Depression & Behavioural Activation
What Is Depression?
What we’re talking in this post is the clinical definition of depression (not the everyday “feeling down” idea of depression). Listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), clinical depression is not simply a matter of feeling sad. We all have ‘normal’ periods of feeling sad, or low, and most of the time these will just pass. Actual depression it’s often matched with other significant symptoms including these:
- apathy
- guilt
- hopelessness
- helplessness
- anxiety
- self-loathing or lack of self-esteem
- fear
- Sleep disturbance
- Appetite disturbance
Also, depression can last quite a long time, crippling a person’s ability to live their life. If you’re suffering from clinical depression you’re not alone – it is the most common form of mental disability in the world for both men and women.
The Depression Cycle
Our thoughts produce feelings, and our feelings dictate the behaviour we will choose to engage in. Depression causes negative automatic thoughts to be fired off. These thoughts contribute to an increase in depressive feelings, which in turn leads to negative behaviour, this of course feeds back into this vicious cycle and increases the negative intensity of your thoughts, your feelings, and the resulting behaviour. A hard cycle to break.
As an example, let’s say part of your depressed behaviour is that you comfort eat. You have a negative thought about yourself, you feel lower in mood, so you eat unhealthy foods in excessive amounts. This results in you gaining weight, which makes you dislike your body image even more, which makes you avoid contact with others… and this results in even greater depression. The cycle then continues, with more power.
Coping Behaviours
Why does depression lend itself to such self-destructive behaviour? Why can’t you avoid it on your own? After all, you know intellectually that such unhealthy eating is going to make you feel worse in the long run… but you do it anyway. And you probably ask yourself, why?
What’s happening is you’re trying to avoid feeling like you’re a failure. (What you feel like you’re failing at depends on your particular life and goals.) Let’s say for example your depression was caused by losing a job, or maybe a relationship. It can be pretty difficult to not be negative about these situations.
This activates the negative thinking we described above, and leads you into any number of negative behaviours – the poor eating habits we mentioned above, self-flagellation for being such failure, sleeping too much, neglecting your personal hygiene, or not keeping your home clean, you might feel as though you are frustrating the people who care about you, and so on. As the intensity of your problems increases you become affected by negative avoidance, another behavioural outcome of depressed thinking. Negative avoidance includes withdrawing from society, ignoring the phone, ignoring family and friends, avoiding your emotions, oversleeping or hiding in bed, refusing to engage in chores or tasks that might challenge you, refusing to leave your home
These behaviours lead to consequences – you avoid seeing others because you’re ashamed of your appearance/presentation or because you can sense their frustration, you grow more annoyed with your own self, which can make you believe that you are a poor candidate for a new job, or that nobody would want to be in a relationship with you. So you experience a further increase in your avoidance, you avoid looking for a new job, and you avoid wanting to meet new people.
You are caught up in a vortex of trying to escape shame or feelings of being a failure which is impossible because the actions taken to avoid those feelings lead to those negative consequences, thereby creating even more reasons for shame and feelings of failure. And so your depression deepens, and the downward spiral continues.
What Is Behavioural Activation?
Behavioural activation is a powerful tool used by many Clinical Psychologists, it’s based on scientific research evidence, which proves its effectiveness in treating depression using principles of Cognitive Behavioural model. To quote here, one of many proven research studies, was a 16-week study, behavioural activation was measured against a standard CBT programme, anti-depressant medication, and a placebo. Behavioural activation was as effective as the anti-depressant, and more effective than standard CBT. Behavioural activation also brought a greater number of patients into remission than the anti-depressant in the longer term.
The idea behind behavioural activation is that it makes you approach, rather than avoid, those negative behaviours you’ve retreated into. Although you might think negatively, and feel negative, the technique means you gradually avoid continuing to retreat into the negative behaviours you have done so far, so they don’t feed back into your depression.
The exact implementation depends on your psychologist, but you’re going to be guided into understanding how your behaviour and actions are the source of your deteriorating emotions. One method is that you will create a journal of the actions you take daily, and the resulting moods that they create in you.
What you’re doing with this record is identifying those cycles of negative behaviours that repeat themselves, and the consequences that they cause for you. Here’s the key to all this charting of your activities and the resulting moods – you will clearly see that you have a choice. You can choose to continue with negative avoidance behaviour or you can choose to very gradually engage in proactive behaviours. You’ll begin to see this more clearly as you begin to schedule these choices – maybe one day with avoidance and the next with approaching the behaviours. Your psychologist can work with you to substitute actions that help you to cope with your feelings, by guiding you into making different behaviour choices.
Putting Behavioural Activation Into Practice
There are several ways to put it into everyday practice. One thing you’re going to is write down goals you have for your life. Want to get a new job? Want to repair a relationship? Aching to eat well and set up an exercise routine? Want to sleep better? Writing these short, medium, and long-term goals makes them more concrete (its human nature) and will make them seem both more real and more attainable for you, as well as help you plan how exactly you’ll get there.
This part of your work with a psychologist does three things – helps you work your way out of the negative cycles brought on by your depression, sets your goals in concrete (with concrete ways of actually achieving them), and helps you identify what you value in life, what is your passion – and how you can bring that into being.
One tip – don’t try to do everything at once. Go slow and make it easy for yourself – schedule goals you can manage for the short term. It’s not a race, you’re not in a competition. And if you try to do too much at once you’re going to set yourself up for failure… and then you’re right back where you started.
So pick activities that are directly going to relate to what you’ve been avoiding. Lost your job? Then schedule getting a haircut, getting your suit cleaned, doing up your CV. And then maybe schedule in a reward or two – after you get that task done to, maybe it’s to go and see that movie you’ve been neglecting because you felt like you weren’t fit to be seen out of doors, or were undeserving of fun.
“When I Get Round To it”
One of the ways you may try to avoid working towards your goals and values is to wait for inspiration. However, “when I feel like it” may be never, especially when you’re working your way out of depression.
You’re going to learn to switch out the need for motivation with a schedule. You’ll no longer wait until you feel like doing something, accomplishing your goals will just be part of your daily routine like getting dressed or brushing your teeth.
As always, if you have any questions at all please don’t hesitate to get in touch via the contact page.
