Thursday, April 12, 2018

Self-Management of Depression: Why, When and How to say “No” without Guilt

You may have a hard time saying no to other people because you are afraid that you will hurt others, appear selfish, look as if you don’t care, or risk a relationship. You may also want people to like you, especially when depression lowers your self-esteem, and saying no is contrary to your subconscious approval-seeking tendencies. However, depression robs you of energy and motivation to do what others want you to do. You then struggle to accomplish what you have said “yes” to, which drives more guilt. You can break this guilt cycle by learning to say “no.”

Why is it okay to say “no”?
Here are a few good reasons why it is okay to say “no”:
Accept that you are not a superhuman who can do everything that everyone wants.

Saying “no” doesn’t make you selfish as you have said “yes” several times to several people in the past. By saying “no,” you are only trying to strike a balance between how much responsibility you can and cannot handle.

Pleasing everyone every time by saying “yes” is not humanly possible.

When you say “no” to something, you are in fact saying “yes” to other things that may matter more in your life. These things include spending more time with your family and friends, paying more attention to your hobbies and interests, and finding more time for personal reflection and growth.

By saying “no,” you are saving yourself from burnout and maintaining your sanity.

When is it okay to say “no”?
Listed below are some objective criteria when you can say “no” without feeling guilty (Linehan, 2015):

1. Capability: Say “no” when you don’t have (and therefore cannot give or do) what the other person wants. 

2. Your priorities: Say “no” when your priorities don’t interfere with a relationship and with others’ self-respect.

3. Self-respect: Say “no” if your saying “no” doesn’t compromise your self-respect.

4. Rights: Say “no” if you are not violating others’ rights.

5. Authority: Say “no” if what the other person is seeking from you is not within their authority.

6. Relationship: Say “no” if what the other person wants from you is not appropriate to the current relationship.

7. Long-term versus short-term goals: Say “no” if giving in will get you short-term peace, but not a long-term relationship that you wish to have.

8. Reciprocity: Say “no” if you don’t owe the other person a favor, or if the other person seldom reciprocates.

9. Clarity: Say “no” if the other person’s request is not clear or you are not sure of what you would be saying “yes” to.

10. Timing: Say “no” if this is not a good time for you to say “yes.”

So far we have dealt with the “why” and “when” of saying “no” without guilt. Next section discusses “how” to say “no” without guilt.

How to Say “No” without Guilt
Saying “no” is a skill in assertiveness. Assertiveness refers to the ability to express one’s feelings, opinions, beliefs, and needs directly, openly and honestly, while not violating the personal rights of others. Saying “no” gives expression to your rights, thoughts, and feelings that promotes balance and equality in relationships. Saying “no” without feeling guilty requires tact and also practice.

“The No Sandwich Technique”: A popular technique to say “no” is the “no sandwich” technique (Clever, 2010). The top layer of the sandwich is an empathic statement or an affirmation, the middle layer conveys the message “no,” and the bottom layer empathizes again or proposes alternatives. Here’s an example. A coworker asks you to cover for some time as he has to be at his son’s soccer game. You have helped this friend with the same request a few times before, but now you feel that he may be taking advantage of you because of your lack of assertiveness. The “no sandwich” response to your friend would be something on the lines of – “I wish I could help you this time, but I have a prior commitment and have to decline. I understand that this is important to you. Have you thought of talking to your supervisor for making alternative arrangements so that you are able enjoy your son’s game without worrying about work?” 

For the middle layer of the “no sandwich,” one can use the following other ways as applied to the above example:

1. Defer: “I would love to help you out, but you need someone who is more in tune with your line of work and understands your responsibilities.”

2. Compliment: “It’s good that you are trying to spend more time with your family, and I need to do so as well. Sorry, I cannot help you.”

3. Don’t complain, don’t explain: Just say, “Sorry, I can’t help you.”

4. Give the “no” a little humor: “I would have to say no as this is my year of saying no.”

5. Set limits: “I cannot do this as I am swamped and cannot take more responsibility.”

6. Point out the facts: “I cannot do this as this conflicts with a meeting I have.”

If you are not sure about saying “no,” then provide the following alternatives:
“I can do it later when I have time.”
“I can do this now, but you may have to take something else off my plate.”
“How do you suggest I get all this done?”
“Who else can help with this?”  

Tips on saying “no”
You don’t have to say “yes” or “no” soon after someone asks you to do something. Buy some time.

Mentally rehearse the statements you will use to say “no.”

Talk in a firm and calm voice and maintain a neutral mood.

Keep an assertive body posture – look the person in the eye and use gestures to emphasize your statements.

Apologize, if you feel you need to, but don’t overdo it. 

Don’t get upset or feel guilty if the other person doesn’t buy your explanation. Your job is done after you have conveyed your intent. 

If the “no sandwich” technique appears unnatural or contrived to you, then by all means use what you are comfortable with as long you drive home the message, “Sorry, I can’t do this.”

To learn more about evidence-based self-management techniques that are proven to work for depression, check out Dr. Duggal's Author Page.


Clever, L. H. (2010). The fatigue prescription: Four steps to renewing your energy, health and life. Berkeley, CA: Viva Editions.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). New York, NY: The Guilford Press.

Written by a board-certified psychiatrist and an international expert on self-management of depression, this blog focuses on proven scientific methods of treating depression that go beyond medications and traditional therapy. It discusses elements of healthy lifestyle, positive psychology, relationships, values, strengths, communication, and wellness. The content of the blog is not to be construed as treatment advice.

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