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Approaching depression from another way

Cognitive Behavioural Therapy (CBT) is currently the gold standard treatment for depression, says psychologist Damien Adler from Mind Life Clinic.

The ‘cognitive’ part of CBT focuses on the way people think. It involves talking through thought processes and challenging people’s ideas.

Meanwhile, the ‘behavioural’ part is aimed at changing people’s behaviours.

But a new, large-scale, study published in The Lancet has shown another, simpler (and cheaper) form of therapy with the potential to be just as effective as CBT.

Known as Behavioural Activation (BA), it encourages people to focus on meaningful activities driven by their own values to help them overcome depression.

The UK-based study involved a randomised controlled trial comparing the cost and outcome of BA versus CBT.

The 440 participants were split into two groups, with roughly half the participants in each group. The study found BA was no less effective than CBT when the groups were assessed and followed up at six, 12 and 18 months.

These results make sense to Adler.

He says that when people develop depression they experience reduced energy and motivation and derive less pleasure from activities. Depression also makes people feel “useless, worthless and hopeless”.

Understandably, these feelings often result in people forgoing activities that either bring them pleasure (such as attending social events) or engaging in those that achieve a purpose (such as mowing the lawn).

Depression also causes people to want to disengage. But disengaging actually worsens depressive symptoms, says Adler. Thus, he says: “A vicious cycle can quickly develop”.

That’s where BA comes in; it helps break that cycle.

The trick is in the ‘doing’

BA works by encouraging people to engage in a healthy mix of activities that tick two main boxes: either providing pleasure, or giving a sense of achievement.

“Put simply, you could say that BA helps depressed people ‘get going again’,” says Adler.

This differs from more cognitive-focused therapy for one main reason – you don’t need to analyse the ‘why’ in order to engage in the behaviour.

So instead of contemplating questions such as, ‘Why should I go out for coffee?’ BA bypasses such thoughts and recommends you just go out and ‘do’.

This is especially important because people with depression have thoughts that are “negatively skewed,” says Adler.

Consequently, they easily talk themselves out of doing activities like social plans.

“As a result they miss out on the positive effects they could gain from simply engaging in such behaviours,” says Adler

“Once you start doing activities you enjoy – or ones that bring a sense of achievement, you will then establish a positive feedback loop.”

That positive feedback may be external (for example, a friend giving you a compliment).

“But commonly, it’s an internal experience such as feeling good for having achieved something.”

Simple achievements, daily

Some people may feel an “immediate lift” in their mood from trying BA, says Adler. However, he says it may take several weeks for others to notice the effects.

If you’re interested in trying BA concepts, Adler recommends scheduling a mix of activities that are either fun (like going to the movies), or achievement-focused (like cleaning out your kitchen cupboard).

Write them down and tick them off when they’re completed. (“This helps provide structure, increases accountability, and adds to the sense of achievement.”)

It’s best to start small and slowly increase the number of activities you do (rather than attempt to do too much and risk getting overwhelmed).

The ‘fun’ activities could be as simple as baking something delicious, bringing in flowers from the garden or doing something creative, like painting.

Meanwhile, achievement-based activities could focus on tasks of daily living, such as cleaning your kitchen, organising your bills or writing your shopping list.

Of course, the specific activities you choose depend on your values and what you enjoy.

“The goal is to set activities that are achievable, but also represent a move forward.”

Always see your doctor for medical advice.

Evelyn Lewin

About the person who wrote this

Evelyn Lewin

Evelyn Lewin is a freelance writer, doctor and mother of three. She has a diploma in obstetrics and gynaecology, a love of strong coffee and an inability to use chopsticks.

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