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Tuesday 29 January 2013

Managing Depression: The 24 Hour Rule

Just get out the door.

Behavioural activation is difficult.

Depression, like all emotional states, brings with it a set of behavioural impulses to do things that will usually intensify, rather than alleviate, the depression:  Stay home, eat little (or binge on sweet or fatty foods), isolate, be inactive, and so on.

Family members (and some clinicians) often look on in frustration. “You’re doing exactly what I would do if I wanted to feel worse!” It can look like the person deliberately wants to maintain the depression. But they don’t.

If we look deeper it’s easy to see the rationale behind all of these behaviours. I didn’t sleep well, so I wouldn’t be able to concentrate if I went in to work anyway. I have no energy, so exercise seems ridiculous. I can’t string a sentence together, so going out with friends would only be embarrassing.

Plus, I’m used to doing what my instincts tell me, and they tell me to do exactly what I’m doing.
When we first give the rationale for behavioural activation (the more friendly name for which is goal setting), the whole idea can seem overwhelming. “So even though I have no energy, no motivation, and apparently no ability to think straight, I’m supposed to live a busy life. Yeah, I'll get right on that.”

The plan is to start small, of course. And it helps to have a few simple guidelines.

One of these is the 24 Hour Rule.

The idea is simple: At least once in every 24 hour period, you have to get out of your home.

We can’t impose this on people, we can only suggest it. But it’s a good general rule for people with mood difficulties. Staying at home can feel a bit cozy and warm, but eventually it leaves people feeling like invalids. Lying in bed is the way to recover from the flu, but it generally makes depression worse, no matter how attractive it feels.

Getting out will usually feel aversive, uncomfortable, and futile, especially at first. But ultimately it gets easier and it helps us reconnect with life.

Fine, but what should you do?

A dietician once told me that when a depressed client hasn’t been eating, her first agenda is “Eat something!” It doesn’t matter what it is. Later on, you can start working on a healthy diet.

Similarly, at first it doesn’t much matter why a person leaves home. Maybe it’s to sit and drink coffee on the front step. Maybe it’s to go to the convenience store to buy the chips they’ve been told they shouldn’t eat. Maybe it’s to attend a doctor’s appointment. Fine. Once getting out has become a habit, we can start to work on enjoyable and healthful activities.

The 24 Hour Rule makes the point that we are not asking for the world. People with depression don’t suddenly have to find the resources to adopt an exhaustingly full life. At first, it’s just to get out the door.

Online Course

Want more behavioral strategies for working with depressed mood? PsychologySalon has developed a cognitive behavioral guide to self-care for depression. Though not a substitute for professional face-to-face care, UnDoing Depression may be a useful adjunct to your efforts.  The preview is below. For 50% off the regular fee of $140 USD, use coupon code “changeways70” when you visit our host site, here.

We also have courses for professionals and for the public entitled What Is Depression, What Causes Depression, Diagnosing Depression, Cognitive Behavioral Group Treatment of Depression, How to Buy Happiness, and Breathing Made Easy. For the full list with previews and substantial discounts, visit us at the Courses page of the Changeways Clinic website.

1 comment:

  1. I agree that getting out of the house is an important step in fighting depression, here are some more things that can help