Behavioral Activation Techniques For Getting Out Of Depression

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

People with depression are more likely to be passive, they may lie in bed for a long time or be inactive - which further strengthens their conviction that it is impossible to influence their emotional state.

Planning activities for people with depression is a top priority in therapy. When they become more active and begin to praise themselves, this allows not only to improve their mood, but also to make sure of their own self-sufficiency and ability to control their condition more effectively than they previously thought.

In this article, I discuss the reasons why people with depression are inactive and lack pleasure and satisfaction. Explain how to use the Activity Graph, Pleasure and Satisfaction Rating, and Achievement List therapy tools. I also describe the benefits of praise, how to compare yourself correctly, and give examples of coping cards that will help clients support themselves in difficult times.

Reasons for inaction and lack of pleasure and satisfaction

The reason for inaction can be dysfunctional automatic thoughts (AM), which arise whenever a client is thinking about something.

For example:

Inaction entails a lack of satisfaction and pleasure from one's successes, which generates even more negative AMs and lowers mood. A negative feedback loop arises - depressed mood leads to passivity, and passivity lowers mood.

Even if they do something, self-critical thoughts are the most common cause of lack of satisfaction and pleasure in what they have done. Therefore, I identify AMs that can prevent the client from taking action and affect feelings of pleasure and satisfaction during or after the activity.

When treating mild forms of depression, I primarily help clients find activities that are easy to do and enjoyable. For clients with more severe depression, I help create an hourly schedule for the week that will help them cope with inactivity. In addition, I give them the task of assessing feelings of pleasure and satisfaction immediately after the activity, so that they understand how an increase in activity and an adequate response to AM improves their mood.

Analysis of a typical daily routine and the need to change it

Working with behavioral activation begins with a breakdown of a typical daily routine. Basically I address the following groups of questions:

• What activities that previously brought pleasure and satisfaction does the client rarely do? This includes hobbies, communication with others, sports, spirituality, success in work or study, cultural or intellectual activity.
• How often does the client experience satisfaction and pleasure? Is it likely that he is overwhelmed with responsibilities and does not get satisfaction from fulfilling them? Does he avoid activities that he considers difficult and, as a result, does not realize his potential?
• What actions worsen the client's condition the most? What actions depress your mood, like lying in bed or doing nothing? Is it possible to reduce their number? Does the client have a bad mood, even while engaging in activities that are pleasant for him?

During therapy, I help the client evaluate how their typical day is going; and decide what changes need to be made to your daily routine.

Therapist: "What has changed in your daily routine with the onset of depression?"

Client: "I used to be very active, but now most of my free time I do nothing or just lie there."

Therapist: “Do you feel refreshed and energized? Is your mood improving?"

Client: "No, rather the opposite - I am in a bad mood and then I have no strength."

Therapist: “It's good that you noticed this. Many depressed people mistakenly think that they would be better off in bed. In fact, any action is much better than that. What else has changed in your routine?"

Client: “In the past, I often met with friends, did yoga and vocals. And now I only leave home for work."

Therapist: "What do you think is possible to change next week in your regime?"

Client: “I could try yoga before work. But I'm afraid I won't have enough strength."

Therapist: “Let's write down your thought“I don’t have the strength to do yoga”. How do you think you can check how true your thought is?"

Client: "I think I can test what happens if I do yoga."

Therapist: "How much time could you devote to this?"

Client: "Well, I don't know, probably no more than 15 minutes."

Therapist: "What do you think can benefit you from this?"

Client: "Perhaps I will feel better, as it was before after yoga."

In the dialogue, we discussed the need to make changes to the client's daily routine. I helped to identify an automatic thought that could interfere with putting the plan into action. I wrote this idea down and suggested conducting a behavioral experiment to test it for reliability.

Activity scheduling

After a joint discussion of the usual daily routine of clients, it becomes obvious that, with the onset of depression, their level of activity has significantly decreased: they spend most of the time passively and without activities that previously brought pleasure and satisfaction, and their mood is depressed.

