How to overcome depression when everything is terrifying
What you need to know
When you are fed up or feeling overwhelmed, it can be tempting to give up and do nothing. You can cancel events and appointments and lie in bed or watch TV. It’s easy to see why this happens: when you’re depressed or feeling overwhelmed, even simple tasks take a lot of effort and energy. And if things do not bring the same pleasure as before, it is even more frustrating.
Of course, during the COVID-19 pandemic, many people had to give up some business and social events. For someone who is depressed or in a bad mood, these restrictions will exacerbate the urge to withdraw, and the prospect of coming out of lockdown can seem daunting. But paradoxically, one of the most effective ways to improve your mood is to do what you don’t feel like doing.
In 1973, the American behavioral psychologist Charles Foerster observed that people who feel depressed tend to do less. In particular, they do less of what gives them pleasure or a sense of importance. He argued that this decrease inactivity is an important factor in the understanding and treatment of depression. His observations served as the basis for a behavioral model of depression, which still helps us in understanding this condition.
According to behavioral approaches, depression occurs as a result of a problematic cycle between decreased activity and low mood. The beginning of the cycle is associated with the fact that the person does less, which means that he becomes more withdrawn and isolated. Accordingly, he has fewer opportunities for positive experiences or distractions, and the bad mood only gets worse. Thus, the motivation to do something interesting and challenging is even less – and the cycle closes.
This negative cycle does not arise out of anywhere, and the cause is often well understood. The bad mood seen in depression is often preceded by a “big contextual shift,” says Dean McMillan, professor of clinical psychology at York University. This shift is caused by significant changes in circumstances, such as a divorce, a difficult period at work, or a global pandemic. A shift in context means that activities that were previously enjoyable become difficult or impossible. For example, after a divorce, people may feel frustrated by going to places they loved to go with their ex-spouse. Or a student who is too overwhelmed at the university, due to fatigue, can no longer pursue his favorite hobbies. And after a long period of isolation and idleness, the usual activities can become difficult or unattractive.
The risk is that people are increasingly distant. They choose the simplest behavior that is of no benefit, such as staying at home (even when restrictions are lifted or new social opportunities appear). And that makes sense. “This refusal is due to the desire of people to avoid the negative emotions that they experience when they try to do something,” – said the University of Exeter professor David Richards. McMillan agrees, adding that this behavior “works immediately because it makes you feel better.” But the problem is that this passivity has long-term consequences – it “takes you away from what needs to be done to get something out of this world.”
To cope with depression, according to behavioral approaches, you need to somehow break this cycle of inaction and bad mood. This is the main goal of the behavioral treatment that American psychologist Peter Levinson and his colleagues began to develop in the 1960s. Today, this approach is known as behavioral activation (PA) and has proven to be an effective psychological therapy for depression.
Through PA, people who are depressed are gradually encouraged to do what they have stopped doing. The idea is that the cycle of passivity and bad mood is replaced by a more positive cycle in which productive, meaningful actions help people feel better, which in turn increases the motivation to be more active. One of the participants in the PA study described the process as follows: “I think [PA] helped me a lot because I became interested in some things and I started doing them. Just the feeling of happiness that arises when you have achieved your goal. “
PA is an independent treatment, but its principles are often found in other forms of therapy, including cognitive-behavioral therapy (CBT). One study comparing different types of therapy found that PA was as effective in fighting depression as complete CBT. Although PA was originally developed as a therapy guided by a therapist, it includes simple principles that you can self-implement to lift your mood.
What to do
Watch what you do every day. First of all, you need to track all your actions for a week. You can find free templates online or make your own. Form an empty schedule by dividing each day into hourly intervals or into morning, afternoon and evening. Then, during the week, write down what you did each day. It is also important to note how you felt during each session, from 0 (really depressed) to 10 (positive and cheerful). For example, you may notice that in the morning, when you were watching TV, your mood was about 3, and during the afternoon yoga class – about 5. “This step helps to gather information about small changes in behavior that can be important, but which we often overlook, ”says Laura Pass, a clinical psychologist at the University of East Anglia.
If the idea of keeping track of your activities for a whole week seems daunting to you, you can shorten the period. “You need to set a step that suits the person,” says Pass. “It can be one day or several moments during the week.” She emphasizes that this step can be selected individually: “For example, parents can help children.”
