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Bilingual Depression Toolkit for Chinese Americans

Depression In-brief 抑郁概览------------------------------------------------------------------------------------------2 Symptoms and Diagnosis症状诊断 3

1. What is depression? 3 2. Using PHQ-9 for depression screening 3

Depression Etiology抑郁成因-----------------------------------------------------------------------------------------5 1. What causes depression? 5 2. Diagram 5

Depression Treatment 抑郁治疗---------------------------------------------------------------------------------------5 1. How can depression be treated? 5 2. Introduction of medication treatment for depression 5 3. Frequently asked questions about antidepressant medications 6 4. Introduction of psychological counseling for depression Medication 8

Self-care skills for depression 自我护理-----------------------------------------------------------------------------8 1. Reactivating your Life 9 2. Thinking realistically 12 3. Solving problems 15

Healthy lifestyle 健康生活--------------------------------------------------------------------------------------------17 1. Diet 17 2. Physical activity 18 3. Sleep 18 4. Caffeine 19 5. Drugs and Alcohol 20

Useful links 有用链接-------------------------------------------------------------------------------------------------20 1. Toolkits 20 2. Websites 20 3. Organizations and clinics 21

Who are we? 我们是谁------------------------------------------------------------------------------------------------21 1. About us 21 2. Contact us 22

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Depression Toolkit for Chinese Americans (English version)

Part One: Depression In-brief Q: What is depression? A: Depression is a common, treatable medical condition. It is characterized by prolonged periods (more than two weeks) of feeling sad and empty that cause you to not be able to function normally in your daily life. Depression can also further exacerbate other medical conditions and negatively impact your professional and personal life. About 1 in every 10 adults in America suffers from depression. The good news is that there are effective treatments and you can get better. Q: Who is predisposed to depression? A: Although the exact how and why depression occurs is still not clear to scientists, the following factors can predispose you to depression: 1. Family history and genetics 2. Trauma and stress: financial problems, interpersonal relationship issues death of a loved one, new job, relocation, graduations, and other major life changes. 3. Pessimistic personality: low self-esteem, negative thinking, negative outlook on life, etc. 4. Physical health: serious health issues such as heart disease, cancer, AIDS, etc. Depression can also compromise your immune system causing your existing healthy issues to become worse. 5. Other mental health issues: anxiety, eating disorders, psychosis, substance abuse, etc. These illnesses can often take place along with depression. If symptoms of depression do not persist for a long period of time, you might not have clinical depression. To get the appropriate diagnosis you need to consult with a trained professional. Q: How can depression be treated? A: You can recover from all of the symptoms and regain a normal level of functioning in work and personal life. At this time, treatment of depression is primarily through medication. However, if combined with psychotherapy and close contact with trained professionals the combined treatment effect is even better than medication alone. Psychotherapy involves talking to a trained professional about your life and trying to figure out why some of your problems occur. You and your therapist will work together to try and understand how changing certain attitudes, relationships, and behaviors can help alleviate depression. Although depression can resolve itself, this may take a long time and treatment can shorten the duration of symptoms and reduce the chance of relapse. Q: How can I prevent depression from relapsing? A: Here are some suggestions to prevent relapse: 1. Do not stop taking your medication without first consulting with your doctor. 2. Decrease amount of stress in your life. Decrease work load and pressure from everyday life. Remember to find the right balance. 3. Regular exercise is important. Do 30 minutes of aerobic exercise each day. This can improve your blood circulation, strengthen your muscles, and it can also decrease your stress. 4. Get plenty of sleep. Lack of sleep can cause restlessness and anxiety. If your brain and your body get the proper amount of rest, you can decrease the chance of feeling depressed again.

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5. Pleasurable activities are important. Make sure you are outdoors enjoying nature and sunlight. You should also be around other people. Q: How can I help myself with depression? A: Here are some ideas to help with depression: 1. Set realistic goals. Do not place too much pressure and demands on yourself. 2. Break big tasks into smaller ones. Prioritize the small goals and then work on them one by one. You will eventually complete the entire task. 3. Try to be with other people. Learn to trust others. This is better than being alone. 4. Incorporate exercise and other pleasurable activities into your daily life. For example, watch movie, attend community events, and participate in religious practices. 5. Expect your mood will slowly improve with time. Don’t expect that things will get better instantaneously. 6. Let your family and friends help you. Don’t be afraid to ask for help. Part Two: Symptoms and Diagnosis

1. What is depression? Depression is a common, treatable medical condition. It is characterized by prolonged periods (more than two weeks) of feeling sad and empty that cause you to not be able to function normally in your daily life. Depression can also further exacerbate other medical conditions and negatively impact your professional and personal life. About 1 in every 10 adults in America suffers from depression. The good news is that there are effective treatments and you can get better. Symptoms of depression include the following:

• depressed mood (such as feelings of sadness or emptiness) • reduced interest in activities that used to be enjoyed, sleep disturbances (either not being able to

sleep well or sleeping to much) • loss of energy or a significant reduction in energy level • difficulty concentrating, holding a conversation, paying attention, or making decisions that used

to be made fairly easily • suicidal thoughts or intentions.

2. Depression Screening

Patient Health Questionnaire Over the last 2 weeks, how often have you been bothered by any of the following problems: No Several Days More Than

Several Days Almost Daily

0 1 2 3 Little interest or pleasure in doing things Feeling down, depressed, or hopeless Trouble sleeping, or sleeping too much Feeling tired, with little energy. Poor appetite or overeating Feeling bad about yourself Trouble Concentrating Moving or speaking too slowly, or being restless or fidgety

Thoughts that you’d be better off dead or

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thoughts to hurt yourself What’s the meaning of your score?

PHQ-9

Score Provisional Diagnosis Treatment Recommendation

5-9 Minimal Symptoms* Support, educate to call if worse; return in 1 month

10-14 Minor depression++

Dysthymia*

Major depression, mild

Support, watchful waiting

Antidepressant or psychotherapy

Antidepressant or psychotherapy

15-19 Major depression, moderately severe

Antidepressant or psychotherapy

≥ 20 Major depression, severe Antidepressant and psychotherapy (especially if not improved on monotherapy)

* If symptoms present ≥ two years, then probable chronic depression which warrants antidepressants or psychotherapy (ask, "In the past 2 years have you felt depressed or sad most days, even if you felt okay sometimes?").

++ If symptoms present ≥ one month or severe functional impairment, consider active treatment.

A depression diagnosis that warrants treatment or treatment change, needs at least one of the first two questions endorsed as positive (little pleasure, feeling depressed) indicating the symptom has been present more than half the time in the past two weeks. In addition, the tenth question about difficulty at work or home or getting along with others should be answered at least “somewhat difficult.” When a depression diagnosis has been made, patient preferences should be considered, especially when choosing between treatment recommendations of antidepressant treatment and psychotherapy.

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Part Three: Depression Etiology 1. What causes depression?

Doctors and scientists are still working to understand better the reasons depression occurs, but they do know it is often based on a combination of family history, brain chemistry, stressful life events, physical illness, and other potential factors. Depression does not indicate any type of personal weakness or flaw. Like diabetes or high blood pressure, depression is a common and treatable medical condition. Diagram: how depression is developed

This diagram is selected, with approvals, from the Antidepressant Skills Workbook developed by Dr. Dan Bilsker and Dr. Randy Paterson (http://comh.ca/antidepressant-skills/adult/).

Part Four: Depression Treatment The information of this section is selected, with approvals, from MacArthur Initiative Depression Tool Kit (www.depression-primarycare.org/clinicians/toolkits/full/).

1. How can depression be treated? At this time, treatment of depression is primarily through medication. However, if combined with psychotherapy and close contact with trained professionals the combined treatment effect is even better than medication alone. Although depression can resolve itself, this may take a long time and treatment can shorten the duration of symptoms and reduce the chance of relapse. You can recover from all of the symptoms and regain a normal level of functioning in work and personal life. However, relapse is possible, especially for those who lack self-esteem and/or those who are more emotionally sensitive to their environment and life experiences. After treatment, it is important to continue to take good care of your physical and mental health to prevent relapse.

2. Introduction of medication treatment for depression Quick facts about antidepressant medications:

• Antidepressant medications work by helping to correct an imbalance of chemicals in the brain.

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• Antidepressant medications are not addictive or habit forming; they are not uppers; and they are not tranquilizers.

Treating depression with antidepressant medications: Your clinician will consider several factors in selecting an appropriate antidepressant medication for you from the many that are available. Most people respond well to medication. Some antidepressant medications are started a low doses to allow your body time to adapt; your clinician will then gradually increase the dose until you begin to feel better. After about 3-6 weeks of taking antidepressant medications, most people with depression begin to feel more like their usual self. It may take time for you and your clinician to find the medication that works best for you with the least number of side effects. It is very important that you continue to take the medication exactly as the clinician prescribed even if you feel better. For the first 6-8 weeks after you begin treatment, your clinician will want to see you often (possibly every week) to check how much and how often you take the medication, to watch for and address any side effects you may experience, and to see how the medication is working on your depression. If your depression is significantly improved after 12 weeks, you will continue taking the medication for an additional 4-9 months to prevent your depression from returning. People who have had 2 or more previous episodes of depression may need to continue taking their medication for longer periods. What can you do to help your clinician treat your depression with medication?

• Keep all of your appointments. • Speak to your clinician about questions or concerns you have about the medication. • Take the medication exactly as your clinician prescribes. • Tell your clinician immediately about any side effects you have to the medication. • Tell your clinician how the medication is working (e.g. whether you are felling better or

worse). 3. Frequently asked questions about antidepressant medication A. How do antidepressants work? Antidepressants help restore the correct balance of important chemicals (called neurotransmitters) in the brain that affect a person’s mood. B. Are antidepressants addictive? No, absolutely not. Antidepressants are not addictive or habit-forming, and they do not provide a “high”. C. Will I get better if I take the antidepressant? Between 50% and 80% of people with depression recover completely with an adequate trial of medication. If you do not feel better after taking an adequate trial of one antidepressant, there is an excellent change that you will respond more favorably to a different antidepressant. D. How long do antidepressant medications take to work? People with depression usually start to feel better after taking an antidepressant medication for two to six weeks. In many cases, sleep and appetite improve first. It may take a little longer for your mood and energy to improve. If the depression is not improved after about six weeks, your clinician may want to increase the dose of the medication you are taking or switch you to another antidepressant.

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E. How long will I have to take the antidepressant? Once you have completely recovered from your depressive episode, you should stay on the medication for another four to nine months to prevent your depression from returning. Some people who have had previous episodes of depression should stay on antidepressant medication for longer periods of time to prevent new episodes of depression. F. What should I do if I forget to take a dose of the medication? Do not take a double dose to correct for the dose you forgot without asking your clinician. Take your next does at the regular time. G. Should I drink alcohol when I’m taking an antidepressant medication? Alcoholic beverages can produce side effects in some persons taking antidepressants. Therefore, if you intend to have any alcohol-containing drinks while taking antidepressants, it is important you discuss this with your clinician. H. Is it safe to take antidepressants with other medications? In general, antidepressants can be taken safely with other medications. However, it is very important for you to tell your clinician exactly which other medications you are taking (including over-the-counter medications) so s/he can assure that there are no potentially dangerous interactions. I. Can I stop taking the medication once I start feeling better? No. You should not stop taking the medication without first talking with your clinician. If you stop taking the medication too soon, you would be at high risk for having your depression return. In addition, some medications must be stopped gradually to give your body time to adjust. In most cases, you should expect to continue taking the medication for four to nine months after all of your depressive symptoms have gone away. J. My problem is inability to sleep. How can an antidepressant help with this? In many cases, poor sleep is a primary symptom of depression. Once the depression lifts, sleep improves as well. Some antidepressants can help restore normal sleep, even in people who do not have depression. They are advantageous over other sleeping pills in that they are not habit-forming, and they usually do not impair concentration or coordination. K. I have a problem with pain. How can an antidepressant help with this? Some antidepressants have been shown to be successful (even in the absence of major depression) in a number of pain conditions such as diabetic neuropathy, post-herpetic neuralgia, and phantom limb pain. Antidepressants may also help restore normal sleep and “reverse” a vicious cycle of pain and poor sleep. L. I have low energy and feel tired a lot of the time. How can antidepressant help with this? Low energy and fatigue commonly occur in people with depression. Once the depression improves, their energy starts to return as well. Antidepressants can help restore energy in patients who are depressed. With successful treatment, patients will feel less tired and more able to do their usual activities. M. I have a lot of stress in my life. How can an antidepressant help with this? Life stress can cause or worsen the symptoms of depression. The depression can then worsen the impact of stress (such as work stress, family problems, physical disabilities or financial worries) and

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your ability to cope with them. Treating depression can help some patients break out of this vicious circle. N. My problem is anxiety or panic attacks, not depression. How can antidepressants help? In many cases, anxiety is a by-product of depression. Once the depression lifts, the anxiety improves as well. Some antidepressant medications are also among the most effective medical treatments for anxiety disorders, including panic disorder and generalized anxiety disorder. O. Are there any dangerous side effects? Side effects from antidepressants are usually mild. You should ask your clinician what to expect and what to do if you have a problem. In many cases, your body will get used to the medication and you won’t be bothered with the side effect for long. In other cases, your clinician may suggest that you lower the dose, add another medication, or change to another antidepressant. If used properly, there are no dangerous or life-threatening side effects. 4. Introduction of psychological counseling for depression Medication

Quick facts about psychological counseling • In psychological counseling, patients with depression work with a qualified mental health care

specialist (mental health specialist) who listens to them, talks, and helps them correct overly negative thinking and improve their relationships with others.

