Corcoran - Depression Solutions Workbook

Depression is the most common mental illness, afflicting 17 percent of the U.S. population at some point in their lifetimes (Kessler et al. 2003). This figure represents tens of millions of people, so youre not alone. If youve picked up this book, you probably suspect that youre depressed. What are the symptoms?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association (2000), which is the standard resource for mental health diagnosis in the United States, three different disorders represent depressive symptoms: major depressive disorder, dysthymic disorder, and adjustment disorder with depressed mood. Major depressive disorder is a period of two weeks or longer during which a person experiences a depressed mood or loss of interest in nearly all life activities. Dysthymic disorder represents a general personality style featuring symptoms that are similar to, but less intense than, those of major depression. In a given year, 1.5 percent of the adult population will suffer from dysthymic disorder (Kessler et al. 2003). Adjustment disorder with depressed mood represents depressive symptoms that develop from a persons response to an identifiable stressor, such as a divorce, a job loss, or a move. To qualify for this diagnosis, the symptoms must begin within three months of the stressor; they usually dont persist any longer than six months; and the persons job, academic, or social functioning must be temporarily impaired in significant ways. Youll find checklists for symptoms of depression in chapter 1.

What are the consequences of being depressed? You may already experience some of them, and they include:

• Isolation
• Employment problems
• Marital problems
• Parenting problems
• Suicidal thoughts or acts
• Health problems

More specifically, depression can be detrimental to physical health, contributing to lack of movement, more illnesses and doctor visits, and even early death. If you already have a medical illness (and people with illnesses and disability are at increased risk for depression), untreated depression can block recovery as well as your motivation and ability to follow through with prescribed treatment.

Finally, although depression often gets better after one episode, its also common for it to follow a chronic, relapsing, or recurrent course. That is, after one episode of depression, many people go on to have more episodes, even though they may recover in between.

As you can see, depression is a serious problem, and its important to tackle it, rather than wait to see if it will fade on its own. The Depression Solutions Workbook: A Strengths and Skills-Based Approach will help you do just that.

Following is a very brief description of each of the three theoretical approaches underlying The Depression Solutions Workbook: solution-focused therapy, motivational interviewing, and cognitive behavioral therapy. Then Ill show how the workbook is organized.

Solution-Focused Therapy

Solution-focused therapy, developed by Steve de Shazer, Insoo Kim Berg, Michelle Weiner-Davis, and colleagues (1986), focuses on a persons strengths, abilities, and other resources, helping the person discover and build upon these resources.

Twenty years ago, when solution-focused therapy was first developed, this was a revolutionary concept: to work on what the person was doing well, not what was wrong with him. Solution-focused therapy is based on the idea that change can occur rapidly, and that even a small change can lead to a spiral effect. The person takes a step in the right direction, prompting others around him to respond differently, which in turn makes him feel more empowered, encouraging further steps toward change. For example, suppose an older woman with depression motivates herself to get dressed and go for a walk so that the fresh air and exercise might give her more energy. Because shes up and around, she might run into a neighbor who responds in a friendly fashion. Then, feeling slightly better from the walk and social interaction,the woman may feel motivated to make a phone call to a recreation center to find out about local senior activities.

Both behaving differently and thinking differently are part of the processes of change (de Shazer 1994). In solution-focused therapy, people are considered the experts on themselves and are encouraged to find the solutions that are right for them. Discovering their own strengths mobilizes them to apply these strengths to problem situations.

The solution-focused techniques presented in this workbook will help you identify:

• What is working well in your life
• What you do differently during depression-free times
• The strengths youve developed as a result of your mood problems
• How youve managed to cope with hardships

Although you may currently feel hopeless about the future, solution-focused techniques will help you visualize a nondepressed future, which you can then start working toward.

Motivational Interviewing

Motivational interviewing, created by William R. Miller and Stephen Rollnick (2002), is a short-term approach that focuses on building motivation for change. Its rooted in the idea that ambivalence toward changewanting to change but also being stuck in the problemis a natural process. Like solution-focused therapy, motivational interviewing helps you develop hope and vision about the possibility of change. Techniques will focus on helping you see why it might be a good idea to go ahead and make changes, even while still working on identifying some of the reasons why depression might actually be meeting some of your needs. Motivational interviewing techniques in this workbook will help you: