CBT therapist, Michael O'Sullivan, explores how to defeat the perils that can await you when trying to make a decision if you're also depressed 

A perennial problem that often arises for anyone with depression and anxiety is decision making.

This is because making a decision runs the risk of “getting it wrong”.

Making a decision when you’re depressed

If I am depressed, getting it wrong may confirm all of the beliefs I have about myself.

If I am depressed, I may try to get around decision making in different ways.

I may try to get as much information as possible before I make a decision, knowing that this will fail because there is “never” enough information.

I may overestimate the risk believing that any potential negative consequences of my decisions will last “forever”.

I may end up making the decision of “not making a decision” because I know that the results of “not acting” are less visible to others.

Therapy and making better decisions

CBT is a therapy that is based on changing how we “read” situations. 

If we are going to make better decisions it can help by changing our “reads”.  

However, this is easier said than done.

Decision making and loss

There are comparisons that we can make from the world of finance.

The financial losses from the 2007 crash have meant that investing in the hope of future profit is now harder for everyone.

Financial decisions from 2007 onwards have been based on our memory of past” losses” rather than future gains.

If we are depressed our memory of “loss” makes us wary of making decisions which may incur future losses.

Risk taking

However we also know that therapeutic change involves risk taking. What can make it easier will be to focus on three questions

  1. What are you worried about?

Worry can come in one of two ways. Type one worries are those that we all experience. They are either problems that we can do something about or ones where we can do nothing.

Type two worries are ones which will keep us worried even though we have no answers.  They are usually those worries that begin with the words “what if….”

Even when we successfully answer a “what if” question another one springs up.

The first approach to successful decision making is to let type two worries go.  However, once we do this and then “act” we have to be aware that there will be” outcomes” to our decisions. 

  1. What is an outcome?

The second question to ask is - what is an outcome?

We judge our decisions on the basis of whether we achieve or fail to reach the outcome we want.

However, there will always be an “outcome” of one kind.

Life is a journey rather than a destination and the “outcomes” we may not expect become the starting points for the next round of decision making. 

However, this is easier said than done because our perception of failure can be painful.

  1. Why is failure painful?

The third question to ask is  - why is failure painful?

If we fail we feel vulnerable.

We can begin to change our perception of what we think vulnerability means. If vulnerability means less than perfect then it may help to remember that we relate more to “imperfection than “perfection”. Vulnerability is about being human.

Characters from popular culture such as Mr. Spock only become interesting when they show their humanity.

Ultimately we need to remind ourselves that our vulnerability is really only a symbol of our vulnerability.

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