This post is the second in a series that accompanies each week in my book, Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks. This week accompanies Week 2, which begins on page 68 in the print edition.
Congratulations—you’re on to the second week of this 7-week program.
If you’re depressed you’ve probably been told by well-meaning loved ones to be more active. They may have said things like, “Of course you’re depressed, sleeping all the time and lying around the house,” or worse, “You need to stop being lazy.” Ouch.
If you haven’t been depressed, it’s nearly impossible to know the effort it takes to complete even a seemingly “easy” task. Unload the dishwasher? Mow the lawn? Meet a friend for a walk? It all feels like too much.
At the same time, there are ways to move toward greater activity, as I spell out in this chapter.
Week 2 focuses on “behavioral activation,” which might sound like we’re going to focus on simply “doing more.” However, as you’ll see in the book, there’s a specific way we approach activities in CBT. So rather than activity, I’d like to emphasize engagement.
Activity per se is not enough; if it were, busy people would never be depressed. In order to be antidepressant, the activities we plan need to bring some kind of reward. After all, why invest time and energy—both of which may be in short supply—in things that aren’t rewarding?
Rewarding activities provide either enjoyment or a sense of accomplishment—and ideally both. Activities like chores tend to be higher on accomplishment than enjoyment, while the reverse is true for leisure activities like watching a movie. Spending close time with people we care about is probably both enjoyable and important. Of course as I emphasize in this chapter, you alone determine what you find rewarding.
A crucial benefit of making your planned activities rewarding is that you’re more likely to complete them. You can probably think of plenty of activities you think you “should” do but have a really hard time completing.
For myself I remember when my gym attendance fell off, and I struggled to make it to even half my workouts. One day I realized, “I hate going to the gym.” It hadn’t always been that way. Once I realized why I dreaded my workouts, I chose other kinds of movement that were more appealing.
[5 Ways to Do More Mood-Boosting Activities on Psychology Today blog]
If behavioral activation is so helpful, why aren’t we naturally drawn to it when we’re depressed? Part of the challenge of behavioral engagement is that we often don’t consciously feel the need for it. My own research suggests that some of us consistently have a harder time than others at recognizing our needs, and the less we know what we need, the more we’ll tend to be anxious and unhappy.
In fact, it’s not uncommon for us to feel drawn toward the opposite of what would bring us lasting happiness. For instance, when we’d benefit from greater engagement we might crave withdrawal and isolation. While there is definitely a time to rest and recharge, persistent withdrawal is not life-giving.
It’d be so much easier if our needs always announced themselves! But we often don’t know automatically that our nervous systems are craving human contact, or exercise, or a sense of accomplishment.
I find that people I’m treating commonly have some reservations and skepticism about behavioral activation. Some of the themes that often show up include:
- How can I be more active when I’m feeling so unmotivated? Let’s be frank: Being active when we’re depressed and/or anxious is hard. It just is. So we need to set ourselves up for success. Remember to start small—as small as you need to to get started—and plan activities you’re likely to complete.
- I won’t get anything out of doing activities. If you believe that no activities can bring you any reward, I encourage you to run
an experiment: For this week, do some activities you used to enjoy and see what it’s like. Sometimes we’re right that we won’t get anything out of an activity, and other times we’re not. Humans tend to be relatively bad at predicting what’s going to bring us happiness. If you give it a shot, you just might be surprised.
- I’m already too busy—how is more of the same going to help? As you look over your Daily Activities form (p. 66), how much enjoyment and importance is built into your daily activities? If you’re busy with many important tasks that drain you and provide minimal enjoyment, more of the same is not what you need. You might look for small ways to enjoy yourself that don’t even require more of your time. For example, a person might decide to listen to her favorite music on the commute home, or to put away the smartphone while walking and focus instead on the feeling of her feet on the earth and the clouds as they move through the sky. Thus part of behavioral engagement might mean doing the same activities in a different way.
- It can’t be that simple. Because depression and anxiety affect so many areas of our lives, it can be hard to imagine that a seemingly simple treatment could really help. Honestly I’m still amazed at how effective the right kinds of activities can be in lifting mood and lowering anxiety. As suggested above, we can treat this approach as an experiment and see how it goes. And rest assured—a large number of studies, including this recent one, have found that behavioral activation is as effective as any existing treatment for depression.
Whether you encounter obstacles or victories (or both) along the way, feel free to leave a comment or question in the Comments section below. We can all benefit from one another’s experience and help each other to get the most out of this work.
I wish you the best as you work your way through Week 2.
I’ll be back with the next installment on November 14, 2016.