In CBT we often spend time mapping out what’s happening when we feel low, what’s happening in our thoughts, bodies, emotions and behaviours. These are all interconnected. How we think has a big impact on our emotions, how we feel in our bodies shapes what we feel like doing, and what we do has a big impact our mood. Targeting our behaviours and activities is known to be the best first line treatment for low mood and is the NHS first line of treatment for depression.
In CBT we call this behavioural activation. It‘s the process of intentionally scheduling activities that can give us a boost. Whether this is through pleasure, a feeling of achievement or closeness to others.
Judith Beck is a wonderful CBT therapist. She has proven that most depressed patients have withdrawn from activities that previously gave them a sense of achievement or pleasure (or both) and lifted their mood. Depression has a nasty tendency to make us increase behaviours which maintain or increase dysphoria – the sense of unease or dissatisfaction. This might be watching TV which doesn’t interest us, spending more time in bed during the day, scrolling on our phones, etc.
Activity scheduling needs to be done extra kindly. If we’re comparing what we’re able to do now with personal bests – known as discrepancy monitoring– this is likely to make it not seem worth trying.
It’s really hard to imagine feeling different from how we do at any given moment. This is exaggerated when we feel low, in a process known as over generalised memory. This is unfortunate because it makes us believe that we cannot change how we feel emotionally. I promise you that you will feel differently. I probably felt differently this morning to how I do right now, but that’s not easy for me to remember. It’s just how our minds work. By becoming more active in a targeted and scheduled way, and giving ourselves credit for our efforts, this not only improves mood but strengthens all important feelings of self efficacy – ie how much we believe in our ability to complete a task or achieve a goal.
If you want to be really thorough about this you can complete a week long baseline diary of activities using hte scheduling sheet: https://humanpractice.co.uk/resources/
Listing how you are spending your time and rating how much achievement (A), pleasure (P) or connectedness (C) each activity brings you, out of 10. For example this morning I showered (A 3, pleasure 4, connectedness 0) I had breakfast P6, achievement 2, connectedness 0) and have been researching and writing (a 8, P8 conectedness 8). You may gather a whole week of data, or perhaps a day or two. Don’t over think it. You can then reflect on this. Prepare to be surprised. Often quite mundane activities might bring pleasure, and perhaps former habits are no longer serving us. Do I have enough pleasure in my day? Often when we become depressed we can become quite out of kilter. Perhaps we’re just doing what we need to do, and missing out on opportunities for pleasure? Or are we just looking for pleasure and letting what we need to do pile up around us, metaphorically and practically? If you have a sense there’s an imbalance in your week, spend a few moments thinking about how you might able to get a hit of what you need. The trick here is to aim low, break things down into small chunks and keep it realistic. Set yourself up to win, you can always be more ambitious in week two. Then look at your week in the round. Sometimes it helps to imagine that we’re doing this really compassionately for someone that we love rather than for ourselves. Whether you use a paper / electronic diary, or a piece of paper doesn’t matter. Or you can use our scheduling sheet: https://humanpractice.co.uk/resources/
Sketch out your commitments for the coming week and then think about what needs to be peppered in to improve the balance of pleasure, mastery and connectedness. If Monday and Tuesday look tiring, would a pleasurable activity be a bubble bath? A call with a friend? If Wednesday is quiet and you have loads of chores that are piling up would scheduling in 45 minutes to complete chores bring a sense of achievement? If you haven’t enjoyed the company of another human by Friday would a cup of tea with a friend, a phone call with someone you love or an exercise class so you can be among other humans feel nice? We are all delightfully different in our preferences so developing your own list of pleasurable activities that you can engage in is a good idea. Tea in the sunshine, reading a book, listening to music.
Once you’ve planned a week for yourself the trick is to try to follow your plan and not your mood. In CBT we say that activity scheduling is like push starting a car. Really really hard to start with but once you get it moving it’s quite easy to keep it going. Reward yourself for sticking to your schedule. This might be with something you were going to do anyway, like have lunch, but see if you can cultivate a feeling that you really deserve this lunch as you did so well sticking to your plan. This can reinforce routines, give a nice dopamine boost and makes it easier to stick to the next plan. If something gets in the way and an activity doesn’t happen, that’s so understandable, try not to be hard on yourself, dust yourself down and rejoin your schedule as soon as you can.
Exercise has been proven to be as effective as anti -depressants and so having some movement in the week is a good idea. It doesn’t have to be lifting weights, it could be a walk, swim or stretching.
A general principal of one pleasurable thing a day is a good idea. Look out for activities that give you joy, the ultimate medicine. Trust that doing these things help you feel like yourself and give you a real boost over time. We need to be kind but firm to overcome feelings of hopelessness and low motivation if they are there. A spirit of experimentation is helpful. Noticing feelings of doubt or reluctance, following the plan and then noticing how it feels. Celebrating your successes and teaming up with others for accountability can galvanize your efforts.