Posted in Bipolar disorder, depression, depression management, lifestyle, mental health, Planning and journaling, wellbeing, wellness

Monday Matters: A mini guide to using Behavioural Activation as a treatment for depression

In last week’s blog post, I mentioned that my support worker and I have been using a technique called Behavioural Activation (B.A.) as a practical treatment for my depression and anxiety. Today, I thought I’d share an introduction to how B.A. works, ways in which it can help ease depression and anxiety and some tips on how to get the most out of using the method.

What is Behavioural Activation?

Behavioural Activation is an effective and pro-active treatment for depression which can be used in addition to medication and CBT techniques. Research shows that when individuals are struggling with depression their activity levels reduce, leading to less enjoyment and achievement and feelings of lethargy and poor motivation so that even small tasks and activities become hard work. This then becomes a vicious cycle of inactivity – depression and anxiety – inactivity and so on leading to us feeling worse.

Source: NHS Greater Manchester Mental Health

Additionally, a person may engage in unhelpful behaviours such as turning to drugs or alcohol, staying in bed late into the day, withdrawing from social situations or sitting ruminating about things.

Behavioural Activation (B.A.) aims to break the above cycle by increasing pleasurable and positive activity each week with a view to improving mood and decreasing feelings of anxiety, including any negative thoughts you might be having such as “I’m a useless wife/husband/partner”, “I can’t do this anymore”, “I’m never going to get better” etc.

Although Behavioural Activation is a relatively simple idea and can be used as a self- help strategy, I think it is best done with a therapist or support worker so that they can guide you through the process and provide encouragement along the way. They can also look at the particular difficulties you’re having and help you to put things in place to make positive steps towards tackling them.

Establishing a baseline – the first step of Behavioural Activation

Once you understand the principles behind B.A. therapy the first step in the process is to monitor your current activities throughout the week and how they affect your mood. This can either be done using an activity monitoring sheet, examples of which can be found online, or by simply making a list of what you do each hour of the day and scoring your mood out of 10 each time, 0 representing feeling very depressed and 10 representing feeling really good. This should help you to clearly see the relationship between your activity levels and your mood. You could also try listing which of your activities made you feel good and which made you feel bad, for example going for a walk in the park made me feel good, sitting and worrying that I’ll never get better made me feel bad.

Using a ‘Weekly Schedule’ sheet to make plans – the next step in the process

Once you’ve established what you are currently doing, it’s time to make some small improvements. Each week, you work on creating a schedule which should include routine plans such as having breakfast, going food shopping, pleasurable activities such as playing cards, watching TV, doing something creative etc and necessary things that need doing e.g. paying your car tax.

You should also try to include activities which you already do that make you feel better such as getting dressed, brushing your hair, going for a daily walk etc. So, for example, even though I didn’t feel like doing my yoga each day, I did it anyway as it helps to calm me and I feel good after doing it.

My modified B.A. weekly schedule sheet created in MS Word

What you write in the boxes depends on your current difficulties. For example, if you are struggling to get out of bed you might write in the first box ‘Up by 9.00am’, ‘Have breakfast’ and ‘Get ready’ (dressed, teeth brushed and face washed). If you’re currently not doing any household chores, you might add laundry related activities to your list. This can be broken down into small steps e.g. ‘Load the washing machine’, ‘hang out clothes’ and ‘Bring in washing’.

You should also try to think of activities which are important to you, for example spending time in nature, being creative, quality time with family or friends, eating a balanced diet etc. These are related to your core values and you might want to talk to a support worker or therapist to establish what you want from life so you can set some goals for the future. Although your depression is likely to lead you to believe that things will never get better and you will never again feel a sense of pleasure or achievement, try to think of your situation as temporary and know that things will improve in time (I know this is much easier said than done though).

Using your weekly schedule to good effect

Your weekly schedule is your plan for the week and is a guide for what you hope to achieve. It should be referred to throughout the day and will help you see what you have planned. It’s also a place to record your achievement and enjoyment levels (out of 10) so you can evaluate the effect B.A. is having on your mood. You might also like to spend time each evening reflecting on your day – you could even do a little journalling too. If you find your enthusiasm waning at any time, remind yourself why you’re using Behavioural Activation and think about the positives so far.

