Documentos de Académico
Documentos de Profesional
Documentos de Cultura
CHNH L LN TH 2
HNG DN CC K NNG
KIM SOT TRM CM
(Chnh l bn dch v in ln th 2)
Bs. Dan Bilsker TS. Sandy Paterson
Bc s Dan l chuyn gia tm l Tin s Sandy l chuyn gia
lm sng ti Bnh vin a khoa tm l, gim c Phng khm
Vancouver v tham gia t vn cho Changeways v l tc gi ca
nhm nghin cu v sc khe tm cun sch S trm cm
thn ti i hc Simon Fraser. ca bn.
Chng Trnh T Chm Sc Trm Cm c xy dng da trn kinh nghim ca
cc tc gi v cc nghin cu khoa hc v cc chin lc kim sot trm cm hiu
qu nht.
Cun sch ny nhm cung cp nhng thng tin chnh xc v trm cm. Cun sch
khng phi iu tr y t hay liu php tm l v khng thay th cho iu tr y t. Nu
cn phi iu tr hoc cn chuyn gia h tr, nn tm kim s gip ca cc
chuyn gia.
Vancouver, Canada
HNG DN CC K NNG
KIM SOT TRM CM
DN
HNG NG
N
CC K
T
KIM SO
M
TRM C
MC LC
Gii thiu 1
Trm cm l g? 3
Cu chuyn ca Hng 53
Cc ti liu nn c 54
Biu mu 63
GII THIU
Nhng tnh trng trm cm ca ngi trm cm c th Thm vo , mt s la chn v phong cch sng
thuyn gim v trm cm c th kt thc. C cc bin gim trm cm c tho lun trong phn Thng Tin
php cha tr v cc k nng t chm sc hiu qu Hu ch cui sch. Mc d cc phng php thng
kim sot trm cm. Nhn vin y t c th cung cp c tho lun ngn gn, phn ln chng ti nhn
cho bn cc bin php iu tr trm cm, nhng bn c mnh vo phng php tip cn: cc k nng kim
th hc cc k nng t chm sc v p dng chng. sot trm cm hn l thuc chng trm cm.
Hng dn ny gip bn nm c cc k nng kim
Chng ti hi vng rng cun hng dn ny s gip
sot trm cm. C lc bn c th ch cn s dng
ch cho bn. Nhng ch c th khng . pht huy
nhng k nng ny khi khng b trm cm qu nng.
tc dng, bn s phi p dng vo thc t. Chng ti
C khi bn phi s dng cc k nng ny ng thi vi
c gng miu t cc k nng mt cch r rng, theo
vic iu tr.
th t tng bc gip bn tng bc vng chc t
c mc tiu ca mnh.
Nu s im ca bn trong hai hoc ba cu hi cao hn 50 im, bn sn sang thay i. Nhng g bn tri qua
l qu v bn chun b dnh thi gian mi ngy lm cho mi vic tt hn.
an thng xuyn cam thy khng vui hoc bun ru, o khng co nghia la
Trm cm l
Nu tnh trng trn khng ci thin v ngy cng t 2. Nu bn c cc vn khc nh:
hn. C th bn b trm cm: thay i ng k v cn nng hoc s thm n;
1. Bn cm thy rt u bun, su no hoc khng khng th ng gic hoc ng qu nhiu;
c bt k hng th, nim vui g trong hu ht cc lun cm thy bn chn hoc chm chp, u oi;
ngy. Cm gic ny c th ko di hng tun; cm thy bn thn v gi tr hoc ti li;
V lun cm thy mt mi;
cm thy ngu ngc hoc trng rng;
gp nhiu kh khn v tp trung hoc ra quyt
nh;
ngh n ci cht hoc t st.
Hai loi trm cm thng gp nht l Chng trm cm nh v Chng trm cm nng.
Mi loi u c cng nhng vn nu trn nhng Bc s, cn b y t, chuyn gia tm l hoc bc s tm
i vi trm cm nng, cc vn ny trm trng hn. thn c th chn on liu bn c b trm cm hay
Khi mt ngi b trm cm, thng l trm cm nh. khng.
TRM
gic
ic
rng
G
v
TRM
IX
cm
CM
ts
N
m
ng
U
GC
v
hi
m t
NH
c tr
hy bun chn
CM
m
ho
t
ho
C
N
gi t
th
NG
th
cb
un
m h c
C
ng
gi chn k R t k h
o di. i
c
au t
b un th y m
, tuy
t vng c tip din. Cm
Mt s quan st v trm cm
T chn on trm cm rt kh Thng c khong hn 4% ngi ln b trm cm
mt thi im nht nh v hn 15% ngi ln b
Tm trng ca chng ta nh hng n kh nng
trm cm mt thi im trong cuc i.
nh gi v bn thn. Do , vic t nh gi liu
chng ta c thc s b trm cm hay khng thng Trm cm khng phi l mt du hiu yu ui
rt kh. Thng thng, cn ngi c chuyn mn
Rt nhiu ngi thng minh, ti gii v thnh cng
chn on.
tng trm cm. B trm cm khng c ngha bn
Nu bn b trm cm, bn khng c n c nhn cch km hoc co tnh cch c thiu st.
Bn mun lm au bn thn
i vi nhiu ngi, trm cm lm cuc sng dng tr khng hong hot ng 24/7. Tm cun Nhng
nh v vng v khng kim sot. Phn ln ngi trm Trang Vng v m phn Cc Trung Tm Khn Cp
cm u c nhng lc cm thy nh vy. i vi mt tm s in thoi trong khu vc bn sinh sng. Bn
s ngi, cm gic v vng qu mnh n mc h bt cng c th n Phng Cp Cu ti bnh vin gn ni
u ngh khng mun sng na. Nu bn cm thy bn sinh sng.
nh vy hoc ai bn bit cm thy nh vy, l
lc cn tm s gip . Tm nhn vin y t c th gip
bn vt qua cc cm gic ny. Nu bn khng th
i n bui hen, bn c th gi cc s khn cp h Hy nh, mi vic c th tr nn tt hn.
