December 21st – CBT session 3

Hey folks,

Today has been another good, but exhausting, day! Visiting the in-laws. Was good to see them, but I’m totally wiped out now!

Anyway, today’s post is about the third session of CBT; Behavioural Activation. This is a technique used in CBT to break the cycle of depression by tracking what you are doing and making gradual changes. IT is a technique where we focus on re-establishing our daily routines (e.g a better sleeping or eating routine, keeping on top of housework), increase our levels of pleasurable activities (e.g watching movies, coffee with a friend, having a long bath), and do the things that are necessary to us (e.g paying bills or looking for a job). This is particularly helpful if you are experiencing less energy, as it can help to get you going. It is also useful if you have too many things to do, as it can help to limit activities and regain control. Basically, Behavioural Activation (or BA), is about “acting our way out of depression”.

“The less activity we do, the more depressed we feel. The more depressed we feel, the less activity we do!”

Withdrawal and avoidance feeds in the the vicious cycle of depression (Thoughts – Feelings & Emotions – Physical Symptoms – Behaviours). This happens because we get short-term relief from not doing some things. However, in the long term, activities become more difficult to do and cause us to feel more tired and more down. To break this vicious cycle, you can increase those activities which make you feel better. These activities have to be balanced for us to notice more pleasure, sense of achievement and closeness with others in our lives.

Feeling down often leads to feeling physically unwell, thinking unhelpful thoughts and changes in the way we behave. All of these feelings, thoughts and behaviours, as we’ve seen, are linked. We end up in a cycle where we withdraw or avoid the normal things we do.

Some of the things we avoid are regular, routine activities such as cleaning the house, washing up, cooking a meal etc. We change the time we go to bed or get up, when we eat and how care for ourselves. Although we often moan about our daily routines, they do make us feel comfortable in our surroundings.

Other activities that get disrupted are the things we do for pleasure. These can include seeing friends, enjoying a day out with family, reading or doing whatever interests we have. There are the things that in normal circumstances we find pleasurable. They are the necessary breaks from our routines.

The third area where we can end up avoiding activities are the important necessary things, such as paying bills or confronting difficult situations at work, home or in our close relationships.

Although the consequences of not doing these things can be quite serious, when we feel down we often avoid doing them. Going back to work after a period of sickness can be one such difficult but necessary activity.

When I’m at my lowest the things that I tend to avoid are socialising and housework. I spend my time hiding away at home, under a blanket on the sofa sleeping and watching mindless daytime tv! Which I know doesn’t really help me in the long run!

BA is not just about doing more, it’s about having a balance in our lives so that we are spending enough time on our own needs, as well as juggling work or demands from other people or chores. Some people with depression may be doing a lot, but it may be out of balance, which is what can reinforce the negative thoughts and feelings.

When we are recovering from depression, working towards consistency is very important. In the initial stages it can be a relief to find we’re able to do more, with our interest and energy beginning to return. As a result we may try to do too much at once and push ourselves to far. This becomes unsustainable and we can find ourselves exhausted and able to achieve very little. We all have up and down days, so planning needs to be around our worst days to reach this consistency. This way we’re not setting ourselves up to fail, and instead we are working within our own realistic expectations.

Before starting the 3 steps of BA, it can be sometimes helpful for you to notice what you are already doing. You can do this by recording your activities in a diary. It can be helpful to note down such details as where you were, when you did things and if you were with anyone. Even if you think you’ve done nothing, make a note, it’s all helpful information.

I’m going to talk you through the 3 steps now.

STEP 1 – Identify routine, pleasurable and necessary activities that you are NOT doing at the moment.
Think about activities that you would like to do, or things that you wish to start doing again. Separate them into 3 categories – ROUTINE, PLEASURE, NECESSARY. Many of these activities with be things you’ve stopped doing since feeling down.

STEP 2 – Order these into a hierarchy
Split the activities again, into 3 categories – Most difficult, Medium difficulty and Easiest. Try to make sure you mix up routine, pleasurable and necessary activities.

STEP 3 – Scheduling in and doing activities gradually, starting with the easiest.
Using a diary, plan out how to start doing the activities on your hierarchy. You can do this by starting with the easiest activities first, and adding activities from higher up the list as you go along. Write down when you’d like to do them, being specific is helpful, for example writing what the activity is, where, when, how, and if it involves other people. Over time, you can gradually increase the amount of activities you plan to do, but don’t rush it, take your time and add things when you feel ready and able.

An example of a simple BA diary entry –

MONDAY –
EASY – Get dressed
MEDIUM – Clean kitchen
HARD – Use the phone to pay a bill

By giving yourself a small amount to do, you may find you get more done in the end anyway. I used to when I was doing it. I’d plan 3 things, and end up doing 4 or 5 things. But, on the other hand, if you only get the 3 things done, you’ve done what you’d set out to do and can feel a sense of achievement; this in itself can often help to lift your mood a little.

Remember, for many people even doing things that were once pleasurable, may not bring immediate pleasure. To start with, people often feel a sense of achievement rather than actual pleasure. As the weeks go on, you should find yourself getting back to either your old routine, or you may develop new ones. The main thing with Behavioural Activation, is to plan carefully and keep going. The approach is called ‘outside-in’ because we are starting to do things before we feel like doing them.

BA really helped me get going again. Even on low days now, I set myself a couple of things to do, and as long as I get those things done, I do feel a bit better. There will be the odd day when you don’t get done everything you set out, and that’s okay too. Just do your best with it, and take your time. Slow and steady wins the race!!

I hope this has made sense to you, and that it helps. Thanks for reading as always, take care and stay strong warriors.

Until next time…..

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