Living Well Is Hard Work — Five Reasons It’s Worth It

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One of the most effective treatments for depression is called behavioral activation. Its premise is very straightforward: We need to do things that bring us a sense of reward in order to break through depression.

Easier said than done! If you've ever been depressed, you know how hard it can be to find motivation for anything. Activities you once looked forward to feel like a chore, and it seems like all you can do just to get through each day.

When our mood is low, our tendency is to withdraw from life. We might ignore our friends' invitations to get together, stop exercising, put off tasks, and leave the house as little as possible. These options are appealing in the short term, because they take less effort and help us avoid the discomfort we expect to feel from doing activities.

However, as I describe in Cognitive Behavioral Therapy Made Simple, they also strengthen our depression. In my book, I give the example of a woman whose friend at work invites her to lunch; while declining the invitation is more appealing in the short term, in the long run, she'll benefit more from accepting (see the figure from the book).

Source: Seth J. Gillihan/Cognitive Behavioral Therapy Made Simple

I recently interviewed psychologist Rachel Hershenberg, who wrote her own book on treating depression called Activating Happiness. If you're a regular reader of the Think Act Be blog, you might recognize her name from a study I described a while back ("How Daily Uplifts Can Counter Depression"). Dr. Hershenberg shared many of her insights about the benefits of doing things that are important to us, even (and especially) when we're feeling low.

There are many ways that positive activities help when we're depressed. Here are five that emerged from my conversation with Dr. Hershenberg:

1. A Sense of Accomplishment

It's hard to predict how satisfying it might feel to take care of a task we've been putting off. We often discount that feeling of accomplishment, imagining we'll feel exactly the same after doing it as before. However, as Dr. Hershenberg points out, that's the negative bias of depression talking. We get tremendous benefit from seeing ourselves do what we need to do — no matter how small the task, as I discuss below.

2. Enjoyment

In addition to a sense of accomplishment, we can get a feeling of enjoyment from activities we care about. We may not get as much reward from activities as when we're not depressed, but it will probably be more than we're expecting in our negative mindset. We need both types of reward — enjoyment and accomplishment — to feel like life is meaningful and worthwhile. Think of it like a diet — some foods are nutritious, some are delicious, and thankfully some are both. Aim for variety in the activities you add into your schedule.

3. Breaking the Cycle of Avoidance

When we put off an activity we think will be unpleasant, we're immediately rewarded by a sense of relief, as illustrated in the figure above. That feeling of relief — whew, thank goodness I don't have to do that — is powerfully reinforcing. As a result, we're even more likely to avoid the next time. For this reason, pushing through avoidance is doubly beneficial, as it provides the opportunity for reward while also getting us out of the habit of withdrawal.

4. Mood Boost

Needless to say, behavioral activation would be a pretty pointless treatment if it didn't actually help to lift depression. Thankfully the majority of people get a lot of benefit from it, often without the need for antidepressant medication. The most recent meta-analyses find that behavioral activation produces, on average, a large, positive effect.

5. Building a Life We Care About

Life consists largely of the choices we make. As Dr. Hershenberg points out, these choices often seem small and insignificant, but taken together, they add up to the sum of our life. For example, if a friend texts us, it matters whether or not we respond; we can reply and make our life slightly better, or ignore it and make our life slightly worse.

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"Such seemingly mundane moments are the many choice points that build the landscape of your daily life.” —Dr. Rachel Hershenberg

So how do we get started when inspiration and motivation are hard to come by? Dr. Hershenberg offers many suggestions; here are three important ones:

1. Go small.

Beating back depression doesn't require grand gestures or obvious "breakthroughs." It happens in small ways, and it builds gradually. Even the smallest step represents progress and must not be discounted.

For example, maybe you've decided to start exercising, which is one of the most reliable ways to lift mood over time. You don't have to start training for a marathon or going to the gym six days a week. Aim to add five minutes to whatever you're doing. If you're completely inactive, add a five-minute walk.

2. Reward yourself.

Give yourself something to look forward to after you've completed a goal you set for yourself. For example, you could let yourself watch a YouTube video after responding to two emails you've been putting off. The reward will give you something to look forward to, and will reinforce the behaviors you're working on.

3. Establish keystone habits.

Some activities are especially potent, as they catalyze other activities. For example, some people find that starting an exercise program leads to eating better, having more social contact, and keeping a good sleep schedule. Others may find that reaching out to friends leads to other life-giving activities, like physical activity or learning opportunities. By establishing these "keystone habits," we maximize the odds that we'll stay on track in other ways.

Finally, keep in mind that balance is key, and that behavioral activation is about the long view rather than trying to do everything all at once. The activities you're doing should be moderately challenging, but not depleting.

I like the analogy of physical therapy for an injury. Physical therapists know that stretching and strengthening are necessary for healing. For this reason, PT sessions can be tough, even painful at times. The right level of challenge won't be altogether comfortable, nor should it be. At the same time, we don't work so intensely that we re-injure ourselves.

In the same way, recovery from depression is about healing, whether from grief, loss, excessive stress, physical illness, or anything else. Behavioral activation is the PT of psychotherapy, stretching and strengthening us in targeted ways that lift us out of the depths. We should aim for a sustainable level of activity that will have a net positive effect on our energy and mood.

For more of the nitty-gritty on doing behavioral activation, check out this earlier post: "5 Ways to Do More Mood-Boosting Activities."

You can listen to the full interview with Dr. Hershenberg here: How to Create a Life You Love.