Therefore, I invite clients to think about how they can change their daily routine, what actions would be easy for them to perform. For example, several tasks a day that will take no more than 10 minutes. Typically, clients find it easy to find such tasks for themselves.

After I help them find specific tasks that are feasible and draw their attention to other activities, I suggest using an activity graph.

Therapist: “How do you look at changing your daily routine and planning the things that you can definitely do. For example, get up a little earlier."

Client: “I’m so tired, I can’t. Maybe I'll try after my recovery."

Therapist: « Most people with depression think this way. But in fact, the opposite is true - people begin to feel much better and get out of depression when they start to show more activity. This is also shown by scientific research.».

Therefore, I suggest you use the activity graph and add useful actions there. Let's see if you can accomplish all of this. You usually wake up at 10:00. Could you try to get up an hour earlier?"

Client: "I can try."

Therapist: "What could you do right after the ascent?"

Client: "Do 15 minutes of yoga, shower and make breakfast."

Therapist: "Is this different from what you usually do?"

Client: "Usually I lie down until the last moment, when I have to go to work, wash my face, dress and go out."

Therapist: "Then we write:" Wake up, yoga 15 minutes, shower, breakfast "in the column 9 hours. What can be written in the 10 hours column? Can I wash the dishes?"

Client: "You can, I usually leave it to wash in the evening, but in the evening I have no strength and it accumulates in the kitchen."

Therapist: “Let's set aside 10 minutes for the dishes - you don't have to wash everything at once. What can you do after washing the dishes? For example, rest a little?"

Client: "It's a good idea."

Therapist: "Then in the column 10 hours we will write:" Washing dishes, rest, getting ready for work ""

We continue this way until we have completed the entire day. It should be noted that the client's activity has been reduced, so we create a routine that is not overwhelmed with tasks, where short periods of activity are mixed with long rest. To make it easier for the client to follow the schedule, we draw up a coping card, reading which, she will remember the importance of increasing her activity.

Praise is an essential tool for behavioral activation

Clients with depression tend to be self-critical, so I ask them to compliment themselves whenever they get things done. Because these actions are fraught with difficulties for them, and by acting, they take steps towards recovery.

Therapist: “Do you think you can praise yourself every time you do something planned? For example, tell yourself: "Great, I was able to do it!"

Client: “Do you suggest praising yourself if I just went to the theater or worked out for 15 minutes? What is there to praise for?"

Therapist: “When people are depressed, it is much more difficult for them to accomplish what was previously very easy to do. Meeting a friend and going to the theater and doing 15 minutes of exercise are important steps to overcome depression. They will give you more energy than simple inaction.

Therefore, of course, yes, you definitely need to praise yourself for them. I would like you to praise yourself every time you wake up earlier, do not lie in bed, meet with friends, do not spend time on social networks."

Self-praise for the simplest activity helps clients improve their mood and make sure they can influence their well-being. It also teaches them to focus on the positive aspects in their life.

Rating of pleasure and satisfaction

Clients usually report a difference in state after performing an activity, but in more severe cases of depression, it is more difficult for them to notice this difference. In this case, I train them to rate satisfaction and pleasure on a 10-point scale immediately after completing the planned activity.

Therapist: “I suggest that you create a scale of pleasure from 0 to 10 points, which you will use to evaluate the performed action. What activities have you enjoyed 10 points in the past?"

Client: "I think the greatest pleasure I got when performing on stage and singing."

Therapist: “Let's write 10 points in the column:“Singing”. What would you give 0 points?"

Client: "When my boss calls me and makes comments on the work."

Therapist: “Write next to 0 points“criticism from the boss”. And what can stand in the middle between them?"

Client: "Probably a walk along the embankment."

Likewise, we create a satisfaction rating, and I suggest using both ratings to evaluate every action that has taken place today.

Being depressed, clients do not always know how to correctly assess the pleasure and satisfaction from the performed actions. Therefore, it is important to teach them to do this right in the session

Therapist: "What did you do an hour before we met?"

Client: "I went to a cafe for coffee and a dessert that I have wanted for a long time."

