Step 1: Depression and heart failure

Description of symptoms of depression Depression is common in people with heart failure Bad news: Depression is bad for the heart Good news: There are treatments for depression Discussion question: “Do any of these symptoms of depression sound familiar to you?”

Step 2: Thoughts, feelings, and behaviors

The connection between thoughts, feelings and behaviors Thoughts can be false and negative, and these thoughts contribute to painful feelings and negative behaviors of depression Two real-life patient stories are told that demonstrate the link between a stressful situation and negative thinking, feelings, and behaviors Discussion question: “Do these stories sound familiar to you? Do you see how the person’s negative thinking led to painful feelings and negative behaviors?”

Step 3: Your story

Interactive component: Patient is asked to describe a recent stressful situation Discussion questions: “What kind of thoughts were going through your head? How did these thoughts make you feel? Did you notice any behaviors?”

Step 4: Thought-stopping

Notice you have a negative thought Snap your fingers or clap your hands and say, “Stop!” By stopping the negative thought you help take away the painful feelings that go with the thought Interactive component: Patient practices the stop technique with the nurse

Step 5: Affirmations

An affirmation is a short, simple phrase that states how life is at its very best Use first person, present tense, and positive words; if you have a religious faith you may use it in your affirmation Interactive component: The patient comes up with 3–4 affirmations with the help of the nurse The nurse writes the affirmations on 2 brightly colored sticky notes: one for the hospital room and one for the patient to take home

Step 6: Homework

Practice the stop technique every time you hear a negative thought Hang the list of affirmations somewhere you will see it every day For every negative thought, think at least 2 positive thoughts