Tips on using Behavioural Activation to treat depression

Start small When I first started planning out my week according to the principles of B.A., I would identify one activity for in the morning, one for in the afternoon and another for in the evening. This would mainly include relatively simple and mindful activities which helped to distract my anxious and negative thoughts and improve my mood a little. So, for example, in the first week I would have breakfast, get dressed and straighten my hair in the morning, go for a walk in the park in the afternoon and then play cards, do some of my jigsaw or watch TV in the evening. By week 5, I was doing several activities in the morning, afternoon and evening and setting more difficult goals for myself. However, we always made sure I had some time for pleasurable and relaxing activities each week such as reading my book in bed two mornings a week (after having a good breakfast and brushing my teeth and washing my face).

Break down activities into steps When you’re feeling depressed, it’s common to lack the motivation to do even basic things. For this reason, it’s helpful to break down activities into small steps which feel more achievable. So, for example, ages ago I bought a cheap set of gouache paints and really wanted to have a go at using them. Rather than creating a full page art piece, I set myself the simpler task of painting some stems and leaves. For the first step, I experimented with creating different shades of green by mixing varying amounts of blue and yellow. Then I introduced small amounts of other colours of paint to explore what happened. I also added white to some of the mixture to make lighter shades. After that, I tried painting samples onto a small strip of watercolour paper to see if I had the consistency of the paint correct as I knew that gouache is quite a bit thicker than watercolour which I’ve used many times before. This was all I did on the first day. I returned to my paint samples a few days later and decided to have a go at some stems and leaves. I spent time looking online at different stem and leaf shape and patterns and then had a go at creating them using a small selection of brushes. By breaking down my art project, I avoided feeling overwhelmed. I also did the same for housework tasks e.g. rather than cleaning the whole kitchen, I started by just cleaning and polishing the sink area.

Routine, Pleasurable and Necessary Try to create a balance of activities on your plan so that you engage in a range of pleasurable and achievement related activities each week. So, for example, you might do some watercolouring on Monday morning because you know that you have enjoyed painting in the past. This would be a pleasurable activity (even if you believe that you won’t enjoy doing it). On Tuesday morning, you might put one load of washing in the machine and then hang it out in the sunshine when it’s finished. This would be a routine task (something that needs doing regularly) and is likely give you a sense of achievement. On Wednesday afternoon, you might plan to get a few necessary tasks out of the way such as renewing your car insurance, replacing a lightbulb or replying to an email or text message from someone.

Evaluate how your week has gone During my weekly support sessions, Nichola would ask me how my week had been and part of this involved talking through how I’d got on with my B.A. plans. This gave me the chance to share my achievements but was also an opportunity to identify any problems I’d had, if I’d found solutions myself or if I needed help to find a way forward. For example, one week, I’d got really upset because my dressing table in the bedroom was thick with dust and I felt ashamed at how bad it was. I only cleaned this one piece of furniture instead of the whole of our bedroom as I became really overwhelmed. We discussed that sometimes a task may need modifying or simplifying to make it easier and that I may need to try to be kinder to myself / show more self compassion etc.

Reward yourself regularly As well as going easy on yourself, it’s also a good idea to spend time recognising your achievements and reward yourself for progress made. As well as doing this with Nichola once a week, my husband talks with me about how my day had been and what I’ve achieved. Also, every Friday afternoon, we go to my favourite café for a coffee and cake as a well deserved treat. This has become a part of our weekly routine which will have carried on even though I’m now feeling much better and it’s not so hard to get things done.

Enlist the support of others If you find it difficult to motivate yourself to do the activities on your weekly schedule, it can be helpful to ask others for support. This could be a family member or friend who regularly checks in with you to see how you’re getting on and provides gentle encouragement. They might also help you with a particular task e.g. preparing a meal, filling in a form or tidying a space in your home.

Final words…

Although Behavioural Activation on its own isn’t a cure for depression, it can be a really useful coping mechanism and a helpful treatment for lifting your mood. Hopefully, in time, you will find that you start to enjoy some of the activities on your plan or feel a sense of achievement when you’ve completed tasks that you’ve probably been avoiding. As you continue to schedule in activities and complete them successfully, you’ll likely be motivated to do more. Remember, though, that there may be days along the way where you don’t feel so good and some of your tasks might not get done. This is okay and perfectly normal – just go easy on yourself and celebrate what you did achieve. Even a small number of activities done each day can have a big impact on your mood.

If you have any questions about Behavioural Activation, feel free to drop them in the comments and hopefully I’ll be able to answer them or direct you to an online resource which might help. Also, if you would like a copy of my Weekly Schedule, I would be more than happy to share it – just get in touch using the email address in the ‘Contact me’ section of my blog.

