This article is written for people who are too overwhelmed, sick, numb, or lost in depression to sort out their thoughts. I say “thoughts” because a lot of therapies for depression require a person to examine and rearrange their “cognitions.” But what happens when mood gets so bad you barely have the energy to get out of bed in the morning, never mind make sense out of your thoughts?
Here we put aside the notion of “thinking” one’s way out of a mood state and focus on something else: activity. The idea is that people can confront depression by changing their behaviors. This is called behavioral activation therapy (BAT), and it’s an effective alternative to other types of psychotherapy for depression.
Like any therapy used in profound depression, BAT isn’t meant to replace antidepressant treatment. But used together, studies show that it’s very effective at improving the quality of life of the sufferer.
Changing behaviors involves four steps: (1) putting aside problem thoughts, (2) doing more healthy activities, (3) stopping or cutting back on unhealthy activities, and (4) jumpstarting yourself into action with a routine.
Note: If you’re severely depressed, reading this whole article in one sitting might be overwhelming. It’s a long article, and there’s a lot of information. I recommend reading one section a day. Hang in there and keep reading!
(1) Put aside problem thoughts until you’re ready to come back to them.
For a person with bad depression, the running dialogue in their head is often more toxic than helpful, and despite heroic efforts to think their way out of depression, their brain just isn’t up to the task. All the friends’ advice and cognitive therapy in the world don’t make a difference. If this sounds familiar, what do you do with this negative running dialogue? Here are a few ideas on how to handle problem thoughts.
Keep a list. Create a “worry list.” Each time that ticker tape in the brain goes off giving you something new to fret about, add the stressor to the list and promise yourself you’ll come back to it when you’re ready. If the problem needs more attention, consider journaling it out of your system before letting it go. Unless the thought is an emergency, you don’t have to deal with it right away. For urgent problems that can’t wait, call a trusted friend to help you work things out.
Distract yourself. Even if you don’t feel like it, get busy. You’ll find lists of activities further down in this article. Pick an activity and do it.
Meditate. Meditation allows your mind to rest for a while. It gives you a chance to exist outside the negative aspects of your life and simply feel free. It involves relaxing your body, closing your eyes, and focusing on your breath. There are different types of meditation, but here is one method.
(1) Sit comfortably for a moment and let your mind focus on the present moment. Be aware of your posture, body, and environment. Forget the past and future. Your mind might wander at times. When this happens, gently bring your thoughts back to the present. Don’t judge or analyze your thoughts. Just let them occur, acknowledge them, and let them go.
(2) After a minute of centering yourself, channel all your energy into your breath. Pay attention to its natural rhythm. Breathe in, breathe out. Breathe in, breathe out. If your mind wanders, gently bring it back to the breath. Don’t judge or analyze your thoughts. Simply let them occur, acknowledge them, and let them go.
(3) Try to meditate every day. Start with 5 minutes at a time and build it up to 30 minutes or longer. Remember, with practice, meditation can help you detach from your thoughts whenever you want to.
Practice mindfulness. Mindfulness is about intentionally feeling the moment. It helps us find a positive mind-body balance. For example, instead of being depressed about a bad day at work, a practitioner of mindfulness backs off to observe their own automatic reaction and the reaction of others, without suffering or judgment. Mindfulness can be done in many ways. It can involve looking, listening, feeling, immersion, appreciation, and other sensory experiences. Here’s an example of mindful immersion:
(1) Rather than anxiously finishing a daily chore in order to get onto something else, consider taking that task and experiencing it like never before. Start by choosing the chore. For example, consider mowing the lawn.
(2) Instead of rushing through the task, become aware of every step and immerse yourself in the process. As you push the mower across the lawn, pay attention to every sensation, one sensation at a time. Feel your muscles tighten and loosen as you move. Notice the vibration of the machine against your hands, the loud roar of the motor, the uneven ground, and the scent of fresh cut grass. What else do you notice? The sun over your head, a slight wind, a neighbor waving as he walks by? Take the activity beyond the “normal” by aligning yourself with it physically and mentally.
(3) Pick a chore and do it mindfully. This can include washing the dishes, vacuuming the living room, driving to the supermarket, and any other task you perform frequently.
Get moving or exercise. There’s an old saying: “Where your body goes, your mind follows.” Exercise is a fundamental tool to dealing with problem thoughts and depression. It raises endorphin levels, causing a natural high, and getting outdoors can bring relief to the aching soul. But if you’re too depressed to exercise, get moving. Do what you can to create movement in your life. Take a brief walk through a forest. Can’t get out of the house? Consider pacing. If you can’t pace, do stretches. Your job is to appreciate movement, the sequence of changes your body makes as it shifts from place to place. Notice how your point of view changes with every transition.