TNH HUNG
l Mt mt
l B c lp
l Xung t/ Mu
thun
l Stress
HNH NG
l C lp bn thn
khi x hi
SUY NGH
l Gim hot ng l Thi quen suy
l T chm sc bn ngh tiu cc
thn km l T ch trch
l Khng cng bng,
khng thc t
CM XC
SINH L l Chn nn
l Ri lon gic ng l Bun
l Thiu nng lng l Tht vng
l Thay i ni tit l Cm thy ngu ngc
trong no l Hi hp
Tnh hung
Trm cm thng khi pht t mt tnh hung rt cng Stress lin quan n sc khe. iu ny c bit
thng trong cuc sng. Nu bn c gng i ph ng trong trng hp c vn mn tnh v sc
vi tnh hung ny bng cch ci thin hoc chp nhn khe gy ra rt nhiu au n hoc kh khn trong
n nhng khng thnh cng, bn c th bt u cm vn ng v vic iu tr ch ci thin mt phn. Mt
thy qu ti v mt hi vng. Sau , nguy c xut hin s bnh tt hoc liu php iu tr c th gy ra
cn trm cm tng ln. Mt s tnh hung c th gy trm cm do tc dng trn c th. V d, nhc gip
ra trm cm bao gm: (tuyn gip tit qu t hormon tuyn gip) thng i
km vi mt mi v trm cm.
S kin quan trng trong cuc sng, nht l lin
quan n mt ngi thn. S kin nh ngi bn Nh vy khng c ngha trm cm ch xy ra khi c
yu qu cht, chuyn i, li d, ph sn hoc mt vic s vic khng nh xy ra. Mt s ngi b trm
l bin c ln trong cuc i. cm ngay c khi cuc sng ca h ang thun
bum xui gi: trm cm xut hin nh t trn tri
Thiu lin lc vi mi ngi. B c lp khi x hi l
ri xung! Cc k nng kim sot trm cm nh
yu t ri ro ng k gy trm cm.
trong cun hng dn ny cng hu ch cho nhng
Xung t trong quan h. Cc xung t mi quan h ngi ny.
c nhn trong hn nhn hoc gia nh rt cng
thng v c th gy ra trm cm.
Stress lin quan n cng vic. C th
l cng vic khng n nh (khng
bit r cng vic ca bn c tip
tc khng), xung t vi ph trch
v ng nghip hoc lm vic
qu ti (con ngi ch c th
lm vic ti a 16 gi mt
ngy, bt k trong mi
trng ngh nghip
hoc vic nh)
Suy ngh
Mi chng ta b nh hng khc nhau t cc s kin ch ng ngi, ngh rng s cm thy ti t v mi
bn ngoi, ph thuc vo cch chng ta ngh nh th ngi s nh gi, chi b mnh. Suy ngh ca mi
no v cc s kin . Tng tng c hai ngi bc ngi nh hng s kin s xy ra nh th no. Kt
vo bui tic. Mt ngi hng ngoi, t nhin, ngh qu nghin cu cho thy ngi trm cm thng c suy
rng c y s rt vui v vi bui tic v ngh mi ngi ngh lch lc v th gii v cch suy ngh sai lch ny
tham gia bui tic thn thin v ci m. Ngi kia s c th gy ra hoc lm ti t thm tnh trng trm cm.
NH Y H
H N H M N N GHT MN
C H U Y U
RA C
I MNH LUN
GY MI NG
T C PH HNG
T
I TH MI TH
G
M NH MNH
O
I SA Y? TH
T S
T M V
QU
L NGU NGU
NGC NG
C!
Cm xc
Trm cm thng bt u vi cm gic tht vng v Nh rng, ngi trm cm nhn nhn th gii theo cch
bun chn sau khi c gng x l tnh hung kh bi quan khng thc t v nh gi bn thn mt cch
khn trong cuc sng nhng khng thnh cng. Tuy khng cng bng v qu nghim khc. Cm xc ngi
nhin, v trm cm vn tip din, cm gic khng hnh trm cm cm thy nh hng rt nhiu t cch nhn
phc gy ra cm xc au n hn v nghim trng nhn tiu cc ca h v cuc sng. Nu suy ngh v
hn. Ngi mc trm cm b nh bi bi cm gic th gii ca h khng thc t v tiu cc, cm xc ca
tuyt vng, khn kh, v vng trn ngp. Cm giac hi h cng s khng thc t v tiu cc theo suy ngh .
hp cng thng (mt mi c th, lo lng v ni bt
C th bn thy kh c th c cm xc khng thc t.
hnh ang treo l lng trn u) thng i km vi
Nhng tng tng mt ngi lun tin rng i li bng
trm cm.
my bay l cc k nguy him v my bay hay b ri khi
Mt s ngi trm cm thy t lit v cm xc, mt kh ang bay. Ngi ny s cm thy rt s bay. Tuy
nng cm thy bt c cm xc g. Nguyn nhn l ni nhin, s s hi ny l da trn nim tin khng ng
au v tm l qu cng thng n mc tm tr ca bn v an ton ca my bay, do khng thc t v
mt ht cc cm xc. khng ng vi hin thc. Tng t, ngi trm cm
thng c nim tin khng thc t v th gii v bn
thn, dn n cm xc tiu cc, khng thc t.
Sinh l
Mt triu chng r rng nht ca trm cm l ri lon Mt l thuyt v trm cm cho rng trm cm l do mt
gic ng. Thng thng, trng thi ny biu hin l cn bng ni tit trong no. c nghin cu ch ra
khng th ng gic c th di dng kh ng hoc rng vi mt s ngi trm cm, mt s ni tit nht
thc gic nhiu ln khi ang ng hoc thc dy qu nh trong no t hot ng hn. Tuy nhin, vn cha r
sm. C nhng trng hp ng qu nhiu gy ra bi liu c phi s thay i ni tit trong no ny gy ra
mong mun mun trn trnh trong gic ng hoc qu trm cm. Tt c nhng g chng ta bit l trm cm
mt mi n mc lun cm thy thiu ng. Khi ng thng lin quan vi vic thay i ni tit trong no.
khng hi phc sc khe - ngha l khi thc dy
Nhng thay i v sinh l khi b trm cm khin cho
khng cm thy c ngh ngi v khe mnh -
ngi mc cm thy kh khn hn khi i mt vi vn
con ngi s cm thy kh khn hn khi i mt vi
ca cuc sng hoc ngay c khi thc hin cc
cc tnh hung v kh khn hng ngy. Ngi trm
bc trong chng trnh qun l trm cm ging nh
cm thng cm thy thiu nng lng v kit sc v
chng trnh ny. Cc thuc chng trm cm thng
cc hot ng thng ngy.
c tc dng hi phc li gic ng v nng lng. S
dng thuc chng trm cm gip bn c th hc v
th thc hin cc k nng mi cn thit vt qua
cn trm cm.
Hnh ng
Trm cm thng c nh hng ng k ln hnh vi ngi mc. Di y l mt s nhng hnh vi thng b
nh hng.
Cc hot ng a thch, lam th cng, chi th thao, c sch v du lch u c th b nh hng. Ngi trm
cm thng cm thy qu mt mi hoc khng c ng lc theo ui cc hot ng ny, do vy cng t thc
hin cc hot ng ny, ngi trm cm cng cm thy t c kh nng thc hin. Hu ht ngi trm cm mt
hng th trong cuc sng, gim cm gic vui v hoc hng th vi mi th xung quanh. Ti sao ti nn i xem
phim, tham gia hot ng gii tr hoc lm vic ti tng thch nu ti khng ngh rng ti s hng th vi cc
hot ng ? Khng hot ng tr thnh thi quen. Kt qu l ngi trm cm khng cn cm thy hi lng
khi tham gia cc hot ng ny, iu ny cng lm gia tng cm gic chn nn ca ngi trm cm.
Cc hnh vi chm sc c th v v b ngoi thng khng c quan tm. Ngi trm cm thng t quan tm
n qun o hoc n mc chnh t nh bnh thng. Thm vo , hot ng th cht cng gim, k c tp th
dc nh chy b hoc n gin i b xung quanh ni . Khng hot ng th cht lm tng trm cm v loi b
hot ng mang li s khe mnh v th cht v nng cao lng t trng. Ngi trm cm cng thng thay i
thi quen n ung c th n t (qun n) do n khng thy ngon hoc n qu nhiu t cm thy thoi mi
bn thn.
Ngi mc trm cm thng xao nhng hoc tr hon nhng vic nh thng ngy nh lm vic vt, rc, dn
nh hoc ti cy, dn vn. Khng hon thnh cc vic vt trong ngy lm tng ln cm gic khng tha mn
v khng kim sot c cuc sng ca ngi trm cm. Vic khng hon thnh cc vic nh thng ngy c
th gy ra xung t vi mi ngi v gy ra thm stress cho cc mi quan h.
Xa ri gia nh v bn b
Ngi mc trm cm thng t chi tham gia cc hot ng x hi, khng nghe in thoi v khng t tp gia
nh hoc bn b. Thu mnh khi x hi nh hng nhiu n tm trng trm cm v ly i s m p v cm
gic kt ni vi mi ngi cn thit cho tt c chng ta. Ngi trm cm thng tin rng mi ngi khng thch
giao tip vi h v h khng c cm xc g hoc rt bun chn.
TRM CM NH
Ni chuyn vi gia nh v bn b tin cy v cm Ni chuyn vi bc s gia nh, chuyn gia tm l
gic ca bn l vic nn lm. H c th gip bn hoc bc s tm thn. Ngi c chuyn mn c th
tm ra gii php cho vn ca bn; bn cnh , gip bn l gii chuyn g ang xy ra v c th a
ch cn bit c ngi quan tm n bn cng ra cc gi hu ch.
gip ch cho bn.
Trong mt s trng hp, cc thuc chng trm
Vit ra giy vn m bn ang gp phi, cm cm c th gip vt qua Chng Trm Cm Nh.
gic, suy ngh ca bn v cc gii php c th thc Nhng vi a s trng hp trm cm nh, cu tr
hin. Cch ny c th gip bn hiu bn ang tri li khng nm thuc chng trm cm.
qua nhng g v bn c nhng la chn no.
TRM CM NNG
Ngoi nhng hnh ng bn c th lm c miu t php hng dn cc k nng suy ngh v hnh
trong phn Trm Cm Nh ng hiu qu hn. Hng dn ny c pht trin
da trn cc phng php CBT.
Chc chn bn nn i n gp bc s nu bn ngh
mnh b trm cm nng. Trm Cm Nng l vn Mt liu php iu tr hiu qu na l Liu php
nghim trng v nn c bc s gia nh, chuyn cng c mi quan h c nhn (IPT), liu php ni
gia tm l hoc bc s tm thn chn on. chuyn nhm hng dn cc k nng giao tip vi
ngi yu, bn b v gia nh.
Cc thuc chng trm cm c ch nh ph bin
vi Trm Cm Nng v thng c tc dng. i vi cc trng hp trm cm ko di hoc ti
pht, phng php tip cn hiu qu nht l kt
Mt cch iu tr cng c hiu qu tng ng
hp thuc chng trm cm vi mt trong cc liu
cho phn ln cc trng hp Trm Cm Nng la
php ni trn.
Liu Php Nhn Thc Hnh Vi (CBT). CBT l liu
huc pht huy tc dng trong mt s trng hp. Rt nhiu ngi s dng
Nhng thuc ch c tc dng ci thin tm trng: vic Thay vo , hy suy ngh thuc gip bn c nng
thay i cch suy ngh v x l cuc sng hng ngy lng v ci thin tm trng bn c th thay i
cng rt quan trng. ng s dng thuc nh mt (nh bt u tp th dc hng ngy, hc cc k nng
cch cho php bn duy tr cch sng khng lnh mnh ra quyt nh hoc lp k hoch v lm vic t
c cc mc tiu cuc sng ca bn).
Mt s im cn ch khc v thuc:
Cc loi thuc khc nhau c tc dng khc nhau trn Vic s dng thuc trong thi gian ko di c th c li
cc c th i vi mt s ngi
C th mt thi gian tm ra loi thuc (hoc phi i vi mt s ngi, thuc chng trm cm vn c
hp cc thuc) ph hp vi mt bnh nhn m khng hiu qu khi s dng ko di. Phn ln bnh nhn ch
gy ra qu nhiu tc dng ph. Cc tc dng ph c s dng trong thi gian ngn c th c nhng thay
th l kh ng, thay i cm gic ngon ming v mt i tch cc, sau gim dn v ngng s dng thuc.
hng th tnh dc.
Mt s ngi gp tc dng ph khi s dng thuc Kt qu ca vic ngng thuc sm l trm cm ti pht
chng trm cm nn mun ngng thuc. Nu bn nhanh chng. V vy tt nht bn nn tip tc s dng
mun ngng thuc, hi kin bc s k n. Thng thuc cho n khi tm trng n nh. Khi tm trng
thng, bn s gim dn liu dng trc khi ngng ca bn c kim sot, bn c th gim thuc dn
thuc hon hon. dn.
Thit lp li
cuc sng ca bn
Gii quyt
vn
Suy ngh mt
cch thc t
Thit lp li
cuc sng ca bn
Gii quyt
vn
Suy ngh mt
cch thc t
Nhng nu bn ngng chm sc bn thn hoc khng Trm cm dn n khng hot ng, nhng khng
lm nhng vic bnh thng bn thch, cuc sng ca hot ng lm cho tnh trng trm cm nng hn. iu
bn tr nn bun chn v c ch. Mc d c th bn bn tng l gii php tt i ph vi tnh trng
cm thy vic t hot ng hn lm bn thoi mi, thc trm cm li lm duy tr hoc trm trng thm tnh
t, bn ang gip trnh trng trm cm tr nn nng n trng trm cm. Gii php: ng i cho n khi bn
hn. Ni cch khc: cm thy mun hot ng hn. Ch i ch cng ngn
bn lm cho mi vic kh hn. V ng i cho n
khi bn cm thy c ng lc - khi bn cm thy kh
hn, bn s cm thy c ng lc hn. Trc ht hy
hnh ng, ng lc s xut hin sau . t cc mc
TRM CM KHNG HOT NG tiu tng mc hot ng ca bn l phng
php hiu qu kim sot trm cm.
Mc tiu l lm cho bn hot ng dn dn mc d
bn c th khng cm thy thch. Di y l cc
bc bn dn dn thay i cch sng.
Cc hot ng gii tr
V d:
c bo. i b gia thin nhin. Lm th cng hoc s thch. Ln k hoch i du lch.
Xem phim, kch hoc chi tr chi.
tng ca bn:
T Chm Sc
V d:
n mc p hng ngy. Dnh thi gian tm ra v v sinh c th. Tp th dc. n sng. n thc n nhiu dinh
dng. (Cc phong cch sng lin quan n gim trm cm c tho lun trong phiu thng tin cui sch).
tng ca bn:
Cc Vic Vt
V d:
Kim tra hm th. Tr cc ha n. V sinh nh ca. Mua dng trong nh. Lm vic lt vt trong nh.
tng ca bn:
T tp vi gia nh v bn b
V d:
Mi mi ngi tham gia hot ng no . Gi lin h vi ngi bn tng sng cng. Tr li cc cuc in
thoi. Tham gia lp hc hoc nhm x hi.
tng ca bn:
Hot ng 1:
Hot ng 2:
Bc 3: t cc mc tiu thc t
t mt mc tiu c th t c cho mi hot ng m Nu bn mun dn dp nh ca, mc tiu u tin ca
bn la chn trong tun ti. Ghi nh rng tnh trng bn c th l ht bi mt phng hoc lau bi gi sch.
trm cm lm bn cm thy kh khn khi thc hin k Nu bn mun giao tip li vi mi ngi, mc tiu u
hoch. Do , bn cn t mc tiu thp hn so vi bnh tin ca bn c th l ni chuyn in thoi vi mt
thng. ngi bn trong vng nm pht
C th
Trm cm c th lm cho tt c mi th dng nh u tht bi. Bn cn c mt tng v mc tiu rt r rng
gip bn bit bn thnh cng.
Thc t
Bn c th t t mc tiu cho mnh da trn mc bn ngh bn c th hon thnh. ng lm nh vy. Nh rng
tnh trng trm cm s lm bn chm i v lm mi vic kh khn hn. Mc tiu ca bn nn d dng thc hin
ngay c khi nu bn cm thy rt trm cm trong tun ti. i khi, bn cm thy qu ti khi ngh v vic bt u
phi hot ng mi. Trong trng hp ny, c gng t mc tiu thu thp thng tin lin quan n hot ng: v d,
tm kim thng tin v vic loi hnh th dc no sn c trong khu vc bn sinh sng.
Anh y s dng quyn s ghi chp lch hn vit cc hot ng. Sau khi thc hin, anh y s nh du
vo s.
1.
2.
Bc 5: Xem li cc mc tiu ca bn
Sau hai tun thc hin cc mc tiu, xem xt li tnh trng ca bn
Bn c mun tng mc tiu ln mt cht khng hoc gi nguyn mc nh vy cho n khi bn cm thy thoi
mi? l la chn ca bn.
y l thi im tt thm mt mc tiu mi. La chn mt mc tiu t mt loi hot ng khc. V d, nu
bn c mc tiu Chm sc bn thn v Cc hot ng gii tr, la chn mc tiu T tp vi gia inh v bn
b hoc mc tiu Cc vic vt.
Hnh ng mi:
HNH NG MC THNG XUYN CHNH XC KHI NO?
Sau hai tun thc hin cc mc tiu ny, xem xt li t cho bn 3 mc tiu.
tnh trng ca bn. C mc tiu no cha c thc Vit vo lch ca bn.
hin khng? iu g ngn tr bn? Bn c cn gim nh du mc tiu bn thc hin.
hoc thay i mc tiu khng? T chc mng bn thn mi khi thc hin c mt
mc tiu.
Xem xt li cc mc tiu hai tun mt ln quyt
Thc hin k hoch ca mnh! Tip tc t ra cc mc nh liu bn c cn sa i hay khng v liu bn
tiu v xem xt b sung thm mc tiu nu nng lng c cn t mc tiu mi hay khng.
ca bn cho php. Nu bn hon thnh mt nhim v
(v d nu bn hon thnh thu thp thng tin v cc Cui cng, bn s thc hin 3-4 mc tiu hoc nhiu
hot ng gii tr trong khu vc bn sng), hy chuyn hn cng mt lc. ng qun rng t ra qu nhiu
sang mt mc tiu mi. Duy tr qui trnh sau: mc tiu c th lm bn qu ti.
