I Need Help With Sadness and Low Mood
Norfolk and Suffolk NHS Foundation Trust
CFYP Advice and Signposting
I Need Help With Sadness and Low Mood
Understanding Sadness / Low Mood
Everyone Feels "sad", "low", "down", or like they "can't be bothered" from time to time, and like with all emotions, feeling sad is very normal and very common. However, if you are feeling sad for most of the day and over an extended period, you may find it helpful to look at what you are doing (or not doing) and make changes in your day-to-day life to make you feel better.
Sadness is an important emotion which tells us and others that something is not right, or that something is missing. Sadness can also lead to important changes in our approach to life. It is often after a period of sadness where positive change occurs.
Sadness can affect our thoughts, feelings, body sensations and our behaviours.
Below are some of the changes you may see because of sadness:
Tension or irritability; Things no longer seen fun or interesting; Feelings of guilt; Thoughts about dying or suicide; Tiredness and fatigue; Difficulties focusing on tasks; Changes to sleep and appetite; Feeling worthless or like a failure; Spending more time alone.
What Causes Low Mood?
Life Events
We can feel low for a variety of reasons. This feeling can follow difficult experiences e.g. divorce, somebody dying, bullying, difficulties in the family, health problems, moving school, moving home, friendships or relationships ending. There is often a theme of 'loss' or 'emptiness' associated with such experiences. On the other hand, sometimes low mood can seem like it comes 'out of the blue', for no reason at all.
Behaviours
Low mood can also occur because we stop doing many of the things we used to enjoy e.g. socialising with friends and family and doing hobbies. This creates a 'vicious cycle'. We explain this in more detail later in the booklet, but it refers to the trap that can happen when our lives appear to be boring or meaningless, which in turn reduces our motivation to engage in activities. We gradually do less and less; hiding away from the world. Over time, we start to feel that our life has become unrewarding and unsatisfying, which reinforces the initial thoughts that our lives are boring or meaningless.
Thinking Styles
The way we interpret, or make sense of things, can also lead us to feel sad. This is because how we think affects our emotions. For example, when we are sad, we often think about situations in a very negative way - only seeing the bad things and ignoring the good things. This way of thinking can lead to uncomfortable feelings of sadness, hopelessness and helplessness. When feeling sad, you might find that you think negatively about yourself, the future and the world around you. It might feel like there is no way out. There is... and the first step is to understand why you feel sad, and what's keeping it going...
NOTICING signs of low mood, and what keeps it going...
To improve your mood, you will first need to explore it. This might feel too hard or difficult to try, but you will need to know what you're thinking and feeling, and why, before you can work out how to make positive changes.
Signs of Low Mood
Every day, we experience thousands of thoughts, but we often don't pause for long enough to really notice them. This might be because they are distressing to experience and we don't want to tune in to them, or just because they have been around for so long that you're used to them. To really start to understand the low mood that you're experiencing at the moment, take a look at the common thoughts, feelings and behaviours of low mood below, and see which ones are familiar to you. There is so much variety to human thoughts that there are bound to be ones that we haven't included. Keep a diary for a few days and write down your own.
My Thoughts
“They don't want me there"
"Things will never change"
"I am no fun"
"I will ruin the day"
"I'm a failure" / "I'm going to fail"
"I can't be bothered"
Behaviours (What did I do?)
Stay at home; Spend more time alone; Avoid family / friends; Stop doing things you enjoyed; Don't try new things; Avoid social events; Avoid school / work
Feelings
Sad, low, flat; Tearful upset; Unmotivated; Irritable; Lonely; Miserable.
Physical symptoms
Tired / lethargic / lacking in energy; Change in appetite (eating more, or eating less); Poor concentration; Changes in sleep (sleeping too much, or too little); Forgetfulness.
What Keeps it Going?