Posted in CBT, compassion, mental health, Mindfulness, psychology, wellbeing, wellness

Are you putting too much pressure on yourself? The unhelpfulness of ‘I should’ and ‘I must’ expectations

As part of my compassion group learning over the last few weeks, we’ve been looking unhelpful and more helpful thinking styles. I’ve previously talked about the psychology of using the term ‘I can’t’ (click here to read this post) when we really mean we find something difficult. In today’s wellbeing post, I’m going to focus on the pressure we put on ourselves using terms such as ‘I should’ and ‘I must’.

At the beginning of the year, I went through a really difficult patch with my mental health. I was suffering from debilitating anxiety and everything was a constant struggle. I was having panic attacks and my mood was very low. I spent a lot of time worrying that I wasn’t going to get better and found it extremely difficult to motivate myself to do anything but cry. I’m pleased to report that I’m now feeling much better and life is good. However, my improved mood and elevated motivation levels did start to cause a few issues with my self talk and my thinking and it is this which today’s post focuses on.

As soon as I started to feel better, I totally went into what is known as ‘drive mode’ and felt like I needed to make up for lost time by doing it all and not stopping. I had finally found the joy in achieving things in my day and my head was full of ideas and thoughts. I was writing huge to do lists and spent my time flitting from activity to activity in a frenzied way from when I got up at 6.00am to when I went to bed at 10pm. My head was filled with talk such as ‘I need to…’, ‘I have to…’ ‘I should…’ and all of the other terms associated with the intense desire to be productive and get a buzz from it.

The therapists in our compassion group helped us to see, however, that constantly being in drive mode and making these unrealistic assumptions of how to live can be really unhelpful. Terms such as I need to, I must, I have to and I should, put undue pressure on ourselves to perform and create expectations of ourselves that are very difficult to keep up with.

The effects of using these rigid terms have been studied by a number of psychologists and was a key part of the work of Albert Ellis. He coined the term ‘musterbation’ which has certainly stuck in my mind since reading about it online! The following quote I found online sums up the effects nicely:

“Musterbation” is a term coined by famed psychologist Albert Ellis to describe the phenomenon whereby people live by a set of absolute and unrealistic demands that they place on themselves, others and the world. For most of us, these rules come out in a series of should statements that we repeat to ourselves over and over again. These “should” and “shouldn’t” statements leave us feeling bad about ourselves because they set up standards that we cannot realistically meet. They also leave us feeling frustrated and hurt by others when they inevitably fail to fulfill our expectations. Recognizing this habit to set rules for yourself, others and the world gives you the opportunity to relieve some of the stress these messages cause. When dealing with “should” statements, it is important to keep in mind that while it may be nice to reach your goals and be treated the way you want all the time, we are human and live in an imperfect world. Therefore, the pressure to be anything all the time is more likely to cause harm than good.

Rowan Center BLOG, 2015.

If you would like to read more of their interesting article click here.

I’m now much more aware of when I’m using these terms (I haven’t stopped using them and I’m very much conditioned to their use, I’m just more mindful of when I do) and I try to reframe my thinking to be more helpful. This is taking time, but I do think it’s a really important step in increasing my good mental health. I’ve also noticed that my husband is fond of saying ‘I’ve got to…’ ‘I need to…’ and the like and so we laugh about it and then help each other to create more compassionate thoughts and beliefs too. Here are some examples and how I’ve re-articulated things:

  • I need to get rid of all of the weeds in the garden this week >>>> it would be great if I found some time this week to do a little bit of weeding as it would make the garden look a little nicer
  • I must take new and improved photographs of my products today >>>> If the lighting is okay today, I might take a few new photos of a couple of my products and upload them to Etsy
  • I really should get all of that washing done whilst the weather is okay >>>> it would be good if I did some washing this week as the basket is getting pretty full. I might do a load tomorrow and hang it out in the sunshine

You’ll notice that I’ve been more gentle and kind with my expectations too as another way of putting less pressure on myself. This is a big part of being more self compassionate which is what our wonderful therapy group is all about.

I hope you’ve found this blog post interesting and helpful. Maybe it’s made you think about the expectations you set and how you might re-frame your thoughts. Perhaps over the next week, you might notice yourself using ‘I must…’, ‘I need to…’ and ‘I should…’ a lot and you might try to be more mindful of what you say or think. It would be great if you let me know in the comments, but remember, you don’t ‘need to’ or ‘have to’, you just might like to or want to!

Much love and kindness.