Thit lp li
cuc sng ca bn
Gii quyt
vn
Suy ngh mt
cch thc t
Suy ngh trm cm l khng thc t v khng cng bng: C phi chng ta mun t nh la bn thn rng
Suy ngh tiu cc, khng thc t v tnh hung ca khng c vic g xu s xy ra khng? Khng. Vt
bn; qua suy ngh trm cm khng c ngha l thay th n
Suy ngh tiu cc, khng thc t, khng cng bng bng suy ngh tch cc lch lc (ai cng yu qu ti,
v bn thn; khng c g xu c th xy ra, ti s lun t c iu
Suy ngh tiu cc, khng thc t v tng lai ca ti mun). Mu cht l suy ngh mt cch khng thc
bn. t d l tch cc hoc tiu cc u lm chng ta cm
Mc ch ca chng ta l thay th suy ngh trm thy v c x mt cch khng ph hp. Mc tiu ca
cm bng suy ngh thc t. chng ta l nh gi cuc sng v bn thn mt cch
thc t. Mc tiu l suy ngh cng bng v thc t.
Suy ngh thc t l:
Suy ngh ng vi tnh hung, nhn mi th r rng iu c ngha l cng bng v thc t v bn thn
nh bn cht ca chng (ch vo kh nng v th mnh cng nh im yu),
Cng bng vi bn thn, nhn cc kha cnh tiu v tnh hung hin ti (cn nhc kha cnh tch cc v
cc v tch cc trong cuc sng ca bn mt cch tiu cc ca cuc sng mt cch chnh xc) v v
cn bng tng lai ca bn (khng phng i kh nng c kt
Suy ngh ng v tng lai ca bn, khng phng qu tiu cc). Nh vy, lm th no bn thay i
i tin on tiu cc suy ngh trm cm?
Mc tiu ca vic i ph vi suy ngh trm cm l g?
Mc tiu c phi l lun lun suy ngh tch cc khng?
Lm theo cc bc sau
Chn lc
Trong suy ngh trm cm, bn ch nhn thy iu xu, khng bao gi nhn thy iu tt. V bn ch nhn thy phn
tiu cc, cuc sng ca bn c v ch c tiu cc. Nhng suy ngh thc t cn nhc cn bng gia kha cnh tch
cc v tiu cc ca cuc sng ca bn.
Qu khi qut ha
Trong suy ngh trm cm, mt s kin tiu cc dng nh l khi u khng bao gi kt thc cho nhng s kin
tiu cc khc. Nu mt ngi bn ra i, tt c ngi khc cng s ra i. Nu bn tht bi ln u, bn s lun lun
tht bi. Nhng suy ngh thc t nhn nhn ra rng tnh hung ng tht vng va xy ra khng quyt nh cc tnh
hung khc s nh th no.
Bi kch ha
L mt cuc hn nh c nhn nhn nh mt thm ha. V d, bn hon thnh mt d n nh hi mun, th l coi
nh c thng ca bn hng; bn phn ng vi bi kch tng tng (thng ti t) hn l vi s kin nh (d n b
mun). Nhng suy ngh thc t nhn nhn s kin theo ng tm quan trng ca n, khng phng i cc s kin
tiu cc.
T nh gi bn thn
Bn t nh gi bn thn mt cch nghim khc, t gi mnh l ngu ngc, k tht bi hoc bt k t g xc phm
bn nht. Bn ni vi mnh theo cch m bn s khng bao gi ni vi ngi khc. Nhng suy ngh thc t khng
s dng cch xc phm bi v cch khng cng bng, bn s khng ni vi mi ngi cch v cch gy
tht vng mt cch khng cn thit.
1 Cc kiu suy ngh lch lc ny c m t trong mt cun sch rt hay, Cm thy sung sng - Feeling Good ca David Burns (Avon, 1992).
D on tng lai
Bn cm thy nh th bn bit tng lai s nh th no v tng lai ca bn rt tiu cc. Khng c g tt p c,
vy ti sao li phi c gng? Nhng suy ngh thc t nhn ra rng bn khng bit mi vic din ra nh th no: bng
cch ci m vi kh nng tch cc c th xy ra, bn c th c nhiu hi vng hn v c th lm mi vic tt p hn.
Qu cu ton
Ch c hon ho mi tt. V bn khng th lm mi th mt cch hon ho, bn him khi hi lng v t ho v bt
c iu g. Nhng suy ngh thc t cho php bn hi lng khi t mt thnh tch no , ngay c khi kt qu khng
c hon ho. Ch c mt s t ngi c th hon thnh hon ho cng vic mnh lm, nhng nhng g chng ta
t c l ng c hi lng.
Nn
Bn ngh rng bit th gii ny nn th no v thc t khng nh vy. Bn bit bn nn nh th no v bn khng
c nh vy. Kt qu: Bn lin tc tht vng v gin vi bn thn v vi mi ngi xung quanh. Nhng suy ngh
thc t hiu gii hn ca th gii v bn thn - c gng ci thin nhng cng chp nhn thc t.
C nhiu loi suy ngh trm cm khc nhau, nhng c mt s loi ph bin nht. Khi bn thy mnh suy ngh trm
cm, bn nn c danh sch ny xem mnh c suy ngh nh vy khng.
Sau th lm g? Mt s suy ngh trm cm r rng C th bn s thy cc suy ngh trm cm t nghim
l lch lc. i , l do tt c mi ngi nhn mnh trng hn khi bn bit chng n t u. Khi chng ta
trn xe but l do mnh ng ng trc, ch khng thc v cc suy ngh trm cm, chng ta c th cm
phi v h mun nh gi mnh! i khi ch cn bit thy mun tn cng bn thn. Lm th no m mnh c
rng vi tnh hung no, suy ngh trm cm xut hin th suy ngh ngc ngch nh vy nh? Trm cm lm
cng l . C gng thc khi suy ngh trm cm cho bn t ch trch v nhn ra rng suy ngh trm cm
xut hin v nhc bn suy ngh n t u. Ti suy c th nh bi chnh bn. ng lm nh vy. Thay vo
ngh nh th bi v tm trng ti ang bun chn v , nhc bn thn rng suy ngh trm cm l kt qu
bi ti l a tr bit thc sm - ch khng phi ca tm trng bun chn v ca qu kh ca bn. Bn
bi v tt c mi ngi ang nh gi ti. khng ngu ngc v suy ngh nh vy. Nhng suy ngh
nh vy l bnh thng khi b trm cm.