• Psychological counseling for depression is not talking about your childhood. Treating depression with psychological counseling Psychological counseling has been shown to be just as effective as antidepressant medication in treating many people with depression. Psychological counseling can be done individually (only you and a mental health specialist), in a group (a mental health specialist, you, and other people with similar problems), or it can be family or marriage therapy where a mental health specialist, you and your spouse or family members participate. More than half of people with mild to moderate depression respond well to psychological counseling. While the length of time that persons are involved in counseling differs, people with depression can typically expect to attend a weekly hour-long counseling session for 8-20 weeks. If your depression is not noticeably improved after six to twelve weeks of counseling, this usually means that you need to try a different treatment for your depression. Psychological counseling by itself is not recommended as the only treatment for persons whose depression is more severe. Medication is needed for this type of depression, and it can be taken in combination with psychological counseling. What can you do to help your clinician most effectively treat your depression with psychological counseling?

• Keep all of your appointments with the mental health specialist. • Be honest and open, and ask questions. • Work cooperatively with the mental health specialist (e.g., complete tasks assigned to you are

part of the therapy). • Keep appointments with your primary care clinician and tell him/her how the therapy is working

(e.g., whether your depression is getting better or worse). Part Five: Depression Self-care The information of this section is selected, with approvals, from the Antidepressant Skills Workbook developed by Dr. Dan Bilsker and Dr. Randy Paterson (http://comh.ca/antidepressant-skills/adult/).

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In this section, you will learn three skills that can stop your mood from sliding down, lessen your depression and help prevent it from happening again. The skills are:

1) Reactivating Your Life 2) Thinking Realistically 3) Solving Problems We will explain how each of these skills helps fight depression and show you in a step-by-step way how to use the skill. It’s best to think about these skills the way you would if you were learning a new job or a new sport: practice is very important. Some people find it helpful to share this guide with a spouse, trusted friend, counsellor or family member – this person can help you keep practicing even when you feel low energy or unmotivated. If there’s no one like that, then keep practicing the antidepressant skills. As you work through the skills, it will gradually get easier and the result is worth it. Depression involves all areas of your life: your emotions, thoughts, actions, physical functioning, and life situation (including social support, family relationships, employment, finances, and so on). Each of these areas is connected to all the others. As a result, changes in one area produce changes in the others. When depression first develops, negative changes in one cause the others to get worse as well. But when you are working on getting better, changing one area leads to improvements in the others. The goal of treatment is to get all areas of your life spiraling upward, each producing positive change that improves the others. 1. Reactivating your Life Depression leads to inactivity, but inactivity makes depression worse. What seems like a good coping strategy actually tends to maintain or intensify depression. The solution: don’t wait until you feel like doing more. Waiting actually makes it less likely that you will get better. And don’t wait until you feel motivated – as you get better, you will regain a sense of motivation. Action starts first, motivation kicks in later. Setting goals to increase your activity level is a powerful method for managing depression. The aim is to gradually get yourself moving even though you might not feel like it. These are the steps to gradually reactivating your life. Step 1: Identify activities to increase

There are four main areas in which depressed people often reduce their activity. These are: Involvement with Family & Friends; Personally Rewarding Activities; Self-Care; and Small Duties. In order to identify some goals to work on, take a moment to consider each of these areas. List some activities in each area that have been affected by depression (or that had been neglected even before the depression began) and that could be increased. Personally Rewarding Activities Examples: Reading magazines. Walking in a natural setting. Doing crafts or hobbies. Planning travel. Seeing movies, plays, or games. Increasing your activity in this area will make a difference because: 1. it reminds you of your own interests, the things that are important to you

2. it provides you with badly-needed rewards as your depression starts to lift Self-Care Examples: Getting dressed each day. Taking time to shower and get cleaned up. Exercising. Eating breakfast. Eating more nutritious food. (Lifestyle factors associated with reducing depression are discussed in the information sheets at the back of the book.) Increasing your activity in this area will make a difference because: 1. it will directly enhance your sense of physical well-being 2. it helps remind you that you are a competent person Small Duties Examples: Opening the mail. Paying bills. Housecleaning. Grocery shopping. Running errands. Increasing your activity in this area will make a difference because: 1. it increases your sense of control 2. it reduces tension with others as you begin to take on a share of the work

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Involvement with family and friends Examples: Inviting people to do things. Keeping in contact with people where you used to live. Returning phone calls. Getting out to a social group or class. Increasing your activity in this area will make a difference because: 1. it will help you regain a sense of being connected to others 2. it gives other people the chance to provide reassurance and support 3. it takes you away from being alone and thinking depressing thoughts

Step 2: Choose two of these activities Pick two activities that are most practical for you to begin changing now. Your first two choices should be from different areas.

Step 3: Set realistic goals For each of the activities you have chosen, set a manageable goal for the coming week. Keep in mind that depression makes it difficult to get moving. As a result, you need to set your goals much lower than you ordinarily would. For example, if you would like to start riding a bicycle again, your first goal might be to find your bicycle and see whether it needs any repairs. If you would like to get the house cleaned up, your first goal might be to vacuum one room, or dust one shelf. If you want to socialize with people again, your first goal might be to talk to one friend on the telephone for five minutes To succeed, your goals must be: Specific (Depression can make almost anything seem like a failure. You need to have a very clear idea of your goal so that you will know you have succeeded.) Realistic (You may find it tempting to set your goals based on how much you think you should be able to accomplish. Don’t. Keep in mind that depression slows you down and makes things more difficult. Your goals should be easy enough to be achievable even if you feel very depressed in the coming week. Sometimes it seems overwhelming to think of starting a new activity. In that case, try setting the goal of gathering information related to the activity: for example, finding out what sorts of exercise activities are available in your local community centre.) Scheduled (You should have a clear idea when and how you are going to carry out your activation goal. “Take a walk Thursday evening for 15 minutes” is much better than “Walk more.”) Here is an example: Frank started with two goals: slightly increasing his level of physical activity (from none to one short walk each week) and increasing his level of social activity (from none to going out with his wife and daughter every two weeks). He used his appointment book to write in each of these activities. After he did each activity, he checked it off in his book. Try setting some goals that would be realistic to do this week. Decide how often or for how long you will do the activity, and when you will do it. Now write your goals: Think of your activity goals as appointments with yourself. Treat these goals as respectfully as you would an appointment with your physician. If you must cancel one of these appointments with yourself, reschedule immediately and don’t miss it. Note: Don’t give yourself extra credit for doing more than the goal you set for yourself. If you do more, that’s fine, but that doesn’t allow you to miss the next appointment. If you let that kind of trade-off happen, your goals will soon be neglected.

Step 4: Carry out your goals It’s important to realize that you probably won’t “feel like” doing your activity goals. In depression, your motivation to do things is much less than usual. But if you wait until you feel like it, most likely nothing will happen. Do the activity because you set a goal for yourself and

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because it will help you get better. After you’ve done and checked off each goal, you will see what you’ve accomplished. In the early stages of recovering from depression, it’s likely that you won’t get much enjoyment from your activities, but as you continue to increase your activity level and focus on recovery, you will gradually regain the ability to enjoy activities. You’ll even regain the ability to motivate yourself! If you completed a goal, did you congratulate yourself? If not, do so now. Depression is likely to make you focus on the things you haven’t done, and ignore or downplay your accomplishments. This keeps the depression going, because you will constantly feel like a failure. Deliberately remind yourself of achievements, no matter how small they may seem. “All right, I planned to walk around the block and I did it. Good.” Don’t ignore small victories or think they don’t count. They do, especially during depression. If you find yourself minimizing your own achievement (“but that was such a small thing to do”), remember that completing small goals while depressed is like walking a short distance with a very heavy pack. Meeting goals while depressed is challenging and deserves to be recognized. If you didn’t succeed, what got in the way? What can you do to make the goal easier? Recognize that your goal may have been too ambitious. Try making it smaller for next week, or substitute a different goal. Depressed people often set their goals too high, fail to reach them, and become discouraged. The problem is not that they are lazy, but that they are too eager to get well! Scale back to something you are sure you can do, even if you feel no better this week than you did last week. Washing one dish, making one phone call, opening one bill, walking around one block, or spending five minutes at a hobby: these are all perfectly reasonable goals. As your energy comes back you will be able to do more. But for now, allow yourself to get started slowly.

Step 5: Review your goals After two weeks of doing these goals, review the situation.

• Do you want to increase the goals slightly or keep doing them at the same level until it feels pretty comfortable? It’s your choice.

• This is a good time to add another goal. Pick one from another area. For example, if you had Self-Care and Personally Rewarding Activities goals before, choose one from Involvement with Family & Friends or from Small Duties.

Write the new goal into your schedule along with the 2 continuing goals. Remember, check off the activity goal as you do it and praise yourself for completing it. After two weeks of doing these goals, review the situation again. Are there any goals that were not getting done? What got in the way? Do you need to reduce or change the goal? Keep going! Continue to set your ongoing goals, and consider adding additional goals as your energy permits. If you complete a task (for example, if you have now finished gathering information about recreational activities in your community), then move on to a new goal. Keep using the procedure:

• Set your 3 goals. • Write them in your schedule. • Check off each goal as you do it. • Praise yourself each time. • Review the goals every two weeks to decide if they need modification and whether you are ready

to add a new goal.

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Eventually, you’ll be working on 3-4 goals at a time or maybe more. Don’t get carried away, though: having too many goals can get overwhelming.

2. Thinking realistically Depressive thinking is unrealistic and unfair:

• unrealistic, negative thoughts about your situation; • unrealistic and unfair, negative thoughts about yourself; • unrealistic, negative thoughts about your future.

The aim is to challenge depressive thinking and replace it with realistic thinking. Realistic thinking is:

• accurate about your situation, seeing things clearly as they are; • fair about yourself, looking in a balanced way at the positive and negatives in your life; • accurate about your future, not exaggerating bad outcomes.

That means being fair and realistic about yourself (paying attention to good qualities and strengths as well as problems), about your current situation (weighing the positive and negative aspects of your life accurately) and about your future (not exaggerating the likelihood of very negative outcomes). So, how do you change depressive thinking? Step 1: Learn to identify depressive thoughts Depressive thoughts are unfair and unrealistic. They are distorted because they are inaccurate reflections of how the world is or how you are. The table below describes some common forms of distorted thinking in depression:

• Filtering. In this kind of depressive thinking, you only look at the bad, never the good. Because all you see is the negative side, your whole life appears to be negative. But realistic thinking equally considers positive and negative aspects of your life.

• Overgeneralization. In this kind of depressive thinking, one negative event seems like the start of a never-ending pattern. If one friend leaves, they all will. If you fail the first time, you’ll fail every time. But realistic thinking recognizes that one disappointing situation does not determine how other situations will turn out.

• All or Nothing Thinking. You see the world in terms of extremes. You are either fat or thin, smart or stupid, tidy or a slob, depressed or joyful, and so on. There is no in-between. Gradual progress is never enough because only a complete change will do. “Who cares that I did half of it? It’s still not finished!” But realistic thinking sees people and events as falling somewhere between the extremes, towards the middle, where most things are found.

• Catastrophizing. A small disappointment is seen as though it were a disaster. For example, you were slightly late in completing a small project, so your entire month is ruined: you react to the imagined catastrophe (a terrible month) rather than to the little event (a late project). But realistic thinking sees events in their true importance, not overemphasizing negative events.

• Labeling. You talk to yourself in a harsh way, calling yourself names like “idiot”, “loser”, or whatever the worst insults are for you. You talk to yourself in a way you would never talk to anyone else. But realistic thinking doesn’t use these kind of insults because they are not fair, you wouldn’t talk to anyone else that way, and they are unnecessarily discouraging.

• Mind-reading. You feel as though you know what others are thinking about you, and it’s always negative. So you react to what you imagine they think, without bothering to ask. But realistic thinking recognizes that guessing what others think about you is likely to be inaccurate, especially when you are depressed.

• Fortune-telling. You feel as though you know what the future will bring, and it’s negative. Nothing will work out, so why bother trying? But realistic thinking recognizes that you don’t

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know how things will turn out: by staying open to the possibility of positive results, you’ll be more hopeful and more likely to make things better.

• Perfectionism. It’s only good enough if it’s perfect. And because you can’t make most things perfect, you’re rarely satisfied and can rarely take pride in anything. But realistic thinking gives credit for accomplishments, even if the result is less than perfect. Few of us reach perfection in what we do, but our achievements are meaningful.

• Shoulds. You think that you know how the world should be, and it isn’t like that. You know what you should be like, and you aren’t. Result: You are constantly disappointed and angry with yourself and with everyone around you. But realistic thinking understands the limitations of the world and of yourself — trying for improvement but also accepting how things are.