Posted in wellness

Writing as therapy and ideas for getting it all down on paper

We all find ourselves struggling at times and in different ways – maybe you have a really difficult decision to make, or maybe you’re finding it hard to fit it all in and still make time for yourself. Or perhaps, you’re having issues with a colleague at work or a family member and it’s getting you down. Or maybe, the cold and miserable weather has made you completely demotivated and you struggle to even get out of your cosy, warm bed in the morning.

Whatever you’re finding hard at the moment, and most of us can identify at least one thing, a technique which you might find really useful is to have a go at writing it down. There are lots of different approaches that you can try depending on your particular needs, but the act of writing has been shown to be really beneficial for improving your mental health. And, of course, all you need is a pen and some paper or a notebook (and perhaps a quiet space to sit).

As you write, you may find solutions or alternative ways of thinking popping into your head and this is your inner wisdom helping you work through your problems or look at things from another perspective.

All you need is notepaper or a notebook and a pen.

Freewriting

Freewriting is a really simple technique where you just write whatever comes into your mind. Start with a blank piece of paper and just get out whatever is in your head. Try not to worry about spelling, grammar or punctuation, focusing instead on just keeping the writing flowing.

When you’ve finished your writing, try spending a few mindful minutes focusing on your breathing or thinking about how you currently feel.

Writing about your emotions

This is a good one to try if you’re feeling uncomfortable emotions such as upset, angry or frustrated. It can help you distance yourself from the emotion in order to rationalise your thoughts or empathise with yourself. Spend time journaling about how you are feeling and why. Don’t judge yourself in any way. Just record your thoughts and this will help you process them, rather than trying to avoid them by doing something else or, trying to switch them off.

Start a gratefulness diary

At the end of a busy day, just before you start to wind down and go to bed, spending a short time writing one or two things that you are grateful for can be a great mood booster. They can be simple things such as having an umbrella when it started to rain or a relaxing bath to soothe your aching muscles. Whatever made you happy or made your day that little bit easier write it down. You can choose the form in which you write, from a simple list to a random explosion of colour with little doodles for each one depending how creative you want to get!

Write a letter to yourself

This is one that I tried a while ago and I often come back to it and re-read what I wrote. First of all, you need to think about how you are feeling right now and what issues and difficulties are present in your life. Then, take a step back from your problems and write to yourself as someone who loves you unconditionally for who you are and shows kindness and compassion in their thoughts and understanding towards what you are going through. you don’t need to add in any solutions or advice but it might be helpful to offer support in the form of understanding and acceptance that things will improve.

Putting the day to rest

When you’ve got lots on your mind and are feeling really stressed, it can be difficult to quieten down your thoughts and relax at the end of your day. This can make sleep extremely difficult as you lie in bed analysing or worrying about what’s ahead. Putting the day to rest is a journaling activity which you can do for about 20 minutes each evening, not literally right before bed, but as a way of recording your thoughts and feelings so that you can switch off more easily. Here’s how it works:

  • Try to do this activity at the same time each evening – write it on your planner or set a reminder on your phone.
  • Use pen and paper rather than a laptop to avoid the glaring light of electronic devices.
  • Start by reflecting you your day – what are you general feelings about how it went?
  • Next, write down the main points of your day and identify what went well, what troubled you etc.
  • Write a to do list of anything which didn’t get done but is a priority.
  • Think forward to tomorrow – what is scheduled? How do you feel about it? etc.
  • Make a note of anything you are unsure about with regard to your day tomorrow and schedule some time to find out in the morning.
  • When you go to bed, if you start to think about things from your day or for tomorrow, remind yourself that you have already dealt these thoughts.
  • If new thoughts arise then you are already in bed, note them down on a piece of paper to be dealt with in the morning.

Ask yourself questions

As a keen bullet journalist, I use this technique regularly to help me to find ways to live my best life. I create a page with a question as a title and then list possible answers. Again, if you want to try this and like getting creative, you could add little doodles to your answers. Here’s some examples of interesting and thought provoking questions you might choose to ask:

  • How can I treat myself?
  • How can I get more organised?
  • What makes me happy?
  • What do I want to achieve this month?
  • How can I improve my relationship with …?

Brain dump

A brain dump is simply a page where you write words and short phrases to get down on paper all of those random thoughts that pop into your head throughout your day when you’re trying to focus on a particular task or activity. In this way, you can get back to the matter in hand and return to your random thought or piece of inspiration when it is no longer a distraction and you have time to further process it.


I hope you have enjoyed reading my suggestions and found them useful. Let me know if you try any of them or if you use any other useful therapeutic writing activities to help with the stresses and strains of life.