We know that those of us who suffered severe childhood trauma are at an elevated risk of developing clinical depression as adults. Indeed, my own depression necessitated hospital admissions and electro-convulsive shock therapy as I’ve written about elsewhere on this site.
One of the hallmarks of serious, clinical depression is reduced ability to perform everyday tasks and activities. Again, in my own case, I was often confined to my bed for much of the day, stopped washing, rarely shaved and stopped brushing my teeth.
I know, therefore, that when very ill with depression, even basic tasks can feel impossible to undertake – indeed, even contemplating having to carry them out can, when one is so ill, create severe anxiety and distress. For those who have not experienced clinical depression, this is almost impossible to imagine or comprehend; such lack of empathy leaves one feeling devastatingly alone and terrifyingly emotionally imprisoned, compounding the problem.
Sadly, this loss of ability to carry out everyday tasks and activities tends to perpetuate and even intensify one’s depressive state, thus creating a vicious cycle.
Above : Avoidant behaviour can set off a vicious circle, whilst behavioural reactivation can set off a virtuous circle.
Behavioral Activation :
The psychologist Lewisohn has carried out research showing how, by reactivating the behaviours we used to carry out before severe depressive illness struck, we can alleviate our depressive symptoms, or, indeed, rid ourselves of the condition entirely.
Lewisohn suggests changing our behaviors may be more effective in treating depression even than changing our thinking style (as occurs in cognitive therapy). In other words, he postulates that:
Behavior Therapy (changing the way we behave)
may be a more effective way of treating depression than:
Cognitive Therapy (changing the way we think)
In order to test this hypothesis, Lewisohn carried out the following research study:
– 200 hundred hospital outpatients suffering from clinical depression were recruited into the study.
– these 200 individuals were the randomly assigned to one of four treatment groups
– these four treatment groups were as follows :
1) individuals were treated with anti-depressants
2) individuals were treated with a placebo
3) individuals were treated with cognitive therapy (to change their thinking styles)
4) individuals were treated with behavioral therapy (to change how they behaved each day)
Results of above research study :
It was found that those in the behaviour therapy group, on average :
– gained more benefit than those in the cognitive therapy group and placebo group
– gained a benefit equal to the benefit those treated with antidepressants derived
Other studies have produced similar results.
In relation to this study, Lewiston devised a therapy known as ‘behavior activation.’
What Is Behavior Activation Therapy?
In basic terms, this therapy involves the depressed person :
a) listing how his/her illness has changed his/her behaviour. For example :
– stopped socializing
– stopped exercising
– spend far more time in bed
– stopped doing housework
– reduced self-catering
b) Then, in relation to list, set goals s/he would ideally achieve. For example :
– socialize as much as before the illness struck
– go to gym for an hour, every other day
– limit self to eight hours a day in bed
– keep house reasonably clean
– care for self in same way as prior to becoming ill
Once these goals have been identified, it is necessary to undertake behaviours that help one achieve them.
Now, clearly, achieving all these goals cannot happen immediately!
Therefore, it is usually necessary to take small steps. For example, if trying to attain the goal of going to the gym, for an hour, every other day, one may start off by going to the gym for twenty minutes once per week, then very gradually increase this rate.
The importance of adjusting our behavior positively and increasing our activity levels to help improve our mood seems hard to overstate. Even by starting with tiny steps, a powerfully therapeutic virtuous cycle may be set in motion.
David Hosier BSc Hons; MSc; PGDE(FAHE).