Major Depressive Disorder: Taking The First Step

Major Depressive Disorder (MDD) is one of the most common psychological disorders, with more than 7% of the U.S. diagnosed with depression. Individuals with MDD experience symptoms that are detrimental to their everyday functioning including sadness, sleep problems, and difficulty concentrating. Other common symptoms include lack of interest or pleasure in activities and low energy. Experiencing these symptoms can be overwhelming and can reinforce the inability to initiate productive habits. We can get stuck in a harmful cycle of feeling overwhelmed, unmotivated, and helpless. During the Covid-19 pandemic, anxiety and depression increased by 25%, yet psychological treatment was widely inaccessible for various reasons. So how do we start making ourselves feel better when we feel so trapped by our depression?

Behavioral Activation is a simple, evidence-based intervention that has shown substantial improvement for those with MDD. Behavioral Activation derives from the behavioral model of depression where it is believed that a lack of positive experiences contributes to the feelings of depression. The idea is that your thoughts and feelings are affected by your interactions with others and overall satisfaction of life. Using Behavioral Activation increases activities and the reward value of the activities. It works by getting your body moving and doing the things that create rewarding experiences in your day-to-day life. Eventually, initiating these positive activities becomes easier and more positive thoughts and feelings begin to emerge.

To start, Behavioral Activation prompts you to list what you used to enjoy or could potentially enjoy, motivates you to try it out, even if it feels like you are “just going through the motions,” and has you document your experience while doing it. Having a list of activities will make it easier to choose activities that a feasible in that moment and documenting the reward value will allow our mind to acknowledge the positive data. When you feel the joy brought on by these activities, your mind starts to remember how this felt and sends positive feedback to your reward center.

Try it out! To begin:

  • Identify potential activities – maybe in social relationships, hobbies, health, spirituality
  • They should be observable, for example, instead of “be healthier” your goal should be “go for a 15-minute walk, twice a week.”
  • Document how difficult the activity would be to complete compared to the rest. For example, of a list of 10 activities, you should determine difficulty rank from 1-10 (easiest to most difficult).
  • Document the activities in a weekly behavior log
  • Determine the ideal frequency of the activity for each week
  • Include the date, duration, and the pleasure felt from that activity (1-10)
  • Hold yourself accountable by documenting if the frequency goal was met.
  • At the end of each week, document the overall satisfaction with these activities and assess the pleasure you are gaining from doing these activities. You will be able to see your progress and including these activities in your life will become easier.

Obviously, this is easier said than done, especially when we are in the depths of a depressive episode, but that’s why we start with a list of activities that we know would be enjoyable and force our bodies to give them a go. Chances are that you’ll find joy in them again and have a
good start to adding more positive experiences into your day.

Want some help getting started? Contact drstephanie@kkjpsych.com to schedule an appointment.

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