When people start Cognitive Behavioural Therapy treatment for depression, low self esteem, or stress, they often start to feel better within the first few sessions. (It’s been widely shown in research studies that many people experience rapid improvement in their problems and feelings when they start CBT).
While people are experiencing this general improvement they usually still have some difficult patches, typically lasting anywhere from a few hours to a few days.
These are some ideas for what to do during those times.
1. Do you understand what triggered the mood dip?
Mood dips usually occur in response to life events. For example, your car fails its warrant, you have an argument with your partner, or someone makes a bitchy comment towards you.
– The triggers may seem minor but minor events can have a lingering impact on mood, especially if the events trigger depressive or low self esteem thinking patterns. For example, if the events seem to confirm to you that you’re a failure, other people are nasty, or a happy future is impossible.
– Mood dips that linger are often caused by two or more minor negative events that occur in succession. A second distressing thing happens before you’ve had a chance to psychologically recover from the first thing.
– Or, mood dips that linger might be caused by a negative life event happening when you’re emotionally vulnerable for some reason. For example, you’ve been sick or your kids have been sick. Or, you’ve been using alcohol or drugs. Or, you’ve had a few especially busy days or days during which you haven’t been able to do your usual self care (e.g. you’ve had some late nights or missed out on your usual exercise).
Understanding that your mood dip is a reaction to something that has happened can help you feel more in control and help you understand that the dip is temporary.
To comprehensively understand what has triggered the dip, ask yourself what went wrong in the days leading up to your mood dip.
Try to understand all the factors that contributed. This article might be helpful in doing that. Its about triggers for unwanted behaviours but there is overlap with triggers for mood dips.
2. Did you use extra self care?
For example, having an early night, going for a long walk to relieve the physical stress/anxiety, phoning or visiting a friend.
3. Did you skip your usual self care?
Did you skip your usual breaks at work? End up eating junk or you went too long without eating? Skip reading the novel you normally like to read in bed? Or skip your usual exercise?
Reinstate your usual self care, even if you don’t manage to do extra.
4. Did you try behaviour that was inconsistent with the thoughts the negative event triggered?
This strategy is very powerful.
For example, if the event triggered failure-related thoughts, did you try behaviour that is inconsistent with the belief that you are a failure?
Behaviour that is inconsistent with the belief that you are a failure could be: continuing on with your recovery plan as usual, without getting derailed with the negative events. For example, if your recovery plan includes that you’ll plan one activity you’ll look forward to each day, then do this despite that you’d rather stay in bed all day and sleep. It could be as simple as visiting the library to find a book you feel excited about reading.
Another example: If the event has triggered a belief that “people are nasty and untrustworthy,” instead of withdrawing from people, break the cycle by
a) spending time with people you can enjoy a casual, enjoyable catchup or phone conversation with, and/or
b) be helpful to someone else just because you can (e.g. go the extra mile to help a customer at work).
5. Did you try getting some perspective on the events?
a) Will whatever has happened matter in a year’s time?
b) If it feels like things keep going wrong for you, ask yourself “What were 3 things that went right today or yesterday?” Ask your partner about 3 things that went right for him/her? This can help break the cycle of your conversations with your partner being too focused on stress and problems.
c) Are other people experiencing life circumstances that are much worse than what you’re going through?
d) What would you like for a really good, supportive and loving friend to say to you right now?
e) Try a balanced thinking strategy.
6. If you have learnt to do thought records in your treatment, now is the time to do one.
Do several thought records if you need to work through more than one hot thought.
Your balanced thoughts should acknowledge real problems but also identify any depressive/low self esteem thinking errors you’ve slipped into (such as mindreading what other people might be thinking, making overly negative predictions about the future based on what has happened, or making overly harsh judgments of yourself or other people).
For each thought record, try to generate at least 2-3 different balanced thoughts and observe which of these is most helpful.
7. Do a pleasure or mastery activity.
Low mood makes thinking narrow, negative and rigid. Therefore its advisable that sometime you are in a good mood, you make a list of possible pleasure and/or mastery activities that you can refer to when your mood is low.
8. If you could “do-over” the current situation, what alternative coping could you have tried? Brainstorm as many ideas as you can.
Is it possible/potentially useful for you to use any of these now?
Or, if you missed the boat this time, difficult experiences can provide learning opportunities and growth.
9. During your next therapy appointment, ask your therapist to discuss and/or practice alternative coping strategies that would’ve avoided or lessened the impact of the mood dip.
For example, you might role play clear communication you could’ve used.
If the low mood is lingering and your next therapy appointment is more than a few days away, then one option is to call to ask for an earlier appointment rather than suffering on your own.
10. I don’t want to be alarmist since this won’t apply to most people reading this article but… If you think you might try to commit suicide and are in need of urgent care then call Psychiatric Emergency Services (use Google, the phonebook or directory assistance to get the number for your local area. Or call your GP, After Hours Medical Clinic or Hospital and request information about what to do in your situation). Be persistent if you are having difficulty getting the help you need.