Beyond Behavioral Activation: What to Do When Unhelpful Thoughts Hinder Enjoyment
By Robert Hindman, Ph.D.
Beck Institute Faculty
When clients initially become depressed, they tend to withdraw from life. For instance, my client, Matt, became depressed after his wife filed for divorce and moved out of their house. After this happened, he began to isolate himself from friends and family, and he spent less time at work. The problem is that withdrawing from life typically makes depression worse because clients are spending less time engaged in meaningful or pleasurable activities. Their decreased physical activity tends to lead to increased mental activity in the form of ruminating about their problems. These clients can often improve their depressed mood by becoming more active overall, through behavioral activation (Sturmey, 2009). At Beck Institute, we often have the client focus on activities they value, but have given up since becoming depressed. Matt’s mood significantly improved once he started working his normal hours and socializing with his friends and siblings more regularly. Nonetheless, not all clients benefit from behavioral activation.
This was the case with one of my clients, Sam. When we were setting goals, I asked him, “How would your life look different if you were not depressed?” Sam told me that absolutely nothing would be different. He loved his job, had a great group of friends, and could not imagine being in a better marriage.
When clients are living the life they want and still feel depressed, it is important to identify what’s going on in their minds before, during, and after events when depression is elevated.
Sam mentioned one such event: going to a concert with his friend. I asked Sam what he was thinking about before the concert, and he told me that he was worrying about potential problems that might reduce his enjoyment of the concert. For example, he was imagining that they might not be able to find parking close to the venue, questioning whether his friend would have a good time with him, and worrying that there would be long lines for food. I asked what emotions he noticed during this time, and he reported a combination of nervousness, disappointment, and dread.
Next, I asked what was going through his mind during the concert. Sam told me he was mainly thinking that he should be feeling happier about being at the concert because it was his favorite band. Sam said that his happiness level started out at a 6/10, which then shifted to him feeling mildly depressed by the end of the concert.
Lastly, I asked Sam about his thoughts after the concert. He said that he continued to analyze why he didn’t enjoy himself as much as he hoped and questioned whether he would ever feel happy.
After we determined the content of his thinking, Sam and I next identified the purpose of this thinking. I asked what he believed the benefits of worrying about potential problems were, and he replied that he thought he could make sure the problems did not happen so that the event could be more enjoyable. We also identified the purpose of analyzing why he was not feeling as happy as he believed he should feel both during and after the event. Sam provided a similar response: he believed he would be able to determine what was getting in the way of his happiness, and therefore, increase his overall level of happiness. Next, I helped Sam evaluate whether these strategies were actually effective by asking about the consequences of his thinking. Sam thought about this for a few moments and reported that the main consequence was his being less happy overall.
Now that Sam recognized that his way of thinking was not productive, we could develop more helpful strategies to improve his mood.
To replace worrying before an activity, Sam came up with the strategy of problem solving. Instead of trying to analyze why he wasn’t as happy as he would prefer to be during the event, we determined that Sam should stop trying to control his level of happiness. We did this by developing a coping response: “If I’m a 5/10 (or whichever happiness level), let me be a 5/10.” Finally, we replaced his rumination about his mood after the event with having him acknowledge one aspect of the event that was “decent to enjoyable” and then bring his attention back to the present moment.
Sturmey, P. (2009). Behavioral activation is an evidence-based treatment for depression. Behavior Modification, 33, 818-829.
CBT for Depression and Suicide
January 28-20, 2019