Dealing with depression: Dr ABC

This is something you might like to try if you feel you are starting to be dragged down into a low mood. Although you might find it helpful it is not intended to take the place of qualified clinical help if that is what you need. Neither can it take the place of the help and support of friends and loved ones. Just an extra tool in the box. Might even work for those who don't have a diagnosis of depression, just wondering how they can give their mood a boost from time to time.

I developed this methodology some years ago for my own benefit. The method has a simple mnemonic approach: Dr (Doctor) A. B. C. just like the first aid equivalent. In first aid, ABC stands for Airways, Breathing, and Circulation. This means ensuring that the person we are assisting has an airway that is clear, checking to see if the patient is breathing and observing the circulation (pulse or observation of colour and temperature of hands or fingers). The D and R is added to remind the first aid provider, on approaching a situation, to check for any danger and then check for a response from the patient: "Hello! Can you hear me?" Or "Do you need some help?"

DR ABC or Drab-C

Some years ago, when I was having a short series of counselling sessions for moderate depression, my counsellor suggested I develop my own 'first aid' approach to any situation where I was starting to sink into a low mood. This is what I came up with, and it helped a lot at the time.

D = Don't ~ R = Ruminate

A = Actions

B = Behaviours

C = Control

The mnemonic was something I thought up to help me to remember what to do if I needed a quick remedy for a falling mood. This is what it means, and is how I used it.

Don't Ruminate

We all have sleepless nights, worrying about something or other that has happened at work or in our home life. Trying to resolve that tricky unresolvable problem. This worrying that we do often goes around in circles and gets us nowhere. For those who experience any level of mood disorder, this cycle of being tied up in troubling thoughts, in ruminating about them, is never ending. It can lead to periods of mild anxiety or depression just getting worse. We sometimes need to remind ourselves to stop doing it, to put something in place to stop us thinking ourselves into a low, or lower mood. If I felt this happening to me, I tried to move on from the over-thinking, to switch myself into a different mode. This, I remembered, as the A. B. C.

ACTIONS ~ BEHAVIOURS ~ CONTROL

Actions

Don't think, do. That cycle of rumination won't go away by trying to think your way through it. Quit the thinking and act. Don't think about what to do, as you will just end up talking yourself out of it. Just do it. I often rely on a walk to give me a boost. Doesn't matter where and sometimes I just walk out of the front door, and turn left or right. Sometimes I plan where to go, like a local park, garden, or shop. I often walk in a big open space near where I live. It has a lake, with lots of ducks, geese and other birds and I take my pocket-sized binoculars with me. Sometimes I go a little further and walk around a big public cemetery. Oddly, it can be quite calming and cheering to commune with the dead... figuratively of course. Sometimes I just walk to the local shop and buy some necessity that we are running low on, or some treats for the family.

It doesn't matter where I walk, the point is just to get the legs moving, the circulation going, the heart quickening, lift up your chest to breath. Lifting the head is also important. Sometimes, in a low mood, we lower our head, fix our gaze below, rather than looking up at the world, the horizon, the sky. The act of lifting the head, raising the chest and breathing to feed oxygen to the body to provide energy for physical exercise is mood lifting in itself. Try it next time you are feeling down, if you are not sure what I mean.

Other actions could be just getting up and tidying the kitchen, doing the dishes, vacuuming the carpet, mopping the floor, cooking a meal, getting out in the back yard, if you have one, or tending your plants, if you have any. Or perhaps hitting the gym.

Working in a prison, over 12 years ago now, I saw a lot of depression. Not just of the mild, moderate and manageable kind, but depression that took every drop of motivation away from a man, rendering him incapable of the simplest acts of self-care. I think that seeing depression in other men helped me to recognise it in myself, although mine was more the moderate presentation even at the worst of times.

These 'actions' I talk about are as much evident in prison, if not more so, than anywhere else. Being in prison has got to be a depressing influence on even the strongest of person but the activity and engagement in a well-run prison could equally help. And in the prison I worked in, there was no shortage of medical intervention too. That was only half the deal though. Going to work, education, behaviour programs, religious service, collecting meals and socialising with others all added to the 'purposeful activity', as we described it.