There are other types of depressive thinking, but these are some of the most common ones. When you catch yourself thinking depressively, it can be useful to look at this list to see if you are using one of them. Step 2: Recognize your own depressive thoughts and how they trigger low mood. Most thinking is so quick and so automatic that we don’t even realize we are doing it. We must learn to become aware of depressive thinking as it occurs. An excellent strategy is to carry around pencil and paper for a week. Although depression can seem like a constant dark cloud, it actually varies over the course of the day. Every time your mood sinks, ask yourself this important question: “What was going through my mind just then?” What were you thinking about? What were you reacting to? Write this down. For example, perhaps getting on the bus one morning you suddenly felt a deepening of the gloom you’ve been feeling. What was going through your mind just then? Perhaps you noticed that everyone on the bus was facing you, and you had the thought that they were judging you negatively. Excellent! Write it down. Keep recording your thoughts until you notice that the same kinds of depressive thinking come up again and again. You might find yourself placing a checkmark beside some of the thoughts you wrote down earlier. “Oh, that one again.” When this happens, you have probably identified the most common kinds of depressive thinking you do. Then what? Some of your depressive thoughts may seem obviously distorted. “Wait, the reason they were facing me on the bus is that I was at the front, not because they wanted to look at what a loser I am!” It can sometimes be enough just to know that your mind generates depressive thinking in certain kinds of situations. Try to become aware of the depressive thinking as it happens and remind yourself where it comes from. “I think this way because my mood is low and because I was a self conscious kid – not because they were all judging me.” You may find that you take the depressive thoughts less seriously once you know where they come from. When you become aware of depressive thoughts you may feel tempted to attack yourself. “How could I think such stupid thoughts?” Depression causes you to be self-critical, and recognizing depressive thinking can give you one more way to beat up on yourself. Don’t. Instead, remind yourself that depressive thoughts are the product of low mood and of your personal history. You are not stupid for having them. They are normal during depression. Step 3: Learn to challenge these depressive thoughts and replace them with fair and realistic ones. Challenging depressive thoughts involves deliberately rethinking the situation that got you upset. To do think you can use a strategy called Challenging Depressive Thoughts. Take a piece of paper and divide it into columns. First, make a brief note of the situation. Some examples: “Talking to daughter,” “Walking to work,” “Planning to make dinner.” Next, write down the negative thoughts that seem related to how you feel. If you like, you can try to classify the type of distortion involved (as shown above).

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Finally, think about the situation and try to come up with a more fair and realistic assessment of the situation. Situation: Friend cancels lunch date.

DEPRESSIVE THOUGHT REALISTIC THOUGHT She doesn’t like me. (Mind-reading) I don’t know why she cancelled; maybe something

urgent came up. It’s only lunch. No one likes me. I’m unlikable. (Overgeneralization)

Some people do seem to like me, so I must be likable.

The world is a cold and rejecting place. (Catastrophizing)

This lunch doesn’t mean much about the world as a whole. I’ve been accepted before.

I’ll always be alone. (Fortune-Telling) I can’t tell the future. One lunch doesn’t mean no one will ever like me.

Hint: Depressive thinking often goes way beyond the facts. Often the fair and realistic thought is simply to remind yourself that you don’t have enough information to know for certain what’s happening. “I don’t know why she cancelled lunch; there might be hundreds of possible reasons.” Calling yourself insulting names like “idiot” will cause you to feel more discouraged; as a result, you may give up on a task. But giving yourself encouragement and fair evaluation is likely to result in trying harder, which increases the odds of a successful outcome. When you’re down or depressed, it’s not easy to come up with fair and realistic thoughts. Here are some questions that will help you do this.

● Can I get more evidence, like asking someone about the situation? ● Would most people agree with this thought? If not, what would be a more realistic thought? ● We are often much more realistic about other people than about ourselves. ● What would I say to a friend in a similar situation? ● What will happen if I continue to think this way? ● What is another way of thinking that is more encouraging or useful?

Now use these questions to come up with more realistic ways of thinking about a situation that upset you. Notice that it usually feels better to think realistic thoughts than depressive thoughts. Step 4: Practice realistic thinking. It’s not enough to come up with a fair and realistic thought just once. Depressive thinking gets repeated over and over, sometimes for years, until it becomes automatic. More balanced thinking will help you to feel better, but it won’t be automatic – at least not for a while. The good news is that changing depressive thinking doesn’t take years: in fact, depressed people often begin to notice emotional differences after only a few weeks of practicing this antidepressant skill. Certain kinds of situations can really trigger depressive thinking. Situations likely to trigger depressive thinking might include meeting with your boss, attending a social gathering with people you don’t know well, or having a disagreement with a family member. In order to get the greatest benefit from this approach, you must catch yourself in situations that normally trigger depressive thoughts for you. When you find yourself in these situations, deliberately rehearse your fair and realistic thinking. Don’t assume that it will happen on its own. You will have to tell yourself how to look at the situation, just as you might give advice or encouragement to a friend. Talk back to the depressive thinking. Don’t allow depressive thinking to happen without replying to it. Every time you talk back, you make the depressive thinking weaker and the realistic thinking stronger. But it takes time before realistic thoughts have more influence over you than depressive ones.

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You will probably find that, for the first while, the realistic thinking sounds false to you. For example: you’ve been thinking in a perfectionistic way about your work, telling yourself that “my work has to be 100% or else it’s worthless,” but you are given very little time to complete each task, so you often feel like a failure. You realize that this is unrealistic thinking and come up with the fair and realistic thought that “ achieving 80% is acceptable in this job, given the time I have; that’s all anyone else accomplishes.” At first, this realistic thought will seem false, as though you are just fooling yourself. Only with time and repetition does realistic thinking – the truth – begin to feel true to you. Eventually you will come to accept realistic thoughts. 3. Solving problems Depression is often the result of life problems that have become overwhelming. The strategies for solving them have been ineffective, or may even have made them worse. Why is it that as people get depressed, their ability to solve problems declines? There are several reasons:

• Solving problems takes energy. As depression worsens, the energy level declines. • Everyday problems take a backseat to a bigger problem – the depression itself. Because the

person becomes so concerned about the mood problem, other problems slide and get worse. • Depression causes difficulties in concentration, memory, decision-making ability, and

creativity. Most problem-solving requires all of these skills. Given all of these factors, it is no great surprise that problems don’t get solved and instead pile up. What can be done? First, recognize that your problem-solving ability may not be as good as it usually is. Don’t beat yourself up over this. It is a normal symptom of depression, and it does get better. Then sit down and follow these next steps...

Step 1: Choose a problem The first step in problem solving is to choose a problem. Sometimes, depressed individuals have difficulty identifying specific problems in their lives – they see everything as one huge problem. For them, identifying particular problems worth tackling is quite helpful. It brings them closer to finding realistic answers. One way to identify problems is to pay close attention to how your mood changes through the week. Notice what’s happening when your mood goes down: what were you thinking about; where were you; and what happened just before your mood changed? Changes in your mood can be a helpful guide to show you where the problems are. Some of your problems might be large ones (for example, “I have an eviction notice that comes up next week”) while some are small (“I’m going to need carrots if I want to make that salad tonight”). Other problems are somewhere in between (“There’s a pile of mail on my desk that I haven’t had the courage to look at in over a week”). Choose one of the smaller problems that is happening now. Later, you can move up to larger problems. Try to be specific. For example, “My relationships are a mess” isn’t specific: it’s not clear what the problem is. “My best friend hasn’t called me in a month” is more specific and makes it clear what is going wrong and what you want to change. Step 2: Think of actions to help solve the problem Write down three things you could do to help solve the problem. Consider things you can do that don’t depend on somebody else. Don’t try to decide which one is best: just come up with different actions you might carry out. Don’t worry if you tried something before and it didn’t work – situations change. And don’t worry whether the actions will solve the problem completely – your aim now is to be doing something useful, not to fix the whole problem.

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Here is an example: It was done by Amy, employed as executive secretary to a senior manager. The Problem: My workload is overwhelming – files are piling up in my tray and, even though I work long hours, I keep getting further behind. I’ve told my boss that the workload has been growing quickly, but she doesn’t do anything about it. The whole situation seems out of control and I’m starting to feel pretty depressed. Possible Actions: 1. Just keep going, maybe my boss will notice how overloaded I am and she will get another employee to take over some of the work. 2. March in to my boss’s office and let her know that I’ve had enough, ask her to stop making unreasonable requests. 3. Write down all the jobs that are on my desk, then note which ones are urgent to do today, and which ones need to be done this week, this month or this century. That way, I’ll be focusing my energy on the highest priority tasks and I can plan ahead a little more effectively. Step 3: Compare these actions Consider which of these actions are most likely to help the problem. Look at the advantages and disadvantages of each one. This is what Amy wrote: Action Advantages disadvantages 1. Just keep going

• It’s what I’m used to doing • I won’t get into conflict

• It will probably keep getting worse

• I’ll become even more depressed • If I fall behind much more, I

could get into big trouble

2. Let my boss know that

• I’ll be speaking my mind • My boss might fix the situation

• I don’t enjoy confronting people • My boss might get angry with

me for being so direct, and this might become a new problem

3. Prioritize my jobs

• I can catch up with the urgent jobs • That would take some pressure off

so I can look for other solutions • I would feel more in control of the

situation, that would help my mood

• I’ll still need to deal with the workload problem at some point

Step 4: Pick the best one Look over the advantages and disadvantages for each action and decide which one is best (or perhaps least bad). There are no fixed rules for how to make this choice: the only rule is that one of the actions must be chosen so that you can begin. Look over the possibilities, think about the good and bad points of each, then just pick one. It should be an action that takes you at least partway towards a solution. Give yourself a limited time to make this decision so it doesn’t drag on. Remember, if you start to move in one direction and discover that it really doesn’t work, you can try another action. Amy, the overworked secretary, chose her third action, prioritizing her jobs so she could focus on the most urgent ones. Step 5: Make an action plan

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There aren’t very many problems that you will solve completely with just one action. But there might be many actions that will take you partway toward a solution. If you have a financial problem, for example, then perhaps your first action should be to gather the paperwork together so that you can look at it. Just gathering the paper won’t solve the problem, but it will take you closer to a solution than you were before. The important thing is to get started on a solution. Your plan of action should follow four rules:

• Manageable. Even if you don’t feel any better in the coming week than you did last week (even if you feel a little worse), you could do it anyway. It’s better to accomplish a goal that is too small than to fail at an ambitious one. Here’s a bad example: For my first time out, run a marathon. Better example: Walk one block.

• Action-oriented. Make a plan for what you will do, not how you will think or feel while you are doing it. You have a certain amount of control over what you do, but you have less control over your emotions and thoughts. Bad example: Spend a pleasant hour with my children. Better example: Spend one hour with my children.

• Specific. It should be very clear what you need to do. Bad example: Get in shape. Better example: Phone the community centre to find out whether they teach yoga.

• Time-limited. Your plan should take only a short time to carry out. Don’t plan to change your style forever. Bad example: Keep up regular exercise for the rest of my life. Better example: Walk 20 minutes three times a week, review after two months.

Step 6: Evaluate Come back to this section when a week has passed or when you have achieved your goal. What was the outcome? What went right? What went wrong? Depressed mood will tempt you to dwell on failures and on the things you haven’t done, rather than to congratulate yourself on any progress you have made. If you succeeded at your goal, deliberately make yourself think about that success (even though the problem still hasn’t been solved). Step 7: Move On Use this experience to plan your next step. You have three main options: Keep going. Example: Spend another 20 minutes finding the papers. Revise your goal and try again. Example: Cleaning the garage for one hour was too difficult, so plan to work on it for just 10 minutes instead. Take a new approach. Perhaps you learned something useful from your first effort that suggests another way of handling the issue. Example: Talking face to face with Aunt Sarah didn’t work, so write her a letter instead. Keep working on this issue in a step-by-step manner. Record your efforts on paper. Keep reminding yourself about the progress you make. Part Six: Healthy lifestyle The information of this section is selected, with approvals, from the Antidepressant Skills Workbook developed by Dr. Dan Bilsker and Dr. Randy Paterson (http://comh.ca/antidepressant-skills/adult/).

1. Diet Food is the most obvious source of our energy. When we are depressed, however, our diet often suffers. Some people overeat. A more common problem is lack of appetite. If this occurs, it is important to remember that although you may not feel particularly hungry, your body’s need for fuel continues. Here are some tips on keeping up adequate nutrition during difficult times.

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• Eat regular meals. It is usually easiest to eat (and to control what you eat) if you keep to a routine. Try to have three set mealtimes per day. Ensure that you have enough food at home for all three.

• Eat by the clock, not by your stomach. If you have lost your appetite, push yourself to eat at mealtimes anyway. If you have been overeating, try to eat only at mealtimes while sitting at the table.

• Make it easy. The important thing is to eat, not to cook. Buy foods that are easier to prepare (but keep an eye on their nutritional value).

• Make extra. You can cut your preparation time by making larger amounts and refrigerating or freezing certain dishes for reheating later.

• Make it healthy. Stock up on nutritious food and snacks. • Watch your sugar intake. Avoid eating too much refined sugar. Complex carbohydrates are

generally preferable (particularly whole grain products, brown rice, and potatoes). • Avoid dieting. Avoid strict diets, even if you wish to lose weight. It is much better to adopt

healthy (rather than restrictive) eating habits and increase your activity level. Ask your physician for advice before attempting to lose weight.

2. Physical activity Regular physical activity is related to improved mental and physical well-being. Recent research indicates that physically fit people are less vulnerable to depression, and that regular exercise can markedly reduce symptoms of depression for many people. Exercise affects mood in four ways. First, it can produce a brief “runner’s high” just after exercising in some people (during depression this effect may not occur). Second, after a few weeks of regular exercise (three to four times a week, at least 20 minutes at a time), a general improvement in mood tends to begin. Third, improvements in physical fitness are associated with improved energy, which can enable you to do more. Finally, exercise can be a good way of “burning off” stress when you are feeling tense. Here are some tips for developing an exercise program:

• Get a physical. Before starting, ask your physician about any limitations on your activity. • Pick the right activities. The biggest challenge is keeping at it. Pick activities that you really enjoy.

