Behavioral Activation to address your Depression and Anxiety

Why Can’t I Get Myself to Exercise?

There are a lot of ways that people advise others to treat depression and anxiety. Those suggestions range in helpfulness and specificity. Sometimes folks recommend a range of healthy behaviors such as exercise, engaging in routines, and setting goals, but these things can be hard to actually engage in when someone is struggling. “If I could feel well enough to do those healthy things I wouldn’t really have depression or anxiety.” Sometimes, when in the throes of depression and anxiety, just getting out of bed in the morning feels like a Herculean effort. Furthermore, behaviors like avoidance, staying in bed, watching Netflix for hours/days, and isolation only make depression and anxiety worse. When one is depressed they are dealing with the negative self-talk of depression, lethargy, sadness, etc of their depression. When they wake up late in the day they feel even worse as they have “wasted the day,” “couldn’t even get out of bed at the right time,” or avoided the basic tasks necessary for everyday life. Oftentimes, we wait for motivation to do even simple tasks when struggling with anxiety and depression and that motivation simply doesn’t seem to come. This creates a vicious, downward cycle.

Behavioral Activation

When I work with folks, I utilize a treatment called Behavioral Activation. Why does this work? We can analyze ourselves with a simple equation - Thoughts + Feelings = Behavior. When one aspect of this equation changes, the rest of the equation must change (just like we learned in grade school math). We cannot simply change how we feel- think about how you respond when angry and someone simply tells you to “let it go” or “forget it”... you get even more angry as they invalidate your emotion. Thus we can only change our thoughts and our behaviors and this will change how we feel. Behavior is typically easier to change than changing how we think because our thoughts typically match our emotions (whatever thought fits or matches our emotion seems more true. For example a depressed thought: things are hopeless seems true, even when we may have felt objectively hopeful about things only days before). Since behavior is easiest to change we start by changing our behaviors.

How Do I Change My Behavior?

It’s simple to write that one must change their behavior, but anyone struggling with anxiety or depression knows that this is much easier said than done. There is also the question about what changes we need to make. When using behavior activation, I have people work on making a list of enjoyable, valued, and routine behaviors that they want to begin incorporating in their life again. This can range from simply brushing your teeth to working on one’s dissertation, but we create a hierarchy of behaviors based on the difficulty one would have in engaging in those behaviors.

How to Create a Hierarchy of Behaviors

You rate each behavior you want to incorporate into your life on a 1-10 scale (1 the easiest and 10 the hardest) to do several times a week. Then we start by picking several low rated behaviors that feel manageable to start engaging in for the first week. It’s helpful to decide how often, when, and how you will start engaging in these behaviors. For example- some people might start by brushing their teeth every morning, playing guitar for 25 minutes 2x a week, or working out for a half-hour 3x a week. The schedule and difficulty of the behaviors that are chosen are based on what feels realistic and possible for the person I’m working with while still being challenging. The goal is to meet yourself where you are at versus telling yourself what you “should” be doing. Our current expectations for ourselves may not be possible or realistic. As these behaviors become easier to do on a regular basis, new behaviors from the hierarchy are added and one continues to engage in the previously assigned behaviors.

Earlier I talked about how many people wait for motivation to engage in the valued, routine, and enjoyable behaviors that are important in their lives. This is a common pattern for many people, not just those who are struggling with depression and anxiety. It is easy to fall into this trap. Yet, motivation follows the behavior. We cannot wait for motivation to engage in many tasks. I felt more motivated to write this article as I started writing it. But I had to force myself to start writing it before I felt significant motivation. Even though I knew I would enjoy writing it. Motivation can be even harder when depression has sapped the joy out of behaviors that give us joy. Behavioral Activation means doing these behaviors even if we feel anxious, or don’t find the usual amount of joy that we would get from these behaviors. As we continue doing the behavior, we will start feeling joy in those things again. Anxiety will fade with continued engagement. We feel more satisfied when we engage in these valued, enjoyable, and routine activities. Furthermore, it is a useful exercise to get clarity about what behaviors are important in your life, and which provide you with purpose, enjoyment, and stability.

The therapists at Shoreside Therapies know how hard it can be to search for ‘therapist near me for depression.’ It takes strength and vulnerability to consider getting help. Many people experience relief right after making that first appointment.

If you have Depression and need help with Motivation or Behavioral Activation Therapy reach out to one of our Depression Therapists: