Daily activities

In addition to handing out the Coping with Depression manual early in therapy, the therapist should also ask the client to complete an activities schedule for at least the first few weeks of therapy. A reduction in usual activities can be quickly identified from the completed schedule. Exploration should then be made of what normal activities have been dropped and why this has occurred. For example, some depressed people believe that they would be a burden on other people and that they would spoil other people's fun; others think that there is no point in trying because they would not enjoy any of their former activities. Using this information, the therapist can identify a range of graded tasks that starts with the easiest one that the person is both most likely to succeed at and perhaps even enjoy. In cases where the person has become extremely inactive, one of the early aims of therapy should be to help the individual increase his or her activity levels. In very extreme cases, the depressed individual may perceive almost any activity or even physical movement as "too much effort". In such cases, it may first be necessary to focus on beliefs about effort, while encouraging the individual to practise small tasks that no longer seem to be carried out under automatic control, but have to be consciously controlled throughout; this situation may parallel a similar problem that is experienced in chronic fatigue syndrome, in which everyday physical and mental activities are perceived to be excessively effortful and are therefore no longer carried out (Lawrie et al., 1997).

In the case of some depressed clients, it is not the reduction in activity that is the problem, but rather the excessive focus on one type of activity. The classic case is that of the workaholic whose waking hours are all spent in the pursuit of ambition and success, often of an unrealistic nature. In such cases, the activities schedule is full of so-called mastery items, but there is an absence of pleasurable activities. The focus on one dominant role or goal and the undervaluing of other roles and goals is, of course, a classic presentation in depression (e.g., Champion & Power, 1995), so the therapist may have to identify and explore long-held quasi-religious beliefs about the importance of such an approach. Indeed, the focus of therapy may become those schematic models that lead the person to exclude happiness or pleasure from day-to-day life.

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