CBT Strategy for Depression: Using Behavioral Activation to Improve Energy and Mood
The Vicious Cycle of Depression
When you’re in the rut of depression, you don’t feel that you have the energy to do anything. It’s overwhelming to think about doing the things that used to bring you joy, let alone take care of basic tasks such as going to the grocery store, doing laundry, or taking a shower. So, you don’t do these things. Instead, you may find yourself sleeping more than usual, isolating from people, or maybe you can keep up with some responsibilities, but a lot is falling through the cracks.
Then comes the flood of thoughts that you are “worthless” or “life is hopeless,” feeling you have failed at everything, or maybe you feel empty or apathetic. You feel powerless to this voice in your head telling you not to do anything, but you cannot find the motivation within yourself to make a move. So, you continue waiting in this pit of despair until you feel like doing something.
What if I told you that you don’t need motivation? And that you are waiting for something that might not come?
Action First, Then Motivation
Once you have found yourself in the downward spiral of depression, you likely are not going to magically one day just “feel” like doing something. The truth is that in order to find motivation, you actually have to act first.
I know you’re thinking this contradicts everything I just described, because the whole problem is that you don’t feel you can do anything– so how can you possibly just get up and do it? It’s true that at first you are not going to feel like making a move–you may even be irritated that this is being suggested– but I’ll explain why it could be worth it to make yourself do it anyway.
Using Behavioral Activation to Help Depression
Behavioral Activation is a strategy used in Cognitive Behavior Therapy (CBT) based on the idea that increased activity, especially meaningful or pleasurable activities, can increase mood and energy, in turn decreasing depression (1,3). This works because once you are engaged in an activity, it can increase your sense of accomplishment, feeling that you achieved or completed something, which can increase feelings of self-worth. A good example of this is procrastination. Think about a time you procrastinated a task, such as writing a paper or doing your taxes. You didn’t want to do it, but once you went ahead and wrote the essay or finished your taxes, I bet it made you feel good that you got it done—and maybe wasn’t even as difficult as you expected once you got going.
Additionally, activity can alter the chemicals in your brain which impact mood and energy. Pleasurable or relaxing activities, such as listening to music, playing with a pet, reading a book, meditation, exercise, walking in nature, etc. can increase dopamine levels in the brain which enhances your mood and energy levels (2). Physical exercise also produces endorphins which enhance mood. The increase in positive thoughts about yourself, heightened energy, and improved mood all lead to motivation to do more because you are feeling better!
Practical Strategies
Consider Your Basic Needs, Values, and Interests
If you’re unsure where to start, first think about your most basic needs including hygiene, healthy diet, and sleep. Physical health directly affects your mental health, so it’s important to ensure you have a good foundation. We then want to add in some “wants” and pleasurable activities. Try thinking about your core values and what matters most to you, such as relationships, health, career, spirituality, etc. Also consider your interests and what activities you used to enjoy doing. It’s okay if most of them do not sound appealing or fun right now, but try to think back on how they used to make you feel. Come up with a list of your needs and wants, and prioritize what you want to focus on doing first.
Start Small
It’s important to remember to start small—even more so than you think. If you’re thinking about making a goal to go on a walk 4x a week when you are currently not going on any walks, I would encourage you to make a goal to go on even just one walk that first week. If you tell yourself you want to clean your whole house, start with cleaning just one room, or even one part of a room, as your goal. It’s important to make small, manageable goals that you can gradually increase over time. If you start too big, you will likely not meet your expectations and this will then lead to increased negative thoughts about yourself, which will then make you even less likely to try again. Instead, make it easier on yourself so you can complete the task and feel a sense of accomplishment.
Create a Routine
Having a structured routine can make accomplishing various tasks much easier once you find a flow. For example, let’s say you decide that as soon as you wake up in the morning, the first thing you’ll do is brush your teeth. If you get into the habit of brushing your teeth at this same time every day, it will eventually become second nature and will help ensure you get it done. Organizing tasks into a structured schedule can also feel less overwhelming than having a long, unorganized list of tasks to complete. Just remember tip #2 to start small, and slowly add to your routine.
Activity Scheduling
Many people find it helpful to not only develop a mental routine or list of tasks to complete, but to physically write them down. I have many of my clients utilize activity schedules such as this one (you can also use the notes app on your phone or a journal). Writing the activities down can not only help you remember them more easily, but it may provide extra accountability in doing them—and an extra sense of accomplishment when you check them off! If you want to take it a step further, you can utilize a chart such as this anti-procrastination sheet where you can record the predicted difficulty and pleasure of the task, and afterwards write down the actual levels of difficulty and pleasure. (Hint: You may find that the task or activity was not as hard as you thought!)
Practice Self-Compassion and Patience
Progress is never linear. There will be times when you don’t meet your goals or expectations, especially when external factors are at play or during times when your depression is weighing you down more than usual. Do your best to treat yourself with kindness and understanding, and be proud that you are even putting in the effort to make things better for yourself. It’s also important to note that it may take time for your mood to catch up, so you may not feel any different at first. Try to focus on the feeling of accomplishment that you completed a task, and internally reward yourself by giving yourself credit for doing something that you needed or wanted to do.
How is Behavioral Activation Used in Therapy for Depression?
While Behavioral Activation is a strategy that can be done on your own, it can be helpful to practice this skill in the context of therapy. Especially if you are dealing with more serious or chronic depression, it is strongly recommended that you seek professional help through a therapist and/or psychiatrist. A CBT therapist can help you set realistic goals for yourself and provide accountability, in addition to providing structured ways you can engage in this technique. Therapy also allows the space to process the difficult thoughts and feelings you are experiencing, and ensure you get to the root of the problem. If the thought of trying to do this alone seems overwhelming, I encourage you to find a therapist familiar with CBT who can help support you as you work through your depression.
References
Burns, D. D. (1980). Feeling good: The new mood therapy. HarperCollins Publishers.
Cleveland Clinic. Dopamine: What it is, Function & Symptoms. https://my.clevelandclinic.org/health/articles/22581-dopamine
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007). Behavioral activation treatments of depression: a meta-analysis. Clinical psychology review, 27(3), 318–326. https://doi.org/10.1016/j.cpr.2006.11.001
Janna Moore, LCSW is a mental health therapist in Tyler, TX providing therapy to individuals across the state. She is passionate about helping people work through their challenges so they can find healing and reclaim control over their lives. Her areas of concentration include depression and other mood disorders, anxiety, life transitions, relationship issues, and college students/young adults.
Contact Janna today to book a phone consultation and begin your recovery journey.
Disclaimer: This blog is not a replacement for mental health services or professional advice, and is for educational purposes only. Always consult with a mental health professional for personalized guidance and assistance.