Often with low mood we find that we can get ourselves stuck in a 'low mood / sadness trap' where we experience the same thoughts, feelings and behaviours over and over again. Thoughts, feelings and behaviours interact (Greenberger & Padesky, 1995); they trigger each other. So, for example, if you have the thought "No-one likes me", it can trigger a feeling of sadness or rejection. These thoughts and feelings feel uncomfortable and distressing; feelings that humans naturally try to push away. So, in an attempt to feel happier and protect ourselves from feeling rejected, we might start to avoid people, places and activities. In the short term this avoidant behaviour (e.g. avoiding people or ignoring texts) seems to work, as you feel less distressed. However, this relief rarely lasts very long, and in the long term the avoidance keeps you trapped in a vicious cycle of sad or critical thoughts, and sad feelings. Trapped because, if you avoid people, you will never find out if they like you or not.
(Greenberger and Padesky, 1995)
The Low Mood / Sadness Trap
Low Mood is maintained (or 'kept going') in the here and now. That means that how you choose to respond to sad thoughts / feelings as they come up on a day-to-day basis will determine whether or not you stay trapped by low mood/ sadness. The sadder you feel, the less you want to do. As a result, you get less out of life and feel lower in mood. In some cases, this vicious cycle (or 'trap') can make you feel as though you have spiralled down so low that it feels impossible to climb back up again. You may feel hopeless and/ or helplessness, which can make you feel very stuck. There is a way out, though, if you choose to take it.
You can see an example of the ways that sad thoughts, feelings and behaviours interact in the 'Low Mood/ Sadness Trap Example' worksheet. Use the information you gained from the previous page to help you complete the 'My Low Mood/ Sadness Trap' worksheet.
A Low Mood / Sadness Trap Example
Here you can see how the behaviours used to escape the difficult thoughts and feelings give short term relief from them, but in the long term actually keep the person trapped in the sad thoughts and feelings.
Situation: (What was going on): My friend invited me to the cinema
My Thoughts: “They don't want me there" "I am no fun" "I will ruin the day" "No-one likes me"
< - - > My Feelings: Sad, Tearful, Unmotivated, Lonely < - - > Physical symptoms: Tired / lethargic, Poor appetite < - - > Behaviours (What did I do?): Stayed at home, Isolated myself from my friends, Laid in bed - slept and watched Netflix all day. < - - > short term relief from the distress < - - > My Thoughts …
Based on Greenberger and Padesky (1995)
My Sadness Trap worksheet
Fill in the boxes below using the 'Common Thoughts, Feelings and Behaviours of Low Mood' worksheet to help you.
Situation: (What was going on) …
My thoughts: (What was going through your mind?) …
My feelings: (What were you feeling?) …
Physical symptoms: (What was going on in your body?) …
Behaviours: (What did you do? How did you react?) …
How Can I Overcome My Sadness / Low Mood?
Now that you have a better understanding of what triggers your sadness, and how your sad thoughts, feelings and behaviours interact, you are in a stronger position to make changes.
Breaking free from the trap through Behaviour Activation
Our mood can be greatly affected by what we do, when we do it and who we do it with. So, to break out of the sadness / low mood trap, we need to start doing things differently, which in turn will help change how you think and Feel. Doing more of what really matters to you each day can make a big shift in the way you feel, and how you think about yourself and your life.
Changing behaviour is one of the easiest ways to break the vicious cycle, and help you start feeling better and thinking more positively. The basic idea behind behaviour activation is: "the more you do, the better you will feel".
(Jacobson et al 1996; Jacobson, Martell & Dimidjian, 2007). Unfortunately, this won't happen overnight, it can take some time to get going and working but research shows it to be an effective treatment for low mood, so try to stick with it. It may be helpful to ask a trusted friend or family member to gently encourage you, or take part in some of the activities with you. Make sure that you take the lead though; it is important that you choose activities that are enjoyable and meaningful to you.
By reducing the avoidant behaviours that keep you stuck in your sadness / low mood trap (e.g. avoidance, isolation, withdrawal) you can help to increase important and enjoyable activities into your daily routine. By increasing positive activities that are meaningful and important to you, you can make a big shift in the way you feel, and how you think about yourself and your life.
''But I'm already doing loads!''
It is possible to be active and functioning and still feel low. This can happen when your daily activities are things that don't feel important to you, or activities that you feel pushed into doing by others. For example, lots of young people who are low in mood are still able to go to school and work hard, but they are not doing many activities for themselves.
They may have stopped hobbies or interests, or be struggling to maintain personal hygiene or spend time socialising with friends and family.
What comes first? Action or motivation?
We often want to wait to feel better or more motivated before actually doing something. It can feel like a long hill to climb; from the bottom of low mood to the top of an active and rewarding life.
Act first and see how you feel afterwards...
Did you know that increasing activity changes our brain state and can make us feel better right away? For example, exercise can produce 'good chemicals' in the brain that can lift our mood while they are in the bloodstream. Also, the more that we activate, the more situations we find ourselves in that can give us positive experiences. The more positive experiences you have, the more motivated you are to increase activity.
So: Instead of waiting for motivation or a 'good' day to arrive, use the time to plan an activity that matters. That activity is likely to increase motivation, which in turn will encourage you to increase activity even more.
How Do I Activate? Where do I start?
Start by completing the 'Activity Diary' worksheet to help you notice patterns in your mood and how particular activities affect your mood.
Once you have highlighted where you may be getting stuck in the sadness trap in your activity diary (e.g. where you are doing less or doing things that have a negative impact on your mood), the next step it to plan a healthy range of activities which give you a sense of achievement, closeness (to others) and enjoyment. It is important to choose activities which are important to you, have positive meanings, and/ or are Focussed. To help you work out which activities are most likely to bring about positive change for you, it is useful to spend some time thinking about what is meaningful to you, and what your goals are...
What is meaningful activity?
Take a moment to think about things that are important to you and give you a sense of purpose. They are the things that give you a sense of achievement, or things you Feel proud of, or just enjoyable to complete. Meaningful activities are different for different people. Taking time to work out what is important to you can be helpful in choosing and planning activities to schedule in to your week. Take a look at the "Discovering My Meaningful Activities" worksheet to help you think about what is meaningful for you.
How Do I Activate? Where do I start?
Start by completing the 'Activity Diary' worksheet to help you notice patterns in your mood and how particular activities affect your mood.
Once you have highlighted where you may be getting stuck in the sadness trap in your activity diary (e.g. where you are doing less or doing things that have a negative impact on your mood), the next step it to plan a healthy range of activities which give you a sense of achievement, closeness (to others) and enjoyment. It is important to choose activities which are important to you, have positive meanings, and/ or are Focussed. To help you work out which activities are most likely to bring about positive change for you, it is useful to spend some time thinking about what is meaningful to you, and what your goals are...
What is meaningful activity?
Take a moment to think about things that are important to you and give you a sense of purpose. They are the things that give you a sense of achievement, or things you Feel proud of, or just enjoyable to complete. Meaningful activities are different for different people. Taking time to work out what is important to you can be helpful in choosing and planning activities to schedule in to your week. Take a look at the "Discovering My Meaningful Activities" worksheet to help you think about what is meaningful for you.
Activity Diary worksheet
Fill in the activity log below to see how your activity and mood are linked.
Day and Time: Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday
What I did (AM):
What I did (PM):
Mood (0-70) (AM):
Mood (0-70) (PM):
Discovering My Meaningful Activities worksheet
Below are some examples of meaningful activities. Which are important to you?
Hobbies:
Education / Work:
Family:
Physical Health:
Everyday Things:
Friends:
Looking After Myself:
The Bigger Picture:
Important Others:
Getting started with meaningful activities
Now you have established a few things that are meaningful to you, you can now think about which changes you can make in your day to day life. These activities will need to be realistic and achievable. Don't set yourself up to fail! You can always build up your activity over time.
Hobbies: What do you find fun? Enjoy doing? --- > Activity …
--- > Activity …
Now plan an activity into your week which will help you move towards doing more things that are meaningful to you. My target activity this week is...
Activity: ............................................................................................................................................
Day / time I can do this activity: ......................................................................................................
Where I can do the activity: .............................................................................................................
Anything that might get in the way: ................................................................................................
Who can support me to complete the activity: ………….....................................................................
Top Tips
- Start with a Few of the easiest activities.
- Schedule activities on the day and time you could reasonably complete them, for example scheduling a walk when school has finished.
- Consider any barriers and ask someone to support you.