Therapist: “Write in the box next to“15 o'clock”went into a cafe and bought a dessert. Now rate your degree of pleasure and satisfaction after you have eaten dessert."

Client: “Satisfaction at 5 - I chose a dessert that I haven’t tasted for a long time. And the pleasure is absolutely zero - I didn't even notice the taste, because I was thinking about something else."

Therapist: "If the pleasure was 0 points, then you felt the same as when the boss reprimands you?"

Client: “What are you, of course not! Most likely, you can put three points."

Therapist: “What an interesting comparison. At first, you thought you didn't enjoy the dessert at all. The fact is that depression makes it difficult to notice and remember pleasant events … Therefore, I suggest you use this rating next week. It will help you realize which actions are more enjoyable than others. Why do you think it is important to complete this task?"

Client: "So that I notice when and why my mood still changes."

I ask clients to fill out the rating as soon as they have finished doing something so they can learn to better assess their feelings. Next week, I am checking out how the customers' assessment of their actions has changed, and I ask them if they noticed something useful to themselves. Then we make the schedule so that it includes more actions, after which the clients feel better, and form a coping card.

How to teach a client to compare themselves correctly

Clients with depression tend to notice negative information and not be aware of positive information. They tend to compare themselves to other people who do not have similar difficulties; or they start comparing themselves to themselves, to the point of depression, which further aggravates their condition.

Therapist: “I noticed that you are critical of yourself. Can you think of something last week to praise yourself for?"

Client: “I have submitted a report to the management. Nothing else.

Therapist: “You may not have noticed everything. For example, how much of what was planned last week did you complete?"

Client: "Everything".

Therapist: “Was it easy for you? Or did you make an effort on yourself?"

Client: “No, it was difficult for me. Probably, such trifles are very easy for others."

Therapist: “Have you noticed that you are comparing yourself to others again? Do you think this is a fair comparison? Would you also be critical of yourself if you suffered from pneumonia and did not complete all the tasks planned?"

Client: "No, this is a good reason."

Therapist: "Remember we the first meeting discussed the symptoms of depression: lack of energy and constant fatigue? Do you deserve credit for your efforts despite your depression?"

Client: "I think yes".

Therapist: "How does your mood change when you compare yourself to others?"

Client: "I am upset".

Therapist: "What happens if you remind yourself that this is an unreasonable comparison and it is better to compare yourself with yourself when you were in the most difficult condition and just lay there most of the time?"

Client: "Then I will remember that now I am doing much more and I will feel better."

I help clients to shift their attention to the results they have already achieved in comparison with their most difficult condition, to positively evaluate their own efforts and thereby motivate them for further activity.

Benefits of the achievement list

The Achievement List is an additional tool that helps the client notice daily positive actions. I ask him to write down the good things he has done every day, even though it took some effort.

Therapist: "How do you think your mood would improve if you began to notice more good things in your day?"

Client: "It would make me happy."

Therapist: “When you try to carry out everything planned, despite depression. Is this commendable?"

Client: "Probably yes".

Therapist: “I suggest that you keep a list of events for which you can praise yourself. Any actions that you have mastered can be entered there, even if it was a little difficult. For example, what have you already done today?"

Client: “I got up an hour early, did yoga, showered and made myself breakfast. I managed to wash the dishes - it was not dirty by the evening. Before work, I had time to sit and read."

Therapist: “Great start. Try it every day."

I usually ask clients to fill out the achievement list every day, right after the accomplishment, but you can also at lunch or dinner, or before bed. This tool will be useful to clients early in therapy to help them learn to notice positive information.

Conclusion

Behavioral activation is an essential part of therapy for depressed clients. Therefore, I use gentle but persistent methods to motivate clients, help them choose the right actions and schedule them. And I also help to identify and adaptively respond to AMs that can prevent clients from performing an activity, and get pleasure and satisfaction from it.

For clients with low levels of activity, I help them plan their activities and adhere to the chosen routine so that the therapy will bring them more benefits. And for those clients who do not believe in the benefits of planning, I help to create behavioral experiments that check the reliability of their predictions and show the real state of affairs.