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 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.
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.
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
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