Khng ai thch mnh. Mnh chn cht. Mt s ngi c v khng thch mnh, mnh s phi c lm
(Qu khi qut ha) mi ngi thch mnh hn.
Cuc sng ny tht c n, t nht v ai cng Mt ba tra khng c lin quan n c th gii. Mnh
chi b mnh. (Bi kch ha) c mi ngi chp nhn trc y.
u tin, vit ngn gn v tnh hung ca bn. V d: Ni chuyn vi con gi, i b n ch lm, Ln k hoch
nu ba ti. Sau , vit ra cc suy ngh tiu cc c v lin quan n cm gic ca bn. Nu thch, bn c th th
lit k mt s suy ngh tiu cc (nh trn).
Cui cng, suy ngh v tnh hung v c gng nh gi tnh hung mt cch cng bng v thc t hn. Gi : Suy
ngh trm cm thng l nhng suy ngh vt qu thc t. Thng thng suy ngh thc t v cng bng ch nhc bn
thn bn rng bn khng c thng tin bit chc iu g ang xy ra. Ti khng bit ti sao c y hy bui hn
n tra; c th c hng trm l do cho chuyn .
Chng ti thng suy ngh thc t hn v ngi khc hn l v bn thn. Nu bn ti gp tnh hung tng t,
ti s ni g vi bn o?
Tnh hung:
Thit lp li
cuc sng ca bn
Gii quyt
vn
Suy ngh mt
cch thc t
Ti sao mi ngi li b trm cm, c phi l kh nng V tt c cc l do trn, khng c g ngc nhin khi cc
gii quyt vn ca h gim i khng? C mt s l vn khng c gii quyt m thay vo chng
do nh sau: cht thm. Vy bn phi lm g? u tin, nhn ra
Gii quyt vn lm tiu tn nng lng. Khi tnh rng kh nng gii quyt vn ca bn khng tt
trng trm cm tng ln, mc nng lng gim i. nh trc kia. ng t nh bi mnh v l do .
l triu chng bnh thng ca trm cm v tnh trng
Cc vn hng ngy gy ra vn ln hn - trm
ca bn c th tt hn. By gi, hy ngi li v lm
cm. V quan tm nhiu hn n vn tm trng,
theo cc bc tip theo
cc vn khc khng c x l v trm trng
hn.
Trm cm lm mt tp trung, gim tr nh, gim
kh nng ra quyt nh v sng to. Phn ln bn
cn cc k nng ni trn gii quyt vn .
Bc 1: La chn mt vn
Bc u tin trong gii quyt vn chnh l la chn trc khi tm trng bn thay i? Nhng chuyn bin
vn . Nhng ngi b trm cm i khi gp phi trong tm trng ca bn c th l mt ch dn hu ch
nhng kh khn trong vic xc nh cc vn c th gip bn xc nh ngun gc ca vn .
trong cuc sng ca h. H cm thy gp kh khn
Mt s vn ca bn c th l nhng vn ln (v
trong mi vic. Vic xc nh mt s vn c th cn
d: Tun ti ti s b tch thu ti sn), hoc c th l
u tin x l l hu ch i vi h. Vic ny s gip h
nhng vn nh (Ti s cn c rt nu ti mun lm
tm ra cc cu tr li mang tnh thc tin.
salad ti nay). Cc vn khc c th nm u
Mt cch xc nh vn l ch n s thay i gia hai mc ny (C mt tp th trn bn ca ti
ca tm trng bn thn trong sut tun. Lu iu g m ti khng th c can m nhn vo n trong
ang xy ra khi tm trng bn i xung: bn ang ngh sut tun qua).
ci g; bn ang u; v chuyn g xy ra ngay
Vn bn chn l:
y l mt v d:
Do Trang, th k ring ca mt gim c cng ty ln, vit lai.
Vn :
Cng vic ca ti ang b qu ti. Cc ti liu ang cht ng trn bn lm vic. D ti x l cng vic trong
nhiu gi m ti vn cn qu nhiu vic. Ti ni chuyn vi ngi qun l rng khi lng cng vic tng ln
yu cu bt hp l.
3. Vit ra tt c cng vic. Sau , ghi ch nhng vic cp bch cn phi c thc hin trong ngy hm nay,
nhng vic cn phi c hon thnh trong tun ny, thng ny v thm ch l th k ny. Theo cch ny, ti
s tp trung nng lng vo nhng mc tiu u tin nht v c th lp k hoch hiu qu hn.
Vn :
My workload is overwhelming files are piling up in my tray and even though I work long hours I keep
getting further behind. Ive told my boss that the workload has been growing quickly, but she doesnt do
anything about it. The whole situation seems out of control and Im starting to feel pretty depressed.
2.
3.
Bc 3: So snh cc hnh ng
Cn nhc hnh ng no c nhiu kh nng gii quyt vn nht. Hy ngh n u im v nhc im ca tng
hnh ng.
HOT NG U IM NHC IM
1.
2.
3.
U TIN:
chn bn c th bt u thc hin. Hy xem xt li
kh nng thc hin, ngh v nhng mt tt cng nh
mt xu ca mi hnh ng, sau hy chn mt hnh Vic phi lm tun ny: ,,,,,,,,,,,,,,,,,
ng trong s . Gii php c chn t nht cng a ,,,,,,,,,,,,,,,,,
bn hng ti mt cch gii quyt vn . Hy t gii Thng ny: ,,,,,,,,,,,,,,,,,
hn cho chnh mnh mt khong thi gian a ra ,,,,,,,,,,,,,,,,,
quyt nh m khng c bt k tr ngi no. Hy nh Th k ny: ,,,,,,,,,,,,,,,,,
rng, nu bn bt u thc hin nh hng dn trn ,,,,,,,,,,,,,,,,,
nhng thy khng hiu qu, bn c th th gii php
khc.
u l hot ng m bn chn?