Create an escape in your home. Create different environments inside your house, something to help you gain a different perspective. Set up a meditation room with incense and candles, or a leisure room with puzzles, video games, and a TV for movies. How about a green room with plants and flowers? A corner of your living room filled with photographs and relics from good times? A bird room, or an alter to the gods? If that’s too much work, consider rearranging furniture or drawing stick-figure pictures for a wall.
(2) Increase healthy activities
“If you get up one more time than you fall, you will make it through.” –-Chinese proverb
When people get depressed, they tend to withdraw from their routines and environment. Over time, this avoidance makes the depression worse. Behavioral activation is a type of therapy for severe depression that involves creating a daily schedule and inserting activities. It’s based on the premise that people overcome depression by getting more active.
Sounds easy, right? But what kinds of activities should you be doing? Some studies show the need for two types of activity, fun and achievement behaviors. Here’s a little information about both.
Don’t feel like doing anything? People with depression often suffer from “anhedonia,” or the inability to feel pleasure. They find it difficult to enjoy things. Give them a million dollars, and they still can’t imagine anything fun.
The good news is that joy can sometimes be jumpstarted by going through the motions. It might be hard to enjoy the activity at first, but this gets better with time. The take-home message: start doing fun stuff and often your mind catches on.
Examples of fun activities:
- Read something funny of inspiring
- Color in a coloring book
- Play with a pet
- Look at old photographs or letters
- Put on some good music and dance
- Make paper airplanes and throw
- Visit the park
- Invite someone to go hiking
- Go shopping or window-shopping
Can you think of stuff you would like to be doing? Consider what you used to enjoy, your past passions and hobbies. Add those things to your list.
Depression causes problems with motivation, organization, decision-making, and self-esteem. This makes chores, homework, and work difficult to do. When it comes to behavioral therapy, chores, homework, work activities, and such are called “achievement activities.” These activities aren’t fun, but they lend a person a sense of accomplishment when completed.
Achievement tasks are good for building self-esteem and can help with organization and decision-making when taken slowly. Getting stuff done can boost motivation to get more done. Completing achievement activities is essential when it comes to battling negative mood.
Take out your list and add all the chores you’ve been putting off doing, as well as the tasks you’d like to accomplish. Don’t forget to include your goals. Here are examples of achievement activities. (This list is longer because I don’t have any links to a list of achievement behaviors!)
- Prepare for and pass an exam
- Do the dishes
- Get your GED
- Mop the floor
- Change oil of car
- Start/finish a paper for class
- Return phone calls
- Make it to school/work on time
- Eat healthy food
- Volunteer at the hospital to help others
- Create a budget
- Plan the future
- Fill out a job application
- Finish writing your memoir
- Plan a family reunion
- Exercise 20 minutes/day
- Apologize to someone who needs it
Is anything important missing? Any unpaid bills, long overdue chores, or long-term goals? Add them to your list.
(3) Stop unhealthy activities
We all do it when depressed: unhealthy stuff. We stay in bed all day or avoid our friends when they call. Some people do drugs. Others drink too much. Still others keep themselves so busy they don’t have time to breathe. The problem is that, even if the behavior helps in the moment, it often makes the depression worse in the long-run.
BAT encourages us to increase healthy behaviors. It also tells us to stop and think about the not-so-good stuff we do in our lives. Here are examples of unhealthy activities that tend to make depression worse.
- Listening to sad music, seeing sad movies, or reading sad books
- Binging-eating, especially sweets or fatty stuff
- Sleeping too much, or staying in bed when not sleepy
- Turning friends away
- Abusing drugs or alcohol, or any kind of addiction
- Cutting for attention or to relieve stress, or other self-injurious behaviors
- Hanging out with mean people
- Absorbing too much of the news
- Being a couch potato
- Running with the wrong crowd
- Not taking medications as prescribed
- Working too much
- Not setting limits and having enough downtime
Any of these sound familiar? What else could you be doing to worsen your depression? Take note of these behaviors and do your best to eliminate them from your life. If you can’t stop them altogether, figure out ways to cut back.
But there’s a trick. If you want to overcome not-so-good behaviors, replace them with healthier ones. Instead of hanging out on the couch, get up and go for a walk. Call a friend and invite them to a movie. Collect watches and colorful fish instead of sad songs and sadder movies. Take a rest and consider spending five minutes meditating instead of missing your break at work. Each time you find yourself doing something that makes you more depressed, think “What can I do instead of this?” and do it.
(4) Keep a routine: FAQ
You have a growing to-do list with both fun and achievement activities. It might be a short list, or long and running. Remember, you don’t need to include everything on your list on day one. On the other hand, if there are activities that seem to help with your depression, schedule them often and repetitively.
Why keep a routine? A routine jumpstarts you into action. And once you’ve started to move, a routine can keep you going. Somehow external structure creates internal structure, a stabilizing force which is very helpful for depression.
What if arranging a schedule is too much work? If the idea of establishing a routine feels overwhelming, find someone to help you. Consider asking a family member, friend, or your provider to help you arrange a daily schedule and stick with it.
