Withdrawing from activities you enjoy is both a product and cause of low mood. Break the cycle with behavioural activation
Monitor what you do each day. The first step involves keeping a record of all your activities for about a week. There are free worksheets available online, but you can make one yourself. Draw up an empty timetable, splitting each day into hourly slots or into morning, afternoon and evening. Then, for a week, make a note of what you did each day. Critically, you should also make a note of how you felt during each activity, from 0 (feeling really down) to 10 (feeling positive and upbeat). For example, you might note that you watched TV in the morning and your mood was about a 3, then you did a yoga class in the afternoon and your mood was about a 5. ‘The idea is that this step helps gather information about the small changes in behaviour that could make a big difference but that we often overlook,’ says Laura Pass, a clinical psychologist at the University of East Anglia.
If the idea of tracking your activities for a full week seems daunting, then you could do it for less time. ‘The aim is to set the recording-activities step at a level that is manageable for the person,’ says Pass. ‘So this might be doing one day, or doing a few time-points during the week.’ She stresses that this step can be tailored to the individual: ‘For example, for a young person, a parent might help them complete this.’
If the idea of tracking your behaviour at all seems too hard, BA principles could still be useful to you – just skip this step and go to the ‘Make a plan’ step below. ‘Personally, I don’t think it’s absolutely essential to do the baseline activity,’ Richards says. Pass agrees, emphasising that the key is about changing future behaviour. ‘So if someone is able to do that without recording their activity, that’s still positive.’
Evaluate what you did. If you tracked your activities and mood, then reflect on what you were doing when your mood was higher. It doesn’t matter if your mood was never very high; that’s common, particularly if you’ve had a prolonged period of feeling down or depressed. A small increase in mood is still helpful and will inform the next step.
Make a plan for the following week. Now you need to schedule activities for the upcoming week, using the same blank worksheet as before. Look back at your diary from the previous week, and include in your schedule the activities you were doing when you experienced a slightly better mood. In addition, try to include some of the activities you have stopped doing, or are doing less often now. You don’t need to fill out every slot, but aim to schedule at least one or two activities for each day.
To figure out the kind of things you should include, it’s useful to think about not just what you enjoy but also what you find meaningful or important – or what you used to, before this period of low mood or lockdown. ‘The idea is to personally identify what’s important to you in your life,’ says Pass. ‘It’s about where you want your life to be going.’ If you enjoy going out with friends, for example, you could invite someone to go for a coffee, or make plans to call a friend. If you value learning, you could plan to take a book out of the library or listen to a new podcast. There isn’t a set list of activities you’re supposed to try; schedules for a school-age teenager, a working parent and a pensioner might vary considerably. What matters to you will depend on your own unique circumstances.
There might be some less fun things in your schedule, too. If it’s important for you to have a tidy house or flat, for example, you might want to schedule some cleaning or a clearout. McMillan emphasises that it’s about finding a balance between three different types of activity: the pleasurable (such as seeing a friend), the routine (showering, cooking) and the necessary – where the consequences of not doing an activity are significant (academic work, paying bills). ‘It isn’t just about doing nice things,’ he says. ‘It’s just as important to get up and brush your teeth and have a bath. It’s about doing things that get you something positive in life.’
In your new schedule, avoid prolonged periods of not doing very much. In particular, be on the lookout for anything from the previous week that helped you to avoid or escape more fulfilling activity. For example, you might have stayed in bed late so you would miss a certain meeting at work, or spent hours scrolling through social media instead of going out with friends or chatting to them on Zoom. Even though these low-effort behaviours might feel appealing in the moment, they could be maintaining your low mood. This is because, when you do these activities, they’re filling up time that you could otherwise spend doing something positive. Doing very little at home or choosing to relax aren’t problematic behaviours in and of themselves; they become problematic only if you’re using them to avoid doing something more important. Try to spot any behaviours that you use to withdraw from the world, and avoid scheduling these for the following week.
Stick to the plan, even when you don’t feel like it. A key aspect of BA is that you need to carry out all your planned activities even when you don’t feel like it. According to the theory, opportunities for positive mood-change occur only once you’re doing the activity, so it’s important to attempt it in spite of how you’re feeling. ‘It’s useful to think about working “from the outside in, not the inside out”,’ says McMillan. ‘Rather than telling yourself: “When I feel better, I’ll do the activity then,” you’re changing your behaviour first, then the thoughts and the feelings catch up.’
If it feels impossible to get going, there are a number of things you can try. First, you could break down the activity into smaller steps or do it for shorter periods of time. Richards gives an example: ‘If someone is avoiding cleaning their home because it’s overwhelming, then it makes sense to clean just one part of your home.’ Second, it might be useful to order your list of planned activities in terms of how difficult they seem, and attempt the smaller, easier ones first. For example, instead of planning to join a gym and trying out an exercise class, a first step might be walking around the block, or trying an exercise video on YouTube, before attending the gym at a quiet, off-peak time.
Finally, you could experiment with strategies that boost the chances of completing your activities. McMillan emphasises the importance of setting up the right context. He suggests that you ask yourself: ‘What’s going to make the behaviour more likely to happen?’ Consider, for example, writing down the task somewhere you’ll see it, or asking a friend to do the activity with you.
Evaluate how it went. At the end of each day, reflect on how you felt when you did each activity. Note which activities led to an increase in positive mood, even if it was small, and which contributed to a lower mood. Notice any other benefits you experienced: maybe you felt a sense of achievement for giving something a go, or a sense of relief for tackling a job you’d been putting off for ages. This will help when planning activities in future weeks. Also note the times when you felt unable to start or complete an activity in your schedule, and think about how you might make it more manageable the next time.
Be patient with yourself. Remember that an improvement in mood might not be instant. ‘[The behaviour] might just be really difficult to do now you’re feeling low, now the context has changed,’ says McMillan. ‘It might feel hard for a while, but if you can, keep going with it. One useful idea is to see it as an experiment: try to experiment with the behaviour long enough to find out what it does for you. It could well take a few weeks to find that out.’
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