C th:
Qun l c (Manageable) Nu tun ny bn khng cm thy tt hn tun trc (thm ch bn cn cm thy n
t hn mt cht), bn vn c th tip tc thc hin k hoch. Hon thnh mt mc tiu d l rt nh cn hn l khng
hon thnh mt mc tiu tham vng. y mt v d khng nn cho ln u tin i ra ngoi: Tham gia mt cuc chy
maratng. V d tt hn l: Mc tiu l i b quanh khu nh
C tnh nh hng hot ng (Action-oriented) Lp mt k hoch v nhng vic bn s lm ch khng phi l bn
ngh hay cm nhn th no khi bn thc hin vic . Thc t cho thy, bn chc chn kim sot c ci bn lm
nhng li kh c th kim sot c cm xc cng nh suy ngh ca mnh. V d khng nn l : Dnh mt gi vui
v cho nhng a con ca ti. V d tt hn l: Dnh mt gi cho nhng a con ca ti.
C Th (Specific) Vic bn cn lm nn c th. V d khng nn: Ly li vc dng trc y. V d tt hn l: Gi
in n trung tm cng ng tm hiu xem h c lp dy yoga khng.
Thi hn thc hin (Time-limited) K hoch ca bn ch nn c thc hin trong khong thi gian ngn. ng lp
k hoch thay i bn mi mi. V d khng nn: Luyn tp th dc thng xuyn cho n cui i. V d tt
hn l: i b 20 pht mt ln, 3 ln mi tun, nh gi vic thc hin sau hai thng.
K hoch chnh xc l g?
Bc 6: nh gi
Bt u nh gi sau khi thc hin k hoch mt tun hoc khi bn t c mc tiu ca mnh.
Bc 7: Tin ln
S dng kinh nghim ny lp k hoch cho cc bc tip theo.
Bn c 3 s la chn:
Tip tc. V d: Thm 20 pht tm kim cc giy t
Sa li mc tiu v c gng mt ln na. V d: Lm sch nha kho/bp trong mt gi l qu kh khn, thay vo
l lm v sinh nha kho hoc bp trong 10 pht.
S dng cch tip cn mi. i khi, bn hc c mt ci g hu ch x l vn t c gng u tin ca
mnh. V d: Ni chuyn trc tip vi d Sarah khng mang li kt qu g. Thay vo , bn s vit mt l th
cho d y.
Tip tc lm vic vi vn ny tng bc mt. Ghi li nhng c gng ca bn v lun nhc nh bn thn v nhng
tin b m bn lm c.
Di y l mt s cch:
Lm quen dn dn vi stress nu c th. V d: Nu bn sp tr li vi cng vic th trc tin bn nn th lm vic
bn thi gian trc.
Gim nh trch nhim. V d: Nu bn ang tham gia mt kha hc bui ti, hy cho php bn thn n ngoi nhiu
hn hoc chp nhn vic nh ca s ba bn hn.
Duy tr vic chm sc bn thn. Lm th no gip bn thn bn lun c cn bng? ng t b nhng th khi
bn cn chng nht. Nu mt ba tra mi tun vi ngi bn thn l quan trng vi bn, hy duy tr n. Nu cc bi
tp th dc gip ch nhiu cho bn, hy lm tt c mi th bn c th tip tc vic tp luyn trong sut thi gian
bn b stress.
Lp K Hoch Hnh ng Khi Tm Trng Trong Tnh hoc kh hi phc. Bng cach lp k hoach trc v
Trng Khn Cp nhng gii php mang li hiu qu, bn c th khng
phi lo lng v gim c kh nng ti pht.
Nu bn lp k hoch trc trong trng hp b ti
pht, bn c th c c s gip nhanh hn. Nh Nu bn b trm cm tr li, bn c th lm nhng g
, cn trm cm khng nng thm, khng ko di gip mnh v hi phc nhanh nht c th?
y l mt s ch bn nn ngh n:
Tng cc hot ng th gin. S dng cc bc trong phn Thay i cch sng
Gim i trch nhim ca mnh. Bn c th ln k hoch nh th no gim trch nhim ca bn khi bn thiu nng
lng nu b trm cm ti pht. V d: Bn c th tha thun trc v yu cu gim s gi lm vic hoc tm thnh
vin trong gia nh gip bn chm sc con ci
Tm s gip ngi c chuyn mn. Cn nhc vic cho php mt vi ngi bn hay thnh vin trong gia nh, hay
i khi l bc s ca bn nhc nh bn khi h nhn thy c v tm trng ca bn ang i xung.
Qun l cch sng ca bn. Tm trng i xung khng c ngha l bn khng tp luyn th dc, khng ra khi nh,
khng duy tr n ung y cng nh c nhng gic ng ngon. Cch sng no gip ch cho tm trng ca bn
nht?
Hy suy ngh v vic lm th no bn c th quay li vi cng vic sm trong giai on b trm cm ngn chn
chng tr nn t hn. iu g s gip ch trong thi gian ny? S dng danh sch trn nh mt im khi u v
t lp mt k hoch r rng v c th.
Cac cun sach di y c xut bn tai nc ngoai va cha co sach dch tai Vit Nam.
Chung ti hy vong se sm dch va a vao phat hanh tai Vit Nam.
Burns, David D. Feeling Good (1992, Avon Books) or The Feeling Good Handbook (1999,
Plume Books). Extremely successful self-help books on depression and anxiety. The
emphasis is on specific exercises to carry out.
Catalano, Ellen Mohr (1990). Getting to Sleep. Oakland: New Harbinger Publications. A
useful book that describes a variety of sleep problems and offers concrete suggestions for
dealing with them.
Paterson, Randy (2002). Your Depression Map: Find the Source of Your Depression and
Chart Your Own Recovery, New Harbinger Publications, Inc. A guide to developing indi-
vidualized strategies for recovering from depression.
Greenberger, Dennis and Padesky, Christine (1995). Mind Over Mood. Guilford Publica-
tions, Inc. A hands-on workbook for therapy clients suffering from depression, panic at-
tacks, anxiety, eating disorders, substance abuse, and relationship problems.