What should go into my schedule? You should include stuff you already do on a daily basis, like meals, meetings, school or work routine. Remember to balance fun and achievement activities. Ideally exercise will be in there too. Even ten minutes a day is worth doing. Finally, especially if you’re overrun with busy tasks, schedule enough down-time to keep yourself healthy.
How do I set up a routine? You’ll need a place to document each day’s schedule. Consider using the calendar app on your phone or buying a daily calendar. Next, every morning, follow the steps below:
(1) Look at your to-do list. Is there anything missing that you need to do TODAY? Do you have any doctor’s appointments or pressing tasks you might have forgotten to put on the list? Make sure everything is complete before going on to the next step.
(2) Write out a list of what you need and want to do today. That includes all regular activities, like sleep, meals, classes, and work. Don’t forget all special tasks, like doctor’s appointments, meetings, or doing laundry. These are all achievement activities. Anything important left out? Next, it’s time for the fun stuff. Choose a few and get those onto today’s list too.
(3) Next, plug all activities into today’s schedule. Which should you do first? Which task is better done in the afternoon? Plug in sleep, meals, school, work, and scheduled activities into your agenda first, then add the rest of the stuff.
(4) Go over the schedule. You probably have lots of achievement activities. This should be balanced by fun stuff, mindfulness, meditation, and exercise. But make sure your schedule isn’t too busy. If so, simplify things as possible. Part of increasing healthy activity is balancing on and off time. Set limits and say “no” when necessary.
(5) Get active. Here’s where you pick the first task on your list and do it. Yikes! So you get that overwhelming feeling of fatigue about now. Remember, if the task seems too complicated, break it down into smaller steps and start with the first step. For example, if the task is “Get my GED,” start by researching schools that offer GED studies.
(6) At the end of the day, rate the effect each activity had on your mood. Compare how you felt before and after each task. You can keep it simple, writing “better/worse” or come up with a rating system like 1-10, 10 being the best you’ve ever felt. Alternatively, consider keeping a mood diary, where you record your mood in detail in context of thoughts, activities, medications, sleep, stressors, and other variables. Remember that some activities aren’t enjoyable but lend you a sense of achievement when finished. Others, like drugs, feel good in the moment but do more harm than good in the long run. Take note of all that. In the end, if you find a healthy activity that really helps, do more of it!
Here’s an example for a depressed person who isn’t working. It’s simplified but good enough. Note she didn’t complete all activities.
Keeping a routine and staying active, with both fun and achievement activities, is key to overcoming severe depression. Letting problem thoughts go (until you feel better), balancing on and off time, and cutting back or stopping problem behaviors are important too.
As the depression lightens, you’ll start to feel joy again, your self-esteem will return, and your thoughts will become more organized. Once your thinking has cleared, you can go back to all the problems you jotted down in section one of this article. Ironically, you just might find most of the stressors on your “worry list” are minor — or nonexistent. Depression is like wearing a dirty pair of sunglasses. Everything is distorted and dark, and you don’t see the world for what it is until you take off those glasses. Activation therapy is about removing those glasses
Ah, an overview! Here’s everything one more time, in a nutshell…
Healthy behaviors improve depression. Increasing healthy tasks in your life, like fun and “achievement” activities, can help you battle severe depression. Going through the motions with fun stuff, even when you don’t feel like it, can jumpstart joy. Completing tasks that lend a sense of achievement are good for building self-esteem. Increasing healthy activity also means balancing active with rest time; know when to set limits and say no. Figure out what brings you peace & completion and do more of that stuff.
Unhealthy behaviors worsen depression. Unhealthy behaviors are those activities that make you feel miserable. These can include toxic relationships, drugs, poor diet, working too much, isolating, and a myriad of other self-defeating behaviors. Figure out what actions bum you out and stop doing them. If you can’t stop, do your best to cut back.
Replace unhealthy behaviors with healthy ones. It’s hard to stop bad habits until you replace them with something more valuable. Replace the not-so-good with the healthy.
Keep a schedule. Routine is vital when it comes to overcoming depression. External organization helps stabilize a stormy internal world. Set up your schedule each day and do your best to stick to it. Ideally your daily routine includes exercise and enough down-time to keep you going.
Monitor how your activities affect you. How do you know which activities are healthy and which aren’t? Rate each activity. Some people jot down a few notes in their journal every day. What did I do today? What helped? What didn’t? Others rate 1-10 next to each item in their schedule or agenda, 10 being the best they’ve ever been. Alternatively, consider keeping a mood diary to monitor the different variables independently, like sleep, medications, thoughts, behaviors, coping skills, and stressors. Do what works for you.
If your depression is so bad you’ve stopped living your life, please reach out for professional help. Depression is treatable. It’s just a matter of not giving up.
For more information, look into this great psychcentral.com article about behavioral therapy for depression.