Both aerobic (cardiovascular) exercise (in which your heart rate accelerates into a target range for 20 minutes or more) and anaerobic exercise (such as weight training or yoga) have shown positive effects on mood. Select the type that suits you best. Variety also helps: pick more than one activity and alternate them.

• Stretch and warm up first. Learn how to do stretching exercises properly, then make sure to do them before each exercise session. This can help reduce the likelihood of exercise-related pain or injury.

• Frequency is more important than duration. Regular short periods of exercise (three to four times a week) are better than irregular long periods.

• Focus on enjoyment. People who exercise for enjoyment and challenge seem to show bigger mood improvements than people who exercise mainly to look better. Try to put an emphasis on how you will feel rather than how you want to look.

• Monitor if bipolar. The effect of exercise on bipolar (manic-depressive) mood problems is less clear than for other forms of depression. Strenuous exercise during a manic episode or upswing in mood may aggravate the problem in some cases. Gentler exercise at these times may be preferable.

• Nothing changes overnight. Use goal-setting when developing a fitness program, and be sure to pick something achievable. For example, aim to swim once for five minutes rather than starting off by committing yourself to a daily 70 laps.

3. Sleep

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Stress, anxiety, and depression often disrupt sleep, but this sleep disruption can lead to even more anxiety and depression. In other words, sleep difficulties are a cause and an effect of mood problems. Regardless of which came first, it can be worth the effort to work on getting a good night’s sleep. Here are some tips:

• Avoid over-the-counter sleeping medication. Although it may help you to fall asleep, the type of sleep you get will usually not be as helpful as normal sleep. Instead, take sleeping medication only as directed by your physician. If you do take sleep medication, remember that the mark of its success is how you feel during the day, not whether it actually puts you to sleep. Report the results to your physician.

• Set a standard bed-time and rising time. Your body operates on a 24-hour cycle that can be disrupted by going to bed and getting up at different times. This is what causes jet lag: not the air travel, but the change in sleeping hours. Having regular hours for going to bed and getting up can help to set your internal clock.

• Don’t go to bed too early. If you never get to sleep before 1 a.m., don’t go to bed before 12. Want to get to sleep earlier? Start by setting your bed-time between 30 minutes and an hour before the time you have normally been getting to sleep. Then gradually begin going to bed earlier (by, say, a half-hour a week).

• Save your bedroom for sleep. Avoid associating this area with activities that are inconsistent with sleep – like working, eating, arguing, exercising, using the telephone, watching television, and so on. Sex, though, is fine.

• Create a good sleep environment. The best bedroom temperature for most people is 18° to 21° (65°F to 70°F). If noise is a problem, some options include earplugs, soundproofing the room (cloth hangings can help a bit), and devices that emit white noise (e.g., fans or special noise machines). Eliminate hourly watch beepers or clocks that gong. If a restless bed partner is a problem, consider a larger bed, special mattress, or even twin beds for a time.

• Avoid napping during the day. Unless, that is, you are a great 20-minute napper. Longer daytime naps can disrupt your ability to get to sleep at night.

• Prepare for sleep. Avoid strenuous activity, exercise, heavy meals, and bright light for at least one hour before going to bed.

• Practice breathing or distraction strategies when attempting to get to sleep. Focusing on your worries or on how much you need to get to sleep will only keep you awake. Practice any mental exercise that takes your mind away from these topics. Caffeine

4. Caffeine

Caffeine stimulates the sympathetic nervous system, which governs the stress response. If your depression comes with a lot of anxiety, the last thing you need is a chemical that makes the stress response system more active. Caffeine can also aggravate tension headache, irritable bowel syndrome, chronic pain, and other physical problems. Caffeine is an addictive drug. Heavy users can become psychologically dependent on it, develop tolerance (meaning that more caffeine is needed to get the same effects), and undergo withdrawal if they don’t get it. Withdrawal symptoms include headache, drowsiness, irritability, and difficulty concentrating. Many people discover that they are dependent on caffeine when they go for a day or two without coffee and develop splitting headaches. How much caffeine does it take to become dependent on it? Estimates vary, but 450 milligrams per day is about average. Some people are more sensitive, others less. Use the table below to calculate your average daily consumption. Notice the small serving sizes. Your coffee cup may hold three or four of these! If you decide to try reducing your caffeine intake, do so slowly to avoid the withdrawal symptoms. Drop your intake by about half for 4-6 days, then half of the remainder, then half again until you are drinking no more than 2 cups per day.

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5. Drugs and Alcohol One of the reasons that depressed people use recreational drugs and drink alcohol is that these substances can make them feel better in the short run. But, in the long run, they can make depression worse:

• Problems are avoided rather than dealt with. • Performance at work, at home, and in social situations is impaired. • Psychological and/or physical dependence can develop. • Physical health can be impaired.

During periods of depression, alcohol and drug use may seem particularly tempting. But, at these times, using such substances is a bad idea. Your tolerance for their effects and your ability to control your use may both be lower than usual. The situation usually requires concrete, constructive action rather than a retreat into substance use. As well, drugs and alcohol interact with many prescription medications, including most of the medications prescribed for anxiety and depression. In general, then, it is best to follow these guidelines for a sustaining and sustainable lifestyle:

• Avoid using alcohol or recreational drugs during periods of depression or severe stress. • Avoid using alcohol or recreational drugs if you have a personal or family history of substance

abuse. • Even if you are feeling fine and have no history of abuse, adopt a personal policy to use these

substances only in moderation. The prospect of eliminating alcohol and drug use from your life can be a daunting one. Remember that while using none is best for some people, reducing your intake is better than becoming overwhelmed and giving up. Use the principles of goal-setting to help you examine the problem and overcome it a bit at a time. If your use of drugs or alcohol is altogether out of your control, you are in good company: many people have had this problem. A number of organizations exist that can help you to regain control. Ask your physician for more information. Part Seven: Useful links

1. Toolkits Full MacArthur Initiative Depression Tool Kit

www.depression-primarycare.org/clinicians/toolkits/full/ This tool kit is intended to help primary care physicians diagnosis and manage depression.

Antidepressant Skills Workbook

http://comh.ca/antidepressant-skills/adult/ A tool kit designed for patients to learn methods for self-managing depression.

Managing-depression BC Partners for Mental Health and Addictions Information Depression Tool Kit

www.heretohelp.bc.ca/skills/managing-depression Another tool kit designed for patients to learn methods for self-managing depression.

Bilingual Depression Toolkit for Chinese Americans

2. Websites Index National Institute of Mental Health

www.nimh.nih.gov/health/topics/depression/index.shtml

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Information from NIMH on depression and other mental illnesses. Psyche John Tung Foundation Mental Health Group

www.jtf.org.tw/psyche Based in Taiwan, the Foundation provides information on mental health and on exercises and management strategies for dealing with stress and depression.

American Academy of Family Physicians

http://familydoctor.org/online/famdocen/home/common/mentalhealth.html Information for depression and other mental health illness.

3. Organizations and clinics

South Cove Community Health Center www.scchc.org South Cove is the largest Asian community health center in Massachusetts with three locations providing medical and behavioral health services and youth and family programs for approximately 24,000 clients at four locations in the greater Boston area.

Depression MGH Depression Clinical and Research Program

www2.massgeneral.org/allpsych/depression The DCRP is currently conducting cutting edge research in the area of depression, with a focus on testing novel antidepressant treatments and on developing new tools to understand the biological changes that occur in this condition.

Families for Depression Awareness

http://www.familyaware.org/ Families for depression awareness helps people in caregiver roles and people with depressive disorders understand the conditions, reduce stigma, and share issues.

IMPACT Evidence-based Depression Care http://impact-uw.org/ An excellent resource for tools and materials developed by the IMPACT randomized trial that involved old patients.

Part Eight: Who are we? The Boston Chinese Americans Research team is led by Dr. Albert Yeung at the MGH Depression Clinical and Research Program Dr. Albert Yeung is currently the Director of Primary Care Research at the Depression Clinical and Research Program at the Massachusetts General Hospital, and Associate Professor of Psychiatry at Harvard Medical School. Dr. Yeung obtained his medical degree from National Taiwan University. He also obtained a Doctor of Science degree with a major in epidemiology from Harvard School of Public Health. Current team member Pauline Tan M.R.E. Pauline Tan, best known as Mrs. “Chen”, is the senior Research Coordinator of the Depression Study Team at the South Cove Community Health Center. She holds a BBA (Honors) from the National University of Singapore, a MRE from the Trinity International University, IL. And she is a PhD candidate in Educational Psychology from the Loyola University of Chicago. She has years of experience in providing care & counseling to adults & families, including many Chinese immigrants, as well as early childhood education.

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Lingjun Chen Ed.M. Lingjun Chen graduated from the Human Development and Psychology Master Program at Harvard Graduate School of Education in May 2010. In her undergraduate education, she double majored in philosophy and psychology at Peking University in China. She is most interested in the etiology and treatment of depression, pathways to self-injurious behaviors, and cultural issues in mental health. Guoyu Ling M.D. Ph.D. Guoyu Ling got his MD from Sun Yat-sun University of China, Ph.D. in Environmental Health from SUNY-Albany. His interests include various mental disorders especially mood disorders. Contact us Interested in participating our studies? Please send an email to: interviews.scheduling@gmail.com For people who are interested in donating? Please send an email to: ayeung@partners.org

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美籍华人双语抑郁治疗手册

抑郁概览----------------------------------------------------------------------------------------------------------------24 症状诊断----------------------------------------------------------------------------------------------------------------25

1. 什么叫抑郁症？ 25 2. 用 PHQ-9 进行抑郁筛查 25

抑郁成因----------------------------------------------------------------------------------------------------------------26 1. 什么导致了抑郁？ 26 2. 成因图表 26

抑郁治疗----------------------------------------------------------------------------------------------------------------27 1. 抑郁症该如何治疗？ 27 2. 药物治疗抑郁简介 27 3. 抗抑郁药物治疗常见问题 28 4. 心理咨询治疗抑郁简介 30

自我护理----------------------------------------------------------------------------------------------------------------30 1. 恢复生活的动力 31 2. 切合实际的思考 34 3. 学会解决问题 37

健康生活----------------------------------------------------------------------------------------------------------------40 1. 饮食 40 2. 运动 40 3. 睡眠 41 4. 咖啡因 41 5. 毒品与酒精 42

有用链接----------------------------------------------------------------------------------------------------------------42 1. 治疗手册 42 2. 网站 42 3. 组织与诊所 42

我们是谁----------------------------------------------------------------------------------------------------------------43 1. 关于我们 43 2. 联系我们 43

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美籍华人双语抑郁治疗手册

一：抑郁概览 问：什么是抑郁症？ 答：所谓的抑郁症，症状往往因人而异。在情绪方面，一个患有抑郁症的人可能常常会感到悲伤

和沮丧，也有可能变得容易焦虑或易怒；在动机上，患者失去了从事一般活动的动力，例如：不

愿意工作、孤立自己、不与人互动；在行为上，患者会效率降低，或者是说话或行动便得缓慢；

在认知方面，抑郁症患者常常觉得很悲观，并对自己有极端负面的看法；在身体上，抑郁症患者

常会出现一些小毛病，例如：头痛、便秘或不名的疼痛，在睡眠和食欲上也常会出现困扰。抑郁

症是一种常见的现代文明疾病，在美国，几乎每二十人里面就有一人饱受抑郁症之苦；而在华人

族群中，得抑郁症的比例也将近有百分之二十。根据研究结果显示，尽管华人得抑郁症的比例和

一般美国人同样高，但大部分的华人还是倾向于接受家庭医生的治疗，而非寻求专业心理健康人

员的协助，并且容易低估了自身抑郁症的严重程度。 问：什么样的人容易得抑郁症？ 答：抑郁症并非单一因素造成的，很多因素都会影响抑郁症的发生，例如：

(1)家族遗传因素 (2)创伤与压力：经济问题、人际关系破裂、亲爱的人死亡。找新工作、毕业或新婚等 (3)悲观性格：低自尊、负面思考等 (4)身体疾病：严重身体疾病例如心脏病、癌症、爱滋病等会导致抑郁症 (5)其他精神疾病：焦虑症、饮食障碍、精神分裂症、物质滥用也会合并抑郁症

问： 如何治疗抑郁症？ 答：如果得了抑郁症，只要在精神科医生和心理师的协助下，大都可以成功治愈。好到完全没有

症答状，并且恢复身心功能及社交职业功能，但是其复发率也不低，特别是那些在个性上较缺乏

自信心或较神经质的人。因此在治愈后，有必要持续注意维持健康的情绪及适当修正自己个性上

的不利因素。目前抑郁症的治疗以药物治疗为主，若能合并心理治疗，将会得到较佳的效果。关

于药物治疗，新一代的抗抑郁剂，不但有效且副作用也少；心理治疗是由心理治疗师对患者的心

理、思考，所采取的治疗方法，心理治疗会帮助患者改变负面思考的过程，进而改善患者的情绪

和行为。抑郁症并不是绝症，事实上，抑郁症是所有心理疾病中最容易成功治愈的一种。 问：如何预防抑郁症的复发？ 答：以下是关于预防抑郁症再度发作的几点建议：

(1)不要很快的就自行停药，需跟主治医师讨论之后才可以减药。 (2)检讨让抑郁症发作的因素有无减少，若无改善，可以考虑接受心理治疗。 (3)平衡工作或生活上的压力。适度的压力会比没有压力或压力过度，让身心更健康。 (4)适度的运动（如每天三十分钟的有氧运动）可增加血清素，减缓抑郁的情绪。 (5)充足的睡眠可使脑部与身体得到充分的休息，抑郁情绪比较不会再犯。 (6)适当的休闲活动（如接近大自然，接近人群）有助降低抑郁症的复发。

