How to Treat Depression by Building a Life You Love
by Seth Gillihan, PhD
One of the most effective treatments for depression is to do activities that bring a sense of reward—what psychologists call “Behavioral Activation.” Easier said than done! If you’ve ever been depressed, you know how low your motivation can be. Things you looked forward to in the past can feel like an impossible chore, and just getting through the day might feel like a victory.
I know from my own experience with depression that it’s much easier to just withdraw from life. We might stop exercising, put off tasks, stay in the house as much as possible, and ignore our friends’ invitations to meet up. Withdrawing is the path of least resistance, especially when we expect the activities to be difficult and draining.
However, as I described in Cognitive Behavioral Therapy Made Simple, withdrawal also strengthens our depression. I give the example of a woman whose friend at work invites her to lunch; while declining the invitation feels better in the short term, in the long run she'll benefit more from going with her friend (see the figure from the book).
There are many ways that positive activities help when we're depressed; here are five common ones:
1. A Sense of Accomplishment. We often think we’ll feel exactly the same after meeting a challenge as we did before. The truth is that we’ll probably have a feeling of satisfaction from taking care of something we’ve been putting off. We can also get tremendous benefit from seeing ourselves take care of our responsibilities—no matter how small the task.
2. Enjoyment. Doing activities we care about can also be enjoyable. We may not get as much reward from activities as when we're feeling well, but it will probably be more than we're expecting (based on our negative mindset). Having both types of reward—enjoyment and accomplishment—helps make our lives feel meaningful and worthwhile. It’s like a diet—some foods are nutritious, some are delicious, and thankfully many are both. Aim for variety in the activities you add into your schedule.
3. Breaking the Avoidance Loop. When we put off an activity we think will be unpleasant, we're immediately rewarded by a sense of relief, as illustrated in the figure above. That feeling of relief—whew, thank goodness I don't have to do that—is powerfully reinforcing, making us even more likely to avoid activities the next time. So pushing through avoidance helps in two ways: it provides the opportunity for reward, while also getting us out of the habit of withdrawing.
4. Mood Boost. Behavioral activation would be pretty pointless if it didn't actually help to lift depression. Thankfully the majority of people get a lot of benefit from it, often without the need for antidepressant medication. The most recent meta-analyses find that behavioral activation generally leads to big improvements.
5. Building a Life We Care About. Life consists largely of the choices we make. Even ones that seem small and insignificant ultimately determine what our life looks like. For example, if a friend texts us, it matters whether or not we respond; we can reply and make our life slightly better, or ignore it and make our life slightly worse. By consistently moving toward activites that matter to you, you’ll build a life you truly want to be a part of.
A crucial part of behavioral activation includes finding ways to get started, even when inspiration and motivation are in short supply. Here are three key principles:
1. Go small. Beating back depression happens in small ways, and it builds gradually. Don’t dismiss even the smallest steps, which represent progress. For example, if you’ve decided to start exercising again, you might aim to start with a five-minute walk once a day.
2. Lead with action. Remember that you probably won’t feel like doing the task when the time comes. Focus on your goal, and complete your planned activity even if (or especially if) your motivation is low. Feeling often follows action.
3. Find your “keystone habits.” Some activities are especially powerful, helping you to add even more activities (a concept I borrowed from my colleague and podcast guest Dr. Rachel Hershenberg). For example, many people find that starting consistent exercise leads to more social contact, a better sleep schedule, and eating more healthfully. Practicing these keystone habits can maximize the odds that you’ll stay on track in other ways.
Finally, balance is key; behavioral activation is about taking the long view rather than trying to do everything all at once. The activities you're doing should be moderately challenging but not depleting. It’s a lot like physical therapy—the right level of challenge won’t be entirely comfortable at times, but shouldn’t lead to re-injury. And just like PT, behavioral activation stretches and strengthens us in targeted ways that lift us out of the depths.
If you’re looking for a way to bring behavioral activation into your life, one option to consider is The CBT Deck, my latest effort to bring practices like behavioral activation to those who need them. As the name suggests, it’s actually a deck of cards, with each card featuring a technique to practice—I recommend using one card per day. Because of the format, it’s easy to take the day’s card with you as a reminder of what you’re working on.
Along with cards on behavioral activation, the deck includes ones that address facing your fears, training your thoughts, practicing mindful presence—a total of 101 techniques. My hope is that these practices will help you to reduce stress, increase positive emotions, overcome self-limiting beliefs, and be more engaged in the present moment.
However you choose to build the life you want, I wish you all the best in the journey.