- If you are unable to do an activity on the day or time that you first planned, just cross it out, write the activity that you did that time, and try to reschedule your planned activity.
- You may need to break activities down if they feel too much or overwhelming.
- Remember not to feel discouraged if you aren't able to complete all the activities. Try to continue to move forward with some form of the activity anyway, even if it isn't going as you hoped.
Be Kind to Yourself
Behavioural Activation can be challenging! It is common to run into hurdles or brick walls during the process, and you may have moments when you want to give up. However the only barrier to improvement is giving up completely; if you can achieve something, you have achieved more than nothing.
Remember to reward yourself. Sadness will try to take away or 'down play' your achievements. Notice the "yes but ..." thoughts and self criticisms that might show up, and pay attention to the steps you have taken towards your goals.
Breaking free from the trap by challenging your thoughts
So far, we have focused on how changing your behaviour can help you break free from the sadness trap. Another important aspect to think about alongside this is how unhelpful thoughts keep the sadness trap going. Therefore, this part of the workbook focuses on how you can break out of the sadness trap by looking at how you can challenge unhelpful thoughts.
Early life experiences can lead to us forming negative views about ourselves. These criticisms can be activated by the way we interpret or understand a situation, as opposed to the facts of the situation. Asan example, two people may both experience a low score on a maths test, but have very different interpretations of it. A realistic and open-minded interpretation might be "Oh, I wasn't expecting that, but I guess I didn't do as much revision as I could have", whereas a negative interpretation might be "Great. I should have known I'd get a low mark. I'm so stupid.
I'm never going to get a job." As a result, our thoughts can influence how we feel and behave and can contribute to the vicious cycle of sadness.
Sometimes when we think about a situation, we have negative thoughts that show up right away that make us feel sad or anxious. These thoughts are unhelpful and often make us feel worse about the situation. These are called negative automatic thoughts. Use the 'My Negative Thoughts' worksheet to identify the negative thoughts that you're having and then come up with new, positive thoughts to have instead.
My Negative Thoughts Worksheet
Identify the negative thoughts that you're having and then come up with new, positive thoughts to have instead.
The situation: .........................................................................
These are the thoughts I am having: …………………………………….
These are thoughts I can have instead! ……………………………….
Thinking Traps
Sometimes we find that we can fall into something called a thinking trap. There are various types of thinks traps that we fall into....
All-or-nothing thinking
Seeing everything as black and white. Rn example might be, "I Failed my maths test. I'm rubbish at everything". In other words, if a situation doesn't go exactly to plan, you immediately think it was a Failure. The problem is, life isn't black and white - it's important to be able to see the shades of grey in between.
Replace this with: "Nothing in life is perfect. Even though I didn't pass this test, it doesn't mean I'm a Failure and won’t pass any test ever".
Emotional reasoning
Believing emotions to be evidence of the truth. As we explained before, how you feel is normally closely tied to the way you think. So just because you're feeling rubbish doesn't mean life is rubbish. An example might be, "I Feel useless, therefore I am useless".
Replace this with: "My Feelings are not factual evidence for reality. I can accept all of my Feelings but still move forward".
Mind-reading
Assuming someone is thinking something negative about you, without having any evidence for it i.e. you're jumping to conclusions.
Replace this with: "I can't read minds, there is no way I can be sure of what my friend is thinking".
Thinking Traps
Fortune-telling
Predicting situations with only negative outcomes. An example might be, "I'm definitely going to make a fool of myself in front of class today".
Replace this with: "No one can possibly predict the Future".
Labelling
Wrongly attributing a negative label to either yourself or someone else. An example might be "I'm a failure" instead of saying "I failed the exam".
Replace this with: "No one deserves to be judged".
Overgeneralisation
Whenever something difficult happens you think it's going to happen again. An example might be saying, "why does this always happen to me?". This thinking trap particularly likes words like ‘never’, ‘every’ and ‘always’ so look out For them.
Replace this with: “I'm overgeneralising here. It's very possible that something different will happen next time”.
Personalisation
Wrongfully assuming responsibility for something. An example might be, “"It's all my fault we didn't have pudding because I forgot the ice cream”.