问：如果得了抑郁症，我能做什么来帮助自己？

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答：(1)设订实际可行的目标。 (2)将大任务拆成小部分，按照先后顺序来排序，逐一完成。 (3)尝试接触人群及试着去信任他人。 (4)尝试运动、休闲及有益身心的社交活动。 (5)期待您的情绪“逐渐”改善，而不是“马上康复”，病情改善通常要花一些时间。 (6)抑郁期常会有负面思考，这是抑郁症的症状之一，等到情绪改善之后，就会消失的。 (7) 请求家人或朋友协助。

二：症状诊断

1. 什么叫抑郁症？ 每个人在生活当中都会经历挫折，在面对生活中的压力事件时，人们常常会感到低落、不愉快或

沮丧，这些情绪都是人们在面对压力时的正常反应。然而，一旦这种情绪起伏的程度比其他人明

显，或者是持续时间比其他人来的久，就代表有患抑郁症的可能。所谓的抑郁症，症状往往因人

而异。在情绪方面，一个患有抑郁症的人可能常常会感到悲伤和沮丧，也有可能变得容易焦虑或

易怒；在动机上，患者失去了从事一般活动的动力，例如：不愿意工作、孤立自己、不与人互

动；在行为上，患者会减少生产力，或者是说话或行动便得缓慢；在认知方面，抑郁症患者常常

觉得很悲观，并对自己有极端负面的看法；在身体上，抑郁症患者常会出现一些小毛病，例如：

头痛、便秘或不名的疼痛，在睡眠和食欲上也常会出现困扰。抑郁症是一种常见的现代文明疾

病，在美国，几乎每二十人里面就有一人饱受抑郁症之苦；而在华人族群中，得抑郁症的比例也

将近有百分之二十。根据研究结果显示，尽管华人得抑郁症的比例和一般美国人同样高，但大部

分的华人还是倾向于接受家庭医生的治疗，而非寻求专业心理健康人员的协助，并且容易低估了

自身抑郁症的症状。 抑郁症常见的症状主要如下列 9 项，其中必须包含下列第 1、2 项。 (1) 情绪低落 (2) 明显对事物失去兴趣 (3) 体重下降或上升 (4) 嗜睡或失眠 (5) 动作迟缓 (6) 容易疲倦或失去活力 (7) 无价值感或强烈罪恶感 (8) 注意力不集中或犹豫不决 (9) 经常出现负面想法

2. 用 PHQ-9 进行抑郁筛查 个人健康问卷

在过去两个礼拜里，您有没有出现以下的征状： 没有 有几天 一半以上的天

数 几乎每天

0 1 2 3 做事情没有兴趣 心情绝望无助‚抑郁或悲伤 难以入睡，易醒或睡太多 觉得疲劳或没有力气

26

胃口不好或吃太多 觉得自己不好、失败、对不起其他人或

家人

集中精神有困难 行动或讲话太慢或烦躁 有自杀或伤害自己的想法 您的总分数（所有项目分数的总积分）：_______________

总分数 0~5 分：极少的抑郁症状 总分数 6~10 分：轻微抑郁 总分数 11~15 分：中度抑郁 总分数 16~20 分：重度抑郁 如果您的总分数高于 10 分以上，欢迎您与麻省总医院的情绪研究小组（617-724-7683）联络，我

们将会由专家提供抑郁症的相关咨询。 三：抑郁成因

2. 什么导致了抑郁的产生？ 抑郁症的产生常与日常生活的压力事件有关，研究指出，抑郁症患者在抑郁症发作得前一个月，

比一般人经验更多的压力事件，例如：失业、离婚、退休、疾病等等。此外，研究也指出遗传因

素对抑郁症的发作有影响，在家族里有抑郁症病史的人有较高的机率得到抑郁症。而在心理学的

研究中，学者发现抑郁症的患者习惯以负面的方式来解释事件，或者是过度追求完美，这样的人

格特质也较容易引发抑郁症。抑郁症并不太表人格上的缺陷与软弱，就像高血压与糖尿病一样，

抑郁症是一种普遍的可治疗的病症。

3. 抑郁产生图 该示意图从 Antidepressant Skills Workbook的中文翻译《抑郁自我护理手册》（修订者骆宏博士）

中摘录，已得到作者 Dr. Dan Bilsker 和 Dr. Randy Paterson 的许可 (http://comh.ca/antidepressant-skills/adult/)。

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四：抑郁治疗 部分内容从 MacArthur Initiative Depression Tool Kit 中摘录和翻译，已得到作者许可。

5. 如何治疗抑郁症 如果得了抑郁症，只要在精神科医生和心理师的协助下，大都可以成功治愈。好到完全没有症答

状，并且恢复身心功能及社交职业功能，但是其复发率也不低，特别是那些在个性上较缺乏自信

心或较神经质的人。因此在治愈后，有必要持续注意维持健康的情绪及适当修正自己个性上的不

利因素。目前抑郁症的治疗以药物治疗为主，若能合并心理治疗，将会得到较佳的效果。关于药

物治疗，新一代的抗抑郁剂，不但有效且副作用也少；心理治疗是由心理治疗师对患者的心理、

思考，所采取的治疗方法，心理治疗会帮助患者改变负面思考的过程，进而改善患者的情绪和行

为。抑郁症并不是绝症，事实上，抑郁症是所有心理疾病中最容易成功治愈的一种。

6. 药物治疗抑郁简介 • 抗抑郁药物通过帮助纠正在大脑中的化学物质的不平衡起作用。 • 服用抗抑郁药物不会上瘾或形成习惯。它们不是兴奋剂或镇静剂。

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您的临床医生会考虑几个因素，从许多可用的抗抑郁药中选择对您适当的药。大多数患者对药物

反应良好。 一些抗抑郁药物以低剂量开始，这样可以让您的身体有一段时间来适应。您的医生会

逐步增加剂量，直到您的病情开始好转。服用约 3-6 周抗抑郁药物后，大多数抑郁症患者觉得自

己开始恢复平常。有时您和您的医生需要一段时间找到最有效而且副作用最小的适合您的药物。 您保持严格按照临床医生治疗方案用药是非常重要的，即使您已经感觉良好。 开始接受治疗的 6-8 周，您的医生会更频繁的约见您（可能是每周一次），以了解您服药的剂量

和次数，观察和与您讨论您可能会遇到的药物副作用，以及观察抗抑郁药的疗效。如果您的抑郁

症经过 12 星期疗程有显着改善，您会继续接受 4-9 个月的药物治疗以防止您的抑郁症复发。以前

有过 2 次或以上抑郁症发作的病人可能需要更长时间的药物治疗。

您能做些什么去帮助您的临床医师用药物来治疗您的抑郁症 • 每次约见您的医师必守约 • 向医生提出您对抗抑郁药的问题或疑虑 • 严格按照临床医生为您制定的方案服用药物 • 有任何副作用立即告诉您的医生，告诉您的医生药物的疗效（您是否感觉更好或更糟）。

7. 抗抑郁药物治疗常见问题

问：抗抑郁药怎么起效的？ 答：抗抑郁药有助于恢复大脑中影响人的情绪的重要化学物质（被称为神经递质）的平衡 。

问：服用抗抑郁药会上瘾吗？ 答：不，绝对不会。服用抗抑郁药不会上瘾或形成习惯，他们不会使您精神兴奋过度。 问：如果我服用抗抑郁药我会好起来吗？ 答：介于 50%和 80%的抑郁症患者经过彻底的药物治疗后会完全康复。如果您经过一种抗抑郁药

的彻底治疗没有改善，另一种抗抑郁药对您有效的概率依然很大。

问：服用抗抑郁药多久才见效？ 答：抑郁症患者通常觉得在服用抗抑郁药二至六周后病情开始改善。许多情况下，睡眠和食欲首

先好转。您的心情和体能的改善可能需要一些时间。如果服用抑郁症用药六个星期后症状没有改

善，您的医生可能会增加您正在服用的药物的剂量或换另一种抗抑郁药。

问：我必须服用多久的抗抑郁药？ 答：一旦您从您的抑郁症中完全恢复过来，您应该持续用药四到九个月以防止抑郁症的复发。对

于那些以前有抑郁症病史的患者应更长时间服用抗抑郁药物以防止抑郁症的新的发作。

问：如果我错过上次服药的时间我应该怎么做？ 答：不要在没有咨询您的医师前擅自服用双重剂量去纠正错过的剂量。下次服药应在规定的时间

服用。

问：我服用抗抑郁药物时能喝酒吗？

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答：酒精饮料在有些服用抗抑郁药的人中可以产生一些副作用，因此，如果您在服用抗抑郁药同

时打算喝何酒精饮料，咨询您的医生是非常重要的。

问：与其他药物一起服用抗抑郁药物是否安全？ 答：一般来说，抗抑郁药物能够安全地与其他药物一起服用。然而告诉您的医生您到底在服用什

么其他药物（包括非处方药物）是非常重要的，这样她/他可以保证危险的药物间不会相互作用。

问：一旦我开始感觉好多了我可以停止服药吗？ 答：不可以，您不能在未咨询您的医生前擅自停止服用药物。如果您太早停止服药，您抑郁症复

发的风险会很高。此外，一些药物必须逐步减量以便给您的身体足够时间来适应。在大多数情况

下，您会预期在抑郁症的症状完全消失后继续四到九个月的疗程。

问：我的问题是无法入睡。抗抑郁药能怎么帮到我？ 答：在许多情况下，睡眠不好是抑郁症的一个主要症状。一旦抑郁症缓解，睡眠也就随之改善。

一些抗抑郁药物甚至能够帮助非抑郁症患者恢复正常睡眠。与其他安眠药相比，他们的好处是没

有成瘾性，并且通常不损害精神集中或动作协调。

问：我有一个疼痛症。抗抑郁药能怎么帮到我？ 答：抗抑郁药已被用来成功地治疗（即使在没有抑郁症的情况下）多种疼痛症， 例如糖尿病神经

病变，带状疱疹后神经痛，幻肢痛等疼痛情况。抗抑郁药可能还有助于恢复正常的睡眠，从而逆

转疼痛和睡眠不好的恶性循环。

问：我没有力气，大部分的时间觉得累。抗抑郁药能怎么帮到我？ 答：抑郁症患者通常会有精力低下和容易疲劳。一旦抑郁症的改善，精力也会好转。抗抑郁药物

能够帮助恢复抑郁症患者的精力。随着治疗的成功和病情的好转，病人会感到不容易疲倦而更能

够完成他们的日常活动。

问：我的生活压力很大。抗抑郁药能怎么帮到我？ 答：生活压力可能会导致或加重抑郁症的症状。然后抑郁症使得各种压力（如工作压力，家庭问

题，身体残疾或经济上的忧虑）的影响和您处理好它们的能力更加进一步恶化。治疗抑郁症可以

帮助一些病人打破这种恶性循环。

问：我的问题是焦虑或恐慌症，而不是抑郁症。抗抑郁药能怎么帮到我？ 答：在许多情况下，焦虑是抑郁症的一种表现。一旦抑郁改善，焦虑也会改善。一些抗抑郁药物

是最有效的治疗焦虑症，包括广泛性焦虑症和恐慌症的办法之一，

问：抗抑郁药是否有危险的副作用？ 答：抗抑郁药的副作用通常是轻微的。您应该问您的医生可能会发生什么副作用和如果您有问题

应该怎么做。在许多情况下，您的身体会习惯于药物的存在。您不会被副作用困扰太久。在其他

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情况下，临床医生会建议您降低剂量，添加其他药物，或换成另一种抗抑郁药。如果使用得当不

会有任何危险或威胁生命的副作用。

8. 心理咨询治疗抑郁简介

在心理咨询中，抑郁患者会与一个有经过资格认证的心理健康专家共同工作。心理健康专家会倾

听他们，与他们交谈，帮助他们改正负性的思维方式并且帮助他们改善与其他人的关系。针对抑

郁的心理咨询并不着重谈您的童年。 用心理咨询来治疗抑郁 就治疗众多抑郁者而言，心理咨询至少与抗抑郁的药物同样有效。心理咨询既可以单独进行（只

有您和一个心理健康专家），也可以用团体的方式进行（一个心理健康专家，您，和其他有着相

同问题的人共同参加），甚至还可以是家庭或婚姻治疗，即您、您的配偶或家人还有心理健康专

家一同参加的咨询。超过一半的带有轻度到中度抑郁的患者对心理咨询的反应良好。虽然人们在

咨询中所需参与的时间各有不同，但一般抑郁的人大概应在 8-20 周内参与每周一次的问诊。如果

您的抑郁在 6 到 12 周的咨询中没有明显的改善，那也许就意味着您需要尝试一种新的治疗方法。

心理咨询本身并不推荐为重度抑郁患者的单独治疗方案。对于这类型的抑郁，药物是必须的，使

用药物的同时也可以结合心理咨询。 您能怎样帮助您的临床医生有效的治疗您的抑郁？

• 每次约见心理健康专家必守约 • 诚实与开放，并且敢于问问题 • 与心理健康专家团结协作（比如，完成医生交给您的作业） • 与您的家庭医生定期见面并且告诉他/她您的治疗到底进展如何（比如，您的抑郁是否好

