By Pamela L. Tippit, LPC-S
Behavioral activation is a coping skill that is often used to treat mood disorders such as depression. Simply put, when we become depressed or experience anxiety, we tend to increase avoidance and isolation, which can make negative symptoms worse. With behavioral activation, the key is to gradually get individuals to decrease avoidance and isolation and participate in activities that can improve mood.
With this in mind, I often think about kindergarten. Remember in Kindergarten there was a daily schedule written and posted in the room. All the most important daily activities had allotted times such as play (socialization), sleep/rest, meals, and work. No minute of the day was unaccounted for. This conditioned us to thrive with routine and positive activity. Don’t believe me? Think about when we were all in lockdown due to the COVID-19 pandemic.
Most of the anxiety and depression people experienced came from the removal of daily behavioral activation of some of the most important things for people: social interaction, work, rest/sleep, movement, and routine.
When clients come in and they are struggling with depression and/or anxiety symptoms, we take a minute to address the following:
1) Sleep: We all understand that sleep is important, yet this is one of the first things we get less intentional about, especially as we move into adolescence and into and through adulthood. Sleep is a requirement for all of us to work efficiently. When clients are struggling to function day to day but cannot seem to improve sleep hygiene, I give the analogy of the cell phone. Most of us have all attempted to use a cell phone that is at 10% or less battery life. When you do this, the phone will work, but it just isn’t the same as if it was at 50% or greater battery life.
The screen light is dim, you may not be able to access certain apps, and if you let the phone go low enough, it will only perform the necessary functions such as making a call. We operate pretty much the same. When we do not recharge with sleep, we do not operate as well. Certain activities are not available to us, we are just less “bright,” and we can only do the bare minimum. And people wonder why they are so irritable, can’t focus or concentrate, and experience little joy??
Bottom line: sleep is the recharge you must have to maintain good mental health.
2) Work: Work, whether it's schoolwork or work, we all need to be engaged in activities that give us a sense of purpose and fulfillment. However, if not managed properly, work can confound our mental health. Work is one element of our lives that needs a lot of balance, which is why in kindergarten we had carefully planned time blocks of work. This was to maximize our time, energy, and effort efficiently. But take away balance from work and we lose that sense of routine and purpose that keeps us grounded. Use of coping skills such as time management and structuring your workspace to maximize effort by having minimal distractions and not working in spaces meant for rest/sleep can help us achieve some work balance. Also, not working during designated rest times and having a cut off for engaging with work can help us achieve work/life balance and prioritize mental health.
Bottom line: work gives us structure, routine, and purpose, if well balanced and managed with intent. Humans crave and need homeostasis, without it, mental health will suffer.
3) Proper diet: Keeping balance in mind, proper diet is necessary to fully achieve it. It’s another way we give the body and mind what it needs to function. When we are small children, this is often well monitored for us. But as we move into adolescence and have more autonomy over our diet and food choices, proper diet can fall by the wayside. When people are struggling with their mental health, incorporating whole foods and minimizing caffeine and processed foods can only provide a good foundation for the mind and body.
Bottom line: without proper nutrition, we are failing to recharge and refuel the body and MIND to do what it needs to do.
4) Socialization: If anyone ever doubted the need for social interaction, after living in and through a pandemic, there should be no doubting how important and necessary social connection is. Humans are social creatures, and just as food and sleep recharge and fuel the body and mind, socialization enriches us, makes us more than just living things, it evolves us, changes us, and allows us to continue to grow.
Bottom line: without socialization, we limit our growth and capacity to change.
5) Movement: There is a famous study that revealed that people who sit for six or more hours a day have a 20 percent higher rate of early death than people who sat for three hours or less each day. This study found that life expectancy was reduced regardless of whether a person got sufficient exercise or not.
This analysis also found that people who spend less than two hours daily watching television live about 1.4 years longer than people who spend more than two hours a day watching TV. I would definitely say the bottom line is to get up and move! But when you are feeling depressed or anxious this may seem next to impossible.
These study results say to me that those 3-4 weekly workouts at the gym will not be enough to help sustain meaningful health. So what to do? Use 10-15 minutes of your lunch time to move around, park farther away from the building to get extra steps, take the stairs whenever possible, stretch during commercial breaks, stop staring at your screen and stand up and stretch, if you talk on the phone walk around while doing so, get a standing desk, use one of those bicycle/pedal machines under your desk, do 5, 10, or 15 minute walking videos (easily found on YouTube). The list goes on and on!
Bottom line: make moving every single day for a minimum of 30 minutes a priority! Movement is an activity that can ground you and improve overall health and mental health.
Speaking of grounding….
5) BONUS! Grounding: Grounding basically means to bring your focus to what is happening to you physically, either in your body or in your surroundings, instead of being trapped by the thoughts in your mind that are causing you to feel anxious. Behavioral activation can assist with grounding. If you work to implement rest/sleep, healthy eating, socialization, a balanced work schedule, and movement you can have something to anchor you daily.
Here are some additional tips to help you get the most out of grounding techniques:
Practice. It can help to practice grounding even when you aren’t dissociating or experiencing distress. If you get used to an exercise before you need to use it, it may take less effort when you want to use it to cope in the moment.
Start early. Try doing a grounding exercise when you first start to feel bad. Don’t wait for distress to reach a level that’s harder to handle. If the technique doesn’t work at first, try to stick with it for a bit before moving on to another.
Avoid assigning values. For example, if you’re grounding yourself by describing your environment, concentrate on the basics of your surroundings, rather than how you feel about them.
Check in with yourself. Before and after a grounding exercise, rate your distress as a number between 1 and 10. What level is your distress when you begin? How much did it decrease after the exercise? This can help you get a better idea of whether a particular technique is working for you.
Keep your eyes open. Avoid closing your eyes, since it’s often easier to remain connected to the present if you’re looking at your current environment.
Grounding techniques can be powerful tools to help you cope with distressing thoughts in the moment. But the relief they provide is generally temporary. If you are suffering with symptoms of depression, anxiety or any other mental health issues, It’s important to get help from a therapist so you can address what’s causing your distress.
References: Koebler, Jason. https://www.usnews.com/news/articles/2012/07/09/study-excessive-sitting-cuts-life-expectancy-by-two-years