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Tuesday 20 March 2012

Hidden Symptoms of Depression: Anticipatory Flatness

This is part of a series of posts on some of the less-talked-about symptoms that tend to go along with depressed mood. As stated in earlier posts, however, it’s important to note that each of these “hidden symptoms” can also occur at other times in our lives. Don’t fret if you see yourself in these experiences.
Even indoor skydiving can seem foolish. Hard to believe.

Emotions in Three Times

When we think of any event - going to a movie, seeing a friend, working on one's taxes - we can identify the emotions that we might feel in three separate periods:

  1. Anticipatory (or Pre). What do we feel when we consider doing the activity in the future? Is it tempting ("That chocolate cake looks good") or repulsive ("I'll never be able to figure out that financial report")?
  2. Concurrent (or During). How do we feel while we are in the event or performing the activity? Are we enjoying the hike? Is the shopping trip bearable?
  3. Retrospective (or Post). How do we feel afterwards? Are we glad we spent the evening playing that video game? Do we regret getting to the gym?

Why do we do the optional, or supposedly enjoyable, things in our lives? Generally, it is because we look forward to them. We think about doing them, and react with a positive emotion to that fantasy. "Oh yeah, that would be great." In order to get ourselves to take part, all we have to do is give in to the resulting temptation.

Of course, the system doesn't work perfectly. Many of the things we will actually enjoy doing hold limited anticipatory appeal. When you wake up early on a frigid morning, the prospect of going out in the cold and strapping on skis may seem dispiriting. But we generally learn which activities will be rewarding, despite their lack of temptation.

As well, even at the best of times, some things seem tempting but don't lead to a positive payoff. That third beer, the television remote, the game controller, the bag of chips in the cupboard, the internet for yet more aimless surfing - all of these can seem to call to us with their siren song. If we give in, we'll waste yet another evening, suffer yet another hangover, gain yet another pound. The mission is not to eliminate temptation, but to recognize which temptations cause us more trouble than joy.

The Influence of Depression

Depression affects emotions in all three times: Pre, during, and post. Anhedonia blunts the enjoyment of activities (during): things just don't seem as much fun as they usually do, and they take much more effort. 

What about post?  A negative cognitive filter makes savouring past activities difficult: we tend to see the flaws in what we have done more readily, and we have difficulty taking pride in our achievements.

But perhaps the greatest problem lies in the anticipatory period.

Formerly tempting activities (getting out of bed, going outside, calling up a friend to get together) lose all or almost all of their appeal. You can call up an image of riding your bicycle around the local park and it just seems like it would be a flat, stupid, boring waste of time. Indeed, if you got yourself to do get out the bike anyway it probably wouldn't be as much fun as usual. But eventually, with repetition, the enjoyment would return a bit at a time.

The result is that it becomes almost impossible to get oneself to do the things that normally make up a fulfilling life. We get depressed, lose our healthy anticipatory desires, then adopt a lifestyle that makes us even more depressed.

It doesn't stop there. Some of the less helpful temptations that we experience even when we are well ("Hey, let's sleep in, play computer solitaire, turn on the TV, eat that junk food, stay at home") get even stronger than usual. It seems as though there is a magnetic pull toward precisely those activities that will, in the long run, make us more depressed.

These shifts in anticipatory desire (decreased temptation for the positive, increased for the negative) are not just symptoms of depression. They represent some of the main reasons that depression worsens and becomes entrenched. "I'm depressed, I need to take care of myself" becomes, without noticing, a powerful force to make the depression stronger.

In effect, our motivations betray us, abandoning our side and taking the side of the depression.

What do we do about it?

There are several steps:

Recognition. We need to notice the shifts in anticipatory desire, and see them for what they are: normal symptoms of the problem.

Acceptance. We need to accept that these shifts are present, and will continue to be present while the depression is strong. In effect, we need to welcome the symptom rather than trying to kill it.

Relinquishment. We need to give up hope that our anticipatory desires will re-establish themselves on their own. They won't. So we can't wait to feel motivated or excited by things.

Identification. We need to identify the activities associated with feeling better. We can look at our own history for this. "When I feel better, what do I normally want to do?" "When I've been well, what are the things that I've been glad to have done, even if they weren't tempting at the time?" We can also look at the research on depression. "A lot of studies suggest that a regular exercise program is effective, so even though I've never had one, maybe I need to start."

Activation. We need to take those positive activities and reduce them to the point that we can actually achieve them. "Swimming three times a week would be a great idea, but first maybe I'll just buy a bathing suit." We won't revolutionize our behaviour, we'll just change it by increments.

Tolerance. Gradually we will increase the magnitude of goals as we gather successes, while tolerating the fact that concurrent enjoyment is also impaired. We will allow ourselves not to enjoy what we formerly enjoyed, and recognize that our old enjoyment is likely to creep back slowly.

By placing our behaviour in the hands of our knowledge rather than our temptations, we can begin shaping our lifestyle toward one that does not support the depression. As we do this, the depression typically begins to lift. This may not be the only thing we need to do, but it is one of the most powerful antidepressant strategies.

Next Tuesday: Let's take a break from the hidden symptoms of depression and return to other topics.

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