转或恶化）。 五：自我护理 该章节从 Antidepressant Skills Workbook的中文翻译《抑郁自我护理手册》（修订者骆宏博士）中

摘录，已得到作者 Dr. Dan Bilsker 和 Dr. Randy Paterson 的许可 (http://comh.ca/antidepressant-skills/adult/)。

在这一章节中，我们将学会如何运用三种技能去阻止您的情绪消沉，减轻抑郁症状并防止复发。

这三个技能是：恢复生活中的动力、切合实际的思考和学会解决问题。我们会解释这些技能如何

帮助治疗抑郁，并且会一步一步的讲解如何应用这些技能。就像学习一个新的职业或运动，坚持

实践对掌握这些技能是非常重要的。有些人发现让自己的配偶，朋友，辅导员和家庭成员参与会

有帮助，因为他们能帮助您坚持实践这些技能， 就算在您觉得没有精力或没有动机的时候。您越

实践这些技能就会觉得越容易，而且它的成效会回报您的努力。

抑郁发作会关系到我们生活中的方方面面，如：情绪、思维、行为、生理功能及日常生活（包括

社会交往、家庭关系、工作状况、财务收支等等）。实际上，我们生活中的方方面面都是相互影

响的。这意味着，某一方面的变化，会导致其它方面也相应地改变。抑郁产生是，某一方面的消

极变化也会间接地影响到其他方面。这说明当您设法令自己康复时，做出某一方面的改变，就有

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可能会改善生活的其它方面。 我们的目标就是要使您所有的生活层面都逐步向好的方面变化，任

何一方面出现的积极变化都会影响其它方面，最终进入了一个积极的良性循环。

1. 恢复生活的动力 抑郁造成不活动，而不活动更加重了抑郁。因此，通过减少活动来减低疲劳，表面上似乎是一个

解决抑郁的好办法，但其实却会加重或者令抑郁持续。显然，解决方法是：不要等到您想活动时

才增加活动量，因为等待无助于您的康复。设定目标去增加您的活动程度是治疗抑郁的一个很强

大的办法。您应该从现在开始就渐渐地促使自己去做多一点。即使您不想做，也要坚持下去。您

可以尝试按照下列步骤去做：

第一步：明确自己将要增加哪些活动？

我们已经提及过患有抑郁障碍的人通常减少四类活动，从而进一步加重了抑郁。这四类活动包

括：与家人及朋友的来往、对自己的照顾、对自己有益的活动及日常的责任。 为了能够明确一些

切实可行的目标，您可以抽出一点时间回顾一下每类活动，想想每一类被抑郁影响（或在抑郁发

生前已被忽略）的活动，并列出哪些是可以增加的。

增加对自己有益的活动

例如：读些短篇小说杂志、外出散步、做点小嗜好、计划外出旅游、看电影或玩游戏等。

在这方面增加活动会很有意义，因为:

1. 它提醒那些对您很重要的自身的兴趣爱好。

2. 在您抑郁即将好转时提供您非常需要的奖励。

照顾自己

例如：每天按时梳洗，搞好个人卫生、定时进行运动、按时吃早餐、给自己定一个营养食

谱。在这方面增加活动会很有意义，因为:

1. 它直接增强您身体良好的感觉。

2. 它提醒您您是一个有能力的个人

日常事务

例如：打扫房间、整理柜子、买菜烧饭、缴付帐单，做做杂事，等等。在这方面增加活动

会很有意义， 因为:

1. 它提高您能掌握事物控制局势的感觉

2. 它减轻您和他人紧张关系，因为您开始参与工作

与家人及朋友的来往

例如：您可以邀请朋友与您参与做事、与您以前的邻居恢复联系，回复电话，答复别人的

一些问题、外出参加一些集体活动（例如，某个俱乐部或培训班)。在这方面增加活动会

很有意义， 因为:

1. 它帮助您重新恢复与他人联系的感觉

2. 它给其他人机会去表达对您的支持

3. 它让您不感到寂寞，不去想那些抑郁的想法

第二步﹕选择其中两项活动

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选择两个您立即可以开始做的事情。最初的两个选择应从两类不同的活动中选出。

第三步﹕定下切合实际的目标

为每个选出的活动定下一个可在未来一个星期内达到的目标。应当注意：抑郁会令人较难推动自

己。因此，您需要把目标定得比平常低一点。

例如﹕如果您想骑自行车外出，您的第一个目标可能是先把您的自行车检查一下，看看它是否需

要修理。如果您想打扫房子，您的第一个目标可能是只用吸尘器打扫一个房间，或清理一个架

子。如果您想再次与别人社交来往，您的第一个目标可能应该是与一个朋友先电话里聊个五分

钟。若要成功，您的目标必须﹕

• 具体：抑郁障碍可使您试图做的所有的事情都似乎不可能成功，为此，您的目标需要明

确，以便自己知道是否已成功达到预定的目标。

• 现实：您可能很想希望按照自己的期望来制定目标，如果这样，请千万别抱着这样的想

法。您需要记住：抑郁会令您减低做事的速度，使平常简单的事情也变得较难实现。为

此，您的目标应该是较容易实行的。您的目标应当足够的简单：即使您在未来的一个星期

内感到非常郁闷，但还是可以完成。有时想到开始一个新的活动会觉得负担很重，难以开

始。如果是这样的话，先尝试设定目标去搜集与活动有关的信息。例如，找出当地活动中

心有什么体育活动可以提供。

• 明确执行时间：您应该明确地知道在何时及如何实行您的目标。例如，“这个星期四下

午，散步 15分钟”，这个目标就比”多散步”要明确。

以下是一个例子﹕

小李开始定下两个目标：少许增加身体活动程度(从全无到每周一次短途散步)，和增加社会交往

活动(从全无到每二周与妻子和女儿外出一次)。 他用记事簿来记录和检查自己是否在执行目标，

每完成一个活动就从记事簿中划掉。

现在，您也要把您的目标定的具体可行些，让您可以实际地在这个星期内做到，明确这项活动要

隔多久做一次或做多长时间、及在什么时候做， 并把它们写下来。

把您的活动目标视为对与自己的承诺。要重视这些目标，正如您重视去看医生一样。如果您必须

取消这个与自己的承诺，便要立刻改期，到时不可不实现。

注意：即使您做得多于原定的目标，也不要奖励自己而减少后面的计划。做得多于原定的目标，

当然是可以的，但是这不代表您下次可以少做点，甚至休息不做。您如果容许这种“交换”，那

么您很快就会不在乎自己制定的目标了。

第四步﹕实行您的目标

认识到您很有可能并不“想要”去完成您的活动目标是很重要的。抑郁发作时，您做事的决心要

比平常差很多。如果您等到自己想做才去做，那很有可能您根本就不会去做。实行您的活动计

划，因为您给自己定下了一个目标，而且会帮您变得更好。当您完成一个目标后，把它在您的计

划中删去， 您会看到您的成就。

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在从抑郁中恢复的早期，您很可能不会因为您开始活动而得到很大的享受。但您不断地增加您的

活动程度，集中精力克服抑郁，您会渐渐恢复享受活动的能力。 您甚至会渐渐恢复让自己决心做

事的能力。

当您完成了一个目标时，您有没有恭喜自己？如果没有的话，现在便应立刻恭喜自己了。因为抑

郁常常会令我们只注意自己未曾做到的事情，或使我们忽视或贬低自己的成就。这常常也是导致

抑郁持续的一个原因，因为您经常都觉得自己是失败的。所以，您应当特别地提醒自己去注意自

己的成就，不论您的成就看来是多么微小。“我最初计划去散步，现在已做到了！这种感觉真

好！” 不要忽略小的成功，或把它们视为微不足道。它们实在非常重要，尤其是在抑郁的时候。

如果您发现您轻视您自己的成就(“只不过完成这么小的一桩事”)，提醒自己在抑郁中完成一件

小事就好像背着很重的包袱走了短距离。 在抑郁中完成目标很不容易，应该得到认可。

如果您达不到目标，究竟是什么阻碍了您呢？您可以做什么使目标更容易达到呢？要知道您的目

标可能过于远大，或许，您可把下星期的目标定得再低点，或者定出另一个更合理的目标来代替

它。大部份患有抑郁的人面对的难关之一就是：他们把目标定得太高，无法达到，以致变得灰

心。问题并不是因为他们懒惰，而是因为他们过分渴望可以立刻康复！所以，您应该把目标降低

至您肯定可以做到的为止，即使这个星期您的状况并不比上星期更佳。洗一个碗、打一个电话、

打开一个账单、外出走一圈、花五分钟做您的嗜好等等，都是完全合理的目标。当您的精力恢复

时，您完全可以做得更多，但暂时应该容许自己慢慢地开始。

第五步：检查您的目标

一直坚持自己的目标，经过两个星期后，您便可再检查一下自己的执行情况。

1、您是想稍为提高您的目标呢？还是想继续保持现有的目标，直至您觉得它们可以容易达到为止

呢？这是您的选择。

2、这个时候适宜增添另一个目标。这次，应当选择一个涉及另一方面的目标。例如，如果您上次

的选择是有关照顾自己及对自己有益的活动，这次则应选择一个有关与家人及朋友来往或有关日

常责任的目标。

新的活动：

把这个新的目标，连同上面两个继续实行的目标，一起写进您的计划表内。完成某个目标的时

候，记得把它从计划表删去及自我表扬一下。一直执行这些目标，经过两个星期后，再检查一下

您的情况。还有什么目标没有执行吗？受到什么阻拦呢？您是否需要调整或改变那个目标？

继续加油！继续您将正在进行的目标。如有精力的话，应考虑增添目标。完成一件事情后（例

如：您现以完成搜集您小区可提供的娱乐活动的资料），便可转移到下一个新的目标。

继续重复以下的步骤：

• 定下三个目标。

• 把它们写进您的计划表内。

• 每完成一个目标，便把它删掉。

• 每次都要自己表扬。

• 每两个星期检查执行情况一次，以决定是否需要修改，或是否需增加新的目标。

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最后，您将可以同时进行三、四个目标或更多。但是，切勿要求自己得太多。同时执行太多的目

标会让您难以应付。

2. 切合实际的思考 抑郁消极的想法是不切合实际和不公平的。

• 不切合实际对周围环境的消极评价。以非常消极的眼光来看待您周围的世界：其他人都很

挑剔/不接受您；您周围都是对您的要求；活着就是一连串没有尽头没有意义的事情。您

见不到生活中积极的东西。

• 不切合实际苛刻的自我评价。以非常消极的眼光来看待自己。您做过的事情中不好一面您

会记得很牢，但是您却很难记得自己好的地方。您用来衡量自己的标准可能远远高于您用

来衡量别人的标准。因此，您常常觉得自己不及别人。

• 对未来的不切合实际的消极期望。您觉得未来的前景很差，您只能预见到前面是一连串无

尽头的失败、灾难及被人拒绝的场景。您高估负面事情发生的可能性（比如，我百分之九

十肯定这种胃痛将会变成绝症；我百分之九十九肯定我的家人会在明年离弃我）。

切合实际的想法是

• 对周围环境的准确评价， 客观的看待事情。

• 对自己有公正的评价。 平衡客观的看待自己的优缺点。

• 客观看待自己的将来。不要夸张坏的结果。

这意味着对自己(注意好的品质和强项，以及问题)，对当前形势(准确衡量您生命中好的和坏的方

面)， 和您的将来(不要夸大坏结果的可能性) 有一个公正客观的评价。 那么，如何改变抑郁消

极的想法？

第一步：学习如何找出消极的偏差思维

带有偏差的思维是不客观及与现实不符的，我们可称之为歪曲的思维方式，因为它们不正确地反

映世界或自己。以下描述了一些在抑郁时常出现的歪曲思维方式：

• 过滤式的想法﹕只见到坏的事情，从不见到好的事情。由于您只看到不好的事情，您的一

生看来都可能只有消极的一面。切合实际的想法同时考虑好的和坏的方面。

• 以偏概全的想法﹕把一件负面的事情视为一个永恒的定律。比方，有一位朋友离开您就等

于所有朋友都会离开您；第一次失败就等于每次都会失败。 切合实际的想法不会认为一

次不行以后都不行。

• 绝对化的想法﹕比如您不是肥胖就是消瘦、不是聪明就是愚蠢、不是整齐就是凌乱、不是

抑郁就是快乐等等。在极端之间再无其它选择。渐渐的进展总是不够，只有完全的改变才

是对的。“只做了一半，谁会理会呢？仍然未曾做好！” 切合实际的想法认为世间万物

分布两极端之间，大部分的分布趋向中间。

• 灾难式的想法﹕ 把小小的失败当作一场大灾难。迟了点才做完一件小的事情等于整个月

都弄糟了。为此，您会对您想象中那场灾难（即很糟糕的一个月），而并非对那件小事

（即迟了完成工作）产生反应。切合实际的想法不会夸张小事的严重性。

• 自我丑化的想法﹕以严厉的字眼来描述自己，如以「白痴」、「迟钝」或其它更差的说话

来侮辱自己。您与自己对话的方法是您绝对不会用于别人的。切合实际的想法不会用这些

不公平的侮辱的字眼。

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• 主观臆断的想法﹕以为自己可猜出别人心里对您的看法，并把别人的看法一律想象为负面

