Behavioural Activation Part 6 – A Tool for the Future and a Promethean Act of Will

William James (1842 – 1910), the philosopher and pioneer of American psychology (teaching the first psychology course in the USA at Harvard) suffered bouts of depression throughout his life. At times they took what he described as a ‘Promethean Act of Will’ to overcome this ‘crisis of meaning’. BA is a tool that you can use for the rest of your life. At times it will be easy, for some people at times, it will require James’ Promethean Act of Will.

You may have times when you use BA more formally and write down an hour by hour daily plan. Other times you might use the principles to ensure you are giving yourself a balance of pleasant and mastery focused activities. You may completely forget about BA at times and then decide to come back to it if you notice changes in your mood.

These last two points are considerations for the future:

9. Prepare for lapses – Unfortunately for most people with anxiety or mood disorders there are likely to be lapses. When life throws new pain and losses at you, stress levels rise, or we stop looking after ourselves so well, then old brain pathways can resurface. Be ready for this and restart what worked as soon as you notice any signs of a lapse. Start planning BA and use your other tools as soon as you can. This was one of the key ideas of MBCT, the ability to detect the early warning signs of depression using mindfulness and to start to take care of ourselves early with BA.

10. Connect and get help – I have mentioned already that a number of these steps work better with friends or in groups. However, we have to watch for the tendency to ruminate out loud with another person. Can we instead put our attention on what they are saying, on their life? Can we do shared activities together rather than talk about our depression? It can be useful to talk to a professional therapist or a close friend or family member. But if it seems like we are going over the same unsolvable loops out loud, then try to switch into a problem-solving mode of what actions you are going to take, or observe and accept the thoughts whilst taking action with the other people.

Again, it’s worth noting that indigenous communities with lower levels of depression tend to spend almost every hour of the day with their friends and family. As they say in Dialectical Behavioural Therapy we need to do opposite action to what the emotion is telling us. So, try to connect with others and face to face connection is always best! Our blood pressure lowers and our heart rate variability improves when we are with friends, its how our nervous systems have evolved!

It can be really disheartening if we experience a lapse or a relapse in our symptoms. It can be important to contact our therapist right away or to connect with our support networks. Depression can resurface but if we continue to practice what worked and to open up with acceptance to these feelings and pursue meaningful activities, then we can recover again. As we develop these skills in a lapse, we actually become more confident that we know what to do next time. Each time we experience these difficult emotions and develop the ability to focus on meaningful goal-directed actions with the people we love (willingly carrying these emotions on our backs), our confidence grows. We get stronger through these promethean trials, much like a right of passage. I hope you have found this series useful and feel free to share any thoughts or questions in the comments below.

Behavioural Activation Part 1 – A Common Sense Approach to Mental Health Your Gran Would Agree With

I think the best psychotherapy and well being programmes have common sense overflowing from each practice, intervention or tool. Would your Gran have told you to do this when you were a child? Did the Greeks, Stoics and indigenous cultures do these things either consciously or as part of ‘the Good Life’? If the answer is an unequivocal yes then it’s definitely worth exploring. Behavioural Activation (BA) is certainly one of these common-sense tools. When we feel depressed or anxious we tend to isolate ourselves, stop doing things that make life meaningful and ruminate on our suffering. BA teaches us to challenge this by doing the opposite, making a list of varied activities to nourish our brains and recover our moods. Its not easy when you are depressed but it makes sense.

Mindfulness Based Cognitive Therapy (MBCT) was primarily developed for maintaining recovery from depression. Its creators had previously been experts in Cognitive Therapy and mixed elements of this with mindfulness in MBCT. One aspect was BA and they titled the session that focuses on it ‘How Can I Best Take Care of Myself’ to reflect the compassion embodied in Jon Kabat-Zinn’s original formulation of Mindfulness Based Stress Reduction.

BA came from the behavioural tradition of psychology, and holds that depression stems from a lack of positive environmental factors and/or too many punishing factors. There are different varying approaches to BA, often they start with an analysis of how you are spending your time hour by hour each day. How do these activities impact your emotions and moods? Then identifying positive experiences to add in and negative experiences to remove. This is followed with tracking the impact on your mood of increasing these positive steps and reducing negative factors. In MBCT we identify positive events by two categories: pleasure activities and mastery activities. Pleasure activities are inherently rewarding and involve enjoyment like talking with a close friend, eating nourishing food, listening to beautiful music etc. Mastery exercises give us a sense of satisfaction through mastery of our environment, like tidying our house, planning our monthly spending etc. Of course, there can be some overlap between pleasure and mastery, but it is good to schedule a balance of these activities.

It sounds very simple, but this can be a herculean task when you are depressed. When the weighted shirt of depression is on you, it can be a huge task just getting out of bed. You can’t think straight, your own mind is attacking you with the weapons of doubt, self-criticism and meaninglessness. So how can you use BA to move through the quicksand of depression or the paralysis of anxiety? In the next article I will explore some ideas that have helped me when using BA to work with my own anxiety and depression.