Replace this with: “It's nobody's fault”.
Think Positive
Positive statements encourage us and help us cope through distressing times. We can say these encouraging words to ourselves, and be our own personal coach. We have all survived some very distressing times, and we can use those experiences to encourage us through current difficulties. Examples of coping thoughts are...
• Stop, and breathe, I can do this
• I can learn from this and it will be easier next time
• I can use my coping skills and get through this
• I can be anxious / angry / sad and still deal with this
• I have done this before, and I can do it again
• These are just feelings, they will go away
• I don't need to rush, I can take things slowly
• It's hard, but I can deal with it
• It's okay to feel this way, it's a normal reaction, I am safe
• I am always important
• Thoughts are just thoughts
• Keep calm and carry on
• It's not as terrible as it seems right now
• Even when I don't succeed it doesn't mean I am a failure
• This is difficult and uncomfortable, but it's only temporary
• I am good at some things and not so good at others
• I can Feel bad and still choose to take a new and healthy direction
Challenging your Negative Automatic Thoughts
So far you have had a go at identifying some common negative thoughts you may have, and you have thought about some possible alternatives. You have also explored more information about common thinking traps, and positive statements that can help you to cope when your thoughts and feelings become distressing.
Now take a look at the "Challenging Negative Automatic Thoughts" worksheet, which helps you to bring together what you have learned about unhelpful thoughts. This worksheet will help you to notice when your unhelpful thoughts pop up and how they make you Feel. It then helps you to think about evidence for/against these thoughts and come up with more accurate/balanced alternatives.
Challenging Negative Automatic Thoughts
Fill in the activity log below to see how challenging your thoughts affects your feelings.
Situation (Where? When? What happened? Who with?) ………………………………………………
Unhelpful Thoughts (Rate strength of thought (0-10, What went through my mind? What do I
think will happen?) ………………………………………………………………………………………………………..
Feelings (0-10) (What emotion did you feel? What did you feel in your body?) ……………….
Evidence and Alternatives (Am I falling into a thinking trap? What would someone else say about the situation? What's the worst that could happen? What is the evidence that this thought is/isn't true? Have I confused a thought with a fact?) …………………………………………………………………………..
Balanced Thought (Can you think of a more balanced thought that might be more accurate?) …………
Re-rate strength of thought and feelings (Rate 0-10) ………………………………………………………………………
Sleep Hygiene
Sleep is very important in keeping you healthy and happy, but unfortunately many people struggle with sleeping at some point in their lives. Disrupted sleep is common, especially when your emotions feel difficult to manage. Not getting enough sleep can make it difficult to concentrate during the day and it can impact on way the you feel. Making sure you get enough sleep is therefore really important, so taking some steps to improve this is one of the most important things you can do. It helps to remember that the average person can take up to an hour to get to sleep, and this hour starts again each time you get out of bed.
Top tips for a better sleep
- Go to bed around the same time each day and get up from bed around the same time each day.
- Set up a relaxing bedtime routine to help you 'wind down'. For example: have a bath, read, listen to calming music/a podcast/an audio book. Some people Find listening to the sound of rain or the ocean relaxing. There are also calming apps on the Appstore such as 'CALM' and 'HEADSPACE'.
- Get regular exercise during the day, so you are more physically tired at night.
- Set up a comfortable sleep environment e.g. the temperature of the room is comfortable and the room is dark and quiet.
- Your brain's sleep-wake cycle gets information from light entering your eyes, that's how your brain knows when it is time to be awake, and time to sleep. So, keep your bedroom dark at night, and in the morning, open your curtains and look outside, this helps to wake up your brain. Also, make sure to spend time outside in natural light or inside in bright lights, especially in the late afternoon.
- Keep your Feet and hands warm.
- Go to sleep when you are truly tired.
References
Greenberger, D., Padesky, C. (1995). Mind over mood: Change how you feel by changing the way you think. New York: The Guilford Press.
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Golian, J. K., & Prince , S. E. (1996). A component analysis of cognitive-behavioral treatment for depression. Journal of consulting and clinical psychology, 64(2), 295.
Jacobson , N. S. , Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: science and practice, 8(3), 255-270.