的。因此，您索性不问清楚别人究竟是否真的这样想，便向自己所想象的情况作出反应。

切合实际的想法认为猜测别人怎没想是不准确的，尤其是在抑郁的时候。

• 预测未来的想法﹕以为自己可预知将来有什么事情发生，而且对未来的预料都是负面的。

如果一切都不会成功，为什么还要尝试呢？切合实际的想法认为您不知道事情将如何发

生。意识到好结局的可能性会让您有希望，更有可能让事情变得更好。

• 完美主义的想法﹕ 只有十全十美的东西才算好。由于您无法使大部分事情变为完美，所

以您总是觉得不满意，总是无法对自己所做的任何事情感到自豪。切合实际的想法会给任

何的成绩以奖励， 即使离完美还很远。很少有人能做到完美，但我们完成的业绩是有意

义的。

• “应该如此”的想法﹕您知道世界“应该”是怎样的，但是现实并非如此。您知道自己

“应该”是怎样的，但是自己又并非如此。结果﹕您经常感到失望，经常怨恨自己及周围

的人。切合实际的想法认识到世界和您都有局限-试图改进同样接受事实。

还有好几种歪曲的思维方式，但上述的几种是最为普遍的。当您发现自己有消极的想法时，最好

利用上面的清单来看看您是否经常存在其中一种歪曲的思维方式。

第二步﹕认出自己的消极抑郁想法，并理解它们如何导致抑郁

我们大部分的思维过程是一闪而过的，因此我们甚至不知道自己在思考。为此，我们必须学习察

觉消极思维的出现。一个好的方法就是：找一个星期，随身准备着铅笔及本子。虽然抑郁时好像

头顶上常常都有一片黑云，但是实际上在一天内情绪是不断有改变的。每当您感到情绪低落一点

时，便要向自己提出这个重要的问题：

“这时，我脑海里有什么想法出现呢？”

您刚刚在想着什么？您对什么产生反应？把答案写下来。例如：一天早上乘坐公车时，您突然感

到一股低落的情绪在蔓延。当时，在您脑海里有什么想法出现呢？或许，当时您注意到公车上的

其他人都看着您，您觉得他们可能都在批评您。好！把它写下来。

继续记录您的想法，直至您注意到同一种消极的思维不断重复出现为止。您可能觉得需要在某些

想法旁边划上一个 √ 记号，表示“这个念头想法又出现了”。当这种情况出现时，表示您已经

找出了一些您最经常使用的消极思维方式。

之后，如何呢？在那些自动出现的想法中，有些可能是明显的歪曲了。“哦，等一会！他们在公

车上对着我的原因是因为我站在他们前面，而不是因为他们想看看我究竟是怎样的一个失败

者！”有时，单单知道您的脑子会在某种情况下产生消极的想法便已足够。设法留意消极念头的

出现，并提醒自己它们的来源。“我有这样的想法是因为我感到抑郁，我是一个自我意识很强的

人，而并不是因为他们都在批评我。”当您知道消极抑郁想法的来源后，您可能会发觉自己不再

把它们看得过分认真。

当您发觉有歪曲想法出现时，您可能会想责备自己：“我怎可想着这样愚蠢的东西！”抑郁使您

对自己苛刻；认出歪曲的想法可给您多一个方法来攻击自己。不要这样，相反，您必须提醒自

己，歪曲的想法是由抑郁及由您的个人历史所产生的。有歪曲的想法并不表示您是愚蠢的。在抑

郁时有这些想法是正常的。

第三步﹕学习驳斥这些消极的歪曲想法，用较为客观及与现实相符的想法来取代它们

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驳斥消极的想法需要您特别地重新考虑那些使您感到不安的情况。若要这样做，您可以采用一个

策略叫”挑战抑郁消极想法”。您拿出一张白纸来，把它分为二栏，好像下面的例子一样。

首先，简单写下情形，例如，和女儿谈话；走路上班；计划晚餐。然后写下相关的消极歪曲想

法。如果您愿意，亦可对消极的歪曲想法进行分类(如上)。最后，想想这个情形， 尝试想出一个

更公正合理的解释。

提示：歪曲的想法通常与现实距离很远。通常，客观和现实的想法只是去提醒自己，我没有足够

的依据去肯定将来一定发生什么。“我不知道她为什么取消午餐约会，如果找原因的话，可能有

太多的可能”。

情景 朋友取消午餐约会。

消极的想法 客观及现实的想法

她不喜欢我。（猜测人心的想法） 我不知道她为什么取消约会，可能有紧急事

情发生。那只是一次午餐约会。

没有人喜欢我。我没有令人喜欢的

地方。（以偏概全的想法）

有些人似乎真的喜欢我。我一定有令人喜欢

的地方。

世界是冷酷无情的。（灾难式的想

法）

这次吃饭并不说明全部的问题。别人曾经接

受过我。

我一生都会孤单过活了。（预测未

来的想法）

我不能预知未来。一次吃饭被取消并不等于

将来没有人会喜欢我。

当您消沉时并不容易找到客观和现实的想法。以下是另一些能帮助您找出客观和现实想法的方

法：

• 您能够找到更多理由来做依据吗？您可能需要请教别人，究竟是发生了什么事。

• 看看您持有的依据。大部份的人是否会同意您的 想法？如果不的话，会是一个怎样的更

实际的想法呢？

• 通常，我们对别人的看法都比对自己的看法现实得很多。

• 如果您面对一个在同样情况、抱着同样想法的朋友，您会说些什么话呢?

• 继续这种想法有什么后果？

• 对于这个情况，有没有另一种想法能够更积极，带来更好的后果？

现在用以上的问题，针对让您消沉的情形去找出客观和现实的想法。通常， 用客观和现实的想法

取代抑郁消极想法会让您感觉更好。

第四步﹕实践客观现实的思考

当然，只想出一次客观和现实的想法是不足够的。消极的想法会重复出现，有时会持续多年，直

至它们不加思考就出现为止。较为客观的想法会令您感到好一点，但是这些好的想法不会自动出

现（至少它们暂是不会自动出现的）。不过，令人高兴的是：使用这些方法去改变消极思维是不

需要花经年的时间的。其实，抑郁的人通常只需要坚持练习抗抑郁技巧几个星期便会开始感到情

绪有所改变。一些情形尤其能促发抑郁思维，比如说与老板开会，参加您不太熟的人的社交聚

会，和家里人有争执。为了使这个方式最见效， 您必须时刻注意那些容易引起您出现消极想法的

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情景，及时察觉它们的出现。当您发现自己在这些情景里时，您应该刻意地在脑海里重复一下客

观和现实的想法。不要期望这种想法会自动出现。您必须告诉自己应如何看待这些情况，好像为

朋友提供意见或鼓励他们一样。您应该向消极的想法提出反驳。不要让消极的想法没有反驳就发

生.您每次提出反驳的时候，都会减弱消极的想法，增强现实的想法。但是，现实的想法却需要一

段时间才会比消极想法产生更多的影响。起初，您可能会觉得现实的想法好像有点别扭。例如：

您一直都以完美主义的眼光来看您的工作，告诉自己：“我的工作一定方方面面都完成的很好，

否则就会没有价值。”但是，由于别人只给您很少时间去完成每件工作，所以您经常都觉得自己

好似是一个失败者一样。您知道这是一种脱离现实的想法，并想出了一个客观及现实的想法：

“这件工作做到百分之八十便算好了；任何人都只可以达到这个标准。”起初，这个现实的想法

看来似乎不对，您总觉得您好像在欺骗自己一样。记住，唯有经过一段时间的重复练习，您才会

开始感到这种现实想法（也即事实情况）是真实的。最后，您将会完全接受这种想法。

3. 学会解决问题 抑郁很多时候就是由于我们面对着许多生活中的问题感到无所适从而给我们带来的压力所引起

的。进一步，我们会发现自己解决问题的方法一直无效，或甚至可能使问题变得更糟。为什么在

抑郁的时候，我们解决问题的能力会减低呢？原因有以下几个：

• 解决问题是需要精力的。抑郁严重的时候，精力会减退。

• 日常生活上的问题会因为另一个更严重的问题—抑郁，而被搁置于一个次要的地位。抑郁

的人只担心情绪上的问题，所以其它问题都受到忽略，结果变得更糟。

• 抑郁会影响注意力、记忆力、决策能力及创造力。若要解决问题，大部份情况下，我们都

需要上述所有的技能。

由于上述的因素，处在抑郁的时候，我们会觉得问题愈发的多和难以应对。那么怎么办呢？首

先，您必须知道，您解决问题的能力可能不如往常那么好。不要因此惩罚自己，这是抑郁发作时

中的一种常见症状，而且是可以得到改善的。现在，请您坐下来，照着下面的程序去尝试着解决

生活中的问题。

第一步：选择一个问题

在解决问题的第一步是选择一个问题。有时候抑郁患者不能找出生活中的具体问题。 他们把所有

一切看做一个大问题。 对他们来说找到可以解决的具体问题是很有帮助的。 这会使他们进一步

接近问题的答案。

找出具体问题的一个办法是仔细注意一个星期心情如何变化。 心情低落时注意有什么事情发生：

您在想什么，在哪里， 什么事情刚刚发生？心情变化对找出问题所在是一个有用的指导。

您面对着的问题中有些可能是大问题（例如:“房东下周要我退房”)； 有些可能是小问题（例如:

“如果我想准备个菜的话，我必须下班后去买胡萝卜”）有些则可能是介乎两者之间的问题（例

如:“有一大堆信一个多星期没有勇气打开处理”)。选择一个现在发生的小问题。过后在关心大

问题，尽量具体，例如“我的情感关系一团糟”就不具体，问题在于不清楚“好朋友一个月没来

电话”更具体， 让您更清楚什么不对，什么要改进。

第二步：想出可能帮助解决问题的措施

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写下三件您能做的帮助解决问题的行动。考虑自己能做的，不需他人帮助的事情。先别决定哪个

行动最好：先尽管想出您能付诸的不同的行动。不要担心以前您以前试过而不成功-现在情况不一

样。不要担心这些行动是否可把问题完全解决-您现在的目标是做一些有用的事情，而不是完全解

决问题。

这有一个例子：

阿梅是一个资深经理的执行秘书。

问题：

我的工作压力太重-文件不断地堆上我的台面。尽管我已延长工作时间，我的进度不断的拖后。我

已经告诉老板工作量最近增加太快，可她没有采取任何行动。形势看上去不可收拾，我感到非常

抑郁。

可能帮助解决问题的行动：

• 继续工作，也许老板会注意到我工作超负荷，会让另一个员工来帮我。

• 大步走进老板的办公室，告诉她我已经受够了，让她停止不合理的要求。

• 写下台面的所有的工作，标记上那些今天要做，哪些这周要做，哪些这个月要做。 这样

我可以把精力集中到紧要的事情，更有效的提早作出计划。

第三步：比较不同的行动

考虑哪一个措施最有可能帮助解决问题。看看每个行动的好处和坏处。

阿梅是这样写的：

行动 好处 坏处

1 继续工作 我一直这么干的

不会导致冲突

情况可能越来越糟

我会更抑郁

进度如果再拖后会有更

大的麻烦

2 告诉老板 讲出心里想的

老板可能帮助解决问题

我不喜欢跟人面对面交

涉

老板也许会对我如此直

接而动怒，这会变成一

个新问题。

3 工作按紧迫

分类去做

能把要紧的先做了

压力少了，有时间想想其它办法

会觉得更好把握形势，对我心情

有帮助

以后还是得解决工作量

大的问题

第四步：选择其中最好的一个行动

想想每个选择的优点与缺点，然后选择其中一个最不错的行动。 没有固定的规则教您应该如何选

择；唯一的规则就是﹕您必须选择一个您可以用来开始进行的行动。您应该考虑一下上述每个可

能的选择，想想每个选择的优点与缺点， 然后选一个。 您所选择的行动最低限度应该导致问题

的部分解决。给自己一个限期去作出决定，使您不会把这个过程拖长。记住：当您开始使用某个

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方法时，如果发觉这个方法是行不通的，您可以尝试另一个行动。阿梅，那个工作超负荷的秘书

选择了第三个行动方案，将工作按紧迫分类去做，以便能集中精力到最紧要的任务上。

第五步：定出行动计划

并没有很多问题只需采取一个行动便可解决， 但很多的行动会帮助您部分的解决问题。例如：如

果您有一个与理财有关的问题，您第一个要做的行动就是收集所有文件资料，让您可以进行审

阅。单单收集这些文件不会解决问题，但会使您较为接近解决的方法。最重要的就是您已开始去

找出解决的方法。

您的行动计划应该符合下面四个原则，即必须是﹕

• 可付之行动的：即使下星期不比上星期感到好一点（或即使比上星期感到更差一点），计

划中的行动都应该是您可以做到的。达到一个较小的目标好过不能达到一个过于远大的目

标。不好的例子：第一次去跑步就要做马拉松式的长跑。较好的例子：步行一个街区。

• 以行动为本的：定计划的时候要想着您会做什么，而不是要想着做这个东西时会有什么的

想法或感受。您对自己的行动有一定的控制，但对自己的情绪和想法则很难控制。不好的

例子﹕与我的孩子在一起愉快地呆一个小时。较好的例子﹕与我的孩子在一起呆一个小

时。

• 具体的：应该清楚地指定您需要做的事情。不好的例子﹕锻炼身体。较好的例子：打电话

给活动中心，看看有没有瑜伽培训班可以参加。

• 有时间要求的：您的计划应只需要一个时间段便可做到。不要计划给您的生活方式来个永

久性的改造。不好的例子﹕我以后都要坚持日常锻炼。较好的例子：每周步行二十分钟，

二个月后在评估。

第六步：评估您的行动

【一个星期后或在您达到您的目标后才看这段。】

有什么结果？哪方面做得顺利？哪方面做得不顺利？

抑郁的情绪可能会令您只想着失败及那些您没有做的事情，而不去为自己的进展肯定自己。如果

您成功地达到自己的目标，便要刻意地强迫自己去想着这次的成功。（即使问题仍然没有被解

决，也要这样做。）

第七步：继续您的计划

利用这次的经验来帮助您计划下一步。您有三个选择﹕

• 继续做下去 — 例子：再花二十分钟找到文件资料。

• 修改目标，再次尝试 — 例子：花一个小时来打扫车库卫生过于困难了。因此，计划只做

十分钟。

• 采取另一个做法 — 或许您可以利用您第一次尝试学得的经验去试行另一个处理问题的方

法。例子：与姨妈面对面交谈没有作用，故可尝试写信给她。

继续遵循上述的步骤来处理您的问题。把您的努力结果记录下来。不断提醒自己所获得的进展。

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六: 健康生活 该章节从 Antidepressant Skills Workbook的中文翻译《抑郁自我护理手册》（修订者骆宏博士）中

