whether you are a practitioner or a member of the
public wanting to use these resources in your own life, you’ll find at least something
that helps.
This book teaches important information about how low mood can affect your life.
It aims to help you work out why you sometimes feel low, anxious, angry or guilty. It
also teaches proven practical skills to help change how you feel.
By using the clearly described practical tools in these workbooks, you can make help-
ful changes to your life.

Who are the workbooks for?

You may be using the workbooks for yourself, or perhaps you are a close friend or
family member wanting to know more about depression and low mood and how
to help. Many healthcare practitioners also use the workbooks and they are widely
used across a range of countries with tens of thousands of people who have benefit-
ted from this approach.
The course can be used by people with problems ranging from mild distress through
to more severe depression. The key thing is that you feel able to use the materials
and want to use this approach.

Using the workbooks

Picking the right time to do the course is important. For example, if your concentra-
tion, energy or motivation levels are far lower than usual, you may find it very hard
to keep your mind on things or to make changes. Other approaches such as anti-
depressant medications may be more appropriate first – or can be used alongside
this approach. If you find that you struggle to use the workbooks, or you feel worse
as you work through them, please discuss this with your doctor or other healthcare
practitioner. The course is not meant to replace getting the right level of support for
more severe mental health problems.

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Introduction

Which workbook should you use first?

There is no right or wrong way to use the workbooks. Many people find it helpful to
first read the two workbooks in Part 1 (Starting out and Understanding why you feel
as you do). This is because these workbooks give you an overview of the approach.
Working through these workbooks will also help you to decide which of the Making
Changes workbooks in Part 2 of the book you should read. You can use as many or as
few workbooks in the course as you wish. You will feel most motivated to try to make
changes if you use the workbooks that tackle problems you have noticed in your life
and that you yourself want to change.
There is no right or wrong choice of workbooks to use, or a set course you must com-
plete. The key to creating change in your life is using the workbooks that address
problems relevant to you, and putting what you learn into practice.

Getting support from others

It can be hard making changes when you feel low. Many people start off trying to
improve things with lots of motivation. But part of feeling low is that it’s easy to
get discouraged or talk ourselves out of change. That’s entirely normal and is very
human. (Think how hard people find it to keep New Year resolutions even when they
aren’t feeling low!).
Time and time again people using resources like this have found the benefits of
working with someone else to support and encourage them when things feel hard.
We therefore suggest that you partner up with someone to help you as you use the
course, for example, a health or social services worker, your doctor, a voluntary sec-
tor worker or a trusted family member or friend.
The amount of support can be quite short – perhaps just 20 to 30 minutes over say
four to six weeks. The important thing is to have someone else there, helping you,
discussing ways of getting round possible blocks to change, and, of course, to say
well done when things move forward.

A word of encouragement
Depression affects lots of people at some time in their lives. Fortunately, it has now
become clear that by changing certain thoughts and behaviour patterns you can
greatly improve how you feel. The content of these workbooks is based on the cog-
nitive behavioural therapy (CBT; a kind of talking treatment) approach. The develop-
ers of CBT have found many effective ways of tackling the common symptoms and
problems people face when feeling low.

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 Introduction

This course is written in a way that clearly explains what to do, so that you can test
the effect of these different suggestions in your own life. The workbooks aim to help
you to regain a sense of control over how you feel.

The course does work

Research has been done involving people who used a previous edition of this book.
The research found that, compared with people receiving usual care for depression,
people using the workbooks with support:

• On average improved far more.

• Felt better and were more active.
• These benefits were present at both four and 12 months later.
The course can make a big difference if you can commit to using it. Having someone
else to encourage you is also important.

International use of this approach

This course is widely used and recommended by professionals across the world.

• It was one of the first 100 recommended books to receive the ABCT (Association
for Behavioral and Cognitive Therapies) seal of approval – a leading North
American organization for Cognitive Behavioural Therapy.

• In the UK, the Overcoming depression and low mood book, and the companion book
Overcoming anxiety: a five areas approach are both named among the 30 books
chosen to be made available in every library across England as part of the national
healthy reading Book Prescription Scheme.

• In Scotland, people can self-refer to receive free copies of the resources with
phone-based support from NHS24 (the NHS Living Life Service).

• In England, the book and companion anxiety book are both recommended as
resources in the Improving Access to Psychological Therapies (IAPT) courses.

• Well over 200,000 people have signed up for free online training using this course.
Overall, many people have been helped by this approach. But can it be useful for
you?

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Introduction

Making a commitment
Sometimes making changes is easier said (or written) than done. All of us feel dis-
couraged and overwhelmed from time to time. This is even more likely in times of
low or anxious mood.
Therefore, I would like to encourage you to try to make a commitment to use this
course and to keep at it even if you feel discouraged or stuck for a time. Set small
goals and aim to move things forward step-by-step by focusing on just one work-
book at a time. Be realistic. Bear in mind your motivation and energy levels so that
you don’t try to do more than you can at one time. This will help you to get as much
from the course as you can at the moment.
The Starting out workbook gives some suggestions of how you can pace things, and
also some suggestions of what to do if you are struggling.

Online resources
Three online resources are available to support users of the course:
1. www.llttf.com (www.livinglifetothefull.com; Twitter @llttfnews). This popu-
lar resource is designed to support readers of this course. There’s also a popular
forum where you can make comments, or ask questions of other people using the
same course.
2. www.llttf.com/shop for resources and books (for members of the public)
3. www.fiveareas.com (Twitter icon @fiveareas for practitioner support and
training). This dedicated site is aimed at practitioners and points to the whole
range of Five Areas resources, including books, handouts, training courses,
translations, accessible versions, and more.

Limited licence to use

Permission is given for limited copying of this book by the purchaser where this is for
use in the normal course of the purchaser’s business within the free-access health-
care industry and within small independent private healthcare clinics in relation to
training and for client consultations. This permission extends to providing copies
of the relevant part or parts of the book to a patient where relevant to a particular
consultation.
This permission does not allow copying or use by other healthcare profession-
als and therefore each practitioner in a clinical service using this book must have
his or her own purchased copy. Nor does this permission extend to any purchaser
working for or within a large commercial organization, including but not limited to
employment assistance programmes, health maintenance companies and insurance

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 Introduction

organizations. Such a purchaser or practitioner is not entitled to copy or otherwise

use the book to assist members of any such organization unless a commercial licence
has been obtained from the publishers.

Training
Training courses for practitioners are available. Contact us at [email protected]
or alternatively visit www.fiveareas.com/training.

Acknowledgments
The illustrations in the workbooks have been produced by Keith Chan, kchan75@
hotmail.com.
The terms LLTTF and Five Areas are registered trademarks of Five Areas Resources
Ltd. The Planner and Review sheets, and Plan, Do, Review model are reproduced from
the Living Life to the Full course courtesy of Five Areas Resources Ltd© (2009–2013).
It’s likely you’ll find some parts of the course help more, and others less. If you have
comments or suggested changes please do let me know via feedback@fiveareas.
com and this really helps shape future content.
Finally, I hope the course proves helpful.

Dr Chris Williams
MBChB BSc MMedSc MD FRCPsych Hon Fellow BABCP
January 2014

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 Part 1
Understanding why
you feel as you do
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 Starting out ... and how to
keep going if you feel stuck

www.llttf.com or www.livinglifetothefull.com @llttfnews (public)

www.fiveareas.com @fiveareas (practitioners)

www.llttf.com/facebook

Dr Chris Williams

overcoming
depression and low mood
a five areas approach
Overcoming Anxiety, Stress and Panic © Dr Chris Williams 2015 3