Cronkite, Kathy (1994). On the Edge of Darkness. New York: Delta. First-person accounts
from well-known people who have been through serious depression. Seligman, Martin E.
P. (1992). Learned optimism. New York: Simon and Schuster. How to overcome a sense
of helplessness in your life.
Hng dn ch n ca Thc n l ngun cung cp nng lng cho c th. Khi chng ta
Canada b trm cm, ch n thng b thay i. Mt s ngi n nhiu
hn. Nhng ph bin hn c l n khng ngon ming. Nu iu
Hng dn l ch n hng ny xy ra, mt iu quan trng phi nh l mc d bn khng
ngy cho ngi trng thnh. thy i nhng c th bn cn nng lng. Sau y l mt s mo
Lng thc t ca thc n ph gi ch n thch hp trong giai on kh khn ny.
thuc vo tui, kch c c th
v mc hot ng. Hng Cc ba n u n. y l cch d nht n (v kim sot
dn khuyn ngh la chn ch nhng g bn n) nu bn gi theo thi quen. C gng c 3 ba
phm t cht bo nu c th. n mi ngy. V m bo rng bn c thc n cho 3 ba .
La chn ng nhng hot ng. Thch thc ln nht l duy tr n. Chn nhng hot ng
m bn thc s hng th. C bi tp th dc vn ng nhiu (cho tim mch) (trong nhp
tim ca bn tng ln n mc tiu trong 20 pht hoc nhiu hn) v bi tp th dc nh
nhng (nh nng t hoc yoga) u c nh hng tch cc n tm trng. La chn loi
ph hp nht vi bn. S a dng cng c ch: chn nhiu hn mt hot ng v xen k
chng.
Khi ng. Hc cch khi ng trc khi tp v m bo rng thc hin ng trc khi tp.
iu ny c th gip gim nguy c b thng hay au khi tp.
Thng xuyn quan trng hn l tp lu. Thng xuyn tp th dc trong mt thi gian
ngn (3-4 ln/tun) tt hn l tp lin tc trong mt thi gian di.
y l mt s mo nh:
Qui nh thi gian i ng v thc dy. C th bn hot ng trong chu k sinh hc 24h, chu
k ny c th b ri lon nu thi gian i ng v ng dy thay i lin tc. iu ny l nguyn
nhn ca s mt mi do chnh lch mi gi: trong trng hp ny khng phi do di chuyn
qua cc mi gi khc nhau m do thay i thi gian ng. u n i ng v thc dy vo
mt thi im c th gip thit lp ng h sinh hc cho bn.
To ra mt mi trng tt cho gic ng. Nhit phng ng tt nht cho mi ngi l 18O
n 21OC (65OF - 70OF). Nu nh phng ng b ting n, mt s la chn nh eo tai nghe,
lm cch m trong phng (treo vai xung quanh c th ci thin mt cht) v cc thit b pht
ra ting ng th gin (nh qut hay my pht ting chuyn bit). Loi b ting n t ng
h hoc ting chung ca ng h. Nu ngi ng cng l vn , xem xt vic c mt
chic ging ln hn, m m hn hoc thm ch ng ring ging trong mt thi gian.
Trnh nhng gic ng ngn trong ngy. Tr khi bn lun thch ng gic ng ngn 20 pht
mi ln ng. Gic ng vo ban ngy di hn c th kh ng vo bui ti.
Chun b cho gic ng. Trnh hot ng nhiu, tp th dc, n nhiu v n sng t nht 1
gi trc khi i ng.
Tp ht th hoc p dng cac cch gim tp trung trc khi i ng. Tp trung vo nhng lo
lng hoc bn cn nhng g c c gic ng s ch lm cho bn tnh to. Thc hnh
bt k bi tp tinh thn gip u c bn trnh nhng ch ny.
Caffeine kch thch h thn kinh giao cm, ni chi phi cc p ng chng li stress. Nu tnh
trng trm cm ca bn km theo nhiu lo lng, iu cui cng m bn cn l thuc kch hot
h thng p ng chng li stress. Caffein c th lm trm trng thm vn nh gy ra nhc
u, hi chng co tht rut kt, cc cn au mn tnh v cc vn vn ng khc.
Dng bao nhiu caffein th s b ph thuc? c tnh l khc nhau mi ngi, nhng
khong trung bnh 450g mi ngy. Mt s ngi nhy cm hn th liu ph thuc thp hn.
Dng bng di y tnh mc dng mi ngy ca bn. Ch y dng n v tnh
l cc phn nh. Cc caf ca bn c th gp 3 hoc 4 ln.
Nu bn quyt nh gim lng caffein, hy gim dn trnh cc triu chng cai nghin.
Gim lng caffein khong mt na trong 4-6 ngy, sau , gim mt na na cho ti khi
bn ung di 2 cc mi ngy.
Coffee
Caf pha phin (5 oz.) 130 x _______________ = ___________
Mt trong nhng nguyn nhn nhng ngi trm cm s dng thuc v ung ru l nhng
th ny gip h cm thy thoi mi hn trong mt thi gian ngn. Nhng trong thi gian di,
chng lm cho trng thi trm cm nng hn:
Trong qua trnh trm cm, ru v cht gy nghin rt hp dn bn. Nhng, trong thi gian
ny, s dng nhng cht ny l hon ton khng nn. Sc chu ng ca bn i vi tc
ng ca chng v kh nng kim sot vic s dng cc cht ny rt c th km hn bnh
thng. Trng hp ny i hi hnh ng c th, c k hoch hn l trn trnh vo cc
cht gy nghin. Cht gy nghin v ru tng tc vi nhiu loi thuc trm cm, bao
gm hu ht thuc k n trong trng hp lo lng, trm cm. Ni chung, tt nht l theo
hng dn sau duy tr li sng cn bng.
Trnh dng ru v cc cht kch thch trong giai on trm cm hoc stress nng.
Trnh dng ru v cc cht kch thch nu bn hay gia nh c tin s lm dng thuc.
Thm ch nu bn thy tt v khng c tin s lm dng thuc, p dng quy nh cho
bn thn ch s dng nhng cht ny c chng mc.
Tnh Hung:
Nhiu ngi s ng vi suy ngh ny? Nu khng, suy ngh no thc t hn?
2.
3.
MC TIU T RA