摘录，已得到作者 Dr。 Dan Bilsker 和 Dr。 Randy Paterson 的许可 (http://comh。ca/antidepressant-skills/adult/)。

1. 饮食 食物是我们生存最基本的需求。但是，当我们抑郁发作的时候，我们的胃口很多时候都会受到影

响。有些人会暴食，但是一个更为普遍的现象则是：食欲不振。如果这个问题出现的话，必须记

住：虽然您可能不觉得肚子饿，但您的身体仍然继续需要能量。以下的一些提示是帮助您在没有

胃口的时候，保证自己营养的一些原则： 1、固定吃饭的时间。保持固定的饮食习惯，通常是帮助您进食（或控制您饮食）最容易的方法。

做到每日三餐，确保您每餐都有足够的食物。 2、按时吃饭，而不要依靠您肚子的感觉。即使您缺乏食欲，仍然要在吃饭时间要求自己进食。如

果您一向的问题是暴食的话，则应做到只在吃饭时间、坐在餐桌旁时才能进食。 3、设法令您容易进食。重要的是吃，不是自己去烧。所以，您可以购买一些方便包装的食品（但

要注意食物的营养价值）。 4、多准备一点食物。您可以多准备一点食物，储藏在冰箱里。日后只需把食物重新回锅一下，便

可食用。这样可减少准备食物的时间。 5、准备健康的食物，应当注意饮食的营养，荤素要搭配平衡，还要注意保证吃一定量的水果。 6、注意糖的食用量。不要吃太多经精炼的糖，一般来说，最好吃含复合碳水化合物的食物（特别

是平常我们说的粗粮、杂粮、土豆）。 7、不要节食。即使您想减肥，也不要依照一些严格的方法来节食。最好是采取健康（而不是很多

限制的）的饮食习惯，以及增加活动量。如果您真想减肥，不妨咨询一下医生，看看有无禁忌。

2. 运动 保持规律的运动有助于身心健康。最近的研究显示，身体健康的人不太容易患上抑郁。而对很多

人来说，定时运动能显著地减低抑郁症状。 运动对情绪主要产生四个方面的影响。第一，在刚刚运动后，很多人都发觉运动能产生一段短暂

的、所谓“长跑选手兴奋”的快感。（在抑郁的时候，这种感觉就不会产生。）第二，经过几个

星期（每星期三至四次，每次最少二十分钟）的规律运动后，情绪通常开始出现较为明显地

（的）改善。第三，身体健康的改善与精力的改善有关，而精力的改善使您可以做得更多的活

动。这是一个良性循环。最后，当您感到紧张时，运动是帮助您消除压力的好方法。 以下的提示可以帮助您定下一个运动计划： 1、接受必要的身体检查。开始运动前，通过体检来明确哪些活动是不适合您参加的。 2、选择适当的活动。体育锻炼最大的挑战就是要有恒心，为此，您应当选择您最喜爱的活动。有

氧运动（即需要把脉搏增快至某个指定目标，并维持二十分钟或以上的运动）与无氧运动（例如

﹕健身或瑜珈）都能对情绪能产生积极的作用。您可以选择一种最适合您的活动；做不同类型的

活动也有帮助：您可以选择两种以上的运动方式，然后交替进行。 3、运动前进行必要的热身。 学习一些简单的伸展运动，每次正式运动前都应该做，它们可以帮

助您减少运动时的受伤或出现疼痛的可能性。 4、次数比每次运动的长短更加重要。按时做短暂的运动（每星期三、四次）比不定时地做长时间

的运动要好。 5、把注意力集中于运动的乐趣上。体验运动的乐趣和挑战感，要比仅仅为了强壮身体有益，通常

前者能够较大地改善情绪。为此，尝试体验您将会有怎样的感受，而不是您想有怎样的体格。

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6、如有躁狂狂抑郁障碍，应该注意监察。运动对躁郁症的影响，不及它对其它类型抑郁的作用那

么清楚。有时，在躁狂期或情绪高涨的期间进行剧烈运动可能还会令病情变得更加严重。在这段

期间内，适宜做较为舒缓的运动。 7、没有东西是即刻见效的。明确目标，制定计划，一定要选择那些可以做得到的活动。例如，计

划游泳 15 分钟，而不要一开始就计划自己每天要游 1000 米。 3. 睡眠

压力、焦虑和抑郁常常会扰乱睡眠，从而使焦虑和抑郁变得更加严重。换言之，睡眠问题是导致

情绪问题的原因，同时也是其后果。不论哪种问题首先出现，都值得我们设法去使自己获得一晚

好的睡眠。以下是一些有益的提示： 1、避免使用安眠药。虽然这类药物可以帮助您入睡，但是这种睡眠通常没有正常的睡眠那么有帮

助。如果您服用安眠药的话，您要在医生的指导下服用，并记得：若要判断药物是否有效，需看

您白天的感觉如何，而不应看它是否可以令您入睡。 2、 定出固定的上床及起床时间。身体是按照一个二十四小时的周期运作的，在不同时间上床及

起床会扰乱这个有规律的周期。这也是坐飞机旅行后睡眠紊乱的原因—即睡眠时间的改变，而不

是坐飞机本身。定下固定的上床和起床时间可帮助您调整体内的生物钟。 3、不要过早上床。如果从不在凌晨一点前上床睡觉的话，则不要在十二点前上床。想早一点睡

吗？起初时，把上床时间提前三十分钟至一小时。然后，再逐渐提早上床（如每星期提早半小

时）。 4、把卧室仅仅用作睡觉的场所。避免把睡觉跟其它与睡觉不相关的活动放在一起，这些活动包

括：工作、吃饭、争论、运动、打电话、看电视等等。性生活则例外。 5、 营造一个好的睡眠环境。 最佳的睡房温度是摄氏 18 至 21 度。如果噪音是一个问题，可以选

择一些应付方法：包括，耳塞、在卧室里添置一些隔音材料（布质的挂吊物可有点帮助）。如果

与您同床的伴侣是造成问题的原因，可考虑使用一张较大的睡床、各自一床棉被、或者暂时分

床。 6、避免在日间小睡。除非您只小睡约二十分钟，否则较长的小睡可令您晚间难以入睡。 7、为睡眠做好准备。最低限度，在临睡一小时前，避免做剧烈的活动、做运动或吃得太饱，也要

避免太亮的灯光。 8、入睡时，可以尝试进行呼吸放松或其它分散注意力的方法。如果总是想着您担心的事情或您多

么需要睡眠只会使您不能入睡。您可以尝试任何能帮助您不想这些事情的方法来帮助您入睡。

4. 咖啡因 茶叶、咖啡等饮料中大多含有咖啡因。咖啡因会刺激控制压力反应的交感神经系统。如果在抑郁

时您同时感到很焦虑的话，那么您绝对不宜摄入过多的这种令压力反应系统更加活跃的化学物

质。咖啡因可使紧张性头痛、应激性结肠综合症、慢性疼痛及其它健康问题变得更加严重。 咖啡因是一种会上瘾的药物。消耗大量咖啡因的人会对它形成心理依赖，需要摄入更多咖啡因才

可得到同样的感觉，摄入量不足时则会出现不舒服的症状。 这些病症包括：头痛、嗜睡、烦躁及难以集中精神。很多人在一两天不喝含有咖啡因的饮料后，

发觉自己已经形成了依赖，而且会有剧烈的头痛。 消耗多少咖啡因便会造成依赖呢？这方面有不同的估计，但是平均的估计是每天 450 毫克。有些

可能较为敏感，有些人没有这么敏感。 如果您决定减少您的咖啡因消耗量，应慢慢地减少，以免有不适症状的出现。比较合理的方法

是：把消耗量减至一半，维持四至六天，然后再减一半直至每天只喝半杯为止，然后停止。

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5. 毒品与酒精 人们使用毒品及酒精的其中一个原因就是：这些物质有时能短暂地令他们感到愉悦。但从长远来

看，这类物质只会使问题变得更加严重： 1、这些人变得只是逃避问题，没有去解决问题。 2、这些人在工作、家庭及社交中的表现都会开始受到影响。 3、他们对这些物质形成心理及/或生理依赖。 4、身体健康受到损害。 在抑郁发作期间，酒精和药物似乎特别具有吸引力。但是，在这些时候使用这类物质是一个十分

糟糕的选择。和平常相比，您会较难忍受这些物质的作用，也较难控制它们的使用。我们面对的

问题通常是需要以具体及有建设性的行动来处理的，而不能借助药物去逃避。此外，药物和酒精

还会与很多药物，包括抗焦虑及抗抑郁药物，产生交互作用。一般来说，最好就是坚持下面的原

则，采取一种对您有益的生活方式： 1、不要把服用药物当作一种娱乐（包括不要使用毒品）。 2、在感到抑郁或很大压力的期间，不要使用酒精。 3、如果您或您的家人有滥用酒精的历史，便应该避免使用酒精。 4、即使您情绪好也没有滥用酒精的历史，您仍应该注意少量饮酒。 要完全戒掉酒精及药物可能是一件颇为艰巨的事情。记着：虽然最好是完全不使用这些物品（尤

其是毒品），但是减低用量则比因为觉得太难做到而一点都不做要好。您可以使用前文中如何制

定目标，及如何解决问题的策略来一点点地克服这个问题。 如果在药物或酒精的使用方面，您已经完全失去控制，那么您应该知道有很多人也有同样的问

题。这时，最有效的办法就是得到专业机构的帮助。具体情况您可以请教专业人员。 七：有用链接

1. 治疗手册 《抑郁自我护理手册》（作者 Dr. Dan Bilsker 和 Dr. Randy Paterson，修订者骆宏博士）

http://comh.ca/antidepressant-skills/adult/ A tool kit designed for patients to learn methods for self-managing depression.

《美籍华人双语抑郁治疗手册》

2. 网站 美国国家心理卫生研究院的抑郁相关说明

www.nimh.nih.gov/health/topics/depression/index.shtml

董氏基金会-心理卫生组 www.jtf.org.tw/psyche

抑郁症相关的华语网站 美国家庭医生协会

http://familydoctor.org/online/famdocen/home/common/mentalhealth.html 提供抑郁与其他心理障碍的说明

3. 组织与诊所 华人医务中心

www.scchc.org

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华人医务中心是麻州最大的亚洲社区医务中心，有三个分中心，为大波士顿地区约 24000 病人提

供医疗卫生服务。 麻省总医院抑郁的临床与研究项目

www2.massgeneral.org/allpsych/depression 该项目进行抑郁症相关的尖端研究，主要集中在测试新的抗抑郁药的疗效和了解药物对人产生的

生理作用。 抑郁意识之家

http://www.familyaware.org/ 该网站旨在帮助抑郁者的家人了解抑郁症、分享信息并且减少羞耻。

IMPACT 抑郁治疗

http://impact-uw.org/ 该网站提供了一些关于老年人的抑郁研究。 八：我们是谁 波士顿美籍华人研究小组由杨世贤博士领导。他现任麻州总医院抑郁临床与研究项目中基础医疗

研究的主任，并且是哈佛医学院精神科的副教授。杨博士在台湾大学获得医学博士学位，还从哈

佛公共卫生学院获取了专业为流行病学的科学博士学位。 小组成员 陈宝玲（Pauline Tan） M.R.E. 陈宝玲女士常被称为“陈太”，是南湾华人医务中心抑郁症研究组的资深研究协调员。她拥有新

加坡国立大学商管荣誉学位和三一国际大学宗教教育硕士学位，也曾是芝加哥罗约拉大学教育心

理学的博士候选人。她有多年向成年人与家庭提供爱关与辅导的经验，也是一名幼儿教育工作

者。 陈凌隽（Lingjun Chen） Ed.M. 陈凌隽于 2010 年 5 月从哈佛教育学院的人类发展与心理学硕士项目毕业。她在中国的北京大学接

受本科教育，完成了哲学和心理学的双重学位。她的研究兴趣包括：抑郁的成因与治疗、自我伤

害行为以及心理卫生领域中的文化问题。 凌国宇（Guoyu Ling） M.D. Ph.D. 凌国宇在中国中山大学获得医学博士学位，在美国 SUNY-Albany 大学获得环境健康博士学位。他

喜欢了解各种心理障碍，特别是心境障碍。 联系我们： 想参加我们的研究？请给发邮件给此邮箱： interviews.scheduling@gmail.com 想资助我们的研究？请给发邮件给此邮箱： ayeung@partners.org