If the very idea of tracking seems daunting, you can still use PA principles – just skip this step and move on to the next. “Personally, I don’t think it’s absolutely necessary to do all the basic steps,” Richards says. Pass agrees, stressing that changing future behavior is key. “If someone can do it without writing down their deeds, it still benefits.”
Appreciate what you have done. If you’ve been tracking your activity and mood, reflect on what you did when you were in a pretty good mood. It doesn’t matter if it wasn’t very good – it often happens, especially if you have had a long period of depression or depression. Even if it has improved a little, it is already useful and prepares for the next step.
Make a plan for the next week. Now you need to schedule activities for the coming week using the same blank slate as before. Look at your diary from the previous week and include in your schedule activities that improved your mood. Also, try to include some of the activities you have stopped doing or are doing less frequently. You don’t need to fill out every slot, but try to schedule at least one or two activities each day.
To understand what needs to be included in the plan, it is helpful to think not only about what you like but also about what you think is significant or important – or what you thought was so before your bad mood or isolation. “It’s important to personally identify what is important to you in your life,” says Pass. “Where you want to direct your life.” If you enjoy hanging out with friends, for example, you can invite someone out for coffee or arrange to have a chat on the phone. If you value learning, you can plan to borrow a book from the library or listen to a new podcast. Plans for schoolchildren, working parents, and retirees can vary considerably. What’s important to you depends on your unique circumstances.
Your schedule can also include more than pleasant things. For example, if keeping your home tidy is important to you, you can schedule cleaning. McMillan emphasizes that it is about finding a balance between three different activities: enjoyable (for example, meeting a friend), routine (showering, cooking), and necessary, which can have serious consequences (academic work, paying bills) if not done. “It’s not just about doing something nice,” he says. – It is equally important to get up, brush your teeth, and take a bath. It’s about doing something positive in life. “
When scheduling a new schedule, avoid long periods of downtime. In particular, pay attention to those events of the previous week, because of which you did not do full-fledged business. For example, you went to bed late and missed a work meeting or scrolled through social media for hours instead of meeting or chatting with friends on Zoom. This behavior may seem attractive at the moment, but it keeps you in a bad mood because doing all of this is wasting time that you could have devoted to something positive. Doing little while you are at home or relaxing is not problematic behavior in and of itself. It becomes so only if you shirk important things in this way. Try to define how you are behaving when trying to hide from the world, and avoid this when planning for the next week.
Stick to the plan, even if you don’t like it. The key aspect of PA is that you need to carry out all planned activities, even if you don’t feel like it. The theory is that positive mood changes only appear after you take action, so it’s important to try, regardless of how you feel. “It’s helpful to look at it ‘from the outside in, not from the inside out,’” says Macmillan. “Instead of telling yourself,” When I feel better, then I’ll do it, “you first change your behavior, and then your thoughts and feelings change.”
If you can’t seem to get down to business, there are a few tricks you can try. First, you can break the activity down into smaller steps or do it over shorter periods of time. Richards gives an example: “If someone does not want to clean because it is exhausting, you can only clean part of the house.” Second, it would be helpful to organize your to-do list in terms of complexity and start with the simpler one. For example, instead of planning to go to the gym and group classes right away, start by walking around the block, watching exercise videos on YouTube, or visiting the gym during a quiet off-peak time.
Finally, you can experiment with strategies that increase the chances of getting these things done. McMillan stresses the importance of creating the right context. He invites you to ask yourself, “How can I make this behavior more likely?” Consider, for example, writing down a task and posting a reminder in a prominent place, or asking a friend to do it with you.
Rate how it went. At the end of each day, consider how you felt when you performed each action. Pay attention to which one improved your mood, even a little, and which one spoiled it. Notice any other upsides: You may have experienced a sense of accomplishment when you did something, or a feeling of relief after completing a job that has been continually put off. This will help in planning future events. Also, pay attention to the times when you have been unable to take on tasks from the schedule, and think about how you could make it more manageable next time.
Be patient with yourself. Remember, the mood doesn’t improve instantly. “It may be difficult for you to do something right now when you feel bad when the context has changed,” says Macmillan. – It may be difficult for a while, but if you can, continue. One helpful idea – treat it like an experiment. Try to experiment with the behavior long enough to understand what it brings you. It may take several weeks. “