Likewise, getting out into the open air, weather permitting, could be a big boost. It surprised me when I first worked in a prison, therefore, that many prisoners declined the opportunity. I recall one man telling me that it gave him too much of a taste of the outside world, which he found unsettling. I remember a time when I was on duty in a part of the prison that was in the lowest level, such that the barred windows looked out at at ground level. It had a bit of a dungeon feel about it. One day, when it was time for early morning exercise, one cell that I opened to ask had a man in it on 'suicide' watch. He refused to go out but, after a lot of persuasion from me, relented, got up and got dressed. His cellmate, also in bed, then popped his head up and said "Oh, if he's going out, I will too." A double success, it seemed. The man I persuaded to go out thanked me later, saying it made him feel much better.

Likewise, I was talking to a young man, one day, who was normally quite cheerful and personable, from an Irish Traveller community. He was in a very low mood and didn't respond much to my poor efforts to get him to do something about it. So I asked him if he had ever been in a bare-knuckle fight, which is something of a tradition among some Travellers. When he said he had, I asked him how he felt after the fight. He smiled when he realised what I was suggesting. Not getting into a fight of course. "I need to get down to the gym, don't I," he told me. The gym (with staff instructors) was a resource we encouraged all men to use when they could. Strenuous physical exercise will often provide a mood boost.

Which is a longwinded way of saying that sport, physical exercise, going to the gym, can be very beneficial for all sorts of reasons. When I asked my doctor about the relative effects of strenuous exercise and a mild dose of antidepressant medication, he had to agree it was about the same. Needless to say, I declined the offer of medication and tried to spend more time practising karate and getting out on walks. Action doesn't have to be hard physical exercise, however, it can be anything that involves movement and doesn't require much thought. If you try different things, you may be surprised at what works best. I never much liked shopping but I found that wondering around a big superstore when I didn't need anything in particular, could have quite a positive effect on my mood.

Behaviour

This is not as simple as the 'A' for Actions. I have included it because I know that there are some things I do that help to boost my mood (actions, particularly those involving exercise) and some things that trigger or worsen a low mood. So the trick here is to avoid doing things that trigger a low mood. I have already mentioned ruminating. If you get into the thinking-about-it-too-much trap, the best course is to go for a walk, or your other best go-to action. We seldom succeed if we try to think our way out of the over-thinking trap.

One other thing that I find often leads me into a downward spiral is having a disagreement with friends, colleagues or love-ones. It might be a small thing or a big thing but just that cooling of the relationship always hurts. And sometimes the disappointment with things not turning out right can produce an exaggerated response. This is one of the common aspects of affective disorder presentation. An exaggerated response to a situation that we all face from time to time. Be it a disappointment, rejection, perhaps even a bereavement. The problematic behaviour is not responding to a disappointment, rejection, or anything else that can be expected to have a negative impact. The problematic behaviour is over-reacting to the negative event. Not sure I can offer any advice as to how to prevent this other than to say that I usually find that either talking about it helps, or trying to put it into perspective. If that doesn't work, I revert back to 'A' for Actions.

I guess the best thing to do is to try to work out for yourself what kind of behaviours trigger a low mood and what can boost your mood. Clearly mood-lowering behaviours should be avoided if possible and to practice mood-boosting behaviours when you can. Here are some things that work for me.

Some mood boosting things I try to do:

Avoid getting cross with people or situations

Try to have positive conversations with strangers

Smile at people more often. A smile returned is a pleasure doubled

Helping others will often help the helper

I like to visit art museums when I can

Cleaning and tidying, organising my life

Learning to let some things go

I am sure there are lots of things you can do, or avoid doing, and would love to read about them in comments.

Control

Control, to me, means the longer-term aim of feeling I can control the mood changes more and not allow the mood to dictate what I do. By using my ABC approach, I think I have gained considerable control over my mood changes. When I first started using this approach, over 10 years ago, I found that I still had mood changes, but the lows were not as low as they had been. I found I could climb out of the dips quicker and more easily.

When it happens now, I tend to focus on the walks, the exercise and activity, and making sure I don't spend too much time alone. I do this without thinking about the DR-ABC. But I keep it there in my back pocket in case I ever need it any time.

I hope you have found something of interest and help in these suggestions. One thing I would say is that if you need help, ask for it. Don't hold yourself back. We all need a helping hand from time to time.

If you try any of these suggestions and they help, please let me know in comments. Likewise if you find the suggestions unhelpful, or if you have your own suggestions to make for dealing with depression.

Thanks for reading.