How can CBT for Depression help us during self-isolation and physical distancing?

Self-isolation to manage COVID-19 brings with it new challenges for all of us. One challenge is how to spend time at home in a way that improves our mood and does not increase feelings of sadness, isolation and a lack of purpose. This can make depression worse in people who are already struggling and lead to low mood in people who might be vulnerable for one reason or another.

Principles from an evidence based treatment for depression called Behavioural Activation (BA) are at hand.

What is Behavioural Activation?

Behavioural Activation is part of the family of Cognitive Behavioural Therapies (CBT) and is widely used and researched. It's based on a simple idea. We feel better when we do activities that we either enjoy, feel a sense of achievement about or which help us feel connected to others.

Research into treating depression shows us that a day that includes a good balance of these three types of activities is one that will lead us to have a better mood. Getting stuck in a vicious cycle of not doing things make us feel miserable, and less likely to want to do anything. These principles are true across the lifespan and are as important for children as they are for older adults.

People have different opinions about what activities fit into these categories, so members of the same household might have different ideas about what a day well spent will be like. One person might enjoy the excuse to miss going to the gym whereas someone else might feel irritable without this. One person might enjoy folding the washing whilst another might see this as a necessary chore.

Whatever it is that you or those you live with enjoy, feel a sense of achievement about or feel connected with others during, try to make sure that you all have a mix of these three things despite being at home.

Planning ahead

Planning your day or even your week ahead to make sure you include these three elements can really help with this, especially if your household suddenly has children at home for more of the time. You could make your own list for the day or timetable for the week. If you use post it notes you could move things around if you need to. Look at what's planned in and check for a mix of things that include enjoyment, achievement and connection. If you're missing one element in the day try to build that in later in the evening.

If there are times when it is hard to act according to your plans it is worth stopping and thinking about what might be getting in the way. It could be feelings associated with becoming physically unwell, in which case it might be necessary to step things down a little and do something similar but less effortful. It might also be that thoughts about the pointlessness of the activity might be making it hard to get started. Where this is the case often starting to do the activity for just 5 or 10 minutes can help to get you going.

Sleep, exercise and regular structure

Whilst it's tempting to have a lie in when you're at home, evidence suggests sticking to a clear sleep routine is more helpful. The same principle goes for mealtimes. Whilst there's no harm in having some unstructured time in a day, be careful of too much baggy time which can start to feel aimless. Exercise is harder if you're stuck inside, but online classes can help. If you can go out, having a run or a walk can really boost your mood. Part of this is due to endorphins, chemicals released when we exercise which help us to feel good.

Values

It can help to check in with whether the way you are spending your time is in line with your own personal values and interests. If you are someone for whom helping others is important then make sure that some of your time includes activities that do that. If learning new things is important make sure that there is time for that. Similarly for making time for creative pursuits, calm time, and whatever else it is you value.

Helping others

We know that one way to boost happiness is to do something for others. This can be for immediate family members if you are not in a position to leave the house or for friends and neighbours if you are. Building in activities that help others are often enjoyable, give you a sense of achievement and make you feel connected, so it's a triple win. Lots of things can be done from a distance, e.g. writing emails or sending letters to loved ones far away.

Reviewing

Take a bit of time for yourself or with your family or housemates at the end of the week to review how things have gone and work out if there are things you want to tweak for the next week. Did any activities noticeably affect your mood in a positive way? Was there a day when you felt blue? What was going on then and what could you tweak for next week?

What is undoubtedly a challenging time might also lead to opportunities for new experiences and activities or time for things that there are normally not enough hours in the day for. Making an effort to build in enjoyable, satisfying and connected activities, as well as time for rest, will help. So will checking in with ourselves and each other about how what we do affects how we think and how we feel.

Dr Andrew Beck, BABCP President-Elect, ELCAS (East Lancs Child and Adolescent Service) @andrewbeck45
Dr Lucy Maddox, BABCP Senior Clinical Advisor @lucy_maddox

For more on how CBT principles can help at this time:
Read BABCP scientific committee member Dr Jo Daniels' advice on how to stop worry spiralling out of control

Listen to Dr Jo Daniels discuss these ideas with Dr Lucy Maddox on the BABCP Podcast, 'Let's Talk About CBT'

Read advice from OCD-UK specifically for people struggling with Obsessive Compulsive Disorder who might be struggling to tell the difference between symptoms of OCD and the very real need to improve hygiene